1
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Abdelbaky SB, Giacopelli B, Rabe KG, Yamaguchi K, Wu YZ, Yan H, Shanafelt TD, Parikh SA, Ding W, Hampel PJ, Brown S, Cerhan JR, Vachon CM, Kay NE, Hanson CA, Parker AS, Braggio E, Slager SL, Oakes CC. Prediction of outcomes for high-count monoclonal B lymphocytosis using an epigenetic and immunogenetic signature. Blood 2024; 143:1752-1757. [PMID: 38194687 DOI: 10.1182/blood.2023022180] [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: 08/15/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
ABSTRACT Monoclonal B-cell lymphocytosis (MBL) progresses to chronic lymphocytic leukemia (CLL) requiring therapy at 1% to 5% per year. Improved prediction of progression would greatly benefit individuals with MBL. Patients with CLL separate into 3 distinct epigenetic subtypes (epitypes) with high prognostic significance, and recently the intermediate epitype has been shown to be enriched for high-risk immunoglobulin lambda variable (IGLV) 3-21 rearrangements, impacting outcomes for these patients. Here, we employed this combined strategy to generate the epigenetic and light chain immunoglobulin (ELCLV3-21) signature to classify 219 individuals with MBL. The ELCLV3-21 high-risk signature distinguished MBL individuals with a high probability of progression (39.9% and 71.1% at 5 and 10 years, respectively). ELCLV3-21 improved the accuracy of predicting time to therapy for individuals with MBL compared with other established prognostic indicators, including the CLL international prognostic index (c-statistic, 0.767 vs 0.668, respectively). Comparing ELCLV3-21 risk groups in MBL vs a cohort of 226 patients with CLL revealed ELCLV3-21 high-risk individuals with MBL had significantly shorter time to therapy (P = .003) and reduced overall survival (P = .03) compared with ELCLV3-21 low-risk individuals with CLL. These results highlight the power of the ELCLV3-21 approach to identify individuals with a higher likelihood of adverse clinical outcome and may provide a more accurate approach to classify individuals with small B-cell clones.
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MESH Headings
- Humans
- Lymphocytosis/genetics
- Lymphocytosis/diagnosis
- Lymphocytosis/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Female
- Male
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- Aged
- Middle Aged
- Prognosis
- Epigenesis, Genetic
- Aged, 80 and over
- Adult
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Affiliation(s)
- Salma B Abdelbaky
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Brian Giacopelli
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Kari G Rabe
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Kyoko Yamaguchi
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Yue-Zhong Wu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Huihuang Yan
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | - Tait D Shanafelt
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | | | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Sochilt Brown
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | | | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Immunology, Mayo Clinic, Rochester, MN
| | - Curtis A Hanson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Susan L Slager
- Division of Computational Biology, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Christopher C Oakes
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
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2
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Ruan GJ, Wu X, Gwin KA, Manske MK, Abeykoon JP, Bhardwaj V, Witter TL, Schellenberg MJ, Rabe KG, Kay NE, Parikh SA, Witzig TE. Monocyte response to SARS-CoV-2 protein ORF8 is associated with severe COVID-19 infection in patients with chronic lymphocytic leukemia. Haematologica 2024. [PMID: 38654668 DOI: 10.3324/haematol.2023.284617] [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: 11/04/2023] [Indexed: 04/26/2024] Open
Abstract
The open reading frame 8 (ORF8) protein, encoded by the SARS-CoV-2 virus after infection, stimulates monocytes/macrophages to produce pro-inflammatory cytokines. We hypothesized that a positive ex vivo monocyte response to ORF8 protein pre-COVID-19 would be associated with subsequent severe COVID-19. We tested ORF8 ex vivo on peripheral blood mononuclear cells (PBMCs) from 26 anonymous healthy blood donors and measured intracellular cytokine/chemokine levels in monocytes by flow cytometry. The % monocytes staining positive in the sample and change in mean fluorescence intensity (ΔMFI) after ORF8 were used to calculate the adjusted MFI for each cytokine. We then tested pre-COVID-19 PBMC samples from 60 CLL patients who subsequently developed COVID-19 infection. Severe COVID-19 was defined as hospitalization due to COVID-19. In the 26 normal donor samples, the adjusted MFI for interleukin (IL)-1β, IL-6, IL-8, and CCL-2 were significantly different with ORF8 stimulation vs controls. We next analyzed monocytes from pre-COVID-19 PBMC samples from 60 CLL patients. The adjusted MFI to ORF8 stimulation of monocyte intracellular IL-1β was associated with severe COVID-19 and a reactive ORF8 monocyte response was defined as an IL- 1β adjusted MFI ≥ 0.18 (sensitivity 67%, specificity 75%). The median time to hospitalization after infection in CLL patients with a reactive ORF8 response was 12 days versus not reached for patients with a non-reactive ORF8 response with a hazard ratio of 7.7 (95% CI: 2.4-132, p=0.005). These results provide new insight on the monocyte inflammatory response to virus with implications in a broad range of disorders involving monocytes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Neil E Kay
- Division of Hematology, Department of Medicine; Department of Immunology, Mayo Clinic Rochester, MN
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3
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Woyach JA, Perez Burbano G, Ruppert AS, Miller C, Heerema NA, Zhao W, Wall A, Ding W, Bartlett NL, Brander DM, Barr PM, Rogers KA, Parikh SA, Stephens DM, Brown JR, Lozanski G, Blachly J, Nattam S, Larson RA, Erba H, Litzow M, Luger S, Owen C, Kuzma C, Abramson JS, Little RF, Dinner S, Stone RM, Uy G, Stock W, Mandrekar SJ, Byrd JC. Follow-up from the A041202 study shows continued efficacy of ibrutinib regimens for older adults with CLL. Blood 2024; 143:1616-1627. [PMID: 38215395 DOI: 10.1182/blood.2023021959] [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: 07/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
ABSTRACT A041202 (NCT01886872) is a phase 3 study comparing bendamustine plus rituximab (BR) with ibrutinib and the combination of ibrutinib plus rituximab (IR) in previously untreated older patients with chronic lymphocytic leukemia (CLL). The initial results showed that ibrutinib-containing regimens had superior progression-free survival (PFS) and rituximab did not add additional benefits. Here we present an updated analysis. With a median follow-up of 55 months, the median PFS was 44 months (95% confidence interval [CI], 38-54) for BR and not yet reached in either ibrutinib-containing arm. The 48-month PFS estimates were 47%, 76%, and 76% for BR, ibrutinib, and IR, respectively. The benefit of ibrutinib regimens over chemoimmunotherapy was consistent across subgroups of patients defined by TP53 abnormalities, del(11q), complex karyotype, and immunoglobulin heavy chain variable region (IGHV). No significant interaction effects were observed between the treatment arm and del(11q), the complex karyotype, or IGHV. However, a greater difference in PFS was observed among the patients with TP53 abnormalities. There was no difference in the overall survival. Notable adverse events with ibrutinib included atrial fibrillation (afib) and hypertension. Afib was observed in 11 patients (pts) on BR (3%) and 67 pts on ibrutinib (18%). All-grade hypertension was observed in 95 pts on BR (27%) and 263 pts on ibrutinib (55%). These data show that ibrutinib regimens prolong PFS compared with BR for older patients with treatment-naïve CLL. These benefits were observed across subgroups, including high-risk groups. Strikingly, within the ibrutinib arms, there was no inferior PFS for patients with abnormalities in TP53, the highest risk feature observed in CLL. These data continue to demonstrate the efficacy of ibrutinib in treatment-naïve CLL.
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Affiliation(s)
| | | | - Amy S Ruppert
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Cecelia Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyla A Heerema
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Weiqiang Zhao
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Anna Wall
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Wei Ding
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Paul M Barr
- University of Rochester Medical Center, Rochester, NY
| | - Kerry A Rogers
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Gerard Lozanski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Harry Erba
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Mark Litzow
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Selina Luger
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carolyn Owen
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Charles Kuzma
- First Health of the Carolinas Cancer Center, Southeast Clinical Oncology Research Consortium, Winston-Salem, NC
| | | | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Shira Dinner
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | | | - Geoffrey Uy
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Wendy Stock
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Sumithra J Mandrekar
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - John C Byrd
- University of Cincinnati Cancer Center, Cincinnati, OH
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4
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Ripoll JG, Tulledge-Scheitel SM, Stephenson AA, Ford S, Pike ML, Gorman EK, Hanson SN, Juskewitch JE, Miller AJ, Zaremba S, Ovrom EA, Razonable RR, Ganesh R, Hurt RT, Fischer EN, Derr AN, Eberle MR, Larsen JJ, Carney CM, Theel ES, Parikh SA, Kay NE, Joyner MJ, Senefeld JW. Outpatient treatment with concomitant vaccine-boosted convalescent plasma for patients with immunosuppression and COVID-19. mBio 2024:e0040024. [PMID: 38602414 DOI: 10.1128/mbio.00400-24] [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: 02/08/2024] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
Although severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. In addition, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 ("vax-plasma"). Thus, we report the clinical outcome of 386 immunocompromised outpatients who were diagnosed with COVID-19 and who received contemporary COVID-19-specific therapeutics (standard-of-care group) and a subgroup who also received concomitant treatment with very high titer COVID-19 convalescent plasma (vax-plasma group) with a specific focus on hospitalization rates. The overall hospitalization rate was 2.2% (5 of 225 patients) in the vax-plasma group and 6.2% (10 of 161 patients) in the standard-of-care group, which corresponded to a relative risk reduction of 65% (P = 0.046). Evidence of efficacy in nonvaccinated patients cannot be inferred from these data because 94% (361 of 386 patients) of patients were vaccinated. In vaccinated patients with immunosuppression and COVID-19, the addition of vax-plasma or very high titer COVID-19 convalescent plasma to COVID-19-specific therapies reduced the risk of disease progression leading to hospitalization.IMPORTANCEAs SARS-CoV-2 evolves, new variants of concern (VOCs) have emerged that evade available anti-spike monoclonal antibodies, particularly among immunosuppressed patients. However, high-titer COVID-19 convalescent plasma continues to be effective against VOCs because of its broad-spectrum immunomodulatory properties. Thus, we report clinical outcomes of 386 immunocompromised outpatients who were treated with COVID-19-specific therapeutics and a subgroup also treated with vaccine-boosted convalescent plasma. We found that the administration of vaccine-boosted convalescent plasma was associated with a significantly decreased incidence of hospitalization among immunocompromised COVID-19 outpatients. Our data add to the contemporary data providing evidence to support the clinical utility of high-titer convalescent plasma as antibody replacement therapy in immunocompromised patients.
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Affiliation(s)
- Juan G Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Anthony A Stephenson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shane Ford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marsha L Pike
- Department of Nursing, Mayo Clinic, Rochester, Rochester, Minnesota, USA
| | - Ellen K Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara N Hanson
- Department of Family Medicine, Mayo Clinic Health Care System, Mankato, Minnesota, USA
| | - Justin E Juskewitch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alex J Miller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Solomiia Zaremba
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik A Ovrom
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymund R Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin N Fischer
- Department of Nursing, Mayo Clinic, Rochester, Rochester, Minnesota, USA
| | - Amber N Derr
- Division of Hematology and Infusion Therapy, Rochester, Minnesota, USA
| | - Michele R Eberle
- Mayo Clinic Health System Northwest Wisconsin, Eau Claire, Wisconsin, USA
| | - Jennifer J Larsen
- Division of Hematology and Infusion Therapy, Rochester, Minnesota, USA
| | | | - Elitza S Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer A Parikh
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health and Kinesiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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5
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Kleinstern G, Boddicker NJ, O’Brien DR, Allmer C, Rabe KG, Norman AD, Griffin R, Yan H, Ma T, Call TG, Bruins L, Brown S, Bonolo de Campos C, Hanson CA, Leis JF, Ding W, Vachon CM, Kay NE, Oakes CC, Parker AS, Brander DM, Weinberg JB, Furman RR, Shanafelt TD, Cerhan JR, Parikh SA, Braggio E, Slager SL. Tumor mutational load is prognostic for progression to therapy among high-count monoclonal B-cell lymphocytosis (HCMBL). Blood Adv 2024; 8:bloodadvances.2023012242. [PMID: 38359367 PMCID: PMC11059316 DOI: 10.1182/bloodadvances.2023012242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
HCMBL is a precursor condition to chronic lymphocytic leukemia (CLL). We have shown that among individuals with HCMBL the CLL-International Prognostic Index (CLL-IPI) is prognostic for time-to-first therapy (TTFT). Little is known about the prognostic impact of somatically mutated genes among individuals with HCMBL. We sequenced DNA from 371 HCMBL individuals using a targeted sequencing panel of 59 recurrently mutated genes in CLL to identify high-impact mutations. We compared the sequencing results to that of our treatment-naïve CLL cohort(N=855) and employed Cox regression to estimate hazard ratios and 95% confidence intervals (CI) for associations with TTFT. Compared to CLL, the frequencies of any mutated genes were lower in HCMBL (70% versus 52%). At 10-years, 37% of HCMBL individuals with any mutated gene had progressed requiring treatment compared to 10% among HCMBL individuals with no mutations; this led to 5.4-fold shorter TTFT (95%CI:2.6-11.0) among HCMBL with any mutated gene versus none, independent of CLL-IPI. When considering individuals with low-risk of progression according to CLL-IPI, HCMBL individuals with any mutations had 4.3-fold shorter TTFT (95%CI:1.6-11.8) versus those with none. Finally, when considering both CLL-IPI and any mutated gene status, we observed HCMBL individuals who were high-risk for both prognostic factors with worse prognosis compared to low-risk CLL patients (i.e., 5-year progression rate of 32% versus 21%, respectively). Among HCMBL, the frequency of somatically mutated genes at diagnosis is lower than that of CLL. Accounting for both the number of mutated genes and CLL-IPI can identify HCMBL individuals with more aggressive clinical course.
