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Wang ES, Goldberg AD, Tallman M, Walter RB, Karanes C, Sandhu K, Vigil CE, Collins R, Jain V, Stone RM. Crenolanib and Intensive Chemotherapy in Adults With Newly Diagnosed FLT3-Mutated AML. J Clin Oncol 2024:JCO2301061. [PMID: 38324741 DOI: 10.1200/jco.23.01061] [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: 05/16/2023] [Revised: 11/07/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024] Open
Abstract
PURPOSE Crenolanib is a second-generation tyrosine kinase inhibitor with activity against FLT3-ITD- and TKD-mutant AML. We conducted a trial of crenolanib plus intensive chemotherapy in adults with newly diagnosed FLT3-mutant AML. METHODS Eligible patients were 18 years and older. Induction chemotherapy consisted of cytarabine (100 mg/m2) continuous infusion on days 1-7 and anthracycline (daunorubicin 60-90 mg/m2 or idarubicin 12 mg/m2, once daily) on days 1-3 followed by consolidation with high-dose cytarabine (1-3 g/m2 twice daily on days 1, 3, 5) and/or allogeneic transplant. Crenolanib (100 mg thrice a day) was given from day 9 until 72 hours before the next cycle, after consolidation, and for 12 months after consolidation or transplant. RESULTS Forty-four patients (median age, 57; range, 19-75 years) were enrolled. Thirty-six had FLT3-ITD, and 11 had FLT3-TKD mutations. European LeukemiaNet 2017 disease risk was favorable in 34%, intermediate in 30%, and adverse in 36%. The overall response rate was 86% (complete remission [CR], 77%; CR with incomplete count recovery [CRi], 9%): 90% in patients 60 years and younger and 80% in older patients. Measurable residual disease-negative CR/CRi rates were 89% and 45%, respectively. With a 45-month follow-up, median overall survival has not been reached and the median event-free survival was 44.7 months. Among younger patients, the estimated 3-year survival was 71.4% with 15% cumulative incidence of relapse. Treatment-related serious adverse events included febrile neutropenia, diarrhea, and nausea. The median time to platelets ≥100,000/µL and absolute neutrophil count ≥1,000/µL during induction was 29 and 32 days, respectively. No new FLT3-mutant clones were detected at relapse in patients completing consolidation. CONCLUSION Crenolanib plus intensive chemotherapy in adults with newly diagnosed FLT3-mutant AML results in high rate of deep responses and long-term survival with acceptable toxicity. A randomized trial of crenolanib versus midostaurin plus chemotherapy in younger patients is ongoing.
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Affiliation(s)
- Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
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2
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Ptashkin RN, Ewalt MD, Jayakumaran G, Kiecka I, Bowman AS, Yao J, Casanova J, Lin YTD, Petrova-Drus K, Mohanty AS, Bacares R, Benhamida J, Rana S, Razumova A, Vanderbilt C, Balakrishnan Rema A, Rijo I, Son-Garcia J, de Bruijn I, Zhu M, Lachhander S, Wang W, Haque MS, Seshan VE, Wang J, Liu Y, Nafa K, Borsu L, Zhang Y, Aypar U, Suehnholz SP, Chakravarty D, Park JH, Abdel-Wahab O, Mato AR, Xiao W, Roshal M, Yabe M, Batlevi CL, Giralt S, Salles G, Rampal R, Tallman M, Stein EM, Younes A, Levine RL, Perales MA, van den Brink MRM, Dogan A, Ladanyi M, Berger MF, Brannon AR, Benayed R, Zehir A, Arcila ME. Enhanced clinical assessment of hematologic malignancies through routine paired tumor and normal sequencing. Nat Commun 2023; 14:6895. [PMID: 37898613 PMCID: PMC10613284 DOI: 10.1038/s41467-023-42585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023] Open
Abstract
Genomic profiling of hematologic malignancies has augmented our understanding of variants that contribute to disease pathogenesis and supported development of prognostic models that inform disease management in the clinic. Tumor only sequencing assays are limited in their ability to identify definitive somatic variants, which can lead to ambiguity in clinical reporting and patient management. Here, we describe the MSK-IMPACT Heme cohort, a comprehensive data set of somatic alterations from paired tumor and normal DNA using a hybridization capture-based next generation sequencing platform. We highlight patterns of mutations, copy number alterations, and mutation signatures in a broad set of myeloid and lymphoid neoplasms. We also demonstrate the power of appropriate matching to make definitive somatic calls, including in patients who have undergone allogeneic stem cell transplant. We expect that this resource will further spur research into the pathobiology and clinical utility of clinical sequencing for patients with hematologic neoplasms.
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Affiliation(s)
- Ryan N Ptashkin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- C2i Genomics, New York, NY, USA
| | - Mark D Ewalt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gowtham Jayakumaran
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Guardant Health, Palo Alto, CA, USA
| | - Iwona Kiecka
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anita S Bowman
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - JinJuan Yao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jacklyn Casanova
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yun-Te David Lin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kseniya Petrova-Drus
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Abhinita S Mohanty
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ruben Bacares
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamal Benhamida
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Satshil Rana
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Razumova
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chad Vanderbilt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anoop Balakrishnan Rema
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ivelise Rijo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julie Son-Garcia
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ino de Bruijn
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Menglei Zhu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Lachhander
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wei Wang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohammad S Haque
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Venkatraman E Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jiajing Wang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying Liu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Khedoudja Nafa
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laetitia Borsu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yanming Zhang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umut Aypar
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah P Suehnholz
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debyani Chakravarty
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jae H Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Omar Abdel-Wahab
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony R Mato
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikhail Roshal
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mariko Yabe
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Connie Lee Batlevi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raajit Rampal
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Eytan M Stein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anas Younes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Oncology R&D, AstraZeneca, New York, NY, USA
| | - Ross L Levine
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Marcel R M van den Brink
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Rose Brannon
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryma Benayed
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Oncology R&D, AstraZeneca, New York, NY, USA
| | - Ahmet Zehir
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Oncology R&D, AstraZeneca, New York, NY, USA.
| | - Maria E Arcila
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Shanafelt TD, Wang XV, Hanson CA, Paietta EM, O'Brien S, Barrientos J, Jelinek DF, Braggio E, Leis JF, Zhang CC, Coutre SE, Barr PM, Cashen AF, Mato AR, Singh AK, Mullane MP, Little RF, Erba H, Stone RM, Litzow M, Tallman M, Kay NE. Long-term outcomes for ibrutinib-rituximab and chemoimmunotherapy in CLL: updated results of the E1912 trial. Blood 2022; 140:112-120. [PMID: 35427411 PMCID: PMC9283968 DOI: 10.1182/blood.2021014960] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/25/2022] [Indexed: 01/14/2023] Open
Abstract
Herein, we present the long-term follow-up of the randomized E1912 trial comparing the long-term efficacy of ibrutinib-rituximab (IR) therapy to fludarabine, cyclophosphamide, and rituximab (FCR) and describe the tolerability of continuous ibrutinib. The E1912 trial enrolled 529 treatment-naïve patients aged ≤70 years with chronic lymphocytic leukemia (CLL). Patients were randomly assigned (2:1 ratio) to receive IR or 6 cycles of FCR. With a median follow-up of 5.8 years, median progression-free survival (PFS) is superior for IR (hazard ratio [HR], 0.37; P < .001). IR improved PFS relative to FCR in patients with both immunoglobulin heavy chain variable region (IGHV) gene mutated CLL (HR: 0.27; P < .001) and IGHV unmutated CLL (HR: 0.27; P < .001). Among the 354 patients randomized to IR, 214 (60.5%) currently remain on ibrutinib. Among the 138 IR-treated patients who discontinued treatment, 37 (10.5% of patients who started IR) discontinued therapy due to disease progression or death, 77 (21.9% of patients who started IR) discontinued therapy for adverse events (AEs)/complications, and 24 (6.8% of patients who started IR) withdrew for other reasons. Progression was uncommon among patients able to remain on ibrutinib. The median time from ibrutinib discontinuation to disease progression or death among those who discontinued treatment for a reason other than progression was 25 months. Sustained improvement in overall survival (OS) was observed for patients in the IR arm (HR, 0.47; P = .018). In conclusion, IR therapy offers superior PFS relative to FCR in patients with IGHV mutated or unmutated CLL, as well as superior OS. Continuous ibrutinib therapy is tolerated beyond 5 years in the majority of CLL patients. This trial was registered at www.clinicaltrials.gov as #NCT02048813.
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Affiliation(s)
| | | | | | | | - Susan O'Brien
- University of California Irvine Medical Center, Irvine, CA
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4
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Hu R, Wei W, Mian A, Gonter-Aubin K, Kabel C, Mato A, Stephens DM, Hanlon A, Khajavian S, Shadman M, Brander D, Madanat Y, Park JH, Tallman M, Pinilla-Ibarz J, Hill BT. Treatment outcomes with purine nucleoside analog alone or with rituximab for hairy cell leukemia at first relapse. Eur J Haematol Suppl 2022; 108:379-382. [PMID: 35043475 DOI: 10.1111/ejh.13744] [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: 09/23/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Frontline treatment of hairy cell leukemia (HCL) with a single course of the purine nucleoside analog (PNA) produces a high rate of complete remission (CR) with prolonged durations. At the time of relapse, although treatment guidelines recommend re-treatment with a PNA alone or in combination with rituximab (R), practice patterns vary and data supporting each approach are limited. METHODS We conducted a multisite outcomes analysis of patients treated for HCL between 1995 and 2018 at six US medical centers. All patients were treated with frontline PNA and subsequently required treatment with a PNA alone (PNA) or with R (+R). RESULTS Of the 88 patients analyzed, 56 (63.6%) received second-line PNA and 22 (36.4%) received a PNA + R. Baseline characteristics of both groups were similar. There was no difference in median PFS [67 months (95% CI 43.8 non-reached (NR)) vs. 65 months (95% CI 60-NR)] or 5-year OS [98% (95% CI 0.94-1) vs. 94% (95% CI 0.83-1), p = .104] in the PNA versus PNA + R cohorts, respectively. CONCLUSION To our knowledge, this is the largest study evaluating the role of R in treatment of relapsed HCL and suggests that there is no advantage to the addition of R to PNA therapy at the time of first re-treatment.
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Affiliation(s)
- Rachel Hu
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Wei Wei
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Agrima Mian
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | | | - Charlene Kabel
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Deborah M Stephens
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Ashley Hanlon
- Duke University Medical Center, Durham, North Carolina, USA
| | - Sirin Khajavian
- Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA
| | - Mazyar Shadman
- Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA
| | | | - Yazan Madanat
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Jae H Park
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Martin Tallman
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Brian T Hill
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
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5
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Wieduwilt MJ, Stock W, Advani A, Luger S, Larson RA, Tallman M, Appelbaum F, Zhang MJ, Bo-Subait K, Wang HL, Bhatt VR, Dholaria B, Eapen M, Hamadani M, Jamy O, Prestidge T, Pulsipher M, Ritchie D, Rizzieri D, Sharma A, Barba P, Sandmaier BM, de Lima M, Kebriaei P, Litzow M, Saber W, Weisdorf D. Correction: Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR. Leukemia 2021; 35:2140. [PMID: 34088982 DOI: 10.1038/s41375-021-01303-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Wendy Stock
- University of Chicago Medicine, Chicago, IL, USA
| | - Anjali Advani
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | | | - Martin Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Khalid Bo-Subait
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omer Jamy
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Michael Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - David Ritchie
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pere Barba
- Vall Hebron University Hospital-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcos de Lima
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic, Rochester, MN, USA
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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6
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Kantarjian HM, Short NJ, Fathi AT, Marcucci G, Ravandi F, Tallman M, Wang ES, Wei AH. Acute Myeloid Leukemia: Historical Perspective and Progress in Research and Therapy Over 5 Decades. Clin Lymphoma Myeloma Leuk 2021; 21:580-597. [PMID: 34176779 DOI: 10.1016/j.clml.2021.05.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
With the Food and Drug Administration approval of 9 agents for different acute myeloid leukemia (AML) indications, the prognosis and management of AML is evolving rapidly. Herein, we review the important milestones in the history of AML research and therapy, discuss insights regarding prognostic assessment and prediction of treatment outcome, detail practical supportive care measures, and summarize the current treatment landscape and areas of evolving research.
