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Iovino L, Wu QV, Voutsinas J, Panaite L, Mullane E, Lynch RC, Ujjani C, Smith SD, Gopal AK, Till BG, Milano F, Chow V, Gauthier J, Turtle CJ, Maloney DG, Shadman M. Predictors of response to axicabtagene-ciloleucel CAR T cells in aggressive B cell lymphomas: A real-world study. J Cell Mol Med 2022; 26:5976-5983. [PMID: 36453136 PMCID: PMC9753434 DOI: 10.1111/jcmm.17550] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/06/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Chimeric antigen receptor T-cell (CAR T) therapy has shown promising efficacy in relapsed and refractory diffuse large B cell lymphoma (DLBCL). While most patients undergo CAR T infusion with active disease, the impact of some clinical variables, such as responsiveness to the pre-CAR T chemotherapy on the response to CAR T, is unknown. In this single-institution study, we studied the impact of several pre-CAR T variables on the post-CAR outcomes. Sixty patients underwent apheresis for axicabtagene-ciloleucel (axi-cel) and 42 of them (70.0%) had primary refractory disease. Bridging therapy between apheresis and lymphodepletion was given in 34 patients (56.7%). After axi-cel, the overall response rate was 63.3%. Responsiveness to the immediate pre-CAR T therapy did not show a significant association with response to axi-cel, progression-free (PFS) or overall (OS) survival. Multivariable analysis determined that bulky disease before lymphodepletion was independently associated with inferior outcomes, and patients that presented with high-burden disease unresponsive to immediate pre-CAR T therapy had a dismal outcome. This data supports proceeding with treatment in CAR T candidates regardless of their response to immediate pre-CAR T therapy. Interim therapeutic interventions should be considered in patients who have known risk factors for poor outcomes (bulky disease, high LDH).
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Affiliation(s)
- Lorenzo Iovino
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Qian Vicky Wu
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Jenna Voutsinas
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Lorena Panaite
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Erin Mullane
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Ryan C. Lynch
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Chaitra Ujjani
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Stephen D. Smith
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Ajay K. Gopal
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Brian G. Till
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Filippo Milano
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Victor Chow
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Jordan Gauthier
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Cameron J. Turtle
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - David G. Maloney
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Mazyar Shadman
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
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Panaite L, Wu QV, Voutsinas J, Mullane E, Chow VA, Lynch RC, Ujjani CS, Smith SD, Gopal AK, Poh C, Iovino L, Turtle CJ, Maloney DG, Till BG, Gauthier J, Shadman M. Predictors of cytopenias after treatment with axicabtagene ciloleucel in patients with large B-cell lymphoma. Leuk Lymphoma 2022; 63:2918-2922. [PMID: 35811554 DOI: 10.1080/10428194.2022.2095632] [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: 12/14/2022]
Abstract
Cytopenias are important but less studied adverse events following chimeric antigen receptor-engineered T cell (CAR-T) therapy. In our analysis of patients with large cell lymphoma who received axicabtagene ciloleucel (axi-cel), we sought to determine the rate and risk factors of clinically significant short term cytopenias defined as grade ≥3 neutropenia, anemia, or thrombocytopenia, or treatment with growth factors or blood product transfusions between days 20-30 after axi-cel. Fifty-three pts received axi-cel during the study period and severe cytopenias were observed in 32 (60%) pts. Significant cytopenias were more common in non-responders (stable or progressive disease) vs. responders (partial or complete response) (100% vs. 70%; p = .01). In the multivariable model, platelet transfusion within a month before leukapheresis, number of red blood cell and platelet transfusions between leukapheresis to lymphodepletion, pre-lymphodepletion absolute neurophil count, pre-lymphodepletion lactate dehydrogenase, and number of dexamethasone treatments after CAR-T were significantly associated with severe cytopenias after axi-cel.
