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Ravandi F, Subklewe M, Walter RB, Vachhani P, Ossenkoppele G, Buecklein V, Döhner H, Jongen-Lavrencic M, Baldus CD, Fransecky L, Pardee TS, Kantarjian H, Yen PK, Mukundan L, Panwar B, Yago MR, Agarwal S, Khaldoyanidi SK, Stein A. Safety and tolerability of AMG 330 in adults with relapsed/refractory AML: a phase 1a dose-escalation study. Leuk Lymphoma 2024:1-11. [PMID: 38712673 DOI: 10.1080/10428194.2024.2346755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
AMG 330, a bispecific T-cell engager (BiTE®) that binds CD33 and CD3 on T cells facilitates T-cell-mediated cytotoxicity against CD33+ cells. This first-in-human, open-label, dose-escalation study evaluated the safety, pharmacokinetics, pharmacodynamics, and preliminary efficacy of AMG 330 in adults with relapsed/refractory acute myeloid leukemia (R/R AML). Amongst 77 patients treated with AMG 330 (0.5 µg/day-1.6 mg/day) on 14-day or 28-day cycles, maximum tolerated dose was not reached; median duration of treatment was 29 days. The most frequent treatment-related adverse events were cytokine release syndrome (CRS; 78%) and rash (30%); 10% of patients experienced grade 3/4 CRS. CRS was mitigated with stepwise dosing of AMG 330, prophylactic dexamethasone, and early treatment with tocilizumab. Among 60 evaluable patients, eight achieved complete remission or morphologic leukemia-free state; of the 52 non-responders, 37% had ≥50% reduction in AML bone marrow blasts. AMG 330 is a promising CD33-targeted therapeutic strategy for R/R AML.
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Affiliation(s)
- Farhad Ravandi
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Research, Gene Center, LMU Munich, Munich, Germany
| | - Roland B Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Veit Buecklein
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Research, Gene Center, LMU Munich, Munich, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Claudia D Baldus
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Lars Fransecky
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Timothy S Pardee
- Department of Internal Medicine, Section on Hematology and Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Hagop Kantarjian
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | | | - Anthony Stein
- Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, CA, USA
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2
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van de Loosdrecht AA, Cremers EMP, Alhan C, Duetz C, In 't Hout FEM, Visser-Wisselaar HA, Chitu DA, Verbrugge A, Cunha SM, Ossenkoppele GJ, Janssen JJWM, Klein SK, Vellenga E, Huls GA, Muus P, Langemeijer SMC, de Greef GE, Te Boekhorst PAW, Raaijmakers MHG, van Marwijk Kooy M, Legdeur MC, Wegman JJ, Deenik W, de Weerdt O, van Maanen-Lamme TM, Jobse P, van Kampen RJW, Beeker A, Wijermans PW, Biemond BJ, Tanis BC, van Esser JWJ, Schaar CG, Noordzij-Nooteboom HS, Jacobs EMG, de Graaf AO, Jongen-Lavrencic M, Stevens-Kroef MJPL, Westers TM, Jansen JH. Determinants of lenalidomide response with or without erythropoiesis-stimulating agents in myelodysplastic syndromes: the HOVON89 trial. Leukemia 2024; 38:840-850. [PMID: 38297135 PMCID: PMC10997501 DOI: 10.1038/s41375-024-02161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
A randomized phase-II study was performed in low/int-1 risk MDS (IPSS) to study efficacy and safety of lenalidomide without (arm A) or with (arm B) ESA/G-CSF. In arm B, patients without erythroid response (HI-E) after 4 cycles received ESA; G-CSF was added if no HI-E was obtained by cycle 9. HI-E served as primary endpoint. Flow cytometry and next-generation sequencing were performed to identify predictors of response. The final evaluation comprised 184 patients; 84% non-del(5q), 16% isolated del(5q); median follow-up: 70.7 months. In arm A and B, 39 and 41% of patients achieved HI-E; median time-to-HI-E: 3.2 months for both arms, median duration of-HI-E: 9.8 months. HI-E was significantly lower in non-del(5q) vs. del(5q): 32% vs. 80%. The same accounted for transfusion independency-at-week 24 (16% vs. 67%), but similar in both arms. Apart from presence of del(5q), high percentages of bone marrow lymphocytes and progenitor B-cells, a low number of mutations, absence of ring sideroblasts, and SF3B1 mutations predicted HI-E. In conclusion, lenalidomide induced HI-E in patients with non-del(5q) and del(5q) MDS without additional effect of ESA/G-CSF. The identified predictors of response may guide application of lenalidomide in lower-risk MDS in the era of precision medicine. (EudraCT 2008-002195-10).
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Affiliation(s)
- A A van de Loosdrecht
- Department of Hematology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - E M P Cremers
- Department of Hematology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C Alhan
- Department of Hematology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - C Duetz
- Department of Hematology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - F E M In 't Hout
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - D A Chitu
- HOVON Foundation, Rotterdam, The Netherlands
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A Verbrugge
- HOVON Foundation, Rotterdam, The Netherlands
| | - S M Cunha
- HOVON Foundation, Rotterdam, The Netherlands
| | - G J Ossenkoppele
- Department of Hematology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J J W M Janssen
- Department of Hematology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S K Klein
- Department of Hematology, Meander Medisch Centrum, Amersfoort, The Netherlands
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Vellenga
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G A Huls
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P Muus
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Haematology, St. James University Hospital, Leeds, UK
| | - S M C Langemeijer
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G E de Greef
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P A W Te Boekhorst
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M H G Raaijmakers
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - M C Legdeur
- Department of Hematology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J J Wegman
- Department of Hematology, Deventer Ziekenhuis, Deventer, The Netherlands
- Department of Hematology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - W Deenik
- Department of Internal Medicine, Tergooi Ziekenhuis, Hilversum, The Netherlands
- Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands
| | - O de Weerdt
- Department of Internal Medicine, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - P Jobse
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - R J W van Kampen
- Department of Internal Medicine, Zuyderland Ziekenhuis, Geleen, The Netherlands
| | - A Beeker
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - P W Wijermans
- Department of Hematology, Haaglanden Ziekenhuis, Den Haag, The Netherlands
| | - B J Biemond
- Department of Hematology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - B C Tanis
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands
- Department of General Practice Erasmus MC, Rotterdam, The Netherlands
| | - J W J van Esser
- Department of Internal Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - C G Schaar
- Department of Internal Medicine, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - H S Noordzij-Nooteboom
- Department of Internal Medicine, Van Weel Bethesda Ziekenhuis, Dirksland, The Netherlands
| | - E M G Jacobs
- Department of Internal Medicine, Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - A O de Graaf
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M J P L Stevens-Kroef
- Department of human genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T M Westers
- Department of Hematology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J H Jansen
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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3
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Hilberink JR, van Zeventer IA, Chitu DA, Pabst T, Klein SK, Stussi G, Griskevicius L, Valk PJM, Cloos J, van de Loosdrecht AA, Breems D, van Lammeren-Venema D, Boersma R, Jongen-Lavrencic M, Fehr M, Hoogendoorn M, Manz MG, Söhne M, van Marwijk Kooy R, Deeren D, van der Poel MWM, Legdeur MC, Tick L, Chalandon Y, Ammatuna E, Blum S, Löwenberg B, Ossenkoppele GJ, Huls G. Age and sex associate with outcome in older AML and high risk MDS patients treated with 10-day decitabine. Blood Cancer J 2023; 13:93. [PMID: 37336890 DOI: 10.1038/s41408-023-00850-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/10/2023] [Accepted: 05/02/2023] [Indexed: 06/21/2023] Open
Abstract
Treatment choice according to the individual conditions remains challenging, particularly in older patients with acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (MDS). The impact of performance status, comorbidities, and physical functioning on survival is not well defined for patients treated with hypomethylating agents. Here we describe the impact of performance status (14% ECOG performance status 2), comorbidity (40% HCT-comorbidity index ≥ 2), and physical functioning (41% short physical performance battery < 9 and 17% ADL index < 6) on overall survival (OS) in 115 older patients (age ≥ 66 years) treated on a clinical trial with a 10-day decitabine schedule. None of the patient-related variables showed a significant association with OS. Multivariable analysis revealed that age > 76 years was significantly associated with reduced OS (HR 1.58; p = 0.043) and female sex was associated with superior OS (HR 0.62; p = 0.06). We further compared the genetic profiles of these subgroups. This revealed comparable mutational profiles in patients younger and older than 76 years, but, interestingly, revealed significantly more prevalent mutated ASXL1, STAG2, and U2AF1 in male compared to female patients. In this cohort of older patients treated with decitabine age and sex, but not comorbidities, physical functioning or cytogenetic risk were associated with overall survival.
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Affiliation(s)
- Jacobien R Hilberink
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Dana A Chitu
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Thomas Pabst
- Department of Oncology, University Hospital, Inselspital, and University of Bern, Bern, Switzerland
| | - Saskia K Klein
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
- Department of Internal Medicine, Meander Hospital Amersfoort, Amersfoort, the Netherlands
| | - Georg Stussi
- Department of Hematology, Oncology Institute of Southern Switzerland, Ospedale Regionale, Bellinzona, Switzerland
| | - Laimonas Griskevicius
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Jacqueline Cloos
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Dimitri Breems
- Department of Hematology, ZNA Stuivenberg/Middelheim, Antwerp, Belgium
| | | | - Rinske Boersma
- Department of Hematology, Amphia Hospital, Breda, the Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martin Fehr
- Department of Medical oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Markus G Manz
- Department of Medical Oncology and Hematology, Universitätsspital Zurich, Zurich, Switzerland
| | - Maaike Söhne
- Department of Hematology, Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Dries Deeren
- Department of Hematology, AZ Delta Roeselare, Roeselare, Belgium
| | - Marjolein W M van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Lidwine Tick
- Department of hematology, Maxima Medical Center, Veldhoven, the Netherlands
| | - Yves Chalandon
- Division of hematology, University Hospital Genève and Faculty of Medicine, University of Genève, Genève, Switzerland
| | - Emanuele Ammatuna
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sabine Blum
- Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Gert J Ossenkoppele
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands.
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4
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Tahir SK, Calvo E, Carneiro BA, Yuda J, Shreenivas A, Jongen-Lavrencic M, Gort E, Ishizawa K, Morillo D, Biesdorf C, Smith M, Cheng D, Motwani M, Sharon D, Uziel T, Modi DA, Buchanan FG, Morgan-Lappe S, Medeiros BC, Phillips DC. Activity of eftozanermin alfa plus venetoclax in preclinical models and patients with acute myeloid leukemia. Blood 2023; 141:2114-2126. [PMID: 36720090 PMCID: PMC10646782 DOI: 10.1182/blood.2022017333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/02/2023] Open
Abstract
Activation of apoptosis in malignant cells is an established strategy for controlling cancer and is potentially curative. To assess the impact of concurrently inducing the extrinsic and intrinsic apoptosis-signaling pathways in acute myeloid leukemia (AML), we evaluated activity of the TRAIL receptor agonistic fusion protein eftozanermin alfa (eftoza; ABBV-621) in combination with the B-cell lymphoma protein-2 selective inhibitor venetoclax in preclinical models and human patients. Simultaneously stimulating intrinsic and extrinsic apoptosis-signaling pathways with venetoclax and eftoza, respectively, enhanced their activities in AML cell lines and patient-derived ex vivo/in vivo models. Eftoza activity alone or plus venetoclax required death receptor 4/5 (DR4/DR5) expression on the plasma membrane but was independent of TP53 or FLT3-ITD status. The safety/tolerability of eftoza as monotherapy and in combination with venetoclax was demonstrated in patients with relapsed/refractory AML in a phase 1 clinical trial. Treatment-related adverse events were reported in 2 of 4 (50%) patients treated with eftoza monotherapy and 18 of 23 (78%) treated with eftoza plus venetoclax. An overall response rate of 30% (7/23; 4 complete responses [CRs], 2 CRs with incomplete hematologic recovery, and 1 morphologic leukemia-free state) was reported in patients who received treatment with eftoza plus venetoclax and 67% (4/6) in patients with myoblasts positive for DR4/DR5 expression; no tumor responses were observed with eftoza monotherapy. These data indicate that combination therapy with eftoza plus venetoclax to simultaneously activate the extrinsic and intrinsic apoptosis-signaling pathways may improve clinical benefit compared with venetoclax monotherapy in relapsed/refractory AML with an acceptable toxicity profile. This trial was registered at www.clinicaltrials.gov as #NCT03082209.
