1
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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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2
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Wolfson JA, Grimes AC, Nuno M, Kerber CL, Ramakrishnan S, Beauchemin M, Dickens D, Levine JM, Roth ME, Scialla M, Woods W, Vargas S, Boayue KB, Chang GJ, Stock W, Hershman D, Curran E, Advani A, O'Dwyer K, Luger S, Liu JJ, Freyer DR, Sung L, Parsons SK. Characteristics of Health Care Settings Where Adolescents and Young Adults Receive Care for ALL. JCO Oncol Pract 2024; 20:491-502. [PMID: 38252911 DOI: 10.1200/op.23.00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Individuals diagnosed with cancer between 15 and 39 years (adolescent and young adult [AYA]) face unique vulnerability. Detail is lacking about care delivery for these patients, especially those with ALL. We address these knowledge gaps by describing AYA ALL care delivery details at National Cancer Institute Community Oncology Research Program (NCORP) (sub)affiliates by model of care. METHODS Participating institutions treated at least one AYA with ALL from 2012 to 2016. Study-specific criteria were used to determine the number of unique clinical facilities (CFs) per NCORP and their model of care (adult/internal medicine [IM], pediatric, mixed [both]). Surveys completed by NCORPs for each CF by model of care captured size, resources, services, and communication. RESULTS Among 84 participating CFs (adult/IM, n=47; pediatric, n=15; mixed, n=24), 34% treated 5-10 AYAs with ALL annually; adult/IM CFs more often treated <5 (adult/IM, 60%; pediatric, 40%; mixed, 29%). Referral decisions were commonly driven by an age/diagnosis combination (58%), with frequent ALL-specific age minimums (87%) or maximums (80%). Medical, navigational, and social work services were similar across models while psychology was available at more pediatric CFs (pediatric, 80%; adult/IM, 40%; mixed, 46%-54%). More pediatric or mixed CFs reported oncologists interacting with pediatric/adult counterparts via tumor boards (pediatric, 93%; adult/IM, 26%; mixed, 96%) or initiating contact (pediatric, 100%; adult/IM, 77%; mixed 96%); more pediatric CFs reported an affiliated counterpart (pediatric, 53%; adult, 19%). Most CFs reported no AYA-specific resources (79%) or meetings (83%-98%). CONCLUSION System-level aspects of AYA ALL care delivery have not been examined previously. At NCORPs, these characteristics differ by models of care. Additional work is ongoing to investigate the impact of these facility-level factors on guideline-concordant care in this population. Together, these findings can inform a system-level intervention for diverse practice settings.
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Affiliation(s)
- Julie A Wolfson
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Allison C Grimes
- Division of Pediatric Hematology-Oncology, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Michelle Nuno
- Children's Oncology Group, Arcadia, CA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | - Charlotte L Kerber
- Department of Public Health Sciences, University of California, Davis, CA
| | | | - Melissa Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, NY
| | - David Dickens
- Division of Pediatric Hematology-Oncology, University of Iowa, Iowa City, IA
| | - Jennifer M Levine
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
| | - Michael E Roth
- Division of Pediatric Hematology-Oncology, MD Anderson Cancer Center, Houston, TX
| | - Michele Scialla
- Division of Pediatric Hematology-Oncology, Nemours, Wilmington, DE
| | - Wendy Woods
- Division of Pediatric Hematology-Oncology, Blank Children's Hospital, Des Moines, IA
| | | | - Koh B Boayue
- Division of Pediatric Hematology-Oncology, University of New Mexico Cancer Center, Albuquerque, NM
| | - George J Chang
- Alliance Cancer Care Delivery Research, Houston, TX
- Department of Colon and Rectal Surgery and Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Wendy Stock
- Alliance Leukemia, Chicago, IL
- Division of Hematology-Oncology, University of Chicago, Chicago, IL
| | - Dawn Hershman
- SWOG Cancer Care Delivery Research, Portland, OR
- Division of Hematology-Oncology, Columbia University, New York, NY
| | - Emily Curran
- Alliance Leukemia, Cincinnati, OH
- Division of Hematology-Oncology, University of Cincinnati, Cincinnati, OH
| | - Anjali Advani
- SWOG Leukemia, Portland, OR
- Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH
| | - Kristen O'Dwyer
- SWOG Leukemia, Portland, OR
- Division of Hematology-Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Selina Luger
- ECOG-ACRIN Leukemia, Boston, MA
- Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jane Jijun Liu
- Alliance Community Oncology, Chicago, IL
- Heartland NCORP, Division of Hematology-Oncology, Illinois CancerCare, Peoria, IL
| | - David R Freyer
- Division of Pediatric Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Lillian Sung
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, ON (Canada)
| | - Susan K Parsons
- Division of Hematology/Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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3
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Laczko D, Poveda-Rogers C, Matthews AH, Snaith O, Luger S, Bagg A, Caponetti GC, Morrissette JJD, Yang G. RAD21 mutations in acute myeloid leukemia. Leuk Lymphoma 2024:1-7. [PMID: 38506144 DOI: 10.1080/10428194.2024.2328233] [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: 07/11/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
The cohesin complex is a ring-shaped protein structure involved in DNA repair and chromosomal segregation. Studies have showed that genomic alterations in the cohesin complex members are among the initial occurrences in the development of acute myeloid leukemia (AML). STAG2 is the most commonly mutated and best-studied member of the cohesin complex in AML and mutations in this gene have been associated with adverse outcomes and are diagnostically relevant. However, the exact role of mutations in other members of the cohesin complex in the development of myeloid neoplasia is controversial. In this single institution study, we retrospectively reviewed data from the molecular profiles of 1,381 AML patients and identified 14 patients with mutations in RAD21, another member of the cohesin complex. We evaluated the frequency, mutational profile, clinico-pathologic features, and prognostic impact of RAD21 in this cohort. This study showed that RAD21-mutated AML often associates with monocytic differentiation, CD7 expression, co-existing mutations in epigenetic regulators, a normal karyotype, and poor prognosis. Our findings provide additional insights into the morphologic, immunophenotypic, and genomic profile of RAD21 mutation-positive AML and suggest that RAD21 mutations should be evaluated for independent prognostic significance in AML.
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Affiliation(s)
- Dorottya Laczko
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corey Poveda-Rogers
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew H Matthews
- Division of Hematology Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Oraine Snaith
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Selina Luger
- Division of Hematology Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam Bagg
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gabriel C Caponetti
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer J D Morrissette
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guang Yang
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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4
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Zarnegar-Lumley S, Alonzo TA, Gerbing RB, Othus M, Sun Z, Ries RE, Wang J, Leonti A, Kutny MA, Ostronoff F, Radich JP, Appelbaum FR, Pogosova-Agadjanyan EL, O’Dwyer K, Tallman MS, Litzow M, Atallah E, Cooper TM, Aplenc RA, Abdel-Wahab O, Gamis AS, Luger S, Erba H, Levine R, Kolb EA, Stirewalt DL, Meshinchi S, Tarlock K. Characteristics and prognostic impact of IDH mutations in AML: a COG, SWOG, and ECOG analysis. Blood Adv 2023; 7:5941-5953. [PMID: 37267439 PMCID: PMC10562769 DOI: 10.1182/bloodadvances.2022008282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/04/2023] Open
Abstract
Somatic mutations in isocitrate dehydrogenase (IDH) genes occur frequently in adult acute myeloid leukemia (AML) and less commonly in pediatric AML. The objective of this study was to describe the prevalence, mutational profile, and prognostic significance of IDH mutations in AML across age. Our cohort included 3141 patients aged between <1 month and 88 years treated on Children's Cancer Group/Children's Oncology Group (n = 1872), Southwest Oncology Group (n = 359), Eastern Cooperative Oncology Group (n = 397) trials, and in Beat AML (n = 333) and The Cancer Genome Atlas (n = 180) genomic characterization cohorts. We retrospectively analyzed patients in 4 age groups (age range, n): pediatric (0-17, 1744), adolescent/young adult (18-39, 444), intermediate-age (40-59, 640), older (≥60, 309). IDH mutations (IDHmut) were identified in 9.2% of the total cohort (n = 288; IDH1 [n = 123, 42.7%]; IDH2 [n = 165, 57.3%]) and were strongly correlated with increased age: 3.4% pediatric vs 21% older, P < .001. Outcomes were similar in IDHmut and IDH-wildtype (IDHWT) AML (event-free survival [EFS]: 35.6% vs 40.0%, P = .368; overall survival [OS]: 50.3% vs 55.4%, P = .196). IDH mutations frequently occurred with NPM1 (47.2%), DNMT3A (29.3%), and FLT3-internal tandem duplication (ITD) (22.4%) mutations. Patients with IDHmut AML with NPM1 mutation (IDHmut/NPM1mut) had significantly improved survival compared with the poor outcomes experienced by patients without (IDHmut/NPM1WT) (EFS: 55.1% vs 17.0%, P < .001; OS: 66.5% vs 35.2%, P < .001). DNTM3A or FLT3-ITD mutations in otherwise favorable IDHmut/NPM1mut AML led to inferior outcomes. Age group analysis demonstrated that IDH mutations did not abrogate the favorable prognostic impact of NPM1mut in patients aged <60 years; older patients had poor outcomes regardless of NPM1 status. These trials were registered at www.clinicaltrials.gov as #NCT00070174, #NCT00372593, #NCT01371981, #NCT00049517, and #NCT00085709.
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Affiliation(s)
- Sara Zarnegar-Lumley
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Todd A. Alonzo
- Children’s Oncology Group, Monrovia, CA
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Zhuoxin Sun
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jim Wang
- Children’s Oncology Group, Monrovia, CA
| | - Amanda Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew A. Kutny
- Division of Hematology/Oncology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | - Fabiana Ostronoff
- Intermountain Blood and Marrow Transplant and Acute Leukemia Program, Intermountain Healthcare, Salt Lake City, UT
| | - Jerald P. Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | - Frederick R. Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | | | - Kristen O’Dwyer
- Department of Medicine, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Martin S. Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Litzow
- Department of Internal Medicine and Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN
| | - Ehab Atallah
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Todd M. Cooper
- Division of Hematology/Oncology, Seattle Children’s Hospital Cancer and Blood Disorders Center, University of Washington, Seattle, WA
| | - Richard A. Aplenc
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Omar Abdel-Wahab
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan S. Gamis
- Division of Hematology/Oncology/Bone Marrow Transplantation, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Selina Luger
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harry Erba
- Division of Hematologic Malignancies and Cellular Therapies, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Ross Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Derek L. Stirewalt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Katherine Tarlock
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Hematology/Oncology, Seattle Children’s Hospital Cancer and Blood Disorders Center, University of Washington, Seattle, WA
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5
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Park CS, Yoshihara H, Gao Q, Qu C, Iacobucci I, Ghate PS, Connelly JP, Pruett-Miller SM, Wagner B, Robinson CG, Mishra A, Peng J, Yang L, Rankovic Z, Finkelstein D, Luger S, Litzow M, Paietta EM, Hebbar N, Velasquez MP, Mullighan CG. Stromal-induced epithelial-mesenchymal transition induces targetable drug resistance in acute lymphoblastic leukemia. Cell Rep 2023; 42:112804. [PMID: 37453060 PMCID: PMC10529385 DOI: 10.1016/j.celrep.2023.112804] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/05/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
The bone marrow microenvironment (BME) drives drug resistance in acute lymphoblastic leukemia (ALL) through leukemic cell interactions with bone marrow (BM) niches, but the underlying mechanisms remain unclear. Here, we show that the interaction between ALL and mesenchymal stem cells (MSCs) through integrin β1 induces an epithelial-mesenchymal transition (EMT)-like program in MSC-adherent ALL cells, resulting in drug resistance and enhanced survival. Moreover, single-cell RNA sequencing analysis of ALL-MSC co-culture identifies a hybrid cluster of MSC-adherent ALL cells expressing both B-ALL and MSC signature genes, orchestrated by a WNT/β-catenin-mediated EMT-like program. Blockade of interaction between β-catenin and CREB binding protein impairs the survival and drug resistance of MSC-adherent ALL cells in vitro and results in a reduction in leukemic burden in vivo. Targeting of this WNT/β-catenin-mediated EMT-like program is a potential therapeutic approach to overcome cell extrinsically acquired drug resistance in ALL.
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Affiliation(s)
- Chun Shik Park
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Hiroki Yoshihara
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Qingsong Gao
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Chunxu Qu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Pankaj S Ghate
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jon P Connelly
- Center for Advanced Genome Engineering, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Shondra M Pruett-Miller
- Center for Advanced Genome Engineering, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ben Wagner
- Cell and Tissue Imaging Center, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Camenzind G Robinson
- Cell and Tissue Imaging Center, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ashutosh Mishra
- Center for Proteomics and Metabolomics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Junmin Peng
- Center for Proteomics and Metabolomics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Structural Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Lei Yang
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Zoran Rankovic
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - David Finkelstein
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19106, USA
| | - Mark Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Nikhil Hebbar
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - M Paulina Velasquez
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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6
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Hetzel S, Mattei AL, Kretzmer H, Qu C, Chen X, Fan Y, Wu G, Roberts KG, Luger S, Litzow M, Rowe J, Paietta E, Stock W, Mardis ER, Wilson RK, Downing JR, Mullighan CG, Meissner A. Acute lymphoblastic leukemia displays a distinct highly methylated genome. Nat Cancer 2022; 3:768-782. [PMID: 35590059 PMCID: PMC9236905 DOI: 10.1038/s43018-022-00370-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/25/2022] [Indexed: 04/13/2023]
Abstract
DNA methylation is tightly regulated during development and is stably maintained in healthy cells. In contrast, cancer cells are commonly characterized by a global loss of DNA methylation co-occurring with CpG island hypermethylation. In acute lymphoblastic leukemia (ALL), the commonest childhood cancer, perturbations of CpG methylation have been reported to be associated with genetic disease subtype and outcome, but data from large cohorts at a genome-wide scale are lacking. Here, we performed whole-genome bisulfite sequencing across ALL subtypes, leukemia cell lines and healthy hematopoietic cells, and show that unlike most cancers, ALL samples exhibit CpG island hypermethylation but minimal global loss of methylation. This was most pronounced in T cell ALL and accompanied by an exceptionally broad range of hypermethylation of CpG islands between patients, which is influenced by TET2 and DNMT3B. These findings demonstrate that ALL is characterized by an unusually highly methylated genome and provide further insights into the non-canonical regulation of methylation in cancer.
