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Barsan V, Li Y, Prabhu S, Baggott C, Nguyen K, Pacenta H, Phillips CL, Rossoff J, Stefanski H, Talano JA, Moskop A, Baumeister S, Verneris MR, Myers GD, Karras NA, Cooper S, Qayed M, Hermiston M, Satwani P, Krupski C, Keating A, Fabrizio V, Chinnabhandar V, Kunicki M, Curran KJ, Mackall CL, Laetsch TW, Schultz LM. Tisagenlecleucel utilisation and outcomes across refractory, first relapse and multiply relapsed B-cell acute lymphoblastic leukemia: a retrospective analysis of real-world patterns. EClinicalMedicine 2023; 65:102268. [PMID: 37954907 PMCID: PMC10632672 DOI: 10.1016/j.eclinm.2023.102268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
Background Tisagenlecleucel was approved by the Food and Drug Administration (FDA) in 2017 for refractory B-cell acute lymphoblastic leukemia (B-ALL) and B-ALL in ≥2nd relapse. Outcomes of patients receiving commercial tisagenlecleucel upon 1st relapse have yet to be established. We aimed to report real-world tisagenlecleucel utilisation patterns and outcomes across indications, specifically including patients treated in 1st relapse, an indication omitted from formal FDA approval. Methods We conducted a retrospective analysis of real-world tisagenlecleucel utilisation patterns across 185 children and young adults treated between August 30, 2017 and March 6, 2020 from centres participating in the Pediatric Real-World CAR Consortium (PRWCC), within the United States. We described definitions of refractory B-ALL used in the real-world setting and categorised patients by reported Chimeric Antigen Receptor (CAR) T-cell indication, including refractory, 1st relapse and ≥2nd relapse B-ALL. We analysed baseline patient characteristics and post-tisagenlecleucel outcomes across defined cohorts. Findings Thirty-six percent (n = 67) of our cohort received tisagenlecleucel following 1st relapse. Of 66 evaluable patients, 56 (85%, 95% CI 74-92%) achieved morphologic complete response. Overall-survival (OS) and event-free survival (EFS) at 1-year were 69%, (95% CI 58-82%) and 49%, (95% CI 37-64%), respectively, with survival outcomes statistically comparable to remaining patients (OS; p = 0.14, EFS; p = 0.39). Notably, toxicity was increased in this cohort, warranting further study. Interestingly, of 30 patients treated for upfront refractory disease, 23 (77%, 95% CI 58-90%) had flow cytometry and/or next-generation sequencing (NGS) minimum residual disease (MRD)-only disease at the end of induction, not meeting the historic morphologic definition of refractory. Interpretation Our findings suggested that tisagenlecleucel response and survival rates overlap across patients treated with upfront refractory B-ALL, B-ALL ≥2nd relapse and B-ALL in 1st relapse. We additionally highlighted that definitions of refractory B-ALL are evolving beyond morphologic measures of residual disease. Funding St. Baldrick's/Stand Up 2 Cancer, Parker Institute for Cancer Immunotherapy, Virginia and D.K. Ludwig Fund for Cancer Research.
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Affiliation(s)
- Valentin Barsan
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Road, Suite 300, Palo Alto, CA 94304, USA
| | - Yimei Li
- Department of Pediatrics, Children's Hospital of Philadelphia/University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Snehit Prabhu
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Road, Suite 300, Palo Alto, CA 94304, USA
| | - Christina Baggott
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Road, Suite 300, Palo Alto, CA 94304, USA
| | - Khanh Nguyen
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Road, Suite 300, Palo Alto, CA 94304, USA
| | - Holly Pacenta
- Cook Children’s Hospital, 1500 Cooper St 5th Floor, Fort Worth, TX 76104, USA
- Department of Pediatrics, The University of Texas Southwestern Medical Center/Children’s Health, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA
| | - Christine L. Phillips
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
- Cincinnati Children’s Hospital Medical Center, Cancer and Blood Disease Institute, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Jenna Rossoff
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA
| | - Heather Stefanski
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Ave S AO-102, Minneapolis, MN 55454, USA
| | - Julie-An Talano
- Department of Pediatric Hematology Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Amy Moskop
- Department of Pediatric Hematology Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Susanne Baumeister
- Dana Farber/Boston Children’s Hospital, 450 Brookline Avenue Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA 02115, USA
| | - Michael R. Verneris
- University of Colorado, Anschutz Medical Campus, Colorado Children’s Hospital, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | | | - Nicole A. Karras
- Department of Pediatrics, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010, USA
| | - Stacy Cooper
- Department of Oncology, Sidney Kimmel Cancer Center at John Hopkins School of Medicine, Baltimore, MD, USA
| | - Muna Qayed
- Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA
| | - Michelle Hermiston
- University of California San Francisco Benioff Children’s Hospital, 1975 4th St., San Francisco, CA 94158, USA
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Christa Krupski
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
- Cincinnati Children’s Hospital Medical Center, Cancer and Blood Disease Institute, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Amy Keating
- University of Colorado, Anschutz Medical Campus, Colorado Children’s Hospital, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Vanessa Fabrizio
- University of Colorado, Anschutz Medical Campus, Colorado Children’s Hospital, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Vasant Chinnabhandar
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Ave S AO-102, Minneapolis, MN 55454, USA
| | - Michael Kunicki
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Road, Suite 300, Palo Alto, CA 94304, USA
| | - Kevin J. Curran
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | - Crystal L. Mackall
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Road, Suite 300, Palo Alto, CA 94304, USA
- Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford Cancer Institute, 265 Campus Drive, Stanford, CA 94305, USA
- Division of Blood and Bone Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H0101, Stanford, CA 94305-5623, USA
| | - Theodore W. Laetsch
- Department of Pediatrics, Children's Hospital of Philadelphia/University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Liora M. Schultz
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Road, Suite 300, Palo Alto, CA 94304, USA
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Ramakrishna S, Good Z, Desai M, Zamler D, Mancusi R, Mahdi J, Majzner R, Schultz L, Richards R, Kamens J, Barsan V, Campen C, Partap S, Ehlinger Z, Reynolds W, Chen Y, Hamilton MP, Moon J, Baggott C, Kunicki M, Fujimoto M, Li A, Jariwala S, Mavroukakis S, Egeler E, Jacobs A, Erickson C, Yamabe-Kwong K, Prabhu S, Davis K, Feldman S, Sahaf B, Mackall CL, Monje M. Abstract 959: Immune signatures of GD2 CAR T cell activity in H3K27M+ diffuse midline glioma patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Introduction: H3K27M-mutated diffuse intrinsic pontine glioma (DIPG) and spinal cord diffuse midline glioma (DMG) are universally lethal central nervous system (CNS) tumors in children and young adults. We previously demonstrated safety and activity of GD2.41BB.z chimeric antigen receptor T cells (CAR-Ts) at dose level 1, 1x106 GD2 CAR-T/kg (Majzner/Ramakrishna et al. Nature 2022) and reported results of dose level 2, 3x106 GD2 CAR-T/kg (Majzner et al. AACR 2022). Here, we present in depth high-dimensional analyses to define the immune states that contribute to CAR-T activity in patients.
Methods: Thirteen patients (10 DIPG/3 spinal DMG; 4-30 years old; 7F/6M) were enrolled in this GD2 CAR-T phase 1 clinical trial (NCT04196413). GD2 CAR-Ts were administered to 12/13 enrolled patients. In the first cohort, CAR-Ts were administered initially intravenously (IV), followed by serial intracerebroventricular infusions (ICV; range 0-11 infusions/patient). Patient GD2 CAR-T product, peripheral blood, and cerebrospinal fluid (CSF) samples were evaluated for CAR-T expansion (qPCR; flow cytometry), cytokine signatures (Multiplex Luminex), and immune cell profiles (single cell RNA-sequencing). Data were analyzed in the context of clinical trajectory and patient response.
Results: 10/12 infused subjects demonstrated clinical and/or radiographic benefit, with less systemic toxicity following ICV compared to IV infusion. CAR-T expansion was noted in the periphery and CSF of all treated patients and following serial ICV infusions. In peripheral blood, cytokine concentrations, including IFN-gamma, IL6, and CXCL9, were higher after IV compared to ICV CAR-T infusions, correlating with increased systemic inflammation. Conversely in CSF, cytokine concentrations, such as CCL2 and CXCL9, were higher following ICV compared to IV CAR-T infusions. Transcriptomic analysis was conducted on 576,199 single cells from 91 samples, including GD2 CAR-T products and patient CSF. This is the largest CAR-T dataset in CNS tumors. Patient CSF samples were dominated by T cell and myeloid populations. After IV CAR-T infusion, patient CSF exhibited an increased fraction of regulatory T cells and suppressive myeloid populations from baseline. These immune suppressive cells reduced after ICV infusion. Ongoing analyses are underway to explore the relation of these immune populations to patient response.
Conclusions: H3K27M-mutated DIPG/DMG patients demonstrate continued clinical response with serial ICV GD2 CAR-T infusions, with heterogeneity in the durability of response across patients. In-depth correlative analyses profile distinct immune populations and demonstrate population shifts depending on route of administration and over the course of treatment. Key findings from these data will allow for iterative improvement in CAR-T therapies for H3K27M+ DIPG/DMG patients, providing hope to shift the paradigm of this fatal disease.