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Affiliation(s)
| | - Emiliano Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Benedito A. Carneiro
- Legorreta Cancer Center at Brown University, Lifespan Cancer Institute, Providence, RI
| | - Junichiro Yuda
- Department of Hematology and Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Aditya Shreenivas
- Department of Medical Oncology, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Eelke Gort
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kenichi Ishizawa
- Department of Internal Medicine III, Division of Hematology and Cell Therapy, Yamagata University Hospital, Yamagata, Japan
| | - Daniel Morillo
- START Madrid-FJD, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Carla Biesdorf
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc, North Chicago, IL
| | - Morey Smith
- Oncology Discovery, AbbVie Inc, North Chicago, IL
| | - Dong Cheng
- Oncology Discovery, AbbVie Inc, North Chicago, IL
| | | | - David Sharon
- Precision Medicine, AbbVie Inc, North Chicago, IL
| | - Tamar Uziel
- Precision Medicine, AbbVie Inc, North Chicago, IL
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5
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Grob T, Sanders MA, Vonk CM, Kavelaars FG, Rijken M, Hanekamp DW, Gradowska PL, Cloos J, Fløisand Y, van Marwijk Kooy M, Manz MG, Ossenkoppele GJ, Tick LW, Havelange V, Löwenberg B, Jongen-Lavrencic M, Valk PJ. Prognostic Value of FLT3-Internal Tandem Duplication Residual Disease in Acute Myeloid Leukemia. J Clin Oncol 2023; 41:756-765. [PMID: 36315929 PMCID: PMC9901965 DOI: 10.1200/jco.22.00715] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The applicability of FLT3-internal tandem duplications (FLT3-ITD) for assessing measurable residual disease (MRD) in acute myeloid leukemia (AML) in complete remission (CR) has been hampered by patient-specific duplications and potential instability of FLT3-ITD during relapse. Here, we comprehensively investigated the impact of next-generation sequencing (NGS)-based FLT3-ITD MRD detection on treatment outcome in a cohort of patients with newly diagnosed AML in relation to established prognostic factors at diagnosis and other MRD measurements, ie, mutant NPM1 and multiparameter flow cytometry. METHODS In 161 patients with de novo FLT3-ITD AML, NGS was performed at diagnosis and in CR after intensive remission induction treatment. FLT3-ITD MRD status was correlated with the cumulative incidence of relapse and overall survival (OS). RESULTS NGS-based FLT3-ITD MRD was present in 47 of 161 (29%) patients with AML. Presence of FLT3-ITD MRD was associated with increased risk of relapse (4-year cumulative incidence of relapse, 75% FLT3-ITD MRD v 33% no FLT3-ITD MRD; P < .001) and inferior OS (4-year OS, 31% FLT3-ITD MRD v 57% no FLT3-ITD MRD; P < .001). In multivariate analysis, detection of FLT3-ITD MRD in CR confers independent prognostic significance for relapse (hazard ratio, 3.55; P < .001) and OS (hazard ratio 2.51; P = .002). Strikingly, FLT3-ITD MRD exceeds the prognostic value of most generally accepted clinical and molecular prognostic factors, including the FLT3-ITD allelic ratio at diagnosis and MRD assessment by NGS-based mutant NPM1 detection or multiparameter flow cytometry. CONCLUSION NGS-based detection of FLT3-ITD MRD in CR identifies patients with AML with profound risk of relapse and death that outcompetes the significance of most established prognostic factors at diagnosis and during therapy, and furnishes support for FLT3-ITD as a clinically relevant biomarker for dynamic disease risk assessment in AML.
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Affiliation(s)
- Tim Grob
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mathijs A. Sanders
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Christian M. Vonk
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Franҫois G. Kavelaars
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Melissa Rijken
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Diana W. Hanekamp
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Patrycja L. Gradowska
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jacqueline Cloos
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Yngvar Fløisand
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | | | - Markus G. Manz
- Department of Medical Oncology and Hematology, Comprehensive Cancer Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Gert J. Ossenkoppele
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Lidwine W. Tick
- Department of Hematology, Maxima Medisch Centrum, Eindhoven, the Netherlands
| | - Violaine Havelange
- Department of Hematology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Bob Löwenberg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter J.M. Valk
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands,Peter J.M. Valk, PhD, Department of Hematology, Erasmus University Medical Center Rotterdam, Nc 806, Wytemaweg 80, 3015 CN Rotterdam Z-H, the Netherlands; e-mail:
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6
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Grob T, Al Hinai AS, Sanders MA, Kavelaars FG, Rijken M, Gradowska PL, Biemond BJ, Breems DA, Maertens J, van Marwijk Kooy M, Pabst T, de Weerdt O, Ossenkoppele GJ, van de Loosdrecht AA, Huls GA, Cornelissen JJ, Beverloo HB, Löwenberg B, Jongen-Lavrencic M, Valk PJ. Molecular characterization of mutant TP53 acute myeloid leukemia and high-risk myelodysplastic syndrome. Blood 2022; 139:2347-2354. [PMID: 35108372 PMCID: PMC11022827 DOI: 10.1182/blood.2021014472] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
Substantial heterogeneity within mutant TP53 acute myeloid leukemia (AML) and myelodysplastic syndrome with excess of blast (MDS-EB) precludes the exact assessment of prognostic impact for individual patients. We performed in-depth clinical and molecular analysis of mutant TP53 AML and MDS-EB to dissect the molecular characteristics in detail and determine its impact on survival. We performed next-generation sequencing on 2200 AML/MDS-EB specimens and assessed the TP53 mutant allelic status (mono- or bi-allelic), the number of TP53 mutations, mutant TP53 clone size, concurrent mutations, cytogenetics, and mutant TP53 molecular minimal residual disease and studied the associations of these characteristics with overall survival. TP53 mutations were detected in 230 (10.5%) patients with AML/MDS-EB with a median variant allele frequency of 47%. Bi-allelic mutant TP53 status was observed in 174 (76%) patients. Multiple TP53 mutations were found in 49 (21%) patients. Concurrent mutations were detected in 113 (49%) patients. No significant difference in any of the aforementioned molecular characteristics of mutant TP53 was detected between AML and MDS-EB. Patients with mutant TP53 have a poor outcome (2-year overall survival, 12.8%); however, no survival difference between AML and MDS-EB was observed. Importantly, none of the molecular characteristics were significantly associated with survival in mutant TP53 AML/MDS-EB. In most patients, TP53 mutations remained detectable in complete remission by deep sequencing (73%). Detection of residual mutant TP53 was not associated with survival. Mutant TP53 AML and MDS-EB do not differ with respect to molecular characteristics and survival. Therefore, mutant TP53 AML/MDS-EB should be considered a distinct molecular disease entity.
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Affiliation(s)
- Tim Grob
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Adil S.A. Al Hinai
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- National Genetic Center, Royal Hospital, Ministry of Health, Muscat, Sultanate of Oman
| | - Mathijs A. Sanders
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - François G. Kavelaars
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Melissa Rijken
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrycja L. Gradowska
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart J. Biemond
- Department of Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Dimitri A. Breems
- Department of Hematology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Thomas Pabst
- Department of Oncology, University Hospital, Inselspital, Bern, Switzerland
| | - Okke de Weerdt
- Department of Hematology, Saint Antonius Hospital, Nieuwegein, The Netherlands
| | - Gert J. Ossenkoppele
- Department of Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Gerwin A. Huls
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan J. Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H. Berna Beverloo
- Department of Clinical Genetics, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J.M. Valk
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Willems SPE, Stenstra M, Jongen-Lavrencic M, Westerhuis MEMH, Beverloo HB, Vreugdenhil G. Non-Invasive Prenatal Testing Leading to Detection of Asymptomatic Acute Myeloid Leukemia in a 30-Year-Old Patient: A Case Report. J Hematol 2021; 10:228-231. [PMID: 34804313 PMCID: PMC8577591 DOI: 10.14740/jh908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022] Open
Abstract
The widely use of non-invasive prenatal testing (NIPT) may lead to accidental findings and the discovery of malignancy in pregnancy, often in asymptomatic patients. Diagnosis of such subclinical malignancy during pregnancy in the asymptomatic patient poses a predicament for both doctor and patient. The risks and benefits of possible treatment for both mother and child have to be weighted, and there is often limited scientific evidence available. We present a case of an abnormal NIPT result, leading to the diagnosis of acute myeloid leukemia (AML) in an asymptomatic pregnant patient. After multiple multidisciplinary meetings and an elaborate shared decision making (SDM) process, a watch and wait strategy was implemented, in contradiction with general treatment recommendations. Following this approach, it was possible to achieve a near term pregnancy before delivery of a healthy baby girl. The patient could subsequently commence treatment of her AML and is still in complete remission after a follow-up of 25 months. Our case report highlights the possibility of watch and wait strategy in selected cases and the importance of multidisciplinary collaboration and SDM, when faced with the accidental finding of AML through NIPT.
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Affiliation(s)
| | | | | | | | - H Berna Beverloo
- Department of Clinical Genetics, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medisch Centrum, Eindhoven/Veldhoven, The Netherlands
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8
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Al Hinai ASA, Grob T, Rijken M, Kavelaars FG, Zeilemaker A, Erpelinck-Verschueren CAJ, Sanders MA, Löwenberg B, Jongen-Lavrencic M, Valk PJM. PPM1D mutations appear in complete remission after exposure to chemotherapy without predicting emerging AML relapse. Leukemia 2021; 35:2693-2697. [PMID: 33589749 DOI: 10.1038/s41375-021-01155-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Adil S A Al Hinai
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,National Genetic Center, Ministry of Health, Muscat, Sultanate of Oman
| | - Tim Grob
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Melissa Rijken
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - François G Kavelaars
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annelieke Zeilemaker
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Mathijs A Sanders
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J M Valk
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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9
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Uy GL, Aldoss I, Foster MC, Sayre PH, Wieduwilt MJ, Advani AS, Godwin JE, Arellano ML, Sweet KL, Emadi A, Ravandi F, Erba HP, Byrne M, Michaelis L, Topp MS, Vey N, Ciceri F, Carrabba MG, Paolini S, Huls GA, Jongen-Lavrencic M, Wermke M, Chevallier P, Gyan E, Récher C, Stiff PJ, Pettit KM, Löwenberg B, Church SE, Anderson E, Vadakekolathu J, Santaguida M, Rettig MP, Muth J, Curtis T, Fehr E, Guo K, Zhao J, Bakkacha O, Jacobs K, Tran K, Kaminker P, Kostova M, Bonvini E, Walter RB, Davidson-Moncada JK, Rutella S, DiPersio JF. Flotetuzumab as salvage immunotherapy for refractory acute myeloid leukemia. Blood 2021; 137:751-762. [PMID: 32929488 PMCID: PMC7885824 DOI: 10.1182/blood.2020007732] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
Approximately 50% of acute myeloid leukemia (AML) patients do not respond to induction therapy (primary induction failure [PIF]) or relapse after <6 months (early relapse [ER]). We have recently shown an association between an immune-infiltrated tumor microenvironment (TME) and resistance to cytarabine-based chemotherapy but responsiveness to flotetuzumab, a bispecific DART antibody-based molecule to CD3ε and CD123. This paper reports the results of a multicenter, open-label, phase 1/2 study of flotetuzumab in 88 adults with relapsed/refractory AML: 42 in a dose-finding segment and 46 at the recommended phase 2 dose (RP2D) of 500 ng/kg per day. The most frequent adverse events were infusion-related reactions (IRRs)/cytokine release syndrome (CRS), largely grade 1-2. Stepwise dosing during week 1, pretreatment dexamethasone, prompt use of tocilizumab, and temporary dose reductions/interruptions successfully prevented severe IRR/CRS. Clinical benefit accrued to PIF/ER patients showing an immune-infiltrated TME. Among 30 PIF/ER patients treated at the RP2D, the complete remission (CR)/CR with partial hematological recovery (CRh) rate was 26.7%, with an overall response rate (CR/CRh/CR with incomplete hematological recovery) of 30.0%. In PIF/ER patients who achieved CR/CRh, median overall survival was 10.2 months (range, 1.87-27.27), with 6- and 12-month survival rates of 75% (95% confidence interval [CI], 0.450-1.05) and 50% (95% CI, 0.154-0.846). Bone marrow transcriptomic analysis showed that a parsimonious 10-gene signature predicted CRs to flotetuzumab (area under the receiver operating characteristic curve = 0.904 vs 0.672 for the European LeukemiaNet classifier). Flotetuzumab represents an innovative experimental approach associated with acceptable safety and encouraging evidence of activity in PIF/ER patients. This trial was registered at www.clinicaltrials.gov as #NCT02152956.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cytokine Release Syndrome/chemically induced
- Cytokine Release Syndrome/drug therapy
- Dose-Response Relationship, Immunologic
- Drug Administration Schedule
- Drug Resistance, Neoplasm
- Female
- Follow-Up Studies
- Hematopoiesis/drug effects
- Humans
- Immunotherapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Male
- Maximum Tolerated Dose
- Middle Aged
- Nausea/chemically induced
- Protein Interaction Maps
- Salvage Therapy
- Survival Rate
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Affiliation(s)
- Geoffrey L Uy
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Peter H Sayre
- Division of Hematology and Blood and Marrow Transplantation, University of California San Francisco, San Francisco, CA
| | | | - Anjali S Advani
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Kendra L Sweet
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Ashkan Emadi
- Marlene & Stewart Greenebaum Cancer, School of Medicine, University of Maryland, Baltimore, MD
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harry P Erba
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Centre, Durham, NC
| | - Michael Byrne
- Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Laura Michaelis
- Division of Hematology/Oncology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI
| | - Max S Topp
- Medizinische Klinik Und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Norbert Vey
- Hematologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Matteo Giovanni Carrabba
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Stefania Paolini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology L. and A. Seràgnoli, University of Bologna, Bologna, Italy
| | - Gerwin A Huls
- Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Martin Wermke
- Universitätsklinikum Carl Gustav Carus an der Technische Universität, Dresden, Germany
| | - Patrice Chevallier
- Institut Universitaire du Cancer Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Gyan
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Christian Récher
- Hôpital Bretonneau, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | | | - Kristen M Pettit
- Michigan Medicine Bone Marrow Transplant and Leukemia, C. S. Mott Children's Hospital, Ann Arbor, MI
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Jayakumar Vadakekolathu
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Michael P Rettig
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | | | | | - Kuo Guo
- MacroGenics Inc, Rockville, MD
| | | | | | | | | | | | | | | | | | | | - Sergio Rutella
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
- Centre for Health, Ageing and Understanding Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - John F DiPersio
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
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10
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Bras AE, Osmani Z, de Haas V, Jongen-Lavrencic M, Te Marvelde JG, Zwaan CM, Mejstrikova E, Fernandez P, Szczepanski T, Orfao A, van Dongen JJM, van der Velden VHJ. Standardised immunophenotypic analysis of myeloperoxidase in acute leukaemia. Br J Haematol 2020; 193:922-927. [PMID: 33161592 PMCID: PMC8247412 DOI: 10.1111/bjh.17210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
Given its myeloid‐restricted expression, myeloperoxidase (MPO) is typically used for lineage assignment (myeloid vs. lymphoid) during acute leukaemia (AL) diagnostics. In the present study, a robust flow cytometric definition for MPO positivity was established based on the standardised EuroFlow protocols, the standardised Acute Leukaemia Orientation Tube and 1734 multicentre AL cases (with confirmed assay stability). The best diagnostic performance was achieved by defining MPO positivity as ≥20% of the AL cells exceeding a lymphocyte‐based threshold. The methodology employed should be applicable to any form of standardised flow cytometry.
