1
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Shadman M, Tedeschi A, Mohseninejad L, Yang K, Lamanna N, Xu S, Cohen A, Challagulla S, Xue M, Williams R, O'Brien SM, Brown JR, Tam C. Similar efficacy of ibrutinib arms across ALPINE and ELEVATE-RR trials in relapsed/refractory chronic lymphocytic leukemia: a matching-adjusted indirect comparison. Blood Cancer J 2024; 14:77. [PMID: 38697986 PMCID: PMC11066086 DOI: 10.1038/s41408-024-01044-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Mazyar Shadman
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
| | | | | | | | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Sheng Xu
- BeiGene (Beijing) Co. Ltd., Beijing, China
| | | | | | - Mei Xue
- BeiGene USA Inc, San Mateo, CA, USA
| | | | - Susan M O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | | | - Constantine Tam
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia
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2
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Woyach JA, Perez Burbano G, Ruppert AS, Miller C, Heerema NA, Zhao W, Wall A, Ding W, Bartlett NL, Brander DM, Barr PM, Rogers KA, Parikh SA, Stephens DM, Brown JR, Lozanski G, Blachly J, Nattam S, Larson RA, Erba H, Litzow M, Luger S, Owen C, Kuzma C, Abramson JS, Little RF, Dinner S, Stone RM, Uy G, Stock W, Mandrekar SJ, Byrd JC. Follow-up from the A041202 study shows continued efficacy of ibrutinib regimens for older adults with CLL. Blood 2024; 143:1616-1627. [PMID: 38215395 DOI: 10.1182/blood.2023021959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
ABSTRACT A041202 (NCT01886872) is a phase 3 study comparing bendamustine plus rituximab (BR) with ibrutinib and the combination of ibrutinib plus rituximab (IR) in previously untreated older patients with chronic lymphocytic leukemia (CLL). The initial results showed that ibrutinib-containing regimens had superior progression-free survival (PFS) and rituximab did not add additional benefits. Here we present an updated analysis. With a median follow-up of 55 months, the median PFS was 44 months (95% confidence interval [CI], 38-54) for BR and not yet reached in either ibrutinib-containing arm. The 48-month PFS estimates were 47%, 76%, and 76% for BR, ibrutinib, and IR, respectively. The benefit of ibrutinib regimens over chemoimmunotherapy was consistent across subgroups of patients defined by TP53 abnormalities, del(11q), complex karyotype, and immunoglobulin heavy chain variable region (IGHV). No significant interaction effects were observed between the treatment arm and del(11q), the complex karyotype, or IGHV. However, a greater difference in PFS was observed among the patients with TP53 abnormalities. There was no difference in the overall survival. Notable adverse events with ibrutinib included atrial fibrillation (afib) and hypertension. Afib was observed in 11 patients (pts) on BR (3%) and 67 pts on ibrutinib (18%). All-grade hypertension was observed in 95 pts on BR (27%) and 263 pts on ibrutinib (55%). These data show that ibrutinib regimens prolong PFS compared with BR for older patients with treatment-naïve CLL. These benefits were observed across subgroups, including high-risk groups. Strikingly, within the ibrutinib arms, there was no inferior PFS for patients with abnormalities in TP53, the highest risk feature observed in CLL. These data continue to demonstrate the efficacy of ibrutinib in treatment-naïve CLL.
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Affiliation(s)
| | | | - Amy S Ruppert
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Cecelia Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyla A Heerema
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Weiqiang Zhao
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Anna Wall
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Wei Ding
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Paul M Barr
- University of Rochester Medical Center, Rochester, NY
| | - Kerry A Rogers
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Gerard Lozanski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Harry Erba
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Mark Litzow
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Selina Luger
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carolyn Owen
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Charles Kuzma
- First Health of the Carolinas Cancer Center, Southeast Clinical Oncology Research Consortium, Winston-Salem, NC
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Shira Dinner
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | | | - Geoffrey Uy
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Wendy Stock
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Sumithra J Mandrekar
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - John C Byrd
- University of Cincinnati Cancer Center, Cincinnati, OH
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3
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Brown JR, Eichhorst B, Hillmen P, Jurczak W, Kaźmierczak M, Lamanna N, O'Brien SM, Tam CS, Qiu L, Zhou K, Simkovic M, Mayer J, Gillespie-Twardy A, Ferrajoli A, Ganly PS, Weinkove R, Grosicki S, Mital A, Robak T, Osterborg A, Yimer HA, Salmi T, Wang MDY, Fu L, Li J, Wu K, Cohen A, Shadman M. Plain language summary of zanubrutinib or ibrutinib in chronic lymphocytic leukemia that is resistant to treatment or has come back after treatment. Future Oncol 2024; 20:717-726. [PMID: 38088119 DOI: 10.2217/fon-2023-0849] [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] [Indexed: 03/26/2024] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a plain language summary of a research study called ALPINE. The study involved people who had been diagnosed with, and previously treated at least once for, relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). Lymphocytes help to find and fight off viruses and infections in the body, but when someone has CLL or SLL, the body creates abnormal lymphocytes, leaving the patient with a weakened immune system and susceptible to illness. In CLL, these lymphocytes are in the bone marrow and bloodstream, whereas for SLL, they are mostly found in the lymph nodes, such as those in the neck. HOW WAS THE RESEARCH DONE? The ALPINE study was designed to directly compare the cancer-fighting effects and side effects of zanubrutinib and ibrutinib as treatment for patients with relapsed or refractory CLL/SLL. WHAT WERE THE RESULTS? After 30 months, zanubrutinib was more effective than ibrutinib at reducing and keeping the cancer from coming back. Clinical Trial Registration: NCT03734016 (ClinicalTrials.gov).
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Affiliation(s)
- Jennifer R Brown
- The Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barbara Eichhorst
- The Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany
| | - Peter Hillmen
- St. James's University Hospital, Leeds, United Kingdom
| | - Wojciech Jurczak
- Maria Skłodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Maciej Kaźmierczak
- The Department of Hematology & Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
| | - Susan M O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, California, USA
| | | | - Lugui Qiu
- The State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Keshu Zhou
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Martin Simkovic
- The Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove, Czech Republic, & The First Faculty of Medicine, Charles University, Prague, & the Department of Internal Medicine, Prague, Czech Republic
| | - Jiri Mayer
- Hematology & Oncology, Masaryk University & University Hospital, Brno, Czech Republic
| | | | - Alessandra Ferrajoli
- The Leukemia Department, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Peter S Ganly
- The Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Robert Weinkove
- Te Rerenga Ora Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, & the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Sebastian Grosicki
- The Department of Hematology & Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Andrzej Mital
- The Department of Hematology & Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Anders Osterborg
- The Department of Oncology-Pathology, Karolinska Institutet, Stockholm & the Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Habte A Yimer
- Texas Oncology-Tyler, US Oncology Network, Tyler, Texas, USA
| | - Tommi Salmi
- BeiGene International GmbH, Basel, Switzerland
| | | | | | | | | | | | - Mazyar Shadman
- The Fred Hutchinson Cancer Center & the Department of Medicine, University of Washington, Seattle, USA
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4
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Brown JR. Clinical Risks for Chronic Lymphocytic Leukemia. J Natl Compr Canc Netw 2024; 22:e247020. [PMID: 38626793 DOI: 10.6004/jnccn.2024.7020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
Our understanding of risk factors for the development of chronic lymphocytic leukemia (CLL) is still incomplete and includes genetic and environmental factors. CLL is one of the most familial of all cancers, yet common high-penetrance risk alleles have not been identified. Genome-wide association studies have identified many common variants with low relative risks, whereas exome-wide rare variant analysis has implicated ATM in CLL causation. Environmental factors have also been challenging to identify given the limited understanding of the relevant time period of exposure relative to diagnosis, and the inability to quantify past exposures. Agent Orange and glyphosate herbicides have perhaps the most data to support their role. CLL is preceded by a precursor condition called monoclonal B-cell lymphocytosis (MBL), which could therefore be considered a risk factor, but which itself is likely caused by the same risk factors that ultimately give rise to CLL. Although virtually all people with CLL have a preceding MBL phase, most people with MBL will not develop CLL.
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Affiliation(s)
- Jennifer R Brown
- 1Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- 2Harvard Medical School, Boston, MA
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5
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Moslehi JJ, Furman RR, Tam CS, Salem JE, Flowers CR, Cohen A, Zhang M, Zhang J, Chen L, Ma H, Brown JR. Cardiovascular events reported in patients with B-cell malignancies treated with zanubrutinib. Blood Adv 2024:bloodadvances.2023011641. [PMID: 38502198 DOI: 10.1182/bloodadvances.2023011641] [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: 09/22/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
First-generation Bruton tyrosine kinase (BTK) inhibitor ibrutinib has been associated with an increased risk for cardiovascular toxicities. Zanubrutinib is a more selective, next-generation BTK inhibitor. In this manuscript, incidence rates of atrial fibrillation, symptomatic (grade ≥2) ventricular arrhythmia, and hypertension were evaluated in a pooled analysis of 10 clinical studies with zanubrutinib monotherapy in patients (N=1550) with B-cell malignancies and a pooled analysis of head-to-head studies comparing zanubrutinib with ibrutinib (ASPEN cohort 1; ALPINE). Across the 10 studies, most patients (median age, 67 years) were male (66.3%), and most had CLL/SLL (60.5%). Overall incidence and exposure-adjusted incidence rates (EAIR) for atrial fibrillation, symptomatic ventricular arrhythmia, and hypertension were lower with zanubrutinib versus ibrutinib. Despite a similar prevalence of pre-existing cardiovascular events in ASPEN and ALPINE, atrial fibrillation/flutter incidence rate (6.1% vs 15.6%) and EAIR (0.2 vs 0.64 persons/100 person-months; P<.0001) were lower with zanubrutinib than with ibrutinib, respectively. Symptomatic ventricular arrhythmia incidence was low for both zanubrutinib (0.7%) and ibrutinib (1.7%) with numerically lower EAIR (0.02 vs 0.06 persons/100 person-months, respectively) for zanubrutinib. The hypertension EAIR was lower with zanubrutinib versus ibrutinib in ASPEN but similar between treatment arms in ALPINE. The higher hypertension EAIR in ALPINE was inconsistent with the other zanubrutinib studies. However, fewer discontinuations (1 vs 14) and deaths (0 vs 6) due to cardiac disorders occurred with zanubrutinib versus ibrutinib in ALPINE. These data support zanubrutinib as a treatment option with improved cardiovascular tolerability over ibrutinib for patients with B-cell malignancies in need of BTK inhibitors. CT# NCT03053440 NCT03336333 NCT03734016 NCT04170283 NCT03206918 NCT03206970 NCT03332173 NCT03846427 NCT02343120 NCT03189524.
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Affiliation(s)
| | - Richard R Furman
- Weill Medical College of Cornell University, New York, New York, United States
| | | | | | | | - Aileen Cohen
- BeiGene USA, Inc., San Mateo, California, United States
| | | | - Jun Zhang
- BeiGene USA, Inc., San Mateo, California, United States
| | | | - Han Ma
- BeiGene USA, Inc., San Mateo, California, United States
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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6
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Arribas AJ, Napoli S, Cascione L, Barnabei L, Sartori G, Cannas E, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, Castro de Moura M, Jovic S, Bordone Pittau R, Stathis A, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. ERBB4-Mediated Signaling Is a Mediator of Resistance to PI3K and BTK Inhibitors in B-cell Lymphoid Neoplasms. Mol Cancer Ther 2024; 23:368-380. [PMID: 38052765 DOI: 10.1158/1535-7163.mct-23-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/28/2023] [Accepted: 10/11/2023] [Indexed: 12/07/2023]
Abstract
BTK and PI3K inhibitors are among the drugs approved for the treatment of patients with lymphoid neoplasms. Although active, their ability to lead to long-lasting complete remission is rather limited, especially in the lymphoma setting. This indicates that tumor cells often develop resistance to the drugs. We started from a marginal zone lymphoma cell line, Karpas-1718, kept under prolonged exposure to the PI3Kδ inhibitor idelalisib until acquisition of resistance, or with no drug. Cells underwent transcriptome, miRNA and methylation profiling, whole-exome sequencing, and pharmacologic screening, which led to the identification of the overexpression of ERBB4 and its ligands HBEGF and NRG2 in the resistant cells. Cellular and genetic experiments demonstrated the involvement of this axis in blocking the antitumor activity of various BTK/PI3K inhibitors, currently used in the clinical setting. Addition of recombinant HBEGF induced resistance to BTK/PI3K inhibitors in parental cells and in additional lymphoma models. Combination with the ERBB inhibitor lapatinib was beneficial in resistant cells and in other lymphoma models already expressing the identified resistance factors. An epigenetic reprogramming sustained the expression of the resistance-related factors, and pretreatment with demethylating agents or EZH2 inhibitors overcame the resistance. Resistance factors were also shown to be expressed in clinical specimens. In conclusion, we showed that the overexpression of ERBB4 and its ligands represents a novel mechanism of resistance for lymphoma cells to bypass the antitumor activity of BTK and PI3K inhibitors and that targeted pharmacologic interventions can restore sensitivity to the small molecules.
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Affiliation(s)
- Alberto J Arribas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Sara Napoli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Laura Barnabei
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Giulio Sartori
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Eleonora Cannas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Eugenio Gaudio
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Chiara Tarantelli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Afua A Mensah
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Filippo Spriano
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | | | | | - Andrea Rinaldi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Manuel Castro de Moura
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
| | - Sandra Jovic
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Georg Stussi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Valter Gattei
- Centro di Riferimento Oncologico di Aviano - CRO, Aviano, Italy
| | - Jennifer R Brown
- Chronic Lymphocytic Leukemia Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
- Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
- Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Davide Rossi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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7
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Gibbons S, Dexter F, Loftus RW, Brown JR, Wanta BT, Charnin JE. The relative efficacy of multiple syringe tip disinfection techniques against virulent staphylococcus contamination. J Hosp Infect 2024; 145:142-147. [PMID: 38272124 DOI: 10.1016/j.jhin.2024.01.006] [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: 10/17/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND A recent study confirmed significant contamination of syringe tips following routine anaesthesia practice of at least 6 h in duration. AIM We assessed the relative efficacy of clinically relevant syringe tip disinfection techniques following contamination with the hyper transmissible and more pathogenic Staphylococcus aureus sequence type 5 (S. aureus ST5) strain characteristic associated with increased strength of biofilm formation and greater desiccation tolerance. METHODS Syringe tips (N=40) contaminated with S. aureus ST5 were randomized to 70% isopropyl pads with 10 or 60 s of drying time, scrubbing alcohol disinfection caps with 10 or 60 s of dwell time, or to non-scrubbing alcohol disinfection caps with 60 s of dwell time. The primary outcome was residual 24-h colony forming units (cfu) >10. RESULTS Scrubbing disinfection caps were more effective than alcohol pads (25% (12/48) <10 cfu for scrubbing caps (10- or 60-s dwell times) vs 0% (0/48) <10 cfu for alcohol pads (10 or 60 s of drying time), Holm-Sidak adjusted P=0.0016). Scrubbing disinfection caps were more effective than non-scrubbing alcohol disinfection caps (25% (12/48) <10 cfu for scrubbing alcohol caps (10- or 60-s dwell times) vs 2% (1/48) for non-scrubbing alcohol caps (60-s dwell time), adjusted P=0.0087). CONCLUSIONS Scrubbing alcohol caps are more effective than alcohol pads or non-scrubbing disinfecting caps for microbial reduction of syringe tips contaminated with the more pathogenic S. aureus ST5.
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Affiliation(s)
- S Gibbons
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - F Dexter
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - R W Loftus
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - J R Brown
- Dartmouth Center for Implementation Science, Departments of Epidemiology Biomedical Data Science, Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - B T Wanta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - J E Charnin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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8
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Brown JR, Ghia P, Jurczak W, Kahl BS, Lamanna N, Robak T, Shadman M, Tam CS, Qiu L, Paik J, Salmi T, Wang L, Zhang J, Zhang M, Cohen A, Ma H, Tedeschi A. Characterization of zanubrutinib safety and tolerability profile and comparison with ibrutinib safety profile in patients with B-cell malignancies: post-hoc analysis of a large clinical trial safety database. Haematologica 2024. [PMID: 38426293 DOI: 10.3324/haematol.2023.283846] [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: 09/05/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan
| | - Wojciech Jurczak
- Maria Skłodowska-Curie National Research Institute of Oncology, Kraków
| | - Brad S Kahl
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | | | | | | | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin
| | | | | | | | | | | | | | - Han Ma
- BeiGene USA, Inc, San Mateo, CA
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Anderson MA, Walewska R, Hackett F, Kater AP, Montegaard J, O'Brien S, Seymour JF, Smith M, Stilgenbauer S, Whitechurch A, Brown JR. Venetoclax Initiation in Chronic Lymphocytic Leukemia: International Insights and Innovative Approaches for Optimal Patient Care. Cancers (Basel) 2024; 16:980. [PMID: 38473342 DOI: 10.3390/cancers16050980] [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: 12/04/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
Venetoclax, a highly selective, oral B-cell lymphoma 2 inhibitor, provides a robust targeted-therapy option for the treatment of chronic lymphocytic leukemia (CLL), including patients with high-risk del(17p)/mutated-TP53 and immunoglobulin heavy variable region unmutated CLL and those refractory to chemoimmunotherapy across all age groups. Due to the potent pro-apoptotic effect of venetoclax, treatment initiation carries a risk of tumor lysis syndrome (TLS). Prompt and appropriate management is needed to limit clinical TLS, which may entail serious adverse events and death. Venetoclax ramp-up involves gradual, stepwise increases in daily venetoclax dosing from 20 mg to 400 mg (target dose) over 5 weeks; adherence to on-label scheduling provides a tumor debulking phase, reducing the risk of TLS. The key components of safe venetoclax therapy involve assessment (radiographic evaluation and baseline blood chemistry), preparation (adequate hydration), and initiation (blood chemistry monitoring). In addition to summarizing the evidence for venetoclax's efficacy and safety, this review uses hypothetical patient scenarios based on risk level for TLS (high, medium, low) to share the authors' clinical experience with venetoclax initiation and present global approaches utilized in various treatment settings. These hypothetical scenarios highlight the importance of a multidisciplinary approach and shared decision-making, outlining best practices for venetoclax initiation and overall optimal treatment strategies in patients with CLL.
