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Chan G, Wong J, Tan T, Ghallyan N, Browett P. False positive Hb Bart's immunochromatographic strip test for alpha thalassaemia in delta-beta thalassaemia carriers. Int J Lab Hematol 2023; 45:984-986. [PMID: 37317650 DOI: 10.1111/ijlh.14122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023]
Affiliation(s)
- George Chan
- LabTests Auckland, Auckland City Hospital, Auckland, New Zealand
| | - Jenna Wong
- LabTests Auckland, Auckland City Hospital, Auckland, New Zealand
| | - Tina Tan
- Molecular Haematology Section, Pathology and Laboratory Medicine Service, Auckland City Hospital, Auckland, New Zealand
| | - Nikhil Ghallyan
- Molecular Haematology Section, Pathology and Laboratory Medicine Service, Auckland City Hospital, Auckland, New Zealand
| | - Peter Browett
- Molecular Haematology Section, Pathology and Laboratory Medicine Service, Auckland City Hospital, Auckland, New Zealand
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2
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Opat S, Tedeschi A, Hu B, Linton KM, McKay P, Leitch S, Coleman M, Zinzani PL, Jin J, Sun M, Sobieraj-Teague M, Browett P, Ke X, Thieblemont C, Ardeshna K, Bijou F, Walker P, Hawkes EA, Ho SJ, Zhou K, Liang Z, Xu J, Tankersley C, Delarue R, Co M, Trotman J. Safety and efficacy of zanubrutinib in relapsed/refractory marginal zone lymphoma: final analysis of the MAGNOLIA study. Blood Adv 2023; 7:6801-6811. [PMID: 37682792 PMCID: PMC10679804 DOI: 10.1182/bloodadvances.2023010668] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 09/10/2023] Open
Abstract
The primary analysis of MAGNOLIA, an open-label, single-arm, multicenter, phase 2 study, demonstrated that the next-generation Bruton tyrosine kinase (BTK) inhibitor zanubrutinib provided a high overall response rate (ORR) in patients with relapsed/refractory marginal zone lymphoma (R/R MZL), with a favorable safety/tolerability profile. Presented here, is the final analysis of MAGNOLIA, performed to characterize the durability of response and longer-term safety and tolerability. Zanubrutinib (160 mg twice daily) was evaluated in 68 patients with R/R MZL who had received at least 1 anti-CD20-directed regimen. The primary end point was independent review committee (IRC)-assessed ORR. Secondary end points included investigator-assessed ORR, duration of response (DOR), progression-free survival (PFS), overall survival (OS), health-related quality of life, safety, and tolerability. With a median follow-up of 27.4 months, the IRC-assessed ORR was 68.2% (95% confidence interval [CI], 55.6-79.1), with a 24-month DOR event-free rate of 72.9% (95% CI, 54.4-84.9). PFS and OS at 24 months were 70.9% (95% CI, 57.2-81.0) and 85.9% (95% CI, 74.7-92.4), respectively. The zanubrutinib safety profile was consistent with the primary analysis, with no new safety signals observed. Atrial fibrillation/flutter (n = 2 [2.9%]) and hypertension (n = 3 [4.4%]) were uncommon. Neutropenia (n = 8 [11.8%]) was the most common grade ≥3 adverse event. In this final analysis of MAGNOLIA, zanubrutinib demonstrated sustained clinical responses beyond 2 years, with 73% of responders alive and progression free. Zanubrutinib continued to demonstrate a favorable safety/tolerability profile with the additional time on treatment. This trial was registered at www.clinicaltrials.gov as #NCT03846427.
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Affiliation(s)
- Stephen Opat
- Monash Health and Monash University, Clayton, VIC, Australia
| | | | - Bei Hu
- Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Kim M. Linton
- Division of Cancer Sciences, Manchester Cancer Research Centre, Manchester, United Kingdom
| | - Pamela McKay
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli,” and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Jie Jin
- The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Mingyuan Sun
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | | | | | - Xiaoyan Ke
- Peking University Third Hospital, Beijing, China
| | - Catherine Thieblemont
- Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Louis, Hemato-oncology, Paris University Diderot, Paris, France
| | - Kirit Ardeshna
- University College London Hospitals/University College London Biomedical Research Centre, London, UK
| | | | - Patricia Walker
- Peninsula Private Hospital, Ramsay Health Care, Frankston, VIC, Australia
| | - Eliza A. Hawkes
- Olivia Newton-John Cancer Research Centre, Austin Health, Heidelberg, VIC, Australia
| | | | | | | | | | | | | | | | - Judith Trotman
- Concord Repatriation General Hospital and University of Sydney, Concord, NSW, Australia
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3
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Opat S, Tedeschi A, Linton K, McKay P, Hu B, Chan H, Jin J, Sobieraj-Teague M, Zinzani PL, Coleman M, Thieblemont C, Browett P, Ke X, Sun M, Marcus R, Portell CA, Ardeshna K, Bijou F, Walker P, Hawkes EA, Mapp S, Ho SJ, Talaulikar D, Zhou KS, Co M, Li X, Zhou W, Cappellini M, Tankersley C, Huang J, Trotman J. The MAGNOLIA Trial: Zanubrutinib, a Next-Generation Bruton Tyrosine Kinase Inhibitor, Demonstrates Safety and Efficacy in Relapsed/Refractory Marginal Zone Lymphoma. Clin Cancer Res 2021; 27:6323-6332. [PMID: 34526366 PMCID: PMC9401507 DOI: 10.1158/1078-0432.ccr-21-1704] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/29/2021] [Accepted: 09/10/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Marginal zone lymphoma (MZL) is an uncommon non-Hodgkin lymphoma with malignant cells that exhibit a consistent dependency on B-cell receptor signaling. We evaluated the efficacy and safety of zanubrutinib, a next-generation selective Bruton tyrosine kinase inhibitor, in patients with relapsed/refractory (R/R) MZL. PATIENTS AND METHODS Patients with R/R MZL were enrolled in the phase II MAGNOLIA (BGB-3111-214) study. The primary endpoint was overall response rate (ORR) as determined by an independent review committee (IRC) based on the Lugano 2014 classification. RESULTS Sixty-eight patients were enrolled. After a median follow-up of 15.7 months (range, 1.6 to 21.9 months), the IRC-assessed ORR was 68.2% and complete response (CR) was 25.8%. The ORR by investigator assessment was 74.2%, and the CR rate was 25.8%. The median duration of response (DOR) and median progression-free survival (PFS) by independent review was not reached. The IRC-assessed DOR rate at 12 months was 93.0%, and IRC-assessed PFS rate was 82.5% at both 12 and 15 months. Treatment was well tolerated with the majority of adverse events (AE) being grade 1 or 2. The most common AEs were diarrhea (22.1%), contusion (20.6%), and constipation (14.7%). Atrial fibrillation/flutter was reported in 2 patients; 1 patient had grade 3 hypertension. No patient experienced major hemorrhage. In total, 4 patients discontinued treatment due to AEs, none of which were considered treatment-related by the investigators. CONCLUSIONS Zanubrutinib demonstrated high ORR and CR rate with durable disease control and a favorable safety profile in patients with R/R MZL.
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Affiliation(s)
- Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | | | - Kim Linton
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Cancer Research Centre, Manchester, United Kingdom
| | - Pamela McKay
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Bei Hu
- Levine Cancer Institute University City, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Henry Chan
- North Shore Hospital, Auckland, New Zealand
| | - Jie Jin
- The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, Zhejiang, China
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Morton Coleman
- WCM Research Alliance, Weill Cornell Medicine, Lake Success, New York
| | - Catherine Thieblemont
- Service d'Hématologie-Oncologie, Hôpital Saint-Louis, APHP, Paris, France
- Paris University, Paris, France
| | - Peter Browett
- Auckland City Hospital, University of Auckland, Grafton, Auckland, New Zealand
| | - Xiaoyan Ke
- Peking University Third Hospital, Beijing, China
| | - Mingyuan Sun
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Robert Marcus
- Sarah Cannon Research Institute, London, United Kingdom
| | - Craig A Portell
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- UCLH NIHR Biomedical Research Centre, London, United Kingdom
| | | | - Patricia Walker
- Peninsula Private Hospital, Ramsay Health Care, Frankston, Australia
| | - Eliza A Hawkes
- Olivia Newton-John Cancer Research Institute and Austin Health, Heidelberg, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Sally Mapp
- Haematology Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Shir-Jing Ho
- Haematology Clinical Services, St George Hospital, Sydney, New South Wales, Australia
| | - Dipti Talaulikar
- The Canberra Hospital, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ke-Shu Zhou
- Henan Cancer Hospital, Zhengzhou, Henan, China
| | | | | | | | | | | | | | - Judith Trotman
- Concord Repatriation General Hospital, Sydney Medical School, University of Sydney, Concord, New South Wales, Australia.