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Affiliation(s)
- Lorena Panaite
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Qian Vicky Wu
- Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | | | - Erin Mullane
- Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Victor A Chow
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Ryan C Lynch
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Chaitra S Ujjani
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Stephen D Smith
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Ajay K Gopal
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Christina Poh
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Lorenzo Iovino
- Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Cameron J Turtle
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - David G Maloney
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Brian G Till
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Jordan Gauthier
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
| | - Mazyar Shadman
- Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch, Seattle, WA, USA
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Iovino L, Wu V, Voutsinas JM, Panaite L, Perkins P, Kirk A, Cearley A, Lynch RC, Ujjani CS, Smith SD, Gopal AK, Till BG, Chow VA, Gauthier J, Turtle CJ, Maloney DG, Shadman M. Non-Responsiveness to Immediate Pre CAR-T Treatment Does Not Preclude Response to Axicabtagene Ciloleucel in Relapsed and Refractory Aggressive B Cell Lymphomas. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00442-5] [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: 11/16/2022]
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Panaite L, Behnia F, Stevenson PA, Gooley TA, Mireles L, Karami M, Tseng YD, Chung KH, Smith SD, Lynch RC, Ujjani CS, Georges GE, Shustov AR, Till BG, Gauthier J, Chow VA, Maloney DG, Gopal AK, Holmberg LA, Shadman M. Multifocal Not Single-Site FDG-PET Residual Disease Prior to Autologous Stem Cell Transplant for Hodgkin Lymphoma Associated with Adverse Outcome. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00506-6] [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: 11/17/2022]
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Possik E, Jalali Z, Nouët Y, Yan M, Gingras MC, Schmeisser K, Panaite L, Dupuy F, Kharitidi D, Chotard L, Jones RG, Hall DH, Pause A. Folliculin regulates ampk-dependent autophagy and metabolic stress survival. PLoS Genet 2014; 10:e1004273. [PMID: 24763318 PMCID: PMC3998892 DOI: 10.1371/journal.pgen.1004273] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 02/14/2014] [Indexed: 12/19/2022] Open
Abstract
Dysregulation of AMPK signaling has been implicated in many human diseases, which emphasizes the importance of characterizing AMPK regulators. The tumor suppressor FLCN, responsible for the Birt-Hogg Dubé renal neoplasia syndrome (BHD), is an AMPK-binding partner but the genetic and functional links between FLCN and AMPK have not been established. Strikingly, the majority of naturally occurring FLCN mutations predisposing to BHD are predicted to produce truncated proteins unable to bind AMPK, pointing to the critical role of this interaction in the tumor suppression mechanism. Here, we demonstrate that FLCN is an evolutionarily conserved negative regulator of AMPK. Using Caenorhabditis elegans and mammalian cells, we show that loss of FLCN results in constitutive activation of AMPK which induces autophagy, inhibits apoptosis, improves cellular bioenergetics, and confers resistance to energy-depleting stresses including oxidative stress, heat, anoxia, and serum deprivation. We further show that AMPK activation conferred by FLCN loss is independent of the cellular energy state suggesting that FLCN controls the AMPK energy sensing ability. Together, our data suggest that FLCN is an evolutionarily conserved regulator of AMPK signaling that may act as a tumor suppressor by negatively regulating AMPK function. The FLCN gene is responsible for the hereditary human tumor disease called Birt-Hogg-Dube syndrome (BHD). Patients that inherit an inactivating mutation in the FLCN gene develop lung collapse as well as tumors in the kidney, colon, and skin. It is not clear yet what the exact function of this protein is in the cell or an organism. In this study, we used a simple model organism (the round worm C. elegans) to study the function of FLCN. We found that it is involved in the regulation of energy metabolism in the cell. FLCN normally binds and blocks the action of another protein (AMPK), which is involved in the maintenance of energy levels. When energy levels fall, AMPK is activated and drives a recycling pathway called autophagy, where cellular components are recycled producing energy. In the absence of FLCN in worms and mammalian cells, like in tumors of BHD patients, AMPK and autophagy are chronically activated leading to an increased energy level, which makes the cells/organism very resistant to many stresses that would normally kill them, which in the end could lead to progression of tumorigenesis.
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Affiliation(s)
- Elite Possik
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Zahra Jalali
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Yann Nouët
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Ming Yan
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Marie-Claude Gingras
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Kathrin Schmeisser
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Lorena Panaite
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Fanny Dupuy
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Physiology, McGill University, Montréal, Québec, Canada
| | - Dmitri Kharitidi
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Laëtitia Chotard
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Russell G. Jones
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Physiology, McGill University, Montréal, Québec, Canada
| | - David H. Hall
- Department of Neuroscience, Albert Einstein College of Medicine, New York, New York, United States of America
| | - Arnim Pause
- Goodman Cancer Research Center, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
- * E-mail:
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