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Cuker A, Kunkle R, Bercovitz RS, Byrne MT, Djulbegovic B, Haberichter SL, Holter-Chakrabarty J, Lottenberg R, Pai M, Rezende SM, Seftel MD, Silverstein RL, Terrell DR, Cheung MC. Distinguishing ASH Clinical Practice Guidelines from Other Forms of ASH Clinical Advice. Blood Adv 2024:bloodadvances.2023011102. [PMID: 38593461 DOI: 10.1182/bloodadvances.2023011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/12/2024] [Accepted: 03/01/2024] [Indexed: 04/11/2024] Open
Abstract
The American Society of Hematology (ASH) develops a variety of resources that provide guidance to clinicians on the diagnosis and management of blood diseases. These resources include clinical practice guidelines (CPGs) and other forms of clinical advice. While both ASH CPGs and other forms of clinical advice provide recommendations, they differ with respect to the methods underpinning their development, the principal type of recommendations they offer, their transparency and concordance with published evidence, and the time and resources required for their development. It is crucial that end users be aware of the differences between CPGs and other forms of clinical advice and that producers and publishers of these resources use clear and unambiguous terminology to facilitate their distinction. The objective of this article is to highlight similarities and differences between ASH CPGs and other forms of ASH clinical advice and to discuss the implications of these differences for end users.
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Affiliation(s)
- Adam Cuker
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robert Kunkle
- American Society of Hematology, Washington DC, Washington, United States
| | - Rachel Sara Bercovitz
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | | | | | | | | | | | | | | | - Matthew D Seftel
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Deirdra R Terrell
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Matthew C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Auletta JJ, Holter-Chakrabarty J, Jain T, Miller B, Ward E, Khera N, Gomez-Arteaga A, Hall A, Nemecek E, Robb D, Yusuf RA, Davies SM. Proceedings of the 2023 Second Annual ASTCT-NMDP ACCESS Initiative Workshop. Transplant Cell Ther 2023; 29:739-746. [PMID: 37805142 DOI: 10.1016/j.jtct.2023.09.026] [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: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
Here the proceedings from the Second Annual American Society for Transplantation and Cellular Therapy (ASTCT) and National Marrow Donor Program (NMDP) ACCESS Initiative are reviewed to inform the hematopoietic cell transplantation (HCT) and cellular therapy (CT) ecosystem about progress and direction of the collaborative. Highlights from the meeting, including updates on the progress of projects from the Awareness, Poverty, and Racial Inequity Committees, are presented. The ACCESS Initiative continues to evolve and will remain dependent on the HCT/CT ecosystem's continued dedication to reduce barriers and improve outcome disparities for all patients in need of HCT/CT.
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Affiliation(s)
- Jeffery J Auletta
- National Marrow Donor Program, Minneapolis, Minnesota; Hematology/Oncology/Blood and Marrow Transplant and Infectious Diseases; Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Tania Jain
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Becca Miller
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Emily Ward
- National Marrow Donor Program, Minneapolis, Minnesota
| | | | | | | | | | - Delilah Robb
- National Marrow Donor Program, Minneapolis, Minnesota
| | | | - Stella M Davies
- Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Epperla N, Kumar A, Abutalib SA, Awan FT, Chen YB, Gopal AK, Holter-Chakrabarty J, Kekre N, Lee CJ, Lekakis L, Lin Y, Mei M, Nathan S, Nastoupil L, Oluwole O, Phillips AA, Reid E, Rezvani AR, Trotman J, Zurko J, Kharfan-Dabaja MA, Sauter CS, Perales MA, Locke FL, Carpenter PA, Hamadani M. ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Diffuse Large B Cell Lymphoma. Transplant Cell Ther 2023; 29:548-555. [PMID: 37419325 DOI: 10.1016/j.jtct.2023.06.012] [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: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