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Affiliation(s)
- Sara Hetzel
- Department of Genome Regulation, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Alexandra L Mattei
- Department of Genome Regulation, Max Planck Institute for Molecular Genetics, Berlin, Germany
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA
| | - Helene Kretzmer
- Department of Genome Regulation, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Chunxu Qu
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Xiang Chen
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yiping Fan
- Center for Applied Bioinformatics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gang Wu
- Center for Applied Bioinformatics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathryn G Roberts
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jacob Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Wendy Stock
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Elaine R Mardis
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard K Wilson
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - James R Downing
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Charles G Mullighan
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Alexander Meissner
- Department of Genome Regulation, Max Planck Institute for Molecular Genetics, Berlin, Germany.
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Biology, Chemistry and Pharmacy, Freie Universität, Berlin, Germany.
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7
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Vaughn DM, Johnson PC, Jagielo AD, Topping CEW, Reynolds MJ, Kavanaugh AR, Webb JA, Fathi AT, Hobbs G, Brunner A, O'Connor N, Luger S, Bhatnagar B, LeBlanc TW, El-Jawahri A. Factors Associated with Health Care Utilization at the End of Life for Patients with Acute Myeloid Leukemia. J Palliat Med 2021; 25:749-756. [PMID: 34861118 DOI: 10.1089/jpm.2021.0249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patients (≥60 years) with acute myeloid leukemia (AML) often receive intense health care utilization at the end of life (EOL). However, factors associated with their health care use at the EOL are unknown. Methods: We conducted a secondary analysis of 168 deceased patients with AML within the United States. We assessed quality of life (QOL) (Functional-Assessment-Cancer-Therapy-Leukemia), and psychological distress (Hospital-Anxiety-and-Depression Scale [HADS]; Patient-Health-Questionnaire-9 [PHQ-9]) at diagnosis. We used multivariable logistic regression models to examine the association between patient-reported factors and the following outcomes: (1) hospitalizations in the last 7 days of life, (2) receipt of chemotherapy in the last 30 days of life, and (3) hospice utilization. Results: About 66.7% (110/165) were hospitalized in the last 7 days of life, 51.8% (71/137) received chemotherapy in the last 30 days of life, and 40.7% (70/168) utilized hospice. In multivariable models, higher education (odds ratio [OR] = 1.54, p = 0.006) and elevated baseline depression symptoms (PHQ-9: OR = 1.09, p = 0.028) were associated with higher odds of hospitalization in the last seven days of life, while higher baseline QOL (OR = 0.98, p = 0.009) was associated with lower odds of hospitalization at the EOL. Higher baseline depression symptoms were associated with receipt of chemotherapy at the EOL (HADS-Depression: OR = 1.10, p = 0.042). Higher education was associated with lower hospice utilization (OR = 0.356, p = 0.024). Conclusions: Patients with AML who are more educated, with higher baseline depression symptoms and lower QOL, were more likely to experience high health care utilization at the EOL. These populations may benefit from interventions to optimize the quality of their EOL care.
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Affiliation(s)
- Dagny M Vaughn
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Connor Johnson
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Annemarie D Jagielo
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlisle E W Topping
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew J Reynolds
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison R Kavanaugh
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jason A Webb
- Department of Medicine, Division of Hematology/Medical Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - Amir T Fathi
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriela Hobbs
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Brunner
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nina O'Connor
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Selina Luger
- Department of Medicine, Division of Hematology and Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bhavana Bhatnagar
- Department of Medicine, Section of Hematology/Oncology, West Virginia University Cancer Institute, Wheeling Hospital, Wheeling, West Virginia, USA
| | - Thomas W LeBlanc
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina, USA
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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8
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Montefiori LE, Bendig S, Gu Z, Chen X, Pölönen P, Ma X, Murison A, Zeng A, Garcia-Prat L, Dickerson K, Iacobucci I, Abdelhamed S, Hiltenbrand R, Mead PE, Mehr CM, Xu B, Cheng Z, Chang TC, Westover T, Ma J, Stengel A, Kimura S, Qu C, Valentine MB, Rashkovan M, Luger S, Litzow MR, Rowe JM, den Boer ML, Wang V, Yin J, Kornblau SM, Hunger SP, Loh ML, Pui CH, Yang W, Crews KR, Roberts KG, Yang JJ, Relling MV, Evans WE, Stock W, Paietta EM, Ferrando AA, Zhang J, Kern W, Haferlach T, Wu G, Dick JE, Klco JM, Haferlach C, Mullighan CG. Enhancer Hijacking Drives Oncogenic BCL11B Expression in Lineage-Ambiguous Stem Cell Leukemia. Cancer Discov 2021; 11:2846-2867. [PMID: 34103329 PMCID: PMC8563395 DOI: 10.1158/2159-8290.cd-21-0145] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/27/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022]
Abstract
Lineage-ambiguous leukemias are high-risk malignancies of poorly understood genetic basis. Here, we describe a distinct subgroup of acute leukemia with expression of myeloid, T lymphoid, and stem cell markers driven by aberrant allele-specific deregulation of BCL11B, a master transcription factor responsible for thymic T-lineage commitment and specification. Mechanistically, this deregulation was driven by chromosomal rearrangements that juxtapose BCL11B to superenhancers active in hematopoietic progenitors, or focal amplifications that generate a superenhancer from a noncoding element distal to BCL11B. Chromatin conformation analyses demonstrated long-range interactions of rearranged enhancers with the expressed BCL11B allele and association of BCL11B with activated hematopoietic progenitor cell cis-regulatory elements, suggesting BCL11B is aberrantly co-opted into a gene regulatory network that drives transformation by maintaining a progenitor state. These data support a role for ectopic BCL11B expression in primitive hematopoietic cells mediated by enhancer hijacking as an oncogenic driver of human lineage-ambiguous leukemia. SIGNIFICANCE: Lineage-ambiguous leukemias pose significant diagnostic and therapeutic challenges due to a poorly understood molecular and cellular basis. We identify oncogenic deregulation of BCL11B driven by diverse structural alterations, including de novo superenhancer generation, as the driving feature of a subset of lineage-ambiguous leukemias that transcend current diagnostic boundaries.This article is highlighted in the In This Issue feature, p. 2659.
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Affiliation(s)
- Lindsey E Montefiori
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Zhaohui Gu
- Department of Computational and Quantitative Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
- Department of Systems Biology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Xiaolong Chen
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Petri Pölönen
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alex Murison
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Andy Zeng
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Laura Garcia-Prat
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Kirsten Dickerson
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sherif Abdelhamed
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ryan Hiltenbrand
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul E Mead
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Cyrus M Mehr
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Beisi Xu
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhongshan Cheng
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ti-Cheng Chang
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tamara Westover
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Shunsuke Kimura
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Chunxu Qu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Marcus B Valentine
- Cytogenetics Core Facility, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Marissa Rashkovan
- Institute for Cancer Genetics, Columbia University, New York, New York
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Victoria Wang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jun Yin
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Steven M Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen P Hunger
- Department of Pediatrics, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wenjian Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kristine R Crews
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kathryn G Roberts
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jun J Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - William E Evans
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy Stock
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | | | - Adolfo A Ferrando
- Institute for Cancer Genetics, Columbia University, New York, New York
- Department of Pediatrics, Columbia University, New York, New York
- Department of Pathology and Cell Biology, Columbia University, New York, New York
- Department of Systems Biology, Columbia University, New York, New York
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | - Gang Wu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John E Dick
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Jeffery M Klco
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | | | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
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9
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Rashkovan M, Albero R, Gianni F, Perez-Duran P, Miller HI, Mackey AL, Paietta EM, Tallman MS, Rowe JM, Litzow MR, Wiernik PH, Luger S, Sulis ML, Soni RK, Ferrando AA. Intracellular cholesterol pools regulate oncogenic signaling and epigenetic circuitries in Early T-cell Precursor Acute Lymphoblastic Leukemia. Cancer Discov 2021; 12:856-871. [PMID: 34711640 DOI: 10.1158/2159-8290.cd-21-0551] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/13/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
Early T-cell acute lymphoblastic leukemia (ETP-ALL) is an aggressive hematologic malignancy associated with early relapse and poor prognosis that is genetically, immunophenotypically and transcriptionally distinct from more mature T-cell acute lymphoblastic (T-ALL) tumors. Here, we leveraged global metabolomic and transcriptomic profiling of primary ETP and T-ALL leukemia samples to identify specific metabolic circuitries differentially active in this high-risk leukemia group. ETP-ALLs showed increased biosynthesis of phospholipids and sphingolipids, and were specifically sensitive to inhibition of 3-hydroxy-3-methylglutaryl-CoA Reductase (HMGCR), the rate-limiting enzyme in the mevalonate pathway. Mechanistically, inhibition of cholesterol synthesis inhibited oncogenic AKT1 signaling and suppressed MYC expression via loss of chromatin accessibility at a leukemia stem cell-specific long range MYC enhancer. In all, these results identify the mevalonate pathway as a druggable novel vulnerability in high-risk ETP-ALL cells and uncover an unanticipated critical role for cholesterol biosynthesis in signal transduction and epigenetic circuitries driving leukemia cell growth and survival.
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Affiliation(s)
| | - Robert Albero
- Institute for Cancer Genetics, Columbia University Medical Center
| | - Francesca Gianni
- Institute for Cancer Genetics, Columbia University Medical Center
| | | | - Hannah I Miller
- Institute for Cancer Genetics, Columbia University Medical Center
| | - Adam L Mackey
- Institute for Cancer Genetics, Columbia University Medical Center
| | - Elisabeth M Paietta
- Montefiore Medical Center-North Division, Albert Einstein College of Medicine
| | - Martin S Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center
| | - Jacob M Rowe
- Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center and Technion
| | - Mark R Litzow
- Division of Hematology and Department of Internal Medicine, Mayo Clinic
| | | | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania
| | | | - Rajesh K Soni
- Proteomics Core Facility, Columbia University Medical Center
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10
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Brown PA, Shah B, Advani A, Aoun P, Boyer MW, Burke PW, DeAngelo DJ, Dinner S, Fathi AT, Gauthier J, Jain N, Kirby S, Liedtke M, Litzow M, Logan A, Luger S, Maness LJ, Massaro S, Mattison RJ, May W, Oluwole O, Park J, Przespolewski A, Rangaraju S, Rubnitz JE, Uy GL, Vusirikala M, Wieduwilt M, Lynn B, Berardi RA, Freedman-Cass DA, Campbell M. Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1079-1109. [PMID: 34551384 DOI: 10.6004/jnccn.2021.0042] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Acute Lymphoblastic Leukemia (ALL) focus on the classification of ALL subtypes based on immunophenotype and cytogenetic/molecular markers; risk assessment and stratification for risk-adapted therapy; treatment strategies for Philadelphia chromosome (Ph)-positive and Ph-negative ALL for both adolescent and young adult and adult patients; and supportive care considerations. Given the complexity of ALL treatment regimens and the required supportive care measures, the NCCN ALL Panel recommends that patients be treated at a specialized cancer center with expertise in the management of ALL This portion of the Guidelines focuses on the management of Ph-positive and Ph-negative ALL in adolescents and young adults, and management in relapsed settings.
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Affiliation(s)
- Patrick A Brown
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Anjali Advani
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Jordan Gauthier
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Nitin Jain
- The University of Texas MD Anderson Cancer Center
| | | | | | | | - Aaron Logan
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Selina Luger
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | - Jae Park
- Memorial Sloan Kettering Cancer Center
| | | | | | - Jeffrey E Rubnitz
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Geoffrey L Uy
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Beth Lynn
- National Comprehensive Cancer Network
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11
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Wieduwilt MJ, Stock W, Advani A, Luger S, Larson RA, Tallman M, Appelbaum F, Zhang MJ, Bo-Subait K, Wang HL, Bhatt VR, Dholaria B, Eapen M, Hamadani M, Jamy O, Prestidge T, Pulsipher M, Ritchie D, Rizzieri D, Sharma A, Barba P, Sandmaier BM, de Lima M, Kebriaei P, Litzow M, Saber W, Weisdorf D. Correction: Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR. Leukemia 2021; 35:2140. [PMID: 34088982 DOI: 10.1038/s41375-021-01303-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Wendy Stock
- University of Chicago Medicine, Chicago, IL, USA
| | - Anjali Advani
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | | | - Martin Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Khalid Bo-Subait
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omer Jamy
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Michael Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - David Ritchie
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pere Barba
- Vall Hebron University Hospital-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcos de Lima
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic, Rochester, MN, USA
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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12
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Altman JK, Koprivnikar J, McCloskey JK, Kota V, Frankfurt O, Emadi A, Bixby D, Burch M, Levy MY, Luger S, Zuckerman T, Bhatnagar B, Wolach O, Ganzel C, Levi I, Gourevitch A, Ben Yakar R, Tessler S, Flaishon L, Rowe J. Efficacy and safety of aspacytarabine (BST-236) as a single-agent, first-line therapy for patients with acute myeloid leukemia unfit for standard chemotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7007 Background: Aspacytarabine (BST-236) is a prodrug of cytarabine, the backbone of acute myeloid leukemia (AML) standard of care chemotherapy, associated with toxicity which precludes its administration in older patients and patients with comorbidities. Aspacytarabine is inactive in its intact prodrug form until cytarabine is gradually released at pharmacokinetics which decrease the systemic exposure to peak toxic cytarabine levels, resulting in reduced systemic toxicity and relative sparing of normal tissues, enabling therapy with high cytarabine doses to patients otherwise unfit to receive it. Methods: A phase 2b open-label, single-arm study to evaluate the efficacy and safety of aspacytarabine as a first-line single-agent therapy in newly-diagnosed AML patients unfit for standard chemotherapy (NCT03435848). Aspacytarabine is administrated at 4.5 g/m2/d (containing 3 g/m2/d cytarabine) in 1-2 induction and 1-3 consolidation courses, each consisting of 6 daily 1-hour infusions. Patients with secondary AML, prior hypomethylating agent (HMA) therapy, and therapy-related AML, are eligible. Results: To date, in the ongoing study, 46 newly-diagnosed AML patients unfit for standard chemotherapy (median age 75 years) were treated with aspacytarabine and completed 1-4 courses of 4.5 g/m2/d aspacytarabine, including 26 patients (63%) with de novo AML and 17 (37%) with secondary AML. Six patients (13%) were previously treated with HMA (median 12 courses). The baseline median bone marrow blasts was 52%, and 54% and 29% of patients had adverse or intermediate European LeukemiaNet (ELN) score, respectively. Twenty (43%) patients had ECOG 2. Aspacytarabine is safe and well-tolerated in repeated-course administration. Grade > 2 drug-related adverse events include mainly hematological events and infections. The 30-day mortality rate is 11%. Of 43 patients evaluable for efficacy analysis to date, 15 patients (35%) reached a complete remission (CR) following 1 (13 patients) or 2 (2 patients) induction courses, all with complete hematological recovery (median 27.5 days, range 22-39 days). The CR rates in de novo AML patients and patients with adverse ELN score are 46% and 33%, respectively. Of the 11 patients evaluable to date for minimal residual disease (MRD) flow cytometry test, 8 are MRD negative (73%). While aspacytarabine treatment consists of a limited number of courses, median duration of response and median overall survival for responders are not reached at 12 and 24 months, respectively (end of follow up). Updated results will be presented at the meeting. Conclusions: The cumulative clinical data suggest that aspacytarabine, a time-limited single-agent treatment, is safe and efficacious as a first-line therapy for patients who are unfit for intensive chemotherapy, which may establish it as a new tolerable AML chemotherapy backbone. Clinical trial information: NCT03435848.