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Affiliation(s)
| | - Nicholas J Short
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Amir T Fathi
- Leukemia Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research City of Hope, Duarte, CA, USA
| | - Farhad Ravandi
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Martin Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Eunice S Wang
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrew H Wei
- Department of Clinical Hematology, The Alfred Hospital and Monash University, Melbourne, Australia
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7
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Bolton KL, Ptashkin RN, Gao T, Braunstein L, Devlin SM, Kelly D, Patel M, Berthon A, Syed A, Yabe M, Coombs CC, Caltabellotta NM, Walsh M, Offit K, Stadler Z, Mandelker D, Schulman J, Patel A, Philip J, Bernard E, Gundem G, Ossa JEA, Levine M, Martinez JSM, Farnoud N, Glodzik D, Li S, Robson ME, Lee C, Pharoah PDP, Stopsack KH, Spitzer B, Mantha S, Fagin J, Boucai L, Gibson CJ, Ebert BL, Young AL, Druley T, Takahashi K, Gillis N, Ball M, Padron E, Hyman DM, Baselga J, Norton L, Gardos S, Klimek VM, Scher H, Bajorin D, Paraiso E, Benayed R, Arcila ME, Ladanyi M, Solit DB, Berger MF, Tallman M, Garcia-Closas M, Chatterjee N, Diaz LA, Levine RL, Morton LM, Zehir A, Papaemmanuil E. Cancer therapy shapes the fitness landscape of clonal hematopoiesis. Nat Genet 2020; 52:1219-1226. [PMID: 33106634 PMCID: PMC7891089 DOI: 10.1038/s41588-020-00710-0] [Citation(s) in RCA: 312] [Impact Index Per Article: 78.0] [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: 04/05/2020] [Accepted: 09/02/2020] [Indexed: 01/30/2023]
Abstract
Acquired mutations are pervasive across normal tissues. However, understanding of the processes that drive transformation of certain clones to cancer is limited. Here we study this phenomenon in the context of clonal hematopoiesis (CH) and the development of therapy-related myeloid neoplasms (tMNs). We find that mutations are selected differentially based on exposures. Mutations in ASXL1 are enriched in current or former smokers, whereas cancer therapy with radiation, platinum and topoisomerase II inhibitors preferentially selects for mutations in DNA damage response genes (TP53, PPM1D, CHEK2). Sequential sampling provides definitive evidence that DNA damage response clones outcompete other clones when exposed to certain therapies. Among cases in which CH was previously detected, the CH mutation was present at tMN diagnosis. We identify the molecular characteristics of CH that increase risk of tMN. The increasing implementation of clinical sequencing at diagnosis provides an opportunity to identify patients at risk of tMN for prevention strategies.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/pharmacology
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/radiation effects
- Child
- Child, Preschool
- Clonal Evolution
- Clonal Hematopoiesis/drug effects
- Clonal Hematopoiesis/genetics
- Cohort Studies
- Female
- Genetic Fitness
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid/genetics
- Male
- Middle Aged
- Models, Biological
- Mutation
- Neoplasms/drug therapy
- Neoplasms/radiotherapy
- Neoplasms, Second Primary/genetics
- Selection, Genetic
- Young Adult
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Affiliation(s)
- Kelly L Bolton
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan N Ptashkin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Teng Gao
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lior Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Kelly
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Minal Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonin Berthon
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aijazuddin Syed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mariko Yabe
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catherine C Coombs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicole M Caltabellotta
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mike Walsh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia Stadler
- Department of Medicine, Clinical Genetics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diana Mandelker
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Schulman
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akshar Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Philip
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elsa Bernard
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunes Gundem
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Juan E Arango Ossa
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Max Levine
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Noushin Farnoud
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dominik Glodzik
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sonya Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul D P Pharoah
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Konrad H Stopsack
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Barbara Spitzer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simon Mantha
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Fagin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Boucai
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Benjamin L Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew L Young
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Todd Druley
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy Gillis
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Markus Ball
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
- Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Jose Baselga
- Research & Development, AstraZeneca, Milton, Cambridge, UK
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Stuart Gardos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Virginia M Klimek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Howard Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Dean Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Eder Paraiso
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Strategy & Innovation, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nilanjan Chatterjee
- Department of Biostatistics, Bloomberg School of Public Health Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Luis A Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Program in Precision Interception and Prevention, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Solid Tumor Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ross L Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Elli Papaemmanuil
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Bolton KL, Ptashkin RN, Gao T, Braunstein L, Devlin SM, Patel M, Berthon A, Syed A, Yabe M, Coombs C, Caltabellotta NM, Walsh M, Offit K, Stadler Z, Lee C, Pharoah P, Stopsack KH, Spitzer B, Mantha S, Fagin J, Boucai L, Gibson CJ, Ebert B, Young AL, Druley T, Takahashi K, Gillis N, Ball M, Padron E, Hyman D, Baselga J, Norton L, Gardos S, Klimek V, Scher H, Bajorin D, Paraiso E, Benayed R, Arcilla M, Ladanyi M, Solit D, Berger M, Tallman M, Garcia-Closas M, Chatterjee N, Diaz L, Levine R, Morton L, Zehir A, Papaemmanuil E. Abstract 5703: Oncologic therapy shapes the fitness landscape of clonal hematopoiesis. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Recent studies among healthy individuals show evidence of somatic mutations in leukemia-associated genes, referred to as clonal hematopoiesis (CH). To determine the relationship between CH and oncologic therapy we collected sequential blood samples from 525 cancer patients (median sampling interval time = 23 months, range: 6-53 months) of whom 61% received cytotoxic therapy or external beam radiation therapy and 39% received either targeted/immunotherapy or were untreated. Samples were sequenced using deep targeted capture-based platforms. To determine whether CH mutational features were associated with tMN risk, we performed Cox proportional hazards regression on 9,549 cancer patients exposed to oncologic therapy of whom 75 cases developed tMN (median time to transformation=26 months). To further compare the genetic and clonal relationships between tMN and the proceeding CH, we analyzed 35 cases for which paired samples were available. We compared the growth rate of the variant allele fraction (VAF) of CH clones across treatment modalities and in untreated patients. A significant increase in the growth rate of CH mutations was seen in DDR genes among those receiving cytotoxic (p=0.03) or radiation therapy (p=0.02) during the follow-up period compared to patients who did not receive therapy. Similar growth rates among treated and untreated patients were seen for non-DDR CH genes such as DNMT3A. Increasing cumulative exposure to cytotoxic therapy (p=0.01) and external beam radiation therapy (2x10-8) resulted in higher growth rates for DDR CH mutations. Among 34 subjects with at least two CH mutations in which one mutation was in a DDR gene and one in a non-DDR gene, we studied competing clonal dynamics for multiple gene mutations within the same patient. The risk of tMN was positively associated with CH in a known myeloid neoplasm driver mutation (HR=6.9, p<10-6), and increased with the total number of mutations and clone size. The strongest associations were observed for mutations in TP53 and for CH with mutations in spliceosome genes (SRSF2, U2AF1 and SF3B1). Lower hemoglobin, lower platelet counts, lower neutrophil counts, higher red cell distribution width and higher mean corpuscular volume were all positively associated with increased tMN risk. Among 35 cases for which paired samples were available, in 19 patients (59%), we found evidence of at least one of these mutations at the time of pre-tMN sequencing and in 13 (41%), we identified two or more in the pre-tMN sample. In all cases the dominant clone at tMN transformation was defined by a mutation seen at CH Our serial sampling data provide clear evidence that oncologic therapy strongly selects for clones with mutations in the DDR genes and that these clones have limited competitive fitness, in the absence of cytotoxic or radiation therapy. We further validate the relevance of CH as a predictor and precursor of tMN in cancer patients. We show that CH mutations detected prior to tMN diagnosis were consistently part of the dominant clone at tMN diagnosis and demonstrate that oncologic therapy directly promotes clones with mutations in genes associated with chemo-resistant disease such as TP53.
Citation Format: Kelly L. Bolton, Ryan N. Ptashkin, Teng Gao, Lior Braunstein, Sean M. Devlin, Minal Patel, Antonin Berthon, Aijazuddin Syed, Mariko Yabe, Catherine Coombs, Nicole M. Caltabellotta, Mike Walsh, Ken Offit, Zsofia Stadler, Choonsik Lee, Paul Pharoah, Konrad H. Stopsack, Barbara Spitzer, Simon Mantha, James Fagin, Laura Boucai, Christopher J. Gibson, Benjamin Ebert, Andrew L. Young, Todd Druley, Koichi Takahashi, Nancy Gillis, Markus Ball, Eric Padron, David Hyman, Jose Baselga, Larry Norton, Stuart Gardos, Virginia Klimek, Howard Scher, Dean Bajorin, Eder Paraiso, Ryma Benayed, Maria Arcilla, Marc Ladanyi, David Solit, Michael Berger, Martin Tallman, Montserrat Garcia-Closas, Nilanjan Chatterjee, Luis Diaz, Ross Levine, Lindsay Morton, Ahmet Zehir, Elli Papaemmanuil. Oncologic therapy shapes the fitness landscape of clonal hematopoiesis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5703.
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Affiliation(s)
| | | | - Teng Gao
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Minal Patel
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Mariko Yabe
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Mike Walsh
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ken Offit
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Choonsik Lee
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Pharoah
- 3University of Cambridge, Cambridge, United Kingdom
| | | | | | - Simon Mantha
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Fagin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Laura Boucai
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | - David Hyman
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose Baselga
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larry Norton
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stuart Gardos
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Howard Scher
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean Bajorin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eder Paraiso
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryma Benayed
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Arcilla
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Ladanyi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Solit
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Luis Diaz
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ross Levine
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ahmet Zehir
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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Ayers B, Marini T, Wood K, Kim S, Croake M, Bernstein W, Storozynsky E, Tallman M, Cheyne C, Barrus B, Prasad S, Gosev I. Sternal-Sparing Approach for LVAD Implantation Allows for a More Consistent Inflow Cannula Angle. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Abstract
The diagnosis, staging, and treatment of acute myeloid leukemia (AML) has evolved based on identification of important genetic alterations and drugs to target those genes. Cytogenetic abnormalities play a major role in managing AML. Achieving minimal residual disease is an increasingly important milestone. Four new targeted therapies are now available for the treatment of AML.
