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Reikvam H, Dillon R. Revisiting the role of measurable residual disease in FLT3 mutated acute myelogenous leukemia. Expert Rev Hematol 2024:1-4. [PMID: 38654593 DOI: 10.1080/17474086.2024.2347303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Håkon Reikvam
- K.G. Jebsen Center for Myeloid Blood Cancer, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Tiong IS, Hiwase DK, Abro E, Bajel A, Palfreyman E, Beligaswatte A, Reynolds J, Anstee N, Nguyen T, Loo S, Chua CC, Ashby M, Wiltshire KM, Fleming S, Fong CY, Teh TC, Blombery P, Dillon R, Ivey A, Wei AH. Targeting Molecular Measurable Residual Disease and Low-Blast Relapse in AML With Venetoclax and Low-Dose Cytarabine: A Prospective Phase II Study (VALDAC). J Clin Oncol 2024:JCO2301599. [PMID: 38427924 DOI: 10.1200/jco.23.01599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/21/2023] [Accepted: 12/18/2023] [Indexed: 03/03/2024] Open
Abstract
PURPOSE A prospective phase II study examined the safety and efficacy of venetoclax combined with low-dose cytarabine (LDAC) in AML at first measurable residual disease (MRD) or oligoblastic relapse. METHODS Patients with either MRD (≥1 log10 rise) or oligoblastic relapse (blasts 5%-15%) received venetoclax 600 mg once daily D1-28 plus LDAC once daily D1-10 in 28-day cycles. The primary objective was MRD response in the MRD relapse cohort or complete remission (CR/CRh/CRi) in the oligoblastic relapse cohort. RESULTS Forty-eight adults with either MRD (n = 26) or oligoblastic (n = 22) relapse were enrolled. Median age was 67 years (range, 18-80) and 94% had received previous intensive chemotherapy. Patients received a median of four cycles of therapy; 17% completed ≥12 cycles. Patients with oligoblastic relapse had more grade ≥3 anemia (32% v 4%; P = .02) and infections (36% v 8%; P = .03), whereas grade 4 neutropenia (32 v 23%) or thrombocytopenia (27 v 15%) were comparable with the MRD relapse cohort. Markers of molecular MRD relapse included mutant NPM1 (77%), CBFB::MYH11 (4%), RUNX1::RUNX1T1 (4%), or KMT2A::MLLT3 (4%). Three patients with a log10 rise in IDH1/2 (12%) were included. By cycle 2 in the MRD relapse cohort, a log10 reduction in MRD was observed in 69%; 46% achieved MRD negative remission. In the oligoblastic relapse cohort, 73% achieved CR/CRh/CRi. Overall, 21 (44%) underwent hematopoietic cell transplantation. Median overall survival (OS) was not reached in either cohort. Estimated 2-year OS rate was 67% (95% CI, 50 to 89) in the MRD and 53% (95% CI, 34 to 84) in the oligoblastic relapse cohorts. CONCLUSION For AML in first remission and either MRD or oligoblastic relapse, venetoclax plus LDAC is well tolerated and highly effective.
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Affiliation(s)
- Ing Soo Tiong
- The Alfred Hospital and Monash University, Melbourne, Australia
- Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Devendra K Hiwase
- Royal Adelaide Hospital, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Emad Abro
- Princess Alexandra Hospital, Queensland, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
| | | | - Ashanka Beligaswatte
- University of Adelaide, Adelaide, Australia
- Flinders Medical Centre, Bedford Park, Australia
| | - John Reynolds
- The Alfred Hospital and Monash University, Melbourne, Australia
| | - Natasha Anstee
- The University of Melbourne, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Tamia Nguyen
- Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
| | - Sun Loo
- Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- The Northern Hospital, Melbourne, Australia
| | - Chong Chyn Chua
- The Alfred Hospital and Monash University, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- The Northern Hospital, Melbourne, Australia
| | - Michael Ashby
- The Alfred Hospital and Monash University, Melbourne, Australia
| | | | - Shaun Fleming
- The Alfred Hospital and Monash University, Melbourne, Australia
| | - Chun Y Fong
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, Australia
| | - Tse-Chieh Teh
- The Alfred Hospital and Monash University, Melbourne, Australia
- Box Hill Hospital, Melbourne, Australia
| | - Piers Blombery
- Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Guy's Hospital, London, United Kingdom
| | - Adam Ivey
- The Alfred Hospital and Monash University, Melbourne, Australia
| | - Andrew H Wei
- Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
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3
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Othman J, Tiong IS, O'Nions J, Dennis M, Mokretar K, Ivey A, Austin M, Latif AL, Amer M, Chan WY, Crawley C, Crolla F, Cross J, Dang R, Elliot J, Fong CY, Galli S, Gallipoli P, Hogan F, Kalkur P, Khan A, Krishnamurthy P, Laurie J, Loo S, Marshall S, Mehta P, Murthy V, Nagumantry S, Pillai S, Potter N, Sellar R, Taylor T, Zhao R, Russell NH, Wei AH, Dillon R. Molecular MRD is strongly prognostic in patients with NPM1-mutated AML receiving venetoclax-based nonintensive therapy. Blood 2024; 143:336-341. [PMID: 37647641 DOI: 10.1182/blood.2023021579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023] Open
Abstract
ABSTRACT Assessment of measurable residual disease (MRD) by quantitative reverse transcription polymerase chain reaction is strongly prognostic in patients with NPM1-mutated acute myeloid leukemia (AML) treated with intensive chemotherapy; however, there are no data regarding its utility in venetoclax-based nonintensive therapy, despite high efficacy in this genotype. We analyzed the prognostic impact of NPM1 MRD in an international real-world cohort of 76 previously untreated patients with NPM1-mutated AML who achieved complete remission (CR)/CR with incomplete hematological recovery following treatment with venetoclax and hypomethylating agents (HMAs) or low-dose cytarabine (LDAC). A total of 44 patients (58%) achieved bone marrow (BM) MRD negativity, and a further 14 (18%) achieved a reduction of ≥4 log10 from baseline as their best response, with no difference between HMAs and LDAC. The cumulative rates of BM MRD negativity by the end of cycles 2, 4, and 6 were 25%, 47%, and 50%, respectively. Patients achieving BM MRD negativity by the end of cycle 4 had 2-year overall of 84% compared with 46% if MRD was positive. On multivariable analyses, MRD negativity was the strongest prognostic factor. A total of 22 patients electively stopped therapy in BM MRD-negative remission after a median of 8 cycles, with 2-year treatment-free remission of 88%. In patients with NPM1-mutated AML attaining remission with venetoclax combination therapies, NPM1 MRD provides valuable prognostic information.
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Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ing S Tiong
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Alfred Hospital and Monash University, Melbourne, Australia
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, Australia
| | - Jenny O'Nions
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Adam Ivey
- Alfred Hospital and Monash University, Melbourne, Australia
| | - Michael Austin
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Anne-Louise Latif
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mariam Amer
- Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Wei Yee Chan
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Charles Crawley
- Department of Haematology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - Joe Cross
- Haematology Department, University Hospital Bristol, Bristol, United Kingdom
| | - Ray Dang
- James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Chun Y Fong
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, Australia
| | - Sofia Galli
- Frimley Park Hospital, London, United Kingdom
| | - Paolo Gallipoli
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Anjum Khan
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | | | | | - Sun Loo
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Scott Marshall
- City Hospitals Sunderland NHS Trust, Sunderland, United Kingdom
| | - Priyanka Mehta
- Haematology Department, University Hospital Bristol, Bristol, United Kingdom
| | - Vidhya Murthy
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | | | - Srinivas Pillai
- Royal Stoke University Hospital, University Hospital of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Rob Sellar
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Tom Taylor
- Nottingham University Hospital, Nottingham, United Kingdom
| | - Rui Zhao
- Torbay Hospital, Torquay, United Kingdom
| | - Nigel H Russell
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew H Wei
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Jimenez-Chillon C, Othman J, Taussig D, Jimenez-Vicente C, Martinez-Roca A, Tiong IS, Jain M, Aries J, Cakmak S, Knapper S, Kristensen DT, Murthy V, Galani JZ, Kallmeyer C, Ngu L, Veale D, Bolam S, Orfali N, Parker A, Manson C, Parker J, Erblich T, Richardson D, Mokretar K, Potter N, Overgaard UM, Roug AS, Wei AH, Esteve J, Jädersten M, Russell N, Dillon R. Venetoclax-based low intensity therapy in molecular failure of NPM1-mutated AML. Blood Adv 2024; 8:343-352. [PMID: 38039513 PMCID: PMC10788851 DOI: 10.1182/bloodadvances.2023011106] [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: 06/30/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
ABSTRACT Molecular failure in NPM1-mutated acute myeloid leukemia (AML) inevitably progresses to frank relapse if untreated. Recently published small case series show that venetoclax combined with low-dose cytarabine or azacitidine can reduce or eliminate measurable residual disease (MRD). Here, we report on an international multicenter cohort of 79 patients treated for molecular failure with venetoclax combinations and report an overall molecular response (≥1-log reduction in MRD) in 66 patients (84%) and MRD negativity in 56 (71%). Eighteen of 79 patients (23%) required hospitalization, and no deaths were reported during treatment. Forty-one patients were bridged to allogeneic transplant with no further therapy, and 25 of 41 were MRD negative assessed by reverse transcription quantitative polymerase chain reaction before transplant. Overall survival (OS) for the whole cohort at 2 years was 67%, event-free survival (EFS) was 45%, and in responding patients, there was no difference in survival in those who received a transplant using time-dependent analysis. Presence of FLT3-ITD mutation was associated with a lower response rate (64 vs 91%; P < .01), worse OS (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.06-5.86; P = .036), and EFS (HR, 1.87; 95% CI, 1.06-3.28; P = .03). Eighteen of 35 patients who did not undergo transplant became MRD negative and stopped treatment after a median of 10 months, with 2-year molecular relapse free survival of 62% from the end of treatment. Venetoclax-based low intensive chemotherapy is a potentially effective treatment for molecular relapse in NPM1-mutated AML, either as a bridge to transplant or as definitive therapy.
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Affiliation(s)
- Carlos Jimenez-Chillon
- Servicio de Hematología y Hemoterapia, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
| | - Jad Othman
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
- Guy’s and St Thomas Hospital, London, United Kingdom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David Taussig
- Department of Haematology, Royal Marsden Hospital, Sutton, United Kingdom
| | | | - Alexandra Martinez-Roca
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ing Soo Tiong
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, VIC, Australia
| | - Manish Jain
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - James Aries
- Department of Haemato-Oncology, St Bartholomew’s Hospital, London, United Kingdom
| | - Seda Cakmak
- Department of Haemato-Oncology, St Bartholomew’s Hospital, London, United Kingdom
| | - Steven Knapper
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Daniel Tuyet Kristensen
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Vidhya Murthy
- Department of Haematology, University Hospitals of Birmingham, Birmingham, United Kingdom
| | | | | | - Loretta Ngu
- Department of Haematology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - David Veale
- Department of Haematology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Simon Bolam
- Department of Haematology, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Nina Orfali
- Department of Haematology, St. James's Hospital, Dublin, Ireland
| | - Anne Parker
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Cara Manson
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jane Parker
- Department of Haematology, Northampton General Hospital, Northampton, United Kingdom
| | - Thomas Erblich
- Department of Haematology, The London Clinic, London, United Kingdom
| | - Deborah Richardson
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | | | - Nicola Potter
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
| | - Ulrik Malthe Overgaard
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
- Department of Haematology, National Hospital, Copenhagen, Denmark
| | - Anne Stidsholt Roug
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew H. Wei
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jordi Esteve
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Martin Jädersten
- Department of Medicine, Center for Haematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Nigel Russell
- Guy’s and St Thomas Hospital, London, United Kingdom
| | - Richard Dillon
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
- Guy’s and St Thomas Hospital, London, United Kingdom
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Russell NH, Wilhelm-Benartzi C, Othman J, Dillon R, Knapper S, Batten LM, Canham J, Hinson EL, Betteridge S, Overgaard UM, Gilkes A, Potter N, Mehta P, Kottaridis P, Cavenagh J, Hemmaway C, Arnold C, Freeman SD, Dennis M. Fludarabine, Cytarabine, Granulocyte Colony-Stimulating Factor, and Idarubicin With Gemtuzumab Ozogamicin Improves Event-Free Survival in Younger Patients With Newly Diagnosed AML and Overall Survival in Patients With NPM1 and FLT3 Mutations. J Clin Oncol 2024:JCO2300943. [PMID: 38215358 DOI: 10.1200/jco.23.00943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/07/2023] [Accepted: 10/20/2023] [Indexed: 01/14/2024] Open
Abstract
PURPOSE To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. PATIENTS AND METHODS One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). RESULTS There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. CONCLUSION Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit.