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Affiliation(s)
- Geffen Kleinstern
- School of Public Health, University of Haifa, Haifa, Israel
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | | | | | - Cristine Allmer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Kari G. Rabe
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Rosalie Griffin
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | - Huihuang Yan
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | - Tao Ma
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | | | - Laura Bruins
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Sochilt Brown
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Curtis A. Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jose F. Leis
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Christopher C. Oakes
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH
- The Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | | | | | - J. Brice Weinberg
- Department of Medicine, Duke University, Duke Cancer Institute, Durham, NC
- Department of Immunology, Duke University Medical Center, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
| | - Richard R. Furman
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY
| | - Tait D. Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Stanford, CA
| | | | | | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Susan L. Slager
- Division of Computational Biology, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
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6
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Samples L, Voutsinas J, Fakhri B, Khajavian S, Spurgeon S, Stephens D, Skarbnik A, Mato A, Broome C, Gopal A, Smith S, Lynch R, Rainey M, Kim MS, Barrett-Campbell O, Hemond E, Tsang M, Ermann D, Malakhov N, Rao D, Shakib-Azar M, Morrigan B, Chauhan A, Plate T, Gooley T, Ryan K, Lansigan F, Hill B, Pongas G, Parikh SA, Roeker L, Allan JN, Cheng R, Ujjani C, Shadman M. Hypertension Treatment in Patients Receiving Ibrutinib: A Multicenter Retrospective Study. Blood Adv 2024; 8:bloodadvances.2023011569. [PMID: 38315043 PMCID: PMC11063398 DOI: 10.1182/bloodadvances.2023011569] [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: 08/31/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 02/07/2024] Open
Abstract
Although Bruton's tyrosine kinase inhibitors (BTKis) are generally well-tolerated and less toxic than chemotherapy alternatives used to treat lymphoid malignancies, BTKis like ibrutinib have the potential to cause new or worsening hypertension (HTN). Little is known about the optimal treatment of BTKi-associated HTN. Randomly selected patients with lymphoid malignancies on a BTKi and anti-hypertensive drug(s) and with at least 3 months of follow up data were sorted into two groups: those diagnosed with HTN prior to BTKi initiation (prior-HTN), and those diagnosed with HTN after BTKi initiation (de novo HTN). Generalized estimating equations assessed associations between time varying mean arterial pressures (MAPs) and individual anti-HTN drug categories. Of the 196 patients included in the study, 118 had prior-HTN, and 78 developed de novo HTN. Statistically significant mean MAP reductions were observed in patients with prior-HTN who took beta blockers (BBs) with hydrochlorothiazide (HCTZ), (-5.05 mmHg; 95% CI -10.0 to -0.0596; p = 0.047), and patients diagnosed with de novo HTN who took either an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) with HCTZ (-5.47 mmHg; 95% CI -10.9 to -0.001; p = 0.05). These regimens also correlated with the greatest percentages of normotensive MAPs. Treatment of HTN in patients taking a BTKi is challenging and may require multiple anti-hypertensives. Patients with prior-HTN appear to benefit from combination regimens with BBs and HCTZ, whereas patients with de novo HTN appear to benefit from ACEi/ARBs with HCTZ. These results should be confirmed in prospective studies.
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Affiliation(s)
- Laura Samples
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Jenna Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Bita Fakhri
- Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Sirin Khajavian
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stephen Spurgeon
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | - Deborah Stephens
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | | | - Anthony Mato
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine Broome
- Division of Hematology and Oncology, Georgetown University, Washington, DC
| | - Ajay Gopal
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Stephen Smith
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Ryan Lynch
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Magdalena Rainey
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Myung Sun Kim
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | | | - Emily Hemond
- Hematology/Oncology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mazie Tsang
- Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Daniel Ermann
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | - Nikita Malakhov
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Danielle Rao
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Beth Morrigan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Ayushi Chauhan
- Division of Hematology and Oncology, Georgia Cancer Center, Augusta University, Augusta, GA
| | - Thomas Plate
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Frederick Lansigan
- Hematology/Oncology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Brian Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Georgios Pongas
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | - Lindsey Roeker
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John N. Allan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Richard Cheng
- Division of Cardiology, University of Washington, Seattle, WA
| | - Chaitra Ujjani
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
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7
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Sakemura RL, Manriquez Roman C, Horvei P, Siegler EL, Girsch JH, Sirpilla OL, Stewart CM, Yun K, Can I, Ogbodo EJ, Adada MM, Bezerra ED, Kankeu Fonkoua LA, Hefazi M, Ruff MW, Kimball BL, Mai LK, Huynh TN, Nevala WK, Ilieva K, Augsberger C, Patra-Kneuer M, Schanzer J, Endell J, Heitmüller C, Steidl S, Parikh SA, Ding W, Kay NE, Nowakowski GS, Kenderian SS. CD19 occupancy with tafasitamab increases therapeutic index of CART19 cell therapy and diminishes severity of CRS. Blood 2024; 143:258-271. [PMID: 37879074 PMCID: PMC10808250 DOI: 10.1182/blood.2022018905] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
ABSTRACT In the development of various strategies of anti-CD19 immunotherapy for the treatment of B-cell malignancies, it remains unclear whether CD19 monoclonal antibody therapy impairs subsequent CD19-targeted chimeric antigen receptor T-cell (CART19) therapy. We evaluated the potential interference between the CD19-targeting monoclonal antibody tafasitamab and CART19 treatment in preclinical models. Concomitant treatment with tafasitamab and CART19 showed major CD19 binding competition, which led to CART19 functional impairment. However, when CD19+ cell lines were pretreated with tafasitamab overnight and the unbound antibody was subsequently removed from the culture, CART19 function was not affected. In preclinical in vivo models, tafasitamab pretreatment demonstrated reduced incidence and severity of cytokine release syndrome and exhibited superior antitumor effects and overall survival compared with CART19 alone. This was associated with transient CD19 occupancy with tafasitamab, which in turn resulted in the inhibition of CART19 overactivation, leading to diminished CAR T apoptosis and pyroptosis of tumor cells.
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Affiliation(s)
- R. Leo Sakemura
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Claudia Manriquez Roman
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN
| | - Paulina Horvei
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Pediatric Bone Marrow Transplant and Cellular Therapy, UPMC Children’s Hospital of Pittsburgh, PA
| | - Elizabeth L. Siegler
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - James H. Girsch
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN
| | - Olivia L. Sirpilla
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Carli M. Stewart
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Kun Yun
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN
| | - Ismail Can
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN
| | - Ekene J. Ogbodo
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Mohamad M. Adada
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Mehrdad Hefazi
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Michael W. Ruff
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Brooke L. Kimball
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Long K. Mai
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Truc N. Huynh
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Saad S. Kenderian
- T Cell Engineering, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN
- Department of Immunology, Mayo Clinic, Rochester, MN
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8
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Welch BM, Manso BA, Gwin KA, Lothert PK, Parikh SA, Kay NE, Medina KL. Comparison of the blood immune repertoire with clinical features in chronic lymphocytic leukemia patients treated with chemoimmunotherapy or ibrutinib. Front Oncol 2023; 13:1302038. [PMID: 38111528 PMCID: PMC10725910 DOI: 10.3389/fonc.2023.1302038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of CD19+ CD5+ clonal B lymphocytes in the blood, bone marrow, and peripheral lymphoid organs. Treatment options for patients range from historical chemoimmunotherapy (CIT) to small molecule inhibitors targeting pro-survival pathways in leukemic B cells, such as the Bruton's tyrosine kinase inhibitor ibrutinib (IBR). Using biobanked blood samples obtained pre-therapy and at standard response evaluation timepoints, we performed an in-depth evaluation of the blood innate and adaptive immune compartments between pentostatin-based CIT and IBR and looked for correlations with clinical sequelae. CD4+ conventional T cells and CD8+ cytotoxic T cells responded similarly to CIT and IBR, although exhaustion status differed. Both treatments dramatically increased the prevalence and functional status of monocyte, dendritic cell, and natural killer cell subsets. As expected, both regimens reduced clonal B cell levels however, we observed no substantial recovery of normal B cells. Although improvements in most immune subsets were observed with CIT and IBR at response evaluation, both patient groups remained susceptible to infections and secondary malignancies during the study.
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Affiliation(s)
- Baustin M. Welch
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Bryce A. Manso
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
- Department of Biomolecular Engineering, University of California, Santa Cruz, Santa Cruz, CA, United States
| | - Kimberly A. Gwin
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Petra K. Lothert
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Sameer A. Parikh
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Neil E. Kay
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Kay L. Medina
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
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9
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Kosydar SR, Parikh SA, Lester SC, Rabe KG, Ding W, Burlile JF, Kenderian SS, Wang Y, Muchtar E, Koehler AB, Schwager SM, Slager SL, Kay NE, Call TG, Breen WG, Hampel PJ. Safety of radiotherapy for second primary malignancies in patients with chronic lymphocytic leukemia receiving concurrent novel agent treatment. Am J Hematol 2023; 98:E318-E321. [PMID: 37614209 DOI: 10.1002/ajh.27060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Samuel R Kosydar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kari G Rabe
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jessica F Burlile
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Saad S Kenderian
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yucai Wang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amber B Koehler
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan M Schwager
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan L Slager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Computational Biology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil E Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul J Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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10
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Senefeld JW, Gorman EK, Johnson PW, Moir ME, Klassen SA, Carter RE, Paneth NS, Sullivan DJ, Morkeberg OH, Wright RS, Fairweather D, Bruno KA, Shoham S, Bloch EM, Focosi D, Henderson JP, Juskewitch JE, Pirofski LA, Grossman BJ, Tobian AA, Franchini M, Ganesh R, Hurt RT, Kay NE, Parikh SA, Baker SE, Buchholtz ZA, Buras MR, Clayburn AJ, Dennis JJ, Diaz Soto JC, Herasevich V, Klompas AM, Kunze KL, Larson KF, Mills JR, Regimbal RJ, Ripoll JG, Sexton MA, Shepherd JR, Stubbs JR, Theel ES, van Buskirk CM, van Helmond N, Vogt MN, Whelan ER, Wiggins CC, Winters JL, Casadevall A, Joyner MJ. Rates Among Hospitalized Patients With COVID-19 Treated With Convalescent Plasma: A Systematic Review and Meta-Analysis. Mayo Clin Proc Innov Qual Outcomes 2023; 7:499-513. [PMID: 37859995 PMCID: PMC10582279 DOI: 10.1016/j.mayocpiqo.2023.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Objective To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19. Patients and Methods On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization. Results Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio [OR], 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82). Conclusion During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.
