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Brun SS, Hansen TF, Wen SWC, Nyhus CH, Bertelsen L, Jakobsen A, Hansen TS, Nederby L. Soluble programmed death ligand 1 as prognostic biomarker in non-small cell lung cancer patients receiving nivolumab, pembrolizumab or atezolizumab therapy. Sci Rep 2024; 14:8993. [PMID: 38637655 PMCID: PMC11026506 DOI: 10.1038/s41598-024-59791-0] [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: 12/08/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
Many studies have focused on the prognostic role of soluble programmed death ligand 1 (sPD-L1) in non-small cell lung cancer (NSCLC), but outcomes are ambiguous and further investigations are needed. We addressed the matter by studying sPD-L1 in baseline samples and in longitudinal samples taken prior to three subsequent cycles of anti-PD-1/anti-PD-L1 treatments. Eighty patients with NSCLC were enrolled. Median sPD-L1 level at baseline was 52 pg/mL [95% confidence interval (CI) 49-57]. In patients treated with pembrolizumab and nivolumab, the concentration of sPD-L1 remained rather stable throughout treatment. In contrast, sPD-L1 rose by 50-fold following the first cycle of atezolizumab therapy. We found the baseline level of sPD-L1 to be related to overall survival (OS) after two years of follow-up in simple Cox analysis (p = 0.006) and multiple Cox Regression, hazard ratio 1.02 (95% CI 1.00-1.03) (p = 0.033). There was no association between sPD-L1 and tissue PD-L1 expression, overall response rate, or progression free survival. In conclusion, sPD-L1 measured in baseline serum samples may be associated with OS in NSCLC patients receiving anti-PD1/anti-PD-L1 treatment. Importantly, the results signify that further research is warranted to explore the clinical utility of sPD-L1 in patients treated with anti-PD-L1.
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Affiliation(s)
- Sinne Søberg Brun
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslowsvej 19, 3, 5000 Odense, Denmark
| | - Sara Witting Christensen Wen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslowsvej 19, 3, 5000 Odense, Denmark
| | - Christa Haugaard Nyhus
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Lisbeth Bertelsen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Anders Jakobsen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslowsvej 19, 3, 5000 Odense, Denmark
| | - Torben Schjødt Hansen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Line Nederby
- Department of Biochemistry and Immunology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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Dempsey PW, Sandu CM, Gonzalezirias R, Hantula S, Covarrubias-Zambrano O, Bossmann SH, Nagji AS, Veeramachaneni NK, Ermerak NO, Kocakaya D, Lacin T, Yildizeli B, Lilley P, Wen SWC, Nederby L, Hansen TF, Hilberg O. Description of an activity-based enzyme biosensor for lung cancer detection. Commun Med (Lond) 2024; 4:37. [PMID: 38443590 PMCID: PMC10914759 DOI: 10.1038/s43856-024-00461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Lung cancer is associated with the greatest cancer mortality as it typically presents with incurable distributed disease. Biomarkers relevant to risk assessment for the detection of lung cancer continue to be a challenge because they are often not detectable during the asymptomatic curable stage of the disease. A solution to population-scale testing for lung cancer will require a combination of performance, scalability, cost-effectiveness, and simplicity. METHODS One solution is to measure the activity of serum available enzymes that contribute to the transformation process rather than counting biomarkers. Protease enzymes modify the environment during tumor growth and present an attractive target for detection. An activity based sensor platform sensitive to active protease enzymes is presented. A panel of 18 sensors was used to measure 750 sera samples from participants at increased risk for lung cancer with or without the disease. RESULTS A machine learning approach is applied to generate algorithms that detect 90% of cancer patients overall with a specificity of 82% including 90% sensitivity in Stage I when disease intervention is most effective and detection more challenging. CONCLUSION This approach is promising as a scalable, clinically useful platform to help detect patients who have lung cancer using a simple blood sample. The performance and cost profile is being pursued in studies as a platform for population wide screening.
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Affiliation(s)
| | | | | | | | | | | | - Alykhan S Nagji
- University of Kansas Medical Center (KUMC), Kansas City, KS, USA
| | | | | | | | | | | | | | - Sara W C Wen
- Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Line Nederby
- Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Torben F Hansen
- Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ole Hilberg
- Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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3
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Zedan AH, Nederby L, Volmer LM, Madsen CV, Sørensen BE, Hansen TF. Natural killer cell activity in metastatic castration resistant prostate cancer patients treated with enzalutamide. Sci Rep 2023; 13:17144. [PMID: 37816781 PMCID: PMC10564750 DOI: 10.1038/s41598-023-43937-7] [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: 04/26/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
Metastatic castration resistant prostate cancer (mCRPC) is still the lethal stage for the whole spectrum of prostate cancer disease. Even though different treatment options have been introduced in the last decade with a significant survival improvement for this population, a lack of more reliable prognostic and predictive markers is still one of the main clinical challenges in management of mCRPC. The aim of this study was to investigate the correlation between Natural Killer cell activity (NKA) and both treatment effect and outcomes in patients with mCRPC treated with enzalutamide. A total of 87 patients with mCRPC treated with enzalutamide as the first line treatment were enrolled. NKA was estimated at baseline and prior to each treatment cycle. Endpoints included both treatment effect with biochemical response (BR), biochemical progression (BP) and radiological progression (RP), as well as outcome data with overall survival (OS), radiologic progression free survival (rPFS), and time to next treatment (TTT). At the time of BR, interferon-gamma (IFNγ) decreased significantly compared to levels detected at baseline (z-score = 2.33, p = 0.019). Regarding outcome data, the whole cohort was divided into four groups according to the change of IFNγ level during the first 3 cycles of enzalutamide treatment. In group 1 (n = 42) the IFNγ level remained within a normal range (≥ 250 pg/mL),while in group 2 (n = 7) it increased from an abnormal (< 250 pg/mL) to a normal level. In group 3 (n = 13) it dropped to an abnormal level, and it remained at an abnormal level during treatment in group 4 (n = 17). Patients in group 2 showed the worst prognosis with shorter both rPFS and TTT (HR 4.30, p = 0.037; and HR 6.82, p = 0.011, respectively). In this study inverse correlations between NKA and both treatment response and outcomes was observed in mCRPC patients receiving enzalutamide, suggesting an unfavourable role of NK cells in the late stage of PCa.
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Affiliation(s)
- A H Zedan
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - L Nederby
- Department of Biochemistry and Immunology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - L M Volmer
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - C V Madsen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - B E Sørensen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - T F Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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4
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Wen SWC, Nederby L, Andersen RF, Hansen TS, Nyhus CH, Hilberg O, Jakobsen A, Hansen TF. NK cell activity and methylated HOXA9 ctDNA as prognostic biomarkers in patients with non-small cell lung cancer treated with PD-1/PD-L1 inhibitors. Br J Cancer 2023:10.1038/s41416-023-02285-z. [PMID: 37137997 DOI: 10.1038/s41416-023-02285-z] [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: 05/05/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND PD-1/PD-L1 inhibitors have improved survival for patients with non-small cell lung cancer (NSCLC). We evaluated natural killer cell activity (NKA) and methylated HOXA9 circulating tumor DNA (ctDNA) as prognostic biomarkers in NSCLC patients treated with PD-1/PD-L1 inhibitors. METHODS Plasma was prospectively collected from 71 NSCLC patients before treatment with PD-1/PD-L1 inhibitors and before cycles 2-4. We used the NK Vue® assay to measure the level of interferon gamma (IFNγ) as a surrogate for NKA. Methylated HOXA9 was measured by droplet digital PCR. RESULTS A score combining NKA and ctDNA status measured after one treatment cycle had a strong prognostic impact. Group 1 had IFNγ < 250 pg/ml and detectable ctDNA (n = 27), group 2 consisted of patients with either low levels of IFNγ and undetectable ctDNA or high levels of IFNγ and detectable ctDNA (n = 29), group 3 had IFNγ ≥250 pg/ml and undetectable ctDNA (n = 15). Median OS was 221 days (95% CI 121-539 days), 419 days (95% CI 235-650 days), and 1158 days (95% CI 250 days-not reached), respectively (P = 0.002). Group 1 had a poor prognosis with a hazard ratio of 5.560 (95% CI 2.359-13.101, n = 71, P < 0.001) adjusting for PD-L1 status, histology, and performance status. CONCLUSIONS Combining NKA and ctDNA status after one cycle of treatment was prognostic in patients with NSCLC treated with PD-1/PD-L1 inhibitors.
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Affiliation(s)
- Sara Witting Christensen Wen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark.