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4
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Risitano AM, Kulasekararaj AG, Lee JW, Maciejewski JP, Notaro R, Brodsky R, Huang M, Geffner M, Browett P. Danicopan: an oral complement factor D inhibitor for paroxysmal nocturnal hemoglobinuria. Haematologica 2021; 106:3188-3197. [PMID: 33121236 PMCID: PMC8634185 DOI: 10.3324/haematol.2020.261826] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/06/2020] [Indexed: 12/02/2022] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is characterised by complement-mediated intravascular hemolysis (IVH) due to absence of complement regulators CD55 and CD59 on affected erythrocytes. Danicopan is a first-in-class oral proximal, complement alternative pathway factor D (FD) inhibitor. Therapeutic FD inhibition was designed to control IVH and prevent C3-mediated extravascular hemolysis (EVH). In this open-label, phase 2, dose-finding trial, 10 untreated hemolytic PNH patients received danicopan monotherapy (100-200 mg thrice daily). Endpoints included change in lactate dehydrogenase (LDH) at day 28 (primary) and day 84 and hemoglobin. Safety, pharmacokinetics/pharmacodynamics, and patient-reported outcomes were measured. Ten patients reached the primary endpoint; two later discontinued: one for a serious adverse event (elevated aspartate aminotransferase/alanine aminotransferase coincident with breakthrough hemolysis, resolving without sequelae) and one for personal reasons unrelated to safety. Eight patients completed treatment. IVH was inhibited, demonstrated by mean decreased LDH (5.7 times upper limit of normal [ULN] at baseline vs 1.8 times ULN [day 28] and 2.2 times ULN [day 84]; both p.
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Affiliation(s)
- Antonio M Risitano
- Federico II University of Naples, Naples, Italy and AORN Moscati, Avellino.
| | - Austin G Kulasekararaj
- King's College Hospital-NHS Foundation Trust, NIHR/Wellcome King's Clinical Research Facility, London, UK and King's College London, London
| | - Jong Wook Lee
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul
| | | | - Rosario Notaro
- Core Research Laboratory, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze, Italy; Azienda Ospedaliera-Universitaria Careggi, Firenze
| | - Robert Brodsky
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mingjun Huang
- Achillion, Inc., A Subsidiary of Alexion Pharmaceuticals, Inc., New Haven, CT, USA; Alexion Pharmaceuticals, New Haven CT
| | - Michael Geffner
- Achillion Inc., A Subsidiary of Alexion Pharmaceuticals, Inc., Blue Bell, PA
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Trotman J, Tedeschi A, Linton K, McKay P, Hu B, Chan H, Jin J, Sobieraj‐Teague M, Zinzani PL, Coleman M, Browett P, Ke X, Sun M, Marcus R, Portell C, Thieblemont C, Zhou K, Liberati AM, Bachy E, Cavallo F, Costello R, Iyengar S, Marasca R, Mociková H, Kim JS, Talaulikar D, Co M, Zhou W, Huang J, Opat S. SAFETY AND EFFICACY OF ZANUBRUTINIB IN PATIENTS WITH RELAPSED/REFRACTORY MARGINAL ZONE LYMPHOMA (MAGNOLIA PHASE 2 STUDY). Hematol Oncol 2021. [DOI: 10.1002/hon.19_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Trotman
- Concord Repatriation General Hospital University of Sydney Oncology Concord Australia
| | - A. Tedeschi
- ASST Grande Ospedale Metropolitano Niguarda Hematology Milan Italy
| | - K. Linton
- The Christie Hematology Manchester UK
| | - P. McKay
- Beatson West of Scotland Cancer Centre Oncology Glasgow UK
| | - B. Hu
- Levine Cancer Institute/Atrium Health Oncology Charlotte USA
| | - H. Chan
- North Shore Hospital Haematology Auckland New Zealand
| | - J. Jin
- The First Affiliated Hospital Zhejiang University Hematology Hangzhou China
| | | | - P. L. Zinzani
- Institute of Hematology “Seràgnoli” University of Bologna Hematology Bologna Italy
| | - M. Coleman
- Clinical Research Alliance Hematology Lake Success USA
| | - P. Browett
- Auckland City Hospital Haematology Grafton New Zealand
| | - X. Ke
- Peking University Third Hospital Hematology Beijing China
| | - M. Sun
- Institute of Hematology & Blood Diseases Hospital Chinese Academy of Medical Sciences Peking Union Medical College Hematology Tianjin China
| | - R. Marcus
- Sarah Cannon Research Institute UK Oncology London UK
| | - C. Portell
- University of Virginia Health System Hematology/Oncology Charlottesville USA
| | - C. Thieblemont
- APHP, Hôpital Saint‐Louis, Hemato‐oncology Paris University Diderot Hematology/Oncology Paris France
| | - K. Zhou
- Henan Cancer Hospital Oncology Zhengzhou China
| | - A. M. Liberati
- Azienda Ospedaliera Santa Maria Di Terni Oncology Terni Italy
| | - E. Bachy
- Centre Hospitalier Lyon Sud Pierre Bénite Hematology Rhone Italy
| | - F. Cavallo
- Azienda Ospedaliera Città della Salute e della Scienza di Torino Hematology Torino Italy
| | - Rég. Costello
- Hôpital de la Conception – APHM Hematology Marseille France
| | - S. Iyengar
- Royal Marsden Hospital Haematology London UK
| | - R. Marasca
- AOU Policlinico di Modena Hematology Modena Italy
| | - H. Mociková
- Fakultní nemocnice Královské Vinohrady Hematology Praha 10 Czech Republic
| | - J. S. Kim
- Severance Hospital Hematology Seoul Korea
| | - D. Talaulikar
- The Canberra Hospital Haematology Canberra Australia
| | - M. Co
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - W. Zhou
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - J. Huang
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - S. Opat
- Monash Health Monash University Haematology Clayton Australia
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6
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Van de Water N, Tan T, Crowley M, Kerr R, Browett P. Novel α-Globin Splice Site Mutation (HBA2: c.96-5C>A) in Combination with Three-Gene Deletion Hb H Disease. Hemoglobin 2018; 42:122-125. [PMID: 30200833 DOI: 10.1080/03630269.2018.1487307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The choice of acceptor splice site during exon-exon splicing by the spliceosome is determined by a variety of factors. We report here a family with a novel acceptor splice site variant within intron 1 of the α-globin gene that provides some in vivo insight into the rules governing RNA splicing in homo sapiens. A 2-year-old female with Hb H disease, was found to have not only three α-globin genes deleted (- -FIL/-α3.7) but also a HBA2: c.96-5C>A variant on her remaining α-globin gene. The HBA2: c.96-5C>A variant was in cis with -α3.7 and mRNA studies indicate that this variant creates a new acceptor splice site which is used in approximately 35.0% of α-globin mRNA transcripts. The reduced levels of normal mRNA transcript predicts a more severe Hb H disease than expected for the three-gene deletion Hb H disease with a phenotype similar to nondeletional Hb H disease. We propose that this variant be called Hb Beach Haven (HBA2: c.96-5C>A).
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Affiliation(s)
- Neil Van de Water
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand
| | - Tina Tan
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand
| | - Megan Crowley
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand
| | - Romy Kerr
- b Genetic Health Service , Auckland City Hospital , New Zealand
| | - Peter Browett
- a Diagnostic Genetics Department , LabPlus, Auckland City Hospital , Auckland , New Zealand.,c Department of Molecular Medicine & Pathology , University of Auckland , Auckland , New Zealand
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7
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Affiliation(s)
- Neil Van de Water
- The Department of Haematology, Auckland Hospital and Department of Molecular Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Ruth Williams
- The Department of Haematology, Auckland Hospital and Department of Molecular Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Andrew Dare
- The Department of Haematology, Auckland Hospital and Department of Molecular Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - William Abbott
- The Department of Haematology, Auckland Hospital and Department of Molecular Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Peter Browett
- The Department of Haematology, Auckland Hospital and Department of Molecular Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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8
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Water NVD, Williams R, Ockelford P, Browett P. A 20.7 kb Deletion within the Factor VIII Gene Associated with LINE-1 Element Insertion. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615098] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
SummaryLarge deletions within the factor VIII gene account for approximately 5% of the mutations causing haemophilia A. The characterization of such mutations can provide insights into the molecular mechanisms of these and other deletions in man. We have analyzed a 20.7 kb deletion spanning exons 15 to 20 within the factor VIII gene in a patient with severe haemophilia A. Long range PCR was used to investigate the extent of the deletion and to provide a template for sequencing across the deletion breakpoint. A 38-base insertion homologous to the 3’ region of a LINE-1 (L1) element was detected at the breakpoint of the deletion. Normal sequence at the 5’ breakpoint in intron 14 was homologous to an L1 flanking region and normal sequence at the 3’ breakpoint in intron 20 was homologous to an adjacent sequence within the same L1 flanking region. A molecular mechanism for the deletion involving retrotransposition of a readthrough product of an L1 element plus its 3’ flanking region is suggested.