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Affiliation(s)
| | - Jamie Koprivnikar
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - James K. McCloskey
- The John Theurer Cancer Center at Hackensack Meridian Health, Hackensack, NJ
| | - Vamsi Kota
- Georgia Cancer Center at Augusta University, Augusta, GA
| | | | - Ashkan Emadi
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Dale Bixby
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | - Micah Burch
- Baylor Scott & White Research Institute, Dallas, TX
| | | | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Bhavana Bhatnagar
- Arthur G James Cancer Hospital Comprehensive Cancer Center, Columbus, OH
| | | | | | - Itai Levi
- Soroka University Medical Center, Beer Sheva, Israel
| | | | | | | | | | - Jacob Rowe
- Shaare Zedek Medical Center, Jerusalem, Israel
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13
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Zeidan AM, Boddu PC, Patnaik MM, Bewersdorf JP, Stahl M, Rampal RK, Shallis R, Steensma DP, Savona MR, Sekeres MA, Roboz GJ, DeAngelo DJ, Schuh AC, Padron E, Zeidner JF, Walter RB, Onida F, Fathi A, DeZern A, Hobbs G, Stein EM, Vyas P, Wei AH, Bowen DT, Montesinos P, Griffiths EA, Verma AK, Keyzner A, Bar-Natan M, Navada SC, Kremyanskaya M, Goldberg AD, Al-Kali A, Heaney ML, Nazha A, Salman H, Luger S, Pratz KW, Konig H, Komrokji R, Deininger M, Cirici BX, Bhatt VR, Silverman LR, Erba HP, Fenaux P, Platzbecker U, Santini V, Wang ES, Tallman MS, Stone RM, Mascarenhas J. Special considerations in the management of adult patients with acute leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a panel of international experts. Lancet Haematol 2020; 7:e601-e612. [PMID: 32563283 PMCID: PMC7302757 DOI: 10.1016/s2352-3026(20)30205-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/28/2023]
Abstract
The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 is a global public health crisis. Multiple observations indicate poorer post-infection outcomes for patients with cancer than for the general population. Herein, we highlight the challenges in caring for patients with acute leukaemias and myeloid neoplasms amid the COVID-19 pandemic. We summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. We recognise that these recommendations might be more applicable to high-income countries and might not be generalisable because of regional differences in health-care infrastructure, individual circumstances, and a complex and highly fluid health-care environment. Despite these limitations, we aim to provide a general framework for the care of patients with acute leukaemias and myeloid neoplasms during the COVID-19 pandemic on the basis of recommendations from international experts.
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Affiliation(s)
- Amer M Zeidan
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Prajwal C Boddu
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Jan Philipp Bewersdorf
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Maximilian Stahl
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raajit K Rampal
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rory Shallis
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - David P Steensma
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Savona
- Department of Hematology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Mikkael A Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Gail J Roboz
- Department of Hematology and Oncology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Daniel J DeAngelo
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andre C Schuh
- Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Joshua F Zeidner
- Division of Hematology and Oncology, Lineberger Comprehensive Care Center, University of North Carolina, Chapel Hill, NC, USA
| | - Roland B Walter
- Division of Hematology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Francesco Onida
- Department of Hematology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Amir Fathi
- Department of Hematology, Centre for Leukemia, Massachusetts General Hospital, Boston, MA, USA
| | - Amy DeZern
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Gabriela Hobbs
- Department of Hematology, Centre for Leukemia, Massachusetts General Hospital, Boston, MA, USA
| | - Eytan M Stein
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paresh Vyas
- MRC Molecular Haematology Unit, BRC Oxford Department of Haematology, University of Oxford, Oxford, UK
| | - Andrew H Wei
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
| | - David T Bowen
- Department of Haematology, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Pau Montesinos
- Department of Haematology, Hospital Universitario y Politecnico La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, University of Valencia, Madrid, Spain
| | - Elizabeth A Griffiths
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amit K Verma
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Alla Keyzner
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michal Bar-Natan
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shyamala C Navada
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marina Kremyanskaya
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron D Goldberg
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aref Al-Kali
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark L Heaney
- Department of Hematology, Herbert Irving Comprehensive Care Centre, Columbia University, New York, NY, USA
| | - Aziz Nazha
- Department of Hematology, Cleveland Clinic-Taussig Cancer Institute, Cleveland, OH, USA
| | - Huda Salman
- Department of Internal Medicine, Stony Brook University Cancer Center, Stony Brook, NY, USA
| | - Selina Luger
- Department of Medicine, Hematology and Oncology Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith W Pratz
- Department of Medicine, Hematology and Oncology Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Heiko Konig
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Division of Hematology and Oncology, Indiana University, Indianapolis, IN, USA
| | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Deininger
- Huntsman Cancer Institute, Department of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA
| | - Blanca Xicoy Cirici
- Clinical Haematology Department, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vijaya Raj Bhatt
- Fred and Pamela Buffett Cancer Center, Department of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lewis R Silverman
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Harry P Erba
- Duke Cancer Institute, Department of Medicine, Division of Hematologic Malignancies and Cellular Therapies, Durham, NC, USA
| | - Pierre Fenaux
- Department of Hematology, Hôpital St Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Haematology, Paris University, Paris, France
| | - Uwe Platzbecker
- Department of Medicine, Division of Translational Hematology, Leipzig University Hospital, Leipzig, Germany
| | - Valeria Santini
- Department of Medicine, University of Florence Medical School, Florence, Italy
| | - Eunice S Wang
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Martin S Tallman
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard M Stone
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John Mascarenhas
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Shallis RM, Stahl M, Wei W, Montesinos P, Lengline E, Neukirchen J, Bhatt VR, Sekeres MA, Fathi AT, Konig H, Luger S, Khan I, Roboz GJ, Cluzeau T, Martínez-Cuadron D, Raffoux E, Germing U, Umakanthan JM, Mukhereje S, Brunner AM, Miller A, McMahon CM, Ritchie EK, Rodríguez-Veiga R, Itzykson R, Boluda B, Rabian F, Tormo M, Acuña-Cruz E, Rabinovich E, Yoo B, Cano I, Podoltsev NA, Bewersdorf JP, Gore S, Zeidan AM. Patterns of care and clinical outcomes of patients with newly diagnosed acute myeloid leukemia presenting with hyperleukocytosis who do not receive intensive chemotherapy. Leuk Lymphoma 2020; 61:1220-1225. [PMID: 32100599 DOI: 10.1080/10428194.2020.1728753] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rory M Shallis
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Maximilian Stahl
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Wei Wei
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | - Etienne Lengline
- Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | - Judith Neukirchen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Vijaya R Bhatt
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Amir T Fathi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Heiko Konig
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Irum Khan
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Gail J Roboz
- Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Thomas Cluzeau
- CHU of Nice, Hematology Department, Cote d'Azur University, Nice, France
| | | | - Emmanuel Raffoux
- Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | | | | | - Andrew M Brunner
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Adam Miller
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | - Ellen K Ritchie
- Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | | | - Raphaël Itzykson
- Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | | | - Florence Rabian
- CIBERONC, Instituto Carlos III, Madrid, Spain.,Hematology Department, Saint-Louis Hospital AP-HP, Paris, France
| | - Mar Tormo
- University Clinical Hospital, INCLIVA, Valencia, Spain
| | | | | | - Brendan Yoo
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabel Cano
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Nikolai A Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Jan Philipp Bewersdorf
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Steven Gore
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
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15
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Kang Y, Assuncao BL, Denduluri S, McCurdy S, Luger S, Lefebvre B, Carver J, Scherrer-Crosbie M. Symptomatic Heart Failure in Acute Leukemia Patients Treated With Anthracyclines. JACC CardioOncol 2019; 1:208-217. [PMID: 32905430 PMCID: PMC7472996 DOI: 10.1016/j.jaccao.2019.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives The purpose of this study was to investigate the occurrence and develop a risk score for heart failure (HF) in acute leukemia. Background Knowledge is scarce regarding the incidence and risk factors of symptomatic HF in patients with acute leukemia. Methods Baseline clinical and echocardiographic parameters, including indices of cardiac function (left ventricular ejection fraction and myocardial strain [global longitudinal strain; GLS]), were obtained in 450 patients with acute leukemia treated with anthracyclines, before chemotherapy initiation. Potential risk factors for HF were evaluated using Fine and Gray’s regression analysis, and from this, a 21-point risk score was generated. Results Forty patients (8.9%) developed HF. The HF risk score included a baseline GLS >−15% (indicative of greater impairment) (6 points), baseline left ventricular ejection fraction <50%, pre-existing cardiovascular disease, acute myeloid leukemia (4 points each), cumulative anthracycline dose ≥250 mg/m2 (2 points), and age >60 years (1 point). Patients were stratified into low (score 0 to 6), moderate (score 7 to 13), and high risk (score 14 to 21). The estimated 1-year cumulative incidence of HF for low-, moderate-, and high-risk groups was 1.0%, 13.6%, and 35.0%, respectively (p < 0.001). The HF risk score was also predictive of all-cause mortality (p < 0.001). After adjustment for age and leukemia type, however, only GLS was significantly associated with all-cause mortality (hazard ratio: 1.73; 95% confidence interval: 1.30 to 2.31; p < 0.001). Conclusions We developed a baseline risk score to determine risk of HF in patients with acute leukemia. Additional studies are needed to determine the external validity of these findings.
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Affiliation(s)
- Yu Kang
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bruna Leal Assuncao
- Departamento de Medicina, Universidade Federal de Sao Paulo, UNIFESP, Sao Paulo-SP, Brazil
| | - Srinivas Denduluri
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shannon McCurdy
- Division of Hematology and Oncology Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Selina Luger
- Division of Hematology and Oncology Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bénédicte Lefebvre
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph Carver
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Address for correspondence: Dr. Marielle Scherrer-Crosbie, Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA. @mariellesc1
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16
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Cascino GJ, Voss WB, Canaani J, Furiasse N, Rademaker A, Ky B, Luger S, Altman JK, Foran JM, Litzow MR, Tallman MS, Rigolin V, Akhter N. Two-dimensional speckle-tracking strain detects subclinical cardiotoxicity in older patients treated for acute myeloid leukemia. Echocardiography 2019; 36:2033-2040. [PMID: 31705570 DOI: 10.1111/echo.14518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/19/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) are surviving longer. There are no data on changes in myocardial mechanics from standard of care low-dose anthracycline-based induction chemotherapy in older patients with AML. The aim of this study was to demonstrate the potential utility of strain imaging in detecting early changes in left ventricular function in this patient population after induction chemotherapy. METHODS Thirty two patients enrolled in the ECOG-ACRIN E2906 study (cytarabine and daunorubicin vs clofarabine [Genzyme/Sanofi]) from 2011 to 2014 were evaluated retrospectively. Two-dimensional transthoracic echocardiography (TTE) imaging with Doppler and two-dimensional speckle-tracking echocardiography (2DSTE) using EchoInsight software (Epsilon imaging) were performed before and after induction chemotherapy. RESULTS Eighteen patients received cytarabine and daunorubicin (7 + 3) and 14 received clofarabine. The clofarabine group was older than the 7 + 3 cohort (67.8 ± 4.0 vs 63.7 ± 3.8, P = .007). There were no other significant differences in cardiac risk factors between groups. The 7 + 3 group had a decrease in average peak systolic global longitudinal (-19.1 ± 2.8 to -17.2 ± 3.0, P = .01) and circumferential strain (-29.4 ± 6.3 to -23.9 ± 4.3, P = .011). These changes were not demonstrated in the clofarabine group and were not associated with a decline in left ventricular ejection fraction (LVEF). CONCLUSIONS In older AML patients, standard cytarabine and daunorubicin chemotherapy causes early changes in global longitudinal and circumferential strain not seen with clofarabine therapy. These findings demonstrate subclinical left ventricular dysfunction after exposure to low cumulative doses of anthracycline-based induction chemotherapy and may help us better identify those patients at risk for adverse long-term cardiovascular outcomes.
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Affiliation(s)
- Gregory J Cascino
- Division of Cardiovascular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Woo Bin Voss
- Department of Cardiology, North Shore Hospital, Auckland, New Zealand
| | - Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Nicholas Furiasse
- Division of Cardiovascular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alfred Rademaker
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bonnie Ky
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Selina Luger
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica K Altman
- Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James M Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Martin S Tallman
- Division of Hematologic Oncology, Sloan Kettering Memorial Cancer Center, New York, New York
| | - Vera Rigolin
- Division of Cardiovascular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nausheen Akhter
- Division of Cardiovascular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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17
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Siegel SE, Stock W, Johnson RH, Advani A, Muffly L, Douer D, Reed D, Lewis M, Freyer DR, Shah B, Luger S, Hayes-Lattin B, Jaboin JJ, Coccia PF, DeAngelo DJ, Seibel N, Bleyer A. Pediatric-Inspired Treatment Regimens for Adolescents and Young Adults With Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia: A Review. JAMA Oncol 2019; 4:725-734. [PMID: 29450465 DOI: 10.1001/jamaoncol.2017.5305] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance The incidence of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in adolescent and young adult (AYA) patients (age range, 15-39 years) in the United States is increasing at a greater rate than in younger or older persons. Their optimal treatment has been increasingly debated as pediatric regimens have become more widely used in the age group. This review compares the basic features of pediatric and adult chemotherapy regimens for ALL and LBL, recognizes and describes the challenges of the pediatric regimen, and suggests strategies to facilitate its adoption for AYAs with ALL and LBL. Observations All but 2 of 25 published comparisons of outcomes with pediatric and adult regimens for ALL and LBL in AYAs and 1 meta-analysis favor the pediatric regimen. After more than a half-century of clinical trials of the pediatric regimens, including at least 160 phase 3 trials in the United States, the pediatric regimens have become far more complex than most adult regimens. Asparaginase, a critical component of the pediatric regimens, is more difficult to administer to AYAs (and older patients) but nonetheless has a favorable benefit to toxicity ratio for AYAs. A dramatic reduction in outcome of ALL and LBL during the AYA years (the "survival cliff") is coincident with similar reductions in proportions of AYAs referred to academic centers and enrolled on clinical trials (the "accrual cliff" and "referral cliff"). Conclusions and Relevance The accumulating data increasingly support treating AYAs with ALL and LBL with a pediatric-inspired regimen or an approved institutional or national clinical trial tailored for this patient group. A need to develop clinical trials specifically for AYAs and to encourage their participation is paramount, with a goal to improve both the quantity and quality of survival.