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Affiliation(s)
- Mary Ann Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
- Division of Blood Cells and Blood Cancers, The Walter and Eliza Hall Institute, Melbourne, VIC 3000, Australia
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Renata Walewska
- University Hospitals Dorset, NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Fidelma Hackett
- Cancer Services Directorate, University Hospital Limerick UL Hospitals Group, St. Nessan's Road, V94 F858 Limerick, Ireland
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Josie Montegaard
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA 92868, USA
| | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Matthew Smith
- Department of Haematology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield S44 5BL, UK
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, 89081 Ulm, Germany
| | - Ashley Whitechurch
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
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10
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Ahn IE, Brander DM, Ren Y, Zhou Y, Tyekucheva S, Walker HA, Black R, Montegaard J, Alencar A, Shune L, Omaira M, Jacobson CA, Armand P, Ng SY, Crombie J, Fisher DC, LaCasce AS, Arnason J, Hochberg EP, Takvorian RW, Abramson JS, Brown JR, Davids MS. Five-year follow-up of a phase 2 study of ibrutinib plus fludarabine, cyclophosphamide, and rituximab as initial therapy in CLL. Blood Adv 2024; 8:832-841. [PMID: 38163317 PMCID: PMC10874751 DOI: 10.1182/bloodadvances.2023011574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
ABSTRACT We previously reported high rates of undetectable minimal residual disease <10-4 (uMRD4) with ibrutinib plus fludarabine, cyclophosphamide, and rituximab (iFCR) followed by 2-year ibrutinib maintenance (I-M) in treatment-naïve chronic lymphocytic leukemia (CLL). Here, we report updated data from this phase 2 study with a median follow-up of 63 months. Of 85 patients enrolled, including 5 (6%) with deletion 17p or TP53 mutation, 91% completed iFCR and 2-year I-M. Five-year progression-free survival (PFS) and overall survival were 94% (95% confidence interval [CI], 89%-100%) and 99% (95% CI, 96%-100%), respectively. No additional deaths have occurred with this extended follow-up. No difference in PFS was observed by immunoglobulin heavy-chain variable region gene status or duration of I-M. High rates of peripheral blood (PB) uMRD4 were maintained (72% at the end of iFCR, 66% at the end of 2-year I-M, and 44% at 4.5 years from treatment initiation). Thirteen patients developed MRD conversion without clinical progression, mostly (77%) after stopping ibrutinib. None had Bruton tyrosine kinase (BTK) mutations. One patient had PLCG2 mutation. Six of these patients underwent ibrutinib retreatment per protocol. Median time on ibrutinib retreatment was 34 months. The cumulative incidence of atrial fibrillation was 8%. Second malignancy or nonmalignant hematologic disease occurred in 13%, mostly nonmelanoma skin cancer. Overall, iFCR with 2-year I-M achieved durably deep responses in patients with diverse CLL genetic markers. Re-emergent clones lacked BTK mutation and retained sensitivity to ibrutinib upon retreatment. This trial is registered at www.clinicaltrials.gov as #NCT02251548.
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Affiliation(s)
- Inhye E. Ahn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Yue Ren
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Yinglu Zhou
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | - Heather A. Walker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Black
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Josie Montegaard
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alvaro Alencar
- Division of Hematology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Leyla Shune
- Department of Hematologic Malignancies, University of Kansas Cancer Center, Westwood, KS
| | - Mohammad Omaira
- Department of Medical Oncology, West Michigan Cancer Center, Kalamazoo, MI
| | - Caron A. Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Samuel Y. Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jennifer Crombie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - David C. Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ann S. LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jon Arnason
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ephraim P. Hochberg
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Ronald W. Takvorian
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Jeremy S. Abramson
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA
| | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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11
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AlJabban A, Paik H, Aster JC, Berliner N, Brouillard J, Brown JR, Burns KH, Castillo JJ, Card J, Dal Cin P, DeAngelo DJ, Dorfman DM, Ebert BL, Garcia JS, Jacobson CA, Lakhani H, Laubach JP, Ligon AH, Lindeman NI, Lindsley RC, Lovitch SB, Luskin MR, Morgan EA, Nowak A, Petrides A, Pinkus GS, Pozdnyakova O, Steensma DP, Stone RM, Weinberg OK, Winer ES, Kim AS. Optimization of Advanced Molecular Genetic Testing Utilization in Hematopathology: A Goldilocks Approach to Bone Marrow Testing. JCO Oncol Pract 2024; 20:220-227. [PMID: 37683132 DOI: 10.1200/op.23.00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/13/2023] [Accepted: 07/10/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE This study investigated the effectiveness of algorithmic testing in hematopathology at the Brigham and Women's Hospital and Dana-Farber Cancer Institute (DFCI). The algorithm was predicated on test selection after an initial pathologic evaluation to maximize cost-effective testing, especially for expensive molecular and cytogenetic assays. MATERIALS AND METHODS Standard ordering protocols (SOPs) for 17 disease categories were developed and encoded in a decision support application. Six months of retrospective data from application beta testing was obtained and compared with actual testing practices during that timeframe. In addition, 2 years of prospective data were also obtained from patients at one community satellite site. RESULTS A total of 460 retrospective cases (before introduction of algorithmic testing) and 109 prospective cases (following introduction) were analyzed. In the retrospective data, 61.7% of tests (509 of 825) were concordant with the SOPs while 38.3% (316 of 825) were overordered and 30.8% (227 of 736) of SOP-recommended tests were omitted. In the prospective data, 98.8% of testing was concordant (244 of 247 total tests) with only 1.2% overordered tests (3 of 247) and 7.6% omitted tests (20 of 264 SOP-recommended tests; overall P < .001). The cost of overordered tests before implementing SOP indicates a potential annualized saving of $1,347,520 in US dollars (USD) in overordered testing at Brigham and Women's Hospital/DFCI. Only two of 316 overordered tests (0.6%) returned any additional information, both for extremely rare clinical circumstances. CONCLUSION Implementation of SOPs dramatically improved test ordering practices, with a just right number of ancillary tests that minimizes cost and has no significant impact on acquiring key informative test results.
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Affiliation(s)
- Ali AlJabban
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Henry Paik
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Enterprise Research IS (ERIS), Digital, Mass General Brigham, Boston, MA
| | - Jon C Aster
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Nancy Berliner
- Harvard Medical School, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | | | - Jennifer R Brown
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kathleen H Burns
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA
| | - Jorge J Castillo
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - James Card
- Department of Quality and Safety, Dana-Farber Cancer Institute, Boston, MA
| | - Paola Dal Cin
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daniel J DeAngelo
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - David M Dorfman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Benjamin L Ebert
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jacqueline S Garcia
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Caron A Jacobson
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Hakim Lakhani
- Department of Quality and Safety, Dana-Farber Cancer Institute, Boston, MA
| | - Jacob P Laubach
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Azra H Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA
| | - Neal I Lindeman
- Department of Pathology, Weill Cornell Medicine, New York, NY
| | - R Coleman Lindsley
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Scott B Lovitch
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marlise R Luskin
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Andrew Nowak
- Department of Performance Improvement, Stanford Medicine Children's Health, Stanford, CA
| | - Athena Petrides
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Enterprise Research IS (ERIS), Digital, Mass General Brigham, Boston, MA
| | - Geraldine S Pinkus
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Olga Pozdnyakova
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - David P Steensma
- Novartis Institutes for BioMedical Research (NIBR), Cambridge, MA
| | - Richard M Stone
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Olga K Weinberg
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX
| | - Eric S Winer
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Annette S Kim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA
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12
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Merryman RW, Redd RA, Freedman AS, Ahn IE, Brown JR, Crombie JL, Davids MS, Fisher DC, Jacobsen ED, Kim AI, LaCasce AS, Ng S, Odejide OO, Parry EM, Isufi I, Kline J, Cohen JB, Mehta-Shah N, Bartlett NL, Mei M, Kuntz TM, Wolff J, Rodig SJ, Armand P, Jacobson CA. A multi-cohort phase 1b trial of rituximab in combination with immunotherapy doublets in relapsed/refractory follicular lymphoma. Ann Hematol 2024; 103:185-198. [PMID: 37851072 DOI: 10.1007/s00277-023-05475-0] [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: 05/16/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
Antibodies targeting PD-1 or 4-1BB achieve objective responses in follicular lymphoma (FL), but only in a minority of patients. We hypothesized that targeting multiple immune receptors could overcome immune resistance and increase response rates in patients with relapsed/refractory FL. We therefore conducted a phase 1b trial testing time-limited therapy with different immunotherapy doublets targeting 4-1BB (utomilumab), OX-40 (ivuxolimab), and PD-L1 (avelumab) in combination with rituximab among patients with relapsed/refractory grade 1-3A FL. Patients were enrolled onto 2 of 3 planned cohorts (cohort 1 - rituximab/utomilumab/avelumab; cohort 2 - rituximab/ivuxolimab/utomilumab). 3+3 dose escalation was followed by dose expansion at the recommended phase 2 dose (RP2D). Twenty-four patients were enrolled (16 in cohort 1 and 9 in cohort 2, with one treated in both cohorts). No patients discontinued treatment due to adverse events and the RP2D was the highest dose level tested in both cohorts. In cohort 1, the objective and complete response rates were 44% and 19%, respectively (50% and 30%, respectively, at RP2D). In cohort 2, no responses were observed. The median progression-free survivals in cohorts 1 and 2 were 6.9 and 3.2 months, respectively. In cohort 1, higher density of PD-1+ tumor-infiltrating T-cells on baseline biopsies and lower density of 4-1BB+ and TIGIT+ T-cells in on-treatment biopsies were associated with response. Abundance of Akkermansia in stool samples was also associated with response. Our results support a possible role for 4-1BB agonist therapy in FL and suggest that features of the tumor microenvironment and stool microbiome may be associated with clinical outcomes (NCT03636503).
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Affiliation(s)
- Reid W Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA.
| | - Robert A Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Arnold S Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Inhye E Ahn
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Jennifer L Crombie
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Austin I Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Samuel Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Oreofe O Odejide
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Erin M Parry
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Iris Isufi
- Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Neha Mehta-Shah
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Nancy L Bartlett
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Thomas M Kuntz
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jacquelyn Wolff
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
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13
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Loftus RW, Brindeiro CT, Loftus CP, Brown JR, Charnin JE, Dexter F. Characterizing the molecular epidemiology of anaesthesia work area transmission of Staphylococcus aureus sequence type 5. J Hosp Infect 2024; 143:186-194. [PMID: 37451409 DOI: 10.1016/j.jhin.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Staphylococcus aureus sequence type 5 (ST5) is an emerging global threat. AIM To characterize the epidemiology of ST5 transmission in the anaesthesia work area. METHODS The retrospective cohort study analysed transmitted, prophylactic antibiotic-resistant Staphylococcus aureus isolates involving anaesthesia work area reservoirs. Using whole-genome analysis, the epidemiology of ST5 transmission was characterized by reservoir(s) of origin, transmission location(s), portal of entry, and mode(s) of transmission. All patients were followed for at least 30 days for surgical site infection (SSI) development. FINDINGS Forty-one percent (18/44; 95% confidence interval: 28-56%) of isolates were ST5. Provider hands were the reservoir of origin for 28% (5/18) of transmitted ST5 vs 4% (1/26) for other STs. Provider hands were the transmission location for 28% (5/18) of ST5 vs 7% (2/26) of other STs. Stopcock contamination occurred for 8% (1/13) of ST5 isolates vs 12% (3/25) of other STs. Sixty-three percent of transmission events occurring between cases on separate operative dates involved ST5. ST5 was more likely to harbour resistance traits (ST5 median (interquartile range) 3 (2-3) vs 2 (1-2) other STs; P < 0.001) and had greater resistance to cefazolin, piperacillin-tazobactam, and/or ciprofloxacin (ST5: 3 (2-3) vs 2 (1-3) other STs; P = 0.02). ST5 was associated with three of six SSIs. CONCLUSION ST5 is prevalent among transmitted, prophylactic antibiotic-resistant isolates in the anaesthesia work area. Transmission involves provider hands and one patient to another on future date(s). ST5 is associated with a greater number of resistance traits and reduced in-vitro susceptibility vs other intraoperative meticillin-resistant S. aureus.
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Affiliation(s)
- R W Loftus
- Department of Anaesthesia, University of Iowa, Iowa City, IA, USA.
| | - C T Brindeiro
- RDB Bioinformatics, University of Iowa, Medical Laboratories Building, Iowa City, IA, USA
| | - C P Loftus
- RDB Bioinformatics, University of Iowa, Medical Laboratories Building, Iowa City, IA, USA
| | - J R Brown
- The Dartmouth Institute, Dartmouth Geisel School of Medicine, NH, USA
| | | | - F Dexter
- Department of Anaesthesia, University of Iowa, Iowa City, IA, USA
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14
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Leung BW, Fay CJ, Said JT, Sheets AR, Lian CG, Brown JR, Castillo JJ, Sarosiek S, Flynn C, LeBoeuf NR. Localized upper extremity edema secondary to Bruton's tyrosine kinase inhibition. Leuk Lymphoma 2023; 64:2047-2050. [PMID: 37671695 DOI: 10.1080/10428194.2023.2245091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Bonnie W Leung
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christopher J Fay
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony R Sheets
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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15
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Tam CS, Lamanna N, O'Brien SM, Qiu L, Yang K, Barnes G, Wu K, Salmi T, Brown JR. Health-related quality of life outcomes associated with zanubrutinib versus ibrutinib monotherapy in patients with relapsed/refractory chronic lymphocytic leukemia and small lymphocytic lymphoma: results from the ALPINE Trial. Curr Med Res Opin 2023:1-7. [PMID: 37752892 DOI: 10.1080/03007995.2023.2262378] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The purpose of this analysis was to assess health-related quality of life (HRQoL) in patients treated with zanubrutinib and ibrutinib in the ALPINE trial (NCT03734016). METHODS HRQoL was measured by the EORTC QLQ-C30 and EQ-5D-5L at baseline, cycle 1, and every third cycle until the end of treatment. Key patient-reported outcome (PRO) endpoints included global health status (GHS), physical and role functioning, as well as symptoms of fatigue, pain, diarrhea, and nausea/vomiting. A mixed model repeated-measure analysis using key PRO endpoints at key clinical cycles (cycles 7 and 13) was performed. RESULTS 652 patients were randomized to receive zanubrutinib (n = 327) or ibrutinib (n = 325). By cycle 7, GHS scores improved with zanubrutinib versus ibrutinib, and in cycle 13, GHS scores remained higher in the zanubrutinib arm. The zanubrutinib arm experienced clinically meaningful improvements in physical and role functioning, as well as pain and fatigue symptoms at both cycles. Patients in the zanubrutinib arm reported lower diarrhea scores. Nausea/vomiting scores maintained in both arms. EQ-VAS scores showed greater improvement from baseline at both cycle 7 (7.92 versus 3.44) and cycle 13 (7.75 versus 3.92) of treatment with zanubrutinib compared to ibrutinib, respectively. CONCLUSIONS Patients with R/R CLL/SLL treated with zanubrutinib demonstrated improvement versus ibrutinib in the GHS scale at cycle 7. Other endpoints continued to improve, suggesting treatment with zanubrutinib positively affected HRQoL over time. Given the generally good HRQoL at baseline in both arms, the differences between the arms were not significant.
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Affiliation(s)
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Susan M O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Keri Yang
- BeiGene USA, Inc, San Mateo, CA, USA
| | | | - Ken Wu
- BeiGene USA, Inc, San Mateo, CA, USA
| | - Tommi Salmi
- BeiGene Switzerland GmbH, Basel, Switzerland
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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16
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Ghia P, Barnes G, Yang K, Tam CS, Robak T, Brown JR, Kahl BS, Tian T, Szeto A, Paik JC, Shadman M. Health-related quality-of-life in treatment-naive CLL/SLL patients treated with zanubrutinib versus bendamustine plus rituximab. Curr Med Res Opin 2023:1-7. [PMID: 37752878 DOI: 10.1080/03007995.2023.2262381] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Zanubrutinib is a highly selective, next-generation Bruton's tyrosine kinase inhibitor. In the phase 3 SEQUOIA trial (NCT03336333), treatment with zanubrutinib resulted in significantly improved progression-free survival compared to bendamustine plus rituximab (BR) in adult patients with treatment-naïve chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) without del(17p). The current analysis compared the effects of zanubrutinib versus BR on patients' health-related quality-of-life (HRQoL). METHODS In the SEQUOIA trial, patient-reported outcomes (PROs) were assessed at baseline and every 12 weeks (3 cycles) using the EORTC QLQ-C30 and EQ-5D-5L. Descriptive analyses were performed on all the questionnaires' scales and a mixed model for repeated measures was performed using the key QLQ-C30 endpoints of global health status/QoL (GHS/QoL), physical and role functioning, and symptoms of fatigue, pain, diarrhea, and nausea/vomiting at weeks 12 and 24. RESULTS Compared with BR-treated patients, those in the zanubrutinib arm experienced greater improvements in HRQoL outcomes at both weeks 12 and 24. By week 24, mean change differences (95% confidence interval) between the arms were significant for GHS/QoL (4.9 [0.9, 9.0]), physical functioning (3.8 [0.8, 6.7]), diarrhea (-6.2 [-10.0, -2.5]), fatigue (-4.5 [-8.9, -0.1]), and nausea/vomiting (-4.5 [-8.9, -0.1]); role functioning (4.8 [-0.2, 9.7]) was marginally better in the zanubrutinib arm and there were no differences in pain symptoms (-0.4 [-4.3, 5.1]) between the arms. CONCLUSIONS During the first 24 weeks of treatment, zanubrutinib was associated with better HRQoL outcomes in patients with treatment-naive CLL/SLL without del(17p) compared to BR. TRIAL REGISTRATION The SEQUOIA trial is registered on clinicaltrials.gov as SEQUOIA trial (NCT03336333).