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9
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Ameratunga R, Koopmans W, Woon ST, Leung E, Lehnert K, Slade CA, Tempany JC, Enders A, Steele R, Browett P, Hodgkin PD, Bryant VL. Epistatic interactions between mutations of TACI ( TNFRSF13B) and TCF3 result in a severe primary immunodeficiency disorder and systemic lupus erythematosus. Clin Transl Immunology 2017; 6:e159. [PMID: 29114388 PMCID: PMC5671988 DOI: 10.1038/cti.2017.41] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 12/22/2022] Open
Abstract
Common variable immunodeficiency disorders (CVID) are a group of primary immunodeficiencies where monogenetic causes account for only a fraction of cases. On this evidence, CVID is potentially polygenic and epistatic although there are, as yet, no examples to support this hypothesis. We have identified a non-consanguineous family, who carry the C104R (c.310T>C) mutation of the Transmembrane Activator Calcium-modulator and cyclophilin ligand Interactor (TACI, TNFRSF13B) gene. Variants in TNFRSF13B/TACI are identified in up to 10% of CVID patients, and are associated with, but not solely causative of CVID. The proband is heterozygous for the TNFRSF13B/TACI C104R mutation and meets the Ameratunga et al. diagnostic criteria for CVID and the American College of Rheumatology criteria for systemic lupus erythematosus (SLE). Her son has type 1 diabetes, arthritis, reduced IgG levels and IgA deficiency, but has not inherited the TNFRSF13B/TACI mutation. Her brother, homozygous for the TNFRSF13B/TACI mutation, is in good health despite profound hypogammaglobulinemia and mild cytopenias. We hypothesised that a second unidentified mutation contributed to the symptomatic phenotype of the proband and her son. Whole-exome sequencing of the family revealed a de novo nonsense mutation (T168fsX191) in the Transcription Factor 3 (TCF3) gene encoding the E2A transcription factors, present only in the proband and her son. We demonstrate mutations of TNFRSF13B/TACI impair immunoglobulin isotype switching and antibody production predominantly via T-cell-independent signalling, while mutations of TCF3 impair both T-cell-dependent and -independent pathways of B-cell activation and differentiation. We conclude that epistatic interactions between mutations of the TNFRSF13B/TACI and TCF3 signalling networks lead to the severe CVID-like disorder and SLE in the proband.
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Affiliation(s)
- Rohan Ameratunga
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand.,Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Wikke Koopmans
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - See-Tarn Woon
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Euphemia Leung
- Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - Klaus Lehnert
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Charlotte A Slade
- Department of Immunology, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.,Department of Allergy and Clinical Immunology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jessica C Tempany
- Department of Immunology, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Anselm Enders
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research and Centre for Personalised Immunology, Australian National University, Canberra, ACT, Australia
| | - Richard Steele
- Department of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Peter Browett
- Department of Hematology, LabPlus, Auckland City Hospital, Auckland, New Zealand.,Department of Molecular Medicine, and Pathology University of Auckland, Auckland, New Zealand
| | - Philip D Hodgkin
- Department of Immunology, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Vanessa L Bryant
- Department of Immunology, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.,Department of Allergy and Clinical Immunology, Royal Melbourne Hospital, Parkville, VIC, Australia
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10
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Hemmington A, Dalbeth N, Jarrett P, Fraser AG, Broom R, Browett P, Petrie KJ. Medical specialists' attitudes to prescribing biosimilars. Pharmacoepidemiol Drug Saf 2017; 26:570-577. [DOI: 10.1002/pds.4186] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Amy Hemmington
- Department of Psychological Medicine; University of Auckland; New Zealand
| | - Nicola Dalbeth
- Department of Medicine; Auckland and Department of Dermatology Middlemore Hospital; University of Auckland; New Zealand
| | - Paul Jarrett
- Department of Medicine; Auckland and Department of Dermatology Middlemore Hospital; University of Auckland; New Zealand
| | - Alan G. Fraser
- Department of Medicine; Auckland and Department of Dermatology Middlemore Hospital; University of Auckland; New Zealand
| | - Reuben Broom
- Regional Cancer and Blood Centre; Auckland City Hospital; New Zealand
| | - Peter Browett
- Department of Molecular Medicine; University of Auckland; New Zealand
| | - Keith J. Petrie
- Department of Psychological Medicine; University of Auckland; New Zealand
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11
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Quach H, Fernyhough L, Henderson R, Corbett G, Baker B, Browett P, Blacklock H, Forsyth C, Underhill C, Cannell P, Trotman J, Neylon A, Harrison S, Link E, Swern A, Cowan L, Dimopoulos MA, Miles Prince H. Upfront lower dose lenalidomide is less toxic and does not compromise efficacy for vulnerable patients with relapsed refractory multiple myeloma: final analysis of the phase II RevLite study. Br J Haematol 2017; 177:441-448. [DOI: 10.1111/bjh.14562] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Hang Quach
- Faculty of Medicine; University of Melbourne; Victoria Australia
- Department of Haematology; St. Vincent's Hospital Melbourne; Melbourne Vic. Australia
| | | | - Ross Henderson
- Department of Medicine; Royal North Shore Hospital; Saint Leonards NSW Australia
| | - Gillian Corbett
- Department of Medicine; Tauranga Hospital; Tauranga New Zealand
| | - Bart Baker
- Department of Haematology; Palmerston North Hospital; Palmerston North New Zealand
| | - Peter Browett
- Department of Medicine; Auckland Hospital; Auckland New Zealand
| | - Hilary Blacklock
- Department of Medicine; Middlemore Hospital; Auckland New Zealand
| | - Cecily Forsyth
- Department of Haematology; Gosford Hospital; North Gosford NSW Australia
| | - Craig Underhill
- Department of Medicine; Border Medical Oncology; Albury-Wodonga Vic. Australia
| | - Paul Cannell
- Department of Medicine; Royal Perth Hospital; Perth WA Australia
| | - Judith Trotman
- Department of Medicine; Concord Hospital; Concord NSW Australia
| | - Annette Neylon
- Department of Medicine; Dunedin Hospital; Dunedin New Zealand
| | - Simon Harrison
- Faculty of Medicine; University of Melbourne; Victoria Australia
- Haematology Service; Peter MacCallum Cancer Centre; Vic. Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Victoria Vic. Australia
| | | | - Linda Cowan
- Centre for Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Victoria Vic. Australia
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics; University of Athens School of Medicine; Athens Greece
| | - H. Miles Prince
- Faculty of Medicine; University of Melbourne; Victoria Australia
- Haematology Service; Peter MacCallum Cancer Centre; Vic. Australia
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Harris G, O'Toole S, George P, Browett P, Print C. Massive parallel sequencing of solid tumours - challenges and opportunities for pathologists. Histopathology 2016; 70:123-133. [DOI: 10.1111/his.13067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gavin Harris
- Department of Molecular Medicine and Pathology and Bioinformatics Institute; University of Auckland; Auckland New Zealand
- Canterbury Health Laboratories; Christchurch New Zealand
| | - Sandra O'Toole
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
- Sydney Medical School; Sydney University; Sydney Australia
- The Kinghorn Cancer Centre; Garvan Institute of Medical Research; Darlinghurst NSW Australia
| | - Peter George
- Canterbury Health Laboratories; Christchurch New Zealand
| | - Peter Browett
- Department of Molecular Medicine and Pathology and Bioinformatics Institute; University of Auckland; Auckland New Zealand
| | - Cristin Print
- Department of Molecular Medicine and Pathology and Bioinformatics Institute; University of Auckland; Auckland New Zealand
- Maurice Wilkins Centre; c/o University of Auckland; Auckland New Zealand
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Fliegauf M, L. Bryant V, Frede N, Slade C, Woon ST, Lehnert K, Winzer S, Bulashevska A, Scerri T, Leung E, Jordan A, Keller B, de Vries E, Cao H, Yang F, Schäffer A, Warnatz K, Browett P, Douglass J, Ameratunga R, van der Meer J, Grimbacher B. Haploinsufficiency of the NF-κB1 Subunit p50 in Common Variable Immunodeficiency. Am J Hum Genet 2015; 97:389-403. [PMID: 26279205 DOI: 10.1016/j.ajhg.2015.07.008] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/16/2015] [Indexed: 12/21/2022] Open
Abstract
Common variable immunodeficiency (CVID), characterized by recurrent infections, is the most prevalent symptomatic antibody deficiency. In ∼90% of CVID-affected individuals, no genetic cause of the disease has been identified. In a Dutch-Australian CVID-affected family, we identified a NFKB1 heterozygous splice-donor-site mutation (c.730+4A>G), causing in-frame skipping of exon 8. NFKB1 encodes the transcription-factor precursor p105, which is processed to p50 (canonical NF-κB pathway). The altered protein bearing an internal deletion (p.Asp191_Lys244delinsGlu; p105ΔEx8) is degraded, but is not processed to p50ΔEx8. Altered NF-κB1 proteins were also undetectable in a German CVID-affected family with a heterozygous in-frame exon 9 skipping mutation (c.835+2T>G) and in a CVID-affected family from New Zealand with a heterozygous frameshift mutation (c.465dupA) in exon 7. Given that residual p105 and p50—translated from the non-mutated alleles—were normal, and altered p50 proteins were absent, we conclude that the CVID phenotype in these families is caused by NF-κB1 p50 haploinsufficiency.