Citation Format: Sneha Ramakrishna, Zinaida Good, Moksha Desai, Daniel Zamler, Rebecca Mancusi, Jasia Mahdi, Robbie Majzner, Liora Schultz, Rebecca Richards, Jennifer Kamens, Valentin Barsan, Cynthia Campen, Sonia Partap, Zachary Ehlinger, Warren Reynolds, Yiyun Chen, Mark P. Hamilton, Jennifer Moon, Christina Baggott, Michael Kunicki, Michelle Fujimoto, Amy Li, Sneha Jariwala, Sharon Mavroukakis, Emily Egeler, Ashley Jacobs, Courtney Erickson, Karen Yamabe-Kwong, Snehit Prabhu, Kara Davis, Steve Feldman, Bita Sahaf, Crystal L. Mackall, Michelle Monje. Immune signatures of GD2 CAR T cell activity in H3K27M+ diffuse midline glioma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 959.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Amy Li
- 1Stanford University, Palo Alto, CA
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Schultz LM, Eaton A, Baggott C, Rossoff J, Prabhu S, Keating AK, Krupski C, Pacenta H, Philips CL, Talano JA, Moskop A, Baumeister SH, Myers GD, Karras NA, Brown PA, Qayed M, Hermiston M, Satwani P, Wilcox R, Rabik CA, Fabrizio VA, Chinnabhandar V, Kunicki M, Mavroukakis S, Egeler E, Li Y, Mackall CL, Curran KJ, Verneris MR, Laetsch TW, Stefanski H. Outcomes After Nonresponse and Relapse Post-Tisagenlecleucel in Children, Adolescents, and Young Adults With B-Cell Acute Lymphoblastic Leukemia. J Clin Oncol 2023; 41:354-363. [PMID: 36108252 PMCID: PMC9839307 DOI: 10.1200/jco.22.01076] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/13/2022] [Accepted: 07/20/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Nonresponse and relapse after CD19-chimeric antigen receptor (CAR) T-cell therapy continue to challenge survival outcomes. Phase II landmark data from the ELIANA trial demonstrated nonresponse and relapse rates of 14.5% and 28%, respectively, whereas use in the real-world setting showed nonresponse and relapse rates of 15% and 37%. Outcome analyses describing fate after post-CAR nonresponse and relapse remain limited. Here, we aim to establish survival outcomes after nonresponse and both CD19+ and CD19- relapses and explore treatment variables associated with inferior survival. METHODS We conducted a retrospective multi-institutional study of 80 children and young adults with B-cell acute lymphoblastic leukemia experiencing nonresponse (n = 23) or relapse (n = 57) after tisagenlecleucel. We analyze associations between baseline characteristics and these outcomes and establish survival rates and salvage approaches. RESULTS The overall survival (OS) at 12 months was 19% across nonresponders (n = 23; 95% CI, 7 to 50). Ninety-five percent of patients with nonresponse had high preinfusion disease burden. Among 156 morphologic responders, the cumulative incidence of relapse was 37% (95% CI, 30 to 47) at 12 months (CD19+; 21% [15 to 29], CD19-; 16% [11 to 24], median follow-up; 380 days). Across 57 patients experiencing relapse, the OS was 52% (95% CI, 38 to 71) at 12 months after time of relapse. Notably, CD19- relapse was associated with significantly decreased OS as compared with patients who relapsed with conserved CD19 expression (CD19- 12-month OS; 30% [14 to 66], CD19+ 12-month OS; 68% [49 to 92], P = .0068). Inotuzumab, CAR reinfusion, and chemotherapy were used as postrelapse salvage therapy with greatest frequency, yet high variability in treatment sequencing and responses limits efficacy analysis across salvage approaches. CONCLUSION We describe poor survival across patients experiencing nonresponse to tisagenlecleucel. In the post-tisagenlecleucel relapse setting, patients can be salvaged; however, CD19- relapse is distinctly associated with decreased survival outcomes.
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Affiliation(s)
- Liora M. Schultz
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Anne Eaton
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Christina Baggott
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA
| | - Jenna Rossoff
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Snehit Prabhu
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA
| | - Amy K. Keating
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Christa Krupski
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Disease Institute, Cincinnati, OH
| | - Holly Pacenta
- Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
- Division of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Christine L. Philips
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Disease Institute, Cincinnati, OH
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI
| | - Amy Moskop
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI
| | - Susanne H.C. Baumeister
- Pediatric Hematology-Oncology, Harvard Medical School, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Gary Douglas Myers
- Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO
| | - Nicole A. Karras
- Department of Pediatrics, City of Hope National Medical Center, Duarte, CA
| | - Patrick A. Brown
- Department of Oncology, Sidney Kimmel Cancer Center at John Hopkins School of Medicine, Baltimore, MD
| | - Muna Qayed
- Emory University and Children's Healthcare of Atlanta, Druid Hills, GA
| | - Michelle Hermiston
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Rachel Wilcox
- Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO
| | - Cara A. Rabik
- Division of Hematologic Malignancies I, Center for Drug Evaluation and Research (CDER), FDA
| | - Vanessa A. Fabrizio
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center
- Department of Pediatrics, Weill Cornell Medical College
| | - Vasant Chinnabhandar
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Michael Kunicki
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA
| | - Sharon Mavroukakis
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA
| | - Emily Egeler
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA
| | - Yimei Li
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Crystal L. Mackall
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, Center for Cancer Cell Therapy, Stanford Cancer Institute, Palo Alto, CA
- Division of Blood and Bone Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Center for Cancer Cell Therapy, Stanford Cancer Institute, Palo Alto, CA
| | - Kevin J. Curran
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center
- Department of Pediatrics, Weill Cornell Medical College
| | - Michael R. Verneris
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Theodore W. Laetsch
- Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather Stefanski
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
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Majzner RG, Mahdi J, Ramakrishna S, Patel S, Chinnasamy H, Yeom K, Schultz L, Barsan V, Richards R, Campen C, Reschke A, Toland AMS, Baggott C, Mavroukakis S, Egeler E, Moon J, Jacobs A, Yamabe-Kwong K, Rasmussen L, Nie E, Green S, Kunicki M, Fujimoto M, Ehlinger Z, Reynolds W, Prabhu S, Warren KE, Cornell T, Partap S, Fisher P, Grant G, Vogel H, Sahaf B, Davis K, Feldman S, Monje M, Mackall CL. Abstract CT001: Major tumor regressions in H3K27M-mutated diffuse midline glioma (DMG) following sequential intravenous (IV) and intracerebroventricular (ICV) delivery of GD2-CAR T cells. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: H3K27M-mutated DMGs are universally lethal central nervous system tumors that express high levels of the disialoganglioside GD2. IV administered GD2-CAR T cells (GD2-CART) regress DMG in preclinical models, and locoregionally delivered CARs demonstrate enhanced activity in xenograft models of brain tumors.
Methods: NCT04196413 is a 3+3 Phase I dose escalation trial testing GD2-CART in patients with H3K27M DMG, with dose-limiting toxicities (DLT) considered independently for DIPG and spinal DMG (sDMG). Arm A tested escalating doses of IV GD2-CART (DL1: 1e6 GD2-CART/kg; DL2=3e6 GD2-CART/kg) following lymphodepletion (LD). After the DLT period, patients with clinical and/or radiographic benefit were eligible for subsequent ICV GD2-CART (10-30e6 GD2-CART) administered via Ommaya catheter without LD every 4-8 weeks for a maximum of 12 doses. We previously reported early results from 4 patients treated on DL1, which demonstrated clinical activity and manageable toxicity. Here we provide updated results for DL1 and DL2.
Results: Thirteen subjects were enrolled and 11 treated [n=4 DL1 (3 DIPG/1 sDMG); n=9 DL2 (7 DIPG/2 sDMG)]. Two subjects were removed prior to treatment due to rapid progression. No DLTs were observed on DL1. Three subjects experienced DLT on DL2 (2 DIPG/1 sDMG) due to grade 4 cytokine release syndrome (CRS), successfully managed with tocilizumab, anakinra, and corticosteroids. CRS occurred earlier on DL2 vs. DL1 (Day 3 vs 7). On both dose levels, all subjects exhibited transient symptoms related to on-tumor inflammation, termed Tumor Inflammation-Associated Neurotoxicity (TIAN), which was successfully managed with anakinra and, in some cases, CSF drainage and dexamethasone. No DLT due to TIAN has occurred.
Ten patients have had adequate follow-up to assess benefit. Nine experienced radiographic and/or clinical benefit after IV infusion, and they received subsequent ICV GD2-CART infusions (median= 4 ICV infusions/pt, range 1-6). ICV infusions were not associated with high-grade CRS, although some subjects developed transient fever, headache, meningismus, nausea, and/or vomiting, and several subjects developed TIAN. Four patients continue to receive ICV infusions on study and have experienced continued clinical and radiographic benefit at 11+, 9.5+, 8+ and 7+ months following enrollment. A 31-year-old with sDMG has experienced a near-complete (>95%) reduction in tumor volume and a 17-year-old with DIPG experienced a near-complete (>98%) reduction in volume of a pontine tumor.