Autologous hematopoietic cell transplantation (auto-HCT) has long been the standard approach for patients with relapsed/refractory (R/R) chemosensitive diffuse large B cell lymphoma (DLBCL). However, the advent of chimeric antigen receptor (CAR) T cell therapy has caused a paradigm shift in the management of R/R DLBCL patients, especially with the recent approval of CD19-directed CAR-T therapy in the second-line setting in high-risk groups (primary refractory and early relapse [≤12 months]). Consensus on the contemporary role, optimal timing, and sequencing of HCT and cellular therapies in DLBCL is lacking; therefore, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines undertook this project to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 20 consensus statements with a few key statements as follows: (1) in the first-line setting, there is no role for auto-HCT consolidation for patients achieving complete remission (CR) following R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone) or similar therapy in non-double-hit/triple-hit cases (DHL/THL) and in DHL/THL cases receiving intensive induction therapies, but auto-HCT may be considered in eligible patients receiving R-CHOP or similar therapies in DHL/THL cases; (2) auto-HCT consolidation with thiotepa-based conditioning is standard of care for eligible patients with primary central nervous system lymphoma achieving CR with first-line therapy; and (3) in the primary refractory and early relapse setting, the preferred option is CAR-T therapy, whereas in late relapse (>12 months), consolidation with auto-HCT is recommended for patients achieving chemosensitivity to salvage therapy (complete or partial response), and CAR-T therapy is recommended for those not achieving remission. These clinical practice recommendations will serve as a tool to guide clinicians managing patients with newly diagnosed and R/R DLBCL.
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Affiliation(s)
| | - Ambuj Kumar
- Department of Internal Medicine, Office of Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Syed A Abutalib
- Co-Director, Hematology & BMT/Cellular Therapy, Medical Director, NMDP Apheresis Midwest Program Associate Professor, Rosalind Franklin University of Medicine and Science, City of Hope, Zion, Illinois
| | - Farrukh T Awan
- Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant & Cell Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Ajay K Gopal
- University of Washington/Fred Hutch Cancer Center, Seattle, Washington
| | | | - Natasha Kekre
- Transplantation & Cellular Therapy Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine J Lee
- Transplant and Cellular Therapy Program at Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Yi Lin
- Mayo Clinic, Rochester, Minnesota
| | | | - Sunita Nathan
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, Illinois
| | | | - Olalekan Oluwole
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Adrienne A Phillips
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Erin Reid
- Moores Cancer Center at UC San Diego Health, La Jolla, California
| | - Andrew R Rezvani
- Division of Blood & Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, California
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | | | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy, Mayo Clinic, Jacksonville, Florida
| | - Craig S Sauter
- Division of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Paul A Carpenter
- University of Washington/Fred Hutch Cancer Center, Seattle, Washington
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Byrne M, Mattison R, Bercovitz R, Lottenberg R, Rezende SM, Silverstein R, Terrell D, Kunkle R, Smith D, Bollard C, Haberichter S, Holter-Chakrabarty J, Pai M, Cheung M, Cuker A, Seftel M, Djulbegovic B. Identifying experts for clinical practice guidelines: perspectives from the ASH Guideline Oversight Subcommittee. Blood Adv 2023; 7:4323-4326. [PMID: 37186271 PMCID: PMC10424133 DOI: 10.1182/bloodadvances.2023010039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
| | - Ryan Mattison
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, Madison, WI
| | | | - Richard Lottenberg
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
| | - Suely M. Rezende
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roy Silverstein
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Deirdra Terrell
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rob Kunkle
- American Society of Hematology, Washington, DC
| | - Deion Smith
- American Society of Hematology, Washington, DC
| | - Catherine Bollard
- Children's National Medical/George Washington University, Washington, DC
| | | | - Jennifer Holter-Chakrabarty