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Affiliation(s)
- Nigel H Russell
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Jad Othman
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Leona M Batten
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Joanna Canham
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Emily L Hinson
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | - Sophie Betteridge
- Centre for Trials Research, Cardiff University, Cardiff, United Kindgom
| | | | - Amanda Gilkes
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Priyanka Mehta
- University Hospitals of Bristol and Weston NHS Trust, Bristol, United Kingdom
| | | | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Falini B, Dillon R. Criteria for Diagnosis and Molecular Monitoring of NPM1-Mutated AML. Blood Cancer Discov 2024; 5:8-20. [PMID: 37917833 PMCID: PMC10772525 DOI: 10.1158/2643-3230.bcd-23-0144] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/28/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
NPM1-mutated acute myeloid leukemia (AML) represents the largest molecular subgroup of adult AML. NPM1-mutated AML is recognizable by molecular techniques and immunohistochemistry, which, when combined, can solve difficult diagnostic problems (including identification of myeloid sarcoma and NPM1 mutations outside exon 12). According to updated 2022 European LeukemiaNet (ELN) guidelines, determining the mutational status of NPM1 (and FLT3) is a mandatory step for the genetic-based risk stratification of AML. Monitoring of measurable residual disease (MRD) by qRT-PCR, combined with ELN risk stratification, can guide therapeutic decisions at the post-remission stage. Here, we review the criteria for appropriate diagnosis and molecular monitoring of NPM1-mutated AML. SIGNIFICANCE NPM1-mutated AML represents a distinct entity in the 2022 International Consensus Classification and 5th edition of World Health Organization classifications of myeloid neoplasms. The correct diagnosis of NPM1-mutated AML and its distinction from other AML entities is extremely important because it has clinical implications for the management of AML patients, such as genetic-based risk stratification according to 2022 ELN. Monitoring of MRD by qRT-PCR, combined with ELN risk stratification, can guide therapeutic decisions at the post-remission stage, e.g., whether or not to perform allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncological Research (CREO), University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
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Ravandi F, Cloos J, Buccisano F, Dillon R, Döhner K, Freeman SD, Hourigan CS, Ossenkoppele GJ, Roboz GJ, Subklewe M, Thiede C, Arnhardt I, Valk PJM, Venditti A, Wei AH, Walter RB, Heuser M. Measurable residual disease monitoring in patients with acute myeloid leukemia treated with lower-intensity therapy: Roadmap from an ELN-DAVID expert panel. Am J Hematol 2023; 98:1847-1855. [PMID: 37671649 PMCID: PMC10841357 DOI: 10.1002/ajh.27087] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
With the availability of effective targeted agents, significant changes have occurred in the management of patients with acute myeloid leukemia (AML) over the past several years, particularly for those considered unfit for intensive chemotherapy. While testing for measurable residual disease (MRD) is now routinely performed in patients treated with intensive chemotherapy to refine prognosis and, possibly, inform treatment decision-making, its value in the context of lower-intensity regimens is unclear. As such regimens have gained in popularity and can be associated with higher response rates, the need to better define the role of MRD assessment and the appropriate time points and assays used for this purpose has increased. This report outlines a roadmap for MRD testing in patients with AML treated with lower-intensity regimens. Experts from the European LeukemiaNet (ELN)-DAVID AML MRD working group reviewed all available data to propose a framework for MRD testing in future trials and clinical practice. A Delphi poll served to optimize consensus. Establishment of uniform standards for MRD assessments in lower-intensity regimens used in treating patients with AML is clinically relevant and important for optimizing testing and, ultimately, improving treatment outcomes of these patients.
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Affiliation(s)
- Farhad Ravandi
- Department of Leukemia, The University of Texas - MD Anderson Cancer Center, Houston
| | - Jacqueline Cloos
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Francesco Buccisano
- Department of Biomedicine and Prevention, Hematology, University Tor Vergata, Rome, Italy
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancy, Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda
| | - Gerrit J Ossenkoppele
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gail J Roboz
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York
| | - Marion Subklewe
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Germany
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Isabell Arnhardt
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Peter J M Valk
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adriano Venditti
- Department of Biomedicine and Prevention, Hematology, University Tor Vergata, Rome, Italy
| | - Andrew H Wei
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Roland B Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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8
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Jimenez-Chillon C, Dillon R, Russell N. Optimal Post-Remission Consolidation Therapy in Patients with AML. Acta Haematol 2023; 147:147-158. [PMID: 38008085 PMCID: PMC10997264 DOI: 10.1159/000535457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Despite recent advances, 40-85% of patients with acute myeloid leukaemia (AML) achieve complete remission after intensive chemotherapy. However, without optimal treatment after remission, the risk of relapse remains high. SUMMARY A variable number of consolidation cycles consisting of intermediate doses of cytarabine are the most commonly used regimens in low-intermediate-risk AML, while patients at higher risk of relapse should consolidate response by proceeding to HSCT. Different post-consolidation (maintenance therapies) have demonstrated their benefit in prolonging relapse-free survival, and others are still under investigation. Careful consideration should be given to which patients benefit most from each of these interventions, considering that the risk of relapse is dynamic. KEY MESSAGES Patients consolidated with chemotherapy should receive either 2 courses of HDAC or no more than 3-4 cycles of IDAC with dose reduction in patients over 60 years. Patients with mutated FLT3 AML benefit from post-consolidation maintenance with FLT3 inhibitors, and selected patients not fit for adequate consolidation may benefit from CC-468 maintenance. Patients at higher risk of relapse should proceed to allogeneic SCT as soon as possible, opting for a more intensive conditioning in patients younger than 55 years. However, autologous HSCT may still have role in favourable-risk MRD-negative AML. Multiple treatment options targeting MRD are emerging, either as definitive treatment or as a bridge to allogeneic transplantation, and are likely to become increasingly relevant.
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Affiliation(s)
- Carlos Jimenez-Chillon
- Servicio de Hematologia y Hemoterapia, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Medical and Molecular Genetics, King’s College, London, UK
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King’s College, London, UK
- Guy’s and St Thomas Hospital, London, UK
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9
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Othman J, Potter N, Mokretar K, Taussig D, Khan A, Krishnamurthy P, Latif AL, Cahalin P, Aries J, Amer M, Belsham E, Conneally E, Craddock C, Culligan D, Dennis M, Duncan C, Freeman SD, Furness C, Gilkes A, Gkreka P, Hodgson K, Ingram W, Jain M, King A, Knapper S, Kottaridis P, McMullin MF, Mohite U, Ngu L, O'Nions J, Patrick K, Rider T, Roberts W, Severinsen MT, Storrar N, Taylor T, Russell NH, Dillon R. FLT3 inhibitors as MRD-guided salvage treatment for molecular failure in FLT3 mutated AML. Leukemia 2023; 37:2066-2072. [PMID: 37558736 PMCID: PMC10539160 DOI: 10.1038/s41375-023-01994-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
Patients with FLT3-mutated AML have a high relapse rate and suboptimal outcomes. Many have co-mutations suitable for measurable residual disease (MRD) monitoring by RT-qPCR and those destined to relapse can be identified by high or rising levels of MRD, called molecular failure. This provides a window for pre-emptive intervention, but there is little evidence to guide treatment. The use of FLT3 inhibitors (FLT3i) appears attractive but their use has not yet been evaluated. We identified 56 patients treated with FLT3i at molecular failure. The FLT3 mutation was an ITD in 52, TKD in 7 and both in 3. Over half of patients had previously received midostaurin. Molecular failure occurred at a median 9.2 months from diagnosis and was treated with gilteritinib (n = 38), quizartinib (n = 7) or sorafenib (n = 11). 60% achieved a molecular response, with 45% reaching MRD negativity. Haematological toxicity was low, and 22 patients were bridged directly to allogeneic transplant with another 6 to donor lymphocyte infusion. 2-year overall survival was 80% (95%CI 69-93) and molecular event-free survival 56% (95%CI 44-72). High-sensitivity next-generation sequencing for FLT3-ITD at molecular failure identified patients more likely to benefit. FLT3i monotherapy for molecular failure is a promising strategy which merits evaluation in prospective studies.
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Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, King's College London, London, England, UK
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College London, London, England, UK
| | | | - David Taussig
- The Royal Marsden NHS Foundation Trust, London, England, UK
| | - Anjum Khan
- Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | | | | | - Paul Cahalin
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, England, UK
| | - James Aries
- Barts Cancer Institute, Queen Mary University of London, London, England, UK
| | - Mariam Amer
- University Hospital Southampton, Southampton, England, UK
| | | | | | | | | | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, England, UK
| | | | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Scotland, UK
| | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, Wales, UK
| | | | | | | | - Manish Jain
- Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | - Andrew King
- Addenbrooke's Hospital, Cambridge, England, UK
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, Wales, UK
| | | | | | | | - Loretta Ngu
- Royal Devon & Exeter NHS Foundation Trust, Exeter, England, UK
| | - Jenny O'Nions
- University College London Hospital NHS Foundation Trust, London, England, UK
| | | | - Tom Rider
- The Royal Sussex County Hospital, Brighton and Hove, England, UK
| | - Wing Roberts
- Great North Children's Hospital, Newcastle upon Tyne, England, UK
| | - Marianne Tang Severinsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tom Taylor
- Nottingham University Hospital, Nottingham, England, UK
| | - Nigel H Russell
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, London, England, UK.
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK.
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10
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Shallis RM, Daver N, Altman JK, Komrokji RS, Pollyea DA, Badar T, Bewersdorf JP, Bhatt VR, de Botton S, de la Fuente Burguera A, Carraway HE, Desai P, Dillon R, Duployez N, El Chaer F, Fathi AT, Freeman SD, Gojo I, Grunwald MR, Jonas BA, Konopleva M, Lin TL, Mannis GN, Mascarenhas J, Michaelis LC, Mims AS, Montesinos P, Pozdnyakova O, Pratz KW, Schuh AC, Sekeres MA, Smith CC, Stahl M, Subklewe M, Uy GL, Voso MT, Walter RB, Wang ES, Zeidner JF, Žučenka A, Zeidan AM. Standardising acute myeloid leukaemia classification systems: a perspective from a panel of international experts. Lancet Haematol 2023; 10:e767-e776. [PMID: 37572683 DOI: 10.1016/s2352-3026(23)00159-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/23/2023] [Accepted: 05/19/2023] [Indexed: 08/14/2023]
Abstract
The existence of two acute myeloid leukaemia classification systems-one put forth by WHO and one by the International Consensus Classification in 2022-is concerning. Although both systems appropriately move towards genomic disease definitions and reduced emphasis on blast enumeration, there are consequential disagreements between the two systems on what constitutes a diagnosis of acute myeloid leukaemia. This fundamental problem threatens the ability of heath-care providers to diagnose acute myeloid leukaemia, communicate with patients and other health-care providers, and deliver appropriate and consistent management strategies for patients with the condition. Clinical trial eligibility, standardised response assessments, and eventual drug development and regulatory pathways might also be negatively affected by the discrepancies. In this Viewpoint, we review the merits and limitations of both classification systems and illustrate how the coexistence, as well as application of both systems is an undue challenge to patients, clinicians, hematopathologists, sponsors of research, and regulators. Lastly, we emphasise the urgency and propose a roadmap, by which the two divergent classification systems can be harmonised.
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Affiliation(s)
- Rory M Shallis
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Naval Daver
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica K Altman
- Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rami S Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel A Pollyea
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Talha Badar
- Division of Hematology & Medical Oncology, Mayo Clinic Cancer Center, Jacksonville, FL, USA
| | - Jan P Bewersdorf
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vijaya R Bhatt
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Hetty E Carraway
- Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pinkal Desai
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, UK
| | - Nicolas Duployez
- Laboratory of Hematology, Centre Hospitalier Universitaire Lille, Lille, France
| | - Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Amir T Fathi
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Ivana Gojo
- Division of Hematologic Malignancies, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Brian A Jonas
- Department of Internal Medicine, Division of Malignant Hematology, Cellular Therapy and Transplantation, University of California Davis, Davis, CA, USA
| | - Marina Konopleva
- Montefiore Einstein Cancer Center & Albert Einstein College of Medicine, New York, NY, USA
| | - Tara L Lin
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Gabriel N Mannis
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura C Michaelis
- Division of Hematology and Oncology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alice S Mims
- Division of Hematology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Pau Montesinos
- Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | - Olga Pozdnyakova
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Keith W Pratz
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andre C Schuh
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mikkael A Sekeres
- Division of Hematology, Sylvester Cancer Center, University of Miami, Miami, FL, USA
| | - Catherine C Smith
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Maximilian Stahl
- Leukemia Division, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marion Subklewe
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Geoffrey L Uy
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, Tor Vergata University, and Neuro-Oncohematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Rome, Italy
| | - Roland B Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Eunice S Wang
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Joshua F Zeidner
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Andrius Žučenka
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania and Institute of Clinical Medicine, Vilnius, Lithuania
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA.
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11
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Othman J, Wilhelm-Benartzi C, Dillon R, Knapper S, Freeman SD, Batten LM, Canham J, Hinson EL, Wych J, Betteridge S, Villiers W, Kleeman M, Gilkes A, Potter N, Overgaard UM, Mehta P, Kottaridis P, Cavenagh J, Hemmaway C, Arnold C, Dennis M, Russell NH. A randomized comparison of CPX-351 and FLAG-Ida in adverse karyotype AML and high-risk MDS: the UK NCRI AML19 trial. Blood Adv 2023; 7:4539-4549. [PMID: 37171402 PMCID: PMC10425682 DOI: 10.1182/bloodadvances.2023010276] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
Liposomal daunorubicin and cytarabine (CPX-351) improved overall survival (OS) compared with 7+3 chemotherapy in older patients with secondary acute myeloid leukemia (AML); to date, there have been no randomized studies in younger patients. The high-risk cohort of the UK NCRI AML19 trial (ISRCTN78449203) compared CPX-351 with FLAG-Ida in younger adults with newly diagnosed adverse cytogenetic AML or high-risk myelodysplastic syndromes (MDS). A total of 189 patients were randomized (median age, 56 years). Per clinical criteria, 49% of patients had de novo AML, 20% had secondary AML, and 30% had high-risk MDS. MDS-related cytogenetics were present in 73% of the patients, with a complex karyotype in 49%. TP53 was the most common mutated gene, in 43%. Myelodysplasia-related gene mutations were present in 75 (44%) patients. The overall response rate (CR + CRi) after course 2 was 64% and 76% for CPX-351 and FLAG-Ida, respectively. There was no difference in OS (13.3 months vs 11.4 months) or event-free survival in multivariable analysis. However, relapse-free survival was significantly longer with CPX-351 (median 22.1 vs 8.35 months). There was no difference between the treatment arms in patients with clinically defined secondary AML or those with MDS-related cytogenetic abnormalities; however, an exploratory subgroup of patients with MDS-related gene mutations had significantly longer OS with CPX-351 (median 38.4 vs 16.3 months). In conclusion, the OS of younger patients with adverse risk AML/MDS was not significantly different between CPX-351 and FLAG-Ida.