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Affiliation(s)
- Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Gisoo Barnes
- Health Economics and Outcomes Research, BeiGene USA, Inc, San Mateo, CA, USA
| | - Keri Yang
- Health Economics and Outcomes Research, BeiGene USA, Inc, San Mateo, CA, USA
| | - Constantine S Tam
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | - Brad S Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Tian Tian
- Health Economics and Outcomes Research, BeiGene USA, Inc, San Mateo, CA, USA
| | - Andy Szeto
- Health Economics and Outcomes Research, BeiGene USA, Inc, San Mateo, CA, USA
| | - Jason C Paik
- Health Economics and Outcomes Research, BeiGene USA, Inc, San Mateo, CA, USA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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17
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Merryman RW, Redd RA, Taranto E, Ahmed G, Jeter E, McHugh KM, Brown JR, Crombie JL, Davids MS, Fisher DC, Freedman AS, Jacobsen E, Jacobson CA, Kim AI, LaCasce AS, Ng SY, Odejide OO, Parry EM, Jacene H, Park H, Dahi PB, Nieto Y, Joyce RM, Chen YB, Shipp MA, Herrera AF, Armand P. Minimal residual disease in patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation. Blood Adv 2023; 7:4748-4759. [PMID: 36399518 PMCID: PMC10468363 DOI: 10.1182/bloodadvances.2022007706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/19/2022] Open
Abstract
Improved biomarkers are required to guide the optimal use of autologous stem cell transplantation (ASCT) in patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We hypothesized that minimal residual disease (MRD) identified using immunoglobulin high-throughput sequencing in apheresis stem cell (ASC) samples, post-ASCT peripheral blood mononuclear cell (PBMC), and plasma samples could predict relapse. We studied 159 patients with R/R DLBCL who underwent ASCT, of whom 98 had an ASC sample and 60 had post-ASCT surveillance samples. After a median post-ASCT follow-up of 60 months, the 5-year progression-free survival (PFS) was 48%. MRD was detected in of 23/98 (23%) ASC samples and was associated with very poor PFS (5-year PFS 13% vs 53%, P < .001) and inferior overall survival (52% vs 68%, P = .05). The sensitivity and specificity of ASC MRD positivity for progression and death were 36% and 93%, respectively. Positive ASC MRD remained a significant predictor of PFS in multivariable analysis (hazard ratio [HR], 3.7; P < .001). Post-ASCT surveillance MRD testing of plasma, but not PBMC samples, reliably identified patients with an impending relapse. A positive plasma MRD result was associated with inferior PFS (HR, 3.0; P = .016) in a multivariable analysis. The median lead time from MRD detection to relapse was 62 days (range, 0-518 days). In conclusion, the detection of MRD in ASC samples is associated with a very high risk of relapse, justifying alternative treatment strategies or trials of novel consolidation options in these patients. Furthermore, post-ASCT MRD monitoring may facilitate the evaluation of the early initiation of treatment at molecular relapse. This trial has been registered at www.clinicaltrials.gov as #NCT02362997.
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Affiliation(s)
- Reid W. Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert A. Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Eleanor Taranto
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Erin Jeter
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kristin M. McHugh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - David C. Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Arnold S. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Eric Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Caron A. Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Austin I. Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ann S. LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Samuel Y. Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Oreofe O. Odejide
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Erin M. Parry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Heather Jacene
- Department of Imaging/Radiology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA
| | - Hyesun Park
- Department of Imaging/Radiology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA
| | - Parastoo B. Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robin M. Joyce
- Department of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yi-Bin Chen
- Bone Marrow Transplantation Program, Massachusetts General Hospital, Boston, MA
| | - Margaret A. Shipp
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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18
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Seymour JF, Byrd JC, Ghia P, Kater AP, Chanan-Khan A, Furman RR, O'Brien S, Brown JR, Munir T, Mato A, Stilgenbauer S, Bajwa N, Miranda P, Higgins K, John E, de Borja M, Jurczak W, Woyach JA. Detailed safety profile of acalabrutinib vs ibrutinib in previously treated chronic lymphocytic leukemia in the ELEVATE-RR trial. Blood 2023; 142:687-699. [PMID: 37390310 PMCID: PMC10644206 DOI: 10.1182/blood.2022018818] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 07/02/2023] Open
Abstract
ELEVATE-RR demonstrated noninferior progression-free survival and lower incidence of key adverse events (AEs) with acalabrutinib vs ibrutinib in previously treated chronic lymphocytic leukemia. We further characterize AEs of acalabrutinib and ibrutinib via post hoc analysis. Overall and exposure-adjusted incidence rate was assessed for common Bruton tyrosine kinase inhibitor-associated AEs and for selected events of clinical interest (ECIs). AE burden scores based on previously published methodology were calculated for AEs overall and selected ECIs. Safety analyses included 529 patients (acalabrutinib, n = 266; ibrutinib, n = 263). Among common AEs, incidences of any-grade diarrhea, arthralgia, urinary tract infection, back pain, muscle spasms, and dyspepsia were higher with ibrutinib, with 1.5- to 4.1-fold higher exposure-adjusted incidence rates. Incidences of headache and cough were higher with acalabrutinib, with 1.6- and 1.2-fold higher exposure-adjusted incidence rate, respectively. Among ECIs, incidences of any-grade atrial fibrillation/flutter, hypertension, and bleeding were higher with ibrutinib, as were exposure-adjusted incidence rates (2.0-, 2.8-, and 1.6-fold, respectively); incidences of cardiac events overall (the Medical Dictionary for Regulatory Activities system organ class) and infections were similar between arms. Rate of discontinuation because of AEs was lower for acalabrutinib (hazard ratio, 0.62; 95% confidence interval, 0.41-0.93). AE burden score was higher for ibrutinib vs acalabrutinib overall and for the ECIs atrial fibrillation/flutter, hypertension, and bleeding. A limitation of this analysis is its open-label study design, which may influence the reporting of more subjective AEs. Overall, event-based analyses and AE burden scores demonstrated higher AE burden overall and specifically for atrial fibrillation, hypertension, and hemorrhage with ibrutinib vs acalabrutinib. This trial was registered at www.clinicaltrials.gov as #NCT02477696.
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Affiliation(s)
- John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - John C Byrd
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Arnon P Kater
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Richard R Furman
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA
| | | | - Talha Munir
- Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | | | | | | | | | | | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
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19
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Glaviano A, Foo ASC, Lam HY, Yap KCH, Jacot W, Jones RH, Eng H, Nair MG, Makvandi P, Geoerger B, Kulke MH, Baird RD, Prabhu JS, Carbone D, Pecoraro C, Teh DBL, Sethi G, Cavalieri V, Lin KH, Javidi-Sharifi NR, Toska E, Davids MS, Brown JR, Diana P, Stebbing J, Fruman DA, Kumar AP. PI3K/AKT/mTOR signaling transduction pathway and targeted therapies in cancer. Mol Cancer 2023; 22:138. [PMID: 37596643 PMCID: PMC10436543 DOI: 10.1186/s12943-023-01827-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [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: 05/21/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023] Open
Abstract
The PI3K/AKT/mTOR (PAM) signaling pathway is a highly conserved signal transduction network in eukaryotic cells that promotes cell survival, cell growth, and cell cycle progression. Growth factor signalling to transcription factors in the PAM axis is highly regulated by multiple cross-interactions with several other signaling pathways, and dysregulation of signal transduction can predispose to cancer development. The PAM axis is the most frequently activated signaling pathway in human cancer and is often implicated in resistance to anticancer therapies. Dysfunction of components of this pathway such as hyperactivity of PI3K, loss of function of PTEN, and gain-of-function of AKT, are notorious drivers of treatment resistance and disease progression in cancer. In this review we highlight the major dysregulations in the PAM signaling pathway in cancer, and discuss the results of PI3K, AKT and mTOR inhibitors as monotherapy and in co-administation with other antineoplastic agents in clinical trials as a strategy for overcoming treatment resistance. Finally, the major mechanisms of resistance to PAM signaling targeted therapies, including PAM signaling in immunology and immunotherapies are also discussed.
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Affiliation(s)
- Antonino Glaviano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Aaron S C Foo
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore
| | - Hiu Y Lam
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore
| | - Kenneth C H Yap
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Inserm U1194, Montpellier University, Montpellier, France
| | - Robert H Jones
- Cardiff University and Velindre Cancer Centre, Museum Avenue, Cardiff, CF10 3AX, UK
| | - Huiyan Eng
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Madhumathy G Nair
- Division of Molecular Medicine, St. John's Research Institute, St. John's Medical College, Bangalore, 560034, India
| | - Pooyan Makvandi
- The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Inserm U1015, Université Paris-Saclay, Paris, France
| | - Matthew H Kulke
- Section of Hematology and Medical Oncology, Boston University and Boston Medical Center, Boston, MA, USA
| | - Richard D Baird
- Cancer Research UK Cambridge Centre, Hills Road, Cambridge, CB2 0QQ, UK
| | - Jyothi S Prabhu
- Division of Molecular Medicine, St. John's Research Institute, St. John's Medical College, Bangalore, 560034, India
| | - Daniela Carbone
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Camilla Pecoraro
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Daniel B L Teh
- Departments of Ophthalmology and Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, and Neurobiology Programme, National University of Singapore, Singapore, Singapore
| | - Gautam Sethi
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Vincenzo Cavalieri
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Kevin H Lin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Eneda Toska
- Department of Biochemistry and Molecular Biology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Matthew S Davids
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Patrizia Diana
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Justin Stebbing
- Division of Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - David A Fruman
- Department of Molecular Biology and Biochemistry, University of California, 216 Sprague Hall, Irvine, CA, USA
| | - Alan P Kumar
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore.
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore.
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20
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Khalsa JK, Cha J, Utro F, Naeem A, Murali I, Kuang Y, Vasquez K, Li L, Tyekucheva S, Fernandes SM, Veronese L, Guieze R, Sasi BK, Wang Z, Machado JH, Bai H, Alasfour M, Rhrissorrakrai K, Levovitz C, Danysh BP, Slowik K, Jacobs RA, Davids MS, Paweletz CP, Leshchiner I, Parida L, Getz G, Brown JR. Genetic events associated with venetoclax resistance in CLL identified by whole-exome sequencing of patient samples. Blood 2023; 142:421-433. [PMID: 37146250 PMCID: PMC10447490 DOI: 10.1182/blood.2022016600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 03/14/2023] [Accepted: 04/04/2023] [Indexed: 05/07/2023] Open
Abstract
Although BCL2 mutations are reported as later occurring events leading to venetoclax resistance, many other mechanisms of progression have been reported though remain poorly understood. Here, we analyze longitudinal tumor samples from 11 patients with disease progression while receiving venetoclax to characterize the clonal evolution of resistance. All patients tested showed increased in vitro resistance to venetoclax at the posttreatment time point. We found the previously described acquired BCL2-G101V mutation in only 4 of 11 patients, with 2 patients showing a very low variant allele fraction (0.03%-4.68%). Whole-exome sequencing revealed acquired loss(8p) in 4 of 11 patients, of which 2 patients also had gain (1q21.2-21.3) in the same cells affecting the MCL1 gene. In vitro experiments showed that CLL cells from the 4 patients with loss(8p) were more resistant to venetoclax than cells from those without it, with the cells from 2 patients also carrying gain (1q21.2-21.3) showing increased sensitivity to MCL1 inhibition. Progression samples with gain (1q21.2-21.3) were more susceptible to the combination of MCL1 inhibitor and venetoclax. Differential gene expression analysis comparing bulk RNA sequencing data from pretreatment and progression time points of all patients showed upregulation of proliferation, B-cell receptor (BCR), and NF-κB gene sets including MAPK genes. Cells from progression time points demonstrated upregulation of surface immunoglobulin M and higher pERK levels compared with those from the preprogression time point, suggesting an upregulation of BCR signaling that activates the MAPK pathway. Overall, our data suggest several mechanisms of acquired resistance to venetoclax in CLL that could pave the way for rationally designed combination treatments for patients with venetoclax-resistant CLL.
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MESH Headings
- Humans
- Antineoplastic Agents/pharmacology
- Bridged Bicyclo Compounds, Heterocyclic/pharmacology
- Drug Resistance, Neoplasm/genetics
- Exome Sequencing
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Myeloid Cell Leukemia Sequence 1 Protein/genetics
- Proto-Oncogene Proteins c-bcl-2
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Affiliation(s)
- Jasneet Kaur Khalsa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Justin Cha
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Aishath Naeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ishwarya Murali
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Yanan Kuang
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA
| | - Kevin Vasquez
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA
| | - Liang Li
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Svitlana Tyekucheva
- Department of Data Sciences, Dana-Farber Cancer Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Stacey M. Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lauren Veronese
- Service de Cytogénétique Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France
- EA7453 CHELTER, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Romain Guieze
- EA7453 CHELTER, Université Clermont Auvergne, Clermont-Ferrand, France
- Service d’Hématologie clinique et thérapie cellulaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Binu Kandathilparambil Sasi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Zixu Wang
- Department of Data Sciences, Dana-Farber Cancer Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - John-Hanson Machado
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Harrison Bai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Maryam Alasfour
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Brian P. Danysh
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Kara Slowik
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Raquel A. Jacobs
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Cloud P. Paweletz
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Gad Getz
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
- Cancer Center, Massachusetts General Hospital, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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21
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Mato AR, Woyach JA, Brown JR, Ghia P, Patel K, Eyre TA, Munir T, Lech-Maranda E, Lamanna N, Tam CS, Shah NN, Coombs CC, Ujjani CS, Fakhri B, Cheah CY, Patel MR, Alencar AJ, Cohen JB, Gerson JN, Flinn IW, Ma S, Jagadeesh D, Rhodes JM, Hernandez-Ilizaliturri F, Zinzani PL, Seymour JF, Balbas M, Nair B, Abada P, Wang C, Ruppert AS, Wang D, Tsai DE, Wierda WG, Jurczak W. Pirtobrutinib after a Covalent BTK Inhibitor in Chronic Lymphocytic Leukemia. N Engl J Med 2023; 389:33-44. [PMID: 37407001 DOI: 10.1056/nejmoa2300696] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) have poor outcomes after the failure of covalent Bruton's tyrosine kinase (BTK) inhibitor treatment, and new therapeutic options are needed. Pirtobrutinib, a highly selective, noncovalent (reversible) BTK inhibitor, was designed to reestablish BTK inhibition. METHODS We conducted a phase 1-2 trial in which patients with relapsed or refractory B-cell cancers received pirtobrutinib. Here, we report efficacy results among patients with CLL or SLL who had previously received a BTK inhibitor as well as safety results among all the patients with CLL or SLL. The primary end point was an overall response (partial response or better) as assessed by independent review. Secondary end points included progression-free survival and safety. RESULTS A total of 317 patients with CLL or SLL received pirtobrutinib, including 247 who had previously received a BTK inhibitor. Among these 247 patients, the median number of previous lines of therapy was 3 (range, 1 to 11), and 100 patients (40.5%) had also received a B-cell lymphoma 2 (BCL2) inhibitor such as venetoclax. The percentage of patients with an overall response to pirtobrutinib was 73.3% (95% confidence interval [CI], 67.3 to 78.7), and the percentage was 82.2% (95% CI, 76.8 to 86.7) when partial response with lymphocytosis was included. The median progression-free survival was 19.6 months (95% CI, 16.9 to 22.1). Among all 317 patients with CLL or SLL who received pirtobrutinib, the most common adverse events were infections (in 71.0%), bleeding (in 42.6%), and neutropenia (in 32.5%). At a median duration of treatment of 16.5 months (range, 0.2 to 39.9), some adverse events that are typically associated with BTK inhibitors occurred relatively infrequently, including hypertension (in 14.2% of patients), atrial fibrillation or flutter (in 3.8%), and major hemorrhage (in 2.2%). Only 9 of 317 patients (2.8%) discontinued pirtobrutinib owing to a treatment-related adverse event. CONCLUSIONS In this trial, pirtobrutinib showed efficacy in patients with heavily pretreated CLL or SLL who had received a covalent BTK inhibitor. The most common adverse events were infections, bleeding, and neutropenia. (Funded by Loxo Oncology; BRUIN ClinicalTrials.gov number, NCT03740529.).