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Menaka Pai
- Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | | | - Adam Cuker
- Department of Pathology/Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew Seftel
- Department of Medicine, Division of Hematology, University of British Columbia and Canadian Blood Services, Vancouver, BC, Canada
| | - Benjamin Djulbegovic
- Department of Medicine, Division of Hematology/Medical Oncology, Medical University of South Carolina, Charleston, SC
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Han Z, MacCuaig WM, Gurcan MN, Claros-Sorto J, Garwe T, Henson C, Holter-Chakrabarty J, Hannafon B, Chandra V, Wellberg E, McNally LR. Dynamic 2-deoxy-D-glucose-enhanced multispectral optoacoustic tomography for assessing metabolism and vascular hemodynamics of breast cancer. Photoacoustics 2023; 32:100531. [PMID: 37485041 PMCID: PMC10362308 DOI: 10.1016/j.pacs.2023.100531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
Clinical tools for measuring tumor vascular hemodynamics, such as dynamic contrast-enhanced MRI, are clinically important to assess tumor properties. Here we explored the use of multispectral optoacoustic tomography (MSOT), which has a high spatial and temporal resolution, to measure the intratumoral pharmacokinetics of a near-infrared-dye-labeled 2-Deoxyglucose, 2-DG-800, in orthotropic 2-LMP breast tumors in mice. As uptake of 2-DG-800 is dependent on both vascular properties, and glucose transporter activity - a widely-used surrogate for metabolism, we evaluate hemodynamics of 2-DG-MP by fitting the dynamic MSOT signal of 2-DG-800 into two-compartment models including the extended Tofts model (ETM) and reference region model (RRM). We showed that dynamic 2-DG-enhanced MSOT (DGE-MSOT) is powerful in acquiring hemodynamic rate constants, including Ktrans and Kep, via systemically injecting a low dose of 2-DG-800 (0.5 µmol/kg b.w.). In our study, both ETM and RRM are efficient in deriving hemodynamic parameters in the tumor. Area-under-curve (AUC) values (which correlate to metabolism), and Ktrans and Kep values, can effectively distinguish tumor from muscle. Hemodynamic parameters also demonstrated correlations to hemoglobin, oxyhemoglobin, and blood oxygen level (SO2) measurements by spectral unmixing of the MSOT data. Together, our study for the first time demonstrated the capability of DGE-MSOT in assessing vascular hemodynamics of tumors.
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Affiliation(s)
- Zheng Han
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Center for Health Systems Innovation, Oklahoma State University, Stillwater, OK 74078, USA
| | - William M. MacCuaig
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Bioengineering, University of Oklahoma, Norman, OK 73019, USA
| | - Metin N. Gurcan
- Center for Biomedical Informatics, Wake Forest Baptist Health, Winston-Salem, NC 27101, USA
| | - Juan Claros-Sorto
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Tabitha Garwe
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Christina Henson
- Department of Internal Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | | | - Bethany Hannafon
- Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Vishal Chandra
- Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Elizabeth Wellberg
- Department of Pathology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Lacey R. McNally
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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Glover J, Nadig A, Vesely S, Neelakantan D, Williams KM, Holter-Chakrabarty J. Fluorothymidine PET/CT Identifies a Case of Herpes Simplex Virus Esophagitis. Radiol Imaging Cancer 2023; 5:e220141. [PMID: 36961315 PMCID: PMC10077096 DOI: 10.1148/rycan.220141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Joshua Glover
- From the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V., D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Ajay Nadig
- From the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V., D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Sara Vesely
- From the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V., D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Deepika Neelakantan
- From the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V., D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Kirsten M Williams
- From the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V., D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Jennifer Holter-Chakrabarty