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Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Richard Dillon
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steve Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Leona M. Batten
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Joanna Canham
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Emily L. Hinson
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Julie Wych
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie Betteridge
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - William Villiers
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | - Michelle Kleeman
- Genomics Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Amanda Gilkes
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, University Hospitals of Bristol and Weston NHS Trust, Bristol, United Kingdom
| | | | - Jamie Cavenagh
- Department of Haemato-Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Claire Hemmaway
- Department of Haematology, Auckland Hospital, Auckland, New Zealand
| | - Claire Arnold
- Clinical Haematology, Belfast City Hospital, Belfast, Northern Ireland
| | - Mike Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nigel H. Russell
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - UK National Cancer Research Institute Acute Myeloid Leukaemia Working Group
- Department of Medical and Molecular Genetics, Kings College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
- School of Medicine, Cardiff University, Cardiff, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Genomics Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
- Copenhagen University Hospital, Copenhagen, Denmark
- Bristol Haematology and Oncology Centre, University Hospitals of Bristol and Weston NHS Trust, Bristol, United Kingdom
- Department of Haematology, University College Hospital, London, United Kingdom
- Department of Haemato-Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
- Department of Haematology, Auckland Hospital, Auckland, New Zealand
- Clinical Haematology, Belfast City Hospital, Belfast, Northern Ireland
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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12
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Borrill R, Poulton K, Kusyk L, Routledge A, Bonney D, Hanasoge-Nataraj R, Powys M, Mustafa O, Campbell H, Senthil S, Dillon R, Jovanovic J, Morton S, James B, Rao K, Stanworth S, Konkel J, Wynn R. Granulocyte transfusion during cord blood transplant for relapsed, refractory AML is associated with massive CD8 + T-cell expansion, significant cytokine release syndrome and induction of disease remission. Br J Haematol 2023; 202:589-598. [PMID: 37211883 DOI: 10.1111/bjh.18863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
In high-risk myeloid malignancy, relapse is reduced using cord blood transplant (CBT) but remains the principal cause of treatment failure. We previously described T-cell expansion in CBT recipients receiving granulocyte transfusions. We now report the safety and tolerability of such transfusions, T-cell expansion data, immunophenotype, cytokine profiles and clinical response in children with post-transplant relapsed acute leukaemia who received T-replete, HLA-mismatched CBT and pooled granulocytes within a phase I/II trial (ClinicalTrials.Gov NCT05425043). All patients received the transfusion schedule without significant clinical toxicity. Nine of ten patients treated had detectable measurable residual disease (MRD) pre-transplant. Nine patients achieved haematological remission, and eight became MRD negative. There were five deaths: transplant complications (n = 2), disease (n = 3), including two late relapses. Five patients are alive and in remission with 12.7 months median follow up. Significant T-cell expansion occurred in nine patients with a greater median lymphocyte count than a historical cohort between days 7-13 (median 1.73 × 109 /L vs. 0.1 × 109 /L; p < 0.0001). Expanded T-cells were predominantly CD8+ and effector memory or TEMRA phenotype. They exhibited markers of activation and cytotoxicity with interferon-gamma production. All patients developed grade 1-3 cytokine release syndrome (CRS) with elevated serum IL-6 and interferon-gamma.
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Affiliation(s)
- Roisin Borrill
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kay Poulton
- Transplantation Laboratory, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Laura Kusyk
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amy Routledge
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denise Bonney
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ramya Hanasoge-Nataraj
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Madeleine Powys
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Omima Mustafa
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Campbell
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Srividhya Senthil
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Dillon
- Department of Medical and Molecular Genetics, Kings College London, London, UK
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, Kings College London, London, UK
| | | | - Beki James
- Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK
| | - Kanchan Rao
- Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Joanne Konkel
- Lydia Becker Institute of Immunology and Inflammation, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Robert Wynn
- Blood and Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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13
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Scott S, Dillon R, Thiede C, Sadiq S, Cartwright A, Clouston HJ, Travis D, Mokretar K, Potter N, Chantry A, Whitby L. Assessment of acute myeloid leukemia molecular measurable residual disease testing in an interlaboratory study. Blood Adv 2023; 7:3686-3694. [PMID: 36939402 PMCID: PMC10368676 DOI: 10.1182/bloodadvances.2022009379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023] Open
Abstract
The European LeukaemiaNet (ELN) measurable residual disease (MRD) working group has published consensus guidelines to standardize molecular genetic MRD testing of the t(8;21)(q22;q22.1) RUNX1::RUNX1T1, inv(16)(p13.1q22) CBFB::MYH11, t(15;17)(q24.1;q21.2) PML::RARA, and NPM1 type A markers. A study featuring 29 international laboratories was performed to assess interlaboratory variation in testing and the subsequent interpretation of results, both crucial to patient safety. Most participants in this study were able to detect, accurately quantify, and correctly interpret MRD testing results, with a level of proficiency expected from a clinical trial or standard-of-care setting. However, a few testing and interpretive errors were identified that, in a patient setting, would have led to misclassification of patient outcomes and inappropriate treatment pathways being followed. Of note, a high proportion of participants reported false-positive results in the NPM1 marker-negative sample. False-positive results may have clinical consequences, committing patients to unneeded additional chemotherapy and/or transplant with the attendant risk of morbidity and mortality, which therefore highlights the need for ongoing external quality assessment/proficiency testing in this area. Most errors identified in the study were related to the interpretation of results. It was noted that the ELN guidance lacks clarity for certain clinical scenarios and highlights the requirement for urgent revision of the guidelines to elucidate these issues and related educational efforts around the revisions to ensure effective dissemination.
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Affiliation(s)
- Stuart Scott
- Laboratory Medicine, UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Richard Dillon
- Department of Haematology, Guy’s International Centre of Excellence in Myeloid Disorders, Guy’s and St. Thomas NHS Foundation Trust, London, United Kingdom
- Department of Medical & Molecular Genetics, King’s College, London, United Kingdom
| | - Christian Thiede
- Department of Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- AgenDix, Applied Molecular Diagnostics GmbH, Dresden, Germany
| | - Sadia Sadiq
- Laboratory Medicine, UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Ashley Cartwright
- Laboratory Medicine, UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Hazel J. Clouston
- Laboratory Medicine, UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Debbie Travis
- Laboratory Medicine, UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Katya Mokretar
- Cancer genetics, Guy’s Hospital, South East Genomics Laboratory Hub, Synnovis, London, United Kingdom
| | - Nicola Potter
- Department of Medical & Molecular Genetics, King’s College, London, United Kingdom
| | - Andrew Chantry
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Liam Whitby
- Laboratory Medicine, UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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14
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Loke J, McCarthy N, Jackson A, Siddique S, Hodgkinson A, Mason J, Crawley C, Gilleece M, Peniket A, Protheroe R, Salim R, Tholouli E, Wilson K, Andrew G, Dillon R, Khan N, Potter V, Krishnamurthy P, Craddock C, Freeman S. Posttransplant MRD and T-cell chimerism status predict outcomes in patients who received allografts for AML/MDS. Blood Adv 2023; 7:3666-3676. [PMID: 37058448 PMCID: PMC10365943 DOI: 10.1182/bloodadvances.2022009493] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
Allogeneic stem-cell transplant allows for the delivery of curative graft-versus-leukemia (GVL) in patients with acute myeloid leukemia/myelodysplasia (AML/MDS). Surveillance of T-cell chimerism, measurable residual disease (MRD) and blast HLA-DR expression may inform whether GVL effectiveness is reduced. We report here the prognostic impact of these biomarkers in patients allografted for AML/MDS. One hundred eighty-seven patients from FIGARO, a randomized trial of reduced-intensity conditioning regimens in AML/MDS, were alive and relapse-free at the first MRD time-point and provided monitoring samples for flow cytometric MRD and T-cell chimerism, requested to month+12. Twenty-nine (15.5%) patients had at least 1 MRD-positive result posttransplant. MRD-positivity was associated with reduced overall survival (OS) (hazard ratio [HR], 2.18; P = .0028) as a time-varying Cox variable and remained significant irrespective of pretransplant MRD status in multivariate analyses (P < .001). Ninety-four patients had sequential MRD with T-cell chimerism results at months+3/+6. Patients with full donor T-cell chimerism (FDTC) had an improved OS as compared with patients with mixed donor T-cell chimerism (MDTC) (adjusted HR=0.4; P = .0019). In patients with MDTC (month+3 or +6), MRD-positivity was associated with a decreased 2-year OS (34.3%) vs MRD-negativity (71.4%) (P = .001). In contrast, in the group with FDTC, MRD was infrequent and did not affect the outcome. Among patients with posttransplant MRD-positivity, decreased HLA-DR expression on blasts significantly reduced OS, supporting this as a mechanism for GVL escape. In conclusion, posttransplant MRD is an important predictor of the outcome in patients allografted for AML/MDS and is most informative when combined with T-cell chimerism results, underlining the importance of a GVL effect in AML/MDS.
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Affiliation(s)
- Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Shamyla Siddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Andrea Hodgkinson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - John Mason
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Rachel Protheroe
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Rahuman Salim
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | | | | - Georgia Andrew
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Naeem Khan
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sylvie Freeman
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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15
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Sriskandarajah P, McLornan DP, Oni C, Wilson AJ, Woodley C, Ciesielska M, Raj K, Dillon R, Ethell M, Chacko J, Orchard K, Radia DH. Advanced Systemic Mastocytosis with associated haematological neoplasm: Treatment with avapritinib can facilitate successful bridge to allogeneic haematopoietic cell transplant. Curr Res Transl Med 2023; 71:103398. [PMID: 37331225 DOI: 10.1016/j.retram.2023.103398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
Advanced systemic mastocytosis (AdvSM) is a rare, life-limiting mast cell (MC) neoplasm, with approximately 70% patients having an associated haematological neoplasm (AHN). Avapritinib, a selective tyrosine kinase inhibitor targeting KIT D816V, has shown potent activity translating clinically into durable responses in the phase 1 EXPLORER (NCT02561988) and phase 2 PATHFINDER (NCT03580655) studies. We report three patients with AdvSM-AHN on avapritinib who achieved complete remission (CR) of SM and were successfully bridged to allogeneic haematopoietic cell transplant (allo-HCT). Two cases additionally highlight the risk of clonal evolution within the AHN component and requirement for close monitoring while on targeted therapy.
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Affiliation(s)
- P Sriskandarajah
- Department of Haematology, Guy's and St Thomas' Hospital, London, United Kingdom.
| | - D P McLornan
- Department of Haematology, University College Hospital, London, United Kingdom
| | - C Oni
- Department of Haematology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - A J Wilson
- Department of Haematology, University College Hospital, London, United Kingdom
| | - C Woodley
- Department of Haematology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - M Ciesielska
- Haematology Research Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - K Raj
- Department of Haematology, University College Hospital, London, United Kingdom
| | - R Dillon
- Department of Haematology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - M Ethell
- Department of Haemato-Oncology, The Royal Marsden Hospital, Sutton, United Kingdom
| | - J Chacko
- Department of Haematology, The Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - K Orchard
- Department of Haematology, Southampton General Hospital, Southampton, United Kingdom
| | - D H Radia
- Department of Haematology, Guy's and St Thomas' Hospital, London, United Kingdom
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16
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Othman J, Dillon R. Time to add gemtuzumab ozogamicin to intensive chemotherapy for NPM1-mutated acute myeloid leukaemia? Lancet Haematol 2023; 10:e478-e479. [PMID: 37187197 DOI: 10.1016/s2352-3026(23)00092-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, King's College, London SE1 9RT, UK; Department of Haematology, Royal North Shore Hospital, Sydney, Australia; Faculty of Medicine and Heath, University of Sydney, Australia
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London SE1 9RT, UK; Department of Haematology, Guy's and St Thomas' Hospitals NHS Trust, London, UK.
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17
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Harrington P, Kurshan A, Delord M, Lechmere T, Sheikh A, Saunders J, Saha C, Dillon R, Woodley C, Asirvatham S, Curto-Garcia N, Sullivan JO, Kordasti S, Radia D, McLornan D, Malim MH, Harrison C, Doores KJ, de Lavallade H. Third-dose SARS-CoV-2 mRNA vaccine increases Omicron variant neutralization in patients with chronic myeloid disorders. Blood Adv 2023; 7:1954-1957. [PMID: 36083126 PMCID: PMC9472701 DOI: 10.1182/bloodadvances.2022008375] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Patrick Harrington
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Cancer and Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Ashwini Kurshan
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Marc Delord
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Thomas Lechmere
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Amna Sheikh
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jamie Saunders
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Chandan Saha
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Richard Dillon
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Medicine and Molecular Genetics, King’s College London, London, United Kingdom
| | - Claire Woodley
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Susan Asirvatham
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Natalia Curto-Garcia
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jennifer O’ Sullivan
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Shahram Kordasti
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Cancer and Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Deepti Radia
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Donal McLornan
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Clinical Haematology, University College Hospital, London, United Kingdom
| | - Michael H. Malim
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Claire Harrison
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Cancer and Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Katie J. Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Hugues de Lavallade
- Department of Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Cancer and Pharmaceutical Science, King’s College London, London, United Kingdom
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18
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Horgan C, Mullanfiroze K, Rauthan A, Patrick K, Butt NA, Mirci-Danicar O, O’Connor O, Furness C, Deshpande A, Lawson S, Broderick V, Evans P, Gibson B, Roberts W, Ali S, Galani S, Kirkwood AA, Jovanovic J, Dillon R, Virgo P, James B, Rao K, Amrolia PJ, Wynn RF. T-cell replete cord transplants give superior outcomes in high-risk and relapsed/refractory pediatric myeloid malignancy. Blood Adv 2023; 7:2155-2165. [PMID: 36649566 PMCID: PMC10206437 DOI: 10.1182/bloodadvances.2022009253] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
Stem cell transplant (SCT) outcomes in high-risk and relapsed/refractory (R/R) pediatric acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) have been historically poor. Cord blood (CB) allows T-cell replete CB transplant (TRCB), enabling enhanced graft-versus-leukemia. We consecutively collected data from 367 patients undergoing TRCB (112 patients) or other cell source (255 patients) SCT for pediatric AML/MDS in the United Kingdom and Ireland between January 2014 and December 2021. Data were collected about the patient's demographics, disease, and its treatment; including previous transplant, measurable residual disease (MRD) status at transplant, human leukocyte antigen-match, relapse, death, graft versus host disease (GvHD), and transplant-related mortality (TRM). Univariable and multivariable analyses were undertaken. There was a higher incidence of poor prognosis features in the TRCB cohort: 51.4% patients were MRD positive at transplant, 46.4% had refractory disease, and 21.4% had relapsed after a previous SCT, compared with 26.1%, 8.6%, and 5.1%, respectively, in the comparator group. Event free survival was 64.1% within the TRCB cohort, 50% in MRD-positive patients, and 79% in MRD-negative patients. To allow for the imbalance in baseline characteristics, a multivariable analysis was performed where the TRCB cohort had significantly improved event free survival, time to relapse, and reduced chronic GvHD, with some evidence of improved overall survival. The effect appeared similar regardless of the MRD status. CB transplant without serotherapy may be the optimal transplant option for children with myeloid malignancy.