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Affiliation(s)
- Martin Tallman
- Presented by Martin Tallman, MD, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York
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11
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Ravandi F, Koumenis I, Johri A, Tallman M, Roboz GJ, Strickland S, Garcia-Manero G, Borthakur G, Naqvi K, Meyer M, Pudipeddi M, Nidarmarthy S, Vaddi K, Kantarjian H. Oral arsenic trioxide ORH-2014 pharmacokinetic and safety profile in patients with advanced hematologic disorders. Haematologica 2019; 105:1567-1574. [PMID: 31558670 PMCID: PMC7271599 DOI: 10.3324/haematol.2019.229583] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 06/13/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
Daily intravenous arsenic trioxide administered with all-trans retinoid acid, the standard-of-care for acute promyelocytic leukemia, is costly and challenging to administer. ORH-2014 is a novel, oral arsenic trioxide formulation, consisting of micron-size drug particles with rapid dissolution and high bioavailability. We conducted a multicenter phase 1 dose-escalating study in patients with advanced hematologic malignancies. Twelve patients received ORH-2014 at 5 mg (n=3), 10 mg (n=6), or 15 mg (n=3) orally once a day (fasted state). Objectives were to assess the safety, tolerability and pharmacokinetics of ORH-2014 to support a dose recommendation for future trials. The median age of the patients was 77 years (range: 45-81) and they had received a median of two (range: 1-5) prior therapies. There were no dose limiting toxicities and no drug-related severe adverse events, except one grade III QT prolongation occurring beyond the dose limiting toxicity assessment period and resolving after treatment interruption. ORH-2014 steady-state plasma concentration was reached on day 15. ORH-2014, 15 mg Cmax was comparable to the calculated approved dose of intravenous arsenic trioxide (mean [% coefficient of variation]: 114 [21%] vs. 124 [60%] ng/mL) and area under the curve from 0 to 24 hours was 2,140 (36%) versus 1,302 (30%) h*ng/mL. These results indicate that ORH-2014 at 15 mg is safe, bioavailable, and provides the required arsenic exposure compared to intravenous arsenic trioxide at the approved dose (0.15 mg/kg); this ORH-2014 dose is recommended for future trials. (NCT03048344; www.clin-icaltrials.gov).
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12
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Shanafelt TD, Wang XV, Kay NE, Hanson CA, O'Brien S, Barrientos J, Jelinek DF, Braggio E, Leis JF, Zhang CC, Coutre SE, Barr PM, Cashen AF, Mato AR, Singh AK, Mullane MP, Little RF, Erba H, Stone RM, Litzow M, Tallman M. Ibrutinib-Rituximab or Chemoimmunotherapy for Chronic Lymphocytic Leukemia. N Engl J Med 2019; 381:432-443. [PMID: 31365801 PMCID: PMC6908306 DOI: 10.1056/nejmoa1817073] [Citation(s) in RCA: 478] [Impact Index Per Article: 95.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data regarding the efficacy of treatment with ibrutinib-rituximab, as compared with standard chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab, in patients with previously untreated chronic lymphocytic leukemia (CLL) have been limited. METHODS In a phase 3 trial, we randomly assigned (in a 2:1 ratio) patients 70 years of age or younger with previously untreated CLL to receive either ibrutinib and rituximab for six cycles (after a single cycle of ibrutinib alone), followed by ibrutinib until disease progression, or six cycles of chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab. The primary end point was progression-free survival, and overall survival was a secondary end point. We report the results of a planned interim analysis. RESULTS A total of 529 patients underwent randomization (354 patients to the ibrutinib-rituximab group, and 175 to the chemoimmunotherapy group). At a median follow-up of 33.6 months, the results of the analysis of progression-free survival favored ibrutinib-rituximab over chemoimmunotherapy (89.4% vs. 72.9% at 3 years; hazard ratio for progression or death, 0.35; 95% confidence interval [CI], 0.22 to 0.56; P<0.001), and the results met the protocol-defined efficacy threshold for the interim analysis. The results of the analysis of overall survival also favored ibrutinib-rituximab over chemoimmunotherapy (98.8% vs. 91.5% at 3 years; hazard ratio for death, 0.17; 95% CI, 0.05 to 0.54; P<0.001). In a subgroup analysis involving patients without immunoglobulin heavy-chain variable region (IGHV) mutation, ibrutinib-rituximab resulted in better progression-free survival than chemoimmunotherapy (90.7% vs. 62.5% at 3 years; hazard ratio for progression or death, 0.26; 95% CI, 0.14 to 0.50). The 3-year progression-free survival among patients with IGHV mutation was 87.7% in the ibrutinib-rituximab group and 88.0% in the chemoimmunotherapy group (hazard ratio for progression or death, 0.44; 95% CI, 0.14 to 1.36). The incidence of adverse events of grade 3 or higher (regardless of attribution) was similar in the two groups (in 282 of 352 patients [80.1%] who received ibrutinib-rituximab and in 126 of 158 [79.7%] who received chemoimmunotherapy), whereas infectious complications of grade 3 or higher were less common with ibrutinib-rituximab than with chemoimmunotherapy (in 37 patients [10.5%] vs. 32 [20.3%], P<0.001). CONCLUSIONS The ibrutinib-rituximab regimen resulted in progression-free survival and overall survival that were superior to those with a standard chemoimmunotherapy regimen among patients 70 years of age or younger with previously untreated CLL. (Funded by the National Cancer Institute and Pharmacyclics; E1912 ClinicalTrials.gov number, NCT02048813.).
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Affiliation(s)
- Tait D Shanafelt
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Xin V Wang
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Neil E Kay
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Curtis A Hanson
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Susan O'Brien
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Jacqueline Barrientos
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Diane F Jelinek
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Esteban Braggio
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Jose F Leis
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Cong C Zhang
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Steven E Coutre
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Paul M Barr
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Amanda F Cashen
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Anthony R Mato
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Avina K Singh
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Michael P Mullane
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Richard F Little
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Harry Erba
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Richard M Stone
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Mark Litzow
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
| | - Martin Tallman
- From Stanford University, Stanford (T.D.S., S.E.C.), the University of California, Irvine, Medical Center, Orange (S.O.), and Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP)-Permanente Medical Group, Oakland (C.C.Z.) - all in California; Dana-Farber Cancer Institute, Boston (X.V.W., R.M.S.); Mayo Clinic, Rochester (N.E.K., C.A.H., J.F.L., M.L.), and Minnesota Oncology, Burnsville (A.K.S.) - both in Minnesota; Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lake Success (J.B.), and University of Rochester, Rochester (P.M.B.) - both in New York; Mayo Clinic, Phoenix, AZ (D.F.J., E.B.); Washington University School of Medicine, St. Louis (A.F.C.); Memorial Sloan Kettering Cancer Center, New York (A.R.M., M.T.); Aurora Cancer Care, West Allis, WI (M.P.M.); National Cancer Institute, Bethesda, MD (R.F.L.); and the University of Alabama, Tuscaloosa (H.E.)
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Ptashkin RN, Benayed R, Ziegler J, Rema AB, Sadowska J, Kiecka I, Ho C, Yao J, Moung C, Petrova-Drus K, Nafa K, Batlevi C, Tallman M, Levine R, Giralt S, Younes A, Ladanyi M, Berger M, Zehir A, Arcila ME. Abstract 3409: MSK-IMPACT Heme: Validation and clinical experience of a comprehensive molecular profiling platform for hematologic malignancies. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3409] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
As the repertoire of molecular targeted therapies for hematologic malignancies continues to expand, so too does the opportunity for molecular profiling to inform treatment decisions. While mutations in certain genes, such as JAK2, MPL, MYD88 and BRAF have diagnostic utility, others such as FLT3, NPM1, IDH1, IDH2, DNMT3A, KIT and CEBPA have prognostic value. Here, we present the development and clinical experience of MSK-IMPACT Heme (Integrated Mutation Profiling of Actionable Cancer Targets for Hematologic malignancies), a comprehensive molecular profiling platform, utilizing hybridization capture and high coverage next generation sequencing of paired tumor and normal tissues.
Methods:
We designed custom DNA probes corresponding to all exons of 400 key oncogenes and tumor suppressor genes implicated in hematologic malignancies, including all genes that are targetable by approved and experimental therapies being investigated in clinical trials at our institution. The accuracy, precision, and sensitivity of MSK-IMPACT Heme was assessed on a validation set of 113 unique tumor samples with known SNVs and indels previously confirmed by orthogonal methods. We implemented a custom analysis pipeline to integrate the analysis of any number of normal samples with a given tumor and provide a reliable assessment of somatic alterations, even in post-transplant chimeric patients. The selection of matched nail, saliva, and/or blood tissue was determined at the time of test initiation as indicated by patient diagnosis and transplant history. The ability to detect somatic copy number alterations was demonstrated with samples previously characterized by SNP array platforms.
Results:
We sequenced 821 tumor samples, from 759 patients that represented over 50 tumor types to a mean depth of 758X. 429 patients were male (56.5%) and 20 cases were post allogeneic stem cell transplantation. The most common tumor types sequenced were Follicular lymphoma (11.9%), DLBCL (11.3%), and AML (11.0%). We identified 4,935 mutations from 732 samples. The most commonly altered genes were TP53, KMT2D, and CREBBP. Implementation of the MSK-IMPACT Heme workflow enabled the characterization of complex tumor specimens, including sorted cells and tumor samples from post-transplant chimeric patients. The joint utilization of matched patient and donor normal tissues enabled differentiation between somatic alterations and both host and donor derived common polymorphisms.
Conclusions:
The MSK-IMPACT Heme assay provides molecular profiling of hematologic malignancies with high accuracy and sensitivity. Paired analysis of tumors and patient and/or donor matched normal tissue samples enables the unambiguous detection of somatic alterations and the ability apply these data towards tumor classification, risk assessment, prognosis, disease monitoring, and treatment optimization.
Citation Format: Ryan N. Ptashkin, Ryma Benayed, John Ziegler, Anoop Balakrishnan Rema, Justyna Sadowska, Iwona Kiecka, Caleb Ho, JinJuan Yao, Christine Moung, Kseniya Petrova-Drus, Khedoudja Nafa, Connie Batlevi, Martin Tallman, Ross Levine, Sergio Giralt, Anas Younes, Marc Ladanyi, Mike Berger, Ahmet Zehir, Maria E. Arcila. MSK-IMPACT Heme: Validation and clinical experience of a comprehensive molecular profiling platform for hematologic malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3409.
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Affiliation(s)
| | - Ryma Benayed
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - John Ziegler
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Iwona Kiecka
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Caleb Ho
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - JinJuan Yao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Ross Levine
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Ladanyi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mike Berger
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Zehir
- Memorial Sloan Kettering Cancer Center, New York, NY
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Bolton K, Ptashkin R, Braunstein L, Gao T, Devlin SM, Kelly D, Coombs C, Patel M, Moarii M, Bernard E, Berthon A, Boucai L, Glodzik D, Martin A, Stadler Z, Walsh M, Mandelker D, Patel A, Schulman J, Gundem G, Syed A, Arcila M, Solit DB, Robson ME, Ladanyi M, Lee C, Philip J, Bajorin D, Garcia-Closas M, Gardos S, Hyman D, Tallman M, Yabe M, Offit K, Scher H, Klimek V, Diaz L, Chatterjee N, Berger MF, Morton L, Levine R, Zehir A, Papaemmanuil E. Abstract LB-304: Oncologic therapy for solid tumors alters the risk of clonal hematopoiesis. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-lb-304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Solid tumor patients often suffer from cytopenias and are at risk for therapy-related myeloid neoplasms (tMN). Somatic mutations in leukemia-associated genes can occur in normal healthy individuals, referred to as clonal hematopoiesis (CH). CH is associated with cytopenias, risk of leukemia and cardiovascular disease. We and others have shown that CH is frequent in cancer patients. Characterization of the relationship between exposure to specific oncologic regimens and CH and how these relate to cytopenias and tMN risk would inform treatment decisions and tMN prevention strategies.