- From the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V., D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
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Holter-Chakrabarty J, Glover J. Ferumoxytol: Another Exciting Addition to the Growing Field of Bone Marrow Imaging. Radiol Imaging Cancer 2023; 5:e230015. [PMID: 37000004 PMCID: PMC10077086 DOI: 10.1148/rycan.230015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Jennifer Holter-Chakrabarty
- From the Stephenson Cancer Center (J.H.C., J.G.), University of Oklahoma, 800 NE 10th St, Oklahoma City, OK 73104
| | - Joshua Glover
- From the Stephenson Cancer Center (J.H.C., J.G.), University of Oklahoma, 800 NE 10th St, Oklahoma City, OK 73104
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Stanojevic M, Grant M, Vesely SK, Knoblach S, Kanakry CG, Nazarian J, Panditharatna E, Panchapakesan K, Gress RE, Holter-Chakrabarty J, Williams KM. Peripheral blood marker of residual acute leukemia after hematopoietic cell transplantation using multi-plex digital droplet PCR. Front Immunol 2022; 13:999298. [PMID: 36248870 PMCID: PMC9556966 DOI: 10.3389/fimmu.2022.999298] [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: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Relapse remains the primary cause of death after hematopoietic cell transplantation (HCT) for acute leukemia. The ability to identify minimal/measurable residual disease (MRD) via the blood could identify patients earlier when immunologic interventions may be more successful. We evaluated a new test that could quantify blood tumor mRNA as leukemia MRD surveillance using droplet digital PCR (ddPCR). Methods The multiplex ddPCR assay was developed using tumor cell lines positive for the tumor associated antigens (TAA: WT1, PRAME, BIRC5), with homeostatic ABL1. On IRB-approved protocols, RNA was isolated from mononuclear cells from acute leukemia patients after HCT (n = 31 subjects; n = 91 specimens) and healthy donors (n = 20). ddPCR simultaneously quantitated mRNA expression of WT1, PRAME, BIRC5, and ABL1 and the TAA/ABL1 blood ratio was measured in patients with and without active leukemia after HCT. Results Tumor cell lines confirmed quantitation of TAAs. In patients with active acute leukemia after HCT (MRD+ or relapse; n=19), the blood levels of WT1/ABL1, PRAME/ABL1, and BIRC5/ABL1 exceeded healthy donors (p<0.0001, p=0.0286, and p=0.0064 respectively). Active disease status was associated with TAA positivity (1+ TAA vs 0 TAA) with an odds ratio=10.67, (p=0.0070, 95% confidence interval 1.91 - 59.62). The area under the curve is 0.7544. Changes in ddPCR correlated with disease response captured on standard of care tests, accurately denoting positive or negative disease burden in 15/16 (95%). Of patients with MRD+ or relapsed leukemia after HCT, 84% were positive for at least one TAA/ABL1 in the peripheral blood. In summary, we have developed a new method for blood MRD monitoring of leukemia after HCT and present preliminary data that the TAA/ABL1 ratio may may serve as a novel surrogate biomarker for relapse of acute leukemia after HCT.
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Affiliation(s)
- M. Stanojevic
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC, United States
| | - M. Grant
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - S. K. Vesely
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - S. Knoblach
- Children’s Research Institute, Research Center for Genetic Medicine, Children’s National Health System, Washington, DC, United States
| | - C. G. Kanakry
- Experimental Transplantation and Immunotherapy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - J. Nazarian
- Children’s Research Institute, Research Center for Genetic Medicine, Children’s National Health System, Washington, DC, United States,Department of Oncology, Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - E. Panditharatna
- Department of Pediatric Oncology, Dana-Farber Boston Children’s Cancer and Blood Disorders Center, Boston, MA, United States
| | - K. Panchapakesan
- Children’s Research Institute, Research Center for Genetic Medicine, Children’s National Health System, Washington, DC, United States
| | - R. E. Gress
- Experimental Transplantation and Immunotherapy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - J. Holter-Chakrabarty
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Kirsten M. Williams
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States,*Correspondence: Kirsten M. Williams,