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Affiliation(s)
| | - Wendy Stock
- Alliance for Clinical Trials in Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Section of Hematology/Oncology, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Rebecca H Johnson
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,National Clinical Oncology Research Program (All in the National Cancer Institute National Clinical Trials Network).,Pediatric Hematology/Oncology, Mary Bridge Children's Hospital and Health Center and Tacoma General Hospital, Tacoma, Washington
| | - Anjali Advani
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Hematology/Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lori Muffly
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Blood and Marrow Transplantation, Department of Medicine, Stanford University, Palo Alto, California
| | - Dan Douer
- ECOG-ACRIN Cancer Research Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Keck Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles
| | - Damon Reed
- National Pediatric Cancer Foundation, Tampa, Florida.,Moffitt Cancer Center, Tampa, Florida
| | - Mark Lewis
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Hematology/Oncology, Intermountain Healthcare, Salt Lake City, Utah
| | - David R Freyer
- Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Keck Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles
| | - Bijal Shah
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Moffitt Cancer Center, Tampa, Florida.,National Comprehensive Cancer Network
| | - Selina Luger
- ECOG-ACRIN Cancer Research Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brandon Hayes-Lattin
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Radiation Medicine, Oregon Health and Science University, Portland
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland.,NRG Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group), National Cancer Institute, Bethesda, Maryland
| | - Peter F Coccia
- Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,National Comprehensive Cancer Network.,Department of Pediatrics, University of Nebraska Medical Center, Omaha
| | - Daniel J DeAngelo
- Alliance for Clinical Trials in Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nita Seibel
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Archie Bleyer
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Radiation Medicine, Oregon Health and Science University, Portland
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18
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Gu Z, Churchman ML, Roberts KG, Moore I, Zhou X, Nakitandwe J, Hagiwara K, Pelletier S, Gingras S, Berns H, Payne-Turner D, Hill A, Iacobucci I, Shi L, Pounds S, Cheng C, Pei D, Qu C, Newman S, Devidas M, Dai Y, Reshmi SC, Gastier-Foster J, Raetz EA, Borowitz MJ, Wood BL, Carroll WL, Zweidler-McKay PA, Rabin KR, Mattano LA, Maloney KW, Rambaldi A, Spinelli O, Radich JP, Minden MD, Rowe JM, Luger S, Litzow MR, Tallman MS, Racevskis J, Zhang Y, Bhatia R, Kohlschmidt J, Mrózek K, Bloomfield CD, Stock W, Kornblau S, Kantarjian HM, Konopleva M, Evans WE, Jeha S, Pui CH, Yang J, Paietta E, Downing JR, Relling MV, Zhang J, Loh ML, Hunger SP, Mullighan CG. PAX5-driven subtypes of B-progenitor acute lymphoblastic leukemia. Nat Genet 2019; 51:296-307. [PMID: 30643249 DOI: 10.1038/s41588-018-0315-5] [Citation(s) in RCA: 329] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/13/2018] [Indexed: 12/20/2022]
Abstract
Recent genomic studies have identified chromosomal rearrangements defining new subtypes of B-progenitor acute lymphoblastic leukemia (B-ALL), however many cases lack a known initiating genetic alteration. Using integrated genomic analysis of 1,988 childhood and adult cases, we describe a revised taxonomy of B-ALL incorporating 23 subtypes defined by chromosomal rearrangements, sequence mutations or heterogeneous genomic alterations, many of which show marked variation in prevalence according to age. Two subtypes have frequent alterations of the B lymphoid transcription-factor gene PAX5. One, PAX5alt (7.4%), has diverse PAX5 alterations (rearrangements, intragenic amplifications or mutations); a second subtype is defined by PAX5 p.Pro80Arg and biallelic PAX5 alterations. We show that p.Pro80Arg impairs B lymphoid development and promotes the development of B-ALL with biallelic Pax5 alteration in vivo. These results demonstrate the utility of transcriptome sequencing to classify B-ALL and reinforce the central role of PAX5 as a checkpoint in B lymphoid maturation and leukemogenesis.
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Affiliation(s)
- Zhaohui Gu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michelle L Churchman
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathryn G Roberts
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ian Moore
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xin Zhou
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joy Nakitandwe
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kohei Hagiwara
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stephane Pelletier
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sebastien Gingras
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hartmut Berns
- Department of Transgenic/Gene Knockout Shared Resource, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Debbie Payne-Turner
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ashley Hill
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lei Shi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stanley Pounds
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chunxu Qu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Scott Newman
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Shalini C Reshmi
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Julie Gastier-Foster
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth A Raetz
- Division of Pediatric Hematology-Oncology, New York University, New York, NY, USA
| | - Michael J Borowitz
- Division of Hematologic Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Brent L Wood
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Kelly W Maloney
- University of Colorado School of Medicine and Children's Hospital, Aurora, CO, USA
| | - Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Orietta Spinelli
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jacob M Rowe
- Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Janis Racevskis
- Cancer Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yanming Zhang
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravi Bhatia
- Division of Hematology-Oncology, University of Birmingham, Birmingham, AL, USA
| | | | - Krzysztof Mrózek
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Clara D Bloomfield
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Wendy Stock
- University of Chicago Medical Center, Chicago, IL, USA
| | - Steven Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Williams E Evans
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jun Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Elisabeth Paietta
- Cancer Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - James R Downing
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mignon L Loh
- Department of Pediatrics, UCSF Benioff Children's Hospital and the Helen Diller Family, San Francisco, CA, USA
| | - Stephen P Hunger
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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19
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Siegel SE, Advani A, Seibel N, Muffly L, Stock W, Luger S, Shah B, DeAngelo DJ, Freyer DR, Douer D, Johnson RH, Hayes-Lattin B, Lewis M, Jaboin JJ, Coccia PF, Bleyer A. Treatment of young adults with Philadelphia-negative acute lymphoblastic leukemia and lymphoblastic lymphoma: Hyper-CVAD vs. pediatric-inspired regimens. Am J Hematol 2018; 93:1254-1266. [PMID: 30058716 DOI: 10.1002/ajh.25229] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/29/2018] [Accepted: 07/16/2018] [Indexed: 01/19/2023]
Abstract
For young adults with acute lymphoblastic leukemia, pediatric-based regimens are likely to provide the following when compared to hyper-CVAD regimens: better disease control, less hospitalization time, diminished acute toxicities, decreased financial cost, more quality-adjusted life years, and fewer adverse late effects, such as infertility, myelodysplasia, and second malignant neoplasms. There are also reasons to expect less cardiac and cognitive dysfunction after pediatric regimens. The improved quality and quantity of life associated with pediatric regimens renders them preferable to hyper-CVAD regimens for the treatment of Philadelphia-negative B-precursor or T-cell acute lymphoblastic leukemia and lymphoblastic lymphoma in young adults.
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Affiliation(s)
- Stuart E. Siegel
- Critical Mass Young Adult Cancer Alliance; Washington District of Columbia
| | | | - Nita Seibel
- Cancer Therapy Evaluation Program, National Cancer Institute; Bethesda Maryland and Children's Oncology Group
| | - Lori Muffly
- Department of Medicine; Blood and Marrow Transplantation, Stanford University; Palo Alto California and SWOG
| | - Wendy Stock
- University of Chicago; Chicago Illinois and The Alliance
| | - Selina Luger
- University of Pennsylvania; Philadelphia Pennsylvania and ECOG-ACRIN
| | - Bijal Shah
- Moffitt Cancer Center; Tampa Florida and SWOG
| | - Daniel J. DeAngelo
- Department of Medical Oncology, Dana Farber Cancer Institute ALL Consortium; Dana Farber Cancer Institute; Boston Massachusetts
| | - David R. Freyer
- University of Southern California, Norris Comprehensive Cancer Center; Los Angeles California and Children's Oncology Group
| | - Dan Douer
- Department of Medicine; University of Southern California; Los Angeles California and ECOG-ACRIN
| | - Rebecca H. Johnson
- Mary Bridge Children's Hospital and Health Center, National Clinical Oncology Research Program and Tacoma General Hospital; Tacoma Washington and SWOG, Children's Oncology Group
| | | | - Mark Lewis
- Department of Hematology/Oncology; Intermountain Healthcare; Salt Lake City Utah and SWOG
| | - Jerry J. Jaboin
- Department of Radiation Oncology; Oregon Health and Science University; Portland Oregon and NRG Oncology Group
| | - Peter F. Coccia
- Department of Pediatrics; University of Nebraska Medical Center; Omaha Nebraska and Children's Oncology Group
| | - Archie Bleyer
- Department of Radiation Oncology; Oregon Health and Science University; Portland Oregon and Children's Oncology Group
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20
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Miller TP, Li Y, Kavcic M, Getz KD, Huang YSV, Sung L, Alonzo TA, Gerbing R, Daves MH, Horton TM, Pulsipher MA, Pollard J, Bagatell R, Seif AE, Fisher BT, Luger S, Gamis AS, Adamson PC, Aplenc R. Center-level variation in accuracy of adverse event reporting in a clinical trial for pediatric acute myeloid leukemia: a report from the Children's Oncology Group. Haematologica 2017. [PMID: 28642300 DOI: 10.3324/haematol.2017.168815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tamara P Miller
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, PA, USA
| | - Yimei Li
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics Departments of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Marko Kavcic
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA
| | - Kelly D Getz
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA, USA
| | - Yuan-Shun V Huang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA, USA
| | - Lillian Sung
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Todd A Alonzo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.,Children's Oncology Group, Monrovia, CA, USA
| | | | - Marla H Daves
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Houston, TX, USA
| | - Terzah M Horton
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Houston, TX, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology and BMT, Children's Hospital of Los Angeles, USC Keck School of Medicine, CA, USA
| | - Jessica Pollard
- Maine Children's Cancer Program, Maine Medical Center, Scarborough, ME, USA
| | - Rochelle Bagatell
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA.,Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Alix E Seif
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA.,Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Brian T Fisher
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics Departments of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Infectious Diseases, The Children's Hospital of Philadelphia, PA, USA
| | - Selina Luger
- Hematology/Bone Marrow Transplant, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Alan S Gamis
- Pediatric Hematology/Oncology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Peter C Adamson
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA.,Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Richard Aplenc
- Divisions of Oncology, The Children's Hospital of Philadelphia, PA, USA .,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, PA, USA.,Departments of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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21
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Zhang J, McCastlain K, Yoshihara H, Xu B, Chang Y, Churchman ML, Wu G, Li Y, Wei L, Iacobucci I, Liu Y, Qu C, Wen J, Edmonson M, Payne-Turner D, Kaufmann KB, Takayanagi SI, Wienholds E, Waanders E, Ntziachristos P, Bakogianni S, Wang J, Aifantis I, Roberts KG, Ma J, Song G, Easton J, Mulder HL, Chen X, Newman S, Ma X, Rusch M, Gupta P, Boggs K, Vadodaria B, Dalton J, Liu Y, Valentine ML, Ding L, Lu C, Fulton RS, Fulton L, Tabib Y, Ochoa K, Devidas M, Pei D, Cheng C, Yang J, Evans WE, Relling MV, Pui CH, Jeha S, Harvey RC, Chen IML, Willman CL, Marcucci G, Bloomfield CD, Kohlschmidt J, Mrózek K, Paietta E, Tallman MS, Stock W, Foster MC, Racevskis J, Rowe JM, Luger S, Kornblau SM, Shurtleff SA, Raimondi SC, Mardis ER, Wilson RK, Dick JE, Hunger SP, Loh ML, Downing JR, Mullighan CG. Deregulation of DUX4 and ERG in acute lymphoblastic leukemia. Nat Genet 2016; 48:1481-1489. [PMID: 27776115 PMCID: PMC5144107 DOI: 10.1038/ng.3691] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [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: 04/18/2016] [Accepted: 09/09/2016] [Indexed: 12/25/2022]
Abstract
Chromosomal rearrangements deregulating hematopoietic transcription factors are common in acute lymphoblastic leukemia (ALL). Here we show that deregulation of the homeobox transcription factor gene DUX4 and the ETS transcription factor gene ERG is a hallmark of a subtype of B-progenitor ALL that comprises up to 7% of B-ALL. DUX4 rearrangement and overexpression was present in all cases and was accompanied by transcriptional deregulation of ERG, expression of a novel ERG isoform, ERGalt, and frequent ERG deletion. ERGalt uses a non-canonical first exon whose transcription was initiated by DUX4 binding. ERGalt retains the DNA-binding and transactivation domains of ERG, but it inhibits wild-type ERG transcriptional activity and is transforming. These results illustrate a unique paradigm of transcription factor deregulation in leukemia in which DUX4 deregulation results in loss of function of ERG, either by deletion or induced expression of an isoform that is a dominant-negative inhibitor of wild-type ERG function.