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Affiliation(s)
- Anne E Bras
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Zgjim Osmani
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Valerie de Haas
- Dutch Childhood Oncology Group, Utrecht, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen G Te Marvelde
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ester Mejstrikova
- CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Paula Fernandez
- Institute for Laboratory Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia (SUM), Katowice, Poland
| | - Alberto Orfao
- Cancer Research Center (IBMCC-CSIC), Department of Medicine and Cytometry Service, University of Salamanca (USAL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Centro de Investigaciόn Biomédicaen Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | | | - Vincent H J van der Velden
- Laboratory Medical Immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Kalin B, van Norden Y, van Gelder M, Breems D, Maertens J, Jongen-Lavrencic M, Broers AEC, Braakman E, Grob T, Zeijlemaker W, Ossenkoppele GJ, Meijer E, Cornelissen JJ. Panobinostat and decitabine prior to donor lymphocyte infusion in allogeneic stem cell transplantation. Blood Adv 2020; 4:4430-4437. [PMID: 32936907 PMCID: PMC7509859 DOI: 10.1182/bloodadvances.2020002074] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
Outcome after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is adversely affected by relapse to a considerable degree. To exploit the graft-versus-leukemia effect more effectively, we assessed the feasibility of early initiation of epigenetic therapy with panobinostat and decitabine after allo-HSCT and before donor lymphocyte infusion (DLI) in poor-risk patients with acute myeloid leukemia (AML) or refractory anemia with excess blasts with International Prognostic Scoring System score ≥1.5. A total of 140 poor-risk patients with AML aged 18 to 70 years were registered, and 110 proceeded to allo-HSCT. Three dose levels were evaluated for dose-limiting toxicities, including panobinostat monotherapy 20 mg at days 1, 4, 8, and 11 of a 4-week cycle (PNB mono group) and panobinostat combined with either decitabine 20 mg/m2 (PNB/DAC20 group) or decitabine 10 mg/m2 (PNB/DAC10 group) at days 1 to 3 of every 4-week cycle. After phase 1, the study continued as phase 2, focusing on completion of protocol treatment and treatment outcome. PNB mono and PNB/DAC10 were feasible, whereas PNB/DAC20 was not related to prolonged cytopenia. Sixty of 110 patients who underwent transplantation were eligible to receive their first DLI within 115 days after allo-HSCT. Grade 3 and 4 adverse events related to panobinostat and decitabine were observed in 23 (26%) of the 87 patients, and they received epigenetic therapy. Cumulative incidence of relapse was 35% (standard error [SE] 5), and overall survival and progression-free survival at 24 months were 50% (SE 5) and 49% (SE 5). Post-allo-HSCT epigenetic therapy with panobinostat alone or in combination with low-dose decitabine is feasible and is associated with a relatively low relapse rate. The trial was registered at the European Clinical Trial Registry, https://www.clinicaltrialsregister.eu, as ECT2012-003344-74.
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Affiliation(s)
- Burak Kalin
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Yvette van Norden
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Michel van Gelder
- Department of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dimitri Breems
- Department of Hematology, Hospital Network Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium; and
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Annoek E C Broers
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Eric Braakman
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Tim Grob
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Wendelien Zeijlemaker
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gert J Ossenkoppele
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ellen Meijer
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
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12
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Huls G, Chitu DA, Pabst T, Klein SK, Stussi G, Griskevicius L, Valk PJM, Cloos J, van de Loosdrecht AA, Breems D, van Lammeren-Venema D, van Zeventer I, Boersma R, Jongen-Lavrencic M, Fehr M, Hoogendoorn M, Manz MG, Söhne M, van Marwijk Kooy R, Deeren D, van der Poel MWM, Legdeur MC, Tick L, Chalandon Y, Ammatuna E, Blum S, Löwenberg B, Ossenkoppele GJ. Ibrutinib added to 10-day decitabine for older patients with AML and higher risk MDS. Blood Adv 2020; 4:4267-4277. [PMID: 32915972 PMCID: PMC7509861 DOI: 10.1182/bloodadvances.2020002846] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/17/2020] [Indexed: 12/30/2022] Open
Abstract
The treatment of older, unfit patients with acute myeloid leukemia (AML) is challenging. Based on preclinical data of Bruton tyrosine kinase expression/phosphorylation and ibrutinib cytotoxicity in AML blasts, we conducted a randomized phase 2 multicenter study to assess the tolerability and efficacy of the addition of ibrutinib to 10-day decitabine in unfit (ie, Hematopoietic Cell Transplantation Comorbidity Index ≥3) AML patients and higher risk myelodysplasia patients (HOVON135/SAKK30/15 trial). In total, 144 eligible patients were randomly (1:1) assigned to either 10-day decitabine combined with ibrutinib (560 mg; sequentially given, starting the day after the last dose of decitabine) (n = 72) or to 10-day decitabine (n = 72). The addition of ibrutinib was well tolerated, and the number of adverse events was comparable for both arms. In the decitabine plus ibrutinib arm, 41% reached complete remission/complete remission with incomplete hematologic recovery (CR/CRi), the median overall survival (OS) was 11 months, and 2-year OS was 27%; these findings compared with 50% CR/CRi, median OS of 11.5 months, and 2-year OS of 21% for the decitabine group (not significant). Extensive molecular profiling at diagnosis revealed that patients with STAG2, IDH2, and ASXL1 mutations had significantly lower CR/CRi rates, whereas patients with mutations in TP53 had significantly higher CR/CRi rates. Furthermore, multicolor flow cytometry revealed that after 3 cycles of treatment, 28 (49%) of 57 patients with available bone marrow samples had no measurable residual disease. In this limited number of cases, measurable residual disease revealed no apparent impact on event-free survival and OS. In conclusion, the addition of ibrutinib does not improve the therapeutic efficacy of decitabine. This trial was registered at the Netherlands Trial Register (NL5751 [NTR6017]) and has EudraCT number 2015-002855-85.
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Affiliation(s)
- Gerwin Huls
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Dana A Chitu
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Thomas Pabst
- Department of Oncology, University Hospital, Inselspital, and University of Bern, Bern, Switzerland
| | - Saskia K Klein
- Department of Hematology, Meander Hospital Amersfoort, Amersfoort, The Netherlands
| | - Georg Stussi
- Department of Hematology, Ospedale Regionale, Bellinzona, Switzerland
| | - Laimonas Griskevicius
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jacqueline Cloos
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Dimitri Breems
- Department of Hematology, ZNA Stuivenberg/Middelheim, Antwerp, Belgium
| | | | - Isabelle van Zeventer
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Rinske Boersma
- Department of Hematology, Amphia Hospital, Breda, The Netherlands
| | | | - Martin Fehr
- Department of Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Markus G Manz
- Department of Medical Oncology and Hematology, Universitätsspital Zurich, Zurich, Switzerland
| | - Maaike Söhne
- Department of Hematology, Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Dries Deeren
- Department of Hematology, AZ Delta Roeselare, Roeselare, Belgium
| | | | | | - Lidwine Tick
- Department of Hematology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Yves Chalandon
- Division of Hematology, University Hospital Genève and Faculty of Medicine, University of Genève, Genève, Switzerland; and
| | - Emanuele Ammatuna
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sabine Blum
- Service and Central Laboratory of Hematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gert J Ossenkoppele
- Department of Hematology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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13
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Grasedieck S, Ruess C, Krowiorz K, Lux S, Pochert N, Schwarzer A, Klusmann JH, Jongen-Lavrencic M, Herold T, Bullinger L, Pollack JR, Rouhi A, Kuchenbauer F. The long non-coding RNA <i>Cancer Susceptibility 15</i> (<i>CASC15</i>) is induced by isocitrate dehydrogenase (IDH) mutations and maintains an immature phenotype in adult acute myeloid leukemia. Haematologica 2020; 105:e448-453. [PMID: 33054061 PMCID: PMC7556616 DOI: 10.3324/haematol.2019.235291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Sarah Grasedieck
- Ulm University Hospital, Department of Internal Medicine III, Ulm, Germany
| | - Christoph Ruess
- Ulm University Hospital, Department of Internal Medicine III, Ulm, Germany
| | - Kathrin Krowiorz
- Ulm University Hospital, Department of Internal Medicine III, Ulm, Germany
| | - Susanne Lux
- Ulm University Hospital, Department of Internal Medicine III, Ulm, Germany
| | - Nicole Pochert
- Ulm University Hospital, Department of Internal Medicine III, Ulm, Germany
| | | | - Jan-Henning Klusmann
- Medizinische Hochschule Hannover (MHH), Hannover, Germany; Universitätsklinik und Poliklinik für Pädiatrie I, Halle (Saale), Germany
| | | | - Tobias Herold
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum München, German Center for Environmental Health (HGMU), Munich, Germany
| | | | - Jonathan R Pollack
- Stanford University School of Medicine, Department of Pathology, Stanford, CA, USA
| | - Arefeh Rouhi
- Ulm University Hospital, Department of Internal Medicine III, Ulm, Germany; Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Florian Kuchenbauer
- Ulm University Hospital, Department of Internal Medicine III, Ulm, Germany; Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada.
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14
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Ravandi F, Walter RB, Subklewe M, Buecklein V, Jongen-Lavrencic M, Paschka P, Ossenkoppele GJ, Kantarjian HM, Hindoyan A, Agarwal SK, Dai T, Khaldoyanidi S, Stein AS. Updated results from phase I dose-escalation study of AMG 330, a bispecific T-cell engager molecule, in patients with relapsed/refractory acute myeloid leukemia (R/R AML). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7508] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7508 Background: In this open label phase 1 dose escalation study, safety, tolerability, pharmacokinetics, pharmacodynamics and preliminary efficacy of AMG 330 were evaluated in patients (pts) with R/R AML (NCT#02520427). Methods: AMG 330 was evaluated as a continuous IV (cIV) infusion using a 3+3 design. Response was assessed per revised IWG criteria. Each cycle (2–4 weeks duration) was followed by an infusion-free interval. Eligible pts were ≥18 y/o with > 5% blasts in bone marrow and ≥1 line/s of prior therapy. Results: As of December 10, 2019, 55 pts (median age, 58.0 [18.0–80.0] years) were enrolled in 16 cohorts. AMG 330 was administered on 4 schedules (0–3 dose steps) prior to the target dose (TD, 0.5–720 µg/day). Dose steps were implemented in the dose schedule design based on the adverse event (AE) profile. Across all schedules, 55 (100%) pts reported treatment-emergent AEs (any grade). AMG 330–related AEs reported in 49/55 (89%) pts included cytokine release syndrome (CRS; 67%; ≥ grade 3 in 13%), (60%) and nausea (20%) as the most frequent AEs. CRS was reversible and occurred in a dose/schedule-dependent manner mostly within the first 24 hours of administration of triggering AMG 330 dose. The frequency and severity of CRS correlated with the dose level and leukemic burden at baseline. AMG 330 exhibited dose-dependent increase in steady state exposures over the studied dose range with clinical PK profile consistent with cIV administration. Eight of 42 evaluable pts responded: 3 complete remissions (CR; including 1 CR with negative measurable residual disease reported after data snapshot), 4 CR with incomplete hematologic recovery, and 1 morphologic leukemia free state. Seven responders who achieved CR/CRi received a TD equal or above the minimal efficacious dose of 120 μg/day. Among analyzed CR/CRi responders, 4/6 (67%) had adverse cytogenetic risk profile, 3/6 (50%) had ≥4 lines of prior therapy and all had relapsed disease. Responders had higher AMG 330 exposures and 3 responders treated with ≥600 μg/day TD remain in CR/CRi: 1 patient for > 5 months after cycle 1, 1 patient bridged to hematopoietic stem cell transplant after cycle 4 and 1 patient is in cycle 3. Preliminary response assessment showed a correlation with lower tumor burden at baseline with a trend towards higher CD8+ lymphocyte count and E:T ratio. Conclusions: AMG 330 dosed up to 720 μg/day provided early evidence of acceptable safety profile, drug tolerability and anti-leukemic activity, and supports further dose escalation. Clinical trial information: NCT02520427 .