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Mamidi MK, Mahmud H, Maiti GP, Mendez MT, Fernandes SM, Vesely SK, Holter-Chakrabarty J, Brown JR, Ghosh AK. Idelalisib activates AKT via increased recruitment of PI3Kδ/PI3Kβ to BCR signalosome while reducing PDK1 in post-therapy CLL cells. Leukemia 2022; 36:1806-1817. [PMID: 35568768 PMCID: PMC10874218 DOI: 10.1038/s41375-022-01595-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022]
Abstract
Idelalisib targets PI3Kδ in the BCR pathway generating only a partial response in CLL patients, indicating that the leukemic cells may have evolved escape signals. Indeed, we detected increased activation of AKT accompanied by upregulation of MYC/BCL2 in post-therapy CLL cells from patients treated with idelalisib/ofatumumab. To unravel the mechanism of increased AKT-activation, we studied the impact of idelalisib on a CLL-derived cell line, MEC1, as a model. After an initial inhibition, AKT-activation level was restored in idelalisib-treated MEC1 cells in a time-dependent manner. As BCAP (B-cell adaptor for PI3K) and CD19 recruit PI3Kδ to activate AKT upon BCR-stimulation, we examined if idelalisib-treatment altered PI3Kδ-recruitment. Immunoprecipitation of BCAP/CD19 from idelalisib-treated MEC1 cells showed increased recruitment of PI3Kδ in association with PI3Kβ, but not PI3Kα or PI3Kγ and that, targeting both PI3Kδ with PI3Kβ inhibited AKT-reactivation. We detected similar, patient-specific recruitment pattern of PI3K-isoforms by BCAP/CD19 in post-idelalisib CLL cells with increased AKT-activation. Interestingly, a stronger inhibitory effect of idelalisib on P-AKT (T308) than S473 was discernible in idelalisib-treated cells despite increased recruitment of PI3Kδ/PI3Kβ and accumulation of phosphatidylinositol-3,4,5-triphosphate; which could be attributed to reduced PDK1 activity. Thus, administration of isoform-specific inhibitors may prove more effective strategy for treating CLL patients.
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Affiliation(s)
- Murali K Mamidi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hasan Mahmud
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Guru P Maiti
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mariana T Mendez
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stacey M Fernandes
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sara K Vesely
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Jennifer R Brown
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Asish K Ghosh
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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10
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Maiti GP, Sinha S, Mahmud H, Boysen J, Mendez MT, Vesely SK, Holter-Chakrabarty J, Kay NE, Ghosh AK. SIRT3 overexpression and epigenetic silencing of catalase regulate ROS accumulation in CLL cells activating AXL signaling axis. Blood Cancer J 2021; 11:93. [PMID: 34001853 PMCID: PMC8129117 DOI: 10.1038/s41408-021-00484-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/16/2020] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022] Open
Abstract
Mitochondrial metabolism is the key source for abundant ROS in chronic lymphocytic leukemia (CLL) cells. Here, we detected significantly lower superoxide anion (O2−) levels with increased accumulation of hydrogen peroxide (H2O2) in CLL cells vs. normal B-cells. Further analysis indicated that mitochondrial superoxide dismutase (SOD)2, which converts O2− into H2O2 remained deacetylated in CLL cells due to SIRT3 overexpression resulting its constitutive activation. In addition, catalase expression was also reduced in CLL cells suggesting impairment of H2O2-conversion into water and O2 which may cause H2O2-accumulation. Importantly, we identified two CpG-islands in the catalase promoter and discovered that while the distal CpG-island (−3619 to −3765) remained methylated in both normal B-cells and CLL cells, variable degrees of methylation were discernible in the proximal CpG-island (−174 to −332) only in CLL cells. Finally, treatment of CLL cells with a demethylating agent increased catalase mRNA levels. Functionally, ROS accumulation in CLL cells activated the AXL survival axis while upregulated SIRT3, suggesting that CLL cells rapidly remove highly reactive O2− to avoid its cytotoxic effect but maintain increased H2O2-level to promote cell survival. Therefore, abrogation of aberrantly activated cell survival pathways using antioxidants can be an effective intervention in CLL therapy in combination with conventional agents.