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Affiliation(s)
- Jinghui Zhang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kelly McCastlain
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Hiroki Yoshihara
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Beisi Xu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yunchao Chang
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Gang Wu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yongjin Li
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lei Wei
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yu Liu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Chunxu Qu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Ji Wen
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Michael Edmonson
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Kerstin B. Kaufmann
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Shin-ichiro Takayanagi
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
- Oncology Research Laboratories, Kyowa Hakko Kirin Co., Ltd., Machida-shi, Tokyo, 194-8533, Japan
| | - Erno Wienholds
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Esmé Waanders
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Human Genetics, Radboud University Medical Center and Radboud Center for Molecular Life Sciences, Nijmegen, the Netherlands
| | | | - Sofia Bakogianni
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Jingjing Wang
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Iannis Aifantis
- Department of Pathology, New York University School of Medicine, New York, NY
- Howard Hughes Medical Institute, New York, NY
| | - Kathryn G. Roberts
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jing Ma
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Guangchun Song
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - John Easton
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Heather L. Mulder
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Xiang Chen
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Scott Newman
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Michael Rusch
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Pankaj Gupta
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kristy Boggs
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Bhavin Vadodaria
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - James Dalton
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yanling Liu
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Marcus L Valentine
- Cytogenetics Core Facility, St. Jude Children’s Research Hospital, Memphis, TN
| | - Li Ding
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Charles Lu
- McDonnell Genome Institute, Washington University, St Louis, MO
| | | | - Lucinda Fulton
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Yashodhan Tabib
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Kerri Ochoa
- McDonnell Genome Institute, Washington University, St Louis, MO
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine, Public Health & Health Profession, University of Florida, Gainesville, FL
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jun Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - William E. Evans
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Richard C. Harvey
- Department of Pathology, The Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM
| | - I-Ming L Chen
- Department of Pathology, The Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM
| | - Cheryl L. Willman
- Department of Pathology, The Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM
| | | | | | | | - Krzysztof Mrózek
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | | | | | - Wendy Stock
- University of Chicago Medical Center, Chicago, IL
| | - Matthew C. Foster
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC
| | - Janis Racevskis
- Department of Medicine (Oncology), Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY
| | - Jacob M. Rowe
- Department of Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Selina Luger
- Department of Pediatrics, Benioff Children’s Hospital, University of California at San Francisco, San Francisco, CA
| | - Steven M. Kornblau
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Sheila A Shurtleff
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Susana C. Raimondi
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - John E. Dick
- Princess Margaret Cancer Centre, University Health Network and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Stephen P Hunger
- Department of Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mignon L. Loh
- Department of Pediatrics, Benioff Children’s Hospital, University of California at San Francisco, San Francisco, CA
| | - James R. Downing
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
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22
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Pine AB, Lee EJ, Sekeres M, Steensma DP, Zelterman D, Prebet T, DeZern A, Komrokji R, Litzow M, Luger S, Stone R, Erba HP, Garcia-Manero G, Lee AI, Podoltsev NA, Barbarotta L, Kasberg S, Hendrickson JE, Gore SD, Zeidan AM. Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States. Transfusion 2016; 57:289-295. [PMID: 27878822 DOI: 10.1111/trf.13934] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transfusion of blood products is a key component of the supportive management in patients with acute leukemia (AL). However high-quality trial evidence and clinical outcome data to support specific transfusion goals for blood products for patients with AL remain limited leading to diverse transfusion practices. The primary objective of this study was to determine the spectrum of transfusion patterns in a variety of care settings among providers who treat AL patients. STUDY DESIGN AND METHODS A 31-question survey queried providers caring for AL patients about the existence of institutional guidelines for transfusion of blood products, transfusion triggers for hemoglobin (Hb), platelets (PLTs), and fibrinogen in various settings including inpatient and outpatient and before procedures. RESULTS We analyzed 130 responses and identified divergent transfusion Hb goals in hospitalized and ambulatory patients, fibrinogen goals for cryoprecipitate transfusions, and variation in practice for use of certain PLTs and red blood cell products. The least variable transfusion patterns were reported for PLT goals in thrombocytopenia and in the setting of invasive procedures such as bone marrow biopsy and lumbar punctures. CONCLUSIONS This survey confirmed wide variations in blood product transfusion practices across several clinical scenarios in patients with AL. The findings emphasized the need for large prospective randomized trials to develop standardized evidence-based guidelines for blood product transfusions in patients with AL with the goal of limiting unnecessary transfusions without compromising outcomes.
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Affiliation(s)
| | - Eun-Ju Lee
- Department of Internal Medicine, Section of Hematology, Cleveland, Ohio
| | | | | | | | - Thomas Prebet
- Department of Internal Medicine, Section of Hematology, Cleveland, Ohio
| | - Amy DeZern
- The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rami Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | | | - Selina Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Alfred I Lee
- Department of Internal Medicine, Section of Hematology, Cleveland, Ohio
| | | | | | | | | | - Steven D Gore
- Department of Internal Medicine, Section of Hematology, Cleveland, Ohio
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Cleveland, Ohio
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23
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Roberts KG, Gu Z, Payne-Turner D, McCastlain K, Harvey RC, Chen IM, Pei D, Iacobucci I, Valentine M, Pounds SB, Shi L, Li Y, Zhang J, Cheng C, Rambaldi A, Tosi M, Spinelli O, Radich JP, Minden MD, Rowe JM, Luger S, Litzow MR, Tallman MS, Wiernik PH, Bhatia R, Aldoss I, Kohlschmidt J, Mrózek K, Marcucci G, Bloomfield CD, Stock W, Kornblau S, Kantarjian HM, Konopleva M, Paietta E, Willman CL, Mullighan CG. High Frequency and Poor Outcome of Philadelphia Chromosome-Like Acute Lymphoblastic Leukemia in Adults. J Clin Oncol 2016; 35:394-401. [PMID: 27870571 DOI: 10.1200/jco.2016.69.0073] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Philadelphia chromosome (Ph) -like acute lymphoblastic leukemia (ALL) is a high-risk subtype of childhood ALL characterized by kinase-activating alterations that are amenable to treatment with tyrosine kinase inhibitors. We sought to define the prevalence and genomic landscape of Ph-like ALL in adults and assess response to conventional chemotherapy. Patients and Methods The frequency of Ph-like ALL was assessed by gene expression profiling of 798 patients with B-cell ALL age 21 to 86 years. Event-free survival and overall survival were determined for Ph-like ALL versus non-Ph-like ALL patients. Detailed genomic analysis was performed on 180 of 194 patients with Ph-like ALL. Results Patients with Ph-like ALL accounted for more than 20% of adults with ALL, including 27.9% of young adults (age 21 to 39 years), 20.4% of adults (age 40 to 59 years), and 24.0% of older adults (age 60 to 86 years). Overall, patients with Ph-like ALL had an inferior 5-year event-free survival compared with patients with non-Ph-like ALL (22.5% [95% CI, 14.9% to 29.3%; n = 155] v 49.3% [95% CI, 42.8% to 56.2%; n = 247], respectively; P < .001). We identified kinase-activating alterations in 88% of patients with Ph-like ALL, including CRLF2 rearrangements (51%), ABL class fusions (9.8%), JAK2 or EPOR rearrangements (12.4%), other JAK-STAT sequence mutations (7.2%), other kinase alterations (4.1%), and Ras pathway mutations (3.6%). Eleven new kinase rearrangements were identified, including four involving new kinase or cytokine receptor genes and seven involving new partners for previously identified genes. Conclusion Ph-like ALL is a highly prevalent subtype of ALL in adults and is associated with poor outcome. The diverse range of kinase-activating alterations in Ph-like ALL has important therapeutic implications. Trials comparing the addition of tyrosine kinase inhibitors to conventional therapy are required to evaluate the clinical utility of these agents in the treatment of Ph-like ALL.
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Affiliation(s)
- Kathryn G Roberts
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhaohui Gu
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debbie Payne-Turner
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly McCastlain
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard C Harvey
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - I-Ming Chen
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deqing Pei
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ilaria Iacobucci
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcus Valentine
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stanley B Pounds
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Shi
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yongjin Li
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jinghui Zhang
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cheng Cheng
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alessandro Rambaldi
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manuela Tosi
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Orietta Spinelli
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jerald P Radich
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark D Minden
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jacob M Rowe
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Selina Luger
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark R Litzow
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Martin S Tallman
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter H Wiernik
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ravi Bhatia
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ibrahim Aldoss
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jessica Kohlschmidt
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Krzysztof Mrózek
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Guido Marcucci
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clara D Bloomfield
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wendy Stock
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen Kornblau
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop M Kantarjian
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elisabeth Paietta
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cheryl L Willman
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles G Mullighan
- Kathryn G. Roberts, Zhaohui Gu, Debbie Payne-Turner, Kelly McCastlain, Deqing Pei, Ilaria Iacobucci, Marcus Valentine, Stanley B. Pounds, Lei Shi, Yongjin Li, Jinghui Zhang, Cheng Cheng, and Charles G. Mullighan, St Jude Children's Research Hospital, Memphis, TN; Richard C. Harvey, I-Ming Chen, and Cheryl L. Willman, University of New Mexico Cancer Center, Albuquerque, NM; Alessandro Rambaldi, Manuela Tosi, and Orietta Spinelli, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Jerald P. Radich, Fred Hutchinson Cancer Research Center, Seattle, WA; Mark D. Minden, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Selina Luger, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Mark R. Litzow, Mayo Clinic, Rochester, MN; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York; Peter H. Wiernik, Cancer Research Foundation of New York; Elisabeth Paietta, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Ravi Bhatia, The University of Alabama at Birmingham, Birmingham, AL; Ibrahim Aldoss and Guido Marcucci, City of Hope, Duarte, CA; Jessica Kohlschmidt, Krzysztof Mrózek, and Clara D. Bloomfield, Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Wendy Stock, University of Chicago Medical Center, Chicago, IL; and Stephen Kornblau, Hagop M. Kantarjian, and Marina Konopleva, The University of Texas MD Anderson Cancer Center, Houston, TX
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Stock W, Diouf B, Crews KR, Pei D, Cheng C, Laumann K, Mandrekar SJ, Luger S, Advani A, Stone RM, Larson RA, Evans WE. An Inherited Genetic Variant in CEP72 Promoter Predisposes to Vincristine-Induced Peripheral Neuropathy in Adults With Acute Lymphoblastic Leukemia. Clin Pharmacol Ther 2016; 101:391-395. [PMID: 27618250 DOI: 10.1002/cpt.506] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 01/28/2023]
Abstract
Peripheral neuropathy is a major toxicity of vincristine, yet no strategies exist for identifying adult patients at high-risk. We used a case-control design of 48 adults receiving protocol therapy for acute lymphoblastic leukemia (ALL) who developed vincristine-induced neuropathy (NCI grade 2-4) during treatment, and 48 matched controls who did not develop grade 2-4 neuropathy. Peripheral neuropathy was prospectively graded by National Cancer Institute (NCI) criteria. CEP72 promoter genotype (rs924607) was determined using polymerase chain reaction (PCR)-based single nucleotide polymorphism (SNP) genotyping. Frequency of the CEP72 T/T genotype was higher in cases (31% vs. 10%, P = 0.0221) and the incidence of vincristine-induced neuropathy (grades 2-4) was significantly higher in patients homozygous for the CEP72 T/T genotype. 75% of the 20 patients homozygous for the CEP72 T allele developed grade 2-4 neuropathy, compared to 44% of patients with CEP72 CC or CT genotype (P = 0.0221). The CEP72 polymorphism can identify adults at increased risk of vincristine-induced peripheral neuropathy.
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Affiliation(s)
- W Stock
- Section of Hematology Oncology, University of Chicago Medicine and Comprehensive Cancer Center, Chicago, Illinois, USA.,Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA
| | - B Diouf
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - K R Crews
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - D Pei
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - C Cheng
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - K Laumann
- Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA.,Alliance Statistics and Data Center; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - S J Mandrekar
- Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA.,Alliance Statistics and Data Center; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - S Luger
- University of Pennsylvania, ECOG-ACRIN Cancer Research Group, Philadelphia, Pennsylvania, USA
| | - A Advani
- Cleveland Clinic, Southwest Oncology Cooperative Group, Cleveland, Ohio, USA
| | - R M Stone
- Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA
| | - R A Larson
- Section of Hematology Oncology, University of Chicago Medicine and Comprehensive Cancer Center, Chicago, Illinois, USA.,Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA
| | - W E Evans
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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25
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Li S, Garrett-Bakelman FE, Chung SS, Hricik T, Rapaport F, Patel J, Dillon R, Vijay P, Brown AL, Perl AE, Connon J, Sanders MA, Valk PJ, Bullinger L, Luger S, Becker MW, Lewis ID, To LB, D’Andrea RJ, Grimwade D, Delwel R, Löwenberg B, Döhner H, Döhner K, Guzman ML, Hassane DC, Roboz GJ, Carroll M, Park CY, Neuberg DS, Levine RL, Melnick AM, Mason CE. Abstract LB-073: Epigenome evolution in relapsed acute myeloid leukemia. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-073] [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
Acute myeloid leukemia (AML) is a predominantly fatal hematopoietic malignancy with high inter-patient and intra-patient genetic and epigenetic heterogeneity. The prognosis of relapsed AML remains dismal, yet the epigenetic basis of relapse is still unclear. Here we investigated whether and how the epigenome evolution impacts AML progression with biological and clinical relevance.
Methods: We obtained clinical annotation and AML specimens from 138 patients with paired diagnosis and relapsed samples. We used normal bone marrow (NBM) as epigenetic/transcriptomic controls and patients’ matched germline DNA as genetic controls. We then performed DNA methylation sequencing (ERRBS), RNA-seq, and Exome-seq. For one patient with 5 serial time points, we performed whole genome sequencing (WGS), ERRBS, and single cell RNA-seq. We measured the epigenetic allele burden using a compositional entropy-based approach (Methclone) and methylation heterogeneity using epipolymorphism.
Results: We found that diagnosis stage epigenetic allele burden (ΔS < -90) was linked to an inferior clinical outcome (p = 0.0064, log-rank test of relapse-free survival). The higher significance in promoter regions implies the functional impact of epigenetic dynamics. Promoter epiallele shift was associated with more differential expression events (p = 3.8 × 10−6, Wilcoxon signed-rank test) and promoter epiallele diversity is significantly associated with single cell resolution transcriptional heterogeneity (p < 2.2 × 10−16, ANOVA test). The global methylation heterogeneity is decreased from diagnosis to relapse, indicating a selective impact of chemotherapy on epigenetic variability (p = 0.0056, paired Wilcoxon test).
We investigated epigenetic allele burden progression from diagnosis to relapse by classifying patients into three clusters using K-means clustering: those with 1) decreased, 2) stable, or 3) increased abundance of epiallele burden. No association was seen between epigenetic clusters and patterns of genetic evolution, and the genetic abundance is higher in Cluster 3 than Cluster 1 (p = 0.048, Wilcoxon test), indicating divergent paths of genetic and epigenetic evolution. We next examined differential expression in the epigenetic cluster samples at diagnosis compared to NBM. Cluster 1 specific genes were enriched for cell cycle processes, while Cluster 3 genes were enriched for immune responses (p < 0.001, gene ontology hypergeometric tests). Integrating WGS and ERRBS data showed that epiallele burden is more dynamic than somatic mutations; a significant increase in epiallele burden preceded a major increase of somatic mutational abundance.