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3rd floor, 5000, Odense C, Denmark.
| | - Line Nederby
- Department of Biochemistry and Immunology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Rikke Fredslund Andersen
- Department of Biochemistry and Immunology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Torben Schjødt Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Christa Haugaard Nyhus
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3rd floor, 5000, Odense C, Denmark
- Department of Medicine, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3rd floor, 5000, Odense C, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3rd floor, 5000, Odense C, Denmark
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Zedan A, Nederby L, Volmer L, Madsen CV, Sørensen BE, Hansen T. Natural killer cell activity in patients with metastatic castration-resistant prostate cancer treated with enzalutamide. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.255] [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: 03/17/2023] Open
Abstract
255 Background: Metastatic castration resistant prostate cancer (mCRPC) is the lethal stage for most patients with prostate cancer (PCa). The need for more reliable prognostic and predictive markers for the management of mCRPC is still unmet. The aim of this study was to elucidate the correlation between Natural Killer cell activity (NKA) and treatment outcome in mCRPC patients. Methods: Blood samples were collected prospectively from 87 patients with mCRPC who were treated by enzalutamide as first line treatment. Samples were collected, in NK Vue tubes, at baseline, and prior to each treatment cycle until treatment change. Tubes were placed in an incubator at 37°C within 15 minutes of sampling. Following 20-24 hours of stimulation the level of interferon-gamma (IFNγ) in the plasma was measured, by ELISA (NK Vue) as a surrogate for NKA. Outcomes data were included as endpoints. Results: At the time of biochemical response, plasma IFNγ decreased significantly compared to levels detected at baseline (z-score= 2.334, p=0.019). Additionally, the level of IFNγ was significantly lower at radiological response compared to values at biochemical progression (z-score=2.168, p=0.030). Regarding outcome data, the whole cohort was divided into four groups. In group 1 (n=41) the IFNγ level remained within a normal range (>250 pg/mL), while in group 2 (n=8) it increased from an abnormal (<250 pg/mL) to a normal level. In group 3 (n=13) it dropped to an abnormal level, and it remained at an abnormal level during treatment in group 4 (n=17). There was a significant difference between patients in group 2 and patients in the other three groups regarding both overall survival, radiological free survival and time to next treatment (HR= 3.98, p= 0.012, HR= 6.10, p=< 0.001 and HR= 6.521, p= < 0.001, compared to group 1 respectively). Conclusions: An inverse correlation between NKA and both treatment response and outcome was observed, suggesting a unique role of NK cells in late stage PCa treated with enzalutamide.
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Affiliation(s)
- Ahmed Zedan
- Department of Oncology, Vejle Hospital, Denmark, Vejle, Denmark
| | - Line Nederby
- Department of Clinical Immunology & Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Lone Volmer
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark, Vejle, Denmark
| | | | - Bente E. Sørensen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark, Vejle, Denmark
| | - Torben Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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6
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Borg M, Nederby L, Wen SWC, Hansen TF, Jakobsen A, Andersen RF, Weinreich UM, Hilberg O. Assessment of circulating biomarkers for detection of lung cancer in a high-risk cohort. Cancer Biomark 2023; 36:63-69. [PMID: 36404535 DOI: 10.3233/cbm-210543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an urgent need for early detection of lung cancer. Screening with low-dose computed tomography (LDCT) is now implemented in the US. Supplementary use of a lung cancer biomarker with high specificity is desirable. OBJECTIVE To assess the diagnostic properties of a biomarker panel consisting of cytokeratin 19 fragment (CYFRA 21-1), carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125). METHODS A cohort of 250 high-risk patients was investigated on suspicion of lung cancer. Ahead of diagnostic work-up, blood samples taken. Cross-validated prediction models were computed to assess lung cancer detection properties. RESULTS In total 32% (79/250) of patients were diagnosed with lung cancer. Area under the curve (AUC) for the three biomarkers was of 0.795, with sensitivity/specificity of 57%/93% and negative predictive value of 83%. When combining the biomarkers with US screening criteria, the AUC was 0.809, while applying only US screening criteria on the cohort, yielded an AUC of 0.62. The ability of the biomarkers to detect stage I-II lung cancer was substantially lower; AUC 0.54. CONCLUSIONS In a high-risk cohort, the detection properties of the three biomarkers were acceptable compared to current LDCT screening criteria. However, the ability to detect early stage lung cancer was low.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Line Nederby
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - Sara Witting Christensen Wen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Jakobsen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Fredslund Andersen
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Wen S, Nederby L, Hansen T, Jakobsen A, Hilberg O. 29P Dynamic NK cell activity as a prognostic biomarker in non-small cell lung cancer treated with curative surgery. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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8
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Iversen KF, Nederby L, Lund T, Plesner T. High Expression of the Costimulatory Checkpoint Factor DNAM-1 by CD4+ T-Cells from Multiple Myeloma Patients Refractory to Daratumumab-Containing Regimens. Clin Hematol Int 2022; 4:107-116. [PMID: 36131131 PMCID: PMC9492812 DOI: 10.1007/s44228-022-00013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
AbstractMultiple myeloma is an incurable disease characterized by unregulated growth of malignant plasma cells in the bone marrow (BM). Tumor-induced dysfunction of T-cells may be responsible for immune evasion and failure of immunotherapy. Therefore, a better understanding of the phenotype of T-cells at the tumor site is needed. We assessed the expression of immune regulatory receptors on T-cell subsets from peripheral blood (PB) and BM using multicolor flow cytometry. Paired PB and BM samples were collected from newly diagnosed, treatment-naïve myeloma patients (n = 19) and patients progressing during treatment with the CD38 monoclonal antibody daratumumab alone or in combination with other anti-myeloma drugs (n = 39). We observed that CD4+ T-cells from both PB and BM of patients relapsing on daratumumab have a higher expression of the costimulatory checkpoint receptor DNAM-1. The potential role of DNAM-1+CD4+ T-cells in the development of resistance to daratumumab needs further exploration. We also observed that the inhibitory checkpoint receptor TIGIT is more frequently expressed by BM CD8+ T-cells from myeloma patients than PD-1 and CTLA-4, which supports the hypothesis that TIGIT may play a central role in the immune escape of the malignant plasma cells.
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Affiliation(s)
- Katrine Fladeland Iversen
- Institute of Regional Health Science, University of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Section of Hematology, Department of Internal Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Line Nederby
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Thomas Lund
- Department of Hematology, Odense University Hospital, J.B. Winsløvs Vej 4, 5000 Odense C, Denmark
| | - Torben Plesner
- Institute of Regional Health Science, University of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Section of Hematology, Department of Internal Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
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9
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Witting Christensen Wen S, Nederby L, Andersen RF, Hansen TS, Haugaard C, Hilberg O, Jakobsen A, Hansen T. NK cell activity and methylated HOXA9 circulating tumor DNA as prognostic biomarkers in patients with non-small cell lung cancer treated with PD-1/PD-L1 inhibitors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2552 Background: PD-1/PD-L1 inhibitors have improved survival for patients with non-small cell lung cancer (NSCLC), but better prognostic biomarkers are needed. Methods: We prospectively collected plasma from 82 patients with NSCLC before initiating treatment with PD-1/PD-L1 inhibitors and before treatment cycles 2-4. We used the NK Vue assay to measure interferon gamma (IFNγ) as a surrogate for natural killer cell activity (NKA) with a cutoff of 250 pg/mL. Circulating tumor DNA (ctDNA) in the form of methylated HOXA9 was measured by droplet digital PCR. ctDNA status was classified as detectable or undetectable ctDNA. Results: Patients were classified into three groups according to IFNγ levels at the available time points. The NKA-low group had a persistently low level of IFNγ or dropped to and remained at a low level after baseline (<250 pg/mL, n=29), the NKA-mixed group experienced either an increase from low to normal levels or vice versa (n=34), while the NKA-high group maintained a normal level of IFNγ (≥250 pg/mL, n=13). The median PFS was 64 days (95% confidence interval (CI) 48-115 days), 228 days (95% CI 146-353 days), and 214 days (95% CI 101-693 days), respectively, for NKA-low, NKA-mixed, and NKA-high (p=0.003). The median OS was 170 days (95% CI 110-285 days), 487 days (95% CI 361-761 days), and 1,131 days (95% CI 235 days to not reached), respectively (p<0.001). Patients were divided according to detectable (ctDNA+, n=41) or undetectable (ctDNA-, n=32) ctDNA after one treatment cycle. Median PFS was 97 days (95% CI 58-192 days) and 228 days (95% CI 146-353 days), respectively, for ctDNA+ and ctDNA- (p=0.018). Median OS was 235 days (95% CI 170-525 days) and 544 days (95% CI 361-1158 days), respectively (p=0.007). A score combining NKA and ctDNA both measured after the first treatment cycle had a strong prognostic impact. Group 1 had a low level of IFNγ (<250 pg/mL) and detectable ctDNA (n=27), group 2 had either low levels of IFNγ and undetectable ctDNA or vice versa (n=29), and group 3 had normal levels of IFNγ (≥250 pg/mL) and undetectable ctDNA (n=15). Median PFS was 69 days (95% CI 48-213 days), 183 days (95% CI 102-235 days), and 307 days (95% CI 140-693 days), respectively, for group 1, 2, and 3 (p=0.022). Median OS was 221 days (95% CI 121-539 days), 419 days (95% CI 235-650 days), and 1,158 days (95% CI 250 days to not reached), respectively (p=0.002). Biomarker score 1 was a marker of poor prognosis for OS with a hazard ratio (HR) of 3.971 (95% CI 1.763-8.943, p=0.001) compared to biomarker score 3. It remained statistically significant with a HR of 5.560 (95% CI 2.359-13.101, n=71, p<0.001) when adjusting for PD-L1 status, histology, and performance status. Conclusions: A biomarker score combining the levels of NKA and ctDNA status after the first cycle of treatment may be used to stratify the prognosis in patients with NSCLC treated with PD-1/PD-L1 inhibitors.