Conclusions: IV treatment of DIPG and sDMG with GD2-CART is safe at a dose of 1e6/kg, but associated with unacceptable rates of high-grade CRS at 3e6/kg. ICV GD2-CART without LD, administered following a previous course of IV GD2-CART with LD, has been well tolerated and has mediated impressive sustained clinical benefit in some patients with DIPG/sDMG. Given these findings, we are launching a new arm to assess safety and activity and to define the recommended phase 2 dose for ICV delivery of GD2-CART without LD. Patients are eligible for up to 12 ICV infusions of GD2-CART administered every 4-6 weeks. Clinical benefit will be formally assessed using patient-reported outcomes. GD2-CART has the potential to transform therapy for patients with H3K27M+ DIPG/sDMG.
Citation Format: Robbie G. Majzner, Jasia Mahdi, Sneha Ramakrishna, Shabnum Patel, Harshini Chinnasamy, Kristen Yeom, Liora Schultz, Valentin Barsan, Rebecca Richards, Cynthia Campen, Agnes Reschke, Angus Martin Shaw Toland, Christina Baggott, Sharon Mavroukakis, Emily Egeler, Jennifer Moon, Ashley Jacobs, Karen Yamabe-Kwong, Lindsey Rasmussen, Esther Nie, Sean Green, Michael Kunicki, Michelle Fujimoto, Zach Ehlinger, Warren Reynolds, Snehit Prabhu, Katherine E. Warren, Tim Cornell, Sonia Partap, Paul Fisher, Gerald Grant, Hannes Vogel, Bita Sahaf, Kara Davis, Steven Feldman, Michelle Monje, Crystal L. Mackall. Major tumor regressions in H3K27M-mutated diffuse midline glioma (DMG) following sequential intravenous (IV) and intracerebroventricular (ICV) delivery of GD2-CAR T cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT001.
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Affiliation(s)
| | - Jasia Mahdi
- 1Stanford University School of Medicine, Stanford, CA
| | | | - Shabnum Patel
- 1Stanford University School of Medicine, Stanford, CA
| | | | - Kristen Yeom
- 1Stanford University School of Medicine, Stanford, CA
| | - Liora Schultz
- 1Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Agnes Reschke
- 1Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Emily Egeler
- 1Stanford University School of Medicine, Stanford, CA
| | - Jennifer Moon
- 1Stanford University School of Medicine, Stanford, CA
| | - Ashley Jacobs
- 1Stanford University School of Medicine, Stanford, CA
| | | | | | - Esther Nie
- 1Stanford University School of Medicine, Stanford, CA
| | - Sean Green
- 1Stanford University School of Medicine, Stanford, CA
| | | | | | - Zach Ehlinger
- 1Stanford University School of Medicine, Stanford, CA
| | | | - Snehit Prabhu
- 1Stanford University School of Medicine, Stanford, CA
| | | | - Tim Cornell
- 1Stanford University School of Medicine, Stanford, CA
| | - Sonia Partap
- 1Stanford University School of Medicine, Stanford, CA
| | - Paul Fisher
- 1Stanford University School of Medicine, Stanford, CA
| | - Gerald Grant
- 1Stanford University School of Medicine, Stanford, CA
| | - Hannes Vogel
- 1Stanford University School of Medicine, Stanford, CA
| | - Bita Sahaf
- 1Stanford University School of Medicine, Stanford, CA
| | - Kara Davis
- 1Stanford University School of Medicine, Stanford, CA
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Monje M, Majzner R, Mahdi J, Ramakrishna S, Patel S, Chinnasamy H, Yeom K, Schultz L, Barsan V, Richards R, Campen C, Reschke A, Toland AM, Baggott C, Mavroukakis S, Egeler E, Moon J, Jacobs A, Yamabe-Kwong K, Rasmussen L, Nie E, Green S, Kunicki M, Fujimoto M, Ehlinger Z, Reynolds W, Prabhu S, Warren KE, Cornell T, Partap S, Fisher P, Grant G, Vogel H, Sahaf B, Davis K, Feldman S, Mackall C. DIPG-15. Major tumor regressions in H3K27M-mutated diffuse midline glioma (DMG) following sequential intravenous (IV) and intracerebroventricular (ICV) delivery of GD2-CAR T-cells. Neuro Oncol 2022. [PMCID: PMC9164854 DOI: 10.1093/neuonc/noac079.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: H3K27M-mutated DMGs express high levels of the disialoganglioside GD2 and GD2-CAR T-cells (GD2-CART) regress DMG in preclinical models. METHODS: NCT04196413 is a 3 + 3 Phase I dose escalation trial testing GD2-CART in patients with biopsy-proved H3K27M DMG, with dose-limiting toxicities (DLT) considered independently for DIPG and spinal DMG (sDMG). Arm A tested escalating doses of IV GD2-CART (DL1=1e6 GD2-CART/kg; DL2=3e6 GD2-CART/kg) following lymphodepletion (LD). After the DLT period, patients with clinical and/or radiographic benefit were eligible for subsequent ICV GD2-CART infusions (10-30e6 GD2-CART) administered via Ommaya without LD. RESULTS: Twelve subjects were treated after standard radiotherapy, 7 of whom began treatment at the time of progression [n=4 DL1 (3 DIPG/1 sDMG); n=8 DL2 (6 DIPG/2 sDMG)]. No DLTs were observed on DL1. Three subjects experienced DLT on DL2 (2 DIPG/1 sDMG) due to grade-4 cytokine release syndrome (CRS). On both dose levels, all subjects exhibited transient symptoms related to on-tumor inflammation, termed Tumor Inflammation-Associated Neurotoxicity (TIAN); no DLT due to TIAN has occurred. Ten subjects experienced radiographic and/or clinical benefit after IV infusion and received subsequent ICV infusions (median=4 ICV infusions/pt, range=1-7). ICV infusions were not associated with high-grade CRS. Four patients continue to receive ICV infusions on study and have experienced continued clinical and radiographic benefit, currently 7-11 months following enrollment. Two patients (one sDMG, one DIPG) have experienced near-complete (>95%) tumor volume reduction. CONCLUSIONS: IV treatment of DIPG and sDMG with GD2-CART is safe at a dose of 1e6/kg, but associated with frequent high-grade CRS at 3e6/kg. ICV GD2-CART has been well tolerated and has mediated impressive sustained clinical benefit in some patients with DIPG/sDMG. Given these findings, we are launching a new arm to assess safety and activity and to define the recommended phase 2 dose for ICV delivery of GD2-CART without LD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Esther Nie
- Stanford University , Stanford, CA , USA
| | - Sean Green
- Stanford University , Stanford, CA , USA
| | | | | | | | | | | | | | | | | | | | | | | | - Bita Sahaf
- Stanford University , Stanford, CA , USA
| | - Kara Davis
- Stanford University , Stanford, CA , USA
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6
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Schultz LM, Baggott C, Prabhu S, Pacenta HL, Phillips CL, Rossoff J, Stefanski HE, Talano JA, Moskop A, Margossian SP, Verneris MR, Myers GD, Karras NA, Brown PA, Qayed M, Hermiston M, Satwani P, Krupski C, Keating AK, Wilcox R, Rabik CA, Fabrizio VA, Rouce RH, Chinnabhandar V, Kunicki M, Barsan VV, Goksenin AY, Li Y, Mavroukakis S, Egeler E, Curran KJ, Mackall CL, Laetsch TW. Disease Burden Affects Outcomes in Pediatric and Young Adult B-Cell Lymphoblastic Leukemia After Commercial Tisagenlecleucel: A Pediatric Real-World Chimeric Antigen Receptor Consortium Report. J Clin Oncol 2022; 40:945-955. [PMID: 34882493 PMCID: PMC9384925 DOI: 10.1200/jco.20.03585] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [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] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Tisagenlecleucel is a CD19-specific chimeric antigen receptor T-cell therapy, US Food and Drug Administration-approved for children, adolescents, and young adults (CAYA) with relapsed and/or refractory (RR) B-cell acute lymphoblastic leukemia (B-ALL). The US Food and Drug Administration registration for tisagenlecleucel was based on a complete response (CR) rate of 81%, 12-month overall survival (OS) of 76%, and event-free survival (EFS) of 50%. We report clinical outcomes and analyze covariates of outcomes after commercial tisagenlecleucel. METHODS We conducted a retrospective, multi-institutional study of CAYA with RR B-ALL across 15 US institutions, who underwent leukapheresis shipment to Novartis for commercial tisagenlecleucel. A total of 200 patients were included in an intent-to-treat response analysis, and 185 infused patients were analyzed for survival and toxicity. RESULTS Intent-to-treat analysis demonstrates a 79% morphologic CR rate (95% CI, 72 to 84). The infused cohort had an 85% CR (95% CI, 79 to 89) and 12-month OS of 72% and EFS of 50%, with 335 days of median follow-up. Notably, 48% of patients had low-disease burden (< 5% bone marrow lymphoblasts, no CNS3, or other extramedullary disease), or undetectable disease, pretisagenlecleucel. Univariate and multivariate analyses associate high-disease burden (HB, ≥ 5% bone marrow lymphoblasts, CNS3, or non-CNS extramedullary) with inferior outcomes, with a 12-month OS of 58% and EFS of 31% compared with low-disease burden (OS; 85%, EFS; 70%) and undetectable disease (OS; 95%, EFS; 72%; P < .0001 for OS and EFS). Grade ≥ 3 cytokine release syndrome and neurotoxicity rates were 21% and 7% overall and 35% and 9% in patients with HB, respectively. CONCLUSION Commercial tisagenlecleucel in CAYA RR B-ALL demonstrates efficacy and tolerability. This first analysis of commercial tisagenlecleucel stratified by disease burden identifies HB preinfusion to associate with inferior OS and EFS and increased toxicity.