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Affiliation(s)
- Anthony R Mato
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Jennifer A Woyach
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Jennifer R Brown
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Paolo Ghia
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Krish Patel
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Toby A Eyre
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Talha Munir
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Ewa Lech-Maranda
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Nicole Lamanna
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Constantine S Tam
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Nirav N Shah
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Catherine C Coombs
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Chaitra S Ujjani
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Bita Fakhri
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Chan Y Cheah
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Manish R Patel
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Alvaro J Alencar
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Jonathon B Cohen
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - James N Gerson
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Ian W Flinn
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Shuo Ma
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Deepa Jagadeesh
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Joanna M Rhodes
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Francisco Hernandez-Ilizaliturri
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Pier L Zinzani
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - John F Seymour
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Minna Balbas
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Binoj Nair
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Paolo Abada
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Chunxiao Wang
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Amy S Ruppert
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Denise Wang
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Donald E Tsai
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - William G Wierda
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
| | - Wojciech Jurczak
- From Memorial Sloan Kettering Cancer Center (A.R.M.), and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center (N.L.), New York, the Donald and Barbara Zucker School of Medicine, Northwell-Hofstra, Uniondale (J.M.R.), Northwell Health Cancer Institute at Lake Success, North New Hyde Park (J.M.R.), and the Lymphoma Section, Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo (F.H.-I.) - all in New York; the Ohio State University Comprehensive Cancer Center, Columbus (J.A.W.), and Cleveland Clinic, Cleveland (D.J.) - both in Ohio; Dana-Farber Cancer Institute and Harvard Medical School - both in Boston (J.R.B.); Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan (P.G.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli" (P.L.Z.), and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna (P.L.Z.), Bologna - all in Italy; the Center for Blood Disorders and Cellular Therapy, Swedish Cancer Institute (K.P.), and the Fred Hutchinson Cancer Center, University of Washington (C.S.U.) - both in Seattle; Oxford University Hospitals NHS Foundation Trust, Churchill Cancer Centre, Oxford (T.A.E.), and the Department of Haematology, St. James's University Hospital, Leeds (T.M.) - both in the United Kingdom; the Institute of Hematology and Transfusion Medicine, Warsaw (E.L.-M.), and Maria Sklodowska-Curie National Research Institute of Oncology, Krakow (W.J.) - both in Poland; Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the University of Melbourne, Melbourne, VIC (C.S.T., J.F.S.), and Linear Clinical Research and Sir Charles Gairdner Hospital (C.Y.C.), and the Medical School, University of Western Australia (C.Y.C.), Perth, WA - all in Australia; Medical College of Wisconsin, Milwaukee (N.N.S.); University of North Carolina at Chapel Hill, Chapel Hill (C.C.C.); the University of California, San Francisco, San Francisco (B.F.); Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota (M.R.P.), and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (A.J.A.) - both in Florida; Winship Cancer Institute, Emory University, Atlanta (J.B.C.); the Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia (J.N.G.); Sarah Cannon Research Institute, Nashville (I.W.F.); Robert H. Lurie Comprehensive Cancer Center, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago (S.M.); Loxo@Lilly (M.B., B.N., P.A., D.W., D.E.T.) and Eli Lilly (C.W., A.S.R.) - both in Indianapolis; and M.D. Anderson Cancer Center, Houston (W.G.W.)
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22
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Naeem A, Utro F, Wang Q, Cha J, Vihinen M, Martindale S, Zhou Y, Ren Y, Tyekucheva S, Kim AS, Fernandes SM, Saksena G, Rhrissorrakrai K, Levovitz C, Danysh BP, Slowik K, Jacobs RA, Davids MS, Lederer JA, Zain R, Smith CIE, Leshchiner I, Parida L, Getz G, Brown JR. Pirtobrutinib targets BTK C481S in ibrutinib-resistant CLL but second-site BTK mutations lead to resistance. Blood Adv 2023; 7:1929-1943. [PMID: 36287227 PMCID: PMC10202739 DOI: 10.1182/bloodadvances.2022008447] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 11/20/2022] Open
Abstract
Covalent inhibitors of Bruton tyrosine kinase (BTK) have transformed the therapy of chronic lymphocytic leukemia (CLL), but continuous therapy has been complicated by the development of resistance. The most common resistance mechanism in patients whose disease progresses on covalent BTK inhibitors (BTKis) is a mutation in the BTK 481 cysteine residue to which the inhibitors bind covalently. Pirtobrutinib is a highly selective, noncovalent BTKi with substantial clinical activity in patients whose disease has progressed on covalent BTKi, regardless of BTK mutation status. Using in vitro ibrutinib-resistant models and cells from patients with CLL, we show that pirtobrutinib potently inhibits BTK-mediated functions including B-cell receptor (BCR) signaling, cell viability, and CCL3/CCL4 chemokine production in both BTK wild-type and C481S mutant CLL cells. We demonstrate that primary CLL cells from responding patients on the pirtobrutinib trial show reduced BCR signaling, cell survival, and CCL3/CCL4 chemokine secretion. At time of progression, these primary CLL cells show increasing resistance to pirtobrutinib in signaling inhibition, cell viability, and cytokine production. We employed longitudinal whole-exome sequencing on 2 patients whose disease progressed on pirtobrutinib and identified selection of alternative-site BTK mutations, providing clinical evidence that secondary BTK mutations lead to resistance to noncovalent BTKis.
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MESH Headings
- Humans
- Agammaglobulinaemia Tyrosine Kinase
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Chemokine CCL4/genetics
- Chemokine CCL4/therapeutic use
- Drug Resistance, Neoplasm/genetics
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Mutation
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Affiliation(s)
- Aishath Naeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | | | - Qing Wang
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Huddinge, Sweden
| | - Justin Cha
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Mauno Vihinen
- Department of Experimental Medical Science, Lund University, SE-221 84, Lund, Sweden
| | - Stephen Martindale
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Yinglu Zhou
- Department of Data Sciences, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Yue Ren
- Department of Data Sciences, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Svitlana Tyekucheva
- Department of Data Sciences, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Annette S. Kim
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Stacey M. Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Gordon Saksena
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | | | | | - Brian P. Danysh
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Kara Slowik
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Raquel A. Jacobs
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Rula Zain
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Huddinge, Sweden
- Centre for Rare Diseases, Department of Clinical Genetics, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - C. I. Edvard Smith
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Huddinge, Sweden
| | - Ignaty Leshchiner
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | | | - Gad Getz
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
- Department of Pathology, Harvard Medical School, Boston, MA
- Cancer Center and Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Cancer Program, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
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23
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Brown JR, Cohen A, Shadman M. Zanubrutinib in Chronic Lymphocytic Leukemia. Reply. N Engl J Med 2023; 388:1720-1721. [PMID: 37133597 DOI: 10.1056/nejmc2302350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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24
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Wu Y, Jin M, Fernandez M, Hart KL, Liao A, Ge X, Fernandes SM, McDonald T, Chen Z, Röth D, Ghoda LY, Marcucci G, Kalkum M, Pillai RK, Danilov AV, Li JJ, Chen J, Brown JR, Rosen ST, Siddiqi T, Wang L. METTL3-Mediated m6A Modification Controls Splicing Factor Abundance and Contributes to Aggressive CLL. Blood Cancer Discov 2023; 4:228-245. [PMID: 37067905 PMCID: PMC10150290 DOI: 10.1158/2643-3230.bcd-22-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 04/18/2023] Open
Abstract
RNA splicing dysregulation underlies the onset and progression of cancers. In chronic lymphocytic leukemia (CLL), spliceosome mutations leading to aberrant splicing occur in ∼20% of patients. However, the mechanism for splicing defects in spliceosome-unmutated CLL cases remains elusive. Through an integrative transcriptomic and proteomic analysis, we discover that proteins involved in RNA splicing are posttranscriptionally upregulated in CLL cells, resulting in splicing dysregulation. The abundance of splicing complexes is an independent risk factor for poor prognosis. Moreover, increased splicing factor expression is highly correlated with the abundance of METTL3, an RNA methyltransferase that deposits N6-methyladenosine (m6A) on mRNA. METTL3 is essential for cell growth in vitro and in vivo and controls splicing factor protein expression in a methyltransferase-dependent manner through m6A modification-mediated ribosome recycling and decoding. Our results uncover METTL3-mediated m6A modification as a novel regulatory axis in driving splicing dysregulation and contributing to aggressive CLL. SIGNIFICANCE METTL3 controls widespread splicing factor abundance via translational control of m6A-modified mRNA, contributes to RNA splicing dysregulation and disease progression in CLL, and serves as a potential therapeutic target in aggressive CLL. See related commentary by Janin and Esteller, p. 176. This article is highlighted in the In This Issue feature, p. 171.
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Affiliation(s)
- Yiming Wu
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
| | - Meiling Jin
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
| | - Mike Fernandez
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
| | - Kevyn L. Hart
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
| | - Aijun Liao
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
| | - Xinzhou Ge
- Department of Statistics, University of California, Los Angeles, California
- Department of Computational Medicine, University of California, Los Angeles, California
| | - Stacey M. Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tinisha McDonald
- The Hematopoietic Tissue Biorepository, City of Hope National Comprehensive Cancer Center, Duarte, California
- Department of Hematological Malignancies Translational Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Zhenhua Chen
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
| | - Daniel Röth
- Department of Molecular Imaging and Therapy, Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, California
| | - Lucy Y. Ghoda
- The Hematopoietic Tissue Biorepository, City of Hope National Comprehensive Cancer Center, Duarte, California
- Department of Hematological Malignancies Translational Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Guido Marcucci
- The Hematopoietic Tissue Biorepository, City of Hope National Comprehensive Cancer Center, Duarte, California
- Department of Hematological Malignancies Translational Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Markus Kalkum
- Department of Molecular Imaging and Therapy, Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, California
| | - Raju K. Pillai
- Department of Pathology, City of Hope National Comprehensive Cancer Center, Duarte, California
| | - Alexey V. Danilov
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jingyi Jessica Li
- Department of Statistics, University of California, Los Angeles, California
- Department of Computational Medicine, University of California, Los Angeles, California
| | - Jianjun Chen
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
| | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Steven T. Rosen
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Tanya Siddiqi
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Lili Wang
- Department of Systems Biology, Beckman Research Institute, City of Hope National Comprehensive Cancer Center, Monrovia, California
- Toni Stephenson Lymphoma Center, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California
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25
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Wu Y, Jin M, Fernandez M, Hart K, Liao A, Fernandes SM, McDonald T, Chen Z, Röth D, Ghoda L, Marcucci G, Kalkum M, Pillai RK, Danilov AV, Chen J, Brown JR, Rosen ST, Siddiqi T, Wang L. Abstract 3482: METTL3-mediated m6A modification controls splicing factor abundance and contributes to CLL progression. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3482] [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: 04/07/2023]
Abstract
Abstract
RNA splicing dysregulation is a hallmark of cancers and underlies the onset and progression of diseases. Chronic lymphocytic leukemia (CLL) is one of the most common adult leukemia in western countries. Spliceosome mutations occur in ~20% of patients. However, the mechanism for splicing defects in spliceosome unmutated CLL cases remains elusive. Through an integrative transcriptomic and proteomic analysis of primary CLL samples, we discovered proteins involved in RNA splicing are post-transcriptionally upregulated. Coupled with clinical annotation, we found spliceosome protein abundance is an independent risk factor and associated with poor prognosis. Splice variants found in CLL are highly overlapped with those driven by high spliceosome abundance but not splicing factor mutations, indicating high spliceosome abundance contributes to genetic lesion-independent splicing defects. To identify potential regulators for spliceosome, we proteome-widely analyzed the proteins that highly correlated with splicing factors expression. Analysis of 113 CLL samples has consistently identified METTL3 upregulation with positive correlation with 77.6% of detected splicing factors. METTL3 is an RNA methyltransferase that modifies N6-methyladenosine (m6A) on mRNA and regulates the translation of m6A-installed transcripts. m6A level on mRNA is increased in CLL cells with differential m6A highly enriched on splicing related transcripts. Moreover, high METTL3 expression in CLL is also associated with poor clinical outcomes. These results suggested that METTL3 translationally controls splicing factors through m6A and plays a role in CLL progression. Toward this end, we demonstrated that METTL3 is essential for CLL growth in both in vitro and in vivo studies. Knock out (KO) and pharmaceutical inhibition of METTL3 decreased cell growth and splicing factor expression. Overexpression of wildtype but not catalytic mutant METTL3 restored both defects in METTL3 KO cells, indicating that the regulation of splicing factor is m6A-dependent. To dissect the underlying mechanism, we performed an integrated Ribo-seq, RNA-seq, and MeRIP-seq on CLL cells with or without METTL3. KO of METTL3 decreased overall translation efficiency (TE) with RNA splicing as the most significantly affected pathway. Splicing factors with reduced TE displayed either hypo-m6A at stop codon region or hyper-m6A at CDS regions upon METTL3 KO, as direct or indirect targets of METTL3. Moreover, we found that m6A at stop codon and CDS regions regulates splicing factor translation via ribosome recycling and ribosome pausing, respectively. Taken together, our results uncovered a novel regulatory axis for METTL3 that controls splicing factor translation and contributes to CLL progression. Our study highlights a post-transcriptional layer of m6A modification as a major contributor to genetic lesion-independent splicing defects in CLL.
Citation Format: Yiming Wu, Meiling Jin, Mike Fernandez, Kevyn Hart, Aijun Liao, Stacey M. Fernandes, Tinisha McDonald, Zhenhua Chen, Daniel Röth, Lucy Ghoda, Guido Marcucci, Markus Kalkum, Raju K. Pillai, Alexey V. Danilov, Jianjun Chen, Jennifer R. Brown, Steven T. Rosen, Tanya Siddiqi, Lili Wang. METTL3-mediated m6A modification controls splicing factor abundance and contributes to CLL progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3482.
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Affiliation(s)
- Yiming Wu
- 1City of Hope National Medical Center, Monrovia, CA
| | - Meiling Jin
- 1City of Hope National Medical Center, Monrovia, CA
| | | | - Kevyn Hart
- 1City of Hope National Medical Center, Monrovia, CA
| | - Aijun Liao
- 1City of Hope National Medical Center, Monrovia, CA
| | | | | | - Zhenhua Chen
- 1City of Hope National Medical Center, Monrovia, CA
| | - Daniel Röth
- 3City of Hope National Medical Center, Duarte, CA
| | - Lucy Ghoda
- 1City of Hope National Medical Center, Monrovia, CA
| | | | | | | | | | - Jianjun Chen
- 1City of Hope National Medical Center, Monrovia, CA
| | | | | | | | - Lili Wang
- 1City of Hope National Medical Center, Monrovia, CA
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Arribas AJ, Napoli S, Cascione L, Barnabei L, Sartori G, Cannas E, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, de Moura MC, Stathis A, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. Abstract 394: ERBB4-mediated signaling is a mediator of resistance to BTK and PI3K inhibitors in B cell lymphoid neoplasms. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-394] [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: 04/07/2023]
Abstract
Abstract
Background: Marginal zone lymphoma (MZL) is an indolent yet incurable B cell malignancy. Two BTK inhibitors, ibrutinib and zanubrutinib, are FDA approved for relapsed/refractory MZL patients. PI3K inhibitors have also shown clinical activity. The identification of the mechanisms of resistance can provide useful information to optimize the use of the agents. We previously reported an IL6 driven MZL model of PI3K inhibitors resistance developed by prolonged exposure to the PI3Kδ inhibitor idelalisib (Arribas, Haematologica 2022). Here, we present the detailed characterization of a second model with resistance to both BTK and PI3K inhibitors.
Methods: MTT assay. RNA-Seq, whole exome sequencing, miRNA and methylation profiling. FACS and ELISA analyses.
Results: Resistant cells, developed by continuous exposure of the cell line Karpas1718 to idelalisib, showed resistance to various inhibitors of BTK (ibrutinib, zanubrutinib, acalabrutinib and pirtobrutinib) and PI3K (idelalisib, duvelisib, copanlisib and umbralisib). No mutations affecting BTK, PLCG2 or CXCR4 were identified in resistant cells, which had higher expression of genes involved in ERBB signaling (HBEGF, NRG2, ERBB4), cell proliferation (PBK, MKI67, TCL1A) and DNA recombination (RAG1, RAG2) than parental cells. We confirmed cell surface ERBB4 up-regulation, and the cytoplasmatic expression and secretion of its ligand HBEGF in resistant cells, which led to increased levels of p-AKT and p-ERK. The miRNAs miR-29c and let-7c, known negative regulators of the HBEGF-ERBB axis, were fully methylated and down-regulated in resistant compared to parental cells. ERBB4 genetic silencing improved sensitivity to PI3Kδ inhibitor, and exposure to let-7c or miR-29c mimics decreased secreted HBEGF and recovered sensitivity to PI3K inhibitors in resistant cells. Addition of recombinant HBEGF (rHBEGF) induced resistance to BTK and to PI3K inhibitors in parental cells and in other lymphoma models including mantle cell lymphomas and diffuse large B cell lymphomas (DLBCL). The rHBEGF induced resistance was reverted adding the ERBB inhibitor lapatinib. To extend our findings to the clinical context, using two MZL and one DLBCL expression datasets, we showed HBEGF and ERBB4 expression in clinical specimens. Finally, HBEGF levels appeared elevated in the serum of CLL patients with primary or acquired resistance to PI3Kδ or to BTK inhibitors, compared to patients responding to the drugs and paired for similar clinical features.
Conclusions: We characterized a novel B cell lymphoma model of secondary resistance to BTK and PI3K inhibitors. Our results indicate that epigenetic plasticity led to the activation of HBEGF-ERBB signaling sustaining resistance to BTK/PI3K inhibitors, which can be overcome using epigenetic agents and ERBB inhibitors. These therapeutics approaches could be tested in novel clinical trials. AJA, SN: equally contributed.
Citation Format: Alberto J. Arribas, Sara Napoli, Luciano Cascione, Laura Barnabei, Giulio Sartori, Eleonora Cannas, Eugenio Gaudio, Chiara Tarantelli, Afua A. Mensah, Filippo Spriano, Antonella Zucchetto, Francesca M. Rossi, Andrea Rinaldi, Manuel Castro de Moura, Anastasios Stathis, Georg Stussi, Valter Gattei, Jennifer R. Brown, Manel Esteller, Emanuele Zucca, Davide Rossi, Francesco Bertoni. ERBB4-mediated signaling is a mediator of resistance to BTK and PI3K inhibitors in B cell lymphoid neoplasms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 394.