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Affiliation(s)
| | - Line Nederby
- Department of Clinical Immunology & Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Rikke Fredslund Andersen
- Department of Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Torben Schjoedt Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Christa Haugaard
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ole Hilberg
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Jakobsen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Torben Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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10
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Borg M, Wen SWC, Hansen TF, Jakobsen A, Andersen RF, Hilberg O, Weinreich UM, Nederby L. Natural killer cell activity as a biomarker for the diagnosis of lung cancer in high-risk patients. J Int Med Res 2022; 50:3000605221108924. [PMID: 35770523 PMCID: PMC9251988 DOI: 10.1177/03000605221108924] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Natural killer (NK) cells play an essential role in the immune response against cancer. However, immune escape mechanisms may cause inferior NK cell activity (NKA) in patients with cancer. This prospective study examined the relationship between NKA and lung cancer in a high-risk cohort. Methods In a cohort study, 250 participants referred by their general practitioner for suspicion of lung cancer were included. Before clinical investigation, blood was collected into NK Vue tubes, and the level of interferon gamma after 24 hours served as a surrogate marker for NKA. Results Among 250 patients, 79 were diagnosed with lung cancer. No difference in NKA was found between patients with lung cancer and control participants in which lung cancer was ruled out (median 226 pg/mL vs. 450 pg/mL). However, there was a significant difference in NKA between patients with late-stage lung cancer and controls (median 161 pg/mL vs. 450 pg/mL). A linear regression model showed that NKA was not influenced by age, sex or smoking status. Conclusions The significantly lower NKA in patients with late-stage lung cancer warrants further investigation combining NKA with other biomarkers and examining the potential role of NKA as a marker of disseminated disease.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Internal Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - Sara Witting Christensen Wen
- Department of Oncology, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Jakobsen
- Department of Oncology, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Fredslund Andersen
- Department of Clinical Biochemistry, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Nederby
- Department of Clinical Biochemistry, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
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11
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Simonsen AT, Meggendorfer M, Hansen MH, Nederby L, Koch S, Hansen M, Rosenberg CA, Kern W, Nyvold CG, Aggerholm A, Haferlach T, Ommen HB. Acute myeloid leukemia displaying clonal instability during treatment: implications for measurable residual disease assessments. Exp Hematol 2022; 107:51-59. [PMID: 35122908 DOI: 10.1016/j.exphem.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022]
Abstract
Next-generation sequencing (NGS) is an excellent methodology for measuring residual disease in acute myeloid leukemia and survey several sub-clones simultaneously. Little experience exists regarding interpretation of differential clonal responses to therapy. We hypothesize that differential clonal response could best be studied in patients with residual disease at the time of response evaluation. We performed targeted panel sequencing of paired diagnostic and first treatment evaluation samples in 69 patients with residual disease by morphology or measurable residual disease (MRD) level >0.02. Five patients displayed a rising clone at the time of evaluation. A representative case showed the rising clone present only in the putative healthy stem cells (CD45lowCD34+CD38-CD123-CD7-) and not in the putative leukemic stem cells (CD34+CD38-CD123+CD7+) cells, thus representing non-malignant clonal hematopoiesis. In contrast, 17/43 evaluable patients displayed a differential response in genes related to the leukemic clone. 26/43 patients displayed a clonal response that followed the overall treatment response. Patients with a differential response had a better event-free survival (EFS) as well as overall survival (OS) than those where the clonal response followed the overall response (log-rank test, EFS P=0.045, OS, P=0.050). This indicates that when following multiple leukemia-related clones the less chemotherapy-responsive clone could, in some cases, have lesser relapse potential, contrary to what is known when using standard mutation or fusion transcript-based disease surveillance. In conclusion, our results confirm the potential of refining MRD assessments by following multiple clones and warrants further studies into the precise interpretations of multi-clone NGS-MRD assays.
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Affiliation(s)
- Anita T Simonsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marcus H Hansen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark; Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Line Nederby
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - Sarah Koch
- Munich Leukemia Laboratory GmbH, Munich, Germany
| | - Maria Hansen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Charlotte G Nyvold
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Anni Aggerholm
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hans B Ommen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
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12
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Borg M, Wen SWC, Nederby L, Hansen TF, Jakobsen A, Andersen RF, Weinreich UM, Hilberg O. Performance of the EarlyCDT® Lung test in detection of lung cancer and pulmonary metastases in a high-risk cohort. Lung Cancer 2021; 158:85-90. [PMID: 34130044 DOI: 10.1016/j.lungcan.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Early detection of lung cancer is pivotal for an optimal prognosis. CT screening is currently implemented in USA. To decrease the amount of CT scans, the application of a blood-based biomarker as part of screening criteria is desirable. MATERIALS AND METHODS The EarlyCDT® Lung test was performed in a high-risk cohort composed 246 patients referred from their GP on suspicion of lung cancer. Blood samples were taken at first visit and patients underwent diagnostic workup on suspicion of lung cancer resulting in either a malignant diagnosis or ruled out cancer. Sensitivity and specificity of the EarlyCDT® Lung were calculated in the cohort and subgroups based on age, smoking history, sex and lung cancer stage. RESULTS Overall sensitivity in the cohort was 33 % for lung cancer and 31 % for primary lung cancer and lung metastases combined. Sensitivity in age groups was 11 % (60 years or below), 31 % (61-75 years) and 55 % (>75 years). In patients with at least 10 tobacco pack years, sensitivity was 33 % while the sensitivity in patients with at least 50 tobacco pack years was 44 %. The assay sensitivity in stage I-II lung cancer patients was 21 %, while this was 40 % in stage III-IV lung cancer patients. In a subgroup of patients that met current CT screening criteria (age 55-80 years and minimum 30 tobacco pack years) the sensitivity was 37 %. CONCLUSION The rationale of screening for lung cancer is to find patients in an early and resectable stage. However, the EarlyCDT® Lung test performed best in elderly, late stage lung cancer patients with a heavy smoking history. Based on these results, the current study finds insufficient sensitivity of the EarlyCDT® Lung test to be used as part of inclusion criteria in a low-dose CT program for detection of lung cancer.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Sara W C Wen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Line Nederby
- Department of Clinical Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Rikke Fredslund Andersen
- Department of Clinical Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Ole Hilberg
- Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark; Department of Internal Medicine, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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13
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Herborg LL, Nederby L, Brøndum RF, Hansen M, Hokland P, Roug AS. Antigen Expression Varies Significantly between Molecular Subgroups of Acute Myeloid Leukemia Patients: Clinical Applicability Is Hampered by Establishment of Relevant Cutoffs. Acta Haematol 2020; 144:275-284. [PMID: 33271547 DOI: 10.1159/000510504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this single-center study of 268 acute myeloid leukemia (AML) patients, we have tested if a subset of 4 routinely employed immunophenotypic stem cell-associated markers correlated with the presence of recurrently mutated genes and if the markers were predictive for mutational status. METHODS Immunophenotypic data from 268 diagnostic AML samples obtained in 2009-2018 were analyzed retrospectively for the antigens CD34, CD117, CD123, and CLEC12A. Correlation between immunophenotypes and mutations was analyzed by Fischer's exact test. Clinical applicability of the markers for predicting mutational status was evaluated by receiver operating characteristics analyses, where an area under the curve (AUC) of at least 0.85 was accepted as clinically relevant. RESULTS For a number of genes, the antigen expression differed significantly between mutated and wild-type gene expression. Despite low AUCs, CD123 and CLEC12A correlated with FLT3+NPM1- and FLT3+NPM1+. Three subsets met the AUC requirements (CD34+, CD34+CD117+, and CD34-CD117+) for predicting FLT3-NPM1+ or FLT3+NPM1+. CONCLUSION The value of immunophenotypes as surrogate markers for mutational status in AML seems limited when employing CD123 and CLEC12A in combination with CD34 and CD117. Defining relevant cutoffs for given markers is challenging and hampered by variation between laboratories and patient groups.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD34/genetics
- Antigens, CD34/metabolism
- Area Under Curve
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunophenotyping
- Interleukin-3 Receptor alpha Subunit/genetics
- Interleukin-3 Receptor alpha Subunit/metabolism
- Kaplan-Meier Estimate
- Lectins, C-Type/genetics
- Lectins, C-Type/metabolism
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Mutation
- Nucleophosmin
- Proto-Oncogene Proteins c-kit/genetics
- Proto-Oncogene Proteins c-kit/metabolism
- ROC Curve
- Receptors, Mitogen/genetics
- Receptors, Mitogen/metabolism
- Retrospective Studies
- Young Adult
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Affiliation(s)
| | - Line Nederby
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Rasmus Froberg Brøndum
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Maria Hansen
- Department of Clinical Genetics, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Peter Hokland
- Department of Hematology, Aarhus University Hospital, Aarhus N, Denmark
| | - Anne Stidsholt Roug
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark,
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,
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14
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Henriksen JR, Nederby L, Donskov F, Waldstrøm M, Adimi P, Jakobsen A, Dahl Steffensen K. Blood natural killer cells during treatment in recurrent ovarian cancer. Acta Oncol 2020; 59:1365-1373. [PMID: 32692270 DOI: 10.1080/0284186x.2020.1791358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Recent research indicated favorable prognostic impact of intratumoral natural killer (NK) cells in ovarian carcinoma (OC). The role of NK cells during chemotherapy in OC is unknown. We investigated impact of NK cells in OC patients treated with palliative chemotherapy. METHODS Participants receiving palliative chemotherapy for recurrent OC (N = 72) had prospectively blood samples at baseline and before cycle 2. NK cell counts were quantified by flow cytometry. NK cell activity was measured by the NK Vue® assay, estimating interferon-gamma production. Overall survival (OS) was the primary endpoint. Cutoffs were predefined, NK numbers (≥184 × 106 cells/L vs. <184 × 106 cells/L) and NK activity (<200 pg/mL vs. ≥200 pg/mL). RESULTS Median OS in patients with low vs. high NK cell count at baseline was 7.1 months vs. 15.6 months (p = .028), respectively, and before cycle 2 was 5.7 vs. 17.3 months, p < .001, respectively. The difference in restricted mean survival (ΔRMST) was 5.7 months (95% CI: 3.3-8.0) at cycle 2 vs. 2.5 months (95% CI: -0.6 to 5.6) at baseline, showing a significant difference with no overlap of confidence intervals. In multivariate analyses, low NK cell count remained significant with a hazard ratio (HR)=2.83, 95% CI: 1.53-5.22, p = .001 (baseline) and HR = 3.34, 95% CI: 1.67-6.71, p = .001 (before cycle 2). Patients with both low NK count and NK activity at baseline (N = 20) had median OS 6.5 months vs. 11.5 months in patients with either high activity, high count or both (p = .007). In parallel, patients with both low NK activity and count at cycle 2 (N = 18) had a median survival of 4.0 months vs. 15.4 months (p < .001). CONCLUSIONS A low blood NK cell count in recurrent metastatic ovarian cancer during chemotherapy is associated with unfavorable prognostic impact. Early increase in survival difference based on NK cell status suggests an association between NK cell count and treatment benefit.