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Affiliation(s)
- Liora M. Schultz
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Liora M. Schultz, MD, Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, 1000 Welch Rd, Suite 300, Stanford, CA 94304; e-mail:
| | | | - Snehit Prabhu
- Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA
| | - Holly L. Pacenta
- Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
- Division of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Christine L. Phillips
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Disease Institute, Cincinnati, OH
| | - Jenna Rossoff
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Heather E. Stefanski
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Wauwatosa, WI
| | - Amy Moskop
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Wauwatosa, WI
| | - Steven P. Margossian
- Harvard Medical School, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Pediatric Hematology-Oncology, Boston, MA
| | - Michael R. Verneris
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Gary Douglas Myers
- Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO
| | - Nicole A. Karras
- Department of Pediatrics, City of Hope National Medical Center, Duarte, CA
| | - Patrick A. Brown
- Department of Oncology, Sidney Kimmel Cancer Center at John Hopkins School of Medicine, Baltimore, MD
| | - Muna Qayed
- Emory University and Children's Healthcare of Atlanta, Druid Hills, GA
| | - Michelle Hermiston
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Christa Krupski
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Disease Institute, Cincinnati, OH
| | - Amy K. Keating
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Rachel Wilcox
- Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, MO
| | - Cara A. Rabik
- Division of Hematologic Malignancies I, Center for Drug Evaluation and Research (CDER), FDA, Silver Spring, MD
| | - Vanessa A. Fabrizio
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Rayne H. Rouce
- Texas Children's Cancer Center, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - Vasant Chinnabhandar
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | | | - Valentin V. Barsan
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - A. Yasemin Goksenin
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Yimei Li
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Emily Egeler
- Stanford University School of Medicine, Stanford, CA
| | - Kevin J. Curran
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Crystal L. Mackall
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, CA
- Department of Medicine, Division of Blood and Bone Marrow Transplantation, Stanford University School of Medicine, Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, CA
| | - Theodore W. Laetsch
- Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
- Department of Pediatrics and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
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7
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Majzner RG, Ramakrishna S, Yeom KW, Patel S, Chinnasamy H, Schultz LM, Richards RM, Jiang L, Barsan V, Mancusi R, Geraghty AC, Good Z, Mochizuki AY, Gillespie SM, Toland AMS, Mahdi J, Reschke A, Nie EH, Chau IJ, Rotiroti MC, Mount CW, Baggott C, Mavroukakis S, Egeler E, Moon J, Erickson C, Green S, Kunicki M, Fujimoto M, Ehlinger Z, Reynolds W, Kurra S, Warren KE, Prabhu S, Vogel H, Rasmussen L, Cornell TT, Partap S, Fisher PG, Campen CJ, Filbin MG, Grant G, Sahaf B, Davis KL, Feldman SA, Mackall CL, Monje M. GD2-CAR T cell therapy for H3K27M-mutated diffuse midline gliomas. Nature 2022; 603:934-941. [PMID: 35130560 PMCID: PMC8967714 DOI: 10.1038/s41586-022-04489-4] [Citation(s) in RCA: 330] [Impact Index Per Article: 165.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) and other H3K27M-mutated diffuse midline gliomas (DMGs) are universally lethal paediatric tumours of the central nervous system1. We have previously shown that the disialoganglioside GD2 is highly expressed on H3K27M-mutated glioma cells and have demonstrated promising preclinical efficacy of GD2-directed chimeric antigen receptor (CAR) T cells2, providing the rationale for a first-in-human phase I clinical trial (NCT04196413). Because CAR T cell-induced brainstem inflammation can result in obstructive hydrocephalus, increased intracranial pressure and dangerous tissue shifts, neurocritical care precautions were incorporated. Here we present the clinical experience from the first four patients with H3K27M-mutated DIPG or spinal cord DMG treated with GD2-CAR T cells at dose level 1 (1 × 106 GD2-CAR T cells per kg administered intravenously). Patients who exhibited clinical benefit were eligible for subsequent GD2-CAR T cell infusions administered intracerebroventricularly3. Toxicity was largely related to the location of the tumour and was reversible with intensive supportive care. On-target, off-tumour toxicity was not observed. Three of four patients exhibited clinical and radiographic improvement. Pro-inflammatory cytokine levels were increased in the plasma and cerebrospinal fluid. Transcriptomic analyses of 65,598 single cells from CAR T cell products and cerebrospinal fluid elucidate heterogeneity in response between participants and administration routes. These early results underscore the promise of this therapeutic approach for patients with H3K27M-mutated DIPG or spinal cord DMG.
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Affiliation(s)
- Robbie G Majzner
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA.,Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Sneha Ramakrishna
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Kristen W Yeom
- Division of Neuroradiology, Department of Radiology, Stanford University, Stanford, CA, USA
| | - Shabnum Patel
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Harshini Chinnasamy
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Liora M Schultz
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Rebecca M Richards
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Li Jiang
- Division of Pediatric Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Valentin Barsan
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Rebecca Mancusi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Anna C Geraghty
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Zinaida Good
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Aaron Y Mochizuki
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Shawn M Gillespie
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | | | - Jasia Mahdi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Agnes Reschke
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Esther H Nie
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Isabelle J Chau
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Maria Caterina Rotiroti
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Christopher W Mount
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Christina Baggott
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Sharon Mavroukakis
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Emily Egeler
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Jennifer Moon
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Courtney Erickson
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Sean Green
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Michael Kunicki
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Michelle Fujimoto
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Zach Ehlinger
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Warren Reynolds
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Sreevidya Kurra
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Katherine E Warren
- Division of Pediatric Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Snehit Prabhu
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Hannes Vogel
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Lindsey Rasmussen
- Division of Critical Care Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Timothy T Cornell
- Division of Critical Care Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Sonia Partap
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Paul G Fisher
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Cynthia J Campen
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Mariella G Filbin
- Division of Pediatric Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Gerald Grant
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Bita Sahaf
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Kara L Davis
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Steven A Feldman
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Crystal L Mackall
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA. .,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA. .,Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA. .,Division of Stem Cell Transplantation and Cell Therapy, Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Michelle Monje
- Stanford Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University, Stanford, CA, USA. .,Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA. .,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA. .,Department of Pathology, Stanford University, Stanford, CA, USA. .,Department of Neurosurgery, Stanford University, Stanford, CA, USA. .,Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA.
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8
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Fabrizio VA, Phillips CL, Lane A, Baggott C, Prabhu S, Egeler E, Mavroukakis S, Pacenta H, Rossoff J, Stefanski HE, Talano JA, Moskop A, Margossian SP, Verneris MR, Myers GD, Karras NA, Brown PA, Qayed M, Hermiston M, Satwani P, Krupski C, Keating AK, Wilcox R, Rabik CA, Chinnabhandar V, Kunicki M, Goksenin AY, Curran KJ, Mackall CL, Laetsch TW, Schultz LM. Tisagenlecleucel outcomes in relapsed/refractory extramedullary ALL: a Pediatric Real World CAR Consortium Report. Blood Adv 2022; 6:600-610. [PMID: 34794180 PMCID: PMC8791593 DOI: 10.1182/bloodadvances.2021005564] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [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: 06/28/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cells have transformed the therapeutic options for relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia. Data for CAR therapy in extramedullary (EM) involvement are limited. Retrospective data were abstracted from the Pediatric Real World CAR Consortium (PRWCC) of 184 infused patients from 15 US institutions. Response (complete response) rate, overall survival (OS), relapse-free survival (RFS), and duration of B-cell aplasia (BCA) in patients referred for tisagenlecleucel with EM disease (both central nervous system (CNS)3 and non-CNS EM) were compared with bone marrow (BM) only. Patients with CNS disease were further stratified for comparison. Outcomes are reported on 55 patients with EM disease before CAR therapy (CNS3, n = 40; non-CNS EM, n = 15). The median age at infusion in the CNS cohort was 10 years (range, <1-25 years), and in the non-CNS EM cohort it was 13 years (range, 2-26 years). In patients with CNS disease, 88% (35 of 40) achieved a complete response vs only 66% (10 of 15) with non-CNS EM disease. Patients with CNS disease (both with and without BM involvement) had 24-month OS outcomes comparable to those of non-CNS EM or BM only (P = .41). There was no difference in 12-month RFS between CNS, non-CNS EM, or BM-only patients (P = .92). No increased toxicity was seen with CNS or non-CNS EM disease (P = .3). Active CNS disease at time of infusion did not affect outcomes. Isolated CNS disease trended toward improved OS compared with combined CNS and BM (P = .12). R/R EM disease can be effectively treated with tisagenlecleucel; toxicity, relapse, and survival rates are comparable to those of patients with BM-only disease. Outcomes for isolated CNS relapse are encouraging.