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Affiliation(s)
| | - Sara Napoli
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Laura Barnabei
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | - Giulio Sartori
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Eugenio Gaudio
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Afua A. Mensah
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | | | - Andrea Rinaldi
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | - Georg Stussi
- 4Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Valter Gattei
- 2Centro di Riferimento Oncologico di Aviano – CRO, Aviano, Italy
| | - Jennifer R. Brown
- 5Chronic Lymphocytic Leukemia Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Manel Esteller
- 3Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Emanuele Zucca
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | - Davide Rossi
- 1Institute of Oncology Research, Bellinzona, Switzerland
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Loftus RW, Dexter F, Brown JR. Transmission of Staphylococcus aureus in the anaesthesia work area has greater risk of association with development of surgical site infection when resistant to the prophylactic antibiotic administered for surgery. J Hosp Infect 2023; 134:121-128. [PMID: 36693592 PMCID: PMC10066826 DOI: 10.1016/j.jhin.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The extent to which the transmission of prophylactic-antibiotic-resistant bacteria from the anaesthesia work area increases the risk of surgical site infection (SSI) is unknown. It was hypothesized that the risk of SSI would increase progressively from no transmission to transmission of prophylactic-antibiotic-resistant isolates. METHODS This was a retrospective analysis of archival samples collected in two previously published studies with similar inclusion criteria and sample collection methodology (observational study 2009-2010 and randomized trial 2018-2019). Archival isolates were linked by barcode to all patient demographic and procedural information, including the prophylactic antibiotic administered, transmission and development of SSI. For this study, all archival isolates underwent prophylactic antibiotic susceptibility testing, and the ordered association of transmission of Staphylococcus aureus (no transmission, transmission of prophylactic-antibiotic-susceptible isolates and transmission of prophylactic-antibiotic-resistant isolates) with SSI was assessed. RESULTS The risk of development of SSI was 2% (8/406) without S. aureus transmission, 11% (9/84) with transmission of S. aureus isolates that were susceptible to the prophylactic antibiotic used, and 18% (4/22) with transmission of prophylactic-antibiotic-resistant S. aureus isolates. The Cochrane-Armitage two-sided test for ordered association was P<0.0001. Treating these three groups as 0, 1 and 2, by exact logistic regression, the odds of SSI increased by 3.59 with each unit increase (95% confidence interval 1.92-6.64; P<0.0001). CONCLUSIONS Transmission of S. aureus in the anaesthesia work area reliably increases the risk of SSI, especially when the isolates are resistant to the prophylactic antibiotic administered.
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Affiliation(s)
| | - F Dexter
- University of Iowa, Iowa City, IA, USA
| | - J R Brown
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
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Shadman M, Manzoor BS, Sail K, Tuncer HH, Allan JN, Ujjani C, Emechebe N, Kamalakar R, Coombs CC, Leslie L, Barr PM, Brown JR, Eyre TA, Rampotas A, Schuh A, Lamanna N, Skarbnik A, Roeker LE, Bannerji R, Eichhorst B, Fleury I, Davids MS, Alhasani H, Jiang D, Hill BT, Schuster SJ, Brander DM, Pivneva I, Burne R, Guerin A, Mato AR. Treatment Discontinuation Patterns for Patients With Chronic Lymphocytic Leukemia in Real-World Settings: Results From a Multi-Center International Study. Clin Lymphoma Myeloma Leuk 2023:S2152-2650(23)00107-6. [PMID: 37076367 DOI: 10.1016/j.clml.2023.03.010] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This study assessed treatment discontinuation patterns and reasons among chronic lymphocytic leukemia (CLL) patients initiating first-line (1L) and second-line (2L) treatments in real-world settings. MATERIALS AND METHODS Using deidentified electronic medical records from the CLL Collaborative Study of Real-World Evidence, premature treatment discontinuation was assessed among FCR, BR, BTKi-based, and BCL-2-based regimen cohorts. RESULTS Of 1364 1L patients (initiated in 1997-2021), 190/13.9% received FCR (23.7% discontinued prematurely); 255/18.7% received BR (34.5% discontinued prematurely); 473/34.7% received BTKi-based regimens, of whom 28.1% discontinued prematurely; and 43/3.2% received venetoclax-based regimens, of whom 16.3% discontinued prematurely (venetoclax monotherapy: 7/0.5%, of whom 42.9% discontinued; VG/VR: 36/2.6%, of whom 11.1% discontinued). The most common reasons for treatment discontinuation were adverse events (FCR: 25/13.2%; BR: 36/14.1%; BTKi-based regimens: 75/15.9%) and disease progression (venetoclax-based: 3/7.0%). Of 626 2L patients, 20/3.2% received FCR (50.0% discontinued); 62/9.9% received BR (35.5% discontinued); 303/48.4% received BTKi-based regimens, of whom 38.0% discontinued; and 73/11.7% received venetoclax-based regimens, of whom 30.1% discontinued (venetoclax monotherapy: 27/4.3%, of whom 29.6% discontinued; VG/VR: 43/6.9%, of whom 27.9% discontinued). The most common reasons for treatment discontinuation were adverse events (FCR: 6/30.0%; BR: 11/17.7%; BTKi-based regimens: 60/19.8%; venetoclax-based: 6/8.2%). CONCLUSION The findings of this study highlight the continued need for tolerable therapies in CLL, with finite therapy offering a better tolerated option for patients who are newly diagnosed or relapsed/refractory to prior treatments.
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Affiliation(s)
- Mazyar Shadman
- Fred Hutch Cancer Center and University of Washington, Seattle, WA
| | | | | | - Hande H Tuncer
- The Cancer Center at Lowell General Hospital, Lowell, MA
| | | | - Chaitra Ujjani
- Fred Hutch Cancer Center and University of Washington, Seattle, WA
| | | | | | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lori Leslie
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Toby A Eyre
- Churchill Hospital, Oxford University, Oxford, UK
| | | | - Anna Schuh
- Churchill Hospital, Oxford University, Oxford, UK
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | | | - Lindsey E Roeker
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Barbara Eichhorst
- Department of Internal Medicine, Center of Integrated Oncology Köln Bonn, University of Cologne, Cologne, Germany
| | | | | | | | | | | | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Anthony R Mato
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Lampson BL, Gupta A, Tyekucheva S, Mashima K, Petráčková A, Wang Z, Wojciechowska N, Shaughnessy CJ, Baker PO, Fernandes SM, Shupe S, Machado JH, Fardoun R, Kim AS, Brown JR. Rare Germline ATM Variants Influence the Development of Chronic Lymphocytic Leukemia. J Clin Oncol 2023; 41:1116-1128. [PMID: 36315919 PMCID: PMC9928739 DOI: 10.1200/jco.22.00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Germline missense variants of unknown significance in cancer-related genes are increasingly being identified with the expanding use of next-generation sequencing. The ataxia telangiectasia-mutated (ATM) gene on chromosome 11 has more than 1,000 germline missense variants of unknown significance and is a tumor suppressor. We aimed to determine if rare germline ATM variants are more frequent in chronic lymphocytic leukemia (CLL) compared with other hematologic malignancies and if they influence the clinical characteristics of CLL. METHODS We identified 3,128 patients (including 825 patients with CLL) in our hematologic malignancy clinic who had received clinical-grade sequencing of the entire coding region of ATM. We ascertained the comparative frequencies of germline ATM variants in categories of hematologic neoplasms, and, in patients with CLL, we determined whether these variants affected CLL-associated characteristics such as somatic 11q deletion. RESULTS Rare germline ATM variants are present in 24% of patients with CLL, significantly greater than that in patients with other lymphoid malignancies (16% prevalence), myeloid disease (15%), or no hematologic neoplasm (14%). Patients with CLL with germline ATM variants are younger at diagnosis and twice as likely to have 11q deletion. The ATM variant p.L2307F is present in 3% of patients with CLL, is associated with a three-fold increase in rates of somatic 11q deletion, and is a hypomorph in cell-based assays. CONCLUSION Germline ATM variants cluster within CLL and affect the phenotype of CLL that develops, implying that some of these variants (such as ATM p.L2307F) have functional significance and should not be ignored. Further studies are needed to determine whether these variants affect the response to therapy or account for some of the inherited risk of CLL.
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Affiliation(s)
- Benjamin L. Lampson
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Aditi Gupta
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Kiyomi Mashima
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Anna Petráčková
- Department of Immunology, Palacký University, Olomouc, Czech Republic
| | - Zixu Wang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Natalia Wojciechowska
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Current Address: Wrocław Medical University, Wrocław, Poland
| | - Conner J. Shaughnessy
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Peter O. Baker
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Stacey M. Fernandes
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Samantha Shupe
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - John-Hanson Machado
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rayan Fardoun
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Annette S. Kim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Jennifer R. Brown
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Hillmen P, Eichhorst B, Brown JR, Lamanna N, O'Brien SM, Tam CS, Qiu L, Kazmierczak M, Zhou K, Šimkovič M, Mayer J, Gillespie-Twardy A, Shadman M, Ferrajoli A, Ganly PS, Weinkove R, Grosicki S, Mital A, Robak T, Österborg A, Yimer HA, Salmi T, Ji M, Yecies J, Idoine A, Wu K, Huang J, Jurczak W. Zanubrutinib Versus Ibrutinib in Relapsed/Refractory Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma: Interim Analysis of a Randomized Phase III Trial. J Clin Oncol 2023; 41:1035-1045. [PMID: 36395435 PMCID: PMC9928683 DOI: 10.1200/jco.22.00510] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Zanubrutinib is a potent, irreversible next-generation Bruton tyrosine kinase (BTK) inhibitor designed to maximize BTK occupancy and minimize off-target kinase inhibition. We hypothesized that complete/sustained BTK occupancy may improve efficacy outcomes and increased BTK specificity may minimize off-target inhibition-related toxicities. PATIENTS AND METHODS ALPINE (ClinicalTrials.gov identifier: NCT03734016) is a global, randomized, open-label phase III study of zanubrutinib versus ibrutinib in patients with relapsed/refractory chronic lymphocytic leukemia. The primary end point was investigator-assessed overall response rate (ORR). The preplanned interim analysis was scheduled approximately 12 months after the first 415 patients were enrolled. RESULTS Between November 1, 2018, and December 14, 2020, 652 patients were enrolled. We present the interim analysis of the first 415 enrolled patients randomly assigned to receive zanubrutinib (n = 207) or ibrutinib (n = 208). At 15 months of median follow-up, ORR (partial or complete response) was significantly higher with zanubrutinib (78.3%; 95% CI, 72.0 to 83.7) versus ibrutinib (62.5%; 95% CI, 55.5 to 69.1; two-sided P < .001). ORR was higher with zanubrutinib versus ibrutinib in subgroups with del(17p)/TP53 mutations (80.5% v 50.0%) and del(11q) (83.6% v 69.1%); 12-month progression-free survival in all patients was higher with zanubrutinib (94.9%) versus ibrutinib (84.0%; hazard ratio, 0.40; 95% CI, 0.23 to 0.69). Atrial fibrillation rate was significantly lower with zanubrutinib versus ibrutinib (2.5% v 10.1%; two-sided P = .001). Rates of cardiac events, major hemorrhages, and adverse events leading to treatment discontinuation/death were lower with zanubrutinib. CONCLUSION Zanubrutinib had a significantly higher ORR, lower atrial fibrillation rate, and improved progression-free survival and overall cardiac safety profile versus ibrutinib. These data support improved efficacy/safety outcomes with selective BTK inhibition.
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Affiliation(s)
- Peter Hillmen
- St James's University Hospital, Leeds, United Kingdom,Peter Hillmen, MBChB, PhD, St James's University Hospital, Level 3, Bexley Wing, Beckett St, Leeds LS9 7TF, United Kingdom; e-mail:
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen, University of Cologne, Bonn, Cologne, Düsseldorf, Germany
| | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Susan M. O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA
| | - Constantine S. Tam
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia,University of Melbourne, Parkville, Victoria, Australia,St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia,Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Maciej Kazmierczak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Keshu Zhou
- Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Martin Šimkovič
- 4th Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove, Czech Republic,Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Mayer
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital, Brno, Czech Republic
| | | | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Medicine, University of Washington, Seattle, WA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter S. Ganly
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Robert Weinkove
- Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Health Sciences Faculty, Medical University of Silesia, Katowice, Poland
| | - Andrzej Mital
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Meng Ji
- BeiGene (Beijing) Co, Ltd, Beijing, China
| | | | | | | | | | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
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Gadi D, Martindale SP, Chiu PY, Khalsa J, Chen PH, Fernandes SM, Wang Z, Tyekucheva S, Machado JH, Fisher DC, Armand P, Davids MS, Rodig S, Sherry B, Brown JR. Circulating Th17 T cells at treatment onset predict autoimmune toxicity of PI3Kδ inhibitors. Blood Cancer J 2023; 13:22. [PMID: 36732326 PMCID: PMC9895075 DOI: 10.1038/s41408-023-00788-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
PI3Kδ inhibitors are approved for the therapy of B cell malignancies, but their clinical use has been limited by unpredictable autoimmune toxicity, despite promising efficacy and evidence that toxicity is associated with improved clinical outcomes. Prior phenotypic evaluation by CyTOF has identified increases in activated CD8 T cells with activation of Th17 T cells, as well as decreases in Tregs, particularly in patients with toxicity. Here we sought to further understand the effects of idelalisib and duvelisib in vitro, and demonstrate that both idelalisib and duvelisib can inhibit T cell proliferation as well as Th1 and Treg differentiation in vitro, while promoting Th2 and Th17 differentiation. We further demonstrate directly using intracellular flow cytometry that autoimmune toxicity in patients is associated with higher absolute numbers of CD4 and CD8 T cells with Th17 differentiation in peripheral blood prior to therapy, and that gastrointestinal tissues from patients with active autoimmune complications of PI3Kδ inhibitors show infiltration with Th17+ T cells. These same tissues show depletion of Tregs as compared to CLL patients without toxicity, suggesting that loss of Tregs may be permissive for Th17 activation to lead to autoimmune toxicity. Clinical trials to restore this balance are warranted.
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Affiliation(s)
- Deepti Gadi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Stephen P Martindale
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Pui Yan Chiu
- Center for Immunology & Inflammation, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Jasneet Khalsa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Pei-Hsuan Chen
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Zixu Wang
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - John-Hanson Machado
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Scott Rodig
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Barbara Sherry
- Center for Immunology & Inflammation, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Ryan CE, Brander DM, Barr PM, Tyekucheva S, Hackett LR, Collins MC, Fernandes SM, Ren Y, Zhou Y, McDonough MM, Walker HA, McEwan MR, Abramson JS, Jacobsen ED, LaCasce AS, Fisher DC, Brown JR, Davids MS. A phase 1b study of ibrutinib in combination with obinutuzumab in patients with relapsed or refractory chronic lymphocytic leukemia. Leukemia 2023; 37:835-842. [PMID: 36717653 DOI: 10.1038/s41375-023-01830-2] [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: 09/06/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
Abstract
This study investigated ibrutinib plus obinutuzumab in relapsed/refractory CLL, evaluating tolerability of 3 sequencing regimens as well as overall safety and efficacy. Fifty-two patients were initially randomized 1:1:1 to receive either obinutuzumab 1 month before ibrutinib initiation, ibrutinib 1 month prior to obinutuzumab initiation, or to start both drugs concomitantly. Higher rates of infusion-related reactions were observed with the first sequence, and only the latter 2 cohorts were expanded. Grade 4 hematologic toxicity was uncommon, and notable all-grade non-hematologic toxicities included bruising (58%), hypertension (46%), arthralgia (38%), diarrhea (37%), transaminitis (35%), atrial fibrillation (21%), and serious infection (17%). Best overall response rate was 96% (including 40% CR and 56% PR). Best rates of undetectable minimal residual disease in peripheral blood and bone marrow were 27% and 19%, respectively. With a median follow-up of 41.5 months, four-year progression-free and overall survival rates are 74% and 93%, respectively. Correlative studies demonstrated that serum CCL4 and CXCL13 levels were associated with clinical response, and BH3 profiling revealed increased BCL-2 and BCL-xL dependence in CLL cells from patients on treatment. Overall, ibrutinib plus obinutuzumab was highly active, with a manageable safety profile, supporting further investigation of this type of approach in relapsed/refractory CLL.