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Affiliation(s)
- Claire Horgan
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | | | - Archana Rauthan
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Katharine Patrick
- Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | | | | | - Olya O’Connor
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Caroline Furness
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- The Institute of Cancer Research, Sutton, United Kingdom
| | | | - Sarah Lawson
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | | | - Pamela Evans
- Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Brenda Gibson
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Wing Roberts
- Great North Children’s Hospital, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Salah Ali
- Leeds Children’s Hospital, Clarendon Wing, Leeds General Infirmary, Leeds, United Kingdom
| | - Sevasti Galani
- CR UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, United Kingdom
| | - Amy A. Kirkwood
- CR UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King’s College London, Strand, London, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King’s College London, Strand, London, United Kingdom
| | - Paul Virgo
- Department of Immunology and Immunogenetics, North Bristol NHS Trust, Bristol, United Kingdom
| | - Beki James
- Leeds Children’s Hospital, Clarendon Wing, Leeds General Infirmary, Leeds, United Kingdom
| | - Kanchan Rao
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Robert F. Wynn
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
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19
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Othman J, Meggendorfer M, Tiacci E, Thiede C, Schlenk R, Dillon R, Stasik S, Venanzi A, Bertoli S, Delabesse E, Dumas PY, Pigneux A, Bidet A, Gilkes AF, Thomas I, Voso MT, Rambaldi A, Brunetti L, Perriello VM, Andresen V, Gjertsen BT, Martelli MP, Récher C, Röllig C, Bornhäuser M, Serve H, Müller-Tidow C, Baldus CD, Haferlach T, Russell N, Falini B. Overlapping features of therapy-related and de novo NPM1-mutated AML. Blood 2023; 141:1846-1857. [PMID: 36508705 DOI: 10.1182/blood.2022018108] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
NPM 1-mutated acute myeloid leukemia (AML) shows unique features. However, the characteristics of "therapy-related" NPM1-mutated AML (t-NPM1 AML) are poorly understood. We compared the genetics, transcriptional profile, and clinical outcomes of t-NPM1 AML, de novo NPM1-mutated AML (dn-NPM1 AML), and therapy-related AML (t-AML) with wild-type NPM1 (t-AML). Normal karyotype was more frequent in t-NPM1 AML (n = 78/96, 88%) and dn-NPM1 (n = 1986/2394, 88%) than in t-AML (n = 103/390, 28%; P < .001). DNMT3A and TET2 were mutated in 43% and 40% of t-NPM1 AML (n = 107), similar to dn-NPM1 (n = 88, 48% and 30%; P > 0.1), but more frequently than t-AML (n = 162; 14% and 10%; P < 0.001). Often mutated in t-AML, TP53 and PPM1D were wild-type in 97% and 96% of t-NPM1 AML, respectively. t-NPM1 and dn-NPM1 AML were transcriptionally similar, (including HOX genes upregulation). At 62 months of median follow-up, the 3-year overall survival (OS) for t-NPM1 AML (n = 96), dn-NPM1 AML (n = 2394), and t-AML (n = 390) were 54%, 60%, and 31%, respectively. In multivariable analysis, OS was similar for the NPM1-mutated groups (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.65-1.25; P = .45), but better in t-NPM1 AML than in t-AML (HR, 1.86; 95% CI, 1.30-2.68; P < .001). Relapse-free survival was similar between t-NPM1 and dn-NPM1 AML (HR, 1.02; 95% CI, 0.72-1.467; P = .90), but significantly higher in t-NPM1 AML versus t-AML (HR, 1.77; 95% CI, 1.19-2.64; P = .0045). t-NPM1 and dn-NPM1 AML have overlapping features, suggesting that they should be classified as a single disease entity.
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Affiliation(s)
- Jad Othman
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's and St Thomas Hospitals NHS Trust, London, United Kingdom
| | | | - Enrico Tiacci
- Institute of Hematology and Center for Hemato-Oncology Research (CREO), Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Christian Thiede
- University Hospital, Medical Clinic I, Dresden University of Technology, Dresden, Germany
| | - Richard Schlenk
- Department of Hematology/Oncology and NCT Trial Center, Heidelberg University Hospital, and German Cancer Research Center, Heidelberg, Germany
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Sebastian Stasik
- University Hospital, Medical Clinic I, Dresden University of Technology, Dresden, Germany
| | - Alessandra Venanzi
- Institute of Hematology and Center for Hemato-Oncology Research (CREO), Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Eric Delabesse
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | | | - Arnaud Pigneux
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Audrey Bidet
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Amanda F Gilkes
- Department of Hematology and Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ian Thomas
- Department of Hematology and Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Vincenzo M Perriello
- Institute of Hematology and Center for Hemato-Oncology Research (CREO), Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Vibeke Andresen
- Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Bjorn T Gjertsen
- Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Maria Paola Martelli
- Institute of Hematology and Center for Hemato-Oncology Research (CREO), Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Christoph Röllig
- University Hospital, Medical Clinic I, Dresden University of Technology, Dresden, Germany
| | - Martin Bornhäuser
- University Hospital, Medical Clinic I, Dresden University of Technology, Dresden, Germany
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Carsten Müller-Tidow
- Department of Hematology/Oncology and NCT Trial Center, Heidelberg University Hospital, and German Cancer Research Center, Heidelberg, Germany
| | | | | | - Nigel Russell
- Department of Haematology, Guy's and St Thomas Hospitals NHS Trust, London, United Kingdom
- Nottingham University, Nottingham, United Kingdom
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research (CREO), Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
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20
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Wang Z, Neelamraju Y, Meydan C, Dunham N, Gandara J, Lee T, Prajapati S, Rapaport F, Sheridan C, Zumbo P, Becker M, Bullinger L, Carroll M, D’Andrea R, Dillon R, Levine R, Mason CE, Melnick A, Neuberg D, Bekiranov S, Zang C, Garrett-Bakelman FE. Abstract 3155: Gene expression profiles reveal distinct regulatory activities of transcription factors GATA1 and TAL1 upon AML relapse. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
The purpose of this study is to identify key regulatory pathways that potentially drive abnormal gene expression program in relapsed Acute Myeloid Leukemia (AML) patients, by integrative computational analyses on multi-omics molecular profiles. Relapsed AML remains a clinical challenge. Epigenetic heterogeneity may contribute to transcriptional dysregulation and disease progression in AML. However, what specific transcriptional programs and potential regulatory mechanisms contribute to disease relapse are not yet well understood. To characterize the global transcriptional landscapes in relapsed AML, we integrated genomics data from two cohorts of matched diagnosis and relapse patient specimens. We identified 5,416 differentially expressed genes (DEGs) between diagnosis and relapse in Cohort I. Unsupervised clustering yielded three distinct DEG groups: group A, B and C genes that were predominantly (88%) down-regulated, divergently regulated, or predominantly (65%) up-regulated, respectively, upon relapse. The expression pattern of all DEGs separated the patients into two clusters, most robustly by Group B genes. Interestingly, the majority of DEGs did not associate with changes in gene promoter methylation. Similar patterns were observed in Cohort II. We used Binding Analysis for Regulation of Transcription (BART) to identify transcriptional regulators (TRs) that potentially regulated the DEGs not associated with DNA methylation changes, and assessed the differential expression of identified TRs during disease progression. PU.1 was identified as a potential TR for Group A genes and was down-regulated upon relapse. GATA1 and TAL1 were identified as regulating Group B genes and were up-regulated in patient cluster1 and down-regulated in cluster2, consistent with the expression pattern of Group B genes. RBBP5 was a top predicted TR for Group C genes and was up-regulated upon relapse. We next validated the potential functionality of those predicted factors. In NSG mice transplanted with a human AML specimen, TAL1 and GATA1 were downregulated in AML cells collected four weeks after chemotherapy treatment, and were inferred as TRs for the down-regulated genes, similar to the patient data. PU.1 was inferred as regulating the up-regulated genes. Furthermore, we found that the level of differential expression of TAL1, GATA1, and PU.1 in each patient specimen associated with the correlation of DEG profiles between the patient specimen and TR perturbation in human-derived hematopoietic cell lines. Our results support the possibility that in some AML patients, TRs with roles in hematopoiesis and leukemia might contribute to disease relapse. Further mechanistic studies deciphering the molecular and phenotypic events facilitated by these TRs will yield significant insight into disease biology and possible therapeutic targeting approaches in relapsed AML.
Citation Format: Zhenjia Wang, Yaseswini Neelamraju, Cem Meydan, Nicholas Dunham, Jorge Gandara, Tak Lee, Subhash Prajapati, Franck Rapaport, Caroline Sheridan, Paul Zumbo, Michael Becker, Lars Bullinger, Martin Carroll, Richard D’Andrea, Richard Dillon, Ross Levine, Christopher E. Mason, Ari Melnick, Donna Neuberg, Stefan Bekiranov, Chongzhi Zang, Francine E. Garrett-Bakelman. Gene expression profiles reveal distinct regulatory activities of transcription factors GATA1 and TAL1 upon AML relapse [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3155.
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Affiliation(s)
| | | | | | | | | | - Tak Lee
- 2Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | | | | | - Richard D’Andrea
- 7University of South Australia and SA Pathology, Adelaide, Australia
| | | | - Ross Levine
- 3Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Harrington P, Dillon R, Radia D, Rousselot P, McLornan DP, Ong M, Green A, Verde A, Hussain F, Raj K, Kordasti S, Harrison C, De Lavallade H. Differential inhibition of T cell receptor and STAT5 signalling pathways determines the immunomodulatory effects of dasatinib in chronic phase chronic myeloid leukemia. Haematologica 2023. [PMID: 36700403 DOI: 10.3324/haematol.2022.282005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
Dasatinib is a multi-kinase inhibitor with activity against the SRC kinase LCK, which plays a critical role in T-cell receptor signalling. Dasatinib, initially developed as an immunosuppressive agent, is by contrast, also noted to result in enhanced tumour immunity in a subset of patients. We studied the impact of dasatinib in CML patients and compared with patients taking other TKI and healthy controls. We found that patients on dasatinib showed inhibition of both TCR and STAT5 signalling pathways, and reduced expression of T effector pro-inflammatory cytokines. In addition, dasatinib induced selective depletion of Tregs and effector Tregs, particularly in patients with clonal expansion of effector CD8+ T-cells, who demonstrated greater and preferential inhibition of Treg TCR intracellular signalling. In addition, we show that dasatinib selectively reduces Treg STAT5 phosphorylation via reduction of IL-2, in relation with the marked reduction of plasma IL-2 levels in patients taking dasatinib. Finally, patients on other TKI had significantly increased TCR signalling in TIM3+ cells compared to patients taking dasatinib, suggesting that chronic SRC kinase inhibition by dasatinib may play a role in preventing TIM-3 mediated T cell exhaustion and preserve anti-tumour immunity. These data provide further insight into the selective immunomodulatory effects of dasatinib and its potential use for pharmacologic control of immunotherapies.
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Affiliation(s)
- Patrick Harrington
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London
| | - Richard Dillon
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK; Medical and Molecular Genetics, King's College London
| | - Deepti Radia
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust
| | - Philippe Rousselot
- Service d'Hematologie, Centre Hospitalier de Versailles, Université de Versailles Paris-Saclay, UMR1184, CEA
| | - Donal P McLornan
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London
| | - Mark Ong
- Department of Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust
| | - Anna Green
- Department of Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust
| | - Alessandro Verde
- Integrated Toxicology Laboratory, Synnovis, King's College Hospital NHS Foundation Trust
| | - Farzana Hussain
- Integrated Toxicology Laboratory, Synnovis, King's College Hospital NHS Foundation Trust
| | - Kavita Raj
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust
| | - Shahram Kordasti
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London
| | - Claire Harrison
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London
| | - Hugues De Lavallade
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London.
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22
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Mehta P, Telford N, Wragg C, Dillon R, Freeman S, Finnegan D, Hamblin A, Copland M, Knapper S. Recommendations for laboratory testing of UK patients with acute myeloid leukaemia. Br J Haematol 2023; 200:150-159. [PMID: 36278472 DOI: 10.1111/bjh.18516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Priyanka Mehta
- University Hospitals of Bristol and Weston NHS FoundationTrust, Bristol, UK
| | - Nick Telford
- Oncology Cytogenetics, The Christie NHS Foundation Trust, Manchester, UK
| | - Chris Wragg
- Bristol Genetic Laboratory, North Bristol NHS Trust, Westbury on Trym, UK
| | - Richard Dillon
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College, London, UK
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Damian Finnegan
- Department of Haematology, Belfast City Hospital, Belfast, UK
| | - Angela Hamblin
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust & Genomics, Oxford, UK
| | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Steve Knapper
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
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23
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Loo S, Dillon R, Ivey A, Anstee NS, Othman J, Tiong IS, Potter N, Jovanovic J, Runglall M, Chong CC, Bajel A, Ritchie D, Gray K, Yeoh ZH, McBean M, Gilkes A, Thomas I, Johnson S, Russell NH, Wei AH. Pretransplant FLT3-ITD MRD assessed by high-sensitivity PCR-NGS determines posttransplant clinical outcome. Blood 2022; 140:2407-2411. [PMID: 35960851 PMCID: PMC10653044 DOI: 10.1182/blood.2022016567] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sun Loo
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
| | - Richard Dillon
- Guy’s and St Thomas Hospital, London, United Kingdom
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Adam Ivey
- Department of Pathology, The Alfred Hospital, Melbourne, Australia
| | - Natasha S. Anstee
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
| | - Jad Othman
- Guy’s and St Thomas Hospital, London, United Kingdom
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Ing Soo Tiong
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Chyn Chua Chong
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
| | - Ashish Bajel
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - David Ritchie
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Kelli Gray
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Zhi Han Yeoh
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Michelle McBean
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amanda Gilkes
- Division of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sean Johnson
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | - Andrew H. Wei
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
- Department of Haematology, The Alfred Hospital, Melbourne, Australia
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24
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Fisher CL, Dillon R, Anguita E, Morris-Rosendahl DJ, Awan AR. A Novel Bead-Capture Nanopore Sequencing Method for Large Structural Rearrangement Detection in Cancer. J Mol Diagn 2022; 24:1264-1278. [PMID: 36243290 DOI: 10.1016/j.jmoldx.2022.09.006] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 08/07/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Rapid, cost-effective genomic stratification of structural rearrangements in cancer is often of vital importance when determining treatment; however, existing diagnostic cytogenetic and molecular testing fails to deliver the required speed when deployed at scale. Next-generation sequencing-based methods are widely used, but these can lack sensitivity and require batching of samples to be cost-effective, with long turnaround times. Here we present a novel method for rearrangement detection from genomic DNA based on third-generation long-read sequencing that overcomes these time and cost issues. The utility of this approach for the genomic stratification of patients with acute myeloid leukemia is shown based on detection of four of the most prevalent structural rearrangements. The method not only determines the precise genomic breakpoint for each expected rearrangement but also discovers and validates novel translocations in one-third of the tested samples, 80% of which involve known oncogenes. This method may prove to be a powerful tool for the diagnosis, genomic stratification, and characterization of cancers.