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Affiliation(s)
- Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - M. Erin Moir
- Department of Kinesiology, University of Wisconsin-Madison, Madison
| | - Stephen A. Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Nigel S. Paneth
- Department of Epidemiology and Biostatistics and Department of Pediatrics and Human Development, Michigan State University, East Lansing
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
| | - Olaf H. Morkeberg
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - R. Scott Wright
- Human Research Protection Program, Mayo Clinic, Rochester, MN
| | | | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M. Bloch
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, MO
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, MO
| | | | - Liise-Anne Pirofski
- Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Brenda J. Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, MO
| | - Aaron A.R. Tobian
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
| | - Massimo Franchini
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Ravindra Ganesh
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ryan T. Hurt
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Immunology, Mayo Clinic, Rochester, MN
| | | | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Zachary A. Buchholtz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew R. Buras
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | - Andrew J. Clayburn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Joshua J. Dennis
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan C. Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allan M. Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Katie L. Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | | | - John R. Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan G. Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A. Sexton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - John R.A. Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - James R. Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Elitza S. Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Noud van Helmond
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew N.P. Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Emily R. Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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11
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Audil HY, Kosydar SR, Larson DP, Parikh SA. Richter Transformation of Chronic Lymphocytic Leukemia-Are We Making Progress? Curr Hematol Malig Rep 2023; 18:144-157. [PMID: 37294394 DOI: 10.1007/s11899-023-00701-y] [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] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW The treatment paradigm of chronic lymphocytic leukemia (CLL) has dramatically changed with the advent of novel targeted agents over the past decade. Richter transformation (RT), or the development of an aggressive lymphoma from a background of CLL, is a well-recognized complication of CLL and carries significantly poor clinical outcomes. Here, we provide an update on current diagnostics, prognostication, and contemporary treatment of RT. RECENT FINDINGS Several genetic, biologic, and laboratory markers have been proposed as candidate risk factors for the development of RT. Although a diagnosis of RT is typically suspected based on clinical and laboratory findings, tissue biopsy is essential for histopathologic confirmation of diagnosis. The standard of care for RT treatment at this time remains chemoimmunotherapy with the goal of proceeding to allogeneic stem cell transplantation in eligible patients. Several newer treatment modalities are being studied for use in the management of RT, including small molecules, immunotherapy, bispecific antibodies, and chimeric antigen receptor T-cell (CAR-T) therapy. The management of patients with RT remains a challenge. Ongoing trials show enormous promise for newer classes of therapy in RT, with the hope being that these agents can synergize, and perhaps supersede, the current standard of care in the near future.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Immunotherapy
- Biopsy
- Cell Transformation, Neoplastic/genetics
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Affiliation(s)
- Hadiyah Y Audil
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Samuel R Kosydar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel P Larson
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Sameer A Parikh
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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12
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Cass SH, Tobin JWD, Seo YD, Gener-Ricos G, Keung EZ, Burton EM, Davies MA, McQuade JL, Lazar AJ, Mason R, Millward M, Sandhu S, Khoo C, Warburton L, Guerra V, Haydon A, Dearden H, Menzies AM, Carlino MS, Smith JL, Mollee P, Burgess M, Mapp S, Keane C, Atkinson V, Parikh SA, Markovic SN, Ding W, Call TG, Hampel PJ, Long GV, Wargo JA, Ferrajoli A. Efficacy of immune checkpoint inhibitors for the treatment of advanced melanoma in patients with concomitant chronic lymphocytic leukemia. Ann Oncol 2023; 34:796-805. [PMID: 37414216 DOI: 10.1016/j.annonc.2023.06.007] [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: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced melanoma (AM). However, data on ICI effectiveness have largely been restricted to clinical trials, thereby excluding patients with co-existing malignancies. Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia and is associated with increased risk of melanoma. CLL alters systemic immunity and can induce T-cell exhaustion, which may limit the efficacy of ICIs in patients with CLL. We, therefore, sought to examine the efficacy of ICI in patients with these co-occurring diagnoses. PATIENTS AND METHODS In this international multicenter study, a retrospective review of clinical databases identified patients with concomitant diagnoses of CLL and AM treated with ICI (US-MD Anderson Cancer Center, N = 24; US-Mayo Clinic, N = 15; AUS, N = 19). Objective response rates (ORRs), assessed by RECIST v1.1, and survival outcomes [overall survival (OS) and progression-free survival (PFS)] among patients with CLL and AM were assessed. Clinical factors associated with improved ORR and survival were explored. Additionally, ORR and survival outcomes were compared between the Australian CLL/AM cohort and a control cohort of 148 Australian patients with AM alone. RESULTS Between 1997 and 2020, 58 patients with concomitant CLL and AM were treated with ICI. ORRs were comparable between AUS-CLL/AM and AM control cohorts (53% versus 48%, P = 0.81). PFS and OS from ICI initiation were also comparable between cohorts. Among CLL/AM patients, a majority were untreated for their CLL (64%) at the time of ICI. Patients with prior history of chemoimmunotherapy treatment for CLL (19%) had significantly reduced ORRs, PFS, and OS. CONCLUSIONS Our case series of patients with concomitant CLL and melanoma demonstrate frequent, durable clinical responses to ICI. However, those with prior chemoimmunotherapy treatment for CLL had significantly worse outcomes. We found that CLL disease course is largely unchanged by treatment with ICI.
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Affiliation(s)
- S H Cass
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J W D Tobin
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - Y D Seo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Gener-Ricos
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | - E Z Keung
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - E M Burton
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - M A Davies
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - J L McQuade
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - A J Lazar
- Departments of Pathology and Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Mason
- Gold Coast University Hospital, Southport
| | | | - S Sandhu
- Peter Macallum Cancer Centre, Melbourne
| | - C Khoo
- Peter Macallum Cancer Centre, Melbourne
| | - L Warburton
- Fiona Stanley Hospital, Perth; Edith Cowan University, Joondalup; Future Health Research and Innovation Fund/Raine Clinician Research Fellowship
| | - V Guerra
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | | | - H Dearden
- Melanoma Institute Australia, The University of Sydney, Sydney
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney; Westmead Hospital, Sydney, Australia
| | - J L Smith
- Westmead Hospital, Sydney, Australia
| | - P Mollee
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - M Burgess
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - S Mapp
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - C Keane
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - V Atkinson
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | | | | | - W Ding
- Mayo Clinic, Rochester, USA
| | | | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - J A Wargo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
| | - A Ferrajoli
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
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13
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Sakemura RL, Hefazi M, Cox MJ, Siegler EL, Sinha S, Hansen MJ, Stewart CM, Feigin JM, Roman CM, Schick KJ, Can I, Tapper EE, Horvei P, Adada MM, Bezerra ED, Fonkoua LAK, Ruff MW, Forsman CL, Nevala WK, Boysen JC, Tschumper RC, Grand CL, Kuchimanchi KR, Mouritsen L, Foulks JM, Warner SL, Call TG, Parikh SA, Ding W, Kay NE, Kenderian SS. AXL Inhibition Improves the Antitumor Activity of Chimeric Antigen Receptor T Cells. Cancer Immunol Res 2023; 11:1222-1236. [PMID: 37378662 PMCID: PMC10530462 DOI: 10.1158/2326-6066.cir-22-0254] [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: 03/29/2022] [Revised: 02/28/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023]
Abstract
The receptor tyrosine kinase AXL is a member of the TYRO3, AXL, and proto-oncogene tyrosine-protein kinase MER family and plays pleiotropic roles in cancer progression. AXL is expressed in immunosuppressive cells, which contributes to decreased efficacy of immunotherapy. Therefore, we hypothesized that AXL inhibition could serve as a strategy to overcome resistance to chimeric antigen receptor T (CAR T)-cell therapy. To test this, we determined the impact of AXL inhibition on CD19-targeted CAR T (CART19)-cell functions. Our results demonstrate that T cells and CAR T cells express high levels of AXL. Specifically, higher levels of AXL on activated Th2 CAR T cells and M2-polarized macrophages were observed. AXL inhibition with small molecules or via genetic disruption in T cells demonstrated selective inhibition of Th2 CAR T cells, reduction of Th2 cytokines, reversal of CAR T-cell inhibition, and promotion of CAR T-cell effector functions. AXL inhibition is a novel strategy to enhance CAR T-cell functions through two independent, but complementary, mechanisms: targeting Th2 cells and reversing myeloid-induced CAR T-cell inhibition through selective targeting of M2-polarized macrophages.
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Affiliation(s)
- R. Leo Sakemura
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mehrdad Hefazi
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Elizabeth L. Siegler
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Sutapa Sinha
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Carli M. Stewart
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | | | - Claudia Manriquez Roman
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ismail Can
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mohamad M. Adada
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Michael W. Ruff
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Cory L. Grand
- Sumitomo Dainippon Pharma Oncology, Inc. Lehi, UT, USA
| | | | | | | | | | | | | | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Saad S. Kenderian
- T Cell Engineering, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
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14
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Boddicker NJ, Parikh SA, Norman AD, Rabe KG, Griffin R, Call TG, Robinson DP, Olson JE, Dispenzieri A, Rajkumar V, Kumar S, Kay NE, Hanson CA, Cerhan JR, Murray D, Braggio E, Shanafelt TD, Vachon CM, Slager SL. Relationship among three common hematological premalignant conditions. Leukemia 2023; 37:1719-1722. [PMID: 37147423 PMCID: PMC10400408 DOI: 10.1038/s41375-023-01914-z] [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: 02/09/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Affiliation(s)
| | | | - Aaron D Norman
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Kari G Rabe
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Rosalie Griffin
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | | | - Dennis P Robinson
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - James R Cerhan
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - David Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Stanford, CA, USA
| | | | - Susan L Slager
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA.
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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15
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Griffin R, Wiedmeier-Nutor JE, Parikh SA, McCabe CE, O'Brien DR, Boddicker NJ, Kleinstern G, Rabe KG, Bruins L, Brown S, Bonolo de Campos C, Ding W, Leis JF, Hampel PJ, Call TG, Van Dyke DL, Kay NE, Cerhan JR, Yan H, Slager SL, Braggio E. Differential prognosis of single and multiple TP53 abnormalities in high-count MBL and untreated CLL. Blood Adv 2023; 7:3169-3179. [PMID: 36877634 PMCID: PMC10338209 DOI: 10.1182/bloodadvances.2022009040] [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: 09/28/2022] [Revised: 01/17/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023] Open
Abstract
TP53 aberrations, including mutations and deletion of 17p13, are important adverse prognostic markers in chronic lymphocytic leukemia (CLL) but are less studied in high count monoclonal B-cell lymphocytosis (HCMBL), an asymptomatic pre-malignant stage of CLL. Here we estimated the prevalence and impact of TP53 aberrations in 1,230 newly diagnosed treatment-naïve individuals (849 CLL, 381 HCMBL). We defined TP53 state as: wild-type (no TP53 mutations and normal 17p), single-hit (del(17p) or one TP53 mutation), or multi-hit (TP53 mutation and del(17p), TP53 mutation and loss of heterozygosity, or multiple TP53 mutations). Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for time to first treatment and overall survival by TP53 state. We found 64 (7.5%) CLL patients and 17 (4.5%) HCMBL individuals had TP53 mutations with variant allele fraction >10%. Del(17p) was present in 58 (6.8%) of CLL and 11 (2.9%) of HCMBL cases. Most individuals had wild-type (N=1,128, 91.7%) TP53 state, followed by multi-hit (N=55, 4.5%) and then single-hit (N=47, 3.8%) TP53 state. The risk of shorter time to therapy and death increased with the number of TP53 abnormalities. Compared to wild-type patients, multi-hit patients had 3-fold and single-hit patients had 1.5-fold increased risk of requiring therapy. Multi-hit patients also had 2.9-fold increased risk of death compared to wild-type. These results remained stable after accounting for other known poor prognostic factors. Both TP53 mutations and del(17p) may provide important prognostic information for HCMBL and CLL that would be missed if only one were measured.
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Affiliation(s)
- Rosalie Griffin
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | | | | | - Chantal E. McCabe
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Daniel R. O'Brien
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Geffen Kleinstern
- Division of Computational Biology, Mayo Clinic, Rochester, MN
- School of Public Health, University of Haifa, Haifa, Israel
| | - Kari G. Rabe
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Laura Bruins
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - Sochilt Brown
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Jose F. Leis
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | | | | | - Daniel L. Van Dyke
- Division of Hematology, Mayo Clinic, Rochester, MN
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Huihuang Yan
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | - Susan L. Slager
- Division of Computational Biology, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
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16
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Rotbain EC, Allmer C, Rostgaard K, Andersen MA, Vainer N, da Cunha-Bang C, Parikh SA, Rabe KG, Hjalgrim H, Frederiksen H, Slager SL, Niemann CU. Impact of type 2 diabetes on mortality, cause of death, and treatment in chronic lymphocytic leukemia. Am J Hematol 2023. [PMID: 37212419 DOI: 10.1002/ajh.26964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Abstract
Age-related comorbid conditions are exceedingly common in patients with chronic lymphocytic leukemia (CLL). As the prevalence of type 2 diabetes (T2D) is predicted to double during the next two decades, a better understanding of the interplay between CLL and T2D is of increasing importance. In this study, analyses were performed in parallel in two separate cohorts, based on Danish national registers and the Mayo Clinic CLL Resource. The primary outcomes were overall survival (OS) from time of CLL diagnosis, OS from time of treatment, and time to first treatment (TTFT), studied using Cox proportional hazard regression analysis and Fine-Gray regression analysis. In the Danish CLL cohort, the prevalence of T2D was 11%, in the Mayo CLL cohort, it was 12%. Patients with CLL and T2D had shorter OS both from time of diagnosis and from first-line treatment for were less likely to receive treatment for CLL compared with patients with CLL and without T2D. The increased mortality was largely driven by an increased risk of death due to infections, especially in the Danish cohort. The findings of this study emphasize a substantial subgroup of CLL patients with co-occurring T2D with an inferior prognosis and a possible unmet treatment need requiring additional interventions and further research.
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Affiliation(s)
- Emelie Curovic Rotbain
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Hematology Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Cristine Allmer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Klaus Rostgaard
- Hematology Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Michael Asger Andersen
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical pharmacology, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Noomi Vainer
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kari G Rabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Henrik Hjalgrim
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Hematology Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Departemnt of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Susan L Slager
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Wang Z, Yan H, Boysen JC, Braggio E, Parikh SA, Kay NE. Abstract 4725: The epigenetic determinants of BTKi efficacy in chronic lymphocytic leukemia. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Introduction: The introduction of Bruton’s tyrosine kinase (BTK) inhibitors (BTKi) to target B cell receptor (BCR) pathways in chronic lymphocytic leukemia (CLL) has significantly improved clinical responses. However, the effectiveness of BTKi is limited by the development of adaptive drug resistance. Therefore, there is an urgent need to identify critical biologic features that determine BTKi efficacy in order to develop more effective therapies. Epigenetic aberrations play an important role in tumor initiation, progression, and drug resistance. However, it is currently unknown if BCR signaling is also dependent on epigenetic mechanisms to support oncogenic gene expression and survival in CLL B cells.
Methods and Results: To gain new insights into the role of epigenetic regulation of BTKi treatment in CLL B cells, we analyzed the genome wide chromatin accessibility (ATAC-seq) and histone modification (H3K4me1, H3K4me3, H3K27ac, H3K27me3) profiles (CUT&Tag) of leukemic cells from 4 CLL patients on ibrutinib treatment in a sequential fashion (i.e., baseline, on ibrutinib treatment, and at relapse). We also performed the same analysis in other cohorts at two stages of ibrutinib treatment (baseline and while on treatment, n=20). Our studies show that suppressing BCR signaling by BTKi treatment leads to an alteration of a pro-survival epigenetic signature (defined by histone modifications and chromatin accessibility landscapes) in CLL and that the genes regulated by these chromatin changes are enriched in pathways associated with malignant B cell survival (i.e., BCR signaling and apoptosis pathways). Importantly, disruption of this pro-survival epigenetic signature is necessary for effective BTKi treatment. We further find that the transcription factor (TF) Nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1) couples the BCR signaling to control this pro-survival epigenetic program that supports CLL B cell survival. In specific, we show that nuclear depletion of NFATc1 is required for BTKi induced epigenetic alteration and effective BTKi treatment. Depletion of NFATc1 disrupts the pro-survival epigenetic signature and inhibits CLL B cells survival, which improves the efficacy of BTKi treatment in CLL.