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Affiliation(s)
- Vanessa A Fabrizio
- University of Colorado, Anschutz Medical Campus, Colorado Children's Hospital, Aurora, CO
| | - Christine L Phillips
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, Cincinnati, OH
| | - Adam Lane
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Christina Baggott
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Snehit Prabhu
- Stanford University School of Medicine, Stanford Cancer Institute, Center for Cancer Cell Therapy, Stanford, CA
| | - Emily Egeler
- Stanford University School of Medicine, Stanford Cancer Institute, Center for Cancer Cell Therapy, Stanford, CA
| | - Sharon Mavroukakis
- Stanford University School of Medicine, Stanford Cancer Institute, Center for Cancer Cell Therapy, Stanford, CA
| | - Holly Pacenta
- Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
| | - Jenna Rossoff
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Heather E Stefanski
- Department of Pediatrics, Division of Pediatric Blood and Marrow Transplantation, University of Minnesota Medical School, Minneapolis, MN
| | - Julie-An Talano
- Department of Pediatric Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Amy Moskop
- Department of Pediatric Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Steven P Margossian
- Harvard Medical School, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Pediatric Hematology-Oncology, Boston, MA
| | - Michael R Verneris
- University of Colorado, Anschutz Medical Campus, Colorado Children's Hospital, Aurora, CO
| | | | - Nicole A Karras
- Department of Pediatrics, City of Hope National Medical Center, Duarte, CA
| | - Patrick A Brown
- Department of Oncology, Sidney Kimmel Cancer Center at John Hopkins School of Medicine, Baltimore, MD
| | - Muna Qayed
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Michelle Hermiston
- Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Christa Krupski
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, Cincinnati, OH
| | - Amy K Keating
- University of Colorado, Anschutz Medical Campus, Colorado Children's Hospital, Aurora, CO
| | | | - Cara A Rabik
- Department of Oncology, Sidney Kimmel Cancer Center at John Hopkins School of Medicine, Baltimore, MD
| | - Vasant Chinnabhandar
- Department of Pediatrics, Division of Pediatric Blood and Marrow Transplantation, University of Minnesota Medical School, Minneapolis, MN
| | - Michael Kunicki
- Division of Hematology and Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - A Yasemin Goksenin
- Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
| | - Kevin J Curran
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Crystal L Mackall
- Division of Hematology and Oncology, Department of Pediatrics, Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, CA
- Division of Stem Cell Transplantation and Cell Therapy, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Theodore W Laetsch
- Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
- Department of Pediatrics and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | - Liora M Schultz
- Department of Pediatrics, Division of Hematology and Oncology, Stanford University School of Medicine, Stanford, CA
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Majzner RG, Ramakrishna S, Mochizuki A, Patel S, Chinnasamy H, Yeom K, Schultz L, Richards R, Campen C, Reschke A, Mahdi J, Toland AMS, Baggott C, Mavroukakis S, Egeler E, Moon J, Landrum K, Erickson C, Rasmussen L, Barsan V, Tamaresis JS, Marcy AC, Kunicki M, Fujimoto M, Ehlinger Z, Kurra S, Cornell T, Partap S, Fisher P, Grant G, Vogel H, Sahaf B, Davis K, Feldman S, Mackall CL, Monje M. Abstract CT031: GD2 CAR T cells mediate clinical activity and manageable toxicity in children and young adults with DIPG and H3K27M-mutated diffuse midline gliomas. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct031] [Citation(s) in RCA: 5] [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: 11/16/2022]
Abstract
Abstract
Background: Diffuse intrinsic pontine glioma (DIPG) and other H3K27M-mutated diffuse midline gliomas (DMGs) are universally lethal central nervous system tumors. We previously discovered that the disialoganglioside GD2 is highly and homogenously expressed on H3K27M+ gliomas and demonstrated that GD2 CAR T cells are effective in preclinical models (Mount/Majzner et al., Nat Med, 2018).
Methods: Four subjects (3 DIPG, 1 spinal cord DMG; 4-25 yr; 1M/3F) were enrolled at DL1. Three subjects with H3K27M+ DIPG received 1e6 autologous GD2 CAR T cells/kg intravenously (IV) on study. One patient, a 25 y/o with spinal cord DMG, developed rapidly progressive disease after enrollment, resulting in complete paraparesis that led to removal from the study prior to cell infusion; she was treated on a single patient eIND with the same treatment regimen as DL1. We utilized a retroviral vector expressing a 14g2a.4-1BB.z CAR construct and an inducible iCasp9 safety switch. Manufacturing was performed in the Miltenyi Prodigy on CD4/CD8 enriched apheresis product. CAR T cells were cultured in the presence of dasatinib to improve T cell fitness (Weber et al., Science, 2021). An Ommaya reservoir was placed in all patients for monitoring of intracranial pressure (ICP).
Results: We generated GD2 CAR T cell products meeting release criteria for all four patients. All subjects received lymphodepletion with cyclophosphamide and fludarabine and remained inpatient for 14+ days after infusion. All patients developed cytokine release syndrome (Grade 1-3) manifested by fever, tachycardia and hypotension, beginning 6-7 days after infusion. Due to concern for tumoral edema and increased ICP, patients were managed with conservative fluid resuscitation, and early intervention with tocilizumab and anakinra +/- corticosteroids. Other toxicities included ICANS (Grade 1-2) and neurotoxicity mediated by inflammation in sites of disease which we have termed Tumor Inflammation-Associated Neurotoxicity (TIAN). TIAN most often manifested as worsening of existing deficits, but one patient developed symptoms of increased ICP which quickly resolved upon removal of CSF via the Ommaya. No evidence of on-target, off-tumor toxicity was observed in any patients. No dose-limiting toxicities occurred.CAR T cells trafficked to the CNS and were detected in both the CSF and peripheral blood. Inflammatory cytokines including IL-6 were elevated in the CSF and blood. 3/4 patients exhibited marked improvement or resolution of neurological deficits and some radiographic improvement. The patient treated on a single patient eIND exhibited a >90% reduction in her spinal cord DMG tumor volume at two months post-infusion. Durability of the therapeutic benefit remains to be determined.
Conclusions: This is the first report of GD2 CAR T cell therapy for DIPG and spinal cord DMG. Toxicities are similar to other CAR T cells with additional, manageable complications due to inflammation at CNS sites of tumor. Treatment at DL1 demonstrated a tolerable safety profile and clear signs of T cell expansion and activity including clinical responses. This approach has the potential to transform therapy for patients with H3K27M+ DIPG/DMG. Further correlative studies, including single-cell RNAseq, longer-term outcomes and results from patients on subsequent dose levels will also be presented.
Citation Format: Robbie G. Majzner, Sneha Ramakrishna, Aaron Mochizuki, Shabnum Patel, Harshini Chinnasamy, Kristen Yeom, Liora Schultz, Rebecca Richards, Cynthia Campen, Agnes Reschke, Jasia Mahdi, Angus Martin Shaw Toland, Christina Baggott, Sharon Mavroukakis, Emily Egeler, Jennifer Moon, Kayla Landrum, Courtney Erickson, Lindsey Rasmussen, Valentin Barsan, John S. Tamaresis, Anne Cunniffe Marcy, Michael Kunicki, Michelle Fujimoto, Zach Ehlinger, Sreevidya Kurra, Timothy Cornell, Sonia Partap, Paul Fisher, Gerald Grant, Hannes Vogel, Bita Sahaf, Kara Davis, Steven Feldman, Crystal L. Mackall, Michelle Monje. GD2 CAR T cells mediate clinical activity and manageable toxicity in children and young adults with DIPG and H3K27M-mutated diffuse midline gliomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT031.