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Affiliation(s)
- Jon Røikjær Henriksen
- Department of Oncology, Vejle Hospital – University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Line Nederby
- Department of Biochemistry and Immunology, Vejle Hospital – University Hospital of Southern Denmark, Vejle, Denmark
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Waldstrøm
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Vejle Hospital – University Hospital of Southern Denmark, Vejle, Denmark
| | - Parvin Adimi
- Department of Oncology, Vejle Hospital – University Hospital of Southern Denmark, Vejle, Denmark
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital – University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Karina Dahl Steffensen
- Department of Oncology, Vejle Hospital – University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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15
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Wen S, Hansen T, Nederby L, Andersen R, Nyhus C, Bertelsen L, Sørensen B, Hager H, Hilberg O, Jakobsen A, Hansen T. 1323P Natural killer cell activity as a prognostic biomarker in non-small cell lung cancer patients treated with check-point inhibitors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Witting Christensen Wen SWC, Thomsen CB, Hansen T, Andersen RF, Nederby L, Hager H, Rasmussen K, Jakobsen AKM, Hilberg O. Validation of tumor DNA in bronchial lavage as a diagnostic tool in lung cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9020 Background: Diagnosing lung cancer requires invasive procedures with risk of complications for the patient. The HOXA9 gene is highly methylated in lung cancer, and methylated tumor DNA (meth-tDNA) in bronchial lavage has previously shown potential as a diagnostic biomarker. The aim of the present study was to validate these preliminary results. Methods: Patients were referred by the general practitioner on suspicion of lung cancer. The Danish diagnostic package includes chest and abdominal CT scan, bronchoscopy, blood tests, and histopathological or cytological verification. Twelve ml lavage fluid was collected at bronchoscopy for analysis of meth-tDNA based on droplet digital PCR according to our published method. A positive test was defined as ≥ 4 droplets containing meth-tDNA and a ratio between HOXA9 and Albumin of > 0.15%. The analysis was performed blinded to clinical data and meth-tDNA status was compared with the final diagnosis. Results: The study population was 204 consecutively enrolled patients. The material consisted of a discovery cohort (n = 105, presented at ASCO 2019) used for establishing the cut-points, and a validation cohort (n = 99). Six were excluded from analysis due to malignancy other than lung cancer and one due to failed analysis. In the discovery cohort, the sensitivity was 68.7% (95% CI 56.2-79.4%), specificity 88.2% (95% CI 72.6-96.7%), and positive predictive value (PPV) 92.0% (95% CI 80.8-97.8%). In the validation cohort, the same values were 76.9% (95% CI 63.2-87.5%), 77.3% (95% CI 62.2-88.5%), and 80.0% (95% CI 66.3-90.0%), respectively. Analyzing the entire patient material (n = 197) the sensitivity, specificity, and PPV were 72.3% (95% CI 63.3-80.1%), 82.1% (95% CI 71.7-89.8%), and 86.0% (95% CI 77.6-92.1%), respectively. The false positive samples were equally distributed among patients with cryptogenic organizing pneumonia, granulomatous inflammation, and acute inflammatory disease. The false negative samples were mainly from patients with peripheral tumor, no radiologically detectable tumor, and mesothelioma. Conclusions: Meth-tDNA in bronchial lavage holds potential as a supplementary tool in the diagnosis of lung cancer with a clinically relevant sensitivity and specificity. Routine clinical application awaits further validation in a clinical trial. [Table: see text]
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Affiliation(s)
| | | | - Torben Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Rikke Fredslund Andersen
- Department of Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Line Nederby
- Department of Clinical Immunology & Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Henrik Hager
- Department of Pathology, Vejle Hospital, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Kristian Rasmussen
- Department of Internal Medicine, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Anders Kristian Moeller Jakobsen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Vejle Hospital, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
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17
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Henriksen JR, Nederby L, Donskov F, Waldstrøm M, Adimi P, Jakobsen A, Steffensen KD. Prognostic significance of baseline T cells, B cells and neutrophil-lymphocyte ratio (NLR) in recurrent ovarian cancer treated with chemotherapy. J Ovarian Res 2020; 13:59. [PMID: 32414391 PMCID: PMC7229632 DOI: 10.1186/s13048-020-00661-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/06/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Biomarkers are needed to guide treatment decisions in recurrent ovarian cancer, as a high proportion of patients do not benefit from treatments. Data on immune subsets in patients receiving chemotherapy are scarce. We investigated the impact of T cells, B cells, neutrophils and the neutrophil-lymphocyte ratio (NLR) in ovarian cancer patients receiving palliative chemotherapy. Methods Blood samples were collected prospectively at baseline in recurrent ovarian cancer (N = 72) receiving chemotherapy. T cells, B cells, neutrophils, and NLR were analyzed. Primary and secondary endpoints were overall survival (OS) and treatment response, respectively. Cut-offs for T and B cells were predefined. Results In patients with low vs. high T and B cells counts, OS was 6.1 months vs 12.0 months (P = 0.017) and 6.1 months vs 12.0 months (P = 0.011, respectively. Low T and B cells analyzed as continuous variables were also associated with unfavorable OS, P = 0.011 and P = 0.007, respectively. Neutrophils had no significant prognostic impact. Median NLR was 4.1. High vs. low NLR was associated with poor survival, 7.4 months vs. 15.9 months (P = 0.012). In multivariate analysis including platinum sensitivity, number of prior lines of chemotherapy, and performance status, high NLR remained an independent poor prognostic factor HR: 2.17 (95% CI 1.21–3.88) (P = 0.009). High NLR was also significantly associated with lack of response, OR 0.15 (95% CI: 0.04–0.51) (P = 0.002). Conclusion In recurrent ovarian cancer patients undergoing palliative chemotherapy, low T and B lymphocyte counts had an unfavorable prognostic impact. High NLR was associated with lack of response and a poor prognosis, and the parameter may be used in patient counselling and treatment decisions.