Conclusion: Here using leukemic cells from CLL patients with BTKi treatment, we demonstrate that epigenetic regulators are exploited by the oncogenic signaling pathway to support malignant cell survival. Specifically, NFATc1 is utilized by the BCR signaling pathway to control an epigenetic signature that supports CLL cell survival. This BCR regulated epigenetic machinery can be targeted to maintain and enhance BTKi treatment efficacy in CLL.
Citation Format: Zhiquan Wang, Huihuang Yan, Justin C. Boysen, Esteban Braggio, Sameer A. Parikh, Neil E. Kay. The epigenetic determinants of BTKi efficacy in chronic lymphocytic leukemia. [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 4725.
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18
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Hampel PJ, Parikh SA. BTKi bonanza in CLL/SLL: Sorting out the differences. Am J Hematol 2023; 98:556-559. [PMID: 36691752 DOI: 10.1002/ajh.26859] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Affiliation(s)
- Paul J Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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19
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Passerini M, Ratishvili T, Monroe JM, Temesgen Z, Witzig TE, Kay NE, Kennedy RB, Parikh SA. Functional humoral and cellular response of monovalent COVID-19-vaccines against Omicron BA.2 variant of SARS-CoV-2 in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2023; 64:874-883. [PMID: 36908110 DOI: 10.1080/10428194.2023.2183730] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
We designed a prospective study to evaluate the humoral (using a surrogate virus neutralization test) and cellular (using an IFN-γ ELISpot) immune response among patients with chronic lymphocytic leukemia (CLL) against Wuhan-Hu-1 and Omicron BA.2 strains of SARS-CoV-2, after mRNA-based vaccination. The proportion of patients with a functional humoral response was higher among untreated CLL patients compared to treated CLL patients against both Wuhan-Hu-1 and Omicron BA.2 after the second and the third dose of vaccination, and at 12 months after the first dose. The proportion of positive cellular response against the peptide pool covering the full-length Wuhan-Hu-1 spike protein was similar between untreated and treated CLL patients at all three timepoints. The cellular response to the mutated regions of BA.2 spike protein was lower than the response to the corresponding regions in the ancestral spike after the second dose, but this difference was eliminated after the third dose.
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Affiliation(s)
- Matteo Passerini
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamar Ratishvili
- Department of Internal Medicine, Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - Jonathon M Monroe
- Department of Internal Medicine, Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - Zelalem Temesgen
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas E Witzig
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Neil E Kay
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Richard B Kennedy
- Department of Internal Medicine, Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - Sameer A Parikh
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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20
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Bantilan KS, Kay NE, Parikh SA, Rabe KG, Call TG, Leis JF, Ding W, Slager SL, Soumerai JD, Roeker LE, Mato A, Zelenetz AD. Time to second treatment can be used to predict overall survival in chronic lymphocytic leukemia: identifying risk factors to help guide treatment selection. Leuk Lymphoma 2023; 64:300-311. [PMID: 36503412 PMCID: PMC10629364 DOI: 10.1080/10428194.2022.2148218] [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: 06/07/2022] [Accepted: 10/29/2022] [Indexed: 12/14/2022]
Abstract
Targeted therapies have largely replaced chemoimmunotherapy (CIT) in first-line treatment of chronic lymphocytic leukemia (CLL). We aimed to develop a prognostic model to determine who would benefit from first-line CIT vs target therapy. In follicular lymphoma, time from diagnosis to second treatment (TT2T) correlates better with overall survival (OS) than time from diagnosis to first treatment (TT1T). We hypothesized that TT2T is a potential surrogate for OS in CLL. In a model-building cohort (n = 298), we evaluated potential predictors for TT2T and derived a risk score, which we validated in an external cohort (n = 1141). Our data demonstrated that TT2T and OS were more strongly correlated than TT1T and OS. Our risk score model consisted of three predictors (unmutated IGHV, β2-microglobulin >297 nmol/L, and Rai stage I-IV), and was prognostic for TT2T and OS. TT2T is a promising surrogate for OS in CLL, but further validation is needed to establish this association.
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Affiliation(s)
| | - Neil E Kay
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kari G Rabe
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Jose F Leis
- Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Wei Ding
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Parry EM, Leshchiner I, Guièze R, Johnson C, Tausch E, Parikh SA, Lemvigh C, Broséus J, Hergalant S, Messer C, Utro F, Levovitz C, Rhrissorrakrai K, Li L, Rosebrock D, Yin S, Deng S, Slowik K, Jacobs R, Huang T, Li S, Fell G, Redd R, Lin Z, Knisbacher BA, Livitz D, Schneider C, Ruthen N, Elagina L, Taylor-Weiner A, Persaud B, Martinez A, Fernandes SM, Purroy N, Anandappa AJ, Ma J, Hess J, Rassenti LZ, Kipps TJ, Jain N, Wierda W, Cymbalista F, Feugier P, Kay NE, Livak KJ, Danysh BP, Stewart C, Neuberg D, Davids MS, Brown JR, Parida L, Stilgenbauer S, Getz G, Wu CJ. Evolutionary history of transformation from chronic lymphocytic leukemia to Richter syndrome. Nat Med 2023; 29:158-169. [PMID: 36624313 PMCID: PMC10155825 DOI: 10.1038/s41591-022-02113-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [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: 12/23/2021] [Accepted: 10/28/2022] [Indexed: 01/11/2023]
Abstract
Richter syndrome (RS) arising from chronic lymphocytic leukemia (CLL) exemplifies an aggressive malignancy that develops from an indolent neoplasm. To decipher the genetics underlying this transformation, we computationally deconvoluted admixtures of CLL and RS cells from 52 patients with RS, evaluating paired CLL-RS whole-exome sequencing data. We discovered RS-specific somatic driver mutations (including IRF2BP2, SRSF1, B2M, DNMT3A and CCND3), recurrent copy-number alterations beyond del(9p21)(CDKN2A/B), whole-genome duplication and chromothripsis, which were confirmed in 45 independent RS cases and in an external set of RS whole genomes. Through unsupervised clustering, clonally related RS was largely distinct from diffuse large B cell lymphoma. We distinguished pathways that were dysregulated in RS versus CLL, and detected clonal evolution of transformation at single-cell resolution, identifying intermediate cell states. Our study defines distinct molecular subtypes of RS and highlights cell-free DNA analysis as a potential tool for early diagnosis and monitoring.
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Affiliation(s)
- Erin M Parry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ignaty Leshchiner
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Romain Guièze
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, EA7453 CHELTER, Clermont-Ferrand, France
| | | | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | | | - Camilla Lemvigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Julien Broséus
- Inserm UMRS1256 Nutrition-Génétique et Exposition aux Risques Environnementaux (N-GERE), Université de Lorraine, Nancy, France
- Université de Lorraine, CHRU-Nancy, service d'hématologie biologique, pôle laboratoires, Nancy, France
| | - Sébastien Hergalant
- Inserm UMRS1256 Nutrition-Génétique et Exposition aux Risques Environnementaux (N-GERE), Université de Lorraine, Nancy, France
| | - Conor Messer
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Filippo Utro
- IBM Research, Yorktown Heights, New York, NY, USA
| | | | | | - Liang Li
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Shanye Yin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephanie Deng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kara Slowik
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Raquel Jacobs
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Teddy Huang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shuqiang Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Geoff Fell
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ziao Lin
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Christof Schneider
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Neil Ruthen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Bria Persaud
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Aina Martinez
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Noelia Purroy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Annabelle J Anandappa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jialin Ma
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Julian Hess
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Laura Z Rassenti
- Moores Cancer Center, Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Thomas J Kipps
- Moores Cancer Center, Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Florence Cymbalista
- Laboratoire d'hématologie, Hôpital Avicenne-AP-HP, INSERM U978- Université Sorbonne Paris Nord, Bobigny, France
| | - Pierre Feugier
- Inserm UMRS1256 Nutrition-Génétique et Exposition aux Risques Environnementaux (N-GERE), Université de Lorraine, Nancy, France
- Université de Lorraine, CHRU Nancy, service d'hématologie clinique, Nancy, France
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kenneth J Livak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Chip Stewart
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Donna Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laxmi Parida
- IBM Research, Yorktown Heights, New York, NY, USA
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Cancer Center and Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
| | - Catherine J Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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22
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Hampel PJ, Parikh SA. Correction: Chronic lymphocytic leukemia treatment algorithm 2022. Blood Cancer J 2022; 12:172. [PMID: 36543762 PMCID: PMC9772411 DOI: 10.1038/s41408-022-00775-6] [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] [Indexed: 12/24/2022] Open
Affiliation(s)
- Paul J. Hampel
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Sameer A. Parikh
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
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23
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Ravandi F, Kreitman RJ, Tiacci E, Andritsos L, Banerji V, Barrientos JC, Bhat SA, Blachly JS, Broccoli A, Call T, Chihara D, Dearden C, Demeter J, Dietrich S, Else M, Epperla N, Falini B, Forconi F, Gladstone DE, Gozzetti A, Iyengar S, Johnston JB, Jorgensen J, Juliusson G, Lauria F, Lozanski G, Parikh SA, Park JH, Polliack A, Quest G, Robak T, Rogers KA, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam CS, Thompson PA, Troussard X, Zent CS, Zenz T, Zinzani PL, Wörmann B, Rai K, Grever M. Consensus opinion from an international group of experts on measurable residual disease in hairy cell leukemia. Blood Cancer J 2022; 12:165. [PMID: 36509740 PMCID: PMC9744664 DOI: 10.1038/s41408-022-00760-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
A significant body of literature has been generated related to the detection of measurable residual disease (MRD) at the time of achieving complete remission (CR) in patients with hairy cell leukemia (HCL). However, due to the indolent nature of the disease as well as reports suggesting long-term survival in patients treated with a single course of a nucleoside analog albeit without evidence of cure, the merits of detection of MRD and attempts to eradicate it have been debated. Studies utilizing novel strategies in the relapse setting have demonstrated the utility of achieving CR with undetectable MRD (uMRD) in prolonging the duration of remission. Several assays including immunohistochemical analysis of bone marrow specimens, multi-parameter flow cytometry and molecular assays to detect the mutant BRAF V600E gene or the consensus primer for the immunoglobulin heavy chain gene (IGH) rearrangement have been utilized with few comparative studies. Here we provide a consensus report on the available data, the potential merits of MRD assessment in the front-line and relapse settings and recommendations on future role of MRD assessment in HCL.
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Affiliation(s)
- Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Leslie Andritsos
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Versha Banerji
- Department of Internal Medicine & Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Jacqueline C Barrientos
- Feinstein Institutes for Medical Research and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Seema A Bhat
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Timothy Call
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Dai Chihara
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Sasha Dietrich
- Department of Hematology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Narendranath Epperla
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Francesco Forconi
- School of Cancer Sciences, Cancer Research UK Southampton Centre, Faculty of Medicine, University of Southampton, Southampton, UK
- Haematology Department, Cancer Care Directorate, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Alessandro Gozzetti
- Dept. of Medicine, Surgery and Neurosciences, University of Siena, Policlinico S. Maria alle Scotte-, Siena, Italy
| | | | - James B Johnston
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey Jorgensen
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Gerard Lozanski
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | | | - Jae H Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Kerry A Rogers
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA, USA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center; and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Constantine S Tam
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Philip A Thompson
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Cote de Nacre, Caen, France
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Thorsten Zenz
- Dept. of Medical Oncology and Haematology, University Hospital Zürich and University of Zurich (UZH), Zurich, Switzerland
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | | | - Kanti Rai
- Feinstein Institutes for Medical Research and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Michael Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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24
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Ripoll JG, Gorman EK, Juskewitch JE, Razonable RR, Ganesh R, Hurt RT, Theel ES, Stubbs JR, Winters JL, Parikh SA, Kay NE, Joyner MJ, Senefeld JW. Vaccine-boosted convalescent plasma therapy for patients with immunosuppression and COVID-19. Blood Adv 2022; 6:5951-5955. [PMID: 36156121 PMCID: PMC9519378 DOI: 10.1182/bloodadvances.2022008932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Neil E. Kay
- Division of Hematology
- Department of Immunology
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
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25
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Andritsos LA, Anghelina M, Neal J, Blachly JS, Mathur P, Lele O, Dearden C, Iyengar S, Cross M, Zent CS, Rogers KA, Epperla N, Lozanski G, Oakes CC, Kraut E, Ruppert AS, Zhao Q, Bhat SA, Forconi F, Banerji V, Handunnetti S, Tam CS, Seymour JF, Else M, Kreitman RJ, Saven A, Call T, Parikh SA, Ravandi F, Johnston JB, Tiacci E, Troussard X, Tallman MS, Dietrich S, Tadmor T, Gozzetti A, Zinzani PL, Robak T, Quest G, Demeter J, Rai K, Fernandez SA, Grever M. Development of a distributed international patient data registry for hairy cell leukemia. Leuk Lymphoma 2022; 63:3021-3031. [PMID: 36070610 PMCID: PMC9990910 DOI: 10.1080/10428194.2022.2109157] [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] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
Hairy cell leukemia (HCL) is a rare lymphoproliferative disorder, comprising only 2% of all leukemias. The Hairy Cell Leukemia Foundation (HCLF) has developed a patient data registry to enable investigators to better study the clinical features, treatment outcomes, and complications of patients with HCL. This system utilizes a centralized registry architecture. Patients are enrolled at HCL Centers of Excellence (COE) or via a web-based portal. All data are de-identified, which reduces regulatory burden and increases opportunities for data access and re-use. To date, 579 patients have been enrolled in the registry. Efforts are underway to engage additional COE's to expand access to patients across the globe. This international PDR will enable researchers to study outcomes in HCL in ways not previously possible due to the rarity of the disease and will serve as a platform for future prospective research.