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Affiliation(s)
- Christine E Ryan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Liam R Hackett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mary C Collins
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yue Ren
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yinglu Zhou
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mikaela M McDonough
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Heather A Walker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Monica R McEwan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital, Boston, MA, USA
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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33
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Brown JR, Eichhorst B, Hillmen P, Jurczak W, Kaźmierczak M, Lamanna N, O'Brien SM, Tam CS, Qiu L, Zhou K, Simkovic M, Mayer J, Gillespie-Twardy A, Ferrajoli A, Ganly PS, Weinkove R, Grosicki S, Mital A, Robak T, Osterborg A, Yimer HA, Salmi T, Wang MDY, Fu L, Li J, Wu K, Cohen A, Shadman M. Zanubrutinib or Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia. N Engl J Med 2023; 388:319-332. [PMID: 36511784 DOI: 10.1056/nejmoa2211582] [Citation(s) in RCA: 105] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In a multinational, phase 3, head-to-head trial, ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, was compared with zanubrutinib, a BTK inhibitor with greater specificity, as treatment for relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). In prespecified interim analyses, zanubrutinib was superior to ibrutinib with respect to overall response (the primary end point). Data from the final analysis of progression-free survival are now available. METHODS We randomly assigned, in a 1:1 ratio, patients with relapsed or refractory CLL or SLL who had received at least one previous course of therapy to receive zanubrutinib or ibrutinib until the occurrence of disease progression or unacceptable toxic effects. In this final analysis, progression-free survival (a key secondary end point) was assessed with the use of a hierarchical testing strategy to determine whether zanubrutinib was noninferior to ibrutinib. If noninferiority was established, the superiority of zanubrutinib was assessed and claimed if the two-sided P value was less than 0.05. RESULTS At a median follow-up of 29.6 months, zanubrutinib was found to be superior to ibrutinib with respect to progression-free survival among 652 patients (hazard ratio for disease progression or death, 0.65; 95% confidence interval, [CI], 0.49 to 0.86; P = 0.002), as assessed by the investigators; the results were similar to those as assessed by an independent-review committee. At 24 months, the investigator-assessed rates of progression-free survival were 78.4% in the zanubrutinib group and 65.9% in the ibrutinib group. Among patients with a 17p deletion, a TP53 mutation, or both, those who received zanubrutinib had longer progression-free survival than those who received ibrutinib (hazard ratio for disease progression or death, 0.53; 95% CI, 0.31 to 0.88); progression-free survival across other major subgroups consistently favored zanubrutinib. The percentage of patients with an overall response was higher in the zanubrutinib group than in the ibrutinib group. The safety profile of zanubrutinib was better than that of ibrutinib, with fewer adverse events leading to treatment discontinuation and fewer cardiac events, including fewer cardiac events leading to treatment discontinuation or death. CONCLUSIONS In patients with relapsed or refractory CLL or SLL, progression-free survival was significantly longer among patients who received zanubrutinib than among those who received ibrutinib, and zanubrutinib was associated with fewer cardiac adverse events. (Funded by BeiGene; ALPINE ClinicalTrials.gov number, NCT03734016.).
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Affiliation(s)
- Jennifer R Brown
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Barbara Eichhorst
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Peter Hillmen
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Wojciech Jurczak
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Maciej Kaźmierczak
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Nicole Lamanna
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Susan M O'Brien
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Constantine S Tam
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Lugui Qiu
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Keshu Zhou
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Martin Simkovic
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Jiri Mayer
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Amanda Gillespie-Twardy
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Alessandra Ferrajoli
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Peter S Ganly
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Robert Weinkove
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Sebastian Grosicki
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Andrzej Mital
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Tadeusz Robak
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Anders Osterborg
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Habte A Yimer
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Tommi Salmi
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Megan-Der-Yu Wang
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Lina Fu
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Jessica Li
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Kenneth Wu
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Aileen Cohen
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
| | - Mazyar Shadman
- From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston (J.R.B.); the Department of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Cologne, Germany (B.E.); St. James's University Hospital, Leeds, United Kingdom (P.H.); Maria Skłodowska-Curie National Research Institute of Oncology, Krakow (W.J.), the Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan (M.K.), the Department of Hematology and Cancer Prevention, Faculty of Health Sciences, Medical University of Silesia, Katowice (S.G.), the Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk (A.M.), and the Medical University of Lodz, Lodz (T.R.) - all in Poland; Herbert Irving Comprehensive Cancer Center, Columbia University, New York (N.L.); Chao Family Comprehensive Cancer Center, University of California, Irvine (S.M.O.), and BeiGene USA, San Mateo (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - both in California; the Alfred Hospital and Monash University - both in Melbourne, VIC, Australia (C.S.T.); the State Key Laboratory of Experimental Hematology, National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin (L.Q.), the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou (K.Z.), and BeiGene (Beijing), Beijing (T.S., M.-D.-Y.W., L.F., J.L., K.W., A.C.) - all in China; the Fourth Department of Internal Medicine-Hematology, University Hospital, Hradec Kralove (M. Simkovic), the First Faculty of Medicine, Charles University, Prague (M. Simkovic), and the Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital, Brno (J.M.) - all in the Czech Republic; Blue Ridge Cancer Care, Roanoke, VA (A.G.-T.); the Leukemia Department , University of Texas M.D. Anderson Cancer Center, Houston (A.F.), and Texas Oncology-Tyler, US Oncology Network, Tyler (H.A.Y.) - both in Texas; the Department of Haematology, Christchurch Hospital, Christchurch (P.S.G.), and Te Rerenga Ora Blood and Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, and the Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington (R.W.) - all in New Zealand; the Department of Oncology-Pathology, Karolinska Institutet, and the Department of Hematology, Karolinska University Hospital - both in Stockholm (A.O.); and the Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington - both in Seattle (M. Shadman)
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Arribas AJ, Napoli S, Cascione L, Barnabei L, Sartori G, Cannas E, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, de Moura MC, Jovic S, Pittau RB, Stathis A, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. ERBB4-mediated signaling is a mediator of resistance to BTK and PI3K inhibitors in B cell lymphoid neoplasms. bioRxiv 2023:2023.01.01.522017. [PMID: 36711490 PMCID: PMC9881865 DOI: 10.1101/2023.01.01.522017] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BTK and PI3K inhibitors are among the drugs approved for the treatment of patients with lymphoid neoplasms. Although active, their ability to lead as single agents to long-lasting complete remission is rather limited especially in the lymphoma setting. This indicates that tumor cells often develop resistance to the drugs. Here, we show that the overexpression of ERBB4 and its ligands represents a modality for B cell neoplastic cells to bypass the anti-tumor activity of BTK and PI3K inhibitors and that targeted pharmacological interventions can restore sensitivity to the small molecules. We started from a marginal zone lymphoma (MZL) cell line, Karpas-1718, kept under prolonged exposure to the PI3Kδ inhibitor idelalisib until acquisition of resistance, or with no drug. Cells underwent transcriptome, miRNA and methylation profiling, whole exome sequencing, and pharmacological screening which led to the identification of the overexpression of ERBB4 and its ligands HBEGF and NRG2 in the resistant cells. Cellular and genetic experiments demonstrated the involvement of this axis in blocking the anti-tumor activity of various BTK and PI3K inhibitors, currently used in the clinical setting. Addition of recombinant HBEGF induced resistance to BTK and PI3K inhibitors in parental cells but also in additional lymphoma models. Combination with the ERBB inhibitor lapatinib was beneficial in resistant cells and in other lymphoma models already expressing the identified resistance factors. Multi-omics analysis underlined that an epigenetic reprogramming affected the expression of the resistance-related factors, and pretreatment with demethylating agents or EZH2 inhibitors overcame the resistance. Resistance factors were shown to be expressed in clinical samples, further extending the findings of the study. In conclusions, we identified a novel ERBB4-driven mechanism of resistance to BTK and PI3K inhibitors and treatments that appear to overcome it. Key points A mechanism of secondary resistance to the PI3Kδ and BTK inhibitors in B cell neoplasms driven by secreted factors.Resistance can be reverted by targeting ERBB signaling.
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Abstract
Phosphatidylinositol 3-kinase (PI3K) inhibitors are effective in chronic lymphocytic leukemia (CLL). However, the severe toxicity profile associated with the first-generation inhibitors idelalisib and duvelisib, combined with the availability of other more tolerable agents, have limited their use. CLL is still considered incurable, and relapse after treatment, development of resistance, and treatment intolerance are common. It is therefore of interest to optimize the administration of currently approved PI3K inhibitors and to develop next-generation agents to improve tolerability, so that this class of agents will be considered an effective and safe treatment option when needed. These efforts are reflected in the large number of emerging clinical trials with PI3K inhibitors in CLL. Current strategies to overcome treatment limitations include intermittent dosing, which is established for copanlisib and zandelisib and under investigation for duvelisib and parsaclisib. A second strategy is to combine the PI3K inhibitor with another novel agent, either as a continuous regimen or a fixedduration regimen, to deepen responses. In addition to these approaches, it is of interest to identify higher-resolution actionable biomarkers that can predict treatment responses and toxicity, and inform personalized treatment decisions. Here, we discuss the current status of PI3K inhibitors in CLL, factors limiting the use of currently approved PI3K inhibitors in CLL, current strategies to overcome these limitations, and where to go next.
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Affiliation(s)
- Sigrid S Skånland
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; K. G. Jebsen Centre for B Cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo.
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA
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36
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Parry EM, Leshchiner I, Guièze R, Johnson C, Tausch E, Parikh SA, Lemvigh C, Broséus J, Hergalant S, Messer C, Utro F, Levovitz C, Rhrissorrakrai K, Li L, Rosebrock D, Yin S, Deng S, Slowik K, Jacobs R, Huang T, Li S, Fell G, Redd R, Lin Z, Knisbacher BA, Livitz D, Schneider C, Ruthen N, Elagina L, Taylor-Weiner A, Persaud B, Martinez A, Fernandes SM, Purroy N, Anandappa AJ, Ma J, Hess J, Rassenti LZ, Kipps TJ, Jain N, Wierda W, Cymbalista F, Feugier P, Kay NE, Livak KJ, Danysh BP, Stewart C, Neuberg D, Davids MS, Brown JR, Parida L, Stilgenbauer S, Getz G, Wu CJ. Evolutionary history of transformation from chronic lymphocytic leukemia to Richter syndrome. Nat Med 2023; 29:158-169. [PMID: 36624313 PMCID: PMC10155825 DOI: 10.1038/s41591-022-02113-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 10/28/2022] [Indexed: 01/11/2023]
Abstract
Richter syndrome (RS) arising from chronic lymphocytic leukemia (CLL) exemplifies an aggressive malignancy that develops from an indolent neoplasm. To decipher the genetics underlying this transformation, we computationally deconvoluted admixtures of CLL and RS cells from 52 patients with RS, evaluating paired CLL-RS whole-exome sequencing data. We discovered RS-specific somatic driver mutations (including IRF2BP2, SRSF1, B2M, DNMT3A and CCND3), recurrent copy-number alterations beyond del(9p21)(CDKN2A/B), whole-genome duplication and chromothripsis, which were confirmed in 45 independent RS cases and in an external set of RS whole genomes. Through unsupervised clustering, clonally related RS was largely distinct from diffuse large B cell lymphoma. We distinguished pathways that were dysregulated in RS versus CLL, and detected clonal evolution of transformation at single-cell resolution, identifying intermediate cell states. Our study defines distinct molecular subtypes of RS and highlights cell-free DNA analysis as a potential tool for early diagnosis and monitoring.
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Affiliation(s)
- Erin M Parry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ignaty Leshchiner
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Romain Guièze
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, EA7453 CHELTER, Clermont-Ferrand, France
| | | | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | | | - Camilla Lemvigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Julien Broséus
- Inserm UMRS1256 Nutrition-Génétique et Exposition aux Risques Environnementaux (N-GERE), Université de Lorraine, Nancy, France
- Université de Lorraine, CHRU-Nancy, service d'hématologie biologique, pôle laboratoires, Nancy, France
| | - Sébastien Hergalant
- Inserm UMRS1256 Nutrition-Génétique et Exposition aux Risques Environnementaux (N-GERE), Université de Lorraine, Nancy, France
| | - Conor Messer
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Filippo Utro
- IBM Research, Yorktown Heights, New York, NY, USA
| | | | | | - Liang Li
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Shanye Yin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephanie Deng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kara Slowik
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Raquel Jacobs
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Teddy Huang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shuqiang Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Geoff Fell
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ziao Lin
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Christof Schneider
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Neil Ruthen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Bria Persaud
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Aina Martinez
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Noelia Purroy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Annabelle J Anandappa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jialin Ma
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Julian Hess
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Laura Z Rassenti
- Moores Cancer Center, Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Thomas J Kipps
- Moores Cancer Center, Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Florence Cymbalista
- Laboratoire d'hématologie, Hôpital Avicenne-AP-HP, INSERM U978- Université Sorbonne Paris Nord, Bobigny, France
| | - Pierre Feugier
- Inserm UMRS1256 Nutrition-Génétique et Exposition aux Risques Environnementaux (N-GERE), Université de Lorraine, Nancy, France
- Université de Lorraine, CHRU Nancy, service d'hématologie clinique, Nancy, France
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kenneth J Livak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Chip Stewart
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Donna Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laxmi Parida
- IBM Research, Yorktown Heights, New York, NY, USA
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Cancer Center and Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
| | - Catherine J Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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37
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Knisbacher BA, Lin Z, Hahn CK, Nadeu F, Duran-Ferrer M, Stevenson KE, Tausch E, Delgado J, Barbera-Mourelle A, Taylor-Weiner A, Bousquets-Muñoz P, Diaz-Navarro A, Dunford A, Anand S, Kretzmer H, Gutierrez-Abril J, López-Tamargo S, Fernandes SM, Sun C, Sivina M, Rassenti LZ, Schneider C, Li S, Parida L, Meissner A, Aguet F, Burger JA, Wiestner A, Kipps TJ, Brown JR, Hallek M, Stewart C, Neuberg DS, Martín-Subero JI, Puente XS, Stilgenbauer S, Wu CJ, Campo E, Getz G. Molecular map of chronic lymphocytic leukemia and its impact on outcome. Nat Genet 2022; 54:1664-1674. [PMID: 35927489 PMCID: PMC10084830 DOI: 10.1038/s41588-022-01140-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/21/2022] [Indexed: 01/02/2023]
Abstract
Recent advances in cancer characterization have consistently revealed marked heterogeneity, impeding the completion of integrated molecular and clinical maps for each malignancy. Here, we focus on chronic lymphocytic leukemia (CLL), a B cell neoplasm with variable natural history that is conventionally categorized into two subtypes distinguished by extent of somatic mutations in the heavy-chain variable region of immunoglobulin genes (IGHV). To build the 'CLL map,' we integrated genomic, transcriptomic and epigenomic data from 1,148 patients. We identified 202 candidate genetic drivers of CLL (109 new) and refined the characterization of IGHV subtypes, which revealed distinct genomic landscapes and leukemogenic trajectories. Discovery of new gene expression subtypes further subcategorized this neoplasm and proved to be independent prognostic factors. Clinical outcomes were associated with a combination of genetic, epigenetic and gene expression features, further advancing our prognostic paradigm. Overall, this work reveals fresh insights into CLL oncogenesis and prognostication.
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Affiliation(s)
| | - Ziao Lin
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard University, Cambridge, MA, USA
| | - Cynthia K Hahn
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ferran Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Martí Duran-Ferrer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | | | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Julio Delgado
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Servicio de Hematología, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Alex Barbera-Mourelle
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
| | | | - Pablo Bousquets-Muñoz
- Departamento de Bioquímica y Biología Molecular, Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Spain
| | - Ander Diaz-Navarro
- Departamento de Bioquímica y Biología Molecular, Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Spain
| | | | | | - Helene Kretzmer
- Department of Genome Regulation, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Jesus Gutierrez-Abril
- Computational Oncology Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sara López-Tamargo
- Departamento de Bioquímica y Biología Molecular, Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Spain
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Clare Sun
- Laboratory of Lymphoid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mariela Sivina
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Z Rassenti
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | | | - Shuqiang Li
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Translational Immunogenomics Laboratory, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Alexander Meissner
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genome Regulation, Max Planck Institute for Molecular Genetics, Berlin, Germany
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | | | - Jan A Burger
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Adrian Wiestner
- Laboratory of Lymphoid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas J Kipps
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael Hallek
- Center for Molecular Medicine, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Chip Stewart
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Donna S Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - José I Martín-Subero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Departament de Fonaments Clinics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Xose S Puente
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Departamento de Bioquímica y Biología Molecular, Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Spain
| | | | - Catherine J Wu
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Elias Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Departament de Fonaments Clinics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Hematopathology Section, Laboratory of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
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Yin Y, Athanasiadis P, Karlsen L, Urban A, Xu H, Murali I, Fernandes SM, Arribas AJ, Hilli AK, Taskén K, Bertoni F, Mato AR, Normant E, Brown JR, Tjønnfjord GE, Aittokallio T, Skånland SS. Functional Testing to Characterize and Stratify PI3K Inhibitor Responses in Chronic Lymphocytic Leukemia. Clin Cancer Res 2022; 28:4444-4455. [PMID: 35998013 PMCID: PMC9588626 DOI: 10.1158/1078-0432.ccr-22-1221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/17/2022] [Accepted: 08/19/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE PI3K inhibitors (PI3Ki) are approved for relapsed chronic lymphocytic leukemia (CLL). Although patients may show an initial response to these therapies, development of treatment intolerance or resistance remain clinical challenges. To overcome these, prediction of individual treatment responses based on actionable biomarkers is needed. Here, we characterized the activity and cellular effects of 10 PI3Ki and investigated whether functional analyses can identify treatment vulnerabilities in PI3Ki-refractory/intolerant CLL and stratify responders to PI3Ki. EXPERIMENTAL DESIGN Peripheral blood mononuclear cell samples (n = 51 in total) from treatment-naïve and PI3Ki-treated patients with CLL were studied. Cells were profiled against 10 PI3Ki and the Bcl-2 antagonist venetoclax. Cell signaling and immune phenotypes were analyzed by flow cytometry. Cell viability was monitored by detection of cleaved caspase-3 and the CellTiter-Glo assay. RESULTS pan-PI3Kis were most effective at inhibiting PI3K signaling and cell viability, and showed activity in CLL cells from both treatment-naïve and idelalisib-refractory/intolerant patients. CLL cells from idelalisib-refractory/intolerant patients showed overall reduced protein phosphorylation levels. The pan-PI3Ki copanlisib, but not the p110δ inhibitor idelalisib, inhibited PI3K signaling in CD4+ and CD8+ T cells in addition to CD19+ B cells, but did not significantly affect T-cell numbers. Combination treatment with a PI3Ki and venetoclax resulted in synergistic induction of apoptosis. Analysis of drug sensitivities to 73 drug combinations and profiling of 31 proteins stratified responders to idelalisib and umbralisib, respectively. CONCLUSIONS Our findings suggest novel treatment vulnerabilities in idelalisib-refractory/intolerant CLL, and indicate that ex vivo functional profiling may stratify PI3Ki responders.