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Iland HJ, Collins M, Bradstock K, Supple SG, Catalano A, Hertzberg M, Browett P, Grigg A, Firkin F, Campbell LJ, Hugman A, Reynolds J, Di Iulio J, Tiley C, Taylor K, Filshie R, Seldon M, Taper J, Szer J, Moore J, Bashford J, Seymour JF. Use of arsenic trioxide in remission induction and consolidation therapy for acute promyelocytic leukaemia in the Australasian Leukaemia and Lymphoma Group (ALLG) APML4 study: a non-randomised phase 2 trial. Lancet Haematol 2015; 2:e357-66. [PMID: 26685769 DOI: 10.1016/s2352-3026(15)00115-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Initial treatment of acute promyelocytic leukaemia traditionally involves tretinoin (all-trans retinoic acid) combined with anthracycline-based risk-adapted chemotherapy, with arsenic trioxide being the treatment of choice at relapse. To try to reduce the relapse rate, we combined arsenic trioxide with tretinoin and idarubicin in induction therapy, and used arsenic trioxide with tretinoin as consolidation therapy. METHODS Patients with previously untreated genetically confirmed acute promyelocytic leukaemia were eligible for this study. Eligibilty also required Eastern Cooperative Oncology Group performance status 0-3, age older than 1 year, normal left ventricular ejection fraction, Q-Tc interval less than 500 ms, absence of serious comorbidity, and written informed consent. Patients with genetic variants of acute promyelocytic leukaemia (fusion of genes other than PML with RARA) were ineligible. Induction comprised 45 mg/m(2) oral tretinoin in four divided doses daily on days 1-36, 6-12 mg/m(2) intravenous idarubicin on days 2, 4, 6, and 8, adjusted for age, and 0·15 mg/kg intravenous arsenic trioxide once daily on days 9-36. Supportive therapy included blood products for protocol-specified haemostatic targets, and 1 mg/kg prednisone daily as prophylaxis against differentiation syndrome. Two consolidation cycles with tretinoin and arsenic trioxide were followed by maintenance therapy with oral tretinoin, 6-mercaptopurine, and methotrexate for 2 years. The primary endpoints of the study were freedom from relapse and early death (within 36 days of treatment start) and we assessed improvement compared with the 2 year interim results. To assess durability of remission we compared the primary endpoints and disease-free and overall survival at 5 years in APML4 with the 2 year interim APML4 data and the APML3 treatment protocol that excluded arsenic trioxide. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12605000070639. FINDINGS 124 patients were enrolled between Nov 10, 2004, and Sept 23, 2009, with data cutoff of March 15, 2012. Four (3%) patients died early. After a median follow-up of 4·2 years (IQR, 3·2-5·2), the 5 year freedom from relapse was 95% (95% CI 89-98), disease-free survival was 95% (89-98), event-free survival was 90% (83-94), and overall survival was 94% (89-97). The comparison with APML3 data showed that hazard ratios were 0·23 (95% CI 0·08-0·64, p=0·002) for freedom from relapse, 0·21 (0·07-0·59, p=0·001) for disease-free survival, 0·34 (0·16-0·69, p=0·002) for event-free survival, and 0·35 (0·14-0·91, p=0·02) for overall survival. INTERPRETATION Incorporation of arsenic trioxide in initial therapy induction and consolidation for acute promyelocytic leukaemia reduced the risk of relapse when compared with historical controls. This improvement, together with a non-significant reduction in early deaths and absence of deaths in remission, translated into better event-free and overall survival. FUNDING Phebra.
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Affiliation(s)
- Harry J Iland
- Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
| | - Marnie Collins
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, VIC, Australia
| | - Ken Bradstock
- University of Sydney, Sydney, NSW, Australia; Haematology, Westmead Hospital, Westmead, NSW, Australia
| | - Shane G Supple
- Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alberto Catalano
- Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Mark Hertzberg
- University of Sydney, Sydney, NSW, Australia; Haematology, Westmead Hospital, Westmead, NSW, Australia
| | | | - Andrew Grigg
- Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Frank Firkin
- University of Melbourne, Melbourne, VIC, Australia; Haematology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Lynda J Campbell
- University of Melbourne, Melbourne, VIC, Australia; Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Amanda Hugman
- Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - John Reynolds
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, VIC, Australia
| | - Juliana Di Iulio
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, VIC, Australia
| | - Campbell Tiley
- Haematology, Gosford Hospital, Gosford, NSW, Australia; University of Newcastle, Callaghan, NSW, Australia
| | - Kerry Taylor
- Haematology, Mater Medical Centre, South Brisbane, QLD, Australia
| | - Robin Filshie
- University of Melbourne, Melbourne, VIC, Australia; Haematology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Michael Seldon
- University of Newcastle, Callaghan, NSW, Australia; Haematology, Calvary Mater Hospital, Newcastle, Australia
| | - John Taper
- Haematology, Nepean Hospital, Kingswood, NSW, Australia
| | - Jeff Szer
- Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - John Moore
- Haematology, St Vincent's Hospital, Darlinghurst, NSW, Australia; University of New South Wales, Kensington, NSW, Australia
| | - John Bashford
- Haematology, Wesley Medical Centre, Auchenflower, QLD, Australia
| | - John F Seymour
- Haematology, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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Ghallyan N, Donald T, Broad D, Johnson S, Browett P, Van de Water N. Hb Feilding [β12(A9)Thr → Pro;HBB: c.37A>C]: A Novel Unstableβ-Globin Chain Variant. Hemoglobin 2015; 39:49-51. [DOI: 10.3109/03630269.2014.999082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Mant S, Taylor G, Dutton D, Butler A, Browett P, Ganly P. Development of T-cell lymphomas with an activated cytotoxic immunophenotype, including anaplastic large cell lymphomas, in patients with chronic lymphocytic leukemia: a series of six cases. Leuk Lymphoma 2014; 56:774-8. [DOI: 10.3109/10428194.2014.927460] [Citation(s) in RCA: 5] [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: 11/13/2022]
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Hertzberg M, Matthews JP, Stone JM, Dubosq MC, Grigg A, Ellis D, Benson W, Browett P, Horvath N, Januszewicz H, Abdi E, Green M, Bonaventura A, Marlton P, Cannell P, Wolf M. A phase III randomized trial of high-dose CEOP + filgrastim versus standard-dose CEOP in patients with non-Hodgkin lymphoma: 10-year follow-up data: Australasian Leukaemia and Lymphoma Group (ALLG) NHL07 trial. Am J Hematol 2014; 89:536-41. [PMID: 24481640 DOI: 10.1002/ajh.23684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 12/31/2022]
Abstract
Increasing dose intensity (DI) of chemotherapy for patients with aggressive non-Hodgkin lymphoma (NHL) may improve outcomes at the cost of increased toxicity. This issue was addressed in a randomized trial aiming to double the DI of myelosuppressive drugs. Between 1994 and 1999, 250 patients with previously untreated aggressive NHL were randomized to treatment with six cycles of 3-weekly standard (s) or intensive (i) chemotherapy: s-CEOP-cyclophosphamide 750, epirubicin 75, vincristine 1.4 mg/m(2) all on day 1, and prednisolone 100 mg days 1-5; i-CEOP-cyclophosphamide 1,500, epirubicin 150, vincristine 1.4 mg/m(2) all on day 1, and prednisolone 100 mg days 1-5. Primary endpoint was 5-year overall survival (OS). Relative to s-CEOP patients, i-CEOP patients achieved a 78% increase in the DI of cyclophosphamide and epirubicin. Despite this, there was no significant difference in any outcome: 5-year OS (56.7% i-CEOP; 55.1% s-CEOP; P = 0.80), 5-year progression free survival (PFS; 41% i-CEOP; 43% s-CEOP; P = 0.73), 5-year time to progression (TTP; 44% i-CEOP; 47% s-CEOP; P = 0.72), or complete remission (CR) + unconfirmed CR (CRu) rates (53% i-CEOP; 59% s-CEOP; P = 0.64). Long-term follow up at 10 years also showed no significant differences in OS, PFS, or TTP. The i-CEOP arm had higher rates of febrile neutropenia (70 vs. 26%), hospitalisations, blood product utilisation, haematological and gastrointestinal toxicities, and lower quality of life scores during treatment, although without significant differences 6-month later. In the treatment of aggressive NHL in the prerituximab era, increasing DI did not result in improved outcomes, while at the same time lead to increased toxicity.
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Affiliation(s)
- Mark Hertzberg
- Department of Haematology; Westmead Hospital; Westmead Australia
| | - Jane Palfrey Matthews
- Center for Biostatistics and Clinical Trials, Peter MacCallum Cancer Center; Melbourne Australia
| | | | | | - Andrew Grigg
- Department of Clinical Haematology; Austin Hospital; Heidelberg Australia
| | | | - Warwick Benson
- Department of Haematology; Westmead Hospital; Westmead Australia
| | - Peter Browett
- Department of Molecular Medicine and Pathology; University of Auckland, Auckland Hospital; Auckland New Zealand
| | - Noemi Horvath
- Department of Haematology; Royal Adelaide Hospital; Adelaide Australia
| | - Henry Januszewicz
- Division of Haematology and Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Australia
| | | | - Michael Green
- Department of Clinical Haematology and Medical Oncology; Western Health; Footscray Australia
| | | | - Paula Marlton
- Department of Haematology Princess Alexandra Hospital; Brisbane; Australia and School of Medicine; University of Queensland; Brisbane Australia
| | - Paul Cannell
- Department of Haematology; Royal Perth Hospital; Perth Australia
| | - Max Wolf
- Division of Haematology and Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Australia
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Burns KE, Goldthorpe MA, Porteus F, Browett P, Helsby NA. CYP2C19 genotype–phenotype discordance in patients with multiple myeloma leads to an acquired loss of drug-metabolising activity. Cancer Chemother Pharmacol 2014; 73:651-5. [DOI: 10.1007/s00280-014-2409-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/03/2014] [Indexed: 01/20/2023]
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Koopmans W, Woon ST, Zeng ISL, Jordan A, Brothers S, Browett P, Ameratunga R. Variability of memory B cell markers in a cohort of common variable immune deficiency patients over 6 months. Scand J Immunol 2013; 77:470-5. [PMID: 23360162 DOI: 10.1111/sji.12028] [Citation(s) in RCA: 15] [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] [Received: 12/09/2012] [Accepted: 01/10/2013] [Indexed: 11/30/2022]
Abstract
Common Variable Immunodeficiency Disorder (CVID) is a complex disorder that predisposes patients to recurrent and severe infections. Immunophenotypic classification schemes were developed to categorize patients with CVID into phenotypic and prognostic groups based on different memory B cell subsets. Whether the B cell subset analysis is stable over time has not been investigated. B cell phenotyping in patients with CVID (n = 15) and sex- and age-matched controls (n = 26) were carried out according to the three B cell classifications. Patients with CVID were evaluated monthly over 6 months. Controls were assessed once during the study. We scored how often each patient was assigned to the same group within each classification. The Freiburg classification assigned patients to the same group at a rate of 73% and the Paris classification at 88%. The EUROclass classification of smB- versus smB+ was at 90%. The two subclassifications [(smB-21low or smB-21norm) and transitional B] were at 87% and 97%, respectively. The level of naïve B cells measured in all patients with CVID during the 6-month evaluation was the most stable B cell subset. We conclude that all classifications systems show considerable variability, but the EUROclass classification was the most reliable scheme for our 15 CVID and 26 healthy cohorts. Our results indicate that phenotypic classifications within CVID will be difficult while there is variability of commonly used assays.