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Affiliation(s)
- Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roland B. Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Veit Buecklein
- Department of Internal Medicine III, University Hospital, LMU Munich, Munich, Germany
| | | | | | | | - Hagop M. Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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15
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Agarwal SK, Bhagwat S, Mehta K, Hindoyan A, Stein AS, Ravandi F, Subklewe M, Walter RB, Jongen-Lavrencic M, Ossenkoppele GJ, Paschka P, Khaldoyanidi S, Dutta S, Upreti VV. Characterization of clinical pharmacokinetics and exposure-response relationships of AMG 330, a bispecific CD33 T-cell engager antibody construct, in patients with relapsed/refractory AML. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7536 Background: AMG 330 binds both CD33 and CD3 and redirects T cells toward CD33+ cells leading to T-cell‒mediated cytotoxicity against AML blasts. An ongoing open label phase I dose-escalation study (NCT02520427) has shown preliminary activity and acceptable safety in relapsed or refractory (R/R) acute myeloid leukemia (AML) patients (pts) (Ravandi et al. ASH 2018). Pharmacokinetics and exposure-response (E-R) relationships of AMG 330 were characterized in this trial. Methods: A continuous IV infusion of AMG 330 was evaluated at escalating target doses (range from 0.5 to 720 μg/day) using a 3+3 design with pts receiving step dose/s prior to reaching target doses of ≥ 30 μg/day. Population pharmacokinetics (popPK) using non-linear mixed effects modeling and E-R analyses were conducted to characterize relationships between AMG 330 exposure (steady-state concentration [Css]) at target dose, the baseline tumor burden, clinical response per revised IWG criteria and incidence of cytokine release syndrome (CRS). Results: As of Dec 10, 2019, 55 patients (males, 56.4%; median age, 58.0 [18.0–80.0] years) were enrolled in 16 cohorts. AMG 330 PK was best described by a one-compartment linear PK model. Dose dependent increases were observed in AMG 330 Css exposures. Responders typically showed higher AMG 330 Css than non-responders. Preliminary exploratory analysis indicated that higher AMG 330 exposures, lower baseline leukemic burden in bone marrow and CD33+ AML cells in peripheral blood, and higher baseline Effector:Target cell ratio may be associated with clinical response. Additionally, a positive relationship was observed for AMG 330 exposures and baseline leukemic burden (p < 0.05) with probability of CRS occurrence and severity. Based on the model, at a baseline leukemic burden of 20%, a 240 µg/day target dose is predicted to result in a 28% and 4% probability of developing CRS of grade ≥ 2 and ≥ 3, respectively. Conclusions: Clinical pharmacokinetic profile and E-R relationships of AMG 330 were characterized to identify optimal AMG 330 dosing regimens that minimize the risk for CRS in ongoing and planned clinical investigations. Clinical trial information: NCT02520427 .
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Affiliation(s)
| | | | | | | | | | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Roland B. Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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16
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Ossenkoppele GJ, Breems DA, Stuessi G, van Norden Y, Bargetzi M, Biemond BJ, A von dem Borne P, Chalandon Y, Cloos J, Deeren D, Fehr M, Gjertsen B, Graux C, Huls G, Janssen JJJW, Jaspers A, Jongen-Lavrencic M, de Jongh E, Klein SK, van der Klift M, van Marwijk Kooy M, Maertens J, Michaux L, van der Poel MWM, van Rhenen A, Tick L, Valk P, Vekemans MC, van der Velden WJFM, de Weerdt O, Pabst T, Manz M, Löwenberg B. Lenalidomide added to standard intensive treatment for older patients with AML and high-risk MDS. Leukemia 2020; 34:1751-1759. [PMID: 32020044 DOI: 10.1038/s41375-020-0725-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/24/2019] [Accepted: 01/22/2020] [Indexed: 11/09/2022]
Abstract
More effective treatment modalities are urgently needed in patients with acute myeloid leukemia (AML) of older age. We hypothesized that adding lenalidomide to intensive standard chemotherapy might improve their outcome. After establishing a safe lenalidomide, dose elderly patients with AML were randomly assigned in this randomized Phase 2 study (n = 222) to receive standard chemotherapy ("3 + 7") with or without lenalidomide at a dose of 20 mg/day 1-21. In the second cycle, patients received cytarabine 1000 mg/m2 twice daily on days 1-6 with or without lenalidomide (20 mg/day 1-21). The CR/CRi rates in the two arms were not different (69 vs. 66%). Event-free survival (EFS) at 36 months was 19% for the standard arm versus 21% for the lenalidomide arm and overall survival (OS) 35% vs. 30%, respectively. The frequencies and grade of adverse events were not significantly different between the treatment arms. Cardiovascular toxicities were rare and equally distributed between the arms. The results of the present study show that the addition of lenalidomide to standard remission induction chemotherapy does not improve the therapeutic outcome of older AML patients. This trial is registered as number NTR2294 in The NederlandsTrial Register (www.trialregister.nl).
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Affiliation(s)
- G J Ossenkoppele
- Amsterdam University Medical Cente, location VUMC, Amsterdam, Netherlands.
| | | | - G Stuessi
- Bellinzona-IOSI, Bellinzona, Switzerland
| | - Y van Norden
- HOVON Data Center, Erasmus MC- Department of Hematology, Rotterdam, The Netherlands
| | - M Bargetzi
- Aarau- Kantonsspital, Aarau, Switzerland
| | - B J Biemond
- Amsterdam University Medical Center, location AMC, Amsterdam, Netherlands
| | | | - Y Chalandon
- University Hospital and University of Geneva, Genève, Switzerland
| | - J Cloos
- Amsterdam University Medical Cente, location VUMC, Amsterdam, Netherlands
| | - D Deeren
- Roeselare-AZ Delta, Roeselare, Belgium
| | - M Fehr
- St Gallen-Kantonnsspital, St. Gallen, Switzerland
| | - B Gjertsen
- Haukeland University Hospital, Bergen (N), Norway
| | - C Graux
- Yvoir-MontGodinne, Yvoir, Belgium
| | - G Huls
- University Medical Center, Groningen, Netherlands
| | - J J J W Janssen
- Amsterdam University Medical Cente, location VUMC, Amsterdam, Netherlands
| | - A Jaspers
- Hôpital Citadelle, Liège (B), Belgium
| | | | | | - S K Klein
- Meander Medical Center, Amersfoort, Netherlands
| | | | | | - J Maertens
- Hospital Gasthuisberg, Leuven (B), Belgium
| | - L Michaux
- Center for Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | | | | | - L Tick
- MaximaMC Eindhoven, Eindhoven, Netherlands
| | - P Valk
- Hôpital Citadelle, Liège (B), Belgium
| | | | | | - O de Weerdt
- St Antonius Hospital, Nieuwegein, Netherlands
| | - T Pabst
- Department of Oncology, University Hospital, Inselspital and University of Bern, Bern, Switzerland
| | - M Manz
- University Hospital, Zurich, Switzerland
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17
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Zeijlemaker W, Grob T, Meijer R, Hanekamp D, Kelder A, Carbaat-Ham JC, Oussoren-Brockhoff YJM, Snel AN, Veldhuizen D, Scholten WJ, Maertens J, Breems DA, Pabst T, Manz MG, van der Velden VHJ, Slomp J, Preijers F, Cloos J, van de Loosdrecht AA, Löwenberg B, Valk PJM, Jongen-Lavrencic M, Ossenkoppele GJ, Schuurhuis GJ. CD34 +CD38 - leukemic stem cell frequency to predict outcome in acute myeloid leukemia. Leukemia 2018; 33:1102-1112. [PMID: 30542144 DOI: 10.1038/s41375-018-0326-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/07/2018] [Accepted: 10/16/2018] [Indexed: 12/29/2022]
Abstract
Current risk algorithms are primarily based on pre-treatment factors and imperfectly predict outcome in acute myeloid leukemia (AML). We introduce and validate a post-treatment approach of leukemic stem cell (LSC) assessment for prediction of outcome. LSC containing CD34+CD38- fractions were measured using flow cytometry in an add-on study of the HOVON102/SAKK trial. Predefined cut-off levels were prospectively evaluated to assess CD34+CD38-LSC levels at diagnosis (n = 594), and, to identify LSClow/LSChigh (n = 302) and MRDlow/MRDhigh patients (n = 305) in bone marrow in morphological complete remission (CR). In 242 CR patients combined MRD and LSC results were available. At diagnosis the CD34+CD38- LSC frequency independently predicts overall survival (OS). After achieving CR, combining LSC and MRD showed reduced survival in MRDhigh/LSChigh patients (hazard ratio [HR] 3.62 for OS and 5.89 for cumulative incidence of relapse [CIR]) compared to MRDlow/LSChigh, MRDhigh/LSClow, and especially MRDlow/LSClow patients. Moreover, in the NPM1mutant positive sub-group, prognostic value of golden standard NPM1-MRD by qPCR can be improved by addition of flow cytometric approaches. This is the first prospective study demonstrating that LSC strongly improves prognostic impact of MRD detection, identifying a patient subgroup with an almost 100% treatment failure probability, warranting consideration of LSC measurement incorporation in future AML risk schemes.
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Affiliation(s)
- Wendelien Zeijlemaker
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Tim Grob
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rosa Meijer
- Clinical trial Center- HOVON data center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diana Hanekamp
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Angèle Kelder
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jannemieke C Carbaat-Ham
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Alexander N Snel
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Dennis Veldhuizen
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Willemijn J Scholten
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johan Maertens
- Department of Hematology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Dimitri A Breems
- Department of Hematology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Thomas Pabst
- Department of Hematology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Markus G Manz
- Department of Hematology, University and University Hospital Zürich, Zürich, Switzerland
| | | | - Jennichjen Slomp
- Department of Clinical Chemistry, Medisch Spectrum Twente/Medlon, Enschede, The Netherlands
| | - Frank Preijers
- Department of Laboratory Medicine - Laboratory for Hematology, Radboud University Nijmegen Medical Center, RUNMC, Nijmegen, The Netherlands
| | - Jacqueline Cloos
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Arjan A van de Loosdrecht
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Gert J Ossenkoppele
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gerrit J Schuurhuis
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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18
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Kalin B, Pijnappel EN, van Gelder M, Visser O, van de Loosdrecht AA, Ossenkoppele GJ, Cornelissen JJ, Dinmohamed AG, Jongen-Lavrencic M. Intensive treatment and trial participation in elderly acute myeloid leukemia patients: A population-based analysis in The Netherlands. Cancer Epidemiol 2018; 57:90-96. [DOI: 10.1016/j.canep.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 12/22/2022]
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19
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Bras AE, de Haas V, van Stigt A, Jongen-Lavrencic M, Beverloo HB, Te Marvelde JG, Zwaan CM, van Dongen JJM, Leusen JHW, van der Velden VHJ. CD123 expression levels in 846 acute leukemia patients based on standardized immunophenotyping. Cytometry B Clin Cytom 2018; 96:134-142. [PMID: 30450744 PMCID: PMC6587863 DOI: 10.1002/cyto.b.21745] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND While it is known that CD123 is normally strongly expressed on plasmacytoid dendritic cells and completely absent on nucleated red blood cells, detailed information regarding CD123 expression in acute leukemia is scarce and, if available, hard to compare due to different methodologies. METHODS CD123 expression was evaluated using standardized EuroFlow immunophenotyping in 139 pediatric AML, 316 adult AML, 193 pediatric BCP-ALL, 69 adult BCP-ALL, 101 pediatric T-ALL, and 28 adult T-ALL patients. Paired diagnosis-relapse samples were available for 57 AML and 19 BCP-ALL patients. Leukemic stem cell (LSC) data was available for 32 pediatric AML patients. CD123 expression was evaluated based on mean fluorescence intensity, median fluorescence intensity, and percentage CD123 positive cells. RESULTS EuroFlow panels were stable over time and between laboratories. CD123 was expressed in the majority of AML and BCP-ALL patients, but absent in most T-ALL patients. Within AML, CD123 expression was lower in erythroid/megakaryocytic leukemia, higher in NPM1 mutated and FLT3-ITD mutated leukemia, and comparable between LSC and leukemic blasts. Within BCP-ALL, CD123 expression was higher in patients with (high) hyperdiploid karyotypes and the BCR-ABL fusion gene. Interestingly, CD123 expression was increased in BCP-ALL relapses while highly variable in AML relapses (compared to CD123 expression at diagnosis). CONCLUSIONS Authors evaluated CD123 expression in a large cohort of acute leukemia patients, based on standardized and reproducible methodology. Our results may facilitate stratification of patients most likely to respond to CD123 targeted therapies and serve as reference for CD123 expression (in health and disease). © 2018 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society.
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Affiliation(s)
- Anne E Bras
- Laboratory Medical immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Arthur van Stigt
- Laboratory for Translational Immunology (LTI), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Berna Beverloo
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen G Te Marvelde
- Laboratory Medical immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C Michel Zwaan
- Department of Pediatric Oncology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jacques J M van Dongen
- Laboratory Medical immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeanette H W Leusen
- Laboratory for Translational Immunology (LTI), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vincent H J van der Velden
- Laboratory Medical immunology (LMI), Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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20
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Abstract
miR-9 and miR-9* (miR-9/9*) were first shown to be expressed in the nervous system and to function as versatile regulators of neurogenesis. The variable expression levels of miR-9/9* in human cancer prompted researchers to investigate whether these small RNAs may also have an important role in the deregulation of physiological and biochemical networks in human disease. In this review, we present a comprehensive overview of the involvement of miR-9/9* in various human malignancies focusing on their opposing roles in supporting or suppressing tumor development and metastasis. Importantly, it is shown that the capacity of miR-9/9* to impact tumor formation is independent from their influence on the metastatic potential of tumor cells. Moreover, data suggest that miR-9/9* may increase malignancy of one cancer cell population at the expense of another. The functional versatility of miR-9/9* emphasizes the complexity of studying miRNA function and the importance to perform functional studies of both miRNA strands in a relevant cellular context. The possible application of miR-9/9* as targets for miRNA-based therapies is discussed, emphasizing the need to obtain a better understanding of the functional properties of these miRNAs and to develop safe delivery methods to target specific cell populations.