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Affiliation(s)
- Guru P Maiti
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Sutapa Sinha
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Hasan Mahmud
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Justin Boysen
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mariana T Mendez
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Sara K Vesely
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Asish K Ghosh
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA. .,Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
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11
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Keruakous AR, Holter-Chakrabarty J, Schmidt SA, Khawandanah MO, Selby G, Yuen C. Azacitidine maintenance therapy post-allogeneic stem cell transplantation in poor-risk acute myeloid leukemia. Hematol Oncol Stem Cell Ther 2021; 16:52-60. [PMID: 36634281 DOI: 10.1016/j.hemonc.2021.03.001] [Citation(s) in RCA: 4] [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: 11/17/2020] [Revised: 01/24/2021] [Accepted: 03/06/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE/BACKGROUND Allogeneic hematopoietic stem cell transplant (HSCT) is the potential curative modality for poor-risk acute myeloid leukemia (AML), relapse remains the main reason for transplant failure. Early-phase studies showed azacitidine is safe for post-transplant maintenance therapy in AML. METHODS We performed a single institutional prospective cohort study to evaluate the benefit of azacitidine maintenance therapy following allogeneic HSCT in poor-risk AML. The main objective of this study is to generate a hypothesis aiming to optimize post-transplantation outcomes in poor-risk AML. Forty-nine adults with poor-risk AML who underwent allogeneic HSCT were evaluated in a nonrandomized prospective cohort fashion. Thirty-one participants received post-transplant azacitidine (32 mg/m2) on Days 1-5 for a 28-day treatment cycle beginning approximately 40 days after transplantation. The study was controlled using 18 matched individuals who were on a noninterventional surveillance protocol. RESULTS The relapse rate was significantly higher in the control cohort (66.67%) versus (25.81%) in the azacitidine maintenance cohort (p < .005). Time to relapse was significantly prolonged by azacitidine maintenance, not reached versus 4.1 months in the control arm (p < .0001). In addition, median overall survival was lower in the control cohort at 7.6 versus 27.4 months in the interventional cohort (p < .0001). At a median follow-up of 24 months, incidence of graft-versus-host disease (GVHD) did not differ between study groups (p = .325). In both cohorts, minimal residual disease was correlated with higher hazard of relapse (95% confidence interval, 2.31-13.74; p < .001). CONCLUSION We conclude that low dose azacitidine maintenance following allogeneic HSCT in poor-risk AML, decreased relapse rate, and increased both the time to relapse and overall survival without increased risk of GVHD.
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Affiliation(s)
- Amany R Keruakous
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA.
| | | | - Sarah A Schmidt
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA
| | - Mohamad O Khawandanah
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA
| | - George Selby
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA
| | - Carrie Yuen
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA.
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12
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Day S, Keruakous A, Holter-Chakrabarty J, Zhao D, Campbell J. Sociodemographic Diversities Influence Allogeneic Hematopoietic Stem Cell Transplantation Utilization Among Adult Acute Leukemia Patients. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Jones MA, MacCuaig WM, Frickenstein AN, Camalan S, Gurcan MN, Holter-Chakrabarty J, Morris KT, McNally MW, Booth KK, Carter S, Grizzle WE, McNally LR. Molecular Imaging of Inflammatory Disease. Biomedicines 2021; 9:152. [PMID: 33557374 PMCID: PMC7914540 DOI: 10.3390/biomedicines9020152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory diseases include a wide variety of highly prevalent conditions with high mortality rates in severe cases ranging from cardiovascular disease, to rheumatoid arthritis, to chronic obstructive pulmonary disease, to graft vs. host disease, to a number of gastrointestinal disorders. Many diseases that are not considered inflammatory per se are associated with varying levels of inflammation. Imaging of the immune system and inflammatory response is of interest as it can give insight into disease progression and severity. Clinical imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) are traditionally limited to the visualization of anatomical information; then, the presence or absence of an inflammatory state must be inferred from the structural abnormalities. Improvement in available contrast agents has made it possible to obtain functional information as well as anatomical. In vivo imaging of inflammation ultimately facilitates an improved accuracy of diagnostics and monitoring of patients to allow for better patient care. Highly specific molecular imaging of inflammatory biomarkers allows for earlier diagnosis to prevent irreversible damage. Advancements in imaging instruments, targeted tracers, and contrast agents represent a rapidly growing area of preclinical research with the hopes of quick translation to the clinic.