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Affiliation(s)
- W Koopmans
- Departments of Virology and Immunology, Auckland City Hospital, Auckland, New Zealand
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20
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O’Sullivan S, Horne A, Wattie D, Porteous F, Gamble G, Browett P, Grey A. Bone metabolism during long-term treatment with imatinib. Leuk Lymphoma 2013; 54:1783-5. [DOI: 10.3109/10428194.2012.760734] [Citation(s) in RCA: 6] [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: 11/13/2022]
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21
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Iland H, Bradstock K, Seymour J, Hertzberg M, Grigg A, Taylor K, Catalano J, Cannell P, Horvath N, Deveridge S, Browett P, Brighton T, Chong L, Springall F, Ayling J, Catalano A, Supple S, Collins M, Di Iulio J, Reynolds J. Results of the APML3 trial incorporating all-trans-retinoic acid and idarubicin in both induction and consolidation as initial therapy for patients with acute promyelocytic leukemia. Haematologica 2012; 97:227-34. [PMID: 21993673 PMCID: PMC3269482 DOI: 10.3324/haematol.2011.047506] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [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: 05/16/2011] [Revised: 10/04/2011] [Accepted: 10/10/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Initial therapy for patients with acute promyelocytic leukemia most often involves the combination of all-trans-retinoic acid with anthracycline-based chemotherapy. The role of non-anthracycline drugs in induction and consolidation is less well-established and varies widely between different cooperative group protocols. DESIGN AND METHODS In an attempt to minimize relapse and maximize survival for patients with newly diagnosed acute promyelocytic leukemia, the Australasian Leukaemia and Lymphoma Group utilized all-trans-retinoic acid and idarubicin as anti-leukemic therapy for both induction and consolidation. The protocol (known as APML3) was subsequently amended to incorporate maintenance with all-trans-retinoic acid, methotrexate and 6-mercaptopurine. RESULTS Eight (8%) of 101 patients died within 30 days, and 91 (90%) achieved complete remission. With a median estimated potential follow-up of 4.6 years, 4-year overall survival was 84%, and 71% of the patients remained in remission at 4 years. The cumulative incidence of all relapses was 28.1%, with 15 of the 25 relapses initially identified as an isolated molecular relapse. Both FLT3 mutations (internal tandem duplications and codon 835/836 kinase domain mutations) and increased white cell count at diagnosis were associated with inferior overall survival, but in multivariate analyses only FLT3 mutations remained significant (hazard ratio 6.647, P=0.005). Maintenance therapy was significantly associated with improved remission duration (hazard ratio 0.281, P<0.001) and disease-free survival (hazard ratio 0.290, P<0.001). CONCLUSIONS The combination of all-trans-retinoic acid and just two cycles of idarubicin followed by triple maintenance produced durable remissions in most patients, but patients with high-risk disease, especially those with FLT3 mutations, require additional agents or alternative treatment approaches. The significant reduction in relapse seen after the addition of maintenance to the protocol supports a role for maintenance in the context of relatively low chemotherapy exposure during consolidation. (actr.org.au identifier: ACTRN12607000410459).
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Affiliation(s)
- Harry Iland
- Royal Prince Alfred Hospital, Camperdown, Australia.
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22
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Jüllig M, Browett P, Middleditch MMJ, Prijic G, Kilfoyle D, Angelo N, Cooper GJS. A unique case of neural amyloidoma diagnosed by mass spectrometry of formalin-fixed tissue using a novel preparative technique. Amyloid 2011; 18:147-55. [PMID: 21859255 DOI: 10.3109/13506129.2011.597798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report here a unique amyloidoma of the radial nerve which could not be subtyped by available techniques, including immunohistochemistry and standard clinical and laboratory evaluation. In order to identify the amyloid monomer, we developed a novel preparative procedure designed to optimize conditions for liquid chromatography tandem mass spectrometry analysis of formalin-fixed/paraffin-embedded (FFPE) tissue. Subsequent mass spectrometric analysis clearly identified kappa light chain as the monomer, with no evidence of lambda light chain. Manual interpretation of the matched spectra revealed no evidence of polyclonality. This study also enabled detailed characterisation of twelve likely amyloid matrix components. Finally, our analysis revealed extensive hydroxylation of collagen type I but, unexpectedly, an almost complete lack of hydroxylated residues in the normally heavily-hydroxylated collagen type VI chains, pointing to structural/functional alterations of collagen VI in this matrix that could have contributed to the pathogenesis of this very unusual tumour. Given the high quality of the data here acquired using a standard quadrupole-time of flight tandem mass spectrometer of modest performance, the robust and straightforward preparative method described constitutes a competitive alternative to more involved approaches using state-of-the-art equipment.
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Affiliation(s)
- Mia Jüllig
- School of Biological and Sciences Maurice Wilkins Centre for Molecular Biodiscovery, Faculty of Science, University of Auckland, Auckland, New Zealand.
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23
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O'Sullivan S, Lin JM, Watson M, Callon K, Tong PC, Naot D, Horne A, Aati O, Porteous F, Gamble G, Cornish J, Browett P, Grey A. The skeletal effects of the tyrosine kinase inhibitor nilotinib. Bone 2011; 49:281-9. [PMID: 21550432 DOI: 10.1016/j.bone.2011.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [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] [Received: 12/23/2010] [Revised: 04/13/2011] [Accepted: 04/17/2011] [Indexed: 10/18/2022]
Abstract
Nilotinib is a tyrosine kinase inhibitor (TKI) developed to manage imatinib-resistance in patients with chronic myeloid leukemia (CML). It inhibits similar molecular targets to imatinib, but is a significantly more potent inhibitor of Bcr-Abl. Nilotinib exhibits off-target effects in other tissues, and of relevance to bone metabolism, hypophosphataemia has been reported in up to 30% of patients receiving nilotinib. We have assessed the effects of nilotinib on bone cells in vitro and on bone metabolism in patients receiving nilotinib for treatment of CML. We firstly investigated the effects of nilotinib on proliferating and differentiating osteoblastic cells, and on osteoclastogenesis in murine bone marrow cultures and RAW264.7 cells. Nilotinib potently inhibited osteoblast proliferation (0.01-1uM), through inhibition of the platelet-derived growth factor (PDGFR). There was a biphasic effect on osteoblast differentiation such that it was reduced by lower concentrations of nilotinib (0.1-0.5uM), with no effect at higher concentrations (1uM). Nilotinib also potently inhibited osteoclastogenesis, predominantly by stromal-cell dependent mechanisms. Thus, nilotinib decreased osteoclast development in murine bone marrow cultures, but did not affect osteoclastogenesis in RAW264.7 cells. Nilotinib treatment of osteoblastic cells increased expression and secretion of OPG and decreased expression of RANKL. In 10 patients receiving nilotinib, levels of bone turnover markers were in the low-normal range, despite secondary hyperparathyroidism, findings that are similar to those in patients treated with imatinib. Bone density tended to be higher than age and gender-matched normal values. These data suggest that nilotinib may have important effects on bone metabolism. Prospective studies should be conducted to determine the long-term effects of nilotinib on bone density and calcium metabolism.