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Affiliation(s)
- Jon Røikjær Henriksen
- Department of Oncology, Vejle Hospital - University Hospital of Southern Denmark, Vejle, Denmark. .,Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Line Nederby
- Biochemistry and Immunology, Vejle Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Waldstrøm
- Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Pathology, Vejle Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Parvin Adimi
- Department of Oncology, Vejle Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital - University Hospital of Southern Denmark, Vejle, Denmark.,Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Karina Dahl Steffensen
- Department of Oncology, Vejle Hospital - University Hospital of Southern Denmark, Vejle, Denmark.,Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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18
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Simonsen AT, Bill M, Rosenberg CA, Hansen MH, Møller PL, Kjeldsen E, Johansen KD, Ommen HB, Nederby L, Aggerholm A, Hokland P, Ludvigsen M. Unraveling clonal heterogeneity at the stem cell level in myelodysplastic syndrome: In pursuit of cell subsets driving disease progression. Leuk Res 2020; 92:106350. [PMID: 32334198 DOI: 10.1016/j.leukres.2020.106350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 02/02/2023]
Affiliation(s)
| | - Marie Bill
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marcus Høy Hansen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Loof Møller
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Eigil Kjeldsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hans Beier Ommen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Line Nederby
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - Anni Aggerholm
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Hokland
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maja Ludvigsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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19
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Hansen TF, Nederby L, Zedan AH, Mejlholm I, Henriksen JR, Steffensen KD, Thomsen CB, Raunkilde L, Jensen LH, Jakobsen A. Correlation Between Natural Killer Cell Activity and Treatment Effect in Patients with Disseminated Cancer. Transl Oncol 2019; 12:968-972. [PMID: 31103777 PMCID: PMC6554227 DOI: 10.1016/j.tranon.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/21/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The aim of the present study was to analyze the possible correlation between Natural Killer (NK) cell activity as measured by the NK Vue assay and treatment efficacy in patients with disseminated cancer. MATERIALS AND METHODS The study included four trials encompassing palliative treatment, i.e. one trial on prostate- and ovarian cancer, respectively, and two trials on colorectal cancer. The current results are based on 93 patients with mature data on treatment effect. Blood samples were collected at baseline and prior to each treatment cycle into NK Vue. Following 24 hours of stimulation the level of interferon-gamma (IFNγ) in the plasma was measured as a surrogate for NK cell activity. RESULTS The relationship between NK cell activity and treatment response was similar across tumor types and treatment. The IFNγ either remained at or dropped to an abnormal level (<200 pg/mL) during treatment in group 1 (n = 35). In group 2 (n = 30) the level remained within a normal range (>200 pg/mL), while in group 3 (n = 28) it increased from an abnormal to a normal level. The response rate was 14%, 47%, and 82%, respectively, P < .001. The median progression free survival was 2.6 months (95% confidence interval (CI) 2.1-3.9), 10.0 months (95% CI 6.5-11.1), and 8.3 months (95% CI 6.5-8.7), respectively, P < .001 (log-rank). CONCLUSION Patients lacking the ability to mount an immune response during the first 2 months of treatment have a poor prognosis, and their clinical benefit of the treatment is questionable.
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Affiliation(s)
- Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark; Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.
| | - Line Nederby
- Department of Clinical Immunology and Biochemistry, Vejle Hospital, Vejle, Denmark.
| | - Ahmed H Zedan
- Department of Oncology, Vejle Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark.
| | - Inge Mejlholm
- Department of Oncology, Vejle Hospital, Vejle, Denmark.
| | - Jon R Henriksen
- Department of Oncology, Vejle Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark.
| | - Karina D Steffensen
- Department of Oncology, Vejle Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark; Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.
| | - Caroline B Thomsen
- Department of Oncology, Vejle Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark; Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.
| | | | - Lars Henrik Jensen
- Department of Oncology, Vejle Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark; Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark; Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.
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20
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Bill M, Aggerholm A, Kjeldsen E, Roug AS, Hokland P, Nederby L. Revisiting CLEC12A as leukaemic stem cell marker in AML: highlighting the necessity of precision diagnostics in patients eligible for targeted therapy. Br J Haematol 2018; 184:769-781. [DOI: 10.1111/bjh.15711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/05/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Marie Bill
- Department of Haematology; Aarhus University Hospital; Aarhus Denmark
| | - Anni Aggerholm
- Department of Haematology; Aarhus University Hospital; Aarhus Denmark
| | - Eigil Kjeldsen
- Department of Haematology; Aarhus University Hospital; Aarhus Denmark
| | - Anne S. Roug
- Department of Haematology; Aarhus University Hospital; Aarhus Denmark
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
| | - Peter Hokland
- Department of Haematology; Aarhus University Hospital; Aarhus Denmark
| | - Line Nederby
- Department of Haematology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Immunology and Biochemistry; Lillebaelt Hospital; Vejle Denmark
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21
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Hansen T, Nederby L, Zedan AH, Mejlholm I, Henriksen J, Steffensen KD, Thomsen CB, Raunkilde L, Jensen LH, Jakobsen AKM. Correlation between natural killer cell activity and treatment effect in patients with disseminated cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Torben Hansen
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Line Nederby
- Department of Clinical Immunology & Biochemistry, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Ahmed Hussien Zedan
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Inge Mejlholm
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Jon Henriksen
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Karina Dahl Steffensen
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Caroline Brenner Thomsen
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Louise Raunkilde
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Lars Henrik Jensen
- Department of Oncology, Vejle Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
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22
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Nederby L, Jakobsen A, Hokland M, Hansen TF. Quantification of NK cell activity using whole blood: Methodological aspects of a new test. J Immunol Methods 2018; 458:21-25. [PMID: 29654815 DOI: 10.1016/j.jim.2018.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
Abstract
Natural Killer (NK) cells are essential in the biological fight against cancer and intracellular pathogens, and their level of activity has in many settings been used as a biomarker for a functional immune response. Currently, NK cell activity is measured using either 51Cr-release assays or flow cytometry based assays revealing the cells´ cytotoxic capacity or by stimulating them to produce cytokines. Although very effective, these are cumbersome techniques not suitable for high volume clinical laboratories. Recently, an assay has been introduced to measure NK cell activity in a simple and standardized manner. Following stimulation of NK cells in whole blood with a recombinant protein, it utilizes the concentration of IFNγ released to the plasma as a surrogate marker for NK cell activity. However, whole blood holds several sources of IFNγ which may blur the results and hamper the interpretation of the test. Therefore, the present study aimed at analyzing how specifically the test is measuring the activity of NK cells. Intracellular flow cytometry showed that NK cells, T cells, and Natural Killer T (NKT) cells were producing IFNγ in the assay, however when analyzing the distribution of lymphocytes in the IFNγ-expressing subset, the proportion of NK cells far exceeded the percentage of T-, and NKT cells (p < .0001). Hence, our data indicate that the readout of the test was indicative of the NK cells´ ability to mount a response and thus the results may pave the way for the assay to become applicable in the clinical setting as an estimate of NK cell activity for both diagnostic and prognostic purposes.
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Affiliation(s)
- Line Nederby
- Department of Clinical Immunology and Biochemistry, Vejle Hospital, Vejle DK-7100, Denmark.
| | - Anders Jakobsen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle DK-7100, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense DK-5000, Denmark
| | - Marianne Hokland
- Department of Biomedicine, Aarhus University, Aarhus DK-8000, Denmark
| | - Torben Frostrup Hansen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle DK-7100, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense DK-5000, Denmark
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23
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Herborg LL, Nederby L, Hasselbalch HC, Aggerholm A, Roug AS. Distinguishing myelofibrosis from polycythemia vera and essential thrombocythemia: The utility of enumerating circulating stem cells with aberrant hMICL expression by flow cytometry. Int J Lab Hematol 2018; 40:320-325. [PMID: 29427319 DOI: 10.1111/ijlh.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/10/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Diagnosing BCR-ABL negative myeloproliferative neoplasms (MPN) may be challenging due to overlapping features and lack of robust discriminatory parameters, especially between essential thrombocythemia (ET) and prefibrotic myelofibrosis (MF). Circulating immature hematopoietic cells are variably present in polycythemia vera (PV), ET, and MF. The C-type lectin hMICL is aberrantly expressed on hematopoietic stem cells in the majority of acute myeloid leukemia patients. However, the hMICL expression in MPN, having varying propensity of leukemic transformation, is unsettled. We hypothesized that enumeration of immature cells by flow cytometry (FCM) could be a discriminatory tool in MPN diagnostics. METHODS By FCM, we quantified circulating stem cells with aberrant hMICL expression in 39 MPN patients, 10 age-matched controls, and in leukapheresis products from 10 patients with lymphoproliferative neoplasms. The utility of the FCM assay for discriminating MPN entities was evaluated by applying ROC curve analysis. RESULTS While hMICL was absent in control samples, MF patients had significantly more hMICL+ stem cells (median 15.2%) than PV and ET (0.0%, P = .001 and 0.0%, P = .002, respectively). By ROC curve analysis, the presence of hMICL+ stem cells (>0 cells) in peripheral blood reliably discriminates MF from ET and PV with a sensitivity of 80% and a specificity of 97%. CONCLUSION Enumeration of circulating hMICL+ stem cells by FCM can discriminate between MPN phenotypes and holds potential for monitoring disease evolution.