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Affiliation(s)
- Katarzyna Nowek
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erik A.C. Wiemer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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21
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Jongen-Lavrencic M, Grob T, Hanekamp D, Kavelaars FG, Al Hinai A, Zeilemaker A, Erpelinck-Verschueren CAJ, Gradowska PL, Meijer R, Cloos J, Biemond BJ, Graux C, van Marwijk Kooy M, Manz MG, Pabst T, Passweg JR, Havelange V, Ossenkoppele GJ, Sanders MA, Schuurhuis GJ, Löwenberg B, Valk PJM. Molecular Minimal Residual Disease in Acute Myeloid Leukemia. N Engl J Med 2018; 378:1189-1199. [PMID: 29601269 DOI: 10.1056/nejmoa1716863] [Citation(s) in RCA: 502] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) often reach complete remission, but relapse rates remain high. Next-generation sequencing enables the detection of molecular minimal residual disease in virtually every patient, but its clinical value for the prediction of relapse has yet to be established. METHODS We conducted a study involving patients 18 to 65 years of age who had newly diagnosed AML. Targeted next-generation sequencing was carried out at diagnosis and after induction therapy (during complete remission). End points were 4-year rates of relapse, relapse-free survival, and overall survival. RESULTS At least one mutation was detected in 430 out of 482 patients (89.2%). Mutations persisted in 51.4% of those patients during complete remission and were present at various allele frequencies (range, 0.02 to 47%). The detection of persistent DTA mutations (i.e., mutations in DNMT3A, TET2, and ASXL1), which are often present in persons with age-related clonal hematopoiesis, was not correlated with an increased relapse rate. After the exclusion of persistent DTA mutations, the detection of molecular minimal residual disease was associated with a significantly higher relapse rate than no detection (55.4% vs. 31.9%; hazard ratio, 2.14; P<0.001), as well as with lower rates of relapse-free survival (36.6% vs. 58.1%; hazard ratio for relapse or death, 1.92; P<0.001) and overall survival (41.9% vs. 66.1%; hazard ratio for death, 2.06; P<0.001). Multivariate analysis confirmed that the persistence of non-DTA mutations during complete remission conferred significant independent prognostic value with respect to the rates of relapse (hazard ratio, 1.89; P<0.001), relapse-free survival (hazard ratio for relapse or death, 1.64; P=0.001), and overall survival (hazard ratio for death, 1.64; P=0.003). A comparison of sequencing with flow cytometry for the detection of residual disease showed that sequencing had significant additive prognostic value. CONCLUSIONS Among patients with AML, the detection of molecular minimal residual disease during complete remission had significant independent prognostic value with respect to relapse and survival rates, but the detection of persistent mutations that are associated with clonal hematopoiesis did not have such prognostic value within a 4-year time frame. (Funded by the Queen Wilhelmina Fund Foundation of the Dutch Cancer Society and others.).
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Affiliation(s)
- Mojca Jongen-Lavrencic
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Tim Grob
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Diana Hanekamp
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - François G Kavelaars
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Adil Al Hinai
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Annelieke Zeilemaker
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Claudia A J Erpelinck-Verschueren
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Patrycja L Gradowska
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Rosa Meijer
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Jacqueline Cloos
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Bart J Biemond
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Carlos Graux
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Marinus van Marwijk Kooy
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Markus G Manz
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Thomas Pabst
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Jakob R Passweg
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Violaine Havelange
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Gert J Ossenkoppele
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Mathijs A Sanders
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Gerrit J Schuurhuis
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Bob Löwenberg
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
| | - Peter J M Valk
- From the Department of Hematology (M.J.-L., T.G., F.G.K., A.H., A.Z., C.A.J.E.-V., M.A.S., B.L., P.J.M.V.) and HOVON Data Center, Department of Hematology (P.L.G., R.M.), Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, the Department of Hematology, VU University Medical Center (D.H., J.C., G.J.O., G.J.S.), and the Department of Hematology, Academic Medical Center (B.J.B.), Amsterdam, and Isala Hospital, Zwolle (M.M.K.) - all in the Netherlands; UCL Namur (Godinne), Yvoir (C.G.), and the Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels (V.H.) - both in Belgium; and the Department of Hematology, University Hospital Zurich, Zurich (M.G.M.), University Hospital, Bern (T.P.), and the Division of Hematology, University Hospital Basel, Basel (J.R.P.) - all in Switzerland
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Obulkasim A, Katsman-Kuipers JE, Verboon L, Sanders M, Touw I, Jongen-Lavrencic M, Pieters R, Klusmann JH, Michel Zwaan C, van den Heuvel-Eibrink MM, Fornerod M. Classification of pediatric acute myeloid leukemia based on miRNA expression profiles. Oncotarget 2018; 8:33078-33085. [PMID: 28380436 PMCID: PMC5464851 DOI: 10.18632/oncotarget.16525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/01/2017] [Indexed: 12/28/2022] Open
Abstract
Pediatric acute myeloid leukemia (AML) is a heterogeneous disease with respect to biology as well as outcome. In this study, we investigated whether known biological subgroups of pediatric AML are reflected by a common microRNA (miRNA) expression pattern. We assayed 665 miRNAs on 165 pediatric AML samples. First, unsupervised clustering was performed to identify patient clusters with common miRNA expression profiles. Our analysis unraveled 14 clusters, seven of which had a known (cyto-)genetic denominator. Finally, a robust classifier was constructed to discriminate six molecular aberration groups: 11q23-rearrangements, t(8;21)(q22;q22), inv(16)(p13q22), t(15;17) (q21;q22), NPM1 and CEBPA mutations. The classifier achieved accuracies of 89%, 95%, 95%, 98%, 91% and 96%, respectively. Although lower sensitivities were obtained for the NPM1 and CEBPA (32% and 66%), relatively high sensitivities (84%−94%) were attained for the rest. Specificity was high in all groups (87%−100%). Due to a robust double-loop cross validation procedure employed, the classifier only employed 47 miRNAs to achieve the aforementioned accuracies. To validate the 47 miRNA signatures, we applied them to a publicly available adult AML dataset. Albeit partial overlap of the array platforms and molecular differences between pediatric and adult AML, the signatures performed reasonably well. This corroborates our claim that the identified miRNA signatures are not dominated by sample size bias in the pediatric AML dataset. In conclusion, cytogenetic subtypes of pediatric AML have distinct miRNA expression patterns. Reproducibility of the miRNA signatures in adult dataset suggests that the respective aberrations have a similar biology both in pediatric and adult AML.
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Affiliation(s)
- Askar Obulkasim
- Pediatric Oncology-Hematology, Erasmus MC, Sophia Children's Hospital, The Netherlands
| | | | - Lonneke Verboon
- Pediatric Oncology-Hematology, Erasmus MC, Sophia Children's Hospital, The Netherlands
| | - Mathijs Sanders
- Department of Hematology, ErasmusMC, Rotterdam, The Netherlands
| | - Ivo Touw
- Department of Hematology, ErasmusMC, Rotterdam, The Netherlands
| | | | - Rob Pieters
- Pediatric Oncology-Hematology, Erasmus MC, Sophia Children's Hospital, The Netherlands.,Prinses Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jan-Henning Klusmann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, German
| | - C Michel Zwaan
- Pediatric Oncology-Hematology, Erasmus MC, Sophia Children's Hospital, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Pediatric Oncology-Hematology, Erasmus MC, Sophia Children's Hospital, The Netherlands.,Prinses Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Maarten Fornerod
- Pediatric Oncology-Hematology, Erasmus MC, Sophia Children's Hospital, The Netherlands
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23
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Versluis J, Kalin B, Zeijlemaker W, Passweg J, Graux C, Manz MG, Vekemans MC, Biemond BJ, Legdeur MCJ, Kooy MVM, de Weerdt O, Wijermans PW, Hoogendoorn M, Bargetzi MJ, Kuball J, Schouten HC, van der Velden VH, Janssen JJ, Pabst T, Lowenberg B, Jongen-Lavrencic M, Schuurhuis GJ, Ossenkoppele G, Cornelissen JJ. Graft-Versus-Leukemia Effect of Allogeneic Stem-Cell Transplantation and Minimal Residual Disease in Patients With Acute Myeloid Leukemia in First Complete Remission. JCO Precis Oncol 2017; 1:1-13. [DOI: 10.1200/po.17.00078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose The detection of minimal residual disease (MRD) in patients with acute myeloid leukemia (AML) may improve future risk-adapted treatment strategies. We assessed whether MRD-positive and MRD-negative patients with AML benefit differently from the graft-versus-leukemia effect of allogeneic hematopoietic stem-cell transplantation (alloHSCT). Methods A total of 1,511 patients were treated in subsequent Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research AML trials, of whom 547 obtained a first complete remission, received postremission treatment (PRT), and had available flow cytometric MRD before PRT. MRD positivity was defined as more than 0.1% cells with a leukemia-associated immunophenotype within the WBC compartment. PRT consisted of alloHSCT (n = 282), conventional PRT by a third cycle of chemotherapy (n = 160), or autologous hematopoietic stem-cell transplantation (n = 105). Results MRD was positive in 129 patients (24%) after induction chemotherapy before proceeding to PRT. Overall survival and relapse-free survival were significantly better in patients without MRD before PRT compared with MRD-positive patients (65% ± 2% v 50% ± 5% at 4 years; P = .002; and 58% ± 3% v 38% ± 4%; P < .001, respectively), which was mainly because of a lower cumulative incidence of relapse (32% ± 2% compared with 54% ± 4%; P < .001, respectively). Multivariable analysis with adjustment for covariables showed that the incidence of relapse was significantly reduced after alloHSCT compared with chemotherapy or autologous hematopoietic stem cell transplantation (hazard ratio [HR], 0.36; P < .001), which was similarly exerted in both MRD-negative and MRD-positive patients (HR, 0.38; P < .001; and HR, 0.35; P < .001, respectively). Conclusion The graft-versus-leukemia effect of alloHSCT is equally present in MRD-positive and MRD-negative patients, which advocates a personalized application of alloHSCT, taking into account the risk of relapse determined by AML risk group and MRD status, as well as the counterbalancing risk of nonrelapse mortality.
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Affiliation(s)
- Jurjen Versluis
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Burak Kalin
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Wendelien Zeijlemaker
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Jakob Passweg
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Carlos Graux
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Markus G. Manz
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Marie-Christiane Vekemans
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Bart J. Biemond
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Marie-Cecile J.C. Legdeur
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Marinus van Marwijk Kooy
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Okke de Weerdt
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Pierre W. Wijermans
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Mels Hoogendoorn
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Mario J. Bargetzi
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Juergen Kuball
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Harry C. Schouten
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Vincent H.J. van der Velden
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Jeroen J.W.M. Janssen
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Thomas Pabst
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Bob Lowenberg
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Mojca Jongen-Lavrencic
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Gerrit Jan Schuurhuis
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Gert Ossenkoppele
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
| | - Jan J. Cornelissen
- Jurjen Versluis, Burak Kalin, Bob Lowenberg, Mojca Jongen-Lavrencic, and Jan J. Cornelissen, Erasmus University Medical Center Cancer Institute; Vincent H.J. van der Velden, Erasmus University Medical Center, Rotterdam; Wendelien Zeijlemaker, Jeroen J.W.M. Janssen, Gerrit Jan Schuurhuis, and Gert Ossenkoppele, VU University Medical Center; Bart J. Biemond, Academic Medical Center, University of Amsterdam, Amsterdam; Marie-Cecile J.C. Legdeur, Medisch Spectrum Twente, Enschede; Marinus van Marwijk Kooy,
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24
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Hirsch S, Blätte TJ, Grasedieck S, Cocciardi S, Rouhi A, Jongen-Lavrencic M, Paschka P, Krönke J, Gaidzik VI, Döhner H, Schlenk RF, Kuchenbauer F, Döhner K, Dolnik A, Bullinger L. Circular RNAs of the nucleophosmin (NPM1) gene in acute myeloid leukemia. Haematologica 2017; 102:2039-2047. [PMID: 28971903 PMCID: PMC5709103 DOI: 10.3324/haematol.2017.172866] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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: 05/16/2017] [Accepted: 09/22/2017] [Indexed: 12/17/2022] Open
Abstract
In acute myeloid leukemia, there is growing evidence for splicing pattern deregulation, including differential expression of linear splice isoforms of the commonly mutated gene nucleophosmin (NPM1). In this study, we detect circular RNAs of NPM1 and quantify circRNA hsa_circ_0075001 in a cohort of NPM1 wild-type and mutated acute myeloid leukemia (n=46). Hsa_circ_0075001 expression correlates positively with total NPM1 expression, but is independent of the NPM1 mutational status. High versus low hsa_circ_0075001 expression defines patient subgroups characterized by distinct gene expression patterns, such as lower expression of components of the Toll-like receptor signaling pathway in high hsa_circ_0075001 expression cases. Global evaluation of circRNA expression in sorted healthy hematopoietic controls (n=10) and acute myeloid leukemia (n=10) reveals circRNA transcripts for 47.9% of all highly expressed genes. While circRNA expression correlates globally with parental gene expression, we identify hematopoietic differentiation-associated as well as acute myeloid leukemia subgroup-specific circRNA signatures.