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Affiliation(s)
- Susannah O'Sullivan
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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O'Sullivan S, Naot D, Callon KE, Watson M, Gamble GD, Ladefoged M, Karsdal MA, Browett P, Cornish J, Grey A. Imatinib mesylate does not increase bone volume in vivo. Calcif Tissue Int 2011; 88:16-22. [PMID: 20978751 DOI: 10.1007/s00223-010-9429-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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] [Received: 03/11/2010] [Accepted: 09/25/2010] [Indexed: 11/24/2022]
Abstract
Imatinib mesylate is a tyrosine kinase inhibitor used in the management of disorders in which activation of c-Abl, PDGFR, or c-Kit signaling plays a critical role. In vitro, imatinib stimulates osteoblast differentiation, inhibits osteoblast proliferation and survival, and decreases osteoclast development. Patients treated with imatinib exhibit altered bone and mineral metabolism, with stable or increased bone mass. However, recovery from the underlying disease and/or weight gain might contribute to these effects. We therefore investigated the skeletal effects of imatinib in healthy rats. We evaluated the effects of imatinib on bone volume, markers of bone turnover, and bone histomorphometry in mature female rats treated for 5 weeks with either vehicle, imatinib 40 mg/kg daily, or imatinib 70 mg/kg daily. Compared to vehicle, imatinib reduced trabecular bone volume/tissue volume (mean [SD]: vehicle 26.4% [5.4%], low-dose imatinib 24.8% [4.9%] [P = 0.5], high-dose imatinib 21.1% [5.7%] [P = 0.05]), reduced osteoblast surface (mean [SD]: vehicle 12.8% [5.8%], low-dose 6.8% [1.9%] [P < 0.01], high-dose 7.8 [3.1%] [P < 0.05]), and reduced serum osteocalcin (mean change from baseline [95% CI]: vehicle -8.2 [-26.6 to 10.2] ng/ml, low dose -79.7 [-97.5 to -61.9] ng/ml [P < 0.01 vs. vehicle], high-dose -66.0 [-82.0 to -50.0] ng/ml [P < 0.05 vs. vehicle]). Imatinib did not affect biochemical or histomorphometric indices of bone resorption. These results suggest that, in healthy animals, treatment with imatinib does not increase bone mass and that the improvements in bone density reported in patients receiving imatinib may not be a direct effect of the drug.
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Affiliation(s)
- Susannah O'Sullivan
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Dare T, Findlay M, Browett P, Amies K, Anderson S. Paternalism in practice: informing patients about expensive unsubsidised drugs. J Med Ethics 2010; 36:260-264. [PMID: 20439327 DOI: 10.1136/jme.2009.033944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73-99% in New Zealand and 72-94% in Australia depending on the scenario) the percentage who would not discuss expensive unfunded drugs was substantially lower in New Zealand (6.4-11.1%) than it was in Australia (28-41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians' decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced.
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Affiliation(s)
- Tim Dare
- Department of Philosophy, The University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand.
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26
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Linch DC, Yung L, Smith P, Maclennan K, Jack A, Hancock B, Cunningham D, Hoskin P, Qian W, Holte H, Boesen AM, Grigg A, Browett P, Trneny M. Final analysis of the UKLG LY02 trial comparing 6-8 cycles of CHOP with 3 cycles of CHOP followed by a BEAM autograft in patients <65 years with poor prognosis histologically aggressive NHL. Br J Haematol 2010; 149:237-43. [DOI: 10.1111/j.1365-2141.2010.08081.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Worthley DL, Ruszkiewicz A, Davies R, Moore S, Nivison-Smith I, Bik To L, Browett P, Western R, Durrant S, So J, Young GP, Mullighan CG, Bardy PG, Michael MZ. Human gastrointestinal neoplasia-associated myofibroblasts can develop from bone marrow-derived cells following allogeneic stem cell transplantation. Stem Cells 2009; 27:1463-8. [PMID: 19492298 DOI: 10.1002/stem.63] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study characterized the contribution of bone marrow-derived cells to human neoplasia and the perineoplastic stroma. The Australasian Bone Marrow Transplant Recipient Registry was used to identify solid organ neoplasia that developed in female recipients of male allogeneic stem cell transplants. Eighteen suitable cases were identified including several skin cancers, two gastric cancers, and one rectal adenoma. Light microscopy, fluorescence and chromogenic in situ hybridization, and immunohistochemistry were performed to determine the nature and origin of the neoplastic and stromal cells. In contrast to recent reports, donor-derived neoplastic cells were not detected. Bone marrow-derived neoplasia-associated myofibroblasts, however, were identified in the rectal adenoma and in a gastric cancer. Bone marrow-derived cells can generate myofibroblasts in the setting of human gastrointestinal neoplasia.
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Affiliation(s)
- Daniel L Worthley
- Royal Brisbane and Women's Hospital Foundation Clinical Research Centre, Queensland Institute of Medical Research, Brisbane, Australia.
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Van de Water N, Tan T, Chan G, Cole N, Browett P. A +8 (C→T) Mutation within the 5′ Untranslated Region of β-Globin Down-Regulates the mRNA Transcription. Hemoglobin 2009; 32:247-53. [DOI: 10.1080/03630260701798375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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O'Sullivan S, Horne A, Wattie D, Porteous F, Callon K, Gamble G, Ebeling P, Browett P, Grey A. Decreased bone turnover despite persistent secondary hyperparathyroidism during prolonged treatment with imatinib. J Clin Endocrinol Metab 2009; 94:1131-6. [PMID: 19174494 DOI: 10.1210/jc.2008-2324] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [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: 02/12/2023]
Abstract
CONTEXT The tyrosine kinase inhibitor imatinib mesylate has an established role in the management of a number of malignant and proliferative conditions. Cross-sectional and short-term prospective studies have demonstrated secondary hyperparathyroidism during imatinib therapy, and variable changes in markers of bone turnover. OBJECTIVE Our objective was to determine the biochemical and skeletal effects of imatinib during long-term therapy. DESIGN This was a 2-yr prospective study. SETTING The study was performed at an academic clinical research center. PATIENTS OR OTHER PARTICIPANTS Nine patients with bcr-abl positive chronic myeloid leukemia were included in the study. INTERVENTIONS Patients received Imatinib mesylate 400 mg/d. MAIN OUTCOME MEASURES Serum and urine biochemistry, markers of bone turnover, and bone mineral density were measured. RESULTS Participants developed mild secondary hyperparathyroidism, with significant decreases in serum calcium and phosphate (P < 0.05 and P < 0.0001 vs. baseline, respectively) and an increase in PTH (P < 0.0001 vs. baseline). Biochemical markers of bone turnover demonstrated a biphasic response, with an initial increase in markers of bone formation being followed by a decrease in markers of both formation and resorption. Bone density at the lumbar spine increased [mean (95% confidence interval) change from baseline 3.6% (1.6, 5.5); P = 0.003] as did that at the total body [1.4% (0.2, 2.5); P = 0.065], whereas that at the proximal femur did not change [-0.12% (-3.0, 2.7); P = 0.93]. Body weight and fat mass increased significantly (P < 0.0001 vs. baseline). CONCLUSIONS Long-term treatment with imatinib leads to persistent mild secondary hyperparathyroidism. Despite this, bone turnover is decreased, and bone density is stable or increased. Evaluation of the skeletal actions and safety of imatinib during longer-term therapy is warranted.
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Affiliation(s)
- Susannah O'Sullivan
- Department of Medicine, The University of Auckland, Private Bag, Auckland, New Zealand.
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30
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Carella AM, Bellei M, Brice P, Gisselbrecht C, Visani G, Colombat P, Fabbiano F, Donelli A, Luminari S, Feugier P, Browett P, Hagberg H, Federico M. High-dose therapy and autologous stem cell transplantation versus conventional therapy for patients with advanced Hodgkin's lymphoma responding to front-line therapy: long-term results. Haematologica 2008; 94:146-8. [PMID: 19001284 DOI: 10.3324/haematol.13484] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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31
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Woon ST, Ameratunga R, Croxson M, Taylor G, Neas K, Edkins E, Browett P, Gane E, Munn S. Follicular lymphoma in a X-linked lymphoproliferative syndrome carrier female. Scand J Immunol 2008; 68:153-8. [PMID: 18702745 DOI: 10.1111/j.1365-3083.2008.02128.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
X-linked lymphoproliferative (XLP) syndrome is a rare primary immune-deficiency disorder caused by mutations of the SH2D1A or XIAP genes. Males with the disorder are usually in good health until contracting Epstein-Barr virus (EBV) whereupon the majority of patients die from fulminant infectious mononucleosis, lymphoma or hypogammaglobulinaemia. This report describes a female carrier with an XLP phenotype who was retrospectively identified after her grandson died from the disorder. Subsequent genetic testing identified the patient's mother and affected maternal grandmother as XLP carriers. The family's medical records were significant. The proband had lymphoma at ages 2 and 8 and made a full recovery following treatment. Both the maternal grandmother and uncle died of non-Hodgkin's lymphoma. We were concerned that the XLP carrier mother may be predisposed to lymphoma if the normal X chromosome is skewed towards inactivation. The human androgen receptor assay detected random X chromosome inactivation in the carrier mother. EBV was not detected in the lymphoma tissues of the proband and his grandmother, confirming previous findings that EBV is not always associated with lymphoma in XLP. More significantly, our study highlights the importance of identifying XLP in families with a high incidence of lymphoma.