Summary: Our results indicate that epigenetic dynamics may provide leukemia cells greater evolutionary fitness via transcriptional adaptation and is associated with clinical outcome. This provides an alternative mechanism of AML resilience during progression and a potential predictor of relapse.
Citation Format: Sheng Li, Francine E. Garrett-Bakelman, Stephen S. Chung, Todd Hricik, Franck Rapaport, Jay Patel, Richard Dillon, Priyanka Vijay, Anna L. Brown, Alexander E. Perl, Joy Connon, Mathijs A. Sanders, Peter J.M. Valk, Lars Bullinger, Selina Luger, Michael W. Becker, Ian D. Lewis, Luen Bik To, Richard J. D’Andrea, David Grimwade, Ruud Delwel, Bob Löwenberg, Hartmut Döhner, Konstanze Döhner, Monica L. Guzman, Duane C. Hassane, Gail J. Roboz, Martin Carroll, Christopher Y. Park, Donna S. Neuberg, Ross L. Levine, Ari M. Melnick, Christopher E. Mason. Epigenome evolution in relapsed acute myeloid leukemia. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-073.
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Affiliation(s)
- Sheng Li
- 1Weill Cornell Medical College, New York, NY
| | | | | | - Todd Hricik
- 2Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jay Patel
- 2Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Anna L. Brown
- 4SA Pathology, University of South Australia, and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Joy Connon
- 5University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Ian D. Lewis
- 9SA Pathology, University of South Australia, Royal Adelaide Hospital, and University of Adelaide, Adelaide, Australia
| | - Luen Bik To
- 4SA Pathology, University of South Australia, and Royal Adelaide Hospital, Adelaide, Australia
| | - Richard J. D’Andrea
- 4SA Pathology, University of South Australia, and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Ruud Delwel
- 6Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bob Löwenberg
- 6Erasmus University Medical Center, Rotterdam, Netherlands
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26
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Shah NN, Stonecypher M, Gopal P, Luger S, Bagg A, Perl A. Acute promyelocytic leukemia presenting as a paraspinal mass. J Community Support Oncol 2016; 14:126-9. [PMID: 27058871 DOI: 10.12788/jcso.0220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/20/2022]
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) that is characterized by a balanced translocation between chromosomes 15 and 17 [t(15;17)], which results in the fusion of the promyelocytic leukemia (PML) and retinoic acid receptor α (RARA) genes. Historically, APL was a fatal disease because of the high relapse rates with cytotoxic chemotherapy alone and a significant bleeding risk secondary to disseminated intravascular coagulation (DIC). However, APL is now one of the most curable hematological malignancies because of molecularly targeted therapies. With the advent of all-trans retinoic acid (ATRA) containing chemotherapy regimens, rates of complete remission and long-term, disease-free survival have improved dramatically. More recently, regimens incorporating both ATRA and arsenic trioxide (ATO) have allowed a substantial number of patients to be treated with little or no additional cytotoxic chemotherapy.
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Affiliation(s)
- Nirav N Shah
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. .,Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Stonecypher
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadephia, Pennsylvania, USA
| | - Pallavi Gopal
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadephia, Pennsylvania, USA
| | - Selina Luger
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadephia, Pennsylvania, USA
| | - Alexander Perl
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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27
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Li S, Garrett-Bakelman FE, Chung SS, Sanders MA, Hricik T, Rapaport F, Patel J, Dillon R, Vijay P, Brown AL, Perl AE, Cannon J, Bullinger L, Luger S, Becker M, Lewis ID, To LB, Delwel R, Löwenberg B, Döhner H, Döhner K, Guzman ML, Hassane DC, Roboz GJ, Grimwade D, Valk PJM, D'Andrea RJ, Carroll M, Park CY, Neuberg D, Levine R, Melnick AM, Mason CE. Distinct evolution and dynamics of epigenetic and genetic heterogeneity in acute myeloid leukemia. Nat Med 2016; 22:792-9. [PMID: 27322744 PMCID: PMC4938719 DOI: 10.1038/nm.4125] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [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: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022]
Abstract
Genetic heterogeneity contributes to clinical outcome and progression of most tumors. Yet, little is known regarding allelic diversity for epigenetic compartments and almost no data exists for acute myeloid leukemia (AML). Here we examined epigenetic heterogeneity as assessed by cytosine methylation within defined genomic loci with four CpGs (epigenetic alleles), somatic mutations and transcriptomes of AML patient samples at serial time points. We observe that epigenetic allele burden is linked to inferior outcome and varies considerably during disease progression. Epigenetic and genetic allelic burden and patterning follow different patterns and kinetics during disease progression. We observed a subset of AMLs with high epiallele and low somatic mutation burden at diagnosis, a subset with high somatic mutation and lower epiallele burdens at diagnosis, and a subset with a mixed profile, suggesting distinct modes of tumor heterogeneity. Genes linked to promoter-associated epiallele shifts during tumor progression display increased single-cell transcriptional variance and differential expression, suggesting functional impact on gene regulation. Thus, genetic and epigenetic heterogeneity can occur with distinct kinetics, each likely able to impact biological and clinical features of tumors.
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Affiliation(s)
- Sheng Li
- Department of Physiology and Biophysics and the HRH Prince Alwaleed Bin Talal Bin Abdulaziz Al-Saud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
| | - Francine E Garrett-Bakelman
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Stephen S Chung
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mathijs A Sanders
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Todd Hricik
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Franck Rapaport
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jay Patel
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Priyanka Vijay
- Tri-Institutional Training Program in Computational Biology and Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anna L Brown
- Center for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Alexander E Perl
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joy Cannon
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lars Bullinger
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Selina Luger
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Becker
- University of Rochester Medical Center, Rochester, New York, USA
| | - Ian D Lewis
- Center for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Luen Bik To
- Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Ruud Delwel
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Bob Löwenberg
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Monica L Guzman
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Duane C Hassane
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Gail J Roboz
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Peter J M Valk
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Richard J D'Andrea
- Center for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department of Hematology, SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Martin Carroll
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Y Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ross Levine
- Leukemia Service, Department of Medicine, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ari M Melnick
- Division of Hematology-Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Christopher E Mason
- Department of Physiology and Biophysics and the HRH Prince Alwaleed Bin Talal Bin Abdulaziz Al-Saud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA.,The Feil Family Brain and Mind Research Institute, New York, New York, USA
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28
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Stitz H, Luger S, Streit M, Gehlenborg N. AVOCADO: Visualization of Workflow-Derived Data Provenance for Reproducible Biomedical Research. Comput Graph Forum 2016; 35:481-490. [PMID: 29973745 PMCID: PMC6027754 DOI: 10.1111/cgf.12924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A major challenge in data-driven biomedical research lies in the collection and representation of data provenance information to ensure that findings are reproducibile. In order to communicate and reproduce multi-step analysis workflows executed on datasets that contain data for dozens or hundreds of samples, it is crucial to be able to visualize the provenance graph at different levels of aggregation. Most existing approaches are based on node-link diagrams, which do not scale to the complexity of typical data provenance graphs. In our proposed approach, we reduce the complexity of the graph using hierarchical and motif-based aggregation. Based on user action and graph attributes, a modular degree-of-interest (DoI) function is applied to expand parts of the graph that are relevant to the user. This interest-driven adaptive approach to provenance visualization allows users to review and communicate complex multi-step analyses, which can be based on hundreds of files that are processed by numerous workflows. We have integrated our approach into an analysis platform that captures extensive data provenance information, and demonstrate its effectiveness by means of a biomedical usage scenario.
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Affiliation(s)
- H Stitz
- Johannes Kepler University Linz, Austria
| | - S Luger
- Johannes Kepler University Linz, Austria
| | - M Streit
- Johannes Kepler University Linz, Austria
| | - N Gehlenborg
- Harvard Medical School, United States of America
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29
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Miller TP, Li Y, Kavcic M, Troxel AB, Huang YSV, Sung L, Alonzo TA, Gerbing R, Hall M, Daves MH, Horton TM, Pulsipher MA, Pollard JA, Bagatell R, Seif AE, Fisher BT, Luger S, Gamis AS, Adamson PC, Aplenc R. Accuracy of Adverse Event Ascertainment in Clinical Trials for Pediatric Acute Myeloid Leukemia. J Clin Oncol 2016; 34:1537-43. [PMID: 26884558 DOI: 10.1200/jco.2015.65.5860] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Reporting of adverse events (AEs) in clinical trials is critical to understanding treatment safety, but data on AE accuracy are limited. This study sought to determine the accuracy of AE reporting for pediatric acute myeloid leukemia clinical trials and to test whether an external electronic data source can improve reporting. METHODS Reported AEs were evaluated on two trials, Children's Oncology Group AAML03P1 and AAML0531 arm B, with identical chemotherapy regimens but with different toxicity reporting requirements. Chart review for 12 AEs for patients enrolled in AAML0531 at 14 hospitals was the gold standard. The sensitivity and positive predictive values (PPV) of the AAML0531 AE report and AEs detected by review of Pediatric Health Information System (PHIS) billing and microbiology data were compared with chart data. RESULTS Select AE rates from AAML03P1 and AAML0531 arm B differed significantly and correlated with the targeted toxicities of each trial. Chart abstraction was performed on 204 patients (758 courses) on AAML0531. AE report sensitivity was < 50% for eight AEs, but PPV was > 75% for six AEs. AE reports for viridans group streptococcal bacteremia, a targeted toxicity on AAML0531, had a sensitivity of 78.3% and PPV of 98.1%. PHIS billing data had higher sensitivity (> 50% for nine AEs), but lower PPV (< 75% for 10 AEs). Viridans group streptococcal detection using PHIS microbiology data had high sensitivity (92.3%) and PPV (97.3%). CONCLUSION The current system of AE reporting for cooperative oncology group clinical trials in pediatric acute myeloid leukemia underestimates AE rates. The high sensitivity and PPV of PHIS microbiology data suggest that using external data sources may improve the accuracy of AE reporting.
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Affiliation(s)
- Tamara P Miller
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO.
| | - Yimei Li
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Marko Kavcic
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Andrea B Troxel
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Yuan-Shun V Huang
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Lillian Sung
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Todd A Alonzo
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Robert Gerbing
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Matt Hall
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Marla H Daves
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Terzah M Horton
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Michael A Pulsipher
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Jessica A Pollard
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Rochelle Bagatell
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Alix E Seif
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Brian T Fisher
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Selina Luger
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Alan S Gamis
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Peter C Adamson
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
| | - Richard Aplenc
- Tamara P. Miller, Yimei Li, Marko Kavcic, Yuan-Shun V. Huang, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Peter C. Adamson, and Richard Aplenc, The Children's Hospital of Philadelphia; Yimei Li, Andrea B. Troxel, Rochelle Bagatell, Alix E. Seif, Brian T. Fisher, Selina Luger, Peter C. Adamson, and Richard Aplenc, University of Pennsylvania School of Medicine, Philadelphia, PA; Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Todd A. Alonzo and Michael A. Pulsipher, University of Southern California; Michael A. Pulsipher, Children's Hospital of Los Angeles, Los Angeles; Todd A. Alonzo and Robert Gerbing, Children's Oncology Group, Monrovia, CA; Matt Hall, Children's Hospital Association, Overland Park, Kansas; Marla H. Daves, Children's Healthcare of Atlanta, Atlanta, GA; Terzah M. Horton, Texas Children's Hospital, Houston, TX; Jessica A. Pollard, Seattle Children's Hospital, Seattle, WA; and Alan S. Gamis, Children's Mercy Hospital, Kansas City, MO
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Rea B, Samulski TD, Strauser H, Aikawa V, Luger S, Bagg A. Chronic lymphocytic leukemia with a t(8;14)(q24;q32): FISHing catches a (sheepish) red herring. Am J Hematol 2015; 90:1187-8. [PMID: 25899556 DOI: 10.1002/ajh.24039] [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: 03/10/2015] [Revised: 04/13/2015] [Accepted: 04/17/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Bryan Rea
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - T. Danielle Samulski
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Honore Strauser
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Vania Aikawa
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Selina Luger
- Abramson Cancer Center; University of Pennsylvania; Philadelphia Pennsylvania
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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Foerch C, Luger S, Be Fast Study Group. Glial fibrillary acidic protein (GFAP) plasma levels distinguish intracerebral hemorrhage from cerebral ischemia in the early phase of acute stroke. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Churchman ML, Low J, Qu C, Paietta EM, Kasper LH, Chang Y, Payne-Turner D, Althoff MJ, Song G, Chen SC, Ma J, Rusch M, McGoldrick D, Edmonson M, Gupta P, Wang YD, Caufield W, Freeman B, Li L, Panetta JC, Baker S, Yang YL, Roberts KG, McCastlain K, Iacobucci I, Peters JL, Centonze VE, Notta F, Dobson SM, Zandi S, Dick JE, Janke L, Peng J, Kodali K, Pagala V, Min J, Mayasundari A, Williams RT, Willman CL, Rowe J, Luger S, Dickins RA, Guy RK, Chen T, Mullighan CG. Efficacy of Retinoids in IKZF1-Mutated BCR-ABL1 Acute Lymphoblastic Leukemia. Cancer Cell 2015; 28:343-56. [PMID: 26321221 PMCID: PMC4573904 DOI: 10.1016/j.ccell.2015.07.016] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/07/2015] [Accepted: 07/28/2015] [Indexed: 01/21/2023]
Abstract
Alterations of IKZF1, encoding the lymphoid transcription factor IKAROS, are a hallmark of high-risk acute lymphoblastic leukemia (ALL), however the role of IKZF1 alterations in ALL pathogenesis is poorly understood. Here, we show that in mouse models of BCR-ABL1 leukemia, Ikzf1 and Arf alterations synergistically promote the development of an aggressive lymphoid leukemia. Ikzf1 alterations result in acquisition of stem cell-like features, including self-renewal and increased bone marrow stromal adhesion. Retinoid receptor agonists reversed this phenotype, partly by inducing expression of IKZF1, resulting in abrogation of adhesion and self-renewal, cell cycle arrest, and attenuation of proliferation without direct cytotoxicity. Retinoids potentiated the activity of dasatinib in mouse and human BCR-ABL1 ALL, providing an additional therapeutic option in IKZF1-mutated ALL.