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Affiliation(s)
| | | | | | | | - Arefeh Rouhi
- Internal Medicine III, University Hospital Ulm, Germany
| | | | - Peter Paschka
- Internal Medicine III, University Hospital Ulm, Germany
| | - Jan Krönke
- Internal Medicine III, University Hospital Ulm, Germany
| | | | | | | | | | | | - Anna Dolnik
- Internal Medicine III, University Hospital Ulm, Germany
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25
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Dinmohamed AG, Visser O, Posthuma EFM, Huijgens PC, Sonneveld P, van de Loosdrecht AA, Jongen-Lavrencic M. MDS classification is improving in an era of the WHO 2016 criteria of MDS: A population-based analysis among 9159 MDS patients diagnosed in the Netherlands. Cancer Epidemiol 2017; 50:137-140. [PMID: 28910695 DOI: 10.1016/j.canep.2017.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/09/2017] [Accepted: 08/29/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Morphologic and cytogenetic assessments are required to characterize diagnostic and prognostic features of myelodysplastic syndromes (MDS). We assessed whether these assessments were performed among newly diagnosed MDS patients in the Netherlands. METHODS MDS cases were retrieved from the nationwide Netherlands Cancer Registry (N=9159; period 2001-2014) and the regional PHAROS MDS registry (N=676; period 2008-2011). RESULTS The proportion of unclassified MDS decreased from 58% in 2001 to 13% in 2014. Data from the more detailed PHAROS registry revealed that the degree of bone marrow dysplasia was only reported in ∼30% of all evaluable bone marrow aspirates. Further, the International Prognostic Scoring System was undetermined in 55% of patients, primarily owing to unperformed cytogenetics in 46% of patients. CONCLUSION The classification of MDS is improving in the Netherlands. Nevertheless, particular diagnostic and prognostic procedures that are essential for the diagnosis and subsequent treatment decision-making of MDS were not fully utilized in particular patient subsets.
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Affiliation(s)
- Avinash G Dinmohamed
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | | | - Peter C Huijgens
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Hematology, VU Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
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26
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Bras AE, Beishuizen A, Langerak AW, Jongen-Lavrencic M, Te Marvelde JG, van den Heuvel-Eibrink MM, Zwaan CM, van Dongen JJM, van der Velden VHJ. CD38 expression in paediatric leukaemia and lymphoma: implications for antibody targeted therapy. Br J Haematol 2016; 180:292-296. [PMID: 27604396 DOI: 10.1111/bjh.14310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Anne E Bras
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Auke Beishuizen
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anton W Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Haematology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jeroen G Te Marvelde
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - C Michel Zwaan
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jacques J M van Dongen
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent H J van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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27
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Dinmohamed AG, van Norden Y, van de Loosdrecht AA, Jongen-Lavrencic M. Effectiveness of azacitidine in higher-risk myelodysplastic syndromes. Leukemia 2016; 30:1795-6. [DOI: 10.1038/leu.2016.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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28
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Hatzl S, Geiger O, Kuepper MK, Caraffini V, Seime T, Furlan T, Nussbaumer E, Wieser R, Pichler M, Scheideler M, Nowek K, Jongen-Lavrencic M, Quehenberger F, Wölfler A, Troppmair J, Sill H, Zebisch A. Increased Expression of miR-23a Mediates a Loss of Expression in the RAF Kinase Inhibitor Protein RKIP. Cancer Res 2016; 76:3644-54. [PMID: 27197200 DOI: 10.1158/0008-5472.can-15-3049] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
Abstract
RAF kinase inhibitor protein (RKIP) is a seminal regulator of intracellular signaling and exhibits both antimetastatic and antitumorigenic properties. Decreased expression of RKIP has been described in several human malignancies, including acute myelogenous leukemia (AML). As the mechanisms leading to RKIP loss in AML are still unclear, we aimed to analyze the potential involvement of miRNAs within this study. miRNA microarray and qPCR data of more than 400 AML patient specimens revealed correlation between decreased expression of RKIP and increased expression of miR-23a, a member of the miR-23a/27a/24-2 cluster. In functional experiments, overexpression of miR-23a decreased RKIP mRNA and protein expression, whereas miR-23a inhibition caused the opposite effect. By using an RKIP 3'-untranslated region luciferase reporter construct with and without mutation or deletion of the putative miR-23a-binding site, we could show that RKIP modulation by miR-23a is mediated via direct binding to this region. Importantly, miR-23a overexpression induced a significant increase of proliferation in hematopoietic cells. Simultaneous transfection of an RKIP expression construct lacking the miR-23a-binding sites reversed this phenotype, indicating that this effect is truly mediated via downregulation of RKIP. Finally, by analyzing more than 4,300 primary patient specimens via database retrieval from The Cancer Genome Atlas, we could highlight the importance of the miR-23a/RKIP axis in a broad range of human cancer entities. In conclusion, we have identified miR-23a as a negative regulator of RKIP expression in AML and have provided data that suggest the importance of our observation beyond this tumor entity. Cancer Res; 76(12); 3644-54. ©2016 AACR.
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Affiliation(s)
- Stefan Hatzl
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Olivia Geiger
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Maja Kim Kuepper
- Division of Hematology, Medical University of Graz, Graz, Austria
| | | | - Till Seime
- Daniel Swarovski Research Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Tobias Furlan
- Daniel Swarovski Research Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Erika Nussbaumer
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Rotraud Wieser
- Department of Medicine I, Medical University of Vienna, Vienna, Austria and Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Martin Pichler
- Division of Oncology, Medical University of Graz, Graz, Austria. Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marcel Scheideler
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Munich, Germany. University Hospital, Heidelberg University, Heidelberg, Germany. German Center for Diabetes Research (DZD), Neuherberg, Germany. Technical University of Munich, Munich, Germany
| | - Katarzyna Nowek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Franz Quehenberger
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Jakob Troppmair
- Daniel Swarovski Research Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Heinz Sill
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Armin Zebisch
- Division of Hematology, Medical University of Graz, Graz, Austria.
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29
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Dinmohamed AG, Brink M, Visser O, Jongen-Lavrencic M. Population-based analyses among 184 patients diagnosed with large granular lymphocyte leukemia in the Netherlands between 2001 and 2013. Leukemia 2016; 30:1449-51. [PMID: 27055870 DOI: 10.1038/leu.2016.68] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- A G Dinmohamed
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Brink
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - O Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - M Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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30
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Nowek K, Sun SM, Dijkstra MK, Bullinger L, Döhner H, Erkeland SJ, Löwenberg B, Jongen-Lavrencic M. Expression of a passenger miR-9* predicts favorable outcome in adults with acute myeloid leukemia less than 60 years of age. Leukemia 2015; 30:303-9. [PMID: 26464168 DOI: 10.1038/leu.2015.282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/16/2015] [Accepted: 10/01/2015] [Indexed: 11/09/2022]
Abstract
In double-stranded miRNA/miRNA* duplexes, one of the strands represents an active miRNA, whereas another, known as a passenger strand (miRNA*), is typically degraded. MiR-9* is not detectable in normal myeloid cells. Here we show that miR-9* is expressed in 59% of acute myeloid leukemia (AML) cases and we investigate its clinical impact in 567 adults with de novo AML (age⩽60 years). AML cases with detectable miR-9* included a lower percentage of cases with favorable risk (P<0.001) as compared with those with no detectable miR-9*. High levels of miR-9* expression independently predicted for higher complete remission (odds ratio=1.28, P=0.013) and better event-free survival (EFS) (hazard ratio (HR)=0.86, P=0.001), relapse-free survival (RFS) (HR=0.84, P=0.008) and overall survival (OS) (HR=0.86, P=0.002). Among the subgroup of adverse risk patients, high miR-9* expressers had strikingly longer median survival than low miR-9* expressers (EFS: 16 vs 5 months, P=0.020; RFS: 12 vs 4, P=0.060; OS: 23 vs 8, P=0.021). Comparative transcriptome analysis suggests that miR-9* regulates genes involved in leukemogenesis, for example, MN1 and MLLT3. This is the first report showing that an miRNA* has prognostic value in AML.
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Affiliation(s)
- K Nowek
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - S M Sun
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - M K Dijkstra
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - L Bullinger
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - H Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - S J Erkeland
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - B Löwenberg
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - M Jongen-Lavrencic
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
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31
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Gentner B, Pochert N, Rouhi A, Boccalatte F, Plati T, Berg T, Sun SM, Mah SM, Mirkovic-Hösle M, Ruschmann J, Muranyi A, Leierseder S, Argiropoulos B, Starczynowski DT, Karsan A, Heuser M, Hogge D, Camargo FD, Engelhardt S, Döhner H, Buske C, Jongen-Lavrencic M, Naldini L, Humphries RK, Kuchenbauer F. MicroRNA-223 dose levels fine tune proliferation and differentiation in human cord blood progenitors and acute myeloid leukemia. Exp Hematol 2015; 43:858-868.e7. [PMID: 26163797 DOI: 10.1016/j.exphem.2015.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 05/07/2015] [Indexed: 11/25/2022]
Abstract
A precise understanding of the role of miR-223 in human hematopoiesis and in the pathogenesis of acute myeloid leukemia (AML) is still lacking. By measuring miR-223 expression in blasts from 115 AML patients, we found significantly higher miR-223 levels in patients with favorable prognosis, whereas patients with low miR-223 expression levels were associated with worse outcome. Furthermore, miR-223 was hierarchically expressed in AML subpopulations, with lower expression in leukemic stem cell-containing fractions. Genetic depletion of miR-223 decreased the leukemia initiating cell (LIC) frequency in a myelomonocytic AML mouse model, but it was not mandatory for rapid-onset AML. To relate these observations to physiologic myeloid differentiation, we knocked down or ectopically expressed miR-223 in cord-blood CD34⁺ cells using lentiviral vectors. Although miR-223 knockdown delayed myeloerythroid precursor differentiation in vitro, it increased myeloid progenitors in vivo following serial xenotransplantation. Ectopic miR-223 expression increased erythropoiesis, T lymphopoiesis, and early B lymphopoiesis in vivo. These findings broaden the role of miR-223 as a regulator of the expansion/differentiation equilibrium in hematopoietic stem and progenitor cells where its impact is dose- and differentiation-stage-dependent. This also explains the complex yet minor role of miR-223 in AML, a heterogeneous disease with variable degree of myeloid differentiation.
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Affiliation(s)
- Bernhard Gentner
- San Raffaele Hospital, Telethon Institute for Gene Therapy and Vita-Salute University, Milan, Italy
| | - Nicole Pochert
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Arefeh Rouhi
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Francesco Boccalatte
- San Raffaele Hospital, Telethon Institute for Gene Therapy and Vita-Salute University, Milan, Italy
| | - Tiziana Plati
- San Raffaele Hospital, Telethon Institute for Gene Therapy and Vita-Salute University, Milan, Italy
| | - Tobias Berg
- Department of Medicine II, Center for Internal Medicine at the Goethe-University, Frankfurt, Germany
| | - Su Ming Sun
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sarah M Mah
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, BC, Canada
| | - Milijana Mirkovic-Hösle
- Department of Chemistry and Biochemistry, Gene Center and Laboratory of Molecular Biology, Ludwig Maximilians University München, Munich, Germany
| | - Jens Ruschmann
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, BC, Canada
| | - Andrew Muranyi
- Institute of Experimental Cancer Research, Comprehensive Cancer Centre, University Hospital of Ulm, Ulm, Germany
| | - Simon Leierseder
- Institute for Pharmakology and Toxicology, Technical University, Germany
| | - Bob Argiropoulos
- Department of Medical Genetics, University of Calgary, Calgary, Canada
| | | | - Aly Karsan
- Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Heuser
- Department of Hematology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Donna Hogge
- Department of Medicine II, Center for Internal Medicine at the Goethe-University, Frankfurt, Germany
| | - Fernando D Camargo
- The Stem Cell Program, Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Stefan Engelhardt
- Institute for Pharmakology and Toxicology, Technical University, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Centre, University Hospital of Ulm, Ulm, Germany
| | | | - Luigi Naldini
- San Raffaele Hospital, Telethon Institute for Gene Therapy and Vita-Salute University, Milan, Italy
| | | | - Florian Kuchenbauer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany.