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Affiliation(s)
- L L Herborg
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark
| | - L Nederby
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark.,Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - H C Hasselbalch
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - A Aggerholm
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark
| | - A S Roug
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark
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24
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Nederby L, Hansen T, Raunkilde L, Jensen LH, Jakobsen AKM. Natural killer cell activity: A test for immune reactivity with clinical perspectives. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.5_suppl.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
87 Background: Natural Killer (NK) cells are essential in the biological fight against cancer and the activity of these cells has been suggested as a biomarker for immunological reaction in cancer patients. An assay has been introduced to measure NK cell activity (NKA) in a simple and standardized manner. Following stimulation of NK cells in whole blood with a recombinant protein, it utilizes the concentration of interferon-gamma (IFNγ) in plasma as a surrogate marker for NKA. This study aimed to verify that the test was indeed measuring NKA and whether it could predict the response to cytostatic treatment in metastatic colorectal cancer (mCRC). Methods: Blood was collected in dedicated tubes (NK Vue Promoca) and placed at 37°C. After 24 hours the plasma was analyzed for IFNγ by ELISA (NK Vue ELISA). Blood from patients with mCRC (n = 22) were sampled at baseline and prior to each treatment cycle, and IFNγ levels were compared to response data from first evaluation. The protocol is ongoing hence the results are preliminary. In healthy controls (n = 8), IFNγ was measured intracellularly using flow cytometry at baseline and after 5-, 10-, 15-, 20-, 24-, and 28 hours of incubation. Results: When analyzing the distribution of cells among the IFNγ expressing subset, the proportion of NK cells was significantly different than that of monocytes, T-, and NKT cells at all time points of incubation (p < 0.0001), thus suggesting that the readout of the test was indicative of the NK cells´ ability to mount a response. Using the NKA test, plasma levels of IFNγ in healthy controls were all above 200pg/mL after 24 hours of incubation. The mCRC patients were divided into three NKA groups: 1) IFNγ dropped below 200pg/mL or remained below that level throughout treatment (n = 9), 2) IFNγ remained above 200pg/mL throughout treatment (n = 5), and 3) IFNγ changed from being below 200pg/mL to above that level during treatment (n = 8). The response rates were 11%, 40%, and 100%, respectively, and the difference was significant (p < 0.001). The positive and negative predictive values of increasing IFNγ were 100% and 79%. Conclusions: These data suggest that increasing NK cell activity during treatment has predictive potential in mCRC. The NKA test performs reliably in this setting. Clinical trial information: NCT02705300.
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Affiliation(s)
- Line Nederby
- Department of Clinical Immunology & Biochemistry, Vejle Hospital, Vejle, Denmark
| | - Torben Hansen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
| | - Louise Raunkilde
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
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25
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Bill M, B van Kooten Niekerk P, S Woll P, Laine Herborg L, Stidsholt Roug A, Hokland P, Nederby L. Mapping the CLEC12A expression on myeloid progenitors in normal bone marrow; implications for understanding CLEC12A-related cancer stem cell biology. J Cell Mol Med 2018; 22:2311-2318. [PMID: 29411522 PMCID: PMC5867061 DOI: 10.1111/jcmm.13519] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022] Open
Abstract
The C-type lectin domain family 12, member A (CLEC12A) receptor has emerged as a leukaemia-associated and cancer stem cell marker in myeloid malignancies. However, a detailed delineation of its expression in normal haematopoiesis is lacking. Here, we have characterized the expression pattern of CLEC12A on the earliest stem- and myeloid progenitor subsets in normal bone marrow. We demonstrate distinct CLEC12A expression in the classically defined myeloid progenitors, where on average 39.1% (95% CI [32.5;45.7]) of the common myeloid progenitors (CMPs) expressed CLEC12A, while for granulocyte-macrophage progenitors and megakaryocyte-erythroid progenitors (MEPs), the average percentages were 81.0% (95% CI [76.0;85.9]) and 11.9% (95% CI [9.3;14.6]), respectively. In line with the reduced CLEC12A expression on MEPs, functional assessment of purified CLEC12A+/- CMPs and MEPs in the colony-forming unit assay demonstrated CLEC12A+ subsets to favour non-erythroid colony growth. In conclusion, we provide evidence that the earliest CLEC12A+ cell in the haematopoietic tree is the classically defined CMP. Furthermore, we show that CLEC12A-expressing CMPs and MEPs are functionally different than their negative counterparts. Importantly, these data can help determine which cells will be spared during CLEC12A-targeted therapy, and we propose CLEC12A to be included in future studies of myeloid cancer stem cell biology.
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Affiliation(s)
- Marie Bill
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Petter S Woll
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Anne Stidsholt Roug
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.,Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Hokland
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Line Nederby
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
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26
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Hansen MC, Nederby L, Kjeldsen E, Petersen MA, Ommen HB, Hokland P. Case report: Exome sequencing identifies T-ALL with myeloid features as a IKZF1-struck early precursor T-cell malignancy. Leuk Res Rep 2017; 9:1-4. [PMID: 29204341 PMCID: PMC5705803 DOI: 10.1016/j.lrr.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/26/2017] [Accepted: 11/13/2017] [Indexed: 01/15/2023] Open
Affiliation(s)
- Marcus C Hansen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Line Nederby
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Eigil Kjeldsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hans B Ommen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Hokland
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
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27
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Hansen T, Nederby L, Bechmann T, Jakobsen E, Zedan A, Mejlholm I, Henriksen J, Steffensen K, Thomsen C, Raunkilde L, Jensen L, Jakobsen A. Monitoring the effect of cytostatic treatment by immune activity. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Toft-Petersen M, Stidsholt Roug A, Plesner T, Ebbesen L, Brown GD, Nederby L. The CLEC12A receptor marks human basophils: Potential implications for minimal residual disease detection in acute myeloid leukemia. Cytometry B Clin Cytom 2017; 94:520-526. [PMID: 28718199 DOI: 10.1002/cyto.b.21540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/22/2017] [Accepted: 07/10/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND The transmembrane receptor C-type lectin domain family 12, member A (CLEC12A) is known to be highly expressed on monocytes and neutrophils and is a reliable leukemia associated marker in acute myeloid leukemia. Consequently, detailed knowledge of the various normal cell types expressing this receptor is essential. We have observed CLEC12A to be expressed on CD45lowSSClowCD14-CD123+ basophils in peripheral blood (PB) and in this study, we aimed at verifying this observation and further delineate the CD45lowSSClowCD14-CD123 + CLEC12A+ subpopulation. METHODS We analyzed PB from 20 diagnostic chronic myeloid leukemia (CML) samples and eight healthy donors in a six-color multicolor flowcytometry (FCM) based assay. Furthermore, we performed fluorescence activated cell sorting on one CML sample to morphologically confirm the CD45lowSSClowCD14-CD123 + CLEC12A+ subset to be highly enriched for basophils. Finally, to further delineate the CD45lowSSClowCD14-CD123 + CLEC12A+ subpopulation in normal PB, we examined three healthy donors in a 10-color FCM assay enabling further separation of the cell subset into basophils and dendritic cells. RESULTS The CLEC12A receptor is expressed on basophils. CONCLUSIONS Identification and enumeration of basophils is of high relevance in diagnostic hematology and immunology. We here show that CLEC12A in a simple FCM assay consistently marks basophils. Importantly, as basophils are characterized by a CD45lowSSClow profile similar to the "blast-gate" used for the evaluation of hematological disorders, awareness of minor normal CLEC12A+ subpopulations is crucial when using CLEC12A as a minimal residual disease marker in myeloid malignancies. © 2017 International Clinical Cytometry Society.
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Affiliation(s)
| | | | - Trine Plesner
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.,Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Ebbesen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Gordon D Brown
- Immunity, Infection and Inflammation Programme, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Line Nederby
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
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29
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Toft-Petersen M, Nederby L, Kjeldsen E, Kerndrup GB, Brown GD, Hokland P, Stidsholt Roug A. Unravelling the relevance of CLEC12A as a cancer stem cell marker in myelodysplastic syndrome. Br J Haematol 2016; 175:393-401. [PMID: 27612176 PMCID: PMC5091626 DOI: 10.1111/bjh.14270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/09/2016] [Indexed: 01/02/2023]
Abstract
Evidence of distinct disease propagating stem cells in myelodysplastic syndrome (MDS) has emerged in recent years. However, immunophenotypic characterization of these cancer stem cells remains sparse. In acute myeloid leukaemia (AML), we have previously described aberrant expression of the C-type lectin domain family 12, member A (CLEC12A) as a stable and reliable marker of leukaemia blasts and as a tool for assessing minimal residual disease. Furthermore, CLEC12A has been proposed as a promising marker of leukaemic stem cells in AML. The role of CLEC12A in MDS, however, remains to be elucidated. In this study, we found CLEC12A aberrantly expressed on the CD34+ CD38- cell compartment in 71% (22/31) of MDS patients, distributed across all Revised International Prognostic Scoring System risk groups. We showed that the CD34+ CD38- CLEC12A+ cells were indeed malignant and possessed functional stem cell properties in the long-term colony-initiating cell assay. As opposed to reported findings in AML, we showed that cancer stem cells from MDS samples derived from both CLEC12A positive and negative CD34+ CD38- subpopulations. Due to the absence of CLEC12A on normal haematopoietic stem cells, CLEC12A stem cell immunophenotyping may contribute to diagnosing and monitoring MDS patients and could furthermore add knowledge about disease propagating cells in MDS.