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Affiliation(s)
- Michelle L Churchman
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jonathan Low
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Chunxu Qu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Elisabeth M Paietta
- Department of Medicine, Montefiore Medical Center, North Division, Bronx, NY 10466, USA
| | - Lawryn H Kasper
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yunchao Chang
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Debbie Payne-Turner
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Mark J Althoff
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Guangchun Song
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Shann-Ching Chen
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Michael Rusch
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Dan McGoldrick
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Michael Edmonson
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Pankaj Gupta
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yong-Dong Wang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - William Caufield
- Preclinical Pharmacokinetics Shared Resource, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Burgess Freeman
- Preclinical Pharmacokinetics Shared Resource, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Lie Li
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - John C Panetta
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Sharyn Baker
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yung-Li Yang
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kathryn G Roberts
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kelly McCastlain
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jennifer L Peters
- Department of Cellular Imaging Shared Resource, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Victoria E Centonze
- Department of Cellular Imaging Shared Resource, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Faiyaz Notta
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Stephanie M Dobson
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Sasan Zandi
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - John E Dick
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Laura Janke
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Junmin Peng
- Departments of Structural Biology and Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; St. Jude Proteomics Facility, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kiran Kodali
- St. Jude Proteomics Facility, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Vishwajeeth Pagala
- St. Jude Proteomics Facility, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jaeki Min
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Anand Mayasundari
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Cheryl L Willman
- Department of Pathology, University of New Mexico Cancer Center, Albuquerque, NM 87131, USA
| | - Jacob Rowe
- Hematology, Shaare Zedek Medical Center, 9103102 Jerusalem, Israel
| | - Selina Luger
- Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ross A Dickins
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - R Kiplin Guy
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Taosheng Chen
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Miller TP, Troxel AB, Li Y, Huang YS, Alonzo TA, Gerbing RB, Hall M, Torp K, Fisher BT, Bagatell R, Seif AE, Sung L, Gamis A, Rubin D, Luger S, Aplenc R. Comparison of administrative/billing data to expected protocol-mandated chemotherapy exposure in children with acute myeloid leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:1184-9. [PMID: 25760019 PMCID: PMC4433587 DOI: 10.1002/pbc.25475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/12/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recently investigators have used analysis of administrative/billing datasets to answer clinical and pharmacoepidemiology questions in pediatric oncology. However, the accuracy of pharmacy data from administrative/billing datasets have not yet been evaluated. The primary objective of this study was to determine the concordance of Pediatric Health Information System (PHIS) administrative/billing chemotherapy data with Children's Oncology Group (COG) protocol-mandated chemotherapy and to assess the implications of this level of concordance for further PHIS research. PROCEDURE Data from 384 pediatric patients (1,060 courses of chemotherapy) with acute myeloid leukemia treated on COG clinical trial AAML0531 were previously merged with PHIS data. PHIS chemotherapy administrative/billing data were reviewed for the first three courses of chemotherapy. Accuracy was assessed using three metrics: recognizability of chemotherapy pattern by course, chemotherapy administration pattern by individual medication, and concordance with the number of days of protocol-defined chemotherapy. RESULTS The chemotherapy pattern was recognizable in 87.3% of courses when course-wide accuracy was assessed. Chemotherapy administration pattern varied by medication. Cytarabine had perfect concordance 70.9% of the time, daunorubicin had perfect concordance 77.4% of the time, and etoposide had perfect concordance 67.8% of the time. CONCLUSIONS The accuracy of chemotherapy administrative/billing data supports the continued use of PHIS data for epidemiology studies as long as investigators perform data quality control checks and evaluate each specific medication prior to undertaking definitive analyses.
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Affiliation(s)
- Tamara P. Miller
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Andrea B. Troxel
- Department of Biostatistics and Epidemiology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Yimei Li
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Yuan-Shung Huang
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Todd A. Alonzo
- Department of Preventative Medicine, University of Southern California, Arcadia, CA,Children’s Oncology Group, Arcadia, CA
| | | | - Matt Hall
- Children’s Hospital Association, Overland Park, KS
| | - Kari Torp
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian T. Fisher
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Rochelle Bagatell
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Alix E. Seif
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Alan Gamis
- Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - David Rubin
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Selina Luger
- The University of Pennsylvania Medical Center, Philadelphia, PA
| | - Richard Aplenc
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
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Reshef R, Huffman AP, Gao A, Sell M, Luskin MR, Luger S, Loren A, Hexner EO, Nasta SD, Frey NV, Gill S, Mangan J, Richman LP, Kambayashi T, Stadtmauer EA, Vonderheide RH, Mick R, Porter DL. A Survival Benefit for Reduced Intensity Allogeneic Transplants from Young Unrelated Donors Compared to Older Sibling Donors Depends on the Graft CD8 T-Cell Content. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sehgal AR, Gimotty PA, Zhao J, Hsu JM, Daber R, Morrissette JD, Luger S, Loren AW, Carroll M. DNMT3A Mutational Status Affects the Results of Dose-Escalated Induction Therapy in Acute Myelogenous Leukemia. Clin Cancer Res 2015; 21:1614-20. [PMID: 25609058 DOI: 10.1158/1078-0432.ccr-14-0327] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 12/11/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE DNA methyltransferase 3A (DNMT3A) is one of the commonly mutated genes in acute myelogenous leukemia (AML). Reports on the prognostic significance of DNMT3A mutations have been inconsistent, and most of the data are available only for patients 60 years of age or younger. We hypothesized that this inconsistency is due to an interaction between the dose of anthracycline used in induction therapy and DNMT3A status. We studied whether patients with DNMT3A-mutated AML treated with standard dose anthracyclines had an inferior survival compared with patients with other mutation profiles or those who received high-dose therapy. EXPERIMENTAL DESIGN A total of 152 patients in this retrospective cohort study (median age, 54 years) with de novo AML underwent induction therapy and next-generation sequencing of 33 commonly mutated genes in hematologic malignancies, including DNMT3A, FLT3-ITD, NPM1, and IDH1/2. Cox regression was used to know whether those with DNMT3A mutations who were treated with standard dose anthracycline had inferior survival. RESULTS DNMT3A mutations, found in 32% of patients, were not associated with an inferior survival. Dose escalation of anthracycline in the induction regimen was associated with improved survival in those with DNMT3A mutations but not those with wild-type DNMT3A. Patients with DNMT3A mutations who received standard dose induction had shorter survival time than other patient groups (10.1 months vs. 19.8 months, P = 0.0129). This relationship remained significant (HR, 1.90; P = 0.006) controlling for multiple variables. CONCLUSIONS Patients with DNMT3A-mutated AML have an inferior survival when treated with standard-dose anthracycline induction therapy. This group should be considered for high-dose induction therapy.
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Affiliation(s)
- Alison R Sehgal
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phyllis A Gimotty
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jianhua Zhao
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jing-Mei Hsu
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Daber
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer D Morrissette
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Selina Luger
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alison W Loren
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin Carroll
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Riccio B, Mato A, Olson EM, Berns JS, Luger S. Spontaneous tumor lysis syndrome in acute myeloid leukemia: Two cases and a review of the literature. Cancer Biol Ther 2014; 5:1614-7. [PMID: 17204864 DOI: 10.4161/cbt.5.12.3610] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Spontaneous tumor lysis syndrome (TLS) is a constellation of electrolyte abnormalities and acute renal failure, which occurs in the setting of rapid cell turnover prior to the administration of cytotoxic chemotherapy. While spontaneous TLS is well described in patients with Burkitt's lymphoma, it is thought to occur less commonly in other hematologic malignancies. We present two cases of spontaneous TLS in patients with newly diagnosed acute myeloid leukemia (AML) followed by a review of the literature in this field.
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Affiliation(s)
- Brett Riccio
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA
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Daber RB, Zhao J, Carroll M, Solderquest C, Luger S, Wertheim GB, Bagg A, Morrissette JJ. Abstract 5609: Next generation sequencing in acute myeloid leukemia: Correlation with cytogenetic studies highlighting different spectrums of mutations. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5609] [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
Acute myeloid leukemia (AML) represents a heterogeneous group of aggressive myeloid malignancies characterized by the accumulation of blasts in the bone marrow. The prognosis of AML is variable, likely reflecting its diversity at a genetic level. The pathogenesis of AML has not been completely defined; however it is clear that recurrent chromosomal abnormalities (e.g., translocations and numeric abnormalities) and genetic events (e.g., point mutations and indels) are necessary for disease development. Genetic changes are diverse and consist of large genomic changes such as rearrangements and ploidy anomalies, as well as submicroscopic changes, including point mutations and indels. Few studies have correlated cytogenetically detected anomalies with molecularly detected mutations in AML. Here we describe our experience using a hematological next generation sequencing (heme-NGS) panel in conjunction with conventional cytogenetic studies to interrogate diagnostic AML specimens in a routine clinical setting. Next generation sequencing was done using a custom designed amplicon panel and Illumina TruSeq Custom Amplicon (TSCA) capture. Using a customized bioinformatics pipelines we were able to detect single nucleotide variants (SNV) and small insertion/deletion (indel) to a lower limit of 5% with 100% sensitivity and specificity. 28 genes recurrently mutated in myeloid malignancies were examined including targeted regions of NPM1, FLT3, KIT, PTPN11, NRAS, IDH1, IDH2, JAK2, DNMT3a, EZH2, PTEN, CEBPA, TP53, WT1, RUNX1, TET2, ATM, BRAF, CBL, MPL, SF3B1, ASXL1, HRAS, KRAS, PHF6, GNAS, ETV6 and MYD88. Over 100 specimens were analyzed by NGS and cytogenetics , with only a single case being ‘normal’ by both tests. Comparison of mutation-positive AML demonstrated more mutations present in cytogenetically normal cases, compared with those with chromosome abnormalities detected. Conversely, in 11 cases no mutations were detected by heme-NGS, with 10/11 of these cases showing recurrent cytogenetic abnormalities. In those cases where NGS mutations were identified, comparison of cases with normal (CN-AML) and abnormal (CA-AML) cytogenetic studies demonstrated different mutation frequencies, with more mutations detected in CN-AML. Interestingly, TP53 was the most commonly mutated gene in CA-AML and least mutated in CN-AML. These results illustrate the complementary information gained from NGS sequencing performed with conventional cytogenetic studies in diagnostic AML specimens, providing a comprehensive picture of the genomic landscape in this disease. A complete description of these combined cytogenetic and molecular abnormalities seen in AML and correlation with clinical features will be presented.
Citation Format: Robert B. Daber, Jianhua Zhao, Martin Carroll, Craig Solderquest, Selina Luger, Gerald B.W. Wertheim, Adam Bagg, Jennifer J.D. Morrissette. Next generation sequencing in acute myeloid leukemia: Correlation with cytogenetic studies highlighting different spectrums of mutations. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5609. doi:10.1158/1538-7445.AM2014-5609
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Affiliation(s)
| | | | | | | | | | | | - Adam Bagg
- University of Pennsylvania, Philadelphia, PA
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Reshef R, Luger S, Loren A, Hexner EO, Nasta SD, Frey NV, Stadtmauer EA, Smith J, Porter DL. High CD8 Cell Doses Correlate with Reduced Relapse Risk and Improved Survival after Allogeneic Peripheral Blood Stem-Cell Transplantation with Reduced-Intensity Conditioning. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hexner E, Roboz G, Hoffman R, Luger S, Mascarenhas J, Carroll M, Clementi R, Bensen-Kennedy D, Moliterno A. Open-label study of oral CEP-701 (lestaurtinib) in patients with polycythaemia vera or essential thrombocythaemia withJAK2-V617F mutation. Br J Haematol 2013; 164:83-93. [DOI: 10.1111/bjh.12607] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gail Roboz
- Weill Cornell Medical College; New York NY USA
| | - Ron Hoffman
- Mount Sinai School of Medicine; Tisch Cancer Institute; New York NY USA
| | | | - John Mascarenhas
- Mount Sinai School of Medicine; Tisch Cancer Institute; New York NY USA
| | | | - Regina Clementi
- Teva Branded Pharmaceutical Products R&D, Inc.; Frazer PA USA
| | - Debra Bensen-Kennedy
- Cephalon, Inc., now a wholly owned subsidiary of Teva Branded Pharmaceutical Products R&D, Inc.; Frazer PA USA
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Landsburg DJ, Stadtmauer E, Loren A, Goldstein S, Frey N, Nasta SD, Porter DL, Tsai DE, Perl AE, Hexner EO, Luger S. Receipt of maintenance therapy is most predictive of survival in older acute lymphoblastic leukemia patients treated with intensive induction chemotherapy regimens. Am J Hematol 2013; 88:657-60. [PMID: 23640768 DOI: 10.1002/ajh.23468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 11/10/2022]
Abstract
While the prognosis for older adults diagnosed with acute lymphoblastic leukemia (ALL) is frequently poor, long-term survival can be achieved in patients treated with curative intent. We reviewed the outcomes of 37 patients age ≥60 treated at our institution with either DVP- or hyperCVAD-based chemotherapy regimens from 2003-2011. In this patient population, a complete response rate of 92%, relapse rate of 56% and median overall survival of 18.1 months was experienced. Univariate analysis revealed that receipt of maintenance therapy vs. no maintenance therapy was associated with a statistically-significant impact on overall survival (p = 0.001, HR 0.15 for death), while disease-related characteristics including high-risk white blood cell count at diagnosis and Philadelphia chromosome status as well as treatment-related factors including chemotherapy regimen or completion of intensive therapy were not. Many patients were unable to initiate or remain on maintenance therapy due to toxicities including infections and cytopenias. Our analysis reveals the benefit of prolonged therapy in the treatment of older adults with ALL as well as the high incidence of treatment-related toxicity experienced by these patients.