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32
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Dinmohamed AG, Brink M, Visser O, Sonneveld P, van de Loosdrecht AA, Jongen-Lavrencic M, de Greef GE. Trends in incidence, primary treatment and survival in chronic myelomonocytic leukaemia: a population-based study of 1359 patients diagnosed in the Netherlands from 1989 to 2012. Br J Haematol 2015; 171:436-9. [DOI: 10.1111/bjh.13414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Avinash G. Dinmohamed
- Department of Hematology; Erasmus MC Cancer Institute; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Mirian Brink
- Department of Registration and Research; Comprehensive Cancer Centre the Netherlands; Utrecht the Netherlands
| | - Otto Visser
- Department of Registration and Research; Comprehensive Cancer Centre the Netherlands; Utrecht the Netherlands
| | - Pieter Sonneveld
- Department of Hematology; Erasmus MC Cancer Institute; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Arjan A. van de Loosdrecht
- Department of Hematology; VU University Medical Center; Cancer Center Amsterdam; Amsterdam the Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology; Erasmus MC Cancer Institute; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Georgine E. de Greef
- Department of Hematology; Erasmus MC Cancer Institute; Erasmus University Medical Center; Rotterdam the Netherlands
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33
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Dinmohamed AG, van Norden Y, Visser O, Posthuma EFM, Huijgens PC, Sonneveld P, van de Loosdrecht AA, Jongen-Lavrencic M. The use of medical claims to assess incidence, diagnostic procedures and initial treatment of myelodysplastic syndromes and chronic myelomonocytic leukemia in the Netherlands. Leuk Res 2014; 39:177-82. [PMID: 25533930 DOI: 10.1016/j.leukres.2014.11.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 12/14/2022]
Abstract
Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) may be underreported in cancer registries such as the Netherlands Cancer Registry (NCR). Analysis of Dutch medical claims can complement NCR data on MDS and CMML. We analyzed data on 3681 MDS patients and 235 CMML patients aged ≥18 years with initial claims for MDS or CMML from the Dutch nationwide medical claims-based Diagnosis Treatment Combination Information System (DIS) between 2008 and 2010. Clinical information was available in the DIS. MDS and CMML were diagnosed without a bone marrow (BM) examination in almost half of the patients. The age-standardized incidence rate (ASR) per 100,000 in the cohort that underwent BM examinations compared with NCR data was 2.8 vs. 3.3 for MDS and 0.2 vs. 0.4 for CMML in 2008-2010. A conservative treatment approach was associated with increasing age and absence of BM examination in MDS (p<0.001 for both) and CMML patients (p<0.033 for both). In conclusion, the ASR of MDS in the cohort that underwent BM examinations was comparable with the NCR. The majority of elderly patients, either with or without BM examinations, received no therapy. Together, MDS and CMML may be misdiagnosed and inappropriately managed without a BM confirmation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Bone Marrow/pathology
- Female
- Humans
- Incidence
- Insurance Claim Review
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/pathology
- Netherlands
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Affiliation(s)
- Avinash G Dinmohamed
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Yvette van Norden
- Clinical Trial Center, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Otto Visser
- Department of Registration and Research, Comprehensive Cancer Centre The Netherlands, Utrecht, The Netherlands
| | | | - Peter C Huijgens
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arjan A van de Loosdrecht
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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34
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Cornelissen JJ, Versluis J, Passweg JR, van Putten WLJ, Manz MG, Maertens J, Beverloo HB, Valk PJM, van Marwijk Kooy M, Wijermans PW, Schaafsma MR, Biemond BJ, Vekemans MC, Breems DA, Verdonck LF, Fey MF, Jongen-Lavrencic M, Janssen JJWM, Huls G, Kuball J, Pabst T, Graux C, Schouten HC, Gratwohl A, Vellenga E, Ossenkoppele G, Löwenberg B. Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40–60 years. Leukemia 2014; 29:1041-50. [DOI: 10.1038/leu.2014.332] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/06/2014] [Accepted: 11/14/2014] [Indexed: 12/27/2022]
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35
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Dinmohamed AG, Visser O, van Norden Y, Huijgens PC, Sonneveld P, van de Loosdrecht AA, Jongen-Lavrencic M. Trends in incidence, initial treatment and survival of myelodysplastic syndromes: A population-based study of 5144 patients diagnosed in the Netherlands from 2001 to 2010. Eur J Cancer 2014; 50:1004-12. [DOI: 10.1016/j.ejca.2013.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/28/2013] [Accepted: 12/03/2013] [Indexed: 12/13/2022]
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36
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Song SJ, Ito K, Ala U, Kats L, Webster K, Sun SM, Jongen-Lavrencic M, Manova-Todorova K, Teruya-Feldstein J, Avigan DE, Delwel R, Pandolfi PP. The oncogenic microRNA miR-22 targets the TET2 tumor suppressor to promote hematopoietic stem cell self-renewal and transformation. Cell Stem Cell 2014; 13:87-101. [PMID: 23827711 DOI: 10.1016/j.stem.2013.06.003] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 03/07/2013] [Accepted: 06/11/2013] [Indexed: 12/21/2022]
Abstract
MicroRNAs are frequently deregulated in cancer. Here we show that miR-22 is upregulated in myelodysplastic syndrome (MDS) and leukemia and its aberrant expression correlates with poor survival. To explore its role in hematopoietic stem cell function and malignancy, we generated transgenic mice conditionally expressing miR-22 in the hematopoietic compartment. These mice displayed reduced levels of global 5-hydroxymethylcytosine (5-hmC) and increased hematopoietic stem cell self-renewal accompanied by defective differentiation. Conversely, miR-22 inhibition blocked proliferation in both mouse and human leukemic cells. Over time, miR-22 transgenic mice developed MDS and hematological malignancies. We also identify TET2 as a key target of miR-22 in this context. Ectopic expression of TET2 suppressed the miR-22-induced phenotypes. Downregulation of TET2 protein also correlated with poor clinical outcomes and miR-22 overexpression in MDS patients. Our results therefore identify miR-22 as a potent proto-oncogene and suggest that aberrations in the miR-22/TET2 regulatory network are common in hematopoietic malignancies.
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Affiliation(s)
- Su Jung Song
- Cancer Genetics Program, Beth Israel Deaconess Cancer Center, Harvard Medical School, Boston, MA 02215, USA
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37
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Leunis A, Blommestein HM, Huijgens PC, Blijlevens NMA, Jongen-Lavrencic M, Uyl-de Groot CA. The costs of initial treatment for patients with acute myeloid leukemia in the Netherlands. Leuk Res 2012; 37:245-50. [PMID: 23069745 DOI: 10.1016/j.leukres.2012.09.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/17/2012] [Accepted: 09/23/2012] [Indexed: 01/08/2023]
Abstract
The aim of this study was to calculate the costs of the current initial treatment of acute myeloid leukemia. Resource use was collected for 202 patients who started with intensive chemotherapy in 2008 or 2009. The costs of the first induction course were significantly higher than the costs of the second induction course. Allogeneic transplantation from a matched unrelated donor was significantly more expensive than the other consolidation treatments. In-hospital stay was the major cost driver in the treatment of AML. Research regarding possibilities of achieving the same or better health outcome with lower costs is warranted.
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Affiliation(s)
- Annemieke Leunis
- Institute for Medical Technology Assessment/Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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38
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Sun SM, Rockova V, Bullinger L, Dijkstra MK, Döhner H, Löwenberg B, Jongen-Lavrencic M. The prognostic relevance of miR-212 expression with survival in cytogenetically and molecularly heterogeneous AML. Leukemia 2012; 27:100-6. [PMID: 22692398 DOI: 10.1038/leu.2012.158] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Acute myeloid leukemia (AML) is a highly heterogeneous disease, characterized by various cytogenetic and molecular abnormalities, many of which may express prognostic value. MicroRNAs (miRNAs) are a class of small regulatory RNAs. The prognostic value of miRNAs in AML is yet to be determined. Here, we set out to identify miRNAs that are consistent significant prognostic determinants, independent from other known prognostic factors. A discovery cohort (n=167) and validation cohort (n=409) of a heterogeneous AML population were used to reliably identify miRNAs with prognostic value. We report miR-212 as an independent prognostic factor, significantly associated with a prolonged overall survival (OS) and also event-free and relapse-free survival in a discovery cohort (hazard ratio (HR)s=0.77, P=0.015 for OS) that was subsequently confirmed in an independent validation cohort of 409 cases (HR=0.83, P=0.016). The prognostic significance and the prevalence of high miR-212 did not correlate with specific (cyto)genetic subtypes of AML. High miR-212 expression levels are associated with a gene expression profile that is significantly enriched for genes involved in the immune response. MiR-212 may improve the current prognostic risk stratification of mixed AML including normal karyotype AML and AML with cytogenetic and molecular abnormalities.
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Affiliation(s)
- S M Sun
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
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39
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Löwenberg B, Muus P, Ossenkoppele G, Rousselot P, Cahn JY, Ifrah N, Martinelli G, Amadori S, Berman E, Sonneveld P, Jongen-Lavrencic M, Rigaudeau S, Stockman P, Goudie A, Faderl S, Jabbour E, Kantarjian H. Phase 1/2 study to assess the safety, efficacy, and pharmacokinetics of barasertib (AZD1152) in patients with advanced acute myeloid leukemia. Blood 2011; 118:6030-6. [PMID: 21976672 PMCID: PMC4186639 DOI: 10.1182/blood-2011-07-366930] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 09/27/2011] [Indexed: 11/20/2022] Open
Abstract
The primary objective of this 2-part phase 1/2 study was to determine the maximum-tolerated dose (MTD) of the potent and selective Aurora B kinase inhibitor barasertib (AZD1152) in patients with newly diagnosed or relapsed acute myeloid leukemia (AML). Part A determined the MTD of barasertib administered as a continuous 7-day infusion every 21 days. In part B, the efficacy of barasertib was evaluated at the MTD. In part A, 32 patients were treated with barasertib 50 mg (n = 3), 100 mg (n = 3), 200 mg (n = 3), 400 mg (n = 4), 800 mg (n = 7), 1200 mg (n = 6), and 1600 mg (n = 6). Dose-limiting toxicities (stomatitis/mucosal inflammation events) were reported in the 800 mg (n = 1), 1200 mg (n = 1), and 1600 mg (n = 2) groups. The MTD was defined as 1200 mg. In part B, 32 patients received barasertib 1200 mg. In each part of the study, 8 of 32 patients had a hematologic response according to Cheson AML criteria. The most commonly reported grade ≥ 3 events were febrile neutropenia (n = 24) and stomatitis/mucosal inflammation (n = 16). We concluded that the MTD of barasertib is 1200 mg in patients with relapsed or newly diagnosed AML. Toxicity was manageable and barasertib treatment resulted in an overall hematologic response rate of 25%. This study is registered at www.ClinicalTrials.gov as NCT00497991.
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Affiliation(s)
- Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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40
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Corthals SL, Sun SM, Kuiper R, de Knegt Y, Broyl A, van der Holt B, Beverloo HB, Peeters JK, el Jarari L, Lokhorst HM, Zweegman S, Jongen-Lavrencic M, Sonneveld P. MicroRNA signatures characterize multiple myeloma patients. Leukemia 2011; 25:1784-9. [DOI: 10.1038/leu.2011.147] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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41
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Corthals SL, Jongen-Lavrencic M, de Knegt Y, Peeters JK, Beverloo HB, Lokhorst HM, Sonneveld P. Micro-RNA-15a and micro-RNA-16 expression and chromosome 13 deletions in multiple myeloma. Leuk Res 2009; 34:677-81. [PMID: 20031211 DOI: 10.1016/j.leukres.2009.10.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 10/28/2009] [Accepted: 10/28/2009] [Indexed: 11/19/2022]
Abstract
We have used copy number variation (CNV) analysis with SNP mapping arrays for miRNA-15a and miRNA-16-1 expression analysis in patients with multiple myeloma (MM) with or without deletion of chromosome 13q14. MiRNA-15a and miRNA-16 display a range of expression patterns in MM patients, independent of the chromosome 13 status. These findings suggest that genes other than miR-15a and miR-16 may explain the prognostic significance of 13q14 deletions.
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Affiliation(s)
- Sophie L Corthals
- Department of Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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42
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Löwenberg B, Ossenkoppele GJ, van Putten W, Schouten HC, Graux C, Ferrant A, Sonneveld P, Maertens J, Jongen-Lavrencic M, von Lilienfeld-Toal M, Biemond BJ, Vellenga E, van Marwijk Kooy M, Verdonck LF, Beck J, Döhner H, Gratwohl A, Pabst T, Verhoef G. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med 2009; 361:1235-48. [PMID: 19776405 DOI: 10.1056/nejmoa0901409] [Citation(s) in RCA: 624] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A complete remission is essential for prolonging survival in patients with acute myeloid leukemia (AML). Daunorubicin is a cornerstone of the induction regimen, but the optimal dose is unknown. In older patients, it is usual to give daunorubicin at a dose of 45 to 50 mg per square meter of body-surface area. METHODS Patients in whom AML or high-risk refractory anemia had been newly diagnosed and who were 60 to 83 years of age (median, 67) were randomly assigned to receive cytarabine, at a dose of 200 mg per square meter by continuous infusion for 7 days, plus daunorubicin for 3 days, either at the conventional dose of 45 mg per square meter (411 patients) or at an escalated dose of 90 mg per square meter (402 patients); this treatment was followed by a second cycle of cytarabine at a dose of 1000 mg per square meter every 12 hours [DOSAGE ERROR CORRECTED] for 6 days. The primary end point was event-free survival. RESULTS The complete remission rates were 64% in the group that received the escalated dose of daunorubicin and 54% in the group that received the conventional dose (P=0.002); the rates of remission after the first cycle of induction treatment were 52% and 35%, respectively (P<0.001). There was no significant difference between the two groups in the incidence of hematologic toxic effects, 30-day mortality (11% and 12% in the two groups, respectively), or the incidence of moderate, severe, or life-threatening adverse events (P=0.08). Survival end points in the two groups did not differ significantly overall, but patients in the escalated-treatment group who were 60 to 65 years of age, as compared with the patients in the same age group who received the conventional dose, had higher rates of complete remission (73% vs. 51%), event-free survival (29% vs. 14%), and overall survival (38% vs. 23%). CONCLUSIONS In patients with AML who are older than 60 years of age, escalation of the dose of daunorubicin to twice the conventional dose, with the entire dose administered in the first induction cycle, effects a more rapid response and a higher response rate than does the conventional dose, without additional toxic effects. (Current Controlled Trials number, ISRCTN77039377; and Netherlands National Trial Register number, NTR212.)