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Affiliation(s)
- Chloe L Fisher
- Genomics Innovation Unit, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics King's College London, London, United Kingdom; Department of Haematology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Eduardo Anguita
- Hematology Department, IML, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Deborah J Morris-Rosendahl
- Clinical Genetics and Genomics Laboratory, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom; Molecular Genetics, NHLI, Imperial College London, London, United Kingdom
| | - Ali R Awan
- Genomics Innovation Unit, Guy's and St Thomas' NHS Trust, London, United Kingdom; Comprehensive Cancer Centre, King's College London, London, United Kingdom.
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25
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Dillon R, Maycock S, Jackson A, Fox S, Freeman S, Craddock C, Thomas C, Homer E, Leahy J, Mamwell A, Potter N, Russell N, Wei A, Ommen HB, Hemmaway C, Knapper S, Billingham L. Venetoclax combined with low dose cytarabine compared to standard of care intensive chemotherapy for the treatment of favourable risk adult acute myeloid leukaemia (VICTOR): Study protocol for an international, open-label, multicentre, molecularly-guided randomised, phase II trial. BMC Cancer 2022; 22:1174. [PMID: 36376888 PMCID: PMC9664612 DOI: 10.1186/s12885-022-10221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For patients with acute myeloid leukaemia (AML), the only potentially curative treatment is intensive chemotherapy (IC). This is highly toxic, particularly for patients > 60 years, potentially leading to prolonged hospitalisations requiring intensive supportive care, and sometimes treatment-related death. This also results in extensive healthcare costs and negatively impacts quality of life (QoL). Venetoclax with low-dose cytarabine (VEN + LDAC) is a novel, low-intensity treatment for AML patients who cannot receive IC. VEN + LDAC is given as an outpatient and toxicity appears significantly lower than with IC. Analysis of clinical trials performed to date are promising for patients with the genotype NPM1mutFLT3 ITDneg, where remission and survival rates appear comparable to those achieved with IC. METHODS VICTOR is an international, two-arm, open-label, multi-centre, non-inferiority, randomised-controlled phase II trial to assess VEN + LDAC compared to standard of care (IC) as first-line treatment in older patients (initially aged ≥ 60 years) with newly diagnosed AML. The trial will recruit patients with a NPM1mutFLT3 ITDneg genotype; those with a favourable risk in relation to the experimental treatment. University of Birmingham is the UK co-ordinating centre, with national hubs in Aarhus University Hospital, Denmark, and Auckland District Health Board, New Zealand. The primary outcome is molecular event-free survival time where an event is defined as failure to achieve morphological complete response (CR) or CR with incomplete blood count recovery after two cycles of therapy; molecular persistence, progression or relapse requiring treatment change; morphological relapse, or; death. Secondary outcomes include cumulative resource use at 12- and 24-months, and QoL as assessed by EORTCQLQ-C30 and EQ-5D-3L at 3-, 6-, 12-, 18- and 24-months. The trial employs an innovative Bayesian design with target sample size of 156 patients aged > 60 years. DISCUSSION The principle underpinning the VICTOR trial is that the chance of cure for patients in the experimental arm should not be compromised, therefore, an adaptive design with regular checks on accumulating data has been employed, which will allow for a staged expansion of the trial population to include younger patients if, and when, there is sufficient evidence of non-inferiority in older patients. TRIAL REGISTRATION EudraCT: 2020-000,273-24; 21-Aug-2020. ISRCTN 15,567,173; 08-Dec-2020.
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Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, London, UK.
- Department of Clinical Haematology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, UK.
| | - Shanna Maycock
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sylvie Freeman
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Clinical Haematology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Charles Craddock
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Clinical Haematology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Catherine Thomas
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Emma Homer
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | | | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Nigel Russell
- School of Medicine, Clinical Sciences Building, The University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Andrew Wei
- Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne. VIC 3000, Australia
| | - Hans Beier Ommen
- Department of Hematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus C, Denmark
| | - Claire Hemmaway
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Steve Knapper
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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26
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Tazi Y, Arango-Ossa JE, Zhou Y, Bernard E, Thomas I, Gilkes A, Freeman S, Pradat Y, Johnson SJ, Hills R, Dillon R, Levine MF, Leongamornlert D, Butler A, Ganser A, Bullinger L, Döhner K, Ottmann O, Adams R, Döhner H, Campbell PJ, Burnett AK, Dennis M, Russell NH, Devlin SM, Huntly BJP, Papaemmanuil E. Unified classification and risk-stratification in Acute Myeloid Leukemia. Nat Commun 2022; 13:4622. [PMID: 35941135 PMCID: PMC9360033 DOI: 10.1038/s41467-022-32103-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023] Open
Abstract
Clinical recommendations for Acute Myeloid Leukemia (AML) classification and risk-stratification remain heavily reliant on cytogenetic findings at diagnosis, which are present in <50% of patients. Using comprehensive molecular profiling data from 3,653 patients we characterize and validate 16 molecular classes describing 100% of AML patients. Each class represents diverse biological AML subgroups, and is associated with distinct clinical presentation, likelihood of response to induction chemotherapy, risk of relapse and death over time. Secondary AML-2, emerges as the second largest class (24%), associates with high-risk disease, poor prognosis irrespective of flow Minimal Residual Disease (MRD) negativity, and derives significant benefit from transplantation. Guided by class membership we derive a 3-tier risk-stratification score that re-stratifies 26% of patients as compared to standard of care. This results in a unified framework for disease classification and risk-stratification in AML that relies on information from cytogenetics and 32 genes. Last, we develop an open-access patient-tailored clinical decision support tool.
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Grants
- MC_PC_17230 Medical Research Council
- BRC-1215-20014 Department of Health
- 203151/Z/16/Z Wellcome Trust
- MR-R009708-1 Medical Research Council
- C18680/A25508 Cancer Research UK
- 29806 Cancer Research UK
- 25350 Cancer Research UK
- P30 CA008748 NCI NIH HHS
- 25508 Cancer Research UK
- 25643 Cancer Research UK
- MR/R009708/1 Medical Research Council
- C49940/A25117 Cancer Research UK
- 205254/Z/16/Z Wellcome Trust
- E.P. is a Josie Robertson Investigator and is supported by the European Hematology Association, American Society of Hematology, Gabrielle’s Angels Foundation, V Foundation and The Geoffrey Beene Foundation and is a Damon Runyon Rachleff Innovator fellow. Work in the BJPH lab is funded by Cancer Research UK (C18680/A25508), the European Research Council (647685), MRC (MR-R009708-1), the Kay Kendall Leukaemia Fund (KKL1243), the Wellcome Trust (205254/Z/16/Z) and the Cancer Research UK Cambridge Major Centre (C49940/A25117). This research was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014), and was funded in part, by the Wellcome Trust who supported the Wellcome - MRC Cambridge Stem Cell Institute (203151/Z/16/Z). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. L.B., H.D. and B.J.P.H. are supported by the HARMONY Alliance (IMI Project No. 116026; https://www.harmony-alliance.eu/). The UK-NCRI AML working group trials were supported with research grants from the Medical Research Council (MRC), Cancer Research UK (CRUK), Blood Cancer UK and Cardiff University. We would like to thank all patients and investigators for their participation in the trials and the study.
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Affiliation(s)
- Yanis Tazi
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Tri-Institutional Computational Biology and Medicine PhD Program, Weill Cornell Medicine of Cornell University and Rockefeller University, New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - Juan E Arango-Ossa
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yangyu Zhou
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elsa Bernard
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Thomas
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Amanda Gilkes
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Yoann Pradat
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean J Johnson
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, UK
| | - Max F Levine
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Leongamornlert
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Adam Butler
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Oliver Ottmann
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - Richard Adams
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Peter J Campbell
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Alan K Burnett
- Visiting Professor University of Glasgow, formerly Cardiff University, Cardiff, UK
| | | | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital, Nottingham, UK
| | - Sean M Devlin
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian J P Huntly
- Department of Haematology and Wellcome Trust-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Elli Papaemmanuil
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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27
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Pagliuca A, Khwaja A, Dillon R, Evans PA, Mohite U. Optimising care for UK patients with acute myeloid leukaemia. Br J Hosp Med (Lond) 2022; 83:42-50. [PMID: 36066288 DOI: 10.12968/hmed.2022.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Acute myeloid leukaemia is a rare cancer, with about 3000 cases diagnosed each year in the UK. Diagnosis is based on patient history, blood and bone marrow tests and, in some cases, imaging. Chemotherapy is the mainstay of treatment for acute myeloid leukaemia, with eligible patients also undergoing allogeneic haematopoietic stem cell transplantation, which can be curative. However, patients must be carefully evaluated by the multidisciplinary team before they are put forward for transplant to ensure they are able to tolerate the conditioning therapy required. Improvements in transplant technology have increased donor availability and reduced transplant toxicity. At the same time, greater understanding of the cytogenetics and molecular genetics of acute myeloid leukaemia have helped to ensure that patients receive treatment that gives them the best chance of survival. A recent roundtable discussion considered how current diagnostic and treatment pathways might be adapted or enhanced to leverage good outcomes for the greatest numbers of patients.
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Affiliation(s)
- Antonio Pagliuca
- Professor of Stem Cell Transplantation, King's College London & King's College Hospital NHS Foundation Trust, London, UK - Chair
| | - Asim Khwaja
- Professor of Haematology, UCL Cancer Institute, and Consultant Haematologist UCL Hospitals, London, UK
| | - Richard Dillon
- Clinical Senior Lecturer in Cancer Genetics, Kings College, London, UK
| | - Paul As Evans
- Principal Clinical Scientist, Haematological Malignancy Diagnostic Service, Leeds, UK
| | - Unmesh Mohite
- Consultant Haematologist, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
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28
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Harrington P, Dillon R, Radia D, McLornan D, Woodley C, Asirvatham S, Raj K, Curto-Garcia N, Saunders J, Kordasti S, Harrison C, de Lavallade H. Chronic myeloid leukaemia patients at diagnosis and resistant to tyrosine kinase inhibitor therapy display exhausted T-cell phenotype. Br J Haematol 2022; 198:1011-1015. [PMID: 35802024 PMCID: PMC9544983 DOI: 10.1111/bjh.18302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
The search for novel targets in chronic myeloid leukaemia (CML) is ongoing, to improve treatment efficacy in refractory disease and increase eligibility for tyrosine kinase inhibitor (TKI) discontinuation. Increased frequency of Tregs and effector Tregs was evident at diagnosis, together with increased expression of T‐cell exhaustion markers, including in regulatory T cells at diagnosis and in patients with refractory disease. Plasma analysis revealed significantly increased levels of cytokines including tumour necrosis factor (TNF)‐a and interleukin (IL)‐6 at diagnosis, in keeping with a pro‐inflammatory state prior to treatment. We hence demonstrate T‐cell exhaustion and a pro‐inflammatory state at diagnosis in CML, likely secondary to leukaemia‐associated antigenic overload associated with increased disease burden.
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Affiliation(s)
- Patrick Harrington
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Richard Dillon
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Department of Medicine and Molecular Genetics, King's College London, London, UK
| | - Deepti Radia
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Donal McLornan
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Claire Woodley
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Susan Asirvatham
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Kavita Raj
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Natalia Curto-Garcia
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jamie Saunders
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Shahram Kordasti
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Claire Harrison
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Hugues de Lavallade
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Science, King's College London, London, UK
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29
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Harrington P, Doores KJ, Saunders J, de Lord M, Saha C, Lechmere T, Khan H, Lam HPJ, Reilly AO, Woodley C, Asirvatham S, Dillon R, Curto-Garcia N, Sullivan JO, Kordasti S, Raj K, Malim MH, Radia D, McLornan D, Harrison C, de Lavallade H. Impaired humoral and T cell response to vaccination against SARS-CoV-2 in chronic myeloproliferative neoplasm patients treated with ruxolitinib. Blood Cancer J 2022; 12:73. [PMID: 35459222 PMCID: PMC9024068 DOI: 10.1038/s41408-022-00651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Patrick Harrington
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Jamie Saunders
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marc de Lord
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Chandan Saha
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas Lechmere
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Hataf Khan
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Ho Pui Jeff Lam
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amy O' Reilly
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claire Woodley
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susan Asirvatham
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Dillon
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Medicine and Molecular Genetics, King's College London, London, UK
| | - Natalia Curto-Garcia
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jennifer O' Sullivan
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shahram Kordasti
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Kavita Raj
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Deepti Radia
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Donal McLornan
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Claire Harrison
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Hugues de Lavallade
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- School of Cancer and Pharmaceutical Science, King's College London, London, UK.