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Affiliation(s)
- S-T Woon
- Department of Virology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
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O'Sullivan S, Naot D, Callon K, Porteous F, Horne A, Wattie D, Watson M, Cornish J, Browett P, Grey A. Imatinib promotes osteoblast differentiation by inhibiting PDGFR signaling and inhibits osteoclastogenesis by both direct and stromal cell-dependent mechanisms. J Bone Miner Res 2007; 22:1679-89. [PMID: 17663639 DOI: 10.1359/jbmr.070719] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [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: 01/08/2023]
Abstract
UNLABELLED Several lines of evidence suggest that imatinib may affect skeletal tissue. We show that inhibition by imatinib of PDGFR signaling in osteoblasts activates osteoblast differentiation and inhibits osteoblast proliferation and that imatinib inhibits osteoclastogenesis by both stromal cell-dependent and direct effects on osteoclast precursors. INTRODUCTION Imatinib mesylate, an orally active inhibitor of the c-abl, c-kit, and platelet-derived growth factor receptor (PDGFR) tyrosine kinases, is in clinical use for the treatment of chronic myeloid leukemia (CML) and gastrointestinal stromal cell tumors. Interruption of both c-kit and c-abl signaling in mice induces osteopenia, suggesting that imatinib might have adverse effects on the skeleton. However, biochemical markers of bone formation increase in patients with CML starting imatinib therapy, whereas bone resorption is unchanged, despite secondary hyperparathyroidism. We assessed the actions of imatinib on bone cells in vitro to study the cellular and molecular mechanism(s) underlying the skeletal effects we observed in imatinib-treated patients. MATERIALS AND METHODS Osteoblast differentiation was assessed using a mineralization assay, proliferation by [(3)H]thymidine incorporation, and apoptosis by a TUNEL assay. Osteoclastogenesis was assessed using murine bone marrow cultures and RAW 264.7 cells. RT and multiplex PCR were performed on RNA prepared from human bone marrow samples, osteoblastic cells, and murine bone marrow cultures. Osteoprotegerin was measured by ELISA. RESULTS The molecular targets of imatinib are expressed in bone cells. In vitro, imatinib increases osteoblast differentiation and prevents PDGF-induced inhibition of this process. Imatinib inhibits proliferation of osteoblast-like cells induced by serum and PDGF. In murine bone marrow cultures, imatinib inhibits osteoclastogenesis stimulated by 1,25-dihydroxyvitamin D(3) and partially inhibits osteoclastogenesis induced by RANKL and macrophage-colony stimulating factor. Imatinib partially inhibited osteoclastogenesis in RANKL-stimulated RAW-264.7 cells. Treatment with imatinib increases the expression of osteoprotegerin in bone marrow from patients with CML and osteoblastic cells. CONCLUSIONS Taken together with recent in vivo data, these results suggest a role for the molecular targets of imatinib in bone cell function, that inhibition by imatinib of PDGFR signaling in osteoblasts activates bone formation, and that the antiresorptive actions of imatinib are mediated by both stromal cell-dependent and direct effects on osteoclast precursors.
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Mollee P, Arthur C, Hughes T, Januszewicz H, Grigg A, Bradstock K, Wolf M, Gibson J, Schwarer AP, Spencer A, Browett P, Hawkins T, Seldon M, Herrmann R, Watson A, Seymour JF, Martin N, Shina S, Low C, Wright S, Rodwell R, Coulston J, Morton J, Blacklock H, Taylor D, Taylor KM. Interferon-alpha-2b and oral cytarabine ocfosfate for newly diagnosed chronic myeloid leukaemia. Ann Oncol 2005; 15:1810-5. [PMID: 15550587 DOI: 10.1093/annonc/mdh468] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment with interferon and subcutaneous cytarabine produces superior cytogenetic responses in chronic myeloid leukaemia (CML) than treatment with interferon alone, but at the expense of greater toxicity. Cytarabine ocfosfate (YNK01) is an oral precursor of cytarabine that may overcome some of the inconvenience and toxicities associated with subcutaneous cytarabine administration. PATIENTS AND METHODS We studied the efficacy and tolerability of combination therapy with interferon-alpha-2b and YNK01 in patients with newly diagnosed, untreated CML. Forty patients were treated with interferon-alpha-2b (5 MU/m2/day) plus monthly courses of YNK01 (600 mg/day for 10 days) for 1 year. RESULTS The 6-month complete haematological response rate was 63% and the 1-year major cytogenetic response rate was 30%, with 10% of cytogenetic responses being complete. With a median follow-up of 57 months, the estimated 5-year overall survival was 86% (95% confidence interval 70% to 94%). Treatment tolerability was poor, with toxicity leading to discontinuation of one or both drugs in 60% of cases. The median daily dose of interferon alpha-2b was 7.75 MU and the median dose of YNK01 was 600 mg/day for each 10-day treatment cycle. CONCLUSIONS Interferon-alpha-2b and YNK01 produce cytogenetic responses comparable to those achieved with interferon-alpha-2b and parenteral cytarabine, although toxicity was excessive. Alternate dosing strategies may enhance the tolerability of YNK01.
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Affiliation(s)
- P Mollee
- Haematology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
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35
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36
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Sullivan M, Browett P, Patton N. Private umbilical cord blood banking: a biological insurance of dubious future benefit! N Z Med J 2005; 118:U1260. [PMID: 15682212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Michael Sullivan
- Children's Cancer Research Group, Christchurch School of Medicine and Health Sciences, University of Otago.
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37
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Van de Water N, Tan T, Ashton F, O'Grady A, Day T, Browett P, Ockelford P, Harper P. Mutations within the protein Z-dependent protease inhibitor gene are associated with venous thromboembolic disease: a new form of thrombophilia. Br J Haematol 2004; 127:190-4. [PMID: 15461625 DOI: 10.1111/j.1365-2141.2004.05189.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Protein Z-dependent protease inhibitor (ZPI) is a serpin that inhibits the activated coagulation factors X and XI. The precise physiological significance of ZPI in the control of haemostasis is unknown although a deficiency of ZPI may be predicted to alter this balance. The coding region of the ZPI gene was screened for mutations using denaturing high-performance liquid chromatography. 16 mutations/polymorphisms within the coding region of ZPI were identified including two mutations, which generated stop codons at residues R67 and W303. We observed nonsense mutations within the ZPI gene in 4.4% of thrombosis patients (n = 250) compared with 0.8% of controls (n = 250). The difference in distribution of stop codon mutations between thrombosis patients and controls was significant (P = 0.02) with an odds ratio of 5.7 (95% confidence interval, 1.25-26.0). Our results suggest an association between ZPI deficiency and venous thrombosis and we propose that ZPI deficiency is potentially a new form of thrombophilia.
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38
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Branford S, Rudzki Z, Parkinson I, Grigg A, Taylor K, Seymour JF, Durrant S, Browett P, Schwarer AP, Arthur C, Catalano J, Leahy MF, Filshie R, Bradstock K, Herrmann R, Joske D, Lynch K, Hughes T. Real-time quantitative PCR analysis can be used as a primary screen to identify patients with CML treated with imatinib who have BCR-ABL kinase domain mutations. Blood 2004; 104:2926-32. [PMID: 15256429 DOI: 10.1182/blood-2004-03-1134] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.1] [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: 11/20/2022] Open
Abstract
Mutations within the BCR-ABL kinase domain in imatinib-treated chronic myeloid leukemia (CML) are the main mechanism of acquired resistance. The early detection of mutations should provide clinical benefit by allowing early intervention. Quantitative polymerase chain reaction (RQ-PCR) results of BCR-ABL mRNA were correlated with mutation analysis in 214 patients treated with imatinib. We determined whether there was a difference in the incidence of mutations between the patients with a more than 2-fold rise in BCR-ABL and patients with stable or decreasing levels. Of the 56 patients with a more than 2-fold rise, 34 (61%) had detectable mutations (median rise, 3.0-fold; 25th-75th percentiles, 2.3-5.2). In 31 (91%) of these 34 patients, the mutation was present at the time of the rise and became detectable within 3 months in the remaining patients. Only 1 (0.6%) of 158 patients with stable or decreasing BCR-ABL levels had a detectable mutation, P less than .0001. Thus, a more than 2-fold rise identified 34 (97%) of 35 patients with a mutation. We conclude that a rise in BCR-ABL of more than 2-fold can be used as a primary indicator to test patients for BCR-ABL kinase domain mutations.
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MESH Headings
- Benzamides
- DNA Mutational Analysis/methods
- Drug Monitoring/methods
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Piperazines/therapeutic use
- Polymerase Chain Reaction/methods
- Predictive Value of Tests
- Protein Structure, Tertiary/genetics
- Pyrimidines/therapeutic use
- RNA, Messenger/blood
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Affiliation(s)
- Susan Branford
- Division of Molecular Pathology, Institute of Medical and Veterinary Science, Adelaide, Australia.
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39
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Chung F, Lu J, Palmer BD, Kestell P, Browett P, Baguley BC, Tingle M, Ching LM. Thalidomide Pharmacokinetics and Metabolite Formation in Mice, Rabbits, and Multiple Myeloma Patients. Clin Cancer Res 2004; 10:5949-56. [PMID: 15355928 DOI: 10.1158/1078-0432.ccr-04-0421] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [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: 11/16/2022]
Abstract
PURPOSE Thalidomide has a variety of biological effects that vary considerably according to the species tested. We sought to establish whether differences in pharmacokinetics could form a basis for the species-specific effects of thalidomide. EXPERIMENTAL DESIGN Mice and rabbits were administered thalidomide (2 mg/kg) p.o. or i.v., and plasma concentrations of thalidomide were measured after drug administration using high performance liquid chromotography. Plasma samples from five multiple myeloma patients over 24 hours after their first dose of thalidomide (200 mg) were similarly analyzed and all data were fitted to a one-compartment model. Metabolites of thalidomide in plasma were identified simultaneously using liquid chromatography-mass spectrometry. RESULTS Plasma concentration-time profiles for the individual patients were very similar to each other, but widely different pharmacokinetic properties were found between patients compared with those in mice or rabbits. Area under the concentration curve values for mice, rabbits, and multiple myeloma patients were 4, 8, and 81 micromol/L. hour, respectively, and corresponding elimination half-lives were 0.5, 2.2, and 7.3 hours, respectively. Large differences were also observed between the metabolite profiles from the three species. Hydrolysis products were detected for all species, and the proportion of hydroxylated metabolites was higher in mice than in rabbits and undetectable in patients. CONCLUSIONS Our results show major interspecies differences in the pharmacokinetics of thalidomide that are related to the altered degree of metabolism. We suggest that the interspecies differences in biological effects of thalidomide may be attributable, at least in part, to the differences in its metabolism and hence pharmacokinetics.