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Aminoglycosides/administration & dosage
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/adverse effects
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Daunorubicin/administration & dosage
- Daunorubicin/adverse effects
- Female
- Gemtuzumab
- Humans
- Infusions, Intravenous
- Leukemia, Myelomonocytic, Acute/drug therapy
- Leukemia, Myelomonocytic, Acute/mortality
- Leukemia, Myelomonocytic, Acute/therapy
- Male
- Middle Aged
- Proportional Hazards Models
- Remission Induction/methods
- Stem Cell Transplantation
- Survival Analysis
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Affiliation(s)
- Bob Löwenberg
- Erasmus University Medical Center, Department of Hematology (L413), P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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43
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Dijkstra MK, van Lom K, Tielemans D, Elstrodt F, Langerak AW, van ‘t Veer MB, Jongen-Lavrencic M. 17p13/TP53 deletion in B-CLL patients is associated with microRNA-34a downregulation. Leukemia 2008; 23:625-7. [DOI: 10.1038/leu.2008.264] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wang M, Tan LP, Dijkstra MK, van Lom K, Robertus JL, Harms G, Blokzijl T, Kooistra K, van t'Veer MB, Rosati S, Visser L, Jongen-Lavrencic M, Kluin PM, van den Berg A. miRNA analysis in B-cell chronic lymphocytic leukaemia: proliferation centres characterized by low miR-150 and highBIC/miR-155 expression. J Pathol 2008; 215:13-20. [DOI: 10.1002/path.2333] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Jongen-Lavrencic M, Salesse S, Delwel R, Verfaillie CM. BCR/ABL-mediated downregulation of genes implicated in cell adhesion and motility leads to impaired migration toward CCR7 ligands CCL19 and CCL21 in primary BCR/ABL-positive cells. Leukemia 2005; 19:373-80. [PMID: 15674360 DOI: 10.1038/sj.leu.2403626] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The mechanism underlying p210(BCR/ABL) oncoprotein-mediated transformation in chronic myelogenous leukemia (CML) is not fully understood. We hypothesized that p210(BCR/ABL) suppresses expression of genes which may explain at least some of the pathogenetic features of CML. A subtractive cDNA library was created between BCR/ABL-enhanced-green-fluorescent-protein (GFP)-transduced umbilical cord blood (UCB) CD34+ cells and GFP-transduced UCB CD34+ cells to identify genes whose expression is downregulated by p210(BCR/ABL). At least 100 genes were identified. We have confirmed for eight of these genes that expression was suppressed by quantitative real-time-RT-PCR (Q-RT-PCR) of additional p210(BCR/ABL)-transduced CD34+ UCB cells as well as primary early chronic phase (CP) bone marrow (BM) CML CD34+ cells. Imatinib mesylate reversed downregulation of some genes, to approximately normal levels. Several of the genes are implicated in cell adhesion and motility, including L-selectin, intercellular adhesion molecule-1 (ICAM-1), and the chemokine receptor, CCR7, consistent with the known defect in adhesion and migration of CML cells. Compared with GFP UCB or normal (NL) BM CD34+ cells, p210 UCB and CML CD34+ cells migrated poorly towards the CCR7 ligands, CCL19 and CCL21, suggesting a possible role for CCR7 in the abnormal migratory behavior of CML CD34+ cells.
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MESH Headings
- Cell Adhesion/genetics
- Cell Adhesion/physiology
- Cell Line
- Cell Movement/genetics
- Cell Movement/physiology
- Chemokine CCL19
- Chemokine CCL21
- Chemokines, CC/genetics
- Chemokines, CC/physiology
- Down-Regulation
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/physiology
- Gene Expression Regulation, Neoplastic/physiology
- Humans
- Intercellular Adhesion Molecule-1/genetics
- K562 Cells
- L-Selectin/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Ligands
- RNA, Messenger/genetics
- Receptors, CCR7
- Receptors, Chemokine/genetics
- Receptors, Chemokine/physiology
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Affiliation(s)
- M Jongen-Lavrencic
- Department of Medicine, University of Minnesota, Stem Cell Institute, Cancer Center, Minneapolis, MN 55455, USA
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Jongen-Lavrencic M, Schneeberger PM, van der Hoeven JG. Ciprofloxacin-induced toxic epidermal necrolysis in a patient with systemic lupus erythematosus. Infection 2004; 31:428-9. [PMID: 14735388 DOI: 10.1007/s15010-003-2128-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2001] [Accepted: 04/08/2003] [Indexed: 11/28/2022]
Abstract
Toxic epidermal necrolysis (TEN), or Lyell's syndrome, is a fulminant bullous dermatitis. TEN is often a drug-induced reaction and virtually any drug class appears capable of provoking it. We report here a case of TEN after administration of ciprofloxacin. Systemic lupus erythematosus (SLE) was suspected as a possible etiologic or modifying cofactor in TEN in this case.
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Affiliation(s)
- M Jongen-Lavrencic
- Dept. of Internal Medicine, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
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Peeters HR, Jongen-Lavrencic M, Bakker CH, Vreugdenhil G, Breedveld FC, Swaak AJ. Recombinant human erythropoietin improves health-related quality of life in patients with rheumatoid arthritis and anaemia of chronic disease; utility measures correlate strongly with disease activity measures. Rheumatol Int 1999; 18:201-6. [PMID: 10399796 DOI: 10.1007/s002960050085] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Treatment with recombinant human erythropoietin (r-hu-Epo) in patients with rheumatoid arthritis (RA) and anaemia of chronic disease (ACD) resulted in improvement of both anaemia and disease activity. Utilities represent a generic and comprehensive quality of life measure, capable of integrating domain-specific information into one overall value which a patient assigns to his state of health. Therefore, the effect of r-hu-Epo on quality of life was studied by measuring utilities, derived from the rating scale and standard gamble, in a 52-week placebo-controlled randomised double-blind study with r-hu-Epo in 70 patients with active RA and ACD. Furthermore, the relation between anaemia as assessed by haemoglobin levels (Hb), disease activity as assessed with the Disease Activity Score (DAS), and utilities was investigated. Compared to the placebo group, significant improvement of Hb (P < 0.001), DAS (P = 0.01) and rating scale utilities (P = 0.002), but not of standard gamble utilities, was observed in the Epo group. Rating scale utilities correlated strongly with DAS (r = -0.47, P < 0.01), Hb (r = 0.37, P < 0.01) and changes in both DAS (r = -0.74, P < 0.01) and Hb (r = 0.44, P < 0.01). Both DAS and Hb contributed significantly to the variance in rating scale utilities (21% and 3% respectively) and to changes in rating scale utilities (43% and 3% respectively). Standard gamble utilities correlated less well with clinical disease variables than rating scale utilities did. These results indicate, that r-hu-Epo improves utility-derived health-related quality of life, most probably by improving both disease activity and anaemia. Utilities, particularly rating scale utilities, correlated well with conventional disease activity variables and proved sensitive to change. Utilities may be a useful tool for investigating quality of life in RA-patients.
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Affiliation(s)
- H R Peeters
- Department of Rheumatology, Atrium Medical Center Heerlen, The Netherlands
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Avontuur JA, Stam TC, Jongen-Lavrencic M, van Amsterdam JG, Eggermont AM, Bruining HA. Effect of L-NAME, an inhibitor of nitric oxide synthesis, on plasma levels of IL-6, IL-8, TNF alpha and nitrite/nitrate in human septic shock. Intensive Care Med 1998; 24:673-9. [PMID: 9722036 DOI: 10.1007/s001340050643] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We tested the effects of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide (NO) synthesis, on plasma levels of interleukin (IL) IL-6, IL-8, tumor necrosis factor-alpha (TNFalpha) and nitrite/nitrate (NO2-/ NO3-) in patients with severe septic shock. DESIGN Prospective clinical study. SETTING Surgical intensive care unit at a university hospital. PATIENTS 11 consecutive patients with severe septic shock. INTERVENTIONS Standard hemodynamic measurements were made and blood samples taken at intervals before, during, and after a 12-h infusion of L-NAME 1 mg x kg(-1) x h(-1) for determination of plasma IL-6, IL-8, TNFalpha and NO2-/NO3- concentration. MEASUREMENTS AND RESULTS Patients with sepsis had increased plasma levels of IL-6, IL-8, TNFalpha and NO2-/NO3- (p < 0.05). Plasma levels of IL-6. IL-8, and NO2-/NO- were negatively correlated with systemic vascular resistance (r = -0.62, r = -0.65, and r = -0.78, respectively, all p < 0.05). Continuous infusion of L-NAME increased mean arterial pressure and systemic vascular resistance, with a concomitant reduction in cardiac output (all p < 0.01). No significant changes were seen in levels of plasma IL-6, IL-8, and NO-/NO3- during the 24-h observation period. Plasma levels of TNFalpha were significantly reduced during L-NAME infusion compared to baseline (p < 0.05). CONCLUSIONS NO plays a role in the cardiovascular derangements of human septic shock. Inhibition of NO synthesis with L-NAME does not promote excessive cytokine release in patients with severe sepsis.
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Affiliation(s)
- J A Avontuur
- Department of Surgery, University Hospital Rotterdam, The Netherlands
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Jongen-Lavrencic M, Peeters HR, Wognum A, Vreugdenhil G, Breedveld FC, Swaak AJ. Elevated levels of inflammatory cytokines in bone marrow of patients with rheumatoid arthritis and anemia of chronic disease. J Rheumatol Suppl 1997; 24:1504-9. [PMID: 9263142] [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: 02/05/2023]
Abstract
OBJECTIVE Inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6) play an important role in decreased erythropoiesis in patients with anemia of chronic disease (ACD) and rheumatoid arthritis (RA). Modulation of quantities of bone marrow erythroid progenitors during chronic inflammation may be one of the pathogenetic mechanisms leading to ACD. We studied bone marrow from patients with ACD with RA by investigating, first, local production of inflammatory cytokines in the bone marrow, and second, the relative fraction of late erythroid progenitors (erythropoietin and transferrin receptor positive cells; EpoR+ TrfR+) in bone marrow. In addition, the effects of TNF-alpha on EpoR+ TrfR+ cells were studied in vitro. METHODS Levels of IL-6 and TNF-alpha were measured by EL ELISA in supernatant of bone marrow and peripheral blood cultures from 14 patients with RA and ACD and 14 patients with RA without anemia. The numbers of EpoR+ TrfR+ cells in bone marrow samples of both groups were assessed by 2 color fluorescence flow cytometry. RESULTS Levels of IL-6 and TNF-alpha were significantly higher in the supernatant of bone marrow cultures of patients with ACD compared to controls. No significant differences in the fraction of EpoR+ TrfR+ cells in samples was observed between the 2 groups of patients. Incubation of the samples with TNF-alpha did not result in modulation of the number of EpoR+ TrfR+ cells. CONCLUSION Local production of proinflammatory cytokines in the bone marrow may be associated with the development of ACD in RA.
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Affiliation(s)
- M Jongen-Lavrencic
- Department of Rheumatology, Dr. Daniel den Hoed Clinic, Rotterdam, The Netherlands
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Stam TC, Jongen-Lavrencic M, Eggermont AM, Swaak AJ. Effects of isolated limb perfusion with tumour necrosis factor-alpha on the function of monocytes and T lymphocytes in patients with cancer. Eur J Clin Invest 1996; 26:1085-91. [PMID: 9013083 DOI: 10.1046/j.1365-2362.1996.480599.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of the present study was to investigate the effects of isolated limb perfusion (ILP) with tumour necrosis factor alpha (TNF-alpha) and melphalan in patients with cancer on, first, plasma levels of cytokines, second, systemic monocyte and T-lymphocyte distribution and, third, the ability of mononuclear cells to produce cytokines upon stimulation in vitro. Six patients undergoing an ILP were entered into the study (group 1). In addition, patients undergoing a major surgical operation (group 2) minor operation (group 3) as well as healthy volunteers (group 4) were included as control groups. Sensitive enzyme-linked immunosorbent assays (ELISAs) were used to measure TNF-alpha and interleukin-6 (IL-6) plasma levels at various time points during and after operation. Furthermore, the percentage of monocytes and T lymphocytes was determined in all studied groups using a FACScan. In addition, cytokine production upon stimulation with lipopolysaccharide (LPS) and a combination of anti-CD3/anti-CD28 monoclonal antibodies in whole-blood cultures was investigated. Increased plasma levels of TNF-alpha and IL-6 in patients undergoing ILP was observed, but only IL-6 appeared to be increased in patients treated with a major operation. No significant fluctuations were found in the other groups studied. Concerning the number of monocytes, a significant decrease was observed only in patients treated with ILP. Furthermore, a decreased production of TNF-alpha, IL-6 and IL-8 upon various types of stimulation in vitro was found in those patients, but also after a major operation. In conclusion, the results of the present study show increased plasma levels of cytokines in patients treated with ILP and major operation. Furthermore, a decrease in numbers of monocytes in the circulation and the ability of mononuclear cells to produce cytokines in vitro may be induced by administration of TNF-alpha in ILP. Although similar results were found in patients treated with major operation, the underlying mechanisms of this phenomenon remain to be elucidated.
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Affiliation(s)
- T C Stam
- Department of Surgical Oncology, Dr. Daniel den Hoed Clinic, Rotterdam, The Netherlands
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