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Affiliation(s)
- Yanping Yin
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Centre for B Cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Paschalis Athanasiadis
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Linda Karlsen
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Centre for B Cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aleksandra Urban
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Centre for B Cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Haifeng Xu
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ishwarya Murali
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stacey M. Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alberto J. Arribas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Abdul K. Hilli
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Kjetil Taskén
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Centre for B Cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | | | | | - Jennifer R. Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Geir E. Tjønnfjord
- K. G. Jebsen Centre for B Cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Tero Aittokallio
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Sigrid S. Skånland
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Centre for B Cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Brown JR. EXABS-179-CLL DEBATE: Sequencing Small Molecules Is the Way to Go. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S81-S82. [PMID: 36164242 DOI: 10.1016/s2152-2650(22)00672-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Parry EM, Leshchiner I, Guieze R, Johnson C, Tausch E, Parikh SA, Lemvigh CK, Messer C, Utro F, Levovitz C, Rhrissorrakrai K, Davids MS, Broseus J, Li S, Lin Z, Knisbacher BA, Schneider C, Rassenti LZ, Kipps TJ, Jain N, Wierda W, Cymbalista F, Kay NE, Livak KJ, Danysh BP, Stewart C, Neuberg D, Brown JR, Paridi L, Stilgenbauer S, Getz G, Wu C. Abstract A13: Evolutionary history of transformation from chronic lymphocytic leukemia to Richter syndrome. Blood Cancer Discov 2022. [DOI: 10.1158/2643-3249.lymphoma22-a13] [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] Open
Abstract
Abstract
Richter syndrome (RS), an aggressive lymphoma that develops in patients with chronic lymphocytic leukemia (CLL), is a striking example of histologic transformation. While recent therapeutic advances have transformed the treatment landscape of CLL and lymphoma, RS remains associated with dismal overall survival. Despite an advanced genomic and molecular characterization of CLL over the past decade, the current understanding of the genetic factors driving evolution of CLL to RS is limited. To decipher the genetics underlying this transformation, we have performed an integrative analysis of exome, genome and transcriptome data generated from matched RS and CLL samples from a discovery cohort of 53 patients with newly diagnosed RS of DLBCL histology. Through computational deconvolution of CLL and RS clones, we constructed phylogenetic relationships and traced evolution of CLL to RS, confirming both clonal related (87%) and unrelated cases (13%). In addition to identifying recognized RS-risk genetic lesions, we discovered novel RS-specific alterations, including 5 putative somatic driver genes (IRF2BP2, SRSF1, B2M, DNMT3A and EZH2), frequent copy number alterations beyond del(9p21)(CDKN2A/B), (including amp(7q21.2) (CDK6), amp(9p24) (PDL1/L2), and amp(1q23)(MCL1)), and recurrent whole genome duplication and chromothripsis. Integration of exome and genome sequencing data led to the identification of distinct molecular subtypes of RS with prognostic importance. To confirm these molecular subtypes, a validation cohort of 47 RS cases has been assembled with paired exome and transcriptome data. To further investigate the stepwise clonal evolution of CLL to RS, we performed single-cell RNA-sequencing on biopsy samples obtained at diagnosis from 5 individuals with clonally related transformation. Using a novel tool, CNVSingle, we inferred allele specific single-cell copy number alterations that enabled identification of the single-cell clusters representing distinct CLL and RS genetic subclones as well as intermediate, or transitional, evolutionary states. RS cells displayed gene expression enriched in pathways of MYC targets and cell cycle, in line with similar analysis on bulk transcriptomes. Finally, by ultra-low pass (ULP)-WGS sequencing of plasma samples from RS patients, we demonstrate detection of RS tumor DNA in plasma months prior to initial clinical diagnosis (n=3 of 6) or post-allogeneic stem cell transplant relapse (n=2 of 2). cfDNA is thus a promising tool for early detection of emerging RS and RS relapse as well as for non-invasive detection surrounding diagnosis. Altogether, our study defines RS-specific alterations and provides a molecular definition of RS, identifies distinct genetic subtypes of RS with prognostic significance, traces the evolutionary path to RS and suggests future strategies for improved detection.
Citation Format: Erin M Parry, Ignaty Leshchiner, Romain Guieze, Connor Johnson, Eugen Tausch, Sameer A Parikh, Camilla K Lemvigh, Conor Messer, Filippo Utro, Chaya Levovitz, Kahn Rhrissorrakrai, Matthew S Davids, Julien Broseus, Shuqiang Li, Ziao Lin, Binyamin A Knisbacher, Christof Schneider, Laura Z Rassenti, Thomas J Kipps, Nitin Jain, William Wierda, Florence Cymbalista, Neil E Kay, Kenneth J Livak, Brian P Danysh, Chip Stewart, Donna Neuberg, Jennifer R Brown, Laxmi Paridi, Stephan Stilgenbauer, Gaddy Getz, Catherine Wu. Evolutionary history of transformation from chronic lymphocytic leukemia to Richter syndrome [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A13.
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Affiliation(s)
| | | | - Romain Guieze
- 3Université Clermont Auvergne, Clermont-Ferrand, France,
| | | | | | | | | | - Conor Messer
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
| | | | | | | | | | | | | | - Ziao Lin
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
| | | | | | | | | | - Nitin Jain
- 11The University of Texas MD Anderson Cancer Center, Houston, TX,
| | - William Wierda
- 11The University of Texas MD Anderson Cancer Center, Houston, TX,
| | | | | | | | | | - Chip Stewart
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
| | | | | | | | | | - Gaddy Getz
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
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Tam CS, Brown JR, Kahl BS, Ghia P, Giannopoulos K, Jurczak W, Šimkovič M, Shadman M, Österborg A, Laurenti L, Walker P, Opat S, Chan H, Ciepluch H, Greil R, Tani M, Trněný M, Brander DM, Flinn IW, Grosicki S, Verner E, Tedeschi A, Li J, Tian T, Zhou L, Marimpietri C, Paik JC, Cohen A, Huang J, Robak T, Hillmen P. Zanubrutinib versus bendamustine and rituximab in untreated chronic lymphocytic leukaemia and small lymphocytic lymphoma (SEQUOIA): a randomised, controlled, phase 3 trial. Lancet Oncol 2022; 23:1031-1043. [PMID: 35810754 DOI: 10.1016/s1470-2045(22)00293-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Zanubrutinib is a next-generation, selective Bruton tyrosine kinase inhibitor with efficacy in relapsed chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). We compared zanubrutinib with bendamustine-rituximab to determine its effectiveness as frontline therapy in patients with CLL or SLL. METHODS We conducted an open-label, multicentre, phase 3 study at 153 academic or community hospitals in 14 countries and regions. Eligible patients had untreated CLL or SLL requiring treatment as per International Workshop on CLL criteria; were aged 65 years or older, or 18 years or older and had comorbidities; and had an Eastern Cooperative Oncology Group performance status score of 0-2. A central interactive web response system randomly assigned patients without del(17)(p13·1) to zanubrutinib (group A) or bendamustine-rituximab (group B) by sequential block method (permutated blocks with a random block size of four). Patients with del(17)(p13·1) were enrolled in group C and received zanubrutinib. Zanubrutinib was administered orally at 160 mg twice per day (28-day cycles); bendamustine at 90 mg/m2 of body surface area on days 1 and 2 for six cycles plus rituximab at 375 mg/m2 of body surface area the day before or on day 1 of cycle 1, and 500 mg/m2 of body surface area on day 1 of cycles 2-6, were administered intravenously. The primary endpoint was progression-free survival per independent review committee in the intention-to-treat population in groups A and B, with minimum two-sided α of 0·05 for superiority. Safety was analysed in all patients who received at least one dose of study treatment. The study is registered with ClinicalTrials.gov, NCT03336333, and is closed to recruitment. FINDINGS Between Oct 31, 2017, and July 22, 2019, 590 patients were enrolled; patients without del(17)(p13·1) were randomly assigned to zanubrutinib (group A; n=241) or bendamustine-rituximab (group B; n=238). At median follow-up of 26·2 months (IQR 23·7-29·6), median progression-free survival per independent review committee was not reached in either group (group A 95% CI not estimable [NE] to NE; group B 28·1 months to NE). Progression-free survival was significantly improved in group A versus group B (HR 0·42 [95% CI 0·28 to 0·63]; two-sided p<0·0001). The most common grade 3 or worse adverse event was neutropenia (27 [11%] of 240 patients in group A, 116 [51%] of 227 in group B, and 17 [15%] of 111 patients in group C). Serious adverse events occurred in 88 (37%) of 240 patients in group A, 113 (50%) of 227 patients in group B, and 45 (41%) of 111 patients in group C. Adverse events leading to death occurred in 11 (5%) of 240 patients in group A, 12 (5%) of 227 patients in group B, and three (3%) of 111 patients in group C, most commonly due to COVID-19 (four [2%] of 240 patients in group A), diarrhoea, and aspiration pneumonia (two each [1%] of 227 patients in group B). INTERPRETATION Zanubrutinib significantly improved progression-free survival versus bendamustine-rituximab, with an acceptable safety profile consistent with previous studies. These data support zanubrutinib as a potential new treatment option for untreated CLL and SLL. FUNDING BeiGene.
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Affiliation(s)
- Constantine S Tam
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia.
| | | | - Brad S Kahl
- Washington University School of Medicine, St Louis, MO, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Krzysztof Giannopoulos
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland; Hematology Department, St John's Cancer Centre, Lublin, Poland
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Martin Šimkovič
- Fourth Department of Internal Medicine-Haematology, University Hospital, Hradec Kralove, Czech Republic; Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Luca Laurenti
- Fondazione Policlinico Universitario A Gemelli UCSC, Rome, Italy
| | | | - Stephen Opat
- Monash Health, Clayton, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - Henry Chan
- North Shore Hospital, Auckland, New Zealand
| | | | - Richard Greil
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Marek Trněný
- First Department of Medicine, First Faculty of Medicine, Charles University, General Hospital, Prague, Czech Republic
| | - Danielle M Brander
- Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Ian W Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Health Sciences Faculty, Medical University of Silesia, Katowice, Poland
| | - Emma Verner
- Concord Repatriation General Hospital, Concord, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | | | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
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Brown JR, Danilov AV, LaCasce AS, Davids MS. PI3K inhibitors in haematological malignancies. Lancet Oncol 2022; 23:e364. [DOI: 10.1016/s1470-2045(22)00300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 10/16/2022]
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Kaufman M, Yan XJ, Li W, Ghia EM, Langerak AW, Rassenti LZ, Belessi C, Kay NE, Davi F, Byrd JC, Pospisilova S, Brown JR, Catherwood M, Davis Z, Oscier D, Montillo M, Trentin L, Rosenquist R, Ghia P, Barrientos JC, Kolitz JE, Allen SL, Rai KR, Stamatopoulos K, Kipps TJ, Neuberg D, Chiorazzi N. Impact of the Types and Relative Quantities of IGHV Gene Mutations in Predicting Prognosis of Patients With Chronic Lymphocytic Leukemia. Front Oncol 2022; 12:897280. [PMID: 35903706 PMCID: PMC9315922 DOI: 10.3389/fonc.2022.897280] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with CLL with mutated IGHV genes (M-CLL) have better outcomes than patients with unmutated IGHVs (U-CLL). Since U-CLL usually express immunoglobulins (IGs) that are more autoreactive and more effectively transduce signals to leukemic B cells, B-cell receptor (BCR) signaling is likely at the heart of the worse outcomes of CLL cases without/few IGHV mutations. A corollary of this conclusion is that M-CLL follow less aggressive clinical courses because somatic IGHV mutations have altered BCR structures and no longer bind stimulatory (auto)antigens and so cannot deliver trophic signals to leukemic B cells. However, the latter assumption has not been confirmed in a large patient cohort. We tried to address the latter by measuring the relative numbers of replacement (R) mutations that lead to non-conservative amino acid changes (Rnc) to the combined numbers of conservative (Rc) and silent (S) amino acid R mutations that likely do not or cannot change amino acids, "(S+Rc) to Rnc IGHV mutation ratio". When comparing time-to-first-treatment (TTFT) of patients with (S+Rc)/Rnc ≤ 1 and >1, TTFTs were similar, even after matching groups for equal numbers of samples and identical numbers of mutations per sample. Thus, BCR structural change might not be the main reason for better outcomes for M-CLL. Since the total number of IGHV mutations associated better with longer TTFT, better clinical courses appear due to the biologic state of a B cell having undergone many stimulatory events leading to IGHV mutations. Analyses of larger patient cohorts will be needed to definitively answer this question.
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Affiliation(s)
- Matthew Kaufman
- Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Xiao-Jie Yan
- Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Wentian Li
- The Robert S. Boas Center for Genomics & Human Genetics, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Emanuela M. Ghia
- Center for Novel Therapeutics, Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Anton W. Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Laura Z. Rassenti
- Center for Novel Therapeutics, Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | | | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Frederic Davi
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - John C. Byrd
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sarka Pospisilova
- Department of Internal Medicine - Hematology and Oncology and Department of Medical Genetics and Genomics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jennifer R. Brown
- Chronic Lymphocytic Leukemia Center, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mark Catherwood
- Clinical Hematology, Belfast City Hospital, Belfast, Ireland
| | - Zadie Davis
- Department of Molecular Pathology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - David Oscier
- Department of Hematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Marco Montillo
- Department of Hematology & Oncology, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Livio Trentin
- Hematology Unit, Department of Medicine-(DIMED), University of Padua University Hospital, Padua, Italy
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Ghia
- Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jacqueline C. Barrientos
- Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, United States
- Departments of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, United States
- Northwell Health Cancer Institute, Lake Success, NY, United States
| | - Jonathan E. Kolitz
- Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Northwell Health Cancer Institute, Lake Success, NY, United States
| | - Steven L. Allen
- Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Northwell Health Cancer Institute, Lake Success, NY, United States
| | - Kanti R. Rai
- Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, United States
- Departments of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, United States
- Northwell Health Cancer Institute, Lake Success, NY, United States
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Thomas J. Kipps
- Center for Novel Therapeutics, Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Donna Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Nicholas Chiorazzi
- Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, United States
- Departments of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY, United States
- Northwell Health Cancer Institute, Lake Success, NY, United States
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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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Hatcher J, Gil E, Storey N, Brown JR, Hartley JC, Breuer J, Lucchini G, Rao K, O'Connor D, Dunn H. Reactivation/relapse of SARS-CoV-2 in a child following haematopoietic stem cell transplantation, confirmed by whole genome sequencing, following apparent viral clearance. J Infect 2022; 85:e56-e58. [PMID: 35724755 PMCID: PMC9212430 DOI: 10.1016/j.jinf.2022.05.043] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022]
Affiliation(s)
- J Hatcher
- Department of Microbiology, Great Ormond Street Hospital for Children, United Kingdom.
| | - E Gil
- Department of Microbiology, Great Ormond Street Hospital for Children, United Kingdom
| | - N Storey
- Department of Microbiology, Great Ormond Street Hospital for Children, United Kingdom
| | - J R Brown
- Department of Microbiology, Great Ormond Street Hospital for Children, United Kingdom
| | - J C Hartley
- Department of Microbiology, Great Ormond Street Hospital for Children, United Kingdom
| | - J Breuer
- Department of Microbiology, Great Ormond Street Hospital for Children, United Kingdom
| | - G Lucchini
- Department of Blood and Marrow Transplant, Great Ormond Street Hospital for Children, United Kingdom
| | - K Rao
- Department of Blood and Marrow Transplant, Great Ormond Street Hospital for Children, United Kingdom
| | - D O'Connor
- Department of Haematology, Great Ormond Street Hospital for Children and University College London Cancer Institute, United Kingdom
| | - H Dunn
- Department of Microbiology, Great Ormond Street Hospital for Children, United Kingdom
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Parry EM, Leshchiner I, Guièze R, Johnson C, Tausch E, Parikh S, Lemvigh C, Messer C, Rosebrock D, Utro F, Levovitz C, Rhrissorrakrai K, Davids M, Jacobs RA, Slowik K, Broseus J, Yin S, Li S, Fell G, Lin Z, Knisbacher BA, Ruthen N, Livitz D, Schneider C, Ma J, Hess J, Rassenti LZ, Kipps TJ, Jain N, Wierda W, Cymbalista F, Kay NE, Livak KJ, Danysh BP, Stewart C, Neuberg D, Brown JR, Parida L, Stilgenbauer S, Getz G, Wu CJ. Abstract 4007: Evolutionary history of transformation from chronic lymphocytic leukemia to Richter’s syndrome. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4007] [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
Richter’s syndrome (RS) arising from chronic lymphocytic leukemia (CLL) is a striking example of an aggressive malignant histology that emerges from indolent cancer. RS is a major barrier to disease control in CLL and is associated with poor clinical outcomes and limited survival. The genetic basis of RS is poorly understood, and its relationship to the antecedent CLL remains incompletely characterized.
To study RS, we performed whole-exome sequencing (WES) on samples collected from 52 patients with RS of diffuse large B cell lymphoma (DLBCL) histology. For this genomic characterization, samples from 42 patients were analyzed as ‘trios’ (matched germline, CLL and RS tissue DNA) and those from 10 as ‘duos’ (matched CLL and RS DNA). Beyond addressing contamination of CLL DNA in the germline sample, we developed methods for discriminating between the RS and CLL clones which often coexist in the same samples.
The discovery cohort revealed that RS and CLL were clonally-related in 45/52 (87%) cases based on WES analysis, with a distinct RS clone emerging from a CLL subclone. The remaining 13% were determined to be clonally unrelated. RS clones presented ~3x higher rates of additional mutations than the ancestral CLL clones from which they developed. We identified novel RS somatic driver mutations (in IRF2BP2, SRSF1, B2M, DNMT3A and others), a high rate of copy number variations with recurrent deletions (e.g., del(17p) [TP53], del(13q14.3), del(7q36), and del(15q13.11) [MGA], del(9p21.3) [CDKN2A/B], del(16q12.2)), focal amplifications (amp(7q21.2) [CDK6], amp(8q24.2) [RECQL4, MYC], amp(13q31.2) [ERCC5], and frequent whole genome duplication.