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Affiliation(s)
- Meredith A. Jones
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (M.A.J.); (W.M.M.); (A.N.F.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - William M. MacCuaig
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (M.A.J.); (W.M.M.); (A.N.F.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - Alex N. Frickenstein
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (M.A.J.); (W.M.M.); (A.N.F.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - Seda Camalan
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA; (S.C.); (M.N.G.)
| | - Metin N. Gurcan
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA; (S.C.); (M.N.G.)
| | - Jennifer Holter-Chakrabarty
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Medicine, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Katherine T. Morris
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Molly W. McNally
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - Kristina K. Booth
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Steven Carter
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - William E. Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Lacey R. McNally
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
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14
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Mendez MT, Mahmud H, Vesely SK, Holter-Chakrabarty J, Ghosh AK. Abstract 3749: MER receptor tyrosine kinase overexpression potentiates survival signal in chronic lymphocytic leukemia cells. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3749] [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
Chronic lymphocytic leukemia (CLL) is the most common form of adult B-cell leukemia in the United States. It is predominantly characterized by the accumulation of CD19+/CD5+/CD23+ monoclonal B-cells in peripheral blood, bone marrow and lymphoid tissues.
BCR signaling pathway has emerged as a key driver for the expansion of neoplastic B-cell clones and pathogenesis in several B-cell malignancies including CLL. Stimulation of BCR induces activation of a cascade of downstream signal mediators including Bruton's tyrosine kinase (BTK), PI3K/AKT and ERK1/2. While the use of BCR-targeted agents, ibrutinib (BTK-inhibitor) or idelalisib (PI3Kδ-inhibitor), has been shown to be effective in relapsed/refractory CLL patients, the responses are limited to partial remissions. Therefore, insights into drugs with unique mechanism(s) of action that are nontoxic to the bone marrow/immune system and feasible in the older patient population (average age: 65 - 70 years) are urgently needed. To achieve such a goal it is critical to identify other targets that are constitutively active and may crosstalk with the BCR signal or other receptor tyrosine kinases (RTKs). MER RTK of the TAM (Tyro3, AXL, MER) family offers such an alternative approach.
Previously, we detected that CLL B-cells express highly active AXL that acts as a docking site of multiple kinases/lipase including LYN, SYK/ZAP70, PI3K and PLCγ2 that, when subject to specific inhibition induces apoptosis. Most recently, we found that CLL B-cells from 50 - 60% of previously untreated CLL patients (n=30) also overexpressed MER at variable levels while, normal B-cells from health subjects did not show any such expression. Interestingly, MER in CLL B-cells remains constitutively phosphorylated (active). In addition, we also detected overexpression of its ligand, growth arrest specific gene 6 (Gas6) in CLL B-cells as compared to normal B-cells. Of note, leukemic B-cells from the Eμ-TCL1 transgenic mice which recapitulate aggressive human CLL also showed overexpression of MER. To this end, we found that exogenous addition of recombinant Gas6 to primary CLL B-cell culture or MEC1 (a CLL cell line) cells activated MER in a time-dependent manner. Interestingly, we also detected co-activation of BTK of the BCR pathway, following MER activation in CLL cells while, in vitro stimulation of BCR did not activate MER. Together, these findings suggest that MER activation may regulate the BCR signal in CLL B-cells in order to potentiate the survival signal.
In conclusion, we detected overexpression of constitutively activated MER in CLL B-cells from some CLL patients which may represent high-risk CLL clones for clinical progression. Importantly, activation of MER may positively regulate the BCR signal inducing increased survival and apoptotic resistance of the leukemic B-cells to BCR-targeted agents. Further studies are in progress to elucidate the impact of targeting MER in CLL B-cell survival and resistance to therapy.
Citation Format: Mariana T. Mendez, Hasan Mahmud, Sara K. Vesely, Jennifer Holter-Chakrabarty, Asish K. Ghosh. MER receptor tyrosine kinase overexpression potentiates survival signal in chronic lymphocytic leukemia cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3749.