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Affiliation(s)
- Leslie A Andritsos
- Division of Hematology Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Mirela Anghelina
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Jasmine Neal
- Department of Internal Medicine, Division of Hematology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - James S Blachly
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Puneet Mathur
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Omkar Lele
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | | | | | | | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Kerry A Rogers
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Narendranath Epperla
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Christopher C Oakes
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Eric Kraut
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Qiuhong Zhao
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Seema A Bhat
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Francesco Forconi
- Cancer Sciences and Haematology Department, University of Southampton Hospital Trust, Southampton, UK
| | - Versha Banerji
- Department of Internal Medicine & Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Research Institute in Oncology and Hematology, Winnipeg, Canada
| | - Sasanka Handunnetti
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Constantine S Tam
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Monica Else
- The Institute of Cancer Research, London, UK
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA, USA
| | - Timothy Call
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James B Johnston
- Department of Internal Medicine & Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Research Institute in Oncology and Hematology, Winnipeg, Canada
| | - Enrico Tiacci
- Department of Medicine and Surgery, Institute of Hematology, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Cote de Nacre, Caen, France
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sascha Dietrich
- Department of Hematology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Tamar Tadmor
- Hematology Division, Bnai Zion Medical Center and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Alessandro Gozzetti
- Department of Medicine, University of Siena Policlinico S Maria alle Scotte, Siena, Italy
| | - Pier Luigi Zinzani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, IRCCS Azienda Ospedaliero-Universitaria di Bologna and Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Graeme Quest
- Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kanti Rai
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Soledad A Fernandez
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Michael Grever
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
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26
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Parikh SA, Achenbach SJ, Rabe KG, Norman AD, Boddicker NJ, Olson JE, Call TG, Cerhan JR, Vachon CM, Kay NE, Braggio E, Hanson CA, Slager SL, Shanafelt TD. The risk of coronavirus disease 2019 (COVID-19) among individuals with monoclonal B cell lymphocytosis. Blood Cancer J 2022; 12:159. [PMID: 36418344 PMCID: PMC9684458 DOI: 10.1038/s41408-022-00754-x] [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: 07/28/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Sara J Achenbach
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Kari G Rabe
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Aaron D Norman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - Janet E Olson
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | - James R Cerhan
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Susan L Slager
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Stanford, CA, USA
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27
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Slager SL, Parikh SA, Achenbach SJ, Norman AD, Rabe KG, Boddicker NJ, Olson JE, Kleinstern G, Lesnick CE, Call TG, Cerhan JR, Vachon CM, Kay NE, Braggio E, Hanson CA, Shanafelt TD. Progression and survival of MBL: a screening study of 10 139 individuals. Blood 2022; 140:1702-1709. [PMID: 35969843 PMCID: PMC9837414 DOI: 10.1182/blood.2022016279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/23/2022] [Indexed: 01/21/2023] Open
Abstract
Monoclonal B-cell lymphocytosis (MBL) is a common hematological premalignant condition that is understudied in screening cohorts. MBL can be classified into low-count (LC) and high-count (HC) types based on the size of the B-cell clone. Using the Mayo Clinic Biobank, we screened for MBL and evaluated its association with future hematologic malignancy and overall survival (OS). We had a two-stage study design including discovery and validation cohorts. We screened for MBL using an eight-color flow-cytometry assay. Medical records were abstracted for hematological cancers and death. We used Cox regression to evaluate associations and estimate hazard ratios and 95% confidence intervals (CIs), adjusting for age and sex. We identified 1712 (17%) individuals with MBL (95% LC-MBL), and the median follow-up time for OS was 34.4 months with 621 individuals who died. We did not observe an association with OS among individuals with LC-MBL (P = .78) but did among HC-MBL (hazard ratio, 1.8; 95% CI, 1.1-3.1; P = .03). Among the discovery cohort with a median of 10.0 years follow-up, 31 individuals developed hematological cancers with two-thirds being lymphoid malignancies. MBL was associated with 3.6-fold risk of hematological cancer compared to controls (95% CI, 1.7-7.7; P < .001) and 7.7-fold increased risk for lymphoid malignancies (95% CI:3.1-19.2; P < .001). LC-MBL was associated with 4.3-fold risk of lymphoid malignancies (95% CI, 1.4-12.7; P = .009); HC-MBL had a 74-fold increased risk (95% CI, 22-246; P < .001). In this large screening cohort, we observed similar survival among individuals with and without LC-MBL, yet individuals with LC-MBL have a fourfold increased risk of lymphoid malignancies. Accumulating evidence indicates that there are clinical consequences to LC-MBL, a condition that affects 8 to 10 million adults in the United States.
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Affiliation(s)
- Susan L. Slager
- Division of Hematology, Mayo Clinic, Rochester, MN
- Division of Computational Biology, Mayo Clinic, Rochester, MN
| | | | - Sara J. Achenbach
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Kari G. Rabe
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | | | - Geffen Kleinstern
- Division of Computational Biology, Mayo Clinic, Rochester, MN
- School of Public Health, University of Haifa, Haifa, Israel
| | | | | | | | | | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Curtis A. Hanson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Tait D. Shanafelt
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
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28
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Johnson IM, Scheckel C, Parikh SA, Enzler M, Fugate J, Call TG. Fatal Powassan virus encephalitis in patients with chronic lymphocytic leukemia. Blood Cancer J 2022; 12:143. [PMID: 36202790 PMCID: PMC9537528 DOI: 10.1038/s41408-022-00737-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Isla M Johnson
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Mark Enzler
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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29
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Parry EM, Leshchiner I, Guieze R, Johnson C, Tausch E, Parikh SA, Lemvigh CK, Messer C, Utro F, Levovitz C, Rhrissorrakrai K, Davids MS, Broseus J, Li S, Lin Z, Knisbacher BA, Schneider C, Rassenti LZ, Kipps TJ, Jain N, Wierda W, Cymbalista F, Kay NE, Livak KJ, Danysh BP, Stewart C, Neuberg D, Brown JR, Paridi L, Stilgenbauer S, Getz G, Wu C. Abstract A13: Evolutionary history of transformation from chronic lymphocytic leukemia to Richter syndrome. Blood Cancer Discov 2022. [DOI: 10.1158/2643-3249.lymphoma22-a13] [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] Open
Abstract
Abstract
Richter syndrome (RS), an aggressive lymphoma that develops in patients with chronic lymphocytic leukemia (CLL), is a striking example of histologic transformation. While recent therapeutic advances have transformed the treatment landscape of CLL and lymphoma, RS remains associated with dismal overall survival. Despite an advanced genomic and molecular characterization of CLL over the past decade, the current understanding of the genetic factors driving evolution of CLL to RS is limited. To decipher the genetics underlying this transformation, we have performed an integrative analysis of exome, genome and transcriptome data generated from matched RS and CLL samples from a discovery cohort of 53 patients with newly diagnosed RS of DLBCL histology. Through computational deconvolution of CLL and RS clones, we constructed phylogenetic relationships and traced evolution of CLL to RS, confirming both clonal related (87%) and unrelated cases (13%). In addition to identifying recognized RS-risk genetic lesions, we discovered novel RS-specific alterations, including 5 putative somatic driver genes (IRF2BP2, SRSF1, B2M, DNMT3A and EZH2), frequent copy number alterations beyond del(9p21)(CDKN2A/B), (including amp(7q21.2) (CDK6), amp(9p24) (PDL1/L2), and amp(1q23)(MCL1)), and recurrent whole genome duplication and chromothripsis. Integration of exome and genome sequencing data led to the identification of distinct molecular subtypes of RS with prognostic importance. To confirm these molecular subtypes, a validation cohort of 47 RS cases has been assembled with paired exome and transcriptome data. To further investigate the stepwise clonal evolution of CLL to RS, we performed single-cell RNA-sequencing on biopsy samples obtained at diagnosis from 5 individuals with clonally related transformation. Using a novel tool, CNVSingle, we inferred allele specific single-cell copy number alterations that enabled identification of the single-cell clusters representing distinct CLL and RS genetic subclones as well as intermediate, or transitional, evolutionary states. RS cells displayed gene expression enriched in pathways of MYC targets and cell cycle, in line with similar analysis on bulk transcriptomes. Finally, by ultra-low pass (ULP)-WGS sequencing of plasma samples from RS patients, we demonstrate detection of RS tumor DNA in plasma months prior to initial clinical diagnosis (n=3 of 6) or post-allogeneic stem cell transplant relapse (n=2 of 2). cfDNA is thus a promising tool for early detection of emerging RS and RS relapse as well as for non-invasive detection surrounding diagnosis. Altogether, our study defines RS-specific alterations and provides a molecular definition of RS, identifies distinct genetic subtypes of RS with prognostic significance, traces the evolutionary path to RS and suggests future strategies for improved detection.
Citation Format: Erin M Parry, Ignaty Leshchiner, Romain Guieze, Connor Johnson, Eugen Tausch, Sameer A Parikh, Camilla K Lemvigh, Conor Messer, Filippo Utro, Chaya Levovitz, Kahn Rhrissorrakrai, Matthew S Davids, Julien Broseus, Shuqiang Li, Ziao Lin, Binyamin A Knisbacher, Christof Schneider, Laura Z Rassenti, Thomas J Kipps, Nitin Jain, William Wierda, Florence Cymbalista, Neil E Kay, Kenneth J Livak, Brian P Danysh, Chip Stewart, Donna Neuberg, Jennifer R Brown, Laxmi Paridi, Stephan Stilgenbauer, Gaddy Getz, Catherine Wu. Evolutionary history of transformation from chronic lymphocytic leukemia to Richter syndrome [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A13.
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Affiliation(s)
| | | | - Romain Guieze
- 3Université Clermont Auvergne, Clermont-Ferrand, France,
| | | | | | | | | | - Conor Messer
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
| | | | | | | | | | | | | | - Ziao Lin
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
| | | | | | | | | | - Nitin Jain
- 11The University of Texas MD Anderson Cancer Center, Houston, TX,
| | - William Wierda
- 11The University of Texas MD Anderson Cancer Center, Houston, TX,
| | | | | | | | | | - Chip Stewart
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
| | | | | | | | | | - Gaddy Getz
- 2Broad Institute of MIT and Harvard, Cambridge, MA,
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Hampel PJ, Rabe KG, Call TG, Ding W, Leis JF, Chanan-Khan AA, Kenderian SS, Muchtar E, Wang Y, Ailawadhi S, Koehler AB, Parrondo R, Schwager SM, Sher T, Hanson CA, Shi M, Van Dyke DL, Braggio E, Slager SL, Kay NE, Parikh SA. Clinical outcomes in patients with chronic lymphocytic leukemia with disease progression on ibrutinib. Blood Cancer J 2022; 12:124. [PMID: 36050317 PMCID: PMC9437078 DOI: 10.1038/s41408-022-00721-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) with disease progression on ibrutinib have worse outcomes compared to patients stopping ibrutinib due to toxicity. A better understanding of expected outcomes in these patients is necessary to establish a benchmark for evaluating novel agents currently available and in development. We evaluated outcomes of 144 patients with CLL treated at Mayo Clinic with 2018 iwCLL disease progression on ibrutinib. The median overall survival (OS) for the entire cohort was 25.5 months; it was 29.8 months and 8.3 months among patients with CLL progression (n = 104) and Richter transformation (n = 38), respectively. Longer OS was observed among patients with CLL progression who had received ibrutinib in the frontline compared to relapsed/refractory setting (not reached versus 28.5 months; p = 0.04), but was similar amongst patients treated with 1, 2, or ≥3 prior lines (18.5, 30.9, and 26.0 months, respectively, p = 0.24). Among patients with CLL disease progression on ibrutinib, OS was significantly longer when next-line treatment was chimeric antigen receptor T-cell therapy (median not reached) or venetoclax-based treatment (median 29.8 months) compared to other approved treatments, such as chemoimmunotherapy, phosphoinositide 3'-kinase inhibitors, and anti-CD20 monoclonal antibodies (9.1 months; p = 0.03). These findings suggest an unmet need for this growing patient population.