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Affiliation(s)
| | | | | | - Shabnum Patel
- Stanford University School of Medicine, Palo Alto, CA
| | | | - Kristen Yeom
- Stanford University School of Medicine, Palo Alto, CA
| | - Liora Schultz
- Stanford University School of Medicine, Palo Alto, CA
| | | | | | - Agnes Reschke
- Stanford University School of Medicine, Palo Alto, CA
| | - Jasia Mahdi
- Stanford University School of Medicine, Palo Alto, CA
| | | | | | | | - Emily Egeler
- Stanford University School of Medicine, Palo Alto, CA
| | - Jennifer Moon
- Stanford University School of Medicine, Palo Alto, CA
| | - Kayla Landrum
- Stanford University School of Medicine, Palo Alto, CA
| | | | | | | | | | | | | | | | - Zach Ehlinger
- Stanford University School of Medicine, Palo Alto, CA
| | | | | | - Sonia Partap
- Stanford University School of Medicine, Palo Alto, CA
| | - Paul Fisher
- Stanford University School of Medicine, Palo Alto, CA
| | - Gerald Grant
- Stanford University School of Medicine, Palo Alto, CA
| | - Hannes Vogel
- Stanford University School of Medicine, Palo Alto, CA
| | - Bita Sahaf
- Stanford University School of Medicine, Palo Alto, CA
| | - Kara Davis
- Stanford University School of Medicine, Palo Alto, CA
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Mochizuki A, Ramakrishna S, Good Z, Patel S, Chinnasamy H, Yeom K, Schultz L, Richards R, Campen C, Reschke A, Mahdi J, Toland A, Baggot C, Mavroukakis S, Egeler E, Moon J, Landrum K, Erickson C, Rasmussen L, Barsan V, Tamaresis J, Marcy A, Kunicki M, Celones M, Ehlinger Z, Kurra S, Cornell T, Partap S, Fisher P, Grant G, Vogel H, Davis K, Feldman S, Sahaf B, Majzner R, Mackall C, Monje M. OMIC-11. SINGLE CELL RNA SEQUENCING FROM THE CSF OF SUBJECTS WITH H3K27M+ DIPG/DMG TREATED WITH GD2 CAR T-CELLULAR THERAPY. Neuro Oncol 2021. [PMCID: PMC8168255 DOI: 10.1093/neuonc/noab090.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction We are conducting a Phase I clinical trial utilizing chimeric antigen receptor (CAR) T-cells targeting GD2 (NCT04196413) for H3K27M-mutant diffuse intrinsic pontine glioma (DIPG) and spinal cord diffuse midline glioma (DMG). Cerebrospinal fluid (CSF) is collected for correlative studies at the time of routine intracranial pressure monitoring via Ommaya catheter. Here we present single cell RNA-sequencing results from the first 3 subjects. Methods Single cell RNA-sequencing was performed utilizing 10X Genomics on cells isolated from CSF at various time points before and after CAR T-cell administration and on the CAR T-cell product. Output was aligned with Cell Ranger and analyzed in R. Results As detailed in the Majzner et al. abstract presented at this meeting, three of four subjects treated at dose-level one exhibited clear radiographic and/or clinical benefit. We have to date completed single cell RNA-sequencing for three of these four subjects (two with benefit, one without). After filtering out low-quality signals and doublets, 89,604 cells across 3 subjects were analyzed. Of these, 4,122 cells represent cells isolated from CSF and 85,482 cells represent CAR T-cell product. Two subjects who demonstrated clear clinical and radiographic improvement exhibited fewer S100A8+S100A9+ myeloid suppressor-cells and CD25+FOXP3+ regulatory T-cells in the CSF pre-infusion compared to the subject who did not derive a therapeutic response. In one subject with DIPG who demonstrated improvement, polyclonal CAR T-cells detectable in CSF at Day +14 demonstrated enrichment of CD8A, GZMA, GNLY and PDCD1 compared to the pre-infusion CAR T-cells by trajectory analysis, suggesting differentiation toward a cytotoxic phenotype; the same subject exhibited increasing numbers of S100A8+S100A9+ myeloid cells and CX3CR1+P2RY12+ microglia over time. Further analyses will be presented as data become available. Conclusions The presence of immunosuppressive myeloid populations, detectable in CSF, may correlate to clinical response in CAR T cell therapy for DIPG/DMG.
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Affiliation(s)
| | | | - Zina Good
- Stanford University, Palo Alto, CA, USA
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11
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Majzner R, Ramakrishna S, Mochizuki A, Patel S, Chinnasamy H, Yeom K, Schultz L, Richards R, Campen C, Reschke A, Mahdi J, Toland AMS, Baggott C, Mavroukakis S, Egeler E, Moon J, Landrum K, Erickson C, Rasmussen L, Barsan V, Tamaresis J, Marcy A, Kunicki M, Fujimoto M, Ehlinger Z, Kurra S, Cornell T, Partap S, Fisher P, Grant G, Vogel H, Sahaf B, Davis K, Feldman S, Mackall C, Monje M. EPCT-14. GD2 CAR T-CELLS MEDIATE CLINICAL ACTIVITY AND MANAGEABLE TOXICITY IN CHILDREN AND YOUNG ADULTS WITH H3K27M-MUTATED DIPG AND SPINAL CORD DMG. Neuro Oncol 2021. [PMCID: PMC8168142 DOI: 10.1093/neuonc/noab090.200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
We previously discovered high expression of the disialoganglioside GD2 on H3K27M+ gliomas and demonstrated preclinical efficacy of intravenous (IV) GD2-targeted chimeric antigen receptor (CAR) T-cells in preclinical models of H3K27M-mutated diffuse intrinsic pontine glioma (DIPG) and diffuse midline gliomas (DMGs). We are now conducting a Phase I clinical trial (NCT04196413) of autologous GD2-targeting CAR T-cells for H3K27M+ DIPG and spinal cord DMG. Here we present the results of subjects treated at dose level 1 (DL1; 1 million GD2-CAR T-cells/kg IV).
Methods
Four patients (3 DIPG, 1 spinal DMG; ages 4–25; 1M/3F) were enrolled at DL1. Three subjects with H3K27M+ DIPG received 1e6 GD2-CAR T-cells/kg IV on study. One patient with spinal DMG enrolled but became ineligible after manufacturing and was treated on an eIND at DL1. An Ommaya reservoir was placed in all subjects for therapeutic monitoring of intracranial pressure. Subjects underwent lymphodepletion with fludarabine/cyclophosphamide and remained inpatient for at least two weeks post-infusion.
Results
All subjects developed cytokine release syndrome (Grade 1–3) manifested by fever, tachycardia and hypotension. Other toxicities included ICANS (Grade 1–2) and neurological symptoms/signs mediated by intratumoral inflammation which we have termed Tumor Inflammation-Associated Neurotoxicity (TIAN). No evidence of on-target, off-tumor toxicity was observed in any patients. No dose-limiting toxicities occurred. CAR T cells trafficked to the CNS and were detected in CSF and blood. 3/4 patients exhibited marked improvement or resolution of neurological deficits and radiographic improvement. The patient treated on an eIND exhibited >90% reduction in spinal DMG volume but progressed by month 3. Re-treatment of this subject via intracerebroventricular administration resulted in a second reduction in spinal DMG volume by ~80%.
Conclusions
GD2-CAR T-cells at DL1 demonstrate a tolerable safety profile in patients with H3K27M+ DIPG/DMG with clear signs of T-cell expansion and activity including clinical responses.
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Affiliation(s)
- Robbie Majzner
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Shabnum Patel
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Kristen Yeom
- Stanford University School of Medicine, Stanford, CA, USA
| | - Liora Schultz
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Cynthia Campen
- Stanford University School of Medicine, Stanford, CA, USA
| | - Agnes Reschke
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jasia Mahdi
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Emily Egeler
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer Moon
- Stanford University School of Medicine, Stanford, CA, USA
| | - Kayla Landrum
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - John Tamaresis
- Stanford University School of Medicine, Stanford, CA, USA
| | - Anne Marcy
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Zach Ehlinger
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Sonia Partap
- Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Fisher
- Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald Grant
- Stanford University School of Medicine, Stanford, CA, USA
| | - Hannes Vogel
- Stanford University School of Medicine, Stanford, CA, USA
| | - Bita Sahaf
- Stanford University School of Medicine, Stanford, CA, USA
| | - Kara Davis
- Stanford University School of Medicine, Stanford, CA, USA
| | - Steven Feldman
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Michelle Monje
- Stanford University School of Medicine, Stanford, CA, USA
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Curran K, Fabrizio V, Mauguen A, Boelens J, Baggott C, Prabhu S, Placenta H, Phillips C, Rossoff J, Stefanski H, Talano J, Moskop A, Margossian S, Verneris M, Myers G, Karras N, Brown P, Qayed M, Hermiston M, Satwani P, Krupski C, Keating A, Wilcox R, Rabik C, Chinnabhandar V, Kunicki M, Goksenin A, Mackall C, Laetsch T, Schultz L. Fludarabine-exposure predicts disease control following CD19-specific car t cell (tisagenlecleucel); a report from pediatric real-world car consortium. Cytotherapy 2021. [DOI: 10.1016/s1465324921002899] [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: 10/21/2022]
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Meczekalski B, Czyzyk A, Kunicki M, Podfigurna-Stopa A, Plociennik L, Jakiel G, Maciejewska-Jeske M, Lukaszuk K. Fertility in women of late reproductive age: the role of serum anti-Müllerian hormone (AMH) levels in its assessment. J Endocrinol Invest 2016; 39:1259-1265. [PMID: 27300031 PMCID: PMC5069312 DOI: 10.1007/s40618-016-0497-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Fertility is referred to the capability for having offspring and can be evaluated by fertility rate. Women's fertility is strictly dependent on individual's age. The fertility peak occurs in the early 20s, and it starts to decline in the third and fourth decades of life (falling sharply after age 35). AIM The aim of this work is to review the available data concerning fertility in women of late reproductive age, especially the role of serum anti-Müllerian hormone (AMH) levels. RESULTS There are a lot of factors responsible for decrease of fertility in women of late reproductive age. These factors can be classified as oocyte-dependent (decrease in oocyte quantity and quality) and oocyte-independent (reproductive organs [uterus, oviducts] status and general health). Anti-Müllerian hormone (AMH) is a dimeric glycoprotein of the transforming growth factor-β (TGF-β) superfamily produced directly by the ovarian granulosa cells of secondary, preantral, and early antral follicles. It has been used as an ovarian reserve marker since 2002. Anti-Müllerian hormone seems to be the best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women. Evaluation of AMH's predictive value in the naturally aging population is important for counseling women about reproductive planning as well as for treatment planning for women experiencing hormone-sensitive gynecological conditions such as endometriosis and fibroids. CONCLUSIONS AMH can be considered as an indicator of fertility in late reproductive age women and pregnancy outcome in assisted reproductive technology cycles. AMH can strongly predict poor response in the controlled ovarian stimulation.