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30
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Halim L, Das KK, Larcombe-Young D, Ajina A, Candelli A, Benjamin R, Dillon R, Davies DM, Maher J. Engineering of an Avidity-Optimized CD19-Specific Parallel Chimeric Antigen Receptor That Delivers Dual CD28 and 4-1BB Co-Stimulation. Front Immunol 2022; 13:836549. [PMID: 35222427 PMCID: PMC8863855 DOI: 10.3389/fimmu.2022.836549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Co-stimulation is critical to the function of chimeric antigen receptor (CAR) T-cells. Previously, we demonstrated that dual co-stimulation can be effectively harnessed by a parallel (p)CAR architecture in which a CD28-containing second generation CAR is co-expressed with a 4-1BB containing chimeric co-stimulatory receptor (CCR). When compared to linear CARs, pCAR-engineered T-cells elicit superior anti-tumor activity in a range of pre-clinical models. Since CD19 is the best validated clinical target for cellular immunotherapy, we evaluated a panel of CD19-specific CAR and pCAR T-cells in this study. First, we generated a panel of single chain antibody fragments (scFvs) by alanine scanning mutagenesis of the CD19-specific FMC63 scFv (VH domain) and these were incorporated into second generation CD28+CD3ζ CARs. The resulting panel of CAR T-cells demonstrated a broad range of CD19 binding ability and avidity for CD19-expressing tumor cells. Each scFv-modified CAR was then converted into a pCAR by co-expression of an FMC63 scFv-targeted CCR with a 4-1BB endodomain. When compared to second generation CARs that contained an unmodified or mutated FMC63 scFv, each pCAR demonstrated a significant enhancement of tumor re-stimulation potential and IL-2 release, reduced exhaustion marker expression and enhanced therapeutic efficacy in mice with established Nalm-6 leukemic xenografts. These data reinforce the evidence that the pCAR platform delivers enhanced anti-tumor activity through effective provision of dual co-stimulation. Greatest anti-tumor activity was noted for intermediate avidity CAR T-cells and derived pCARs, raising the possibility that effector to target cell avidity is an important determinant of efficacy.
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Affiliation(s)
- Leena Halim
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Daniel Larcombe-Young
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Adam Ajina
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Reuben Benjamin
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Department of Clinical Haematology, King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Richard Dillon
- Department of Clinical Haematology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom.,Department of Medicine and Molecular Genetics, King's College London, London, United Kingdom
| | - David M Davies
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - John Maher
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Leucid Bio, Guy's Hospital, London, United Kingdom.,Department of Clinical Immunology and Allergy, King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,Department of Immunology, Eastbourne Hospital, Eastbourne, United Kingdom
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31
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Dillon R, Hills RK, Burnett AK, Russell NH. Gemtuzumab ozogamicin in (KMT2A)-rearranged adult acute myeloid leukaemia (AML) in the UK Medical Research Council AML15 and AML16 trials. Br J Haematol 2022; 196:e50-e52. [PMID: 34799856 DOI: 10.1111/bjh.17943] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, UK
- Department of Haematology, Guy's Hospital, London, UK
| | - Robert K Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Nigel H Russell
- Department of Haematology, Guy's Hospital, London, UK
- Nottingham University Hospital, Nottingham, UK
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32
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Ting Loke JC, McCarthy N, Jackson A, Siddique S, Hodgkinson A, Crawley C, Gilleece MH, Protheroe R, Peniket A, Salim R, Tholouli E, Wilson KM, Andrew G, Dillon R, Khan N, Potter V, Krishnamurthy P, Craddock C, Freeman S. Post-Transplant MRD Status and T Cell Chimerism Predict Outcomes in Patients Allografted for AML/MDS-a Prospective Analysis from the UK NCRI Figaro Trial. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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33
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Coats T, Bean D, Basset A, Sirkis T, Brammeld J, Johnson S, Thomas I, Gilkes A, Raj K, Dennis M, Knapper S, Mehta P, Khwaja A, Hunter H, Tauro S, Bowen D, Jones G, Dobson R, Russell N, Dillon R. A novel algorithmic approach to generate consensus treatment guidelines in adult acute myeloid leukaemia. Br J Haematol 2022; 196:1337-1343. [PMID: 34957541 DOI: 10.1111/bjh.18013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
Induction therapy for acute myeloid leukaemia (AML) has changed with the approval of a number of new agents. Clinical guidelines can struggle to keep pace with an evolving treatment and evidence landscape and therefore identifying the most appropriate front-line treatment is challenging for clinicians. Here, we combined drug eligibility criteria and genetic risk stratification into a digital format, allowing the full range of possible treatment eligibility scenarios to be defined. Using exemplar cases representing each of the 22 identified scenarios, we sought to generate consensus on treatment choice from a panel of nine aUK AML experts. We then analysed >2500 real-world cases using the same algorithm, confirming the existence of 21/22 of these scenarios and demonstrating that our novel approach could generate a consensus AML induction treatment in 98% of cases. Our approach, driven by the use of decision trees, is an efficient way to develop consensus guidance rapidly and could be applied to other disease areas. It has the potential to be updated frequently to capture changes in eligibility criteria, novel therapies and emerging trial data. An interactive digital version of the consensus guideline is available.
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Affiliation(s)
- Thomas Coats
- Haematology Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Biostatistics and Health Informatics, King's College London, UK
| | - Daniel Bean
- Biostatistics and Health Informatics, King's College London, UK
- Health Data Research UK London, University College London, UK
| | - Aymeric Basset
- Biostatistics and Health Informatics, King's College London, UK
| | | | | | - Sean Johnson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Amanda Gilkes
- Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Kavita Raj
- Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Mike Dennis
- Haematology, The Christie NHS Foundation Trust, Manchester, UK
| | - Steve Knapper
- Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Priyanka Mehta
- Haematology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Asim Khwaja
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Hannah Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sudhir Tauro
- Haematology, Ninewells Hospital & School of Medicine, University of Dundee, Dundee, UK
| | - David Bowen
- Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gail Jones
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Richard Dobson
- Biostatistics and Health Informatics, King's College London, UK
- Health Data Research UK London, University College London, UK
| | - Nigel Russell
- Guys' and St Thomas' NHS Foundation Trust, London, UK
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34
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Heuser M, Freeman SD, Ossenkoppele GJ, Buccisano F, Hourigan CS, Ngai LL, Tettero JM, Bachas C, Baer C, Béné MC, Bücklein V, Czyz A, Denys B, Dillon R, Feuring-Buske M, Guzman ML, Haferlach T, Han L, Herzig JK, Jorgensen JL, Kern W, Konopleva MY, Lacombe F, Libura M, Majchrzak A, Maurillo L, Ofran Y, Philippe J, Plesa A, Preudhomme C, Ravandi F, Roumier C, Subklewe M, Thol F, van de Loosdrecht AA, van der Reijden BA, Venditti A, Wierzbowska A, Valk PJM, Wood BL, Walter RB, Thiede C, Döhner K, Roboz GJ, Cloos J. 2021 Update on MRD in acute myeloid leukemia: a consensus document from the European LeukemiaNet MRD Working Party. Blood 2021; 138:2753-2767. [PMID: 34724563 PMCID: PMC8718623 DOI: 10.1182/blood.2021013626] [Citation(s) in RCA: 270] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Measurable residual disease (MRD) is an important biomarker in acute myeloid leukemia (AML) that is used for prognostic, predictive, monitoring, and efficacy-response assessments. The European LeukemiaNet (ELN) MRD Working Party evaluated standardization and harmonization of MRD in an ongoing manner and has updated the 2018 ELN MRD recommendations based on significant developments in the field. New and revised recommendations were established during in-person and online meetings, and a 2-stage Delphi poll was conducted to optimize consensus. All recommendations are graded by levels of evidence and agreement. Major changes include technical specifications for next-generation sequencing-based MRD testing and integrative assessments of MRD irrespective of technology. Other topics include use of MRD as a prognostic and surrogate end point for drug testing; selection of the technique, material, and appropriate time points for MRD assessment; and clinical implications of MRD assessment. In addition to technical recommendations for flow- and molecular-MRD analysis, we provide MRD thresholds and define MRD response, and detail how MRD results should be reported and combined if several techniques are used. MRD assessment in AML is complex and clinically relevant, and standardized approaches to application, interpretation, technical conduct, and reporting are of critical importance.
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Affiliation(s)
- Michael Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Gert J Ossenkoppele
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Francesco Buccisano
- Department of Biomedicine and Prevention, Hematology, University Tor Vergata, Rome, Italy
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancy, Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Lok Lam Ngai
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jesse M Tettero
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Costa Bachas
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Marie-Christine Béné
- Department of Hematology and Biology, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - Veit Bücklein
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Anna Czyz
- Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Barbara Denys
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | | | - Monica L Guzman
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY
| | | | | | - Julia K Herzig
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | | | | | | | - Francis Lacombe
- Hematology Biology, Flow Cytometry, Bordeaux University Hospital, Pessac, France
| | | | - Agata Majchrzak
- Department of Experimental Hematology, Copernicus Memorial Hospital, Lodz, Poland
| | - Luca Maurillo
- Department of Biomedicine and Prevention, Hematology, University Tor Vergata, Rome, Italy
| | - Yishai Ofran
- Department of Hematology, Shaare Zedek Medical Center Faculty of Medicine Hebrew University, Jerusalem Israel
| | - Jan Philippe
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University
| | - Adriana Plesa
- Department of Hematology Laboratory, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | | | | | | | - Marion Subklewe
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Felicitas Thol
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bert A van der Reijden
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Adriano Venditti
- Department of Biomedicine and Prevention, Hematology, University Tor Vergata, Rome, Italy
| | | | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Brent L Wood
- Department of Hematopathology, Children's Hospital Los Angeles, CA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany; and
- AgenDix GmbH, Dresden, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Gail J Roboz
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY
| | - Jacqueline Cloos
- Department of Hematology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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35
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Tiong IS, Dillon R, Ivey A, Kuzich JA, Thiagarajah N, Sharplin KM, Kok CH, Tedjaseputra A, Rowland JP, Grove CS, Abro E, Shortt J, Hiwase DK, Bajel A, Potter NE, Smith ML, Hemmaway CJ, Thomas A, Gilkes AF, Russell NH, Wei AH. Clinical impact of NPM1-mutant molecular persistence after chemotherapy for acute myeloid leukemia. Blood Adv 2021; 5:5107-5111. [PMID: 34555849 PMCID: PMC9153038 DOI: 10.1182/bloodadvances.2021005455] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 01/07/2023] Open
Abstract
Monitoring of NPM1 mutant (NPM1mut) measurable residual disease (MRD) in acute myeloid leukemia (AML) has an established role in patients who are treated with intensive chemotherapy. The European LeukemiaNet has defined molecular persistence at low copy number (MP-LCN) as an MRD transcript level <1% to 2% with a <1-log change between any 2 positive samples collected after the end of treatment (EOT). Because the clinical impact of MP-LCN is unknown, we sought to characterize outcomes in patients with persistent NPM1mut MRD after EOT and identify factors associated with disease progression. Consecutive patients with newly diagnosed NPM1mut AML who received ≥2 cycles of intensive chemotherapy were included if bone marrow was NPM1mut MRD positive at the EOT, and they were not transplanted in first complete remission. One hundred patients were followed for a median of 23.5 months; 42% remained free of progression at 1 year, either spontaneously achieving complete molecular remission (CRMRD-; 30%) or retaining a low-level NPM1mut transcript (12% for ≥12 months and 9% at last follow-up). Forty percent met the criteria for MP-LCN. Preemptive salvage therapy significantly prolonged relapse-free survival. Risk factors associated with disease progression were concurrent FLT3-internal tandem duplication at diagnosis and suboptimal MRD response (NPM1mut reduction <4.4-log) at EOT.
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Affiliation(s)
- Ing S. Tiong
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
- Guy’s Hospital, London, United Kingdom
| | - Adam Ivey
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
| | - James A. Kuzich
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, VIC, Australia
| | - Nisha Thiagarajah
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Chung Hoow Kok
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | | | - Carolyn S. Grove
- Department of Haematology, Sir Charles Gairdner Hospital and PathWest, Perth, WA, Australia
| | - Emad Abro
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Jake Shortt
- Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | | | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nicola E. Potter
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Matthew L. Smith
- Department of Haematology, St. Bartholomew’s Hospital, London, United Kingdom
| | - Claire J. Hemmaway
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand; and
| | | | - Amanda F. Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | | | - Andrew H. Wei
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
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36
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Harrington P, Doores KJ, Saha C, Saunders J, Child F, Dillon R, Saglam S, Raj K, McLornan D, Avenoso D, Kordasti S, O'Reilly A, Espehana A, Lechmere T, Khan H, Malim MH, Harrison C, Mehra V, de Lavallade H. Repeated vaccination against SARS-CoV-2 elicits robust polyfunctional T cell response in allogeneic stem cell transplantation recipients. Cancer Cell 2021; 39:1654. [PMID: 34906318 PMCID: PMC8667332 DOI: 10.1016/j.ccell.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Harrington P, de Lavallade H, Doores KJ, O'Reilly A, Seow J, Graham C, Lechmere T, Radia D, Dillon R, Shanmugharaj Y, Espehana A, Woodley C, Saunders J, Curto-Garcia N, O'Sullivan J, Raj K, Kordasti S, Malim MH, Harrison CN, McLornan DP. Single dose of BNT162b2 mRNA vaccine against SARS-CoV-2 induces high frequency of neutralising antibody and polyfunctional T-cell responses in patients with myeloproliferative neoplasms. Leukemia 2021; 35:3573-3577. [PMID: 34023850 PMCID: PMC8140572 DOI: 10.1038/s41375-021-01300-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Patrick Harrington
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Hugues de Lavallade
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
- Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Amy O'Reilly
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jeffrey Seow
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Thomas Lechmere
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Deepti Radia
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Richard Dillon
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Department of Medicine and Molecular Genetics, King's College London, London, UK
| | - Yogita Shanmugharaj
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Andreas Espehana
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Claire Woodley
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jamie Saunders
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Natalia Curto-Garcia
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jennifer O'Sullivan
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Kavita Raj
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Shahram Kordasti
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Claire N Harrison
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Donal P McLornan
- Department of Clinical Haematology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
- School of Cancer and Pharmaceutical Science, King's College London, London, UK.