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Affiliation(s)
| | - Line Nederby
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Eigil Kjeldsen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte B Kerndrup
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Gordon D Brown
- Immunity, Infection and Inflammation Programme, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter Hokland
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
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30
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Nederby L, Roug AS, Knudsen SS, Skovbo A, Kjeldsen E, Moller HJ, Hokland M. Soluble CD163 as a prognostic biomarker in B-cell chronic lymphocytic leukemia. Leuk Lymphoma 2015; 56:3219-21. [PMID: 25747973 DOI: 10.3109/10428194.2015.1026899] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Line Nederby
- a Department of Hematology , Aarhus University Hospital , Denmark
| | - Anne S Roug
- a Department of Hematology , Aarhus University Hospital , Denmark.,b Department of Hematology , Aalborg University Hospital , Denmark
| | | | - Anni Skovbo
- d Department of Biomedicine , Aarhus University , Denmark
| | - Eigil Kjeldsen
- a Department of Hematology , Aarhus University Hospital , Denmark
| | - Holger J Moller
- e Department of Clinical Biochemistry , Aarhus University Hospital , Denmark
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31
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Hansen MC, Nederby L, Roug A, Villesen P, Kjeldsen E, Nyvold CG, Hokland P. Novel scripts for improved annotation and selection of variants from whole exome sequencing in cancer research. MethodsX 2015; 2:145-53. [PMID: 26150983 PMCID: PMC4487347 DOI: 10.1016/j.mex.2015.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/06/2015] [Indexed: 12/30/2022] Open
Abstract
Sequencing the exome is quickly becoming the preferred method for discovering disease-inducing mutations. While obtaining data sets is a straightforward procedure, the subsequent analysis and interpretation of the data is a limiting step for clinical applications. Thus, while the initial mutation and variant calling can be performed by a bioinformatician or trained researcher, the output from robust packages such as MuTect and GATK is not directly informative for the general life scientists. In attempt to obviate this problem we have created complementary Wolfram scripts, which enable easy downstream annotation and selection, presented here in the perspective of hematological relevance. It also provides the researcher with the opportunity to extend the analysis by having a full-fledged programming and analysis environment of Mathematica at hand. In brief, post-processing is performed by: Mapping of germ line and somatic variants to coding regions, and defining variant sets within Mathematica. Processing of variants in variant effect predictor. Extended annotation, relevance scoring and defining focus areas through the provided functions.
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Affiliation(s)
| | - Line Nederby
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Roug
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Palle Villesen
- Bioinformatics Research Centre, Aarhus University, Denmark
| | - Eigil Kjeldsen
- Bioinformatics Research Centre, Aarhus University, Denmark
| | | | - Peter Hokland
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
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32
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Hansen MC, Nyvold CG, Roug AS, Kjeldsen E, Villesen P, Nederby L, Hokland P. Nature and nurture: a case of transcending haematological pre-malignancies in a pair of monozygotic twins adding possible clues on the pathogenesis of B-cell proliferations. Br J Haematol 2015; 169:391-400. [PMID: 25752595 DOI: 10.1111/bjh.13305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/23/2014] [Indexed: 02/05/2023]
Abstract
We describe a comprehensive molecular analysis of a pair of monozygotic twins, who came to our attention when one experienced amaurosis fugax and was diagnosed with JAK2+ polycythaemia vera. He (Twin A) was also found to have an asymptomatic B-cell chronic lymphocytic leukaemia (B-CLL). Although JAK2-, Twin B was subsequently shown to have a benign monoclonal B-cell lymphocytosis (MBL). Flow cytometric and molecular analyses of the B-cell compartments revealed different immunoglobulin light and heavy chain usage in each twin. We hypothesized that whole exome sequencing could help delineating the pattern of germline B-cell disorder susceptibility and reveal somatic mutations potentially contributing to the differential patterns of pre-malignancy. Comparing bone marrow cells and T cells and employing in-house engineered integrative analysis, we found aberrations in Twin A consistent with a myeloid neoplasm, i.e. in TET2, RUNX1, PLCB1 and ELF4. Employing the method for detecting high-ranking variants by extensive annotation and relevance scoring, we also identified shared germline variants in genes of proteins interacting with B-cell receptor signalling mediators and the WNT-pathway, including IRF8, PTPRO, BCL9L, SIT1 and SIRPB1, all with possible implications in B-cell proliferation. Similar patterns of IGHV-gene usage to those demonstrated here have been observed in inherited acute lymphoblastic leukaemia. Collectively, these findings may help in facilitating identification of putative master gene(s) involved in B-cell proliferations in general and MBL and B-CLL in particular.
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Affiliation(s)
- Marcus C Hansen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
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33
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Roug AS, Hansen MC, Nederby L, Hokland P. Diagnosing and following adult patients with acute myeloid leukaemia in the genomic age. Br J Haematol 2014; 167:162-76. [PMID: 25130287 DOI: 10.1111/bjh.13048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/04/2014] [Indexed: 12/24/2022]
Abstract
The diagnosis and follow-up process of adult patients with acute myeloid leukaemia (AML) is challenging to clinicians and laboratory staff alike. While several sets of recommendations have been published over the years, the development of high throughput screening and characterization for both genetic and epigenetic events have evolved with astonishing speed. Here we attempt to provide a practical guide to diagnose and follow adult AML patients with a focus on how to balance the wealth of information on the one hand, with the restriction put on these processes in terms of time, feasibility and economy when caring for these patients, on the other.
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Affiliation(s)
- Anne S Roug
- Department of Haematology, Aarhus University Hospital, Aarhus C, Denmark
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Pløen GG, Nederby L, Guldberg P, Hansen M, Ebbesen LH, Jensen UB, Hokland P, Aggerholm A. Persistence of DNMT3A mutations at long-term remission in adult patients with AML. Br J Haematol 2014; 167:478-86. [PMID: 25371149 DOI: 10.1111/bjh.13062] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/04/2014] [Indexed: 12/16/2022]
Abstract
Mutations in DNMT3A, the gene encoding DNA methyltransferase 3 alpha, have been identified as molecular drivers in acute myeloid leukaemia (AML) with possible implications for minimal residual disease monitoring and prognosis. To further explore the utility of DNMT3A mutations as biomarkers for AML, we developed assays for sensitive detection of recurrent mutations affecting residue R882. Analysis of DNA from 298 diagnostic AML samples revealed DNMT3A mutations in 45 cases (15%), which coincided with mutations in NPM1, FLT3 and IDH1. DNMT3A mutations were stable in 12 of 13 patients presenting with relapse or secondary myelodysplastic syndrome, but were also present in remission samples from 14 patients (at allele frequencies of <1-50%) up to 8 years after initial AML diagnosis, despite the loss of all other molecular AML markers. The mutant DNMT3A allele burden was not related to the clinical course of disease. Cell sorting demonstrated the presence of DNMT3A mutations in leukaemic blasts, but also at lower allele frequencies in T and B-cells from the same patients. Our data are consistent with the recent finding of preleukaemic stem cells in AML, which are resistant to chemotherapy. The persistence of DNMT3A mutations during remission may have important implications for the management of AML.
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Affiliation(s)
- Gro G Pløen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
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van Kooten Niekerk PB, Petersen CC, Nyvold CG, Ommen HB, Roug AS, Nederby L, Hokland P, Kjeldsen E. Cell sorting enables interphase fluorescence in situ hybridization detection of low BCR-ABL1 producing stem cells in chronic myeloid leukaemia patients beyond deep molecular remission. Br J Haematol 2014; 164:53-60. [PMID: 24903628 DOI: 10.1111/bjh.12589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/28/2013] [Indexed: 11/28/2022]
Abstract
The exact disease state of chronic myeloid leukaemia (CML) patients in deep molecular remission is unknown, because even the most sensitive quantitative reverse transcription polymerase chain reaction (qPCR) methods cannot identify patients prone to relapse after treatment withdrawal. To elucidate this, CD34(+) stem cell and progenitor cell subpopulations were isolated by fluorescence-activated cell sorting (FACS), and their content of residual Philadelphia positive (Ph(+) ) cells was evaluated in 17 CML patients (major molecular response, n = 6; 4-log reduction in BCR-ABL1 expression (MR(4) ), n = 11) using both sensitive qPCR and interphase fluorescence in situ hybridization (iFISH). Despite evaluating fewer cells, iFISH proved superior to mRNA-based qPCR in detecting residual Ph(+) stem cells (P = 0·005), and detected Ph(+) stem- and progenitor cells in 9/10 patients at frequencies of 2-14%. Moreover, while all qPCR(+) samples also were iFISH(+) , 9/33 samples were qPCR-/iFISH(+) , including all positive samples from MR(4) patients. Our findings show that residual Ph(+) cells are low BCR-ABL1 producers, and that DNA-based methods are required to assess the content of persisting Ph(+) stem cells in these patients. This approach demonstrates a clinically applicable manner of assessing residual disease at the stem cell level in CML patients in MR(4) , and may enable early and safe identification of candidates for tyrosine kinase inhibitor withdrawal.