To determine the relationship between CH and oncologic therapy we interrogated CH in a cohort of 9045 solid tumor patients. Subjects were sequenced using a targeted panel of cancer-associated mutations used to screen tumor samples against a blood control sample. Mutation detection was performed on blood-derived sequencing data using the matched tumor as a comparator and accounted for background sequencing error rates.
CH was identified in 23% of patients. In multivariate regression analyses adjusted by age, CH was more often found in current smokers (OR=1.20, 95%CI=1.07-1.35, p<0.001) and less often found in Asians compared to Whites (OR=0.72, 95%CI=0.56-0.89, p<0.001). Smoking was associated with CH mutations in ASXL1 (OR=3.75, 95%CI=2.73-5.17, p<0.001). There was a higher proportion of patients with CH among those who had received chemotherapy (OR=1.14, 95%CI=1.02-1.26, p=0.02) and those who had received external beam radiation therapy (OR=1.45, 95%CI=1.28-1.63, p<0.001) prior to blood collection. Mutations in the DNA repair/cell cycle pathway (including TP53, PPM1D and CHEK2) were more common among patients who received chemotherapy and radiation therapy prior to IMPACT testing compared to those who were treatment naïve (p<0.001). Exposure to prior cytotoxic chemotherapy (OR=1.20, 95%CI=1.02-1.30; p=0.007) and radiation therapy (OR=1.6, 95%CI=1.4-1.9, p<0.001) was associated with having CH while exposure to immunotherapy and targeted therapy was not. Increasing cumulative dose of chemotherapy overall and cytotoxic therapy was associated with a higher likelihood of CH (p=0.015 and p=0.007 respectively). There was evidence of specific gene, treatment and dosage effects. To further examine the relationship between oncologic therapy and clonal evolution of CH, we collected 375 sequential samples at least 18 months apart. T mean change in VAF of CH mutations per year was found to increase by 0.17% in patients who did not receive further therapy during the follow-up time and 0.49% in those who were exposed to cytotoxic chemotherapy. A subset of patients with CH were consented to germline testing for cancer predisposition genes (N=6368). We observe a higher rate of CH among patients with a germline mutation in the cell cycle/DNA repair pathway (i.e. TP53) when compared to patients without germline mutations (OR=3.7, 95% CI: 1.35-9.35, p-value=0.01).
CH is frequent in solid tumor patients and can be reliably detected when a matched tumor normal targeted gene sequencing approach is performed. Beyond age, CH is strongly associated with race, smoking and importantly prior exposure to oncologic therapy with evidence of specific treatment effects. Screening of CH in cancer cohorts is critical to the development of future clinical guidelines and risk-adapted prevention strategies for tMN.
Note: This abstract was not presented at the meeting.
Citation Format: Kelly Bolton, Ryan Ptashkin, Lior Braunstein, Teng Gao, Sean M. Devlin, Daniel Kelly, Catherine Coombs, Minal Patel, Matahi Moarii, Elsa Bernard, Antonin Berthon, Laura Boucai, Dominik Glodzik, Axel Martin, Zsofia Stadler, Michael Walsh, Diana Mandelker, Akshar Patel, Jessica Schulman, Gunes Gundem, Aijazuddin Syed, Maria Arcila, David B. Solit, Mark E. Robson, Marc Ladanyi, Choonsik Lee, John Philip, Dean Bajorin, Montserrat Garcia-Closas, Stuart Gardos, David Hyman, Martin Tallman, Mariko Yabe, Kenneth Offit, Howard Scher, Virginia Klimek, Luis Diaz, Nilanjan Chatterjee, Michael F. Berger, Lindsay Morton, Ross Levine, Ahmet Zehir, Elli Papaemmanuil. Oncologic therapy for solid tumors alters the risk of clonal hematopoiesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-304.
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Affiliation(s)
- Kelly Bolton
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryan Ptashkin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Teng Gao
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Daniel Kelly
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Minal Patel
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Elsa Bernard
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Laura Boucai
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Axel Martin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Michael Walsh
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Akshar Patel
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Gunes Gundem
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Maria Arcila
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Marc Ladanyi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - John Philip
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean Bajorin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Stuart Gardos
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Hyman
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mariko Yabe
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Offit
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Howard Scher
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Luis Diaz
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Ross Levine
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Zehir
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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Lin RJ, Elko TA, Devlin SM, Perales MA, Papadopoulos EB, Castro-Malaspina H, Gyurkocza B, Shaffer BC, Tamari R, Tallman M, Stein E, Goldberg AD, Maloy MA, Giralt SA, Jakubowski AA. Impact of Pre-Transplant Measurable Residual Disease on Relapse Incidence and Progression-Free Survival in Older AML/MDS Patients Following Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ignatz-Hoover JJ, Wang V, Mackowski NM, Roe AJ, Ghansah IK, Ueda M, Lazarus HM, de Lima M, Paietta E, Fernandez H, Cripe L, Tallman M, Wald DN. Aberrant GSK3β nuclear localization promotes AML growth and drug resistance. Blood Adv 2018; 2:2890-2903. [PMID: 30385433 PMCID: PMC6234355 DOI: 10.1182/bloodadvances.2018016006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/23/2018] [Indexed: 12/12/2022] Open
Abstract
Acute myeloid leukemia (AML) is a devastating disease with poor patient survival. As targetable mutations in AML are rare, novel oncogenic mechanisms are needed to define new therapeutic targets. We identified AML cells that exhibit an aberrant pool of nuclear glycogen synthase kinase 3β (GSK3β). This nuclear fraction drives AML growth and drug resistance. Nuclear, but not cytoplasmic, GSK3β enhances AML colony formation and AML growth in mouse models. Nuclear GSK3β drives AML partially by promoting nuclear localization of the NF-κB subunit, p65. Finally, nuclear GSK3β localization has clinical significance as it strongly correlates to worse patient survival (n = 86; hazard ratio = 2.2; P < .01) and mediates drug resistance in cell and animal models. Nuclear localization of GSK3β may define a novel oncogenic mechanism in AML and represent a new therapeutic target.
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MESH Headings
- Animals
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Cell Line, Tumor
- Cell Nucleus/metabolism
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Drug Resistance, Neoplasm
- Female
- Glycogen Synthase Kinase 3 beta/metabolism
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Myeloid-Lymphoid Leukemia Protein/metabolism
- NF-kappa B/metabolism
- Oncogene Proteins, Fusion/metabolism
- Proportional Hazards Models
- Survival Rate
- Transplantation, Heterologous
- Up-Regulation
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Affiliation(s)
| | - Victoria Wang
- Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA
| | | | - Anne J Roe
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Isaac K Ghansah
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Masumi Ueda
- Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Hillard M Lazarus
- Department of Hematology and Oncology, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH
| | - Marcos de Lima
- Department of Hematology and Oncology, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH
| | | | - Hugo Fernandez
- Department of Blood and Marrow Transplant, Moffitt Cancer Center, Tampa, FL
| | - Larry Cripe
- Department of Medicine, Indiana University, Indianapolis, IN
| | - Martin Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - David N Wald
- Department of Pathology, Case Western Reserve University, Cleveland, OH
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, OH
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17
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Preston EV, Chinapen S, Borrill T, Davis E, Shaffer BC, Tamari R, Jakubowski AA, Perales MA, Ponce DM, Shah GL, Dahi PB, Barker JN, Berman E, Tallman M, Giralt SA, Stein E, Gyurkocza B. Disease Progression is Main Barrier to Allogeneic Hematopoietic Stem Cell Transplantation (HCT) in Patients with Newly Diagnosed and Relapsed Acute Leukemia. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Kunimoto H, Meydan C, Nazir A, Whitfield J, Shank K, Rapaport F, Maher R, Pronier E, Meyer SC, Garrett-Bakelman FE, Tallman M, Melnick A, Levine RL, Shih AH. Cooperative Epigenetic Remodeling by TET2 Loss and NRAS Mutation Drives Myeloid Transformation and MEK Inhibitor Sensitivity. Cancer Cell 2018; 33:44-59.e8. [PMID: 29275866 PMCID: PMC5760367 DOI: 10.1016/j.ccell.2017.11.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/02/2017] [Accepted: 11/17/2017] [Indexed: 12/11/2022]
Abstract
Mutations in epigenetic modifiers and signaling factors often co-occur in myeloid malignancies, including TET2 and NRAS mutations. Concurrent Tet2 loss and NrasG12D expression in hematopoietic cells induced myeloid transformation, with a fully penetrant, lethal chronic myelomonocytic leukemia (CMML), which was serially transplantable. Tet2 loss and Nras mutation cooperatively led to decrease in negative regulators of mitogen-activated protein kinase (MAPK) activation, including Spry2, thereby causing synergistic activation of MAPK signaling by epigenetic silencing. Tet2/Nras double-mutant leukemia showed preferential sensitivity to MAPK kinase (MEK) inhibition in both mouse model and patient samples. These data provide insights into how epigenetic and signaling mutations cooperate in myeloid transformation and provide a rationale for mechanism-based therapy in CMML patients with these high-risk genetic lesions.
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Affiliation(s)
- Hiroyoshi Kunimoto
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Cem Meydan
- Institute for Computational Biomedicine and Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Abbas Nazir
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Justin Whitfield
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kaitlyn Shank
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Franck Rapaport
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Rebecca Maher
- University of Connecticut School of Medicine, Farmington, CT 06032, USA
| | - Elodie Pronier
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sara C Meyer
- Division of Hematology, University Hospital Basel, 4031 Basel, Switzerland; Department of Biomedicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Francine E Garrett-Bakelman
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medical College, New York, NY 10065, USA; Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA; Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA 22908, USA
| | - Martin Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ari Melnick
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medical College, New York, NY 10065, USA; Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Ross L Levine
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Alan H Shih
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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19
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Hill BT, Ahn KW, Hu ZH, Aljurf M, Beitinjaneh A, Cahn JY, Cerny J, Kharfan-Dabaja MA, Ganguly S, Ghosh N, Grunwald MR, Inamoto Y, Kindwall-Keller T, Nishihori T, Olsson RF, Saad A, Seftel M, Seo S, Szer J, Tallman M, Ustun C, Wiernik PH, Maziarz RT, Kalaycio M, Alyea E, Popat U, Sobecks R, Saber W. Assessment of Impact of HLA Type on Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Lymphocytic Leukemia. Biol Blood Marrow Transplant 2017; 24:581-586. [PMID: 29032274 DOI: 10.1016/j.bbmt.2017.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/04/2017] [Indexed: 01/24/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy with many highly effective therapies. Chemorefractory disease, often characterized by deletion of chromosome 17p, has historically been associated with very poor outcomes, leading to the application of allogeneic hematopoietic stem cell transplantation (allo-HCT) for medically fit patients. Although the use of allo-HCT has declined since the introduction of novel targeted therapy for the treatment of CLL, there remains significant interest in understanding factors that may influence the efficacy of allo-HCT, the only known curative treatment for CLL. The potential benefit of transplantation is most likely due to the presence of alloreactive donor T cells that mediate the graft-versus-leukemia (GVL) effect. The recognition of potentially tumor-specific antigens in the context of class I and II major histocompatibility complex on malignant B lymphocytes by donor T cells may be influenced by subtle differences in the highly polymorphic HLA locus. Given previous reports of specific HLA alleles impacting the incidence of CLL and the clinical outcomes of allo-HCT for CLL, we sought to study the overall survival and progression-free survival of a large cohort of patients with CLL who underwent allo-HCT from fully HLA-matched related and unrelated donors at Center for International Blood and Marrow Transplant Research transplantation centers. We found no statistically significant association of allo-HCT outcomes in CLL based on previously reported HLA combinations. Additional study is needed to further define the immunologic features that portend a more favorable GVL effect after allo-HCT for CLL.