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Affiliation(s)
- Mariana T. Mendez
- 1The University of Oklahoma Health Science Center, Oklahoma City, OK
| | - Hasan Mahmud
- 2The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sara K. Vesely
- 2The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Asish K. Ghosh
- 2The University of Oklahoma Health Sciences Center, Oklahoma City, OK
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15
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Mahmud H, Mendez M, Mukhopadhyay B, Holter-Chakrabarty J, Ghosh AK. HSP90 overexpression potentiates the B-cell receptor and fibroblast growth factor receptor survival signals in chronic lymphocytic leukemia cells. Oncotarget 2020; 11:2037-2046. [PMID: 32547702 PMCID: PMC7275782 DOI: 10.18632/oncotarget.27409] [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] [Received: 08/12/2019] [Accepted: 12/16/2019] [Indexed: 12/02/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is still an incurable disease despite aggressive chemotherapies including the B-cell receptor (BCR) targeted-inhibitors. Therefore, we assessed the expression status of key signal mediators of the BCR pathway in CLL cells. Indeed, we detected aberrantly elevated levels of CD79a, B-cell adaptor for PI3K (BCAP) and phospholipase C (PLC)γ2, key mediators of BCR signal, in CLL cells. As HSP90 is also overexpressed in CLL cells, we hypothesized that HSP90 could potentiate the BCR signal via stabilization of multiple key components of the BCR-signalosome. We found that HSP90 formed a multi-molecular complex with CD79a, BCAP, PLCγ2, LYN, SYK, Bruton tyrosine kinase (BTK) and AKT and that, pharmacologic inhibition or partial depletion of HSP90 reduced the expression of these signal mediators in CLL cells. In addition, our findings also demonstrated that HSP90 could stabilize the tyrosine phosphatase, PTPN22 which positively regulates AKT phosphorylation, and the constitutively active fibroblast growth factor receptor 3 (FGFR3) in CLL cells. Finally, HSP90 inhibition induced apoptosis in CLL cells in a dose-dependent manner likely via downregulation of anti-apoptotic proteins MCL-1 and XIAP, but not BCL2, reported to be overexpressed in CLL cells. In total, our findings suggest that HSP90-inhibition may sensitize the leukemic B-cells to BCR-targeted agents, particularly those become resistant to these therapies.
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Affiliation(s)
- Hasan Mahmud
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Mariana Mendez
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Bedabrata Mukhopadhyay
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | - Asish K Ghosh
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Baxley AA, Kumm DE, Bishop CB, Medina PJ, Holter-Chakrabarty J. Severe infusion reactions to brentuximab vedotin in two patients with Hodgkin lymphoma previously treated with allogeneic stem cell transplantation. J Oncol Pharm Pract 2012; 19:279-83. [DOI: 10.1177/1078155212464021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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
Brentuximab vendotin is a monoclonal antibody approved in August 2011 for use in patients with Hodgkin disease and a rare systemic lymphoma known as anaplastic large cell lymphoma. Brentuximab is approved in patients with Hodgkin disease who have failed autologous transplantation or after failure of at least two prior multi-agent chemotherapy regimens but has not been studied following allogeneic transplantation. Four patients with relapsed Hodgkin disease have been treated at our institution with at least two doses of brentuximab vendotin. Two patients have experienced significant infusion reactions on multiple occasions, and two patients have tolerated the infusions well. During phase 2 trials, there were no reports of Grade 3 or 4 infusion-related reactions. Both patients with reactions had relapsed following allogeneic stem cell transplants, while neither of the patients who tolerated the infusions had undergone transplantation. We report our experience with brentuximab vendotin-treated patients at our institution, focusing on the two post-allogeneic patients who experienced multiple significant infusion reactions. This report evaluates possible mechanisms behind their reactions, including previous allogeneic stem cell transplantation as a likely precipitating factor.
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Affiliation(s)
- Allison A Baxley
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Debra E Kumm
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Courtney B Bishop
- Department of Pharmacy Practice, University of Oklahoma College of Pharmacy, OK, USA
| | - Patrick J Medina
- Department of Pharmacy Practice, University of Oklahoma College of Pharmacy, OK, USA
| | - Jennifer Holter-Chakrabarty
- Section of Hematology-Oncology, Department of Medicine, University of Oklahoma Health Sciences Center, OK, USA
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