To further investigate RS and CLL clonal evolution, we performed single-cell RNA-sequencing on biopsies at the time of RS diagnosis in 5 individuals with clonally related transformation. Using our novel tool, CNVSingle, we inferred allele specific single-cell copy number alterations, yielding cluster-specific copy number profiles that matched the WES results of individual subclones of the RS and CLL populations. This enabled mapping genetic clones to specific expression patterns. Finally, we devised and tested a methodology that uses cfDNA for early detection of emerging Richter’s disease and have successfully identified Richter‘s tumor DNA in the blood several months prior to the clinical diagnosis. Our study thus defines drivers, distinct molecular subtypes and evolutionary path to RS and suggests strategies for its improved detection.
Citation Format: Erin M. Parry, Ignaty Leshchiner, Romain Guièze, Connor Johnson, Eugen Tausch, Sameer Parikh, Camilla Lemvigh, Conor Messer, Daniel Rosebrock, Filippo Utro, Chaya Levovitz, Kahn Rhrissorrakrai, Matthew Davids, Raquel A. Jacobs, Kara Slowik, Julien Broseus, Shanye Yin, Shuqiang Li, Geoff Fell, Ziao Lin, Binyamin A. Knisbacher, Neil Ruthen, Dimitri Livitz, Christof Schneider, Jialin Ma, Julian Hess, Laura Z. Rassenti, Thomas J. Kipps, Nitin Jain, William Wierda, Florence Cymbalista, Neil E. Kay, Kenneth J. Livak, Brian P. Danysh, Chip Stewart, Donna Neuberg, Jennifer R. Brown, Laxmi Parida, Stephan Stilgenbauer, Gad Getz, Catherine J. Wu. Evolutionary history of transformation from chronic lymphocytic leukemia to Richter’s syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4007.
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Affiliation(s)
| | | | | | | | | | | | | | - Conor Messer
- 2Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | | | | | | | | | - Kara Slowik
- 2Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Shanye Yin
- 1Dana-Farber Cancer Institute, Boston, MA
| | - Shuqiang Li
- 2Broad Institute of MIT and Harvard, Cambridge, MA
| | - Geoff Fell
- 1Dana-Farber Cancer Institute, Boston, MA
| | - Ziao Lin
- 2Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | | | | | - Jialin Ma
- 2Broad Institute of MIT and Harvard, Cambridge, MA
| | - Julian Hess
- 2Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | | | | | | | | | | | | | - Chip Stewart
- 2Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | | | | | - Gad Getz
- 2Broad Institute of MIT and Harvard, Cambridge, MA
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Roeker LE, Mato AR, Brown JR, Coombs CC, Shah NN, Wierda WG, Patel MR, Lewis KL, Balbas M, Zhao J, Ku NC, Kherani JF, Tsai DE, Nair B, Cheah CY. Abstract CT138: Pirtobrutinib, a highly selective, non-covalent (reversible) BTK inhibitor in combination with venetoclax ± rituximab in relapsed/refractory chronic lymphocytic leukemia: Results from the BRUIN phase 1b study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Covalent Bruton tyrosine kinase inhibitors (BTKi) have transformed the management of chronic lymphocytic leukemia (CLL), but patients (pts) discontinue these agents due to resistance or intolerance. Pirtobrutinib is an oral, highly selective, non-covalent (reversible) BTKi with promising efficacy and safety in heavily pretreated relapsed/refractory (R/R) CLL pts, regardless of BTK C481 mutation status. Recent clinical studies reported on the safety and efficacy of time-limited venetoclax and covalent BTKi combination regimens. We evaluated the safety and efficacy of pirtobrutinib combined with venetoclax ± rituximab in pts with R/R CLL.
Methods: BRUIN is a phase 1/2 global, multicenter study (NCT03740529) of pirtobrutinib in pts with advanced B-cell malignancies. The phase 1b portion evaluated the safety of pirtobrutinib at a continuous dose of 200 mg QD from Cycle 1, Day 1 plus venetoclax starting on Cycle 2, Day 1 with a standard 5-week dose ramp to 400 mg QD (PV) and PV plus rituximab at 375 mg/m2 on Cycle 1, Day 1, then 500 mg/m2 on Day 1 of Cycles 2-6 (PVR). Prior BTKi was allowed; prior venetoclax was not permitted. Objectives included safety and overall response rate (ORR) of each combination.
Results: As of 27 SEP 2021, 15 pts received PV and 10 pts received PVR. Median age was 66 years (range, 39-78). Median prior lines of therapy was 2 (range, 1-4). The majority of pts in both cohorts had received prior chemotherapy (56%, n=14), CD20 monoclonal antibody (72%, n=18), and/or covalent BTKi (68%, n=17). No dose-limiting toxicities were reported. Safety profiles were generally similar across both cohorts. The most common treatment-emergent adverse events (TEAE) of any grade, regardless of attribution, were neutrophil count decrease (36%), nausea (32%), fatigue (32%), diarrhea (28%), and constipation (24%). The only Grade ≥3 TEAE to occur in more than 2 pts was neutrophil count decrease (36%, n=9). One pt experienced Grade 4 clinical tumor lysis syndrome with resultant acute kidney injury during venetoclax dose escalation, which resolved with supportive measures. No pts discontinued treatment due to AEs. For the 22 pts with efficacy data available as of 03 NOV 2021, median duration of follow-up was 9 months (range, 3.9-15) and the ORR was 95.5% (95% CI, 77-100). All responding pts except 1 remain on therapy (PVR responder discontinued due to death unrelated to study treatment). As all responses were ongoing and early, and MRD analysis was not yet performed.
Conclusions: Pirtobrutinib combined with venetoclax ± rituximab was well tolerated and had a safety profile consistent with known drug class findings and no clear additive toxicities in pts with R/R CLL. Early results demonstrate promising efficacy with combination therapy.
Citation Format: Lindsey E. Roeker, Anthony R. Mato, Jennifer R. Brown, Catherine C. Coombs, Nirav N. Shah, William G. Wierda, Manish R. Patel, Katharine L. Lewis, Minna Balbas, Junjie Zhao, Nora C. Ku, Jennifer F. Kherani, Donald E. Tsai, Binoj Nair, Chan Y. Cheah. Pirtobrutinib, a highly selective, non-covalent (reversible) BTK inhibitor in combination with venetoclax ± rituximab in relapsed/refractory chronic lymphocytic leukemia: Results from the BRUIN phase 1b study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT138.
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Affiliation(s)
| | | | - Jennifer R. Brown
- 2Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | | | - Manish R. Patel
- 6Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL
| | - Katharine L. Lewis
- 7Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | | | | | | | | | - Chan Y. Cheah
- 7Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, Australia
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Kuang Y, Fernandes SM, Fardoun R, Vasquez K, Mogili A, Paweletz CP, Brown JR. Abstract 3960: BCL-2 G101V mutations develop in one-third of patients on continuous venetoclax. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3960] [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
The development of targeted therapies has revolutionized the treatment of chronic lymphocytic leukemia (CLL). To date, these therapies are generally given continuously, indefinitely, leading to the development of resistance, which is often on target. Venetoclax is the first-in-class BCL-2 inhibitor which was initially approved for continuous therapy in relapsed high-risk CLL. In that context the BCL-2 G101V mutation (mut) was identified in post-progression samples and shown to reduce venetoclax binding to BCL-2, limiting its efficacy. The mut can be identified at low variant allele frequency (VAF) prior to clinical progression. We were therefore interested to identify the frequency of this mut in our cohort of relapsed refractory CLL patients (pts) on continuous venetoclax, and to assess the sensitivity of measurements in blood vs bone marrow. To this end we utilized a ddPCR assay which has LNA probes that specifically bind to either the BCL2 G101wt or G101V sequences, to screen for G101V muts in DNA extracted from patient samples. We also started to investigate additional co-occurring BCL2 muts in G101V positive samples by Sanger sequencing.
Our patient cohort included 28 pts, of whom 20 had serial samples collected during venetoclax therapy. The median age of the pts was 66, and they had a median of 3 prior therapies before venetoclax, including chemoimmunotherapy in 67.9% and a BTK inhibitor in 60.7%. Deletion of 17p was present in 43%, with five additional pts having isolated TP53 mut (total with known TP53 aberrancy, 61%). 75% (21/28) of those evaluated had an unmutated IGHV. The median duration of venetoclax treatment was 43.5 months (mos). The timing of the first sample tested was a median of 23.3 mos after venetoclax initiation.
We detected the G101V allele in peripheral blood mononuclear cells (PBMCs) in 9 out of 28 pts, at a median allele frequency (AF) of 1.38% (range 0.04%-22.31%), at a median of 44.6 mos on venetoclax. Out of the three pts who had G101V detected at multiple timepoints, two had AF increased with time (7.8 fold increase over 6 mos and 7.7 fold increase over 5 mos, respectively), one had similar AF with time (4.68% at 18.9 mos, 3.43% at 23.8 mos on treatment). Six of these pts also had bone marrow evaluated and all were also positive (at a median AF of 0.21%; range 0.2%-18.66%); one additional patient without a PBMC sample at that timepoint was positive in bone marrow. In order to screen for any co-occurring acquired resistance muts in BCL2 G101V positive samples, we performed Sanger sequencing across the BCL2 open-reading frame. We have identified a duplication mut (R107-R110dup) in one of the samples.
In conclusion, this study shows that approximately one-third of pts on continuous venetoclax for 2+ years develop evidence of low-level BCL-2 G101V mut. Further work is underway to identify additional co-existing muts in BCL2 or other genes, and to characterize the additional genetic events at the time of clear clinical progression.
Citation Format: Yanan Kuang, Stacey M. Fernandes, Rayan Fardoun, Kevin Vasquez, Abhishek Mogili, Cloud P. Paweletz, Jennifer R. Brown. BCL-2 G101V mutations develop in one-third of patients on continuous venetoclax [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3960.
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Affiliation(s)
| | | | | | | | | | | | - Jennifer R. Brown
- 2Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Bannerji R, Arnason JE, Advani RH, Brown JR, Allan JN, Ansell SM, Barnes JA, O'Brien SM, Chávez JC, Duell J, Rosenwald A, Crombie JL, Ufkin M, Li J, Zhu M, Ambati SR, Chaudhry A, Lowy I, Topp MS. Odronextamab, a human CD20×CD3 bispecific antibody in patients with CD20-positive B-cell malignancies (ELM-1): results from the relapsed or refractory non-Hodgkin lymphoma cohort in a single-arm, multicentre, phase 1 trial. Lancet Haematol 2022; 9:e327-e339. [PMID: 35366963 PMCID: PMC10681157 DOI: 10.1016/s2352-3026(22)00072-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [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: 08/20/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Odronextamab is a hinge-stabilised, fully human IgG4-based CD20 × CD3 bispecific antibody that binds CD3 on T cells and CD20 on B cells. We aimed to evaluate the safety and antitumour activity of odronextamab in patients with relapsed or refractory B-cell non-Hodgkin lymphoma. METHODS This single-arm, multicentre, phase 1, dose-escalation and dose-expansion (ELM-1) trial was conducted at ten academic sites across the USA and Germany. Patients aged 18 years or older with CD20-positive relapsed or refractory B-cell malignancies who previously received CD20-directed antibody therapy and who had at least one measurable lesion, and an ECOG performance status of 0 or 1 were included. Patients received intravenous odronextamab, according to a step-up dosing schedule in cycle 1, followed by treatment once per week at target doses ranging from 0·1 mg to 320 mg during cycles 2-4 (each cycle was 21 days). After cycle 4, maintenance treatment occurred every 2 weeks until disease progression or unacceptable toxicity. The primary endpoint of safety was assessed by the incidence of adverse events and dose-limiting toxicities to determine the maximum tolerated dose or phase 2 dose of odronextamab, or both. Preliminary antitumour activity, as measured by objective response rate, was a secondary endpoint. This study is registered with ClinicalTrials.gov, NCT02290951. FINDINGS From Feb 4, 2015, to Sept 25, 2021, 145 heavily pretreated patients (median of 3 (IQR 2-5] previous therapies) were enrolled (94 to the dose-escalation and 51 to the dose-expansion part of the study). The median age of patients was 67·0 years (IQR 57·0-73·0); 101 (70%) were male and 44 (30%) were female; most participants were White (119 [82%]) and not Hispanic or Latino (132 [91%]). 42 (29%) patients received previous CAR T therapy and 119 (82%) were refractory to the last line of therapy. Median duration of follow-up was 4·2 months (IQR 1·5-11·5). During dose escalation, odronextamab was administered up to the maximum dose of 320 mg once per week and no dose-limiting toxicities were observed. The recommended dose for expansion in patients with follicular lymphoma grade 1-3a was 80 mg and was 160 mg for patients with diffuse large B-cell lymphoma. Cytokine release syndrome and neurological treatment-emergent adverse events were predominantly low grade and did not result in treatment discontinuation. The most common grade 3 or worse treatment-emergent adverse events were anaemia (36 [25%]), lymphopenia (28 [19%]), hypophosphataemia (27 [19%]), neutropenia (27 [19%]), and thrombocytopenia (20 [14%]). Serious treatment-emergent adverse events occurred in 89 (61%) of 145 patients; the most frequent were cytokine release syndrome (41 [28%]), pyrexia (11 [8%]), pneumonia (nine [6%]), and infusion-related reaction (six [4%]). Four deaths were considered related to treatment (gastric perforation in a patient with gastric involvement by lymphoma, lung infection, pneumonia, and tumour-lysis syndrome). Objective response rate was 51% (95% CI 42-59; 72 of 142). In patients with follicular lymphoma who received odronextamab doses of 5 mg or higher, the objective response rate was 91% (95% CI 75-98; 29 of 32) and the complete response rate was 72% (95% CI 53-86; 23 of 32). In patients with diffuse large B-cell lymphoma without previous CAR T-cell therapy who received doses of 80 mg or higher, the objective response rate was 53% (eight of 15) and all responses were complete responses. In patients with diffuse large B-cell lymphoma who had previous CAR T-cell therapy and received doses of 80 mg or higher, the objective response rate was 33% (ten of 30) and complete response rate was 27% (eight of 30). INTERPRETATION Odronextamab monotherapy showed a manageable safety profile and encouraging preliminary activity, including durable responses in heavily pretreated patients with B-cell non-Hodgkin lymphoma, supporting further clinical investigation in phase 2 and 3 trials. FUNDING Regeneron Pharmaceuticals.
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Affiliation(s)
- Rajat Bannerji
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Jon E Arnason
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | | | | | | | - Johannes Duell
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | | | | | - Jingjin Li
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Min Zhu
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | - Israel Lowy
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
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Arribas AJ, Napoli S, Cascione L, Sartori G, Barnabei L, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, De Moura MC, Jovic S, Bordone-Pittau R, Di Veroli A, Stathis A, Cruciani G, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. Resistance to PI3κδ inhibitors in marginal zone lymphoma can be reverted by targeting the IL-6/PDGFRA axis. Haematologica 2022; 107:2685-2697. [PMID: 35484662 PMCID: PMC9614536 DOI: 10.3324/haematol.2021.279957] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
PI3Kδ inhibitors are active in patients with lymphoid neoplasms and a first series of them have been approved for the treatment of multiple types of B-cell lymphoid tumors, including marginal zone lymphoma (MZL). The identification of the mechanisms underlying either primary or secondary resistance is fundamental to optimize the use of novel drugs. Here we present a model of secondary resistance to PI3Kδ inhibitors obtained by prolonged exposure of a splenic MZL cell line to idelalisib. The VL51 cell line was kept under continuous exposure to idelalisib. The study included detailed characterization of the model, pharmacological screens, silencing experiments, and validation experiments on multiple cell lines and on clinical specimens. VL51 developed resistance to idelalisib, copanlisib, duvelisib, and umbralisib. An integrative analysis of transcriptome and methylation data highlighted an enrichment of upregulated transcripts and low-methylated promoters in resistant cells, including IL-6/STAT3- and PDGFRA-related genes and surface CD19 expression, alongside the repression of the let-7 family of miRNA, and miR-125, miR-130, miR-193 and miR-20. The IL-6R blocking antibody to-cilizumab, the STAT3 inhibitor stattic, the LIN28 inhibitor LIN1632, the PDGFR inhibitor masitinib and the anti-CD19 antibody drug conjugate loncastuximab tesirine were active compounds in the resistant cells as single agents and/or in combination with PI3Kδ inhibition. Findings were validated on additional in vitro lymphoma models and on clinical specimens. A novel model of resistance obtained from splenic MZL allowed the identification of therapeutic approaches able to improve the antitumor activity of PI3Kδ inhibitors in B-cell lymphoid tumors.
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Affiliation(s)
- Alberto J Arribas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne.
| | - Sara Napoli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne
| | - Giulio Sartori
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Laura Barnabei
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Eugenio Gaudio
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Chiara Tarantelli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | | | - Filippo Spriano
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | | | | | - Andrea Rinaldi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | | | - Sandra Jovic
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona
| | | | - Alessandra Di Veroli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Faculty of Biomedical Sciences, USI, Bellinzona
| | - Gabriele Cruciani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia
| | - Georg Stussi
- Oncology Institute of Southern Switzerland, Bellinzona
| | - Valter Gattei
- Centro di Riferimento Oncologico di Aviano - CRO, Aviano
| | - Jennifer R Brown
- Chronic Lymphocytic Leukemia Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain; Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Madrid, Spain; Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain; Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Catalonia
| | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona
| | - Davide Rossi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona.
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