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Affiliation(s)
- Brian T Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplantation and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Center for International Blood and Marrow Transplantation and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | | | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Jan Cerny
- UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, National Cancer Research Center East, Chiba, Japan
| | - Jeffrey Szer
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
| | - Martin Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Celalettin Ustun
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - Richard T Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Edwin Alyea
- Center of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Uday Popat
- M.D. Anderson Cancer Center, Houston, Texas
| | | | - Wael Saber
- Center for International Blood and Marrow Transplantation and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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20
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Liu HD, Ahn KW, Hu ZH, Hamadani M, Nishihori T, Wirk B, Beitinjaneh A, Rizzieri D, Grunwald MR, Sabloff M, Olsson RF, Bajel A, Bredeson C, Daly A, Inamoto Y, Majhail N, Saad A, Gupta V, Gerds A, Malone A, Tallman M, Reshef R, Marks DI, Copelan E, Gergis U, Savoie ML, Ustun C, Litzow MR, Cahn JY, Kindwall-Keller T, Akpek G, Savani BN, Aljurf M, Rowe JM, Wiernik PH, Hsu JW, Cortes J, Kalaycio M, Maziarz R, Sobecks R, Popat U, Alyea E, Saber W. Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia. Biol Blood Marrow Transplant 2017; 23:767-775. [PMID: 28115276 DOI: 10.1016/j.bbmt.2017.01.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 06/16/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for patients with chronic myelomonocytic leukemia (CMML); however, few data exist regarding prognostic factors and transplantation outcomes. We performed this retrospective study to identify prognostic factors for post-transplantation outcomes. The CMML-specific prognostic scoring system (CPSS) has been validated in subjects receiving nontransplantation therapy and was included in our study. From 2001 to 2012, 209 adult subjects who received HCT for CMML were reported to the Center for International Blood and Marrow Transplant Research. The median age at transplantation was 57 years (range, 23 to 74). Median follow-up was 51 months (range, 3 to 122). On multivariate analyses, CPSS scores, Karnofsky performance status (KPS), and graft source were significant predictors of survival (P = .004, P = .01, P = .01, respectively). Higher CPSS scores were not associated with disease-free survival, relapse, or transplantation-related mortality. In a restricted analysis of subjects with relapse after HCT, those with intermediate-2/high risk had a nearly 2-fold increased risk of death after relapse compared to those with low/intermediate-1 CPSS scores. Respective 1-year, 3-year, and 5-year survival rates for low/intermediate-1 risk subjects were 61% (95% confidence interval [CI], 52% to 72%), 48% (95% CI, 37% to 59%), and 44% (95% CI, 33% to 55%), and for intermediate-2/high risk subjects were 38% (95% CI, 28% to 49%), 32% (95% CI, 21% to 42%), and 19% (95% CI, 8% to 29%). We conclude that higher CPSS score at time of transplantation, lower KPS, and a bone marrow graft are associated with inferior survival after HCT. Further investigation of CMML disease-related biology may provide insights into other risk factors predictive of post-transplantation outcomes.
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Affiliation(s)
- Hien Duong Liu
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Amer Beitinjaneh
- Department of Hematology and Oncology, University of Miami Sylvester Cancer Center, Miami, Florida
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Ashish Bajel
- Department of Haematology and Bone Marrow Transplant, Royal Melbourne Hospital, Victoria, Australia
| | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew Daly
- Department of Medicine, Tom Baker Cancer Centre, Calgary, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Canada
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Navneet Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Vikas Gupta
- Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aaron Gerds
- Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Adriana Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Martin Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan, New York, New York
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - David I Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Usama Gergis
- Hematologic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Mary Lynn Savoie
- Division of Hematology and Hematologic Malignancies, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Celalettin Ustun
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Mark R Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Gorgun Akpek
- Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Jack W Hsu
- Division of Hematology and Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, Florida
| | - Jorge Cortes
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matt Kalaycio
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Richard Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Ronald Sobecks
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Uday Popat
- Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas
| | - Edwin Alyea
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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21
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Coombs C, Zehir A, Devlin S, Middha S, Cheng D, Kishtagari A, Hyman D, Solit D, Robson M, Baselga J, Arcila M, Tallman M, Levine R, Berger M. Abstract 2640: Clonal hematopoiesis identified by matched-normal blood sequencing of solid tumor patients without hematologic malignancy is common and is associated with decreased overall survival. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent genomic studies have identified somatic mutations in leukemia genes in asymptomatic individuals without hematologic malignancy. A subset of patients (pts) with clonal hematopoiesis (CH) subsequently develops hematologic malignancies. However, the incidence of CH in pts with solid tumors has not been extensively studied. We sought to assess for CH and its associated clinical impact in pts with solid tumors who were profiled using paired tumor/blood sequencing.
Methods: This study included pts who were consented on protocol NCT01775072. All had tumor and blood genomic profiling using the MSK-IMPACT hybridization capture-based next-generation sequencing assay, encompassing all protein-coding exons of 410 cancer-associated genes. In matched blood, we investigated for hotspot mutations from COSMIC database (v71) and non-hotspot mutations in leukemia-associated genes and genes reported in prior CH studies. Mutations were scored as present if variant allele frequency (VAF) in blood was greater than 2% and at least twice the VAF seen in tumor. For cases where at least one mutation exceeded these thresholds, we reduced the VAF threshold in blood to 1% to detect subsequent events. Mutations with VAF >35% in both blood and tumor were excluded as likely germline events.
Results: We analyzed 2,146 pts, including 239 pts (11%) with CH. Most commonly identified mutations were in DNMT3A, TET2, and TP53, seen in 167, 52, and 18 pts, respectively. The mean age at time of testing was 62.6 years in pts with CH and 55.4 years in pts without CH (p< 0.001). When comparing baseline blood parameters, there were no statistically significant differences except for higher MCV in CH vs. non-CH pts (91 vs. 90, p = 0.047). 51% of pts with CH had previous radiation therapy compared to 45% of pts without clonal mutations in their blood (p = 0.057). There was no statistically significant difference in the proportion of pts who had received previous chemotherapy (71% of pts in each group). On prospective follow up of pts with CH, no pts have progressed to develop overt hematologic malignancy, with limited follow up (median 13.1 months). Overall survival (OS) was estimated for pts without CH (n = 1907; 1-yr OS: 0.70), CH with 1 mutation (n = 184; 1-yr OS: 0.64), and CH with >1 mutation (n = 55; 1-yr OS: 0.59). The univariate hazard ratios were 1.16 (p = 0.269) and 1.63 (p = 0.015) for 1 mutation and >1 mutation, respectively, when compared to pts without CH. After adjusting for age and sex, a marginal OS association persisted for >1 mutation compared to no CH (HR: 1.46, p = 0.060)
Conclusions: CH is common among solid tumor pts without known hematologic malignancy, occurring in 11% of pts, and appears to be associated with decreased OS. Analyses will be replicated in a larger cohort with longer follow up to determine the clinical impact of these mutations in cancer pts.
Citation Format: Catherine Coombs, Ahmet Zehir, Sean Devlin, Sumit Middha, Donavan Cheng, Ashwin Kishtagari, David Hyman, David Solit, Mark Robson, Jose Baselga, Maria Arcila, Martin Tallman, Ross Levine, Michael Berger. Clonal hematopoiesis identified by matched-normal blood sequencing of solid tumor patients without hematologic malignancy is common and is associated with decreased overall survival. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2640.
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Affiliation(s)
| | - Ahmet Zehir
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sumit Middha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Donavan Cheng
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - David Hyman
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Solit
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Arcila
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ross Levine
- Memorial Sloan Kettering Cancer Center, New York, NY
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22
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Shaffer BC, Ahn KW, Hu ZH, Nishihori T, Malone AK, Valcárcel D, Grunwald MR, Bacher U, Hamilton B, Kharfan-Dabaja MA, Saad A, Cutler C, Warlick E, Reshef R, Wirk BM, Sabloff M, Fasan O, Gerds A, Marks D, Olsson R, Wood WA, Costa LJ, Miller AM, Cortes J, Daly A, Kindwall-Keller TL, Kamble R, Rizzieri DA, Cahn JY, Gale RP, William B, Litzow M, Wiernik PH, Liesveld J, Savani BN, Vij R, Ustun C, Copelan E, Popat U, Kalaycio M, Maziarz R, Alyea E, Sobecks R, Pavletic S, Tallman M, Saber W. Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome. J Clin Oncol 2016; 34:1864-71. [PMID: 27044940 DOI: 10.1200/jco.2015.65.0515] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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
PURPOSE To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). PATIENTS AND METHODS We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. RESULTS Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 × 10(9)/L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high (≥ 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P < .001). Increasing score was predictive of increased relapse (P < .001) and treatment-related mortality (P < .001) in the HLA-matched set and relapse (P < .001) in the HLA-mismatched cohort. CONCLUSION The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.
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Affiliation(s)
- Brian C Shaffer
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Kwang Woo Ahn
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Zhen-Huan Hu
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Taiga Nishihori
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Adriana K Malone
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - David Valcárcel
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Michael R Grunwald
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ulrike Bacher
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Betty Hamilton
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Mohamed A Kharfan-Dabaja
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ayman Saad
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Corey Cutler
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Erica Warlick
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ran Reshef
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Baldeep Mona Wirk
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Mitchell Sabloff
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Omotayo Fasan
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Aaron Gerds
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - David Marks
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Richard Olsson
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - William Allen Wood
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Luciano J Costa
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Alan M Miller
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Jorge Cortes
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Andrew Daly
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Tamila L Kindwall-Keller
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Rammurti Kamble
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - David A Rizzieri
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Jean-Yves Cahn
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Robert Peter Gale
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Basem William
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Mark Litzow
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Peter H Wiernik
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Jane Liesveld
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Bipin N Savani
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ravi Vij
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Celalettin Ustun
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Edward Copelan
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Uday Popat
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Matt Kalaycio
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Richard Maziarz
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Edwin Alyea
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ron Sobecks
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Steven Pavletic
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Martin Tallman
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Wael Saber
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
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Tallman M, Lo-Coco F, Barnes G, Kruse M, Wildner R, Martin M, Mueller U, Tang B. Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States. Clin Lymphoma Myeloma Leuk 2015; 15:771-7. [PMID: 26361645 DOI: 10.1016/j.clml.2015.07.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/16/2015] [Accepted: 07/28/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study estimated the cost-effectiveness of arsenic trioxide (ATO) added to all-trans retinoic acid (ATRA) when used in first-line acute promyelocytic leukemia (APL) treatment. MATERIALS AND METHODS A Markov cohort model was developed with 3 states: stable disease (during first- or second-line treatment), disease event, and death. Newly diagnosed patients with low- to intermediate-risk APL were included and each month could remain in their current health state or move to another. Treatment consisted of ATO + ATRA, ATRA + idarubicin (IDA), or ATRA + cytarabine (AraC) + additional chemotherapy. After an initial disease event, patients discontinued first-line therapy and switched to a second-line ATO regimen. Efficacy and safety data were obtained from published trials; quality of life/utility estimates were obtained from the literature; costs were obtained from US data sources. Costs and outcomes over time were used to calculate incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted. RESULTS Compared to ATRA + AraC + additional chemotherapy, ATRA + IDA treatment had ICERs of $2933 per life-year (LY) saved and $3122 per quality-adjusted life-year (QALY) gained. Compared to the ATRA + IDA regimen, first-line ATO + ATRA treatment had ICERs of $4512 per LY saved and $5614 per QALY gained. Results were sensitive to changes in pharmacy costs of the ATO + ATRA regimen during consolidation. CONCLUSION The ATO + ATRA regimen is highly cost-effective compared to ATRA + AraC + additional chemotherapy or ATRA + IDA in the treatment of newly diagnosed low- to intermediate-risk APL patients.