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Affiliation(s)
- B Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland.
| | - A Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - M Kunicki
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - A Podfigurna-Stopa
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - L Plociennik
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - G Jakiel
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- Department of Obstetrics and Gynecology, Center of Postgraduate Education, Warsaw, Poland
| | - M Maciejewska-Jeske
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - K Lukaszuk
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland
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Meczekalski B, Czyzyk A, Kunicki M, Podfigurna-Stopa A, Plociennik L, Jakiel G, Maciejewska-Jeske M, Lukaszuk K. Erratum to: Fertility in women of late reproductive age: the role of serum anti-Müllerian hormone (AMH) levels in its assessment. J Endocrinol Invest 2016; 39:1267. [PMID: 27444619 PMCID: PMC6828111 DOI: 10.1007/s40618-016-0513-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland.
| | - A Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - M Kunicki
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - A Podfigurna-Stopa
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - L Plociennik
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - G Jakiel
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- Department of Obstetrics and Gynecology, Center of Postgraduate Education, Warsaw, Poland
| | - M Maciejewska-Jeske
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - K Lukaszuk
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland
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Łukaszuk K, Kunicki M, Kulwikowska P, Liss J, Pastuszek E, Jaszczołt M, Męczekalski B, Skowroński K. The impact of the presence of antithyroid antibodies on pregnancy outcome following intracytoplasmatic sperm injection-ICSI and embryo transfer in women with normal thyreotropine levels. J Endocrinol Invest 2015; 38:1335-43. [PMID: 26280321 DOI: 10.1007/s40618-015-0377-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of our study was to investigate the impact of anti-thyroid peroxidase antibodies (Anti-TPO) on pregnancy outcome following the in vitro fertilization and embryo transfer (IVF-ET) in general groups and in subgroups divided according to AMH level and age. METHODS A total of 114 patients positive for anti-thyroid peroxidase antibodies (Anti-TPO+ group) and 495 infertile women negative for anti-thyroid peroxidase antibodies (Anti-TPO- group) undergoing IVF with ICSI from April 2010 to April 2012 were analyzed retrospectively. RESULTS There were no significant differences in age, BMI, basal FSH, LH, AMH levels and duration of infertility between the two main groups. No significant differences in terms of the days of ovarian stimulation, estradiol level in day 8, total gonadotropin dose, number of oocytes retrieved, available embryos and blastocysts, number of embryos transferred nor in rates of fertilization, implantation, clinical pregnancy, live birth and abortion rate between two main groups were found. The only statistically significant difference among the groups with different anti-TPO antibodies levels was found in basal FSH concentration and BMI. Among the clinical outcomes of IVF with respect to the different anti-TPO levels, the only significant difference was found for the number of oocytes retrieved. Analysis of the baseline parameters in relationship to age categories and AMH levels found significant differences between women positive and negative for thyroid antibodies with respect to basal FSH and LH levels for women >37 years and for basal FSH in AMH <0.6 subgroup. CONCLUSIONS The present study reveals that patients with anti-TPO antibodies showed no significant differences in fertilization, implantation, pregnancy rates, live birth rates and no higher risk for miscarriage following IVF-ET when compared with those negative for anti-thyroid antibodies.
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Affiliation(s)
- K Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
- INVICTA Fertility and Reproductive Center, Invicta Złota 6 Str, 00019, Warsaw, Poland
| | - M Kunicki
- INVICTA Fertility and Reproductive Center, Invicta Złota 6 Str, 00019, Warsaw, Poland.
| | - P Kulwikowska
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - J Liss
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - E Pastuszek
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - M Jaszczołt
- Department of Chemical and Process Engineering Chemical Faculty, Gdansk University of Technology, Gdańsk, Poland
| | - B Męczekalski
- Department of Gynecological Endocrinology, Poznan Univeristy of Medcial Sciences, Poznan, Poland
| | - K Skowroński
- Institute of Computer Science, Faculty of Mathematics, Physics and Informatics, University of Gdansk, Gdańsk, Poland
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Nazzaro A, Salerno A, Di Iorio L, Landino G, Marino S, Pastore E, Fabregues F, Iraola A, Casals G, Creus M, Peralta S, Penarrubia J, Manau D, Civico S, Balasch J, Lindgren I, Giwercman YL, Celik E, Turkcuoglu I, Ata B, Karaer A, Kirici P, Berker B, Park J, Kim J, Rhee J, Krishnan M, Rustamov O, Russel R, Fitzgerald C, Roberts S, Hapuarachi S, Tan BK, Mathur RS, van de Vijver A, Blockeel C, Camus M, Polyzos N, Van Landuyt L, Tournaye H, Turhan NO, Hizli D, Kamalak Z, Kosus A, Kosus N, Kafali H, Lukaszuk A, Kunicki M, Liss J, Bednarowska A, Jakiel G, Lukaszuk K, Lukaszuk M, Olszak-Sokolowska B, Lukaszuk K, Kunicki M, Liss J, Jakiel G, Bednarowska A, Wasniewski T, Neuberg M, Lukaszuk M, Cavalcanti V, Peluso C, Lechado BL, Cordts EB, Christofolini DM, Barbosa CP, Bianco B, Venetis CA, Kolibianakis EM, Bosdou J, Tarlatzis BC, Onal M, Gungor DN, Acet M, Kahraman S, Kuijper E, Twisk J, Caanen M, Korsen T, Hompes P, Kushnir M, Rockwood A, Meikle W, Lambalk CB, Hizli D, Kamalak Z, Kosus A, Kosus N, Turhan NO, Kafali H, Yan X, Dai X, Wang J, Zhao N, Cui Y, Liu J, Yarde F, Maas AHEM, Franx A, Eijkemans MJC, Drost JT, van Rijn BB, van Eyck J, van der Schouw YT, Broekmans FJM, Martyn F, Anglim B, Wingfield M, Fang T, Yan GJ, Sun HX, Hu YL, Chrudimska J, Krenkova P, Macek M, Macek M, Teixeira da Silva J, Cunha M, Silva J, Viana P, Goncalves A, Barros N, Oliveira C, Sousa M, Barros A, Nelson SM, Lloyd SM, McConnachie A, Khader A, Fleming R, Lawlor DA, Thuesen L, Andersen AN, Loft A, Smitz J, Abdel-Rahman M, Ismail S, Silk J, Abdellah M, Abdellah AH, Ruiz F, Cruz M, Piro M, Collado D, Garcia-Velasco JA, Requena A, Kollmann Z, Bersinger NA, McKinnon B, Schneider S, Mueller MD, von Wolff M, Vaucher A, Kollmann Z, Bersinger NA, Weiss B, Stute P, Marti U, von Wolff M, Chai J, Yeung WYT, Lee CYV, Li WHR, Ho PC, Ng HYE, Kim SM, Kim SH, Jee BC, Ku S, Suh CS, Choi YM, Kim JG, Moon SY, Lee JH, Kim SG, Kim YY, Kim HJ, Lee KH, Park IH, Sun HG, Hwang YI, Sung NY, Choi MH, Cha SH, Park CW, Kim JY, Yang KM, Song IO, Koong MK, Kang IS, Kim HO, Haines C, Wong WY, Kong WS, Cheung LP, Choy TK, Leung PC, Fadini R, Coticchio G, Renzini MM, Guglielmo MC, Brambillasca F, Hourvitz A, Albertini DF, Novara P, Merola M, Dal Canto M, Iza JAA, DePablo JL, Anarte C, Domingo A, Abanto E, Barrenetxea G, Kato R, Kawachiya S, Bodri D, Kondo M, Matsumoto T, Maldonado LGL, Setti AS, Braga DPAF, Iaconelli A, Borges E, Iaconelli C, Setti AS, Braga DPAF, Figueira RCS, Iaconelli A, Borges E, Kitaya K, Taguchi S, Funabiki M, Tada Y, Hayashi T, Nakamura Y, Snajderova M, Zemkova D, Lanska V, Teslik L, Calonge RN, Ortega L, Garcia A, Cortes S, Guijarro A, Peregrin PC, Bellavia M, Pesant MH, Wirthner D, Portman L, de Ziegler D, Wunder D, Chen X, Chen SHL, Liu YD, Tao T, Xu LJ, Tian XL, Ye DSH, He YX, Carby A, Barsoum E, El-Shawarby