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Sørensen CD, Jørgensen JM, Nederby L, Hokland P, Nyvold CG. Common consensus LNA probe for quantitative PCR assays in cancer: vehicles for minimal residual disease detection in t(11;14) and t(14;18) positive malignant lymphomas. J Immunol Methods 2014; 406:131-6. [PMID: 24631717 DOI: 10.1016/j.jim.2014.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/12/2013] [Accepted: 03/04/2014] [Indexed: 12/30/2022]
Abstract
The use of locked nucleic acid (LNA) probes and primers potentially improves sensitivity and specificity of quantitative PCR (qPCR) assays. One area of application is that of minimal residual cancer where PCR techniques have proved to be highly relevant tools in patient follow-up. We present here sensitive and specific consensus qPCR assays for quantification of the malignant lymphoma translocations, t(11;14) and t(14;18), by taking advantage of the thermodynamic properties of LNA. The assays were applied to genomic DNA from patients diagnosed with mantle cell lymphoma (MCL) and follicular lymphoma (FL), respectively. Two consensus forward primers targeting the BCL1 and BCL2 genes were designed together with a common consensus reverse primer and hydrolysis probe, the latter consisting exclusively of LNA, both targeting the J segments of the immunoglobulin heavy chain (IgH) gene. The quantitative range of both assays was 1×10(0) to 5×10(-5), and the sensitivity was 10(-5), without the need for patient-specific primers. Peripheral blood (PB) and bone marrow (BM) samples from 36 patients diagnosed with MCL and nine patients diagnosed with FL were analysed using this novel qPCR approach. The level of minimal residual disease (MRD) using t(11;14) and t(14;18) as genetic targets reflected the clinical status of the patients: low levels of MRD at clinical remission, and increasing levels at disease progression. The present assays could prove as useful tools in lymphoma therapy.
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Affiliation(s)
- Camilla Darum Sørensen
- Department of Haematology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Judit Meszaros Jørgensen
- Department of Haematology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Line Nederby
- Department of Haematology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Peter Hokland
- Department of Haematology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
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Toft-Petersen M, Kjeldsen E, Nederby L, Grønbæk K, Hokland P, Roug AS. A novel del(8)(q23.2q24.11) contributing to disease progression in a case of JAK2/TET2 double mutated chronic myelomonocytic leukemia. Leuk Res Rep 2014; 3:94-7. [PMID: 25473623 PMCID: PMC4250842 DOI: 10.1016/j.lrr.2014.09.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/04/2014] [Accepted: 09/21/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Eigil Kjeldsen
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Line Nederby
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Hokland
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Anne Stidsholt Roug
- Department of Hematology, Aarhus University Hospital, Denmark
- Correspondence to: Department of Hematology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark. Tel.: +45 78467593; fax: +45 78467598.
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Roug AS, Larsen HØ, Nederby L, Just T, Brown G, Nyvold CG, Ommen HB, Hokland P. hMICL and CD123 in combination with a CD45/CD34/CD117 backbone - a universal marker combination for the detection of minimal residual disease in acute myeloid leukaemia. Br J Haematol 2013; 164:212-22. [PMID: 24152218 DOI: 10.1111/bjh.12614] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/06/2013] [Indexed: 12/22/2022]
Abstract
Real-time quantitative polymerase chain reaction (qPCR) has been extensively validated for the detection of minimal residual disease (MRD) in acute myeloid leukaemia (AML). Meanwhile, multicolour flow cytometry (MFC) has received less attention because the so-called leukaemia-associated immunophenotypes (LAIPs) are generally of lower sensitivity and specificity, and prone to change during therapy. To improve MRD assessment by MFC, we here evaluate the combination of human Myeloid Inhibitory C-type Lectin (hMICL, also termed C-type lectin domain family 12, member A, CLEC12A) and CD 123 (also termed interleukin-3 receptor alpha, IL3RA) in combination with CD34 and CD117 (KIT), as an MRD assay in pre-clinical and clinical testing in 69 AML patients. Spiking experiments revealed that the assay could detect MRD down to 10(-4) in normal bone marrow with sensitivities equalling those of validated qPCR assays. Moreover, it provided at least one MFC MRD marker in 62/69 patients (90%). High levels of hMICL/CD123 LAIPs at the post-induction time-point were a strong prognostic marker for relapse in patients in haematological complete remission (P < 0·001). Finally, in post induction samples, hMICL/CD123 LAIPs were strongly correlated (r = 0·676, P = 0·0008) to applied qPCR targets. We conclude the hMICL/CD123-based MFC assay is a promising MRD tool in AML.
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Affiliation(s)
- Anne S Roug
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
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van Kooten Niekerk PB, Roug AS, Petersen CC, Ommen HB, Kjeldsen E, Bendix K, Nyvold CG, Nederby L, Hokland P. Chronic myeloid leukaemia presenting with isolated thrombocythaemia, a case revealing its stem cell biology. Br J Haematol 2013; 162:141-4. [PMID: 23593974 DOI: 10.1111/bjh.12339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
MESH Headings
- Aged
- Diagnosis, Differential
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Neoplastic Stem Cells/metabolism
- Thrombocytosis/diagnosis
- Thrombocytosis/drug therapy
- Thrombocytosis/metabolism
- Treatment Outcome
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Petersen CC, Nederby L, Roug AS, Skovbo A, Peterslund NA, Hokland P, Nielsen B, Hokland M. Increased expression of CD69 on T cells as an early immune marker for human cytomegalovirus reactivation in chronic lymphocytic leukemia patients. Viral Immunol 2011; 24:165-9. [PMID: 21449727 DOI: 10.1089/vim.2010.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Reactivation of human cytomegalovirus (HCMV) remains a serious problem in immunosuppressed individuals. To investigate whether a change in the immune status can be used as an earlier marker for HCMV reactivation than the traditional PCR analysis, eight chronic lymphocytic leukemia (CLL) patients at risk for reactivation due to commencement of alemtuzumab (anti-CD52) treatment were longitudinally followed. Five series of consecutive weekly blood samples were immunophenotyped by flow cytometry to cover both the innate and adaptive immune responses. Concurrently, patients were monitored by PCR for HCMV reactivation. We found a minor upregulation of the early activation marker CD69 on NK cells immediately before HCMV was detected in circulation by PCR. Interestingly, for the specific immune response, CD69 was highly upregulated on CD3(+) T cells, especially for the CD8(+) subset, in the two patients experiencing an HCMV reactivation between 6 and 20 d before HCMV viremia was measured by PCR. Moreover, a CD4(+):CD8(+) ratio lower than 0.6 may indicate a trend toward an increased risk for viral reactivation. In conclusion, an increase in CD69 expression is a promising candidate as an early predictor of HCMV reactivation.
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Affiliation(s)
- Charlotte C Petersen
- Department of Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark.
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Eskelund CW, Nederby L, Thysen AH, Skovbo A, Roug AS, Hokland ME. Interleukin-21 and rituximab enhance NK cell functionality in patients with B-cell chronic lymphocytic leukaemia. Leuk Res 2011; 35:914-20. [PMID: 21354618 DOI: 10.1016/j.leukres.2011.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 01/24/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
Abstract
We have examined natural killer (NK) cell functionality of 54 B-CLL patients upon in vitro stimulation with interleukin-21 (IL-21), together with the anti-CD20 antibody, rituximab. Upon stimulation with rituximab-coated target cells IFN-γ production was reduced in patients' NK cells compared to healthy donors', while both natural- and antibody-dependent cytotoxicity (ADCC) was normal. Following additional stimulation with IL-21, IFN-γ production, natural cytotoxicity and ADCC were significantly augmented in patients. A complete restoration of IFN-γ production, however, required the depletion of malignant cells prior to stimulation. Collectively, our data show that NK cells of B-CLL patients are reversibly inhibited, but that their functionality can be normalized by stimulation with IL-21 and when inhibitory effects of the malignant B-CLL cells are eliminated by depletion.
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Affiliation(s)
- Christian W Eskelund
- Institute of Medical Microbiology and Immunology, Aarhus University, and Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.
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Bohn AB, Nederby L, Harbo T, Skovbo A, Vorup-Jensen T, Krog J, Jakobsen J, Hokland ME. The effect of IgG levels on the number of natural killer cells and their Fc receptors in chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol 2011; 18:919-24. [PMID: 21219545 DOI: 10.1111/j.1468-1331.2010.03333.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE High-dose intravenous immunoglobulin (IVIg) is an established treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Although Fc receptors on natural killer cells have been suggested as a target for IVIg, the pharmacological effects are not yet clarified. We hypothesize that IVIg therapy, dependent on the plasma IgG level, suppresses the cytotoxic capacity by a reduction in numbers of NK cells and their Fc receptor CD16. PATIENTS AND METHODS Ten consecutive patients with CIDP in maintenance therapy with IVIg were studied before and immediately after the infusion of 0.7-2.0 g/kg IVIg. Peripheral blood mononuclear cell samples from these patients were analyzed immediately after isolation using flow cytometry and cytotoxicity assays. RESULTS We found that following IVIg treatment, the cytotoxic activity of NK cells in CIDP patients was suppressed, partly caused by a dose-dependent decline in the number of circulating NK cells. In addition, a dose-dependent blockage of CD16 occurred. CONCLUSIONS The study implies that IVIg infusion induces a substantial decline in the number of peripheral NK cells and a suppression of NK-cell-mediated cytotoxicity. We propose that these impairments of the NK cells contribute to the therapeutic effect of IVIg in CIDP.
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Affiliation(s)
- A B Bohn
- Department of Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark.
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