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Shih AH, Jiang Y, Meydan C, Shank K, Pandey S, Barreyro L, Antony-Debre I, Viale A, Socci N, Sun Y, Robertson A, Cavatore M, de Stanchina E, Hricik T, Rapaport F, Woods B, Wei C, Hatlen M, Baljevic M, Nimer SD, Tallman M, Paietta E, Cimmino L, Aifantis I, Steidl U, Mason C, Melnick A, Levine RL. Mutational cooperativity linked to combinatorial epigenetic gain of function in acute myeloid leukemia. Cancer Cell 2015; 27:502-15. [PMID: 25873173 PMCID: PMC4518555 DOI: 10.1016/j.ccell.2015.03.009] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/24/2014] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
Abstract
Specific combinations of acute myeloid leukemia (AML) disease alleles, including FLT3 and TET2 mutations, confer distinct biologic features and adverse outcome. We generated mice with mutations in Tet2 and Flt3, which resulted in fully penetrant, lethal AML. Multipotent Tet2(-/-);Flt3(ITD) progenitors (LSK CD48(+)CD150(-)) propagate disease in secondary recipients and were refractory to standard AML chemotherapy and FLT3-targeted therapy. Flt3(ITD) mutations and Tet2 loss cooperatively remodeled DNA methylation and gene expression to an extent not seen with either mutant allele alone, including at the Gata2 locus. Re-expression of Gata2 induced differentiation in AML stem cells and attenuated leukemogenesis. TET2 and FLT3 mutations cooperatively induce AML, with a defined leukemia stem cell population characterized by site-specific changes in DNA methylation and gene expression.
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Affiliation(s)
- Alan H Shih
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yanwen Jiang
- Institute for Computational Biomedicine and Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA; Department of Medicine/Hematology-Oncology and Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Cem Meydan
- Institute for Computational Biomedicine and Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Kaitlyn Shank
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Suveg Pandey
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Laura Barreyro
- Department of Cell Biology and Division of Hematologic Malignancies, Department of Medicine (Oncology), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Ileana Antony-Debre
- Department of Cell Biology and Division of Hematologic Malignancies, Department of Medicine (Oncology), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Agnes Viale
- Genomics Core, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nicholas Socci
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yongming Sun
- Life Technologies, South San Francisco, CA 94080, USA
| | | | - Magali Cavatore
- Genomics Core, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elisa de Stanchina
- Antitumor Assessment Core, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Todd Hricik
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Franck Rapaport
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Brittany Woods
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Chen Wei
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Megan Hatlen
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Muhamed Baljevic
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen D Nimer
- Sylvester Cancer Center, University of Miami, Miami, FL 33136, USA
| | - Martin Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Luisa Cimmino
- Department of Pathology and Howard Hughes Medical Institute, NYU School of Medicine, New York, NY 10016, USA
| | - Iannis Aifantis
- Department of Pathology and Howard Hughes Medical Institute, NYU School of Medicine, New York, NY 10016, USA
| | - Ulrich Steidl
- Department of Cell Biology and Division of Hematologic Malignancies, Department of Medicine (Oncology), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Chris Mason
- Institute for Computational Biomedicine and Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Ari Melnick
- Department of Medicine/Hematology-Oncology and Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA; Weill Cornell Medical College, Cornell University, 413 E 69th Street, BB-1462, New York, NY 10021, USA.
| | - Ross L Levine
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 20, New York, NY 10065, USA.
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Stein E, Tallman M, Pollyea DA, Flinn IW, Fathi AT, Stone RM, Levine RL, Agresta S, Schenkein D, Yang H, Fan B, Yen K, Botton SD. Abstract CT103: Clinical safety and activity in a phase I trial of AG-221, a first in class, potent inhibitor of the IDH2-mutant protein, in patients with IDH2 mutant positive advanced hematologic malignancies. Clin Trials 2014. [DOI: 10.1158/1538-7445.am2014-ct103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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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Chung S, Kim E, Park J, Chung YR, Tallman M, Abdel-Wahab O, Park C. BRAFV600E mutations occur in hematopoietic stem cells in hairy cell leukemia. Exp Hematol 2014. [DOI: 10.1016/j.exphem.2014.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hobbs G, Kishtagari A, Hilden P, Barker JN, Jakubowski AA, Papadopoulos E, Devlin S, Boulad F, Kernan N, Kobos R, Steinherz PG, O'Reilly R, Giralt SA, Tallman M, Stein E, Perales MA. Do Patients with High Risk or Relapsed Core Binding Factor Acute Myeloid Leukemia Benefit from Salvage Allogeneic Stem Cell Transplantation? Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Deininger MW, Kopecky KJ, Radich JP, Kamel-Reid S, Stock W, Paietta E, Emanuel PD, Tallman M, Wadleigh M, Larson RA, Lipton JH, Slovak ML, Appelbaum FR, Druker BJ. Imatinib 800 mg daily induces deeper molecular responses than imatinib 400 mg daily: results of SWOG S0325, an intergroup randomized PHASE II trial in newly diagnosed chronic phase chronic myeloid leukaemia. Br J Haematol 2013; 164:223-32. [PMID: 24383843 DOI: 10.1111/bjh.12618] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
The standard dose of imatinib for newly diagnosed patients with chronic phase chronic myeloid leukaemia (CP-CML) is 400 mg daily (IM400), but the optimal dose is unknown. This randomized phase II study compared the rates of molecular, haematological and cytogenetic response to IM400 vs. imatinib 400 mg twice daily (IM800) in 153 adult patients with CP-CML. Dose adjustments for toxicity were flexible to maximize retention on study. Molecular response (MR) at 12 months was deeper in the IM800 arm (4-log reduction of BCR-ABL1 mRNA: 25% vs. 10% of patients, P = 0·038; 3-log reduction: 53% vs. 35%, P = 0·049). During the first 12 months BCR-ABL1 levels in the IM800 arm were an average 2·9-fold lower than in the IM400 arm (P = 0·010). Complete haematological response was similar, but complete cytogenetic response was higher with IM800 (85% vs. 67%, P = 0·040). Grade 3-4 toxicities were more common for IM800 (58% vs. 31%, P = 0·0007), and were most commonly haematological. Few patients have relapsed, progressed or died, but both progression-free (P = 0·048) and relapse-free (P = 0·031) survival were superior for IM800. In newly diagnosed CP-CML patients, IM800 induced deeper MRs than IM400, with a trend for improved progression-free and overall survival, but was associated with more severe toxicity.
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Barreyro L, Mitchell K, Will B, Bartholdy B, Zhou L, Todorova T, Stanley R, Ben-Neriah S, Montagna C, Parekh S, Pellagatti A, Boultwood J, Paietta E, Ketterling R, Cripe L, Fernandez H, Greenberg P, Rowe J, Tallman M, Steidl C, Mitsiades C, Verma A, Steidl U. Abstract C225: IL1RAP as functionally relevant target for stem-cell directed therapy in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Mol Cancer Ther 2013. [DOI: 10.1158/1535-7163.targ-13-c225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite the established use of poly-chemotherapy, relapse continues to be the most common cause of death in AML and MDS and cure rates remain below 20%. AML/MDS arise following the accumulation of stepwise genetic and epigenetic changes in hematopoietic stem and progenitor cells (HSPC).
Utilizing a novel strategy of parallel transcriptional analysis of sorted HSPC populations in distinct subtypes of AML, we compared the gene expression in AML HSPC with identical compartments from age-matched healthy controls and identified Interleukin 1 receptor accessory protein (IL1RAP) as one of the most significantly upregulated genes in HSPC in all examined subtypes of AML. Fluorescence in situ hybridization of sorted IL1RAP+ and IL1RAP- cells from patients with monosomy 7 AML (-7) indicated that the aberrant clone was restricted to IL1RAP+ cells, demonstrating that IL1RAP overexpression is a distinguishing feature of the -7 clone. Multivariate analysis of a large cohort of patients with normal karyotype AML showed that patients with high IL1RAP levels had inferior overall survival than patients with lower IL1RAP levels, suggesting an independent prognostic value for this molecule in AML. IL1RAP expression levels in MDS were found elevated on stem cells of patients with high risk disease, proposing a role of IL1RAP in higher risk MDS and progression to AML.
Downregulation of IL1RAP expression by lentivirally expressed shRNAs decreased clonogenicity in cell lines and AML/MDS primary patient samples, induced apoptosis of AML cells, and reduced proliferation of AML cells and infiltration of hematopoietic organs in vivo. IL1RAP is a transmembrane protein required for signaling through several receptors of the IL1 family. Downregulation of IL1RAP expression in AML cells led to phosphorylation changes in several kinases and their substrates suggesting participation of IL1RAP in multiple signaling pathways and highlighting its potential as therapeutic target.
We investigated whether inhibition of IL1RAP with pharmacological compounds is feasible and effective. Antibody-mediated inhibition of IL1RAP led to inhibition of AML cell growth in vitro. In addition, we designed peptides to interfere with IL1RAP-receptor interactions which lead to inhibition of AML cell growth. Both types of agents are being further tested and optimized.
In summary, our study reveals IL1RAP as aberrantly expressed on HSPC of AML and high-risk MDS patients. Inhibition of IL1RAP is feasible and functionally effective, and thus has the potential to lead to novel therapies specifically directed at such stem cells.
Beyond IL1RAP, our study provides a map of dysregulated transcripts in HSPC from patients with AML, which may offer further opportunities for therapeutic intervention. The strategy of comparative analysis of sorted stem and progenitor cells in cancer versus healthy controls may be applicable to other type of cancers with a suspected stem cell origin, and instrumental for the identification of targets for stem cell-directed therapy.
Citation Information: Mol Cancer Ther 2013;12(11 Suppl):C225.
Citation Format: Laura Barreyro, Kelly Mitchell, Britta Will, Boris Bartholdy, Li Zhou, Tihomira Todorova, Robert Stanley, Susana Ben-Neriah, Cristina Montagna, Samir Parekh, Andrea Pellagatti, Jacqueline Boultwood, Elisabeth Paietta, Rhett Ketterling, Larry Cripe, Hugo Fernandez, Peter Greenberg, Jacob Rowe, Martin Tallman, Christian Steidl, Constantine Mitsiades, Amit Verma, Ulrich Steidl. IL1RAP as functionally relevant target for stem-cell directed therapy in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr C225.