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Affiliation(s)
- Paul J Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kari G Rabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Asher A Chanan-Khan
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Saad S Kenderian
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eli Muchtar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yucai Wang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Amber B Koehler
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ricardo Parrondo
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Susan M Schwager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Taimur Sher
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Van Dyke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Esteban Braggio
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Susan L Slager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Neil E Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Hampel PJ, Rabe KG, Call TG, Ding W, Leis JF, Kenderian SS, Muchtar E, Wang Y, Koehler AB, Parrondo R, Schwager SM, Shi M, Braggio E, Slager SL, Kay NE, Parikh SA. Combined ibrutinib and venetoclax for treatment of patients with ibrutinib-resistant or double-refractory chronic lymphocytic leukaemia. Br J Haematol 2022; 199:239-244. [PMID: 35841338 DOI: 10.1111/bjh.18357] [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: 06/02/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
Patients with chronic lymphocytic leukaemia (CLL) disease progression on ibrutinib or after sequential ibrutinib and venetoclax-based treatments (double-refractory) have poor outcomes. In this retrospective study, we analysed outcomes with combined ibrutinib and venetoclax treatment in these groups of patients. The median treatment-free and overall survival for 22 patients with prior progression on ibrutinib (venetoclax-naïve) were 23.7 and 47.1 months respectively. In 11 patients with double-refractory CLL, the median treatment-free and overall survival were 11.2 and 27.0 months respectively. The combination of ibrutinib and venetoclax may help bridge the current gap in options for patients with disease refractory to the most commonly used novel agents.
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Affiliation(s)
- Paul J Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kari G Rabe
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose F Leis
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Saad S Kenderian
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yucai Wang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amber B Koehler
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ricardo Parrondo
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Susan M Schwager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Susan L Slager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil E Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Wang Z, Yan H, Boysen JC, Secreto CR, Tschumper RC, Ali D, Guo Q, Zhong J, Zhou J, Gan H, Yu C, Jelinek DF, Slager SL, Parikh SA, Braggio E, Kay NE. B cell receptor signaling drives APOBEC3 expression via direct enhancer regulation in chronic lymphocytic leukemia B cells. Blood Cancer J 2022; 12:99. [PMID: 35778390 PMCID: PMC9249768 DOI: 10.1038/s41408-022-00690-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
Constitutively activated B cell receptor (BCR) signaling is a primary biological feature of chronic lymphocytic leukemia (CLL). The biological events controlled by BCR signaling in CLL are not fully understood and need investigation. Here, by analysis of the chromatin states and gene expression profiles of CLL B cells from patients before and after Bruton's tyrosine kinase inhibitor (BTKi) ibrutinib treatment, we show that BTKi treatment leads to a decreased expression of APOBEC3 family genes by regulating the activity of their enhancers. BTKi treatment reduces enrichment of enhancer marks (H3K4me1 and H3K27ac) and chromatin accessibility at putative APOBEC3 enhancers. CRISPR-Cas9 directed deletion or inhibition of the putative APOBEC3 enhancers leads to reduced APOBEC3 expression. We further find that transcription factor NFATc1 couples BCR signaling with the APOBEC3 enhancer activity to control APOBEC3 expression. We also find that enhancer-regulated APOBEC3 expression contributes to replication stress in malignant B cells. In total we demonstrate a novel mechanism for BTKi suppression of APOBEC3 expression via direct enhancer regulation in an NFATc1-dependent manner, implicating BCR signaling as a potential regulator of leukemic genomic instability.
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MESH Headings
- APOBEC Deaminases/biosynthesis
- APOBEC Deaminases/genetics
- APOBEC Deaminases/metabolism
- Chromatin
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Protein Kinase Inhibitors/pharmacology
- Pyrazoles/pharmacology
- Pyrimidines/pharmacology
- Receptors, Antigen, B-Cell/genetics
- Receptors, Antigen, B-Cell/metabolism
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Affiliation(s)
- Zhiquan Wang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Huihuang Yan
- Division of Computational Biology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Justin C Boysen
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Charla R Secreto
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Dania Ali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Qianqian Guo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jian Zhong
- Epigenomics Development Laboratory, Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jiaqi Zhou
- Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Haiyun Gan
- Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Chuanhe Yu
- The Hormel Institute, University of Minnesota, Austin, MN, 55912, USA
| | - Diane F Jelinek
- Department of Immunology, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Susan L Slager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Computational Biology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Esteban Braggio
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Neil E Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
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Sakemura R, Hefazi M, Siegler EL, Cox MJ, Larson DP, Hansen MJ, Manriquez Roman C, Schick KJ, Can I, Tapper EE, Horvei P, Adada MM, Bezerra ED, Kankeu Fonkoua LA, Ruff MW, Nevala WK, Walters DK, Parikh SA, Lin Y, Jelinek DF, Kay NE, Bergsagel PL, Kenderian SS. Targeting cancer-associated fibroblasts in the bone marrow prevents resistance to CART-cell therapy in multiple myeloma. Blood 2022; 139:3708-3721. [PMID: 35090171 DOI: 10.1182/blood.2021012811] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [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: 06/03/2021] [Accepted: 01/20/2022] [Indexed: 11/20/2022] Open
Abstract
Pivotal clinical trials of B-cell maturation antigen-targeted chimeric antigen receptor T (CART)-cell therapy in patients with relapsed/refractory multiple myeloma (MM) resulted in remarkable initial responses, which led to a recent US Food and Drug Administration approval. Despite the success of this therapy, durable remissions continue to be low, and the predominant mechanism of resistance is loss of CART cells and inhibition by the tumor microenvironment (TME). MM is characterized by an immunosuppressive TME with an abundance of cancer-associated fibroblasts (CAFs). Using MM models, we studied the impact of CAFs on CART-cell efficacy and developed strategies to overcome CART-cell inhibition. We showed that CAFs inhibit CART-cell antitumor activity and promote MM progression. CAFs express molecules such as fibroblast activation protein and signaling lymphocyte activation molecule family-7, which are attractive immunotherapy targets. To overcome CAF-induced CART-cell inhibition, CART cells were generated targeting both MM cells and CAFs. This dual-targeting CART-cell strategy significantly improved the effector functions of CART cells. We show for the first time that dual targeting of both malignant plasma cells and the CAFs within the TME is a novel strategy to overcome resistance to CART-cell therapy in MM.
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Affiliation(s)
| | | | | | | | | | | | - Claudia Manriquez Roman
- T Cell Engineering
- Division of Hematology
- Mayo Clinic Graduate School of Biomedical Sciences
- Department of Molecular Medicine
| | - Kendall J Schick
- T Cell Engineering
- Division of Hematology
- Mayo Clinic Graduate School of Biomedical Sciences
- Department of Molecular Pharmacology and Experimental Therapeutics, and
| | - Ismail Can
- T Cell Engineering
- Division of Hematology
- Mayo Clinic Graduate School of Biomedical Sciences
| | | | | | | | | | | | - Michael W Ruff
- T Cell Engineering
- Department of Neurology, Mayo Clinic, Rochester, MN; and
| | | | | | | | | | | | | | | | - Saad S Kenderian
- T Cell Engineering
- Division of Hematology
- Department of Immunology
- Department of Molecular Medicine
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Ansari AN, Achenbach SJ, Parikh SA, Kleinstern G, Norman AD, Rabe KG, Lesnick CE, Call TG, Olson JE, Cerhan JR, Kay NE, Vachon CM, Braggio E, Hanson CA, Shanafelt TD, Baum CL, Slager SL. Abstract 5256: Incidence of squamous cell carcinoma (SCC) in a large screening cohort of monoclonal B-cell lymphocytosis (MBL). Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5256] [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
MBL is a common pre-malignant condition characterized by circulating clonal B-cells with an absolute B-cell count <5x109/L and no lymphadenopathy, organomegaly, or cytopenias. MBL is the precursor to CLL. The incidence of cutaneous SCC in CLL is significantly higher compared to controls. The incidence of SCC in MBLs has not yet been determined. Study participants from the Mayo Clinic Biobank who had no prior history of hematologic malignancy, were 40 years or older, and were Olmsted County residents completed a health questionnaire and provided blood samples between 7/2009 and 12/2020. Stored peripheral blood mononuclear cells were screened for MBL using flow cytometry. We defined three MBL immunophenotypes: CLL-like MBL (CD5+, CD20dim), atypical MBL (CD5+, CD20+), and non-CLL-like MBL (CD5-, CD20+). MBL individuals were also classified by cell count into low-count MBL (LC-MBL) and high-count MBL (HC-MBL), with HC-MBL having a percent clonal B-cell count ≥85%. Data on newly diagnosed SCC was abstracted from the medical records, and prior history of skin cancer before sample collection was ascertained from patient questionnaires. Individuals were followed from sample date to the earliest of SCC, death, loss to follow-up, progression, or 12/31/2020. Cumulative SCC incidence was adjusted for competing risk of death. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) adjusted for age and sex. A total of 5,470 participants were screened for MBL and included 949 (17%) with LC-MBL, 63 (1%) with HC-MBL, and 4,458 (81%) controls (negative for MBL). Individuals with HC-MBL (median age 75 years) or LC-MBL (median age 73 years) were significantly older (P<0.001) than controls (median age 66 years). There were 41 (65%) males among HC-MBL, 447 (47%) among LC-MBL, and 1,551 (35%) among controls. Prior skin cancer history was highest among HC-MBLs (N=17, 27%) or LC-MBLs (N=236, 25%) compared to controls (N=767, 17%). After a median follow-up of 18 months (range 0-138), 154 of the 5,470 individuals were identified to have incident SCC following MBL screening. At least one SCC was observed in 3 individuals with HC-MBL, 33 individuals with LC-MBL, and 118 controls. The 5- and 10-year cumulative incidence of SCC in individuals with MBLs was 7% and 16%, respectively; control estimates were 4% and 8%, respectively. However, after adjusting for age and sex, we observed no evidence of an association between MBL and risk of incident SCC (HR=0.95, CI=0.65-1.40, P=0.80), nor when we stratified individuals by age or by sex (all P>0.05). In the largest MBL screening cohort to date, individuals with MBL do not have an increased risk of incident SCC compared to controls. In contrast to individuals with CLL, these individuals with screening MBL do not need increased dermatologic examination for skin cancer, which is important given the high prevalence of MBL (18% of the population above age 40).
Citation Format: Ahmed Nadeem Ansari, Sara J. Achenbach, Sameer A. Parikh, Geffen Kleinstern, Aaron D. Norman, Kari G. Rabe, Connie E. Lesnick, Timothy G. Call, Janet E. Olson, James R. Cerhan, Neil E. Kay, Celine M. Vachon, Esteban Braggio, Curtis A. Hanson, Tait D. Shanafelt, Christian L. Baum, Susan L. Slager. Incidence of squamous cell carcinoma (SCC) in a large screening cohort of monoclonal B-cell lymphocytosis (MBL) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5256.
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Soof CM, Spektor TM, Parikh SA, Slager SL, Rabe KG, Call TG, Kenderian SS, Ding W, Muchtar E, Ghermezi M, Kay NE, Berenson JR. Serum B-Cell Maturation Antigen is an Independent Prognostic Marker in Previously Untreated Chronic Lymphocytic Leukemia. Exp Hematol 2022; 111:32-40. [PMID: 35525334 DOI: 10.1016/j.exphem.2022.04.007] [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: 01/24/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Abstract
B-cell maturation antigen (BCMA) is a cell membrane receptor expressed on mature B lymphocytes with elevated serum levels found among patients with B-cell malignancies, including chronic lymphocytic leukemia (CLL). Serum BCMA (sBCMA) levels were measured in 331 untreated, newly diagnosed CLL patients using an ELISA with a polyclonal anti-BCMA antibody. Elevated sBCMA was found among patients with CLL compared to age- and sex-matched healthy controls and those with more active CLL based on prognostic factors. The relationships between sBCMA, time to first treatment (TTFT), overall survival (OS) and multiple prognostic factors were compared using Mann Whitney and Kruskal-Wallis tests. The median sBCMA level in the CLL cohort (48.6 ng/mL) was significantly higher (p < 0.001) compared to age- and sex-matched healthy subjects (n = 100; 37.8 ng/mL). sBCMA correlated with TTFT (hazard ratio [HR] 2.9, 95% confidence interval [CI] 2.0-4.2, p < 0.001) and OS (HR 2.5, 95% CI 1.5-4.0, p < 0.001). Multiple models were utilized to test the predictive effects of sBCMA, sex, CLL-IPI and IPS-E on TTFT and OS. The addition of sBCMA to CLL-IPI and IPS-E improved their prognostic ability to predict TTFT and OS. Thus, serum BCMA is a new promising prognostic biomarker for CLL.
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Affiliation(s)
- Camilia M Soof
- OncoTracker Inc., West Hollywood, CA; Oncotherapeutics, West Hollywood, CA
| | | | | | - Susan L Slager
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Kari G Rabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - James R Berenson
- OncoTracker Inc., West Hollywood, CA; Oncotherapeutics, West Hollywood, CA; Institute for Myeloma and Bone Cancer Research, West Hollywood, CA.