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38
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Harrington P, Doores KJ, Saha C, Saunders J, Child F, Dillon R, Saglam S, Raj K, McLornan D, Avenoso D, Kordasti S, O'Reilly A, Espehana A, Lechmere T, Khan H, Malim MH, Harrison C, Mehra V, de Lavallade H. Repeated vaccination against SARS-CoV-2 elicits robust polyfunctional T cell response in allogeneic stem cell transplantation recipients. Cancer Cell 2021; 39:1448-1449. [PMID: 34717827 PMCID: PMC8506143 DOI: 10.1016/j.ccell.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Patrick Harrington
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Chandan Saha
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Jamie Saunders
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Fiona Child
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Richard Dillon
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK; Department of Medicine & Molecular Genetics, King's College London, London, UK
| | - Sukran Saglam
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Kavita Raj
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Donal McLornan
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Daniele Avenoso
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Shahram Kordasti
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Amy O'Reilly
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Andreas Espehana
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Thomas Lechmere
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Hataf Khan
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Claire Harrison
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Varun Mehra
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Hugues de Lavallade
- Department of Clinical Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Science, King's College London, London, UK.
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Harrington P, Doores KJ, Radia D, O’Reilly A, Lam HPJ, Seow J, Graham C, Lechmere T, McLornan D, Dillon R, Shanmugharaj Y, Espehana A, Woodley C, Saunders J, Curto-Garcia N, O'Sullivan J, Raj K, Kordasti S, Malim MH, Harrison C, de Lavallade H. Single dose of BNT162b2 mRNA vaccine against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) induces neutralising antibody and polyfunctional T-cell responses in patients with chronic myeloid leukaemia. Br J Haematol 2021; 194:999-1006. [PMID: 34085278 PMCID: PMC8239833 DOI: 10.1111/bjh.17568] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022]
Abstract
Patients receiving targeted cancer treatments such as tyrosine kinase inhibitors (TKIs) have been classified in the clinically extremely vulnerable group to develop severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), including patients with chronic myeloid leukaemia (CML) taking TKIs. In addition, concerns that immunocompromised individuals with solid and haematological malignancies may not mount an adequate immune response to a single dose of SARS-CoV-2 BNT162b2 (Pfizer-BioNTech) vaccine have been raised. In the present study, we evaluated humoral and cellular immune responses after a first injection of BNT162b2 vaccine in 16 patients with CML. Seroconversion and cellular immune response before and after vaccination were assessed. By day 21 after vaccination, anti-Spike immunoglobulin G was detected in 14/16 (87·5%) of the patients with CML and all developed a neutralising antibody response [serum dilution that inhibits 50% infection (ID50 ) >50], including medium (ID50 of 200-500) or high (ID50 of 501-2000) neutralising antibodies titres in nine of the 16 (56·25%) patients. T-cell response was seen in 14/15 (93·3%) evaluable patients, with polyfunctional responses seen in 12/15 (80%) patients (polyfunctional CD4+ response nine of 15, polyfunctional CD8+ T-cell response nine of 15). These data demonstrate the immunogenicity of a single dose of SARS-CoV-2 BNT162b2 vaccine in most patients with CML, with both neutralising antibodies and polyfunctional T-cell responses seen in contrast to patients with solid tumour or lymphoid haematological malignancies.
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MESH Headings
- Adult
- Aged
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/immunology
- BNT162 Vaccine
- CD4-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/immunology
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19 Vaccines/administration & dosage
- COVID-19 Vaccines/immunology
- Female
- Hematologic Neoplasms/drug therapy
- Hematologic Neoplasms/immunology
- Humans
- Immunity, Cellular/drug effects
- Immunoglobulin G/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Male
- Middle Aged
- Protein Kinase Inhibitors/administration & dosage
- SARS-CoV-2/immunology
- Spike Glycoprotein, Coronavirus/immunology
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Affiliation(s)
- Patrick Harrington
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical ScienceKing’s College LondonLondonUK
| | - Katie J. Doores
- Department of Infectious DiseasesSchool of Immunology and Microbial SciencesKing’s College LondonLondonUK
| | - Deepti Radia
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Amy O’Reilly
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Ho Pui Jeff Lam
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Jeffrey Seow
- Department of Infectious DiseasesSchool of Immunology and Microbial SciencesKing’s College LondonLondonUK
| | - Carl Graham
- Department of Infectious DiseasesSchool of Immunology and Microbial SciencesKing’s College LondonLondonUK
| | - Thomas Lechmere
- Department of Infectious DiseasesSchool of Immunology and Microbial SciencesKing’s College LondonLondonUK
| | - Donal McLornan
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical ScienceKing’s College LondonLondonUK
| | - Richard Dillon
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
- Department of Medicine and Molecular GeneticsKing’s College LondonLondonUK
| | - Yogita Shanmugharaj
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Andreas Espehana
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Claire Woodley
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Jamie Saunders
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Natalia Curto-Garcia
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Jennifer O'Sullivan
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Kavita Raj
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Shahram Kordasti
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical ScienceKing’s College LondonLondonUK
| | - Michael H. Malim
- Department of Infectious DiseasesSchool of Immunology and Microbial SciencesKing’s College LondonLondonUK
| | - Claire Harrison
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical ScienceKing’s College LondonLondonUK
| | - Hugues de Lavallade
- Department of Clinical HaematologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical ScienceKing’s College LondonLondonUK
- Department of Haematological MedicineKing’s College London School of MedicineLondonUK
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Abstract
In recent years there have been major advances in the use of molecular diagnostic and monitoring techniques for patients with acute myeloid leukaemia (AML). Coupled with the simultaneous explosion of new therapeutic agents, this has sown the seeds for significant improvements to treatment algorithms. Here we show, using a selection of real-life examples, how molecular monitoring can be used to refine clinical decision-making and to personalise treatment in patients with AML with nucleophosmin (NPM1) mutations, core binding factor translocations and other fusion genes. For each case we review the established evidence base and provide practical recommendations where evidence is lacking or conflicting. Finally, we review important technical considerations that clinicians should be aware of in order to safely exploit these technologies as they undergo widespread implementation.
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Affiliation(s)
- Richard Dillon
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College, London, UK
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Nicola Potter
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College, London, UK
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nigel Russell
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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41
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Monroy-Iglesias MJ, Russell B, Moss C, George G, Palmer K, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Sylva R, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Kulasekararaj A, Ko TK, Shah V, Rigg A, Sullivan R, Van Hemelrijck M, Dolly S. Abstract S12-03: Clinical and demographic characteristics associated with shorter time to COVID-19 death. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for >2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy’s Cancer Centre and one of its partner trusts (King’s College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death <7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer >24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death <7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and >5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death <7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients.
Citation Format: Maria J. Monroy-Iglesias, Beth Russell, Charlotte Moss, Gincy George, Kieran Palmer, Sophie Papa, Sheeba Irshad, Paul Ross, James Spicer, Sharam Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Rushan Sylva, Kamarul Zaki, Fareen Rahman, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Mary Lei, Sharmistha Ghosh, Claire Harrison, Angela Swampillai, Elinor Sawyer, Andrea D'Souza, Simon Gomberg, Paul Fields, David Wrench, Kavita Raj, Mary Gleeson, Kate Bailey, Richard Dillon, Matthew Streetly, Austin Kulasekararaj, Thinzar Ko Ko, Vallari Shah, Anne Rigg, Richard Sullivan, Mieke Van Hemelrijck, Saoirse Dolly. Clinical and demographic characteristics associated with shorter time to COVID-19 death [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S12-03.
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Affiliation(s)
- Maria J. Monroy-Iglesias
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Beth Russell
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Charlotte Moss
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Gincy George
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Kieran Palmer
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Sophie Papa
- 3Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Sheeba Irshad
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Paul Ross
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - James Spicer
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Sharam Kordasti
- 6Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Danielle Crawley
- 7Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London; Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Harriet Wylie
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Fidelma Cahill
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Anna Haire
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Rushan Sylva
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Kamarul Zaki
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Fareen Rahman
- 8Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom, London, United Kingdom,
| | - Ailsa Sita-Lumsden
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Debra Josephs
- 9Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Deborah Enting
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Mary Lei
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Sharmistha Ghosh
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Claire Harrison
- 10King’s College Hospital NHS Foundation Trust; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Angela Swampillai
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Elinor Sawyer
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Andrea D'Souza
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Simon Gomberg
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Paul Fields
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - David Wrench
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Kavita Raj
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Mary Gleeson
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Kate Bailey
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Richard Dillon
- 12Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT); Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King’s College London, London, United Kingdom,
| | - Matthew Streetly
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Austin Kulasekararaj
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Thinzar Ko Ko
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Vallari Shah
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Anne Rigg
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Richard Sullivan
- 14School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Mieke Van Hemelrijck
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Saoirse Dolly
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
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Harrington P, Harrison CN, Dillon R, Radia DH, Rezvani K, Raj K, Woodley C, Curto-Garcia N, O'Sullivan J, Saunders J, Kordasti S, Ali S, de Lavallade H, McLornan DP. Evidence of robust memory T-cell responses in patients with chronic myeloproliferative neoplasms following infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Br J Haematol 2021; 193:692-696. [PMID: 33719038 PMCID: PMC8251225 DOI: 10.1111/bjh.17402] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Patrick Harrington
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Claire N Harrison
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Richard Dillon
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Deepti H Radia
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kavita Raj
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Claire Woodley
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Natalia Curto-Garcia
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Jennifer O'Sullivan
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Jamie Saunders
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Shahram Kordasti
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Sahra Ali
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Hugues de Lavallade
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK.,Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Donal P McLornan
- Department of Haematology, Guy's International Centre of Excellence in Myeloid Disorders, Guy's and St Thomas NHS Foundation Trust, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
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43
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Craddock C, Jackson A, Loke J, Siddique S, Hodgkinson A, Mason J, Andrew G, Nagra S, Malladi R, Peniket A, Gilleece M, Salim R, Tholouli E, Potter V, Crawley C, Wheatley K, Protheroe R, Vyas P, Hunter A, Parker A, Wilson K, Pavlu J, Byrne J, Dillon R, Khan N, McCarthy N, Freeman SD. Augmented Reduced-Intensity Regimen Does Not Improve Postallogeneic Transplant Outcomes in Acute Myeloid Leukemia. J Clin Oncol 2021; 39:768-778. [PMID: 33373276 PMCID: PMC8078252 DOI: 10.1200/jco.20.02308] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Reduced-intensity conditioning (RIC) regimens have extended the curative potential of allogeneic stem-cell transplantation to older adults with high-risk acute myeloid leukemia (AML) and myelodysplasia (MDS) but are associated with a high risk of disease relapse. Strategies to reduce recurrence are urgently required. Registry data have demonstrated improved outcomes using a sequential transplant regimen, fludarabine/amsacrine/cytarabine-busulphan (FLAMSA-Bu), but the impact of this intensified conditioning regimen has not been studied in randomized trials. PATIENTS AND METHODS Two hundred forty-four patients (median age, 59 years) with high-risk AML (n = 164) or MDS (n = 80) were randomly assigned 1:1 to a fludarabine-based RIC regimen or FLAMSA-Bu. Pretransplant measurable residual disease (MRD) was monitored by flow cytometry (MFC-MRD) and correlated with outcome. RESULTS There was no difference in 2-year overall survival (hazard ratio 1.05 [85% CI, 0.80 to 1.38] P = .81) or cumulative incidence of relapse (CIR) (hazard ratio 0.94 [95%CI, 0.60 to 1.46] P = .81) between the control and FLAMSA-Bu arms. Detectable pretransplant MFC-MRD was associated with an increased CIR (2-year CIR 41.0% v 20.0%, P = .01) in the overall trial cohort with a comparable prognostic impact when measured by an unsupervised analysis approach. There was no evidence of interaction between MRD status and conditioning regimen intensity for relapse or survival. Acquisition of full donor T-cell chimerism at 3 months abrogated the adverse impact of pretransplant MRD on CIR and overall survival. CONCLUSION The intensified RIC conditioning regimen, FLAMSA-Bu, did not improve outcomes in adults transplanted for high-risk AML or MDS regardless of pretransplant MRD status. Our data instead support the exploration of interventions with the ability to accelerate acquisition of full donor T-cell chimerism as a tractable strategy to improve outcomes in patients allografted for AML.
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Affiliation(s)
- Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Shamyla Siddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Andrea Hodgkinson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - John Mason
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Georgia Andrew
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ram Malladi
- Addenbrookes Hospital, Cambridge, United Kingdom
| | | | | | | | | | | | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | | | | | - Ann Hunter
- Leicester Royal Infirmary, United Kingdom
| | - Anne Parker
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Jiri Pavlu
- Imperial College Hospital, London, Unite Kingdom
| | - Jenny Byrne
- Centre for Clinical Haematology, Nottingham, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Naeem Khan
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
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44
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Tiong IS, Dillon R, Ivey A, Teh T, Nguyen P, Cummings N, Taussig DC, Latif A, Potter NE, Runglall M, Russell NH, Raj K, Schwarer AP, Fong CY, Grigg AP, Wei AH. Venetoclax induces rapid elimination of NPM1 mutant measurable residual disease in combination with low-intensity chemotherapy in acute myeloid leukaemia. Br J Haematol 2021; 192:1026-1030. [PMID: 32458446 PMCID: PMC8048658 DOI: 10.1111/bjh.16722] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
Based on promising results in older adults with acute myeloid leukaemia (AML), we treated patients with NPM1mut measurable residual disease (MRD) using off-label venetoclax in combination with low-dose cytarabine or azacitidine. Twelve consecutive patients were retrospectively identified, including five with molecular persistence and seven with molecular relapse/progression. All patients with molecular persistence achieved durable molecular complete remission (CRMRD- ) without transplantation. Six of seven patients with molecular relapse/progression achieved CRMRD- after 1-2 cycles of venetoclax. This paper highlights the promising efficacy of venetoclax-based therapy to reduce the relapse risk in patients with persistent or rising NPM1mut MRD.