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Affiliation(s)
| | | | - Britta Will
- 1Albert Einstein College of Medicine, Bronx, NY
| | | | - Li Zhou
- 1Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | | | - Andrea Pellagatti
- 4Leukaemia & Lymphoma Research Molecular Haematology Unit, Oxford, United Kingdom
| | - Jacqueline Boultwood
- 4Leukaemia & Lymphoma Research Molecular Haematology Unit, Oxford, United Kingdom
| | | | | | - Larry Cripe
- 6Indiana University Simon Cancer Center, Indianapolis, IN
| | - Hugo Fernandez
- 7Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Jacob Rowe
- 9Shaare Zedek Medical Center, Israel, Israel
| | | | - Christian Steidl
- 2Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | | | - Amit Verma
- 1Albert Einstein College of Medicine, Bronx, NY
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Zeidan A, Zhuoxin S, Prebet T, Greenberg P, Juckett M, Smith M, Paietta E, Gabrilove J, Erba H, Gore S, Tallman M. P-124 Application of the French Prognostic Score to assess overall survival in a US-based cohort of patients treated with azacitidine. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mascarenhas J, Heaney ML, Najfeld V, Hexner E, Abdel-Wahab O, Rampal R, Ravandi F, Petersen B, Roboz G, Feldman E, Podoltsev N, Douer D, Levine R, Tallman M, Hoffman R. Proposed criteria for response assessment in patients treated in clinical trials for myeloproliferative neoplasms in blast phase (MPN-BP): formal recommendations from the post-myeloproliferative neoplasm acute myeloid leukemia consortium. Leuk Res 2012; 36:1500-4. [PMID: 22938832 PMCID: PMC4114151 DOI: 10.1016/j.leukres.2012.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 08/03/2012] [Accepted: 08/09/2012] [Indexed: 11/26/2022]
Abstract
Leukemic transformation (LT) of a myeloproliferative neoplasm (MPN) is associated with a dismal prognosis and no medical therapies have shown a survival improvement in patients with MPN in blast phase (MPN-BP). Effective therapies for the treatment of MPN-BP are a serious unmet need. Consensus response criteria do not exist for the treatment of patients with MPN-BP and this is necessary for the uniformed reporting of treatment response in clinical trials. We have identified relevant MPN and MPN-BP features in order to define treatment response categories that reflect hematological, clinical, pathological, cytogenetic and molecular changes after therapeutic intervention. We plan to validate these proposed response criteria within multi-centered clinical trials.
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Affiliation(s)
- John Mascarenhas
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY, USA.
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Moorman AV, Schwab C, Ensor HM, Russell LJ, Morrison H, Jones L, Masic D, Patel B, Rowe JM, Tallman M, Goldstone AH, Fielding AK, Harrison CJ. IGH@ translocations, CRLF2 deregulation, and microdeletions in adolescents and adults with acute lymphoblastic leukemia. J Clin Oncol 2012; 30:3100-8. [PMID: 22851563 DOI: 10.1200/jco.2011.40.3907] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the prevalence and prognostic impact of significant acute lymphoblastic leukemia (ALL) -related genes: CRLF2 deregulation (CRLF2-d), IGH@ translocations (IGH@-t), and deletions of CDKN2A/B, IKZF1, PAX5, ETV6, RB1, BTG1, and EBF1 in adolescents and adults. PATIENTS AND METHODS The cohort comprised 454 patients (age 15 to 60 years old) treated on the multicenter United Kingdom Acute Lymphoblastic Leukaemia Trial XII/Eastern Cooperative Oncology Group 2993 trial (UKALLXII/ECOG2993) with Philadelphia-negative B-cell precursor ALL. Fluorescent in situ hybridization and multiplex ligation-dependent probe amplification were used to detect these genetic alterations. RESULTS Twenty patients (5%) had CRLF2-d (P2RY8-CRLF2, n = 7; IGH@-CRLF2, n = 13), and 36 patients (8%) harbored an IGH@-t with a different partner gene. There was little overlap between IGH@-t, CRLF2-d, and established chromosomal abnormalities. Deletions of CDKN2A/B, IKZF1, PAX5, ETV6, RB1, BTG1, or EBF1 were prevalent with 101 (33%) of 304 patients harboring one and 102 (33%) harboring two or more alterations, occurring with varying frequency in all cytogenetic subgroups. The 5-year event-free survival, relapse-free survival (RFS), and overall survival (OS) rates for the whole cohort were 40%, 55%, and 43%, respectively. Patients with CRLF2-d, IGH@-t, and IKZF1 deletions were associated with an inferior outcome in univariate but not multivariate analysis. In particular, CRLF2-d patients had a lower RFS compared with other patients (30%), whereas those with IGH@-t or IKZF1 deletions had a lower OS (27% and 35%, respectively). CONCLUSION CRLF2-d and IGH@-t represent distinct subtypes of adolescent and adult ALL. Deletions of key B-cell differentiation and cell cycle control genes are highly prevalent but vary in frequency by cytogenetic subgroup. CRLF2-d, IGH@-t, and IKZF1 deletions are associated with poor outcome in adolescent and adult ALL.
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Affiliation(s)
- Anthony V Moorman
- Leukaemia Research Cytogenetics Group, Northern Institute for Cancer Research, Level 5, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-upon-Tyne, NE1 4LP, United Kingdom.
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Gore S, Sun Z, Prebet T, Greenberg P, Gabrilove J, Erba H, Juckett M, Czader M, Paietta E, Ketterling R, Tallman M. 170 Azacitidine plus entinostat: Results from E1905, the first randomized trial adding a histone deacetylase inhibitor to a DNMT inhibitor (DNMTi). Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70172-2] [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: 11/28/2022]
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Prebet T, Sun Z, Carraway H, Thakar M, Greenberg P, Czader M, Paietta E, Juckett M, Erba H, Gabrilove J, Tallman M, Herman J, Gore S. 299 SOCS1 methylation and azacitidine response in high risk myelodysplasia (MDS) and secondary acute myeloid leukemia (AML). Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mehta J, Mehta J, Frankfurt O, Altman J, Evens A, Tallman M, Gordon L, Williams S, Winter J, Krishnamurthy J, Duffey S, Singh V, Meagher R, Grinblatt D, Kaminer L, Singhal S. Optimizing the CD34 + cell dose for reduced-intensity allogeneic hematopoietic stem cell transplantation. Leuk Lymphoma 2011; 50:1434-41. [PMID: 19603344 DOI: 10.1080/10428190903085944] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Low CD34 + cell doses increase allograft-related mortality and very high doses increase the risk of graft-versus-host disease. The optimum CD34 + cell dose remains undefined. The effect of the CD34 + cell dose based on ideal weight was analyzed in 130 patients with hematologic malignancies undergoing reduced-intensity allogeneic blood cell transplantation in the context of factors known to affect the outcome: chemosensitivity, donor age, lactate dehydrogenase (LDH), human leukocyte antigen (HLA) match, performance status, and platelet count. The survival of patients receiving >8 x 10(6)/kg CD34 + cells was not significantly different from those receiving <6. The outcome of those receiving 6-8 x 10(6)/kg CD34 + cells was significantly better than the rest. This superiority was confirmed in multivariable analysis. Among patients receiving <or=8 x 10(6)/kg CD34 + cells, an increasing number of infused cells was associated with higher overall survival in a continuous fashion (Risk ratio (RR) 0.8759; p = 0.045). Cell dose based on actual weight did not correlate with survival. The number of CD34 + cells infused, a potentially modifiable factor, affects survival after reduced-intensity allogeneic transplantation. We recommend a CD34 + cell dose of 6-8 x 10(6) per kg ideal body weight to optimize outcome. The possible adverse effect of higher cell doses (>8) needs further confirmation.
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Affiliation(s)
- Jayesh Mehta
- The Feinberg School of Medicine, The Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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Parajuli R, Altman J, Kuzel T, Perdekamp M, Tallman M. Renal cell carcinoma and acute promyelocytic leukemia: a nonrandom association? Am J Hematol 2010; 85:829. [PMID: 20721888 DOI: 10.1002/ajh.21813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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37
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Tallman M, Douer D, Gore S, Powell BL, Ravandi F, Rowe J, Ranganathan A, Sanz MA. Treatment of patients with acute promyelocytic leukemia: a consensus statement on risk-adapted approaches to therapy. Clin Lymphoma Myeloma Leuk 2010; 10 Suppl 3:S122-6. [PMID: 21115429 DOI: 10.3816/clml.2010.s.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The integration of all-trans-retinoic acid (ATRA) with anthracycline chemotherapy into up-front regimens for acute promyelocytic leukemia (APL) has produced striking improvements in clinical outcomes, making APL one of the most curable forms of hematologic malignancies in adults. In addition, arsenic trioxide has proven efficacy in relapse and when combined with ATRA in frontline regimens has demonstrated high efficacy in a number of trials and the potential to replace chemotherapy, which would thereby reduce chemotherapy-related adverse events. Cure in APL is also largely dependent on timely and effective supportive care measures that counteract such life-threatening emergencies as coagulopathy and APL differentiation syndrome. The risk of mortality during induction and the risk of relapse following frontline therapy are related to the individual's initial clinical presentation and relapse-risk score at diagnosis; however, these risks are now quite low even in high-risk patients as long as appropriate therapy is initiated expeditiously. Multiple European and North American trials have investigated risk-adapted approaches to the treatment of APL and have reported high success rates. Further refinement of risk-adapted strategies is ongoing and will likely contribute to better patient care. A roundtable conference was conducted to discuss risk-adapted therapy for APL and to develop a consensus statement and approach for clinical oncologists. Expert opinions and evidence-based strategies presented during the roundtable are summarized herein.
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Affiliation(s)
- Martin Tallman
- Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Chicago, IL 60611, USA.
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Lancet J, Feldman E, Kolitz J, Tallman M, Hogge DE, Louie A. Phase IIB Randomized Study of CPX-351 Versus Conventional Cytarabine + Daunorubicin in Newly Diagnosed AML Patients Aged 60-75: An Interim Analysis. Clinical Lymphoma Myeloma and Leukemia 2010. [DOI: 10.3816/clml.2010.n.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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39
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Gregory J, Kim H, Alonzo T, Gerbing R, Woods W, Weinstein H, Shepherd L, Schiffer C, Appelbaum F, Willman C, Wiernik P, Rowe J, Tallman M, Feusner J. Treatment of children with acute promyelocytic leukemia: results of the first North American Intergroup trial INT0129. Pediatr Blood Cancer 2009; 53:1005-10. [PMID: 19743516 PMCID: PMC3508725 DOI: 10.1002/pbc.22165] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This report focuses on the children enrolled on the first North American Intergroup study of APL (INT0129). This study was designed to compare the rates of CR, disease-free survival (DFS), overall survival (OS) and toxicity of therapy with all-trans-retinoic acid (ATRA) for remission induction and/or maintenance compared to conventional chemotherapy in patients with previously untreated APL. PROCEDURE Fifty-three patients who were documented to have the t(15;17) translocation were able to be evaluated for toxicity of treatment, outcome of induction, and survival. RESULTS The overall CR rate was 81%. The estimated 5-year DFS from time of CR was 41% for all patients. The estimated 5-year OS for all patients from entry into the study was 69%. The 5-year DFS from time of CR for patients who were randomized to ATRA for induction or maintenance or both was 48% compared to 0% for patients who never received ATRA (P < 0.0001). CONCLUSIONS The most important finding of our study is that a significant DFS advantage exists for children with APL who received ATRA during induction or maintenance or both compared to children who received no ATRA. Furthermore, remissions in these children appear durable as the OS rates are stable at 10 years.