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Bezerra ED, Sakemura R, Girsch JH, Stewart CM, Yun K, Sirpilla OL, Roman CM, Schick KJ, Can I, Ogbodo EJ, Tapper EE, Siegler EL, Adada MM, Kankeu Fonkoua LA, Hefazi M, Ruff MW, Slager SL, Parikh SA, Kay NE, Durrant C, Ahmed O, Chappell D, Cox MJ, Kenderian SS. Optimized Inhibition of GM-CSF in Preclinical Models of Anti-CD19 Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Davids MS, Shadman M, Parikh SA, Ujjani C, Crombie JL, Jiang D, Llamas C, Feng D, Lamanna N. A multicenter, retrospective study of accelerated venetoclax ramp-up in patients with relapsed/refractory chronic lymphocytic leukemia. Am J Hematol 2022; 97:E105-E109. [PMID: 34929063 DOI: 10.1002/ajh.26444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Matthew S. Davids
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Mazyar Shadman
- Division of Medical Oncology University of Washington Seattle Washington USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center Seattle Washington USA
| | | | - Chaitra Ujjani
- Clinical Research Division, Fred Hutchinson Cancer Research Center Seattle Washington USA
| | - Jennifer L. Crombie
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | | | | | - Dai Feng
- AbbVie Inc. North Chicago Illinois USA
| | - Nicole Lamanna
- Columbia University Medical Center New York New York USA
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38
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Affiliation(s)
- Manuel B Braga Neto
- From the Division of Gastroenterology and Hepatology (M.B.B.N., P.S.K.), the Division of Infectious Diseases (A.D.B.), and the Division of Hematology (S.A.P.), Department of Medicine, and the Department of Laboratory Medicine and Pathology (R.P.G.), Mayo Clinic, Rochester, MN
| | - Andrew D Badley
- From the Division of Gastroenterology and Hepatology (M.B.B.N., P.S.K.), the Division of Infectious Diseases (A.D.B.), and the Division of Hematology (S.A.P.), Department of Medicine, and the Department of Laboratory Medicine and Pathology (R.P.G.), Mayo Clinic, Rochester, MN
| | - Sameer A Parikh
- From the Division of Gastroenterology and Hepatology (M.B.B.N., P.S.K.), the Division of Infectious Diseases (A.D.B.), and the Division of Hematology (S.A.P.), Department of Medicine, and the Department of Laboratory Medicine and Pathology (R.P.G.), Mayo Clinic, Rochester, MN
| | - Rondell P Graham
- From the Division of Gastroenterology and Hepatology (M.B.B.N., P.S.K.), the Division of Infectious Diseases (A.D.B.), and the Division of Hematology (S.A.P.), Department of Medicine, and the Department of Laboratory Medicine and Pathology (R.P.G.), Mayo Clinic, Rochester, MN
| | - Patrick S Kamath
- From the Division of Gastroenterology and Hepatology (M.B.B.N., P.S.K.), the Division of Infectious Diseases (A.D.B.), and the Division of Hematology (S.A.P.), Department of Medicine, and the Department of Laboratory Medicine and Pathology (R.P.G.), Mayo Clinic, Rochester, MN
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39
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King RL, Gupta A, Kurtin PJ, Ding W, Call TG, Rabe KG, Kenderian SS, Leis JF, Wang Y, Schwager SM, Slager SL, Kay NE, Koehler A, Ansell SM, Inwards DJ, Habermann TM, Shi M, Hanson CA, Howard MT, Parikh SA. Chronic lymphocytic leukemia (CLL) with Reed-Sternberg-like cells vs Classic Hodgkin lymphoma transformation of CLL: does this distinction matter? Blood Cancer J 2022; 12:18. [PMID: 35091549 PMCID: PMC8799721 DOI: 10.1038/s41408-022-00616-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/14/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
The distinction between chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with isolated Hodgkin/Reed-Sternberg cells (CLL-HRS; background milieu with a paucity of inflammatory cells) and overt transformation to classic Hodgkin lymphoma (CLL-HL; mixed inflammatory background) is incompletely understood. This retrospective study examined the clinicopathologic features of CLL-HRS (n = 15) and CLL-HL (n = 31) patients seen over the past three decades from a single institution. The phenotypic features of Reed-Sternberg cells in both groups were similar, including expression of CD30, CD15, and PAX5, as well as EBV status. However, a spectrum of background CLL/SLL infiltration amongst the HRS cells was noted on pathologic review, and four patients had both diagnoses, either concurrently or in succession. The median overall survival (OS) of patients with CLL-HRS was 17.5 months compared to 33.5 months for patients with CLL-HL (P = 0.24). Among patients with CLL-HRS, those who received Hodgkin-directed therapy had a significantly longer median OS (57 months) compared to those who received CLL-directed therapy (8.4 months, P = 0.02). Our clinical and pathologic findings suggest a biologic continuum between CLL-HRS and CLL-HL and indicate that CLL-HRS patients may benefit from Hodgkin-directed therapy.
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Affiliation(s)
- Rebecca L. King
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Alia Gupta
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Paul J. Kurtin
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Wei Ding
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Timothy G. Call
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Kari G. Rabe
- Department of Quantitative Health Sciences, Rochester, MN USA
| | - Saad S. Kenderian
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Jose F. Leis
- grid.417468.80000 0000 8875 6339Department of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ USA
| | - Yucai Wang
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Susan M. Schwager
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Susan L. Slager
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA ,Department of Quantitative Health Sciences, Rochester, MN USA
| | - Neil. E. Kay
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Amber Koehler
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Stephen M. Ansell
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - David J. Inwards
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Thomas M. Habermann
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Min Shi
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Curtis A. Hanson
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Matthew T. Howard
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Sameer A. Parikh
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
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40
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Muchtar E, Koehler AB, Johnson MJ, Rabe KG, Ding W, Call TG, Leis JF, Kenderian SS, Hayman SR, Wang Y, Hampel PJ, Holets MA, Darby HC, Slager SL, Kay NE, Miao C, Canniff J, Whitaker JA, Levin MJ, Scott Schmid D, Kennedy RB, Weinberg A, Parikh SA. Humoral and cellular immune responses to recombinant herpes zoster vaccine in patients with chronic lymphocytic leukemia and monoclonal B cell lymphocytosis. Am J Hematol 2022; 97:90-98. [PMID: 34699616 PMCID: PMC9199015 DOI: 10.1002/ajh.26388] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 01/03/2023]
Abstract
Monoclonal B-cell lymphocytosis (MBL) and chronic lymphocytic leukemia (CLL) are clonal B-cell disorders associated with an increased risk of infections and impaired vaccination responses. We investigated the immunogenicity of recombinant zoster vaccine (RZV) in these patients. Individuals with MBL/untreated CLL and Bruton tyrosine kinase inhibitor (BTKi)-treated CLL patients were given two doses of RZV separated by 2 months. Responses assessed at 3 and 12 months from the first dose of RZV by an anti-glycoprotein E ELISA antibody assay and by dual-color Interferon-γ and Interleukin-2FLUOROSPOT assays were compared to historic controls matched by age and sex. About 62 patients (37 MBL/untreated CLL and 25 BTKi-treated CLL) were enrolled with a median age of 68 years at vaccination. An antibody response at 3 months was seen in 45% of participants, which was significantly lower compared to historic controls (63%, p = .03). The antibody response did not significantly differ between MBL/untreated CLL and BTKi-treated CLL (51% vs. 36%, respectively, p = .23). The CD4+ T-cell response to vaccination was significantly lower in study participants compared to controls (54% vs. 96%, p < .001), mainly due to lower responses among BTKi-treated patients compared to untreated MBL/CLL (32% vs. 73%, p = .008). Overall, only 29% of participants achieved combined antibody and cellular responses to RZV. Among participants with response assessment at 12 months (n = 47), 24% had antibody titers below the response threshold. Hypogammaglobulinemia and BTKi therapy were associated with reduced T-cell responses in a univariate analysis. Strategies to improve vaccine response to RZV among MBL/CLL patients are needed.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Amber B. Koehler
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael J. Johnson
- Department of Pediatrics (Infectious Diseases), University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kari G. Rabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Timothy G. Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jose F. Leis
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Saad S. Kenderian
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Suzanne R. Hayman
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Yucai Wang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Paul J. Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A. Holets
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Heather C. Darby
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Susan L. Slager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Neil E. Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Congrong Miao
- National VZV Laboratory, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer Canniff
- Department of Pediatrics (Infectious Diseases), University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer A Whitaker
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Myron J. Levin
- Departments of Pediatrics (Infectious Diseases) and Medicine (Infectious Diseases), University of Colorado Anschutz Medical Campus, Aurora, CO
| | - D. Scott Schmid
- National VZV Laboratory, Centers for Disease Control and Prevention, Atlanta, GA
| | - Richard B. Kennedy
- Vaccine Research Group, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Adriana Weinberg
- Department of Pediatrics (Infectious Diseases), Medicine (Infectious Diseases), and Pathology University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sameer A. Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
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41
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Boddicker NJ, Achenbach SJ, Parikh SA, Kleinstern G, Braggio E, Norman AD, Rabe KG, Vachon CM, Lesnick CE, Call TG, Olson JE, Cerhan JR, Kay NE, Hanson CA, Shanafelt TD, Slager SL. Associations of history of vaccination and hospitalization due to infection with risk of monoclonal B-cell lymphocytosis. Leukemia 2022; 36:1404-1407. [PMID: 35169244 PMCID: PMC8853183 DOI: 10.1038/s41375-022-01514-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/02/2021] [Revised: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Nicholas J. Boddicker
- grid.66875.3a0000 0004 0459 167XDivision of Computational Biology, Mayo Clinic, Rochester, MN USA
| | - Sara J. Achenbach
- grid.66875.3a0000 0004 0459 167XDivision of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN USA
| | - Sameer A. Parikh
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Geffen Kleinstern
- grid.66875.3a0000 0004 0459 167XDivision of Computational Biology, Mayo Clinic, Rochester, MN USA ,grid.18098.380000 0004 1937 0562School of Public Health, University of Haifa, Haifa, Israel
| | - Esteban Braggio
- grid.470142.40000 0004 0443 9766Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ USA
| | - Aaron D. Norman
- grid.66875.3a0000 0004 0459 167XDivision of Epidemiology, Mayo Clinic, Rochester, MN USA
| | - Kari G. Rabe
- grid.66875.3a0000 0004 0459 167XDivision of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN USA
| | - Celine M. Vachon
- grid.66875.3a0000 0004 0459 167XDivision of Epidemiology, Mayo Clinic, Rochester, MN USA
| | - Connie E. Lesnick
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Timothy G. Call
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Janet E. Olson
- grid.66875.3a0000 0004 0459 167XDivision of Epidemiology, Mayo Clinic, Rochester, MN USA
| | - James R. Cerhan
- grid.66875.3a0000 0004 0459 167XDivision of Epidemiology, Mayo Clinic, Rochester, MN USA
| | - Neil E. Kay
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Curtis A. Hanson
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Tait D. Shanafelt
- grid.168010.e0000000419368956Department of Medicine, Division of Hematology, Stanford University, Stanford, CA USA
| | - Susan L. Slager
- grid.66875.3a0000 0004 0459 167XDivision of Computational Biology, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
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42
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Ho M, Zanwar S, Duggan P, Carr R, Habermann T, Navin PJ, Salama ME, Parikh SA. Hiding in (not so) plain sight: Spontaneous tumor Lysis syndrome due to intravascular large B cell lymphoma. Am J Hematol 2022; 97:151-159. [PMID: 34677833 DOI: 10.1002/ajh.26383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Ho
- Division of General Internal Medicine, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Saurabh Zanwar
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Patrick Duggan
- Division of General Internal Medicine, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Ryan Carr
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Thomas Habermann
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Mohamed E. Salama
- Division of Hematopathology, Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Sameer A. Parikh
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
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43
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Kay NE, Hampel PJ, Van Dyke DL, Parikh SA. CLL update 2022: A continuing evolution in care. Blood Rev 2022; 54:100930. [DOI: 10.1016/j.blre.2022.100930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/20/2022]
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44
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Wang H, Tian S, Zhao Q, Blumenschein W, Yearley JH, Secreto CR, Sinha S, Call TG, Wang Y, Parikh SA, Kenderian SS, He R, Leis JF, Shi M, Van Dyke DL, Kay NE, Slager SL, Braggio E, Yan H, Ding W. Differential transcriptomic profiling in ibrutinib-naïve versus ibrutinib-resistant Richter syndrome. Hematol Oncol 2021; 40:302-306. [PMID: 34806797 DOI: 10.1002/hon.2950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hanyin Wang
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA
| | - Shulan Tian
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Qing Zhao
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Wendy Blumenschein
- Genome and Biomarker Sciences, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Jennifer H Yearley
- Genome and Biomarker Sciences, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Sutapa Sinha
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy G Call
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer A Parikh
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Van Dyke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Esteban Braggio
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Huihuang Yan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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45
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Wang Y, Achenbach SJ, Rabe KG, Shanafelt TD, Call TG, Ding W, Kenderian SS, Muchtar E, Leis JF, Koehler AB, Schwager SM, Cerhan JR, Slager SL, Kay NE, Parikh SA. Cause of death in patients with newly diagnosed chronic lymphocytic leukemia (CLL) stratified by the CLL-International Prognostic Index. Blood Cancer J 2021; 11:140. [PMID: 34354039 PMCID: PMC8342603 DOI: 10.1038/s41408-021-00532-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Sara J Achenbach
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Kari G Rabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jose F Leis
- Division of Hematology Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Susan L Slager
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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46
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Sakemura R, Bansal A, Siegler EL, Hefazi M, Yang N, Khadka RH, Newsom AN, Hansen MJ, Cox MJ, Manriquez Roman C, Schick KJ, Can I, Tapper EE, Nevala WK, Adada MM, Bezerra ED, Kankeu Fonkoua LA, Horvei P, Ruff MW, Parikh SA, Pandey MK, DeGrado TR, Suksanpaisan L, Kay NE, Peng KW, Russell SJ, Kenderian SS. Development of a Clinically Relevant Reporter for Chimeric Antigen Receptor T-cell Expansion, Trafficking, and Toxicity. Cancer Immunol Res 2021; 9:1035-1046. [PMID: 34244299 DOI: 10.1158/2326-6066.cir-20-0901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022]
Abstract
Although chimeric antigen receptor T (CART)-cell therapy has been successful in treating certain hematologic malignancies, wider adoption of CART-cell therapy is limited because of minimal activity in solid tumors and development of life-threatening toxicities, including cytokine release syndrome (CRS). There is a lack of a robust, clinically relevant imaging platform to monitor in vivo expansion and trafficking to tumor sites. To address this, we utilized the sodium iodide symporter (NIS) as a platform to image and track CART cells. We engineered CD19-directed and B-cell maturation antigen (BCMA)-directed CART cells to express NIS (NIS+CART19 and NIS+BCMA-CART, respectively) and tested the sensitivity of 18F-TFB-PET to detect trafficking and expansion in systemic and localized tumor models and in a CART-cell toxicity model. NIS+CART19 and NIS+BCMA-CART cells were generated through dual transduction with two vectors and demonstrated exclusive 125I uptake in vitro. 18F-TFB-PET detected NIS+CART cells in vivo to a sensitivity level of 40,000 cells. 18F-TFB-PET confirmed NIS+BCMA-CART-cell trafficking to the tumor sites in localized and systemic tumor models. In a xenograft model for CART-cell toxicity, 18F-TFB-PET revealed significant systemic uptake, correlating with CART-cell in vivo expansion, cytokine production, and development of CRS-associated clinical symptoms. NIS provides a sensitive, clinically applicable platform for CART-cell imaging with PET scan. 18F-TFB-PET detected CART-cell trafficking to tumor sites and in vivo expansion, correlating with the development of clinical and laboratory markers of CRS. These studies demonstrate a noninvasive, clinically relevant method to assess CART-cell functions in vivo.