S, Trew G, Lavery S, Mishieva N, Barkalina N, Korneeva I, Ivanets T, Abubakirov A, Chavoshinejad R, Hartshorne GM, Marei W, Fouladi-nashta AA, Kyrkou G, Trakakis E, Chrelias CH, Alexiou E, Lykeridou K, Mastorakos G, Bersinger N, Kollmann Z, Mueller MD, Vaucher A, von Wolff M, Ferrero H, Gomez R, Garcia-Pascual CM, Simon C, Pellicer A, Turienzo A, Lledo B, Guerrero J, Ortiz JA, Morales R, Ten J, Llacer J, Bernabeu R, De Leo V, Focarelli R, Capaldo A, Stendardi A, Gambera L, Marca AL, Piomboni P, Kim JJ, Choi YM, Kang JH, Hwang KR, Chae SJ, Kim SM, Yoon SH, Ku SY, Kim SH, Kim JG, Moon SY, Iliodromiti S, Kelsey TW, Anderson RA, Nelson SM, Lee HJ, Weghofer A, Kushnir VA, Shohat-Tal A, Lazzaroni E, Lee HJ, Barad DH, Gleicher NN, Shavit T, Shalom-Paz E, Fainaru O, Michaeli M, Kartchovsky E, Ellenbogen A, Gerris J, Vandekerckhove F, Delvigne A, Dhont N, Madoc B, Neyskens J, Buyle M, Vansteenkiste E, De Schepper E, Pil L, Van Keirsbilck N, Verpoest W, Debacquer D, Annemans L, De Sutter P, Von Wolff M, Kollmann Z, Vaucher A, Weiss B, Bersinger NA, Verit FF, Keskin S, Sargin AK, Karahuseyinoglu S, Yucel O, Yalcinkaya S, Comninos AN, Jayasena CN, Nijher GMK, Abbara A, De Silva A, Veldhuis JD, Ratnasabapathy R, Izzi-Engbeaya C, Lim A, Patel DA, Ghatei MA, Bloom SR, Dhillo WS, Colodron M, Guillen JJ, Garcia D, Coll O, Vassena R, Vernaeve V, Pazoki H, Bolouri G, Farokhi F, Azarbayjani MA, Alebic MS, Stojanovic N, Abali R, Yuksel A, Aktas C, Celik C, Guzel S, Erfan G, Sahin O, Zhongying H, Shangwei L, Qianhong M, Wei F, Lei L, Zhun X, Yan W, Vandekerckhove F, De Baerdemaeker A, Gerris J, Tilleman K, Vansteelandt S, De Sutter P, Oliveira JBA, Baruffi RLR, Petersen CG, Mauri AL, Nascimento AM, Vagnini L, Ricci J, Cavagna M, Massaro FC, Pontes A, Franco JG, El-khayat W, Elsadek M, Foroozanfard F, Saberi H, Moravvegi A, Kazemi M, Gidoni YS, Raziel A, Friedler S, Strassburger D, Hadari D, Kasterstein E, Ben-Ami I, Komarovsky D, Maslansky B, Bern O, Ron-El R, Izquierdo MP, Ten J, Guerrero J, Araico F, Llacer J, Bernabeu R, Somova O, Feskov O, Feskova I, Bezpechnaya I, Zhylkova I, Tishchenko O, Oguic SK, Baldani DP, Skrgatic L, Simunic V, Vrcic H, Rogic D, Juras J, Goldstein MS, Garcia De Miguel L, Campo MC, Gurria A, Alonso J, Serrano A, Marban E, Peregrin PC, Hourvitz A, Shalev L, Yung Y, Yerushalmi G, Giovanni C, Dal Canto M, Fadini R, Has J, Maman E, Monterde M, Gomez R, Marzal A, Vega O, Rubio JM, Diaz-Garcia C, Pellicer A, Eapen A, Datta A, Kurinchi-selvan A, Birch H, Lockwood GM, Ornek MC, Ates U, Usta T, Goksedef CP, Bruszczynska A, Glowacka J, Kunicki M, Jakiel G, Wasniewski T, Jaguszewska K, Liss J, Lukaszuk K, Oehninger S, Nelson S, Verweij P, Stegmann B, Ando H, Takayanagi T, Minamoto H, Suzuki N, Maman E, Rubinshtein N, Yung Y, Shalev L, Yerushalmi G, Hourvitz A, Saltek S, Demir B, Dilbaz B, Demirtas C, Kutteh W, Shapiro B, Witjes H, Gordon K, Lauritsen MP, Loft A, Pinborg A, Freiesleben NL, Mikkelsen AL, Bjerge MR, Andersen AN, Chakraborty P, Goswami SK, Chakravarty BN, Mittal M, Bajoria R, Narvekar N, Chatterjee R, Bentzen JG, Johannsen TH, Scheike T, Andersen AN, Friis-Hansen L, Sunkara S, Coomarasamy A, Faris R, Braude P, Khalaf Y, Makedos A, Kolibianakis EM, Venetis CA, Masouridou S, Chatzimeletiou K, Zepiridis L, Mitsoli A, Lainas G, Sfontouris I, Tzamtzoglou A, Kyrou D, Lainas T, Tarlatzis BC, Fermin A, Crisol L, Exposito A, Prieto B, Mendoza R, Matorras R, Louwers Y, Lao O, Kayser M, Palumbo A, Sanabria V, Rouleau JP, Puopolo M, Hernandez MJ, Diaz-Garcia C, Monterde M, Marzal A, Vega O, Rubio JM, Gomez R, Pellicer A, Ozturk S, Sozen B, Yaba-Ucar A, Mutlu D, Demir N, Olsson H, Sandstrom R, Grundemar L, Papaleo E, Corti L, Rabellotti E, Vanni VS, Potenza M, Molgora M, Vigano P, Candiani M, Andersen AN, Fernandez-Sanchez M, Bosch E, Visnova H, Barri P, Garcia-Velasco JA, De Sutter P, Fauser BJCM, Arce JC, Sandstrom R, Olsson H, Grundemar L, Peluso P, Trevisan CM, Cordts EB, Cavalcanti V, Christofolini DM, Fonseca FA, Barbosa CP, Bianco B, Bakas P, Vlahos N, Hassiakos D, Tzanakaki D, Gregoriou O, Liapis A, Creatsas G, Adda-Herzog E, Steffann J, Sebag-Peyrelevade S, Poulain M, Benachi A, Fanchin R, Gordon K, Zhang D, Andersen AN, Aybar F, Temel S, Kahraman S, Hamdine O, Macklon NS, Eijkemans MJC, Laven JS, Cohlen BJ, Verhoeff A, van Dop PA, Bernardus RE, Lambalk CB, Oosterhuis GJE, Holleboom CAG, van den Dool-Maasland GC, Verburg HJ, van der Heijden PFM, Blankhart A, Fauser BCJM, Broekmans FJ, Bhattacharya J, Mitra A, Dutta GB, Kundu A, Bhattacharya M, Kundu S, Pigny P, Dassonneville A, Catteau-Jonard S, Decanter C, Dewailly D, Pouly J, Olivennes F, Massin N, Celle M, Caizergues N, Fleming R, Gaudoin M, Messow M, McConnachie A, Nelson SM, Dewailly D, Vanhove L, Peigne M, Thomas P, Robin G, Catteau-Jonard S. Reproductive endocrinology. Hum Reprod 2013. [DOI: 10.1093/humrep/det221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The objective of this study was to evaluate serum prostate specific antigen (PSA) levels in women with menstrual disturbances and fibrocystic mastopathy. A total of 114 women with fibrocystic breast disease with cysts <10 mm (group I), 62 with macrocysts >10 mm (group II) and 46 healthy volunteers, who served as control subjects, were recruited for this prospective study. Each patient underwent complete gynecological examination and had performed sonography of the breasts. Moreover menstrual pattern, serum levels of free and total PSA, LH, FSH, SHBG, PRL, estradiol, progesterone, TSH, T4, as well as serum total testosterone, were evaluated in each subject. We compared serum free and total PSA levels between women with different menstrual pattern within groups of women with micro- and macrocysts. We also evaluated correlations between serum free and total PSA and hormonal/descriptive variables. We found that, in group II, women with regular menses and polymenorrhea revealed significantly higher serum free PSA than women with oligomenorrhea and secondary amenorrhea. Moreover, we found a positive correlation between serum total testosterone and total PSA in the control group and between progesterone and total PSA in group II. Our data show that serum free PSA is increased in women with regular menstrual cycles and polymenorrhea. This later relationship refers to women with macrocysts. Further studies are required to clarify the relationships between serum PSA and menstrual disturbances in women with mastopathy.
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Affiliation(s)
- S Radowicki
- Department of Gynecological Endocrinology, Medical University of Warsaw, Karowa Street 2, 00-350 Warsaw, Poland
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Radowicki S, Horoszko-Husiatyńska B, Kunicki M, Sieńkowska M. [Effects of continuous estradiol-progestogen treatment on hemostasis in postmenopausal women]. Ginekol Pol 1998; 69:62-6. [PMID: 9591382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A study was undertaken to asses the effects of oral continuous hormone replacement therapy on haemostatic balance. Blood samples were drawn from 28 postmenopausal women (mean age 54.1 +/- 4.1) with severe climacteric complaints. All the women were treated for one year with a continuous oestradiol-progestogen regimen which was administrated daily and consisting of 2 mg 17 beta-oestradiol in combination with norethisteron acetate, 1 mg (Kliogest-Novo-Nordisk). Hormone replacement therapy had no effect on fibrinogen and thrombin time. Activated partial thromboplastin time as well as prothrombin time was significantly decreased (p < 0.05) respectively 1.7 +/- 3.1 s and 0.6 +/- 1.4 s. No women developed crural thrombosis during therapy.
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Affiliation(s)
- S Radowicki
- Kliniki Endokrynologii Ginekologicznej AM w Warszawie
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