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Affiliation(s)
- Francisco Chung
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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40
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Branford S, Rudzki Z, Harper A, Grigg A, Taylor K, Durrant S, Arthur C, Browett P, Schwarer AP, Ma D, Seymour JF, Bradstock K, Joske D, Lynch K, Gathmann I, Hughes TP. Imatinib produces significantly superior molecular responses compared to interferon alfa plus cytarabine in patients with newly diagnosed chronic myeloid leukemia in chronic phase. Leukemia 2004; 17:2401-9. [PMID: 14523461 DOI: 10.1038/sj.leu.2403158] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [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: 01/13/2023]
Abstract
We analyzed molecular responses in 55 newly diagnosed chronic-phase chronic myeloid leukemia (CML) patients enrolled in a phase 3 study (the IRIS trial) comparing imatinib to interferon-alfa plus cytarabine (IFN+AraC). BCR-ABL/BCR% levels were measured by real-time quantitative RT-PCR and were significantly lower for the imatinib-treated patients at all time points up to 18 months, P<0.0001. The median levels for imatinib-treated patients continued to decrease and had not reached a plateau by 24 months. A total of 24 IFN+AraC-treated patients crossed over to imatinib. Once imatinib commenced, the median BCR-ABL/BCR% levels in these patients were not significantly different to those on first-line imatinib for the equivalent number of months. The incidence of progression in imatinib-treated patients, defined by hematologic, cytogenetic or quantitative PCR criteria, was significantly higher in the patients who failed to achieve a 1 log reduction by 3 months or a 2 log reduction by 6 months, P=0.002. A total of 49 patients were screened for BCR-ABL kinase domain mutations. Mutations were detected in two imatinib-treated patients who crossed over from IFN+AraC and both lost their imatinib response. In conclusion, first-line imatinib-treated patients had profound reductions in BCR-ABL/BCR%, which significantly exceeded those of IFN+AraC-treated patients and early measurements were predictive of subsequent response.
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MESH Headings
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Agents/administration & dosage
- Benzamides
- Bone Marrow/metabolism
- Cross-Over Studies
- Cytarabine/administration & dosage
- Cytogenetics
- DNA Mutational Analysis
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/chemistry
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Interferon-alpha/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Phosphotransferases/chemistry
- Phosphotransferases/genetics
- Piperazines/administration & dosage
- Prognosis
- Protein Structure, Tertiary
- Pyrimidines/administration & dosage
- Treatment Outcome
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Affiliation(s)
- S Branford
- Institute of Medical and Veterinary Science, Adelaide, South Australia
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Lu J, Palmer BD, Kestell P, Browett P, Baguley BC, Muller G, Ching LM. Thalidomide metabolites in mice and patients with multiple myeloma. Clin Cancer Res 2003; 9:1680-8. [PMID: 12738721] [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: 03/02/2023]
Abstract
PURPOSE This research examines the profile of metabolites of thalidomide that are formed in refractory multiple myeloma patients undergoing thalidomide therapy in comparison with those that are detected in healthy mice. EXPERIMENTAL DESIGN Urine or plasma samples from patients during thalidomide therapy (100-400 mg daily), or from mice treated i.p. (100 mg/kg) or p.o. with thalidomide (50 mg/kg) were analyzed using liquid chromatography-mass spectrometry. Metabolites in each of the peaks observed in the UV- and mass spectrometry-detected high-performance liquid chromatography traces were identified by comparison of retention times and spectra with those of authentic standards. RESULTS Plasma and urine samples from mice 4 h after treatment with thalidomide contained eight major metabolites formed by hydroxylation and/or hydrolysis of thalidomide. In contrast, urine samples from seven multiple myeloma patients at steady state levels of thalidomide therapy showed the presence of only three hydrolysis breakdown products and no hydroxylated metabolites. CONCLUSIONS Our results show that thalidomide metabolite profiles in multiple myeloma patients differ considerably from those in mice. The lack of measurable hydroxylated metabolites in urine and in 1 case plasma of these patients suggests that such metabolites are not responsible for the therapeutic effects of thalidomide in multiple myeloma. We suggest that thalidomide may act directly, down-regulating growth factors essential for multiple myeloma growth.
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Affiliation(s)
- Jun Lu
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
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Couban S, Simpson DR, Barnett MJ, Bredeson C, Hubesch L, Howson-Jan K, Shore TB, Walker IR, Browett P, Messner HA, Panzarella T, Lipton JH. A randomized multicenter comparison of bone marrow and peripheral blood in recipients of matched sibling allogeneic transplants for myeloid malignancies. Blood 2002; 100:1525-31. [PMID: 12176866 DOI: 10.1182/blood-2002-01-0048] [Citation(s) in RCA: 231] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cytokine-mobilized peripheral blood is increasingly used instead of bone marrow as the source of cells for allogeneic transplantation. Although cells lead to faster hematologic recovery, their effects on graft-versus-host disease, relapse, and survival are less certain. Between January 1996 and February 2000, 228 patients with chronic myeloid leukemia, acute myeloid leukemia, or myelodysplasia were randomized to receive either bone marrow or peripheral blood allografts from HLA-matched siblings. All patients received busulfan and cyclophosphamide as conditioning chemotherapy and cyclosporine and methotrexate as graft-versus-host disease prophylaxis. We compared the times to neutrophil and platelet recovery, acute and chronic graft-versus-host disease, relapse, and overall survival between the groups. The median times to neutrophil recovery were 19 days and 23 days and the times to platelet recovery were 16 days and 22 days in the peripheral blood and bone marrow groups, respectively (P <.0001 for both comparisons). The cumulative incidence of grades II to IV acute graft-versus-host disease 100 days after transplantation was 44% in both groups (hazard ratio, 0.99; 95% confidence interval, 0.66-1.49; P >.9), and the incidence of extensive chronic graft-versus-host disease at 30 months after transplantation was 40% with peripheral blood and 30% with bone marrow (hazard ratio, 1.23; 95% confidence interval, 0.78-1.96; P =.37). There was no statistically significant difference in the probability of relapse of the underlying disease between the groups. The probabilities of survival at 30 months after transplantation were 68% and 60% in the peripheral blood and bone marrow groups, respectively (hazard ratio, 0.62; 95% confidence interval, 0.39-0.97; P =.04). In patients with chronic myeloid leukemia, acute myeloid leukemia, and myelodysplasia undergoing allogeneic transplantation from matched siblings, the use of peripheral blood instead of bone marrow leads to faster hematologic recovery, similar risk of graft-versus-host disease, and improved survival.
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Affiliation(s)
- Stephen Couban
- Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
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Van de Water N, Williams R, Ockelford P, Browett P. A 20.7 kb deletion within the factor VIII gene associated with LINE-1 element insertion. Thromb Haemost 1998; 79:938-42. [PMID: 9609225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Large deletions within the factor VIII gene account for approximately 5% of the mutations causing haemophilia A. The characterization of such mutations can provide insights into the molecular mechanisms of these and other deletions in man. We have analyzed a 20.7 kb deletion spanning exons 15 to 20 within the factor VIII gene in a patient with severe haemophilia A. Long range PCR was used to investigate the extent of the deletion and to provide a template for sequencing across the deletion breakpoint. A 38-base insertion homologous to the 3' region of a LINE-1 (L1) element was detected at the breakpoint of the deletion. Normal sequence at the 5' breakpoint in intron 14 was homologous to an L1 flanking region and normal sequence at the 3' breakpoint in intron 20 was homologous to an adjacent sequence within the same L1 flanking region. A molecular mechanism for the deletion involving retrotransposition of a readthrough product of an L1 element plus its 3' flanking region is suggested.
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Affiliation(s)
- N Van de Water
- Department of Haematology, Auckland Hospital, University of Auckland, New Zealand.
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Broady R, Hawkins T, Browett P, Palmer S. Successful allogeneic bone marrow transplant for chronic myeloid leukaemia despite previous interferon-induced cardiomyopathy. Bone Marrow Transplant 1998; 21:833-4. [PMID: 9603410 DOI: 10.1038/sj.bmt.1701188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/07/2023]
Abstract
We report a patient with CML who developed a reversible dilated cardiomyopathy with cardiac failure following 10 months of IFN therapy. Despite the previous cardiomyopathy, he tolerated subsequent allogeneic BMT without any adverse cardiac events. Reversible IFN-induced cardiomyopathy should not be considered a contraindication to bone marrow transplantation.
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Affiliation(s)
- R Broady
- Haematology Department, Auckland Hospital, New Zealand
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Van de Water N, Williams R, Dare A, Abbott W, Browett P. The prevalence of factor V Leiden (Gln506) in Polynesians. Thromb Haemost 1997; 78:962-3. [PMID: 9268206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Affiliation(s)
- L Delany
- School of Law, Manchester Metropolitan University
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