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Affiliation(s)
- Reona Sakemura
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Aditya Bansal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth L Siegler
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Mehrdad Hefazi
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Nan Yang
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Infectious Disease, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Roman H Khadka
- Department of Immunology, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
| | - Alysha N Newsom
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Michelle J Cox
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Claudia Manriquez Roman
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota.,Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kendall J Schick
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Ismail Can
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
| | - Erin E Tapper
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Wendy K Nevala
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Mohamad M Adada
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Evandro D Bezerra
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Paulina Horvei
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Bone Marrow Transplant, University of California, San Francisco, San Francisco, California
| | - Michael W Ruff
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Kah-Whye Peng
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen J Russell
- Division of Hematology, Mayo Clinic, Rochester, Minnesota.,Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Saad S Kenderian
- T Cell Engineering, Mayo Clinic, Rochester, Minnesota. .,Division of Hematology, Mayo Clinic, Rochester, Minnesota.,Department of Immunology, Mayo Clinic, Rochester, Minnesota.,Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
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47
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de Campos CB, O'Brien DR, McCabe CE, Yan H, Kleinstern G, Wang Z, Bruins LA, Allmer C, Boddicker NJ, Secreto CR, Norman AD, Tian S, Rabe KG, Call TG, Parikh SA, Leis JF, Ding W, Furman R, Weinberg JB, Cerhan JR, Vachon CM, Kay NE, Slager SL, Braggio E. Abstract 2209: Characterization of underlying genomic features among African ancestry populations diagnosed with chronic lymphocytic leukemia. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2209] [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
Chronic lymphocytic leukemia (CLL) is a neoplastic disease of mature B-cells with a highly heterogeneous clinical course. While European ancestry (EA) populations present an increased incidence of CLL, African ancestry (AA) populations have a younger median age of onset, higher frequency of adverse prognostic factors, and inferior clinical outcomes. Despite the considerable effort to characterize the genetic landscape of CLL, AA are overwhelmingly underrepresented. Our hypothesis is that the clinical differences observed between AA and EA populations are, in part, explained by underlying genetic features. To address this imbalance, we identified 90 AA patients diagnosed with CLL, 64% of which were untreated at sample collection. RNA and DNA were extracted from CD5+/CD19+ clonal B-cells. We performed mRNA-seq and targeted sequencing in 59 recurrently mutated somatic CLL driver genes. Differentially expressed genes were identified using edgeR. Data was compared to our previously analyzed EA CLL cohort (N=445). The median age at diagnosis was 59 years for AA and 66 for EA and 74% of AA and 50% of EA had unmutated IGHV (u-IGHV) status. When evaluating the entire AA and EA cohorts, there was a significant increased frequency of mutations in TP53, SF3B1, and NFKBIE, identified in 29%, 24%, and 20% of AA CLLs, compared to 5%, 9%, and 9%, respectively, in EA CLLs (p<0.01). When exclusively evaluating the untreated and u-IGHV cases, AA CLLs showed greater proportion of TP53 (30% vs 12%; p=0.0145), NFKBIE (30% vs 15%; p=0.0492), BIRC3 (21% vs 10%; p=0.0697), and KRAS (15% vs 7%; p=0.1683). Furthermore, there was an increase in mutations targeting relevant molecular pathways, such as NF-κB (42% vs 15%) and MAPK (18% vs 8%). Upregulation MAPK pathway was also confirmed by mRNA-seq analysis in the AA u-IGHV CLLs. Because of the high prevalence of TP53 mutations in the AA cohort, we further evaluated differential gene expression in the DNA Damage/Telomere Stress-Induced Senescence pathway. AA CLLs presented a significant downregulation of multiple genes associated with genome stability and cellular DNA damage response - DDR (including TP53 and ATM), double strand break repair (H2AFX and RAD50), telomere maintenance (POT1 and ACD), and cell cycle regulation (RB1, CCNA1, and CCNE2) (FDR<0.05). DDR is responsible for DNA repair or induction of apoptosis, with its deficiency resulting in the accumulation of chromosomal aberrations, negatively impacting clinical outcome in CLL. Disparities in cancer are influenced by numerous factors that affect disease risk, screening and diagnosis, access to treatment, and survival. We identified an increased number of genomic alterations in the AA CLL cohort, primarily inducing activation of NF-κB and MAPK pathways and DDR impairment, with the increased frequency of mutations, notably in TP53 and BIRC3, expected to negatively impact prognosis.
Citation Format: Cecilia Bonolo de Campos, Daniel R. O'Brien, Chantal E. McCabe, Huihuang Yan, Geffen Kleinstern, Zhiquan Wang, Laura A. Bruins, Cristine Allmer, Nicholas J. Boddicker, Charla R. Secreto, Aaron D. Norman, Shulan Tian, Kari G. Rabe, Timothy G. Call, Sameer A. Parikh, Jose F. Leis, Wei Ding, Richard Furman, J Brice Weinberg, James R. Cerhan, Celine M. Vachon, Neil E. Kay, Susan L. Slager, Esteban Braggio. Characterization of underlying genomic features among African ancestry populations diagnosed with chronic lymphocytic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2209.
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Horna P, Olteanu H, Jevremovic D, Otteson GE, Corley H, Ding W, Parikh SA, Shah MV, Morice WG, Shi M. Single-Antibody Evaluation of T-Cell Receptor β Constant Chain Monotypia by Flow Cytometry Facilitates the Diagnosis of T-Cell Large Granular Lymphocytic Leukemia. Am J Clin Pathol 2021; 156:139-148. [PMID: 33438036 DOI: 10.1093/ajcp/aqaa214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The diagnosis of T-cell large granular lymphocytic leukemia (T-LGLL) is challenging because of overlapping immunophenotypic features with reactive T cells and limitations of T-cell clonality assays. We studied whether adding an antibody against T-cell receptor β constant region 1 (TRBC1) to a comprehensive flow cytometry panel could facilitate the diagnosis of T-LGLL. METHODS We added TRBC1 antibody to the standard T-cell and natural killer (NK) cell panel to assess T-cell clonality in 56 T-LGLLs and 34 reactive lymphocytoses. In addition, 20 chronic lymphoproliferative disorder of NK cells (CLPD-NKs) and 10 reactive NK-cell lymphocytoses were analyzed. RESULTS Clonal T cells were detected in all available T-LGLLs by monotypic TRBC1 expression and clonal/equivocal T-cell receptor gene rearrangement (TCGR) studies, compared with only 27% of T-LGLLs by killer-cell immunoglobulin-like receptor (KIR) restriction. Overall, 85% of T-LGLLs had a blood tumor burden greater than 500 cells/µL. Thirty-four reactive cases showed polytypic TRBC1 expression, except for 5 that revealed small T-cell clones of uncertain significance. All CLPD-NKs showed expected clonal KIR expression and negative TRBC1 expression. CONCLUSIONS Addition of TRBC1 antibody to the routine flow cytometry assay could replace the TCGR molecular study and KIR flow cytometric analysis to assess clonality, simplifying the diagnosis of T-LGLL.
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Affiliation(s)
- Pedro Horna
- Departments of Laboratory Medicine and Pathology, Rochester, MN
| | - Horatiu Olteanu
- Departments of Laboratory Medicine and Pathology, Rochester, MN
| | | | | | - Heidi Corley
- Departments of Laboratory Medicine and Pathology, Rochester, MN
| | - Wei Ding
- Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Min Shi
- Departments of Laboratory Medicine and Pathology, Rochester, MN
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Audil HY, Hampel PJ, Van Dyke DL, Achenbach SJ, Rabe KG, Smoley SA, Call TG, Ding W, Shi M, Hanson CA, Wang Y, Muchtar E, Koehler AB, Schwager SM, Leis JF, Braggio E, Slager SL, Kay NE, Kenderian SS, Parikh SA. The prognostic significance of del6q23 in chronic lymphocytic leukemia. Am J Hematol 2021; 96:E203-E206. [PMID: 33749852 DOI: 10.1002/ajh.26168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Sara J. Achenbach
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | - Kari G. Rabe
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | | | | | - Wei Ding
- Division of Hematology Mayo Clinic Rochester Minnesota
| | - Min Shi
- Division of Hematopathology Mayo Clinic Rochester Minnesota
| | | | - Yucai Wang
- Division of Hematology Mayo Clinic Rochester Minnesota
| | - Eli Muchtar
- Division of Hematology Mayo Clinic Rochester Minnesota
| | | | | | - Jose F. Leis
- Division of Hematology and Oncology Mayo Clinic Phoenix Arizona
| | - Esteban Braggio
- Division of Hematology and Oncology Mayo Clinic Phoenix Arizona
| | - Susan L. Slager
- Division of Hematology Mayo Clinic Rochester Minnesota
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | - Neil E. Kay
- Division of Hematology Mayo Clinic Rochester Minnesota
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Slager SL, Lanasa MC, Marti GE, Achenbach SJ, Camp NJ, Abbasi F, Kay NE, Vachon CM, Cerhan JR, Johnston JB, Call TG, Rabe KG, Kleinstern G, Boddicker NJ, Norman AD, Parikh SA, Leis JF, Banerji V, Brander DM, Glenn M, Ferrajoli A, Curtin K, Braggio E, Shanafelt TD, McMaster ML, Weinberg JB, Hanson CA, Caporaso NE. Natural history of monoclonal B-cell lymphocytosis among relatives in CLL families. Blood 2021; 137:2046-2056. [PMID: 33512457 PMCID: PMC8057266 DOI: 10.1182/blood.2020006322] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 04/20/2020] [Accepted: 11/14/2020] [Indexed: 12/21/2022] Open
Abstract
Chronic lymphocytic lymphoma (CLL) has one of the highest familial risks among cancers. Monoclonal B-cell lymphocytosis (MBL), the precursor to CLL, has a higher prevalence (13%-18%) in families with 2 or more members with CLL compared with the general population (5%-12%). Although, the rate of progression to CLL for high-count MBLs (clonal B-cell count ≥500/µL) is ∼1% to 5%/y, no low-count MBLs have been reported to progress to date. We report the incidence and natural history of MBL in relatives from CLL families. In 310 CLL families, we screened 1045 relatives for MBL using highly sensitive flow cytometry and prospectively followed 449 of them. MBL incidence was directly age- and sex-adjusted to the 2010 US population. CLL cumulative incidence was estimated using Kaplan-Meier survival curves. At baseline, the prevalence of MBL was 22% (235/1045 relatives). After a median follow-up of 8.1 years among 449 relatives, 12 individuals progressed to CLL with a 5-year cumulative incidence of 1.8%. When considering just the 139 relatives with low-count MBL, the 5-year cumulative incidence increased to 5.7%. Finally, 264 had no MBL at baseline, of whom 60 individuals subsequently developed MBL (2 high-count and 58 low-count MBLs) with an age- and sex-adjusted incidence of 3.5% after a median of 6 years of follow-up. In a screening cohort of relatives from CLL families, we reported progression from normal-count to low-count MBL to high-count MBL to CLL, demonstrating that low-count MBL precedes progression to CLL. We estimated a 1.1% annual rate of progression from low-count MBL, which is in excess of that in the general population.
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Affiliation(s)
- Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Mark C Lanasa
- Department of Medicine, Duke University, Duke Cancer Institute, Durham, NC
| | - Gerald E Marti
- Lymphoid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sara J Achenbach
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Nicola J Camp
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Fatima Abbasi
- Center for Biologics Research and Evaluation, Food and Drug Administration, Silver Springs, MD
| | - Neil E Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - James B Johnston
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kari G Rabe
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Aaron D Norman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jose F Leis
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Versha Banerji
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Danielle M Brander
- Department of Medicine, Duke University, Duke Cancer Institute, Durham, NC
| | - Martha Glenn
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Alessandra Ferrajoli
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen Curtin
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Tait D Shanafelt
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Mary L McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - J Brice Weinberg
- Department of Medicine, Duke University, Duke Cancer Institute, Durham, NC
- Department of Immunology, Duke University Medical Center, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC; and
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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