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Affiliation(s)
- John Gregory
- Morristown Memorial Hospital, Morristown, New Jersey 07962, USA.
| | | | - Todd Alonzo
- University of Southern California, Los Angeles, CA
| | - Rob Gerbing
- Children’s Oncology Group Statistics and Data Center, Arcadia, CA
| | | | | | | | | | | | - Cheryl Willman
- University of New Mexico School of Medicine, Albuquerque, NM
| | | | | | | | - James Feusner
- Children’s Research Hospital of Oakland, Oakland, CA
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Borthakur G, Faderl S, Ravandi F, Padmanabhan S, Stock W, Wu K, Li J, Curt G, Tallman M, Minden M. Clinical, pharmacokinetic (PK), and pharmacodynamic findings from a phase I trial of an Eg5 inhibitor (AZD4877) in patients with refractory acute myeloid leukemia (AML). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
3580 Background: AZD4877 is a potent, specific inhibitor of Eg5 (kinesin spindle protein). The only known function of Eg5 is to separate the centromeres during mitosis. Eg5 inhibition is thus specific for dividing cells, resulting in monoastral mitotic spindles (monoasters) and apoptotic cell death. Preclinically, hematologic tumor cell lines were generally more sensitive to AZD4877 than those derived from solid tumors. Methods: AZD4877 was administered IV daily x 3 as induction for up to 2 cycles, followed by consolidation (daily x 2) for up to 4 cycles. Eligibility criteria were standard. Results: Cohorts of 3–6 patients (pts) were treated at doses of 2, 4, 7, 10, 13, 16, and 18 mg/day. To date, 24 evaluable pts have received 33 induction and 3 consolidation cycles of treatment. Monoasters were detected at all dose levels evaluated (2, 7, 10, 13, and 18 mg/day). The T1/2 of AZD4877 ranged from 26 to 42 hr; PK were linear and drug levels non-cumulative. Myelosuppression, the dose limiting toxicity (DLT) in solid tumor studies, was not considered a DLT in this trial. Mucositis was the DLT at 18 mg/day; with 1 pt developing Gr 3 palmar-plantar syndrome at this dose. Bone marrow biopsies were undertaken at screening and as clinically indicated. In pts with evaluable biopsies, marrow blasts decreased by 60–80% in 2 pts, and by 30–50% in 3 pts, with no response in 3 pts. Conclusions: Enrollment is ongoing at 16 mg, the likely Phase 2 dose. Preliminary results suggest possible clinical activity in AML. An expansion phase at the MTD is planned. [Table: see text]
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Affiliation(s)
- G. Borthakur
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - S. Faderl
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - F. Ravandi
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - S. Padmanabhan
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - W. Stock
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - K. Wu
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - J. Li
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - G. Curt
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - M. Tallman
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
| | - M. Minden
- University of Texas M. D. Anderson Cancer Center, Houston, TX; UT Health Science Center San Antonio, San Antonio, TX; University of Chicago, Chicago, IL; AstraZeneca R&D Boston, Waltham, MD; AstraZeneca, Wilmington, DE; Northwestern University, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada
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Tallman M. Existing and emerging therapeutic options for the treatment of acute myeloid leukemia. Clin Adv Hematol Oncol 2008; 6:3-5. [PMID: 19205108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
MESH Headings
- Adenine
- Adenine Nucleotides/therapeutic use
- Aminoglycosides/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Arabinonucleosides/therapeutic use
- Carbazoles/therapeutic use
- Clofarabine
- Cytarabine/therapeutic use
- Dasatinib
- Daunorubicin/therapeutic use
- Furans
- Gemtuzumab
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Naphthalimides/therapeutic use
- Organophosphonates
- Prognosis
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Sesquiterpenes/therapeutic use
- Staurosporine/analogs & derivatives
- Staurosporine/therapeutic use
- Stem Cell Transplantation
- Thiazoles/therapeutic use
- Tretinoin/therapeutic use
- fms-Like Tyrosine Kinase 3/metabolism
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Trifilio S, Pi J, Singhal S, Frankfurt O, Evens A, Gordon L, Tallman M, Winter J, Williams S, Mehta J. 313: Tacrolimus Dosing in Allogeneic Hematopoietic Stem-Cell Transplantation Recipients Receiving Voriconazole. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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43
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Trifilio S, Singhal S, Williams S, Frankfurt O, Gordon L, Evens A, Winter J, Tallman M, Pi J, Mehta J. Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole. Bone Marrow Transplant 2007; 40:451-6. [PMID: 17589527 DOI: 10.1038/sj.bmt.1705754] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Seventy-one allograft recipients receiving voriconazole, in whom complete clinical, microbiologic and pharmacokinetic data were available, were studied to determine the efficacy of voriconazole in preventing fungal infections. The length of voriconazole therapy was 6-956 days (median 133). The total number of patient-days on voriconazole was 13 805 ( approximately 38 years). A total of 10 fungal infections were seen in patients on voriconazole (18% actuarial probability at 1 year): Candida glabrata (n=5), Candida krusei (n=1), Cunninghamella (n=1), Rhizopus (n=2) and Mucor (n=1). Two of the four zygomycosis cases were preceded by short durations of voriconazole therapy, but prolonged itraconazole prophylaxis. The plasma steady-state trough voriconazole levels around the time the infection occurred were <0.2, <0.2, 0.33, 0.55, 0.63 and 1.78 microg/ml in the six candidiasis cases. Excluding the four zygomycosis cases, all the six candidiasis cases were seen among the 43 patients with voriconazole levels of < or =2 microg/ml and none among the 24 with levels of >2 microg/ml (P=0.061). We conclude that voriconazole is effective at preventing aspergillosis. However, breakthrough zygomycosis is seen in a small proportion of patients. The role of therapeutic voriconazole monitoring with dose adjustment to avoid breakthrough infections with fungi that are otherwise susceptible to the drug needs to be explored prospectively.
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Affiliation(s)
- S Trifilio
- Northwestern Memorial Hospital, Chicago, IL, USA
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Trifilio S, Pennick G, Pi J, Zook J, Golf M, Kaniecki K, Singhal S, Williams S, Winter J, Tallman M, Gordon L, Frankfurt O, Evens A, Mehta J. Monitoring plasma voriconazole levels may be necessary to avoid subtherapeutic levels in hematopoietic stem cell transplant recipients. Cancer 2007; 109:1532-5. [PMID: 17351937 DOI: 10.1002/cncr.22568] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Low voriconazole levels have been associated with a higher failure rate in patients with confirmed fungal infections. METHODS Steady-state plasma trough voriconazole levels were measured after at least 5 days of therapy in 87 patients with hematologic malignancies on 201 separate occasions (1-5 levels per patient; median, 2). Most patients (90%) had undergone allogeneic hematopoietic stem cell transplantation. The daily voriconazole dose, administered in 2 divided doses, was 200 mg (n = 4), 400 mg (n = 151), 500 mg (n = 20), 600 mg (n = 18), and 800 mg (n = 8); corresponding to 2.0-16.3 (median, 5.4) mg/kg. Plasma voriconazole levels were 0-12.5 microg/mL (median, 1.2). Voriconazole was undetectable (<0.2 mug/mL) in 15%. RESULTS The correlation between dose and levels was weak (r = 0.14; P = .045). The median absolute daily drug dose (400 mg) was identical in groups of patients with levels of 0, 0.2 to 0.5, >0.5 to 2.0, >2.0 to 5.0, and >5.0. Whereas the daily drug dose in mg/kg was significantly higher when the levels were >5.0 microg/mL, there was no consistent relation between dose and level below that threshold. In adult patients getting standard doses of voriconazole orally, the drug levels are highly variable. Based on limited available data, between a quarter and two-thirds of these levels could potentially be associated with a lower likelihood of response or a higher likelihood of failure. CONCLUSIONS Future voriconazole studies should incorporate prospective therapeutic drug monitoring and consideration should be given to checking levels in patients receiving the drug for confirmed, life-threatening fungal infections.
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Affiliation(s)
- Steve Trifilio
- Northwestern Memorial Hospital, Chicago, Illinois 60611, USA
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45
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Trifilio S, Singhal S, Williams S, Winter J, Tallman M, Gordon L, Evens A, Frankfurt O, Pi J, Mehta J. 429: Voriconazole prophylaxis in patients at high risk for invasive fungal infections following allogeneic hematapoetic stem cell transplantion. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2007.01.060] [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: 11/28/2022]
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46
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Trifilio S, Gordon L, Singhal S, Tallman M, Evens A, Rashid K, Fishman M, Masino K, Pi J, Mehta J. Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia. Bone Marrow Transplant 2006; 37:997-1001. [PMID: 16708061 DOI: 10.1038/sj.bmt.1705379] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recombinant urate oxidase (rasburicase) lowers uric acid levels rapidly to very low levels at the labeled dose of 0.15-0.2 mg/kg daily for 5 days. Our past experience showed that a lower dose (3 mg) lowered uric acid levels sufficiently in most patients. A retrospective review was conducted to determine the effect of a fixed 3 mg dose of rasburicase in 43 adult patients with cancer undergoing hematopoietic stem cell transplantation or receiving chemotherapy who had elevated or rising uric acid levels (6.4-16.8 mg/dl; median 9.6). Six patients received a second dose of rasburicase (3 mg in four patients and 1.5 mg in two patients) 24 h later. Patients received allopurinol, adequate hydration, as well as other supportive therapy as required. Uric acid levels declined by 6-95% (median 43%) within the first 24 h after rasburicase administration, and levels at 48 h were 9-91% (median 65%) lower than the baseline levels. Serum creatinine changed by < or =10% in 21 patients, increased by >10% in four patients and decreased by >10% in 18 patients. No significant renal dysfunction developed in any of the patients. We conclude that rasburicase is effective in lowering uric acid levels at a fixed dose of 3 mg, which is much lower than the recommended dose.
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Affiliation(s)
- S Trifilio
- Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL 60611, USA
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47
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Appelbaum FR, Kopecky KJ, Slovak ML, Gundacker HM, Tallman M, Kim H, Dewald GW, Estey E, Kantarjian H, Pierce S. The clinical spectrum of adult acute myeloid leukemia (AML) associated with core binding factor (CBF) translocations. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- F. R. Appelbaum
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - K. J. Kopecky
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - M. L. Slovak
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - H. M. Gundacker
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - M. Tallman
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - H. Kim
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - G. W. Dewald
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - E. Estey
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - H. Kantarjian
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
| | - S. Pierce
- Southwest Oncology Group, Seattle, WA; Eastern Cooperative Group, Philadelphia, PA; MD Anderson Cancer Ctr, Houston, TX
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48
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Mehta J, Cetiner M, Gordon L, Evens A, Tallman M, Williams S, Winter J, Meagher R, Singhal S. Effect of impaired renal function on the outcome of submyeloablative allogeneic hematopoietic stem cell transplantation in patients with hematologic malignancies. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6666] [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
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49
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Balasubramanian L, Trifilio SM, Tallman M, Mehta J, Bennett C. Breakthrough zygomycoses in patients receiving antifungal therapy with voriconazole. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6664] [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
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50
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Singhal S, Cetiner M, Gordon L, Evens A, Tallman M, Williams S, Winter J, Meagher R, Mehta J. Factors affecting survival after submyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) for hematologic malignancies. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6662] [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
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