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Affiliation(s)
- Ing S. Tiong
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
- Department of Clinical HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneVic.Australia
| | - Richard Dillon
- Department of Medical and Molecular GeneticsKing's CollegeLondonUK
- Guy's and St Thomas’ HospitalsLondonUK
| | - Adam Ivey
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | - Tse‐Chieh Teh
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | - Phillip Nguyen
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | | | | | | | - Nicola E. Potter
- Department of Medical and Molecular GeneticsKing's CollegeLondonUK
| | - Manohursingh Runglall
- NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College HospitalLondonUK
| | | | | | | | - Chun Yew Fong
- Department of Clinical HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneVic.Australia
| | - Andrew P. Grigg
- Department of Clinical HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneVic.Australia
| | - Andrew H. Wei
- Alfred Hospital and Monash UniversityMelbourneVic.Australia
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Dillon R, Ahearne MJ, Quek L, Potter N, Jovanovic J, Foot N, Valganon M, Jayne S, Dennis M, Raj K, Tauro S, Dyer MJS, Russell N, Solomon E, Grimwade D. Therapy-related leukaemias with balanced translocations can arise from pre-existing clonal haematopoiesis. Leukemia 2021; 35:2407-2411. [PMID: 33547376 PMCID: PMC8324469 DOI: 10.1038/s41375-021-01150-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/08/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Richard Dillon
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK ,grid.451052.70000 0004 0581 2008Department of Haematology, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK ,grid.239826.40000 0004 0391 895XCancer Genetics Service, Viapath, Guy’s Hospital, London, UK
| | - Matthew J. Ahearne
- grid.9918.90000 0004 1936 8411The Ernest and Helen Scott Haematological Research Institute, University of Leicester, Leicester, UK
| | - Lynn Quek
- grid.421962.a0000 0004 0641 4431Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK ,grid.13097.3c0000 0001 2322 6764Department of Haematology, King’s College, London, UK
| | - Nicola Potter
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
| | - Jelena Jovanovic
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
| | - Nicola Foot
- grid.239826.40000 0004 0391 895XCancer Genetics Service, Viapath, Guy’s Hospital, London, UK
| | - Mikel Valganon
- grid.239826.40000 0004 0391 895XCancer Genetics Service, Viapath, Guy’s Hospital, London, UK
| | - Sandrine Jayne
- grid.9918.90000 0004 1936 8411The Ernest and Helen Scott Haematological Research Institute, University of Leicester, Leicester, UK
| | - Mike Dennis
- grid.415720.50000 0004 0399 8363Department of Haematology, The Christie Hospital, Manchester, UK
| | - Kavita Raj
- grid.451052.70000 0004 0581 2008Department of Haematology, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Sudhir Tauro
- grid.416266.10000 0000 9009 9462Department of Haematology, Ninewells Hospital and Medical School, Dundee, UK
| | - Martin J. S. Dyer
- grid.9918.90000 0004 1936 8411The Ernest and Helen Scott Haematological Research Institute, University of Leicester, Leicester, UK
| | - Nigel Russell
- grid.451052.70000 0004 0581 2008Department of Haematology, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Ellen Solomon
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
| | - David Grimwade
- grid.13097.3c0000 0001 2322 6764Department of Medical and Molecular Genetics, King’s College, London, UK
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46
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Russell N, Dillon R. UK Experience of an Alternative ATO Dosing Regimen in APL. Front Oncol 2020; 10:594129. [PMID: 33262951 PMCID: PMC7688053 DOI: 10.3389/fonc.2020.594129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022] Open
Abstract
The introduction of all-trans retinoic acid (ATRA), and more recently of arsenic trioxide (ATO) in the treatment of Acute Promyelocytic Leukaemia (APL), has been instrumental in achieving the high cure rates recently reported. For the majority of patients, it is now possible to successfully treat this disease “chemo-free” without the use of cytotoxic chemotherapy as reflected in current clinical guidelines. The Sanz risk score developed by the GIMEMA and PETHEMA groups categorizes patients into three risk groups—low, intermediate, and high and correlates with relapse-free survival (RFS). Low- and intermediate-risk APL are now often considered together as ‘standard-risk’ defined by a white blood cell count (WBC) of less than 10 x 109/L. High-risk APL has a WBC greater than 10 x 109/L. In the UK our approach for patients with standard risk APL is to treat with ATRA and ATO without the use of cytotoxic chemotherapy. This approach is based on results from two large randomized clinical trials. The GIMEMA APL0406 trial showed an overall survival advantage compared to anthracycline-based chemotherapy plus ATRA. The UK NCRI AML17 trial which used an attenuated dose of ATO demonstrated a significant reduction in relapse and improved relapse-free survival. In the UK, the National Institute for Clinical Excellence approved both ATO plus ATRA regimens for re-imbursement for standard risk Acute Promyelocytic Leukaemia (APL). We use the AML17 schedule in standard-risk patients upfront and also in patients with relapsed Acute Promyelocytic Leukaemia (APL) previously treated with chemotherapy or in those with molecular persistence. The treatment of high-risk Acute Promyelocytic Leukaemia (APL) remains an area of contention as ATO is not approved for this indication. These patients have a greater risk of complications during remission induction with ATO including differentiation syndrome. The optimal approach is to incorporate chemotherapy early into the treatment schedule with either Gemtuzumab Ozogamicin (GO) as in the high-risk arm of the NCRI AML17 trial and MD Anderson Cancer Centre studies or Idarubicin as in the Australian APML4 study.
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Affiliation(s)
- Nigel Russell
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Trust, London, United Kingdom
| | - Richard Dillon
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Trust, London, United Kingdom.,Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College, London, United Kingdom
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47
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Pandey M, Peetermans M, Doyle AJ, Dillon R, Meadows CIS. Extracorporeal membrane oxygenation in a patient with newly diagnosed acute myeloblastic leukaemia presenting with severe respiratory failure. J Artif Organs 2020; 24:387-391. [PMID: 33180228 DOI: 10.1007/s10047-020-01225-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
Veno-venous extracorporeal membrane oxygenation (ECMO) is typically instituted in severe respiratory failure, defined by Lung Injury Score, and caused either by pulmonary or extra-pulmonary reversible disease processes. These processes will have led to acute worsening of oxygenation and/or respiratory acidosis together with an inability to provide safe, lung protective, mechanical ventilation. Patients with underlying chronic immunosuppression or haematological malignancies treated with ECMO for severe respiratory failure have poor short- and long-term functional and survival outcomes. Consequently, in many centres, a diagnosis of haematological malignancy is considered a contraindication to provision of ECMO support for severe respiratory failure. We present a case of a 51-year-old female who attended her local hospital with symptoms suggestive of community-acquired pneumonia. Within a few days, there was progression to severe respiratory failure, initially managed with invasive mechanical ventilation but rapidly deteriorating respiratory failure triggered referral for ECMO support. Initial investigations on ECMO demonstrated features of acute myeloblastic leukaemia with a superimposed community-acquired pneumonia. This was successfully managed with supportive treatment alongside mechanical respiratory therapy and targeted chemotherapy, achieving complete remission and full functional recovery.
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Affiliation(s)
- Manish Pandey
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Marijke Peetermans
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew J Doyle
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Dillon
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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48
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Alimam S, Ann Timms J, Harrison CN, Dillon R, Mare T, DeLavallade H, Radia D, Woodley C, Francis Y, Sanchez K, Kordasti S, McLornan DP. Altered immune response to the annual influenza A vaccine in patients with myeloproliferative neoplasms. Br J Haematol 2020; 193:150-154. [PMID: 33159465 DOI: 10.1111/bjh.17096] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
Abstract
The seasonal influenza A vaccine is recommended for patients with myeloproliferative neoplasms (MPNs). We hypothesised that immune deregulation associated with MPNs may affect the immune response gained following vaccinations when compared to healthy controls. Using deep immunophenotyping with high-dimensional single-cell analysis and mass cytometry we could demonstrate an altered immune response in MPN patients following vaccination. We found that prior to vaccination, MPN patients had reduced numbers of naive CD4 T cells. Furthermore, at 3-weeks and 3-months post-vaccination there was evidence of both delayed and impaired B- and T-memory cells responses. Thus, although, the immune systems of MPN patients can 'recognise' the Influenza A vaccine, the response appears inferior compared to healthy controls.
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Affiliation(s)
- Samah Alimam
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Medical and Molecular Genetics, King's College, London, UK
| | - Jessica Ann Timms
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Richard Dillon
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Medical and Molecular Genetics, King's College, London, UK
| | - Tracey Mare
- Viapath, Department of Specialist Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Hugues DeLavallade
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Haematological Medicine, King's College Hospital, London, UK
| | - Deepti Radia
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Claire Woodley
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Yvonne Francis
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Katy Sanchez
- Haematological Medicine, King's College Hospital, London, UK.,Viapath, King's College Hospital, London, UK
| | - Shahram Kordasti
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Donal P McLornan
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
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49
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Russell B, Moss C, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Rigg A, Sullivan R, Dolly S, Van Hemelrijck M. Factors Affecting COVID-19 Outcomes in Cancer Patients: A First Report From Guy's Cancer Center in London. Front Oncol 2020; 10:1279. [PMID: 32903324 PMCID: PMC7396540 DOI: 10.3389/fonc.2020.01279] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background: There is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies. Methods: We used data from a single large UK Cancer Center to assess the demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February and 12 May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death. Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with a severe case of the disease. An initial cancer diagnosis >24 months before COVID-19 [OR: 1.74 (95% CI: 0.71-4.26)], presenting with fever [6.21 (1.76-21.99)], dyspnea [2.60 (1.00-6.76)], gastro-intestinal symptoms [7.38 (2.71-20.16)], or higher levels of C-reactive protein [9.43 (0.73-121.12)] were linked with greater COVID-19 severity. During a median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Being of Asian ethnicity [3.73 (1.28-10.91)], receiving palliative treatment [5.74 (1.15-28.79)], having an initial cancer diagnosis >24 months before [2.14 (1.04-4.44)], dyspnea [4.94 (1.99-12.25)], and increased CRP levels [10.35 (1.05-52.21)] were positively associated with COVID-19 death. An inverse association was observed with increased levels of albumin [0.04 (0.01-0.04)]. Conclusions: A longer-established diagnosis of cancer was associated with increased severity of infection as well as COVID-19 death, possibly reflecting the effects a more advanced malignant disease has on this infection. Asian ethnicity and palliative treatment were also associated with COVID-19 death in cancer patients.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sophie Papa
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sheeba Irshad
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Paul Ross
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - James Spicer
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Shahram Kordasti
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Fidelma Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Kamarul Zaki
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Fareen Rahman
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Ailsa Sita-Lumsden
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Debra Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Deborah Enting
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Mary Lei
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Sharmistha Ghosh
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Claire Harrison
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Angela Swampillai
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Elinor Sawyer
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Andrea D'Souza
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Simon Gomberg
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Paul Fields
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - David Wrench
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Kavita Raj
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Mary Gleeson
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Kate Bailey
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Richard Dillon
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Matthew Streetly
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Anne Rigg
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Saoirse Dolly
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
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50
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Dillon R, Hills R, Freeman S, Potter N, Jovanovic J, Ivey A, Kanda AS, Runglall M, Foot N, Valganon M, Khwaja A, Cavenagh J, Smith M, Ommen HB, Overgaard UM, Dennis M, Knapper S, Kaur H, Taussig D, Mehta P, Raj K, Novitzky-Basso I, Nikolousis E, Danby R, Krishnamurthy P, Hill K, Finnegan D, Alimam S, Hurst E, Johnson P, Khan A, Salim R, Craddock C, Spearing R, Gilkes A, Gale R, Burnett A, Russell NH, Grimwade D. Molecular MRD status and outcome after transplantation in NPM1-mutated AML. Blood 2020; 135:680-688. [PMID: 31932839 PMCID: PMC7059484 DOI: 10.1182/blood.2019002959] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Relapse remains the most common cause of treatment failure for patients with acute myeloid leukemia (AML) who undergo allogeneic stem cell transplantation (alloSCT), and carries a grave prognosis. Multiple studies have identified the presence of measurable residual disease (MRD) assessed by flow cytometry before alloSCT as a strong predictor of relapse, but it is not clear how these findings apply to patients who test positive in molecular MRD assays, which have far greater sensitivity. We analyzed pretransplant blood and bone marrow samples by reverse-transcription polymerase chain reaction in 107 patients with NPM1-mutant AML enrolled in the UK National Cancer Research Institute AML17 study. After a median follow-up of 4.9 years, patients with negative, low (<200 copies per 105ABL in the peripheral blood and <1000 copies in the bone marrow aspirate), and high levels of MRD had an estimated 2-year overall survival (2y-OS) of 83%, 63%, and 13%, respectively (P < .0001). Focusing on patients with low-level MRD before alloSCT, those with FLT3 internal tandem duplications(ITDs) had significantly poorer outcome (hazard ratio [HR], 6.14; P = .01). Combining these variables was highly prognostic, dividing patients into 2 groups with 2y-OS of 17% and 82% (HR, 13.2; P < .0001). T-depletion was associated with significantly reduced survival both in the entire cohort (2y-OS, 56% vs 96%; HR, 3.24; P = .0005) and in MRD-positive patients (2y-OS, 34% vs 100%; HR, 3.78; P = .003), but there was no significant effect of either conditioning regimen or donor source on outcome. Registered at ISRCTN (http://www.isrctn.com/ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Nuclear Proteins/genetics
- Nucleophosmin
- Recurrence
- Young Adult
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Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Anju Shankar Kanda
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Nicola Foot
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Mikel Valganon
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College, London, United Kingdom
| | | | | | | | | | - Mike Dennis
- Christie Hospital, Manchester, United Kingdom
| | - Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Harpreet Kaur
- Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Kavita Raj
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | | | | | | | | | - Kate Hill
- University Hospital, Southampton, United Kingdom
| | | | - Samah Alimam
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Erin Hurst
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | | | - Anjum Khan
- St James' Hospital, Leeds, United Kingdom
| | - Rahuman Salim
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Rosemary Gale
- Department of Haematology, University College, London, United Kingdom
| | - Alan Burnett
- Blackwaterfoot, Isle of Arran, United Kingdom; and
| | - Nigel H Russell
- Department of Haematology, Guy's Hospital, London, United Kingdom
- Nottingham University Hospital, Nottingham, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
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