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Affiliation(s)
- Daniel J. Landsburg
- Division of Hematology/Oncology; Abramson Cancer Center, Hospital of the University of Pennsylvania; Philadelphia; Pennsylvania
| | | | | | | | | | | | | | | | | | - Elizabeth O. Hexner
- Division of Hematology/Oncology; Abramson Cancer Center, Hospital of the University of Pennsylvania; Philadelphia; Pennsylvania
| | - Selina Luger
- Division of Hematology/Oncology; Abramson Cancer Center, Hospital of the University of Pennsylvania; Philadelphia; Pennsylvania
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Kantarjian H, Faderl S, Garcia-Manero G, Luger S, Venugopal P, Maness L, Wetzler M, Coutre S, Stock W, Claxton D, Goldberg SL, Arellano M, Strickland SA, Seiter K, Schiller G, Jabbour E, Chiao J, Plunkett W. Oral sapacitabine for the treatment of acute myeloid leukaemia in elderly patients: a randomised phase 2 study. Lancet Oncol 2012; 13:1096-104. [PMID: 23075701 DOI: 10.1016/s1470-2045(12)70436-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Available treatments for acute myeloid leukaemia (AML) have limited durable activity and unsatisfactory safety profiles in most elderly patients. We assessed the efficacy and toxicity of sapacitabine, a novel oral cytosine nucleoside analogue, in elderly patients with AML. METHODS In this randomised, phase 2 study, we recruited patients with AML who were either treatment naive or at first relapse and who were aged 70 years or older from 12 centres in the USA. We used a computer-generated randomisation sequence to randomly allocate eligible patients to receive one of three schedules of oral sapacitabine (1:1:1; stratified by a history of AML treatment): 200 mg twice a day for 7 days (group A); 300 mg twice a day for 7 days (group B); and 400 mg twice a day for 3 days each week for 2 weeks (group C). All schedules were given in 28 day cycles. To confirm the safety and tolerability of dosing schedules, after 20 patients had been treated in a group we enrolled an expanded cohort of 20-25 patients to that group if at least four patients had achieved complete remission or complete remission with incomplete blood count recovery, and if the 30 day death rate was 20% or less. Our primary endpoint was 1-year overall survival, analysed by intention-to-treat (ie, patients who have received at least one dose of sapacitabine) in those patients who had been randomly allocated to treatment. This trial is registered with ClinicalTrials.gov, number NCT00590187. RESULTS Between Dec 27, 2007, and April 21, 2009, we enrolled 105 patients: 86 patients were previously untreated and 19 were at first relapse. Of the 60 patients randomly allocated to treatment, 1-year overall survival was 35% (95% CI 16-59) in group A, 10% (2-33) in group B, and 30% (13-54) in group C. 14 (13%) of 105 patients died within 30 days and 27 (26%) died within 60 days. The most common grade 3-4 adverse events were anaemia (eight of 40 patients in group A, 12 of 20 patients in group B, and 15 of 45 patients in group C), neutropenia (14 in group A, 10 in group B, 11 in group C), thrombocytopenia (24 in group A, 12 in group B, and 22 in group C), febrile neutropenia (16 in group A, nine in group B, and 22 in group C), and pneumonia (seven in group A, five in group B, and 10 in group C). The most common grade 5 events were pneumonia (two in group A, one in group B, and three in group C) and sepsis (six in group A, three in group B, and one in group C). Seven deaths were thought to be probably or possibly related to sapacitabine treatment. INTERPRETATION Sapacitabine seems active and tolerable in elderly patients with AML. The 400 mg dose schedule had the best efficacy profile. Future investigations should aim to combine sapacitabine with other low-intensity therapies in elderly patients with AML. FUNDING Cyclacel Limited.
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Affiliation(s)
- Hagop Kantarjian
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Patel JP, Gönen M, Figueroa ME, Fernandez H, Sun Z, Racevskis J, Van Vlierberghe P, Dolgalev I, Thomas S, Aminova O, Huberman K, Cheng J, Viale A, Socci ND, Heguy A, Cherry A, Vance G, Higgins RR, Ketterling RP, Gallagher RE, Litzow M, van den Brink MRM, Lazarus HM, Rowe JM, Luger S, Ferrando A, Paietta E, Tallman MS, Melnick A, Abdel-Wahab O, Levine RL. Prognostic relevance of integrated genetic profiling in acute myeloid leukemia. N Engl J Med 2012; 366:1079-89. [PMID: 22417203 PMCID: PMC3545649 DOI: 10.1056/nejmoa1112304] [Citation(s) in RCA: 1466] [Impact Index Per Article: 122.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a heterogeneous disease with respect to presentation and clinical outcome. The prognostic value of recently identified somatic mutations has not been systematically evaluated in a phase 3 trial of treatment for AML. METHODS We performed a mutational analysis of 18 genes in 398 patients younger than 60 years of age who had AML and who were randomly assigned to receive induction therapy with high-dose or standard-dose daunorubicin. We validated our prognostic findings in an independent set of 104 patients. RESULTS We identified at least one somatic alteration in 97.3% of the patients. We found that internal tandem duplication in FLT3 (FLT3-ITD), partial tandem duplication in MLL (MLL-PTD), and mutations in ASXL1 and PHF6 were associated with reduced overall survival (P=0.001 for FLT3-ITD, P=0.009 for MLL-PTD, P=0.05 for ASXL1, and P=0.006 for PHF6); CEBPA and IDH2 mutations were associated with improved overall survival (P=0.05 for CEBPA and P=0.01 for IDH2). The favorable effect of NPM1 mutations was restricted to patients with co-occurring NPM1 and IDH1 or IDH2 mutations. We identified genetic predictors of outcome that improved risk stratification among patients with AML, independently of age, white-cell count, induction dose, and post-remission therapy, and validated the significance of these predictors in an independent cohort. High-dose daunorubicin, as compared with standard-dose daunorubicin, improved the rate of survival among patients with DNMT3A or NPM1 mutations or MLL translocations (P=0.001) but not among patients with wild-type DNMT3A, NPM1, and MLL (P=0.67). CONCLUSIONS We found that DNMT3A and NPM1 mutations and MLL translocations predicted an improved outcome with high-dose induction chemotherapy in patients with AML. These findings suggest that mutational profiling could potentially be used for risk stratification and to inform prognostic and therapeutic decisions regarding patients with AML. (Funded by the National Cancer Institute and others.).
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Affiliation(s)
- Jay P Patel
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA
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Sive JI, Buck G, Fielding A, Lazarus HM, Litzow MR, Luger S, Marks DI, McMillan A, Moorman AV, Richards SM, Rowe JM, Tallman MS, Goldstone AH. Outcomes in older adults with acute lymphoblastic leukaemia (ALL): results from the international MRC UKALL XII/ECOG2993 trial. Br J Haematol 2012; 157:463-71. [PMID: 22409379 DOI: 10.1111/j.1365-2141.2012.09095.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/14/2012] [Indexed: 12/21/2022]
Abstract
Although the incidence rate of acute lymphoblastic leukaemia (ALL) is slightly higher in older than in younger adults, response rates to induction chemotherapy and survival rates are poorer. The contribution of disease-related versus treatment-related factors remains unclear. We analysed 100 older patients (aged 55-65 years) treated on the UKALLXII/ECOG2993 trial compared with 1814 younger patients (aged 14-54 years). Baseline characteristics, induction chemotherapy course, infections, drug reductions and survival outcomes were compared. There were more Philadelphia-positive (Ph+) patients in the older group (28% vs. 17%, P = 0·02), and a trend towards higher combined cytogenetic risk score (46% vs. 35%, P = 0·07). The complete remission rate in older patients was worse (73% vs. 93%, P < 0·0001) as was 5-year overall survival (21% vs. 41%, P < 0·0001) and event-free survival (EFS) (19% vs. 37%, P < 0·0001). Older patients had more infections during induction (81% vs. 70%, P = 0·05), and drug reductions (46% vs. 28%, P = 0·0009). Among older patients, Ph+ and cytogenetic risk category as well as infection during induction predicted for worse EFS. Poorer outcomes in these patients are partly due to cytogenetic risk, but there is significant morbidity and mortality during induction chemotherapy with frequent delays and drug reductions. New approaches, including better risk stratification and use of targeted therapies, could improve treatment for these patients.
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Affiliation(s)
- Jonathan I Sive
- Department of Haematology, University College London Hospital, London.
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Cortes J, Moore JO, Maziarz RT, Wetzler M, Craig M, Matous J, Luger S, Dey BR, Schiller GJ, Pham D, Abboud CN, Krishnamurthy M, Brown A, Laadem A, Seiter K. Control of plasma uric acid in adults at risk for tumor Lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone--results of a multicenter phase III study. J Clin Oncol 2010; 28:4207-13. [PMID: 20713865 DOI: 10.1200/jco.2009.26.8896] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Rasburicase is effective in controlling plasma uric acid in pediatric patients with hematologic malignancies. This study in adults evaluated safety of and compared efficacy of rasburicase alone with rasburicase followed by oral allopurinol and with allopurinol alone in controlling plasma uric acid. PATIENTS AND METHODS Adults with hematologic malignancies at risk for hyperuricemia and tumor lysis syndrome (TLS) were randomly assigned to rasburicase (0.20 mg/kg/d intravenously days 1-5), rasburicase plus allopurinol (rasburicase 0.20 mg/kg/d days 1 to 3 followed by oral allopurinol 300 mg/d days 3 to 5), or allopurinol (300 mg/d orally days 1 to 5). Primary efficacy variable was plasma uric acid response rate defined as percentage of patients achieving or maintaining plasma uric acid ≤ 7.5 mg/dL during days 3 to 7. RESULTS Ninety-two patients received rasburicase, 92 rasburicase plus allopurinol, and 91 allopurinol. Plasma uric acid response rate was 87% with rasburicase, 78% with rasburicase plus allopurinol, and 66% with allopurinol. It was significantly greater for rasburicase than for allopurinol (P = .001) in the overall study population, in patients at high risk for TLS (89% v 68%; P = .012), and in those with baseline hyperuricemia (90% v 53%; P = .015). Time to plasma uric acid control in hyperuricemic patients was 4 hours for rasburicase, 4 hours for rasburicase plus allopurinol, and 27 hours for allopurinol. CONCLUSION In adults with hyperuricemia or at high risk for TLS, rasburicase provided control of plasma uric acid more rapidly than allopurinol. Rasburicase was well tolerated as a single agent and in sequential combination with allopurinol.
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Affiliation(s)
- Jorge Cortes
- MD Anderson Cancer Center, Houston, TX 77030, USA.
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Ochs RC, Gormley RH, Luger S, Bagg A. Isolated bowel relapse in acute promyelocytic leukemia: an unusual site of extramedullary recurrence. J Clin Oncol 2010; 28:e550-3. [PMID: 20713873 DOI: 10.1200/jco.2010.29.7424] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Rachel C Ochs
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Felsche J, Luger S. Structural Collapse or Expansion of the Hydro-Sodalite Series Na8[AlSiO4]6(OH)2·nH2O and Na6[AlSiO4]6·nH2O Upon Dehydratation. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19860900822] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mato A, Fuchs BD, Heitjan DF, Mick R, Halpern SD, Shah PD, Jacobs S, Olson EM, Schuster SJ, Ujjani C, Chong EA, Loren AW, Miltiades AN, Luger S. Utility of the systemic inflammatory response syndrome (SIRS) criteria in predicting the onset of septic shock in hospitalized patients with hematologic malignancies. Cancer Biol Ther 2009; 8:1095-1100. [PMID: 19652524 DOI: 10.4161/cbt.8.12.8528] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The systemic inflammatory response syndrome (SIRS) criteria have not been validated in patients with hematologic malignancies (HM). OBJECTIVE To determine whether daily assessment of SIRS criteria allows early identification of HM patients who will develop septic shock (SS). DESIGN Observational, single-center,nested case-control study. SETTING Oncology unit of a tertiary care center. PATIENTS 547 consecutive, hospitalized, HM subject were enrolled. Using incidence-density sampling, 184 controls were matched to 46 SS cases. MEASUREMENTS The study exposure was the SIRS score. The study outcome was the development of SS during the hospitalization. MAIN RESULTS 8.4% of subjects developed SS. SIRS scores measured 24 hours prior to SS were significantly higher in cases than in controls (2.1 vs. 1.4,p<0.0001). Using standard SIRS cutpoints, fever, tachypnea and tachycardia were each associated with the onset of SS. Population-specific SIRS criteria were empirically derived. LIMITATIONS Single-center study. Further validation is warranted. CONCLUSIONS SIRS can identify HM patients at risk for SS at least 24 hours before SS onset. These data may lead to evidence-based guidelines using routine vital signs to risk-stratify HM patients for SS.
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Affiliation(s)
- Anthony Mato
- Hematology & Oncology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Vogl DT, Glatstein E, Carver JR, Schuster SJ, Stadtmauer EA, Luger S, Nasta SD, Porter DL, Elstrom R, Tsai DE. Gemcitabine-induced pericardial effusion and tamponade after unblocked cardiac irradiation. Leuk Lymphoma 2009; 46:1313-20. [PMID: 16109609 DOI: 10.1080/10428190500158649] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gemcitabine therapy has been associated with radiation recall reactions when used in the treatment of carcinoma. We report four cases of hemodynamically significant pericardial effusion in patients with refractory lymphoma who were receiving gemcitabine, all of whom had a history of mediastinal radiation without subcarinal blocking. All four patients had pericardial abnormalities on echocardiography prior to receiving gemcitabine. Two patients required emergent surgical procedures. Of twenty other patients in our practice who received gemcitabine for refractory lymphoma without developing pericardial effusion, none had received prior direct radiation to the heart. The overall response rate of these 24 refractory lymphomas to gemcitabine-containing regimens was 46%. Although gemcitabine-based regimens have clear efficacy in refractory lymphoma, prior mediastinal radiation without subcarinal blocking may be a relative contraindication, especially in the presence of pericardial abnormalities on echocardiography. Physicians should be aware of the potential for developing a gemcitabine-induced radiation recall reaction resulting in hemodynamically significant pericardial effusion.
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Affiliation(s)
- Dan T Vogl
- Abramson Cancer Center, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Tsai DE, Wang W, Reshef R, Vogl D, Stadtmauer E, Andreadis C, Carlson A, Luger S. Effect of bexarotene on platelet counts in patients undergoing cancer treatment: An analysis of clinical trials in lung cancer and leukemia. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20533] [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: 11/20/2022] Open
Abstract
e20533 Background: Bexarotene (Bex) is an oral retinoid X receptor agonist with activity against cutaneous T cell lymphoma and currently under investigation for other malignancies. In patients receiving this agent for acute myeloid leukemia (AML), we noted increases in platelet counts. We therefore reviewed the available clinical trial data on Bex and its effects on platelet counts. Methods: We analyzed platelet count data from 3 Bex clinical trials encompassing non-small cell lung cancer (NSCLC) and AML. Results: In two phase III trials of Bex in NSCLC, patients underwent carboplatin + paclitaxel (CarP, n=587) or cisplatin + vinorelbine (CisV, n=613) and were randomized to receive concurrent Bex or placebo. More patients on Bex than on placebo had an increase in platelet count of at least 50 K/uL (55% vs. 27% for CarP, p<0.0001; 81% vs. 66% for CisV, p<0.0001) over pre-treatment baseline. The median increase in platelet count was higher on Bex than on placebo (69 vs 0 K/uL for CarP, p<0.0001; 168 vs. 95 K/uL for CisV, p<0.0001) and was maintained while on treatment. In both NSCLC trials, the median time to platelet increase >50 K/uL on Bex was 22 days. Similar findings were seen in a phase I monotherapy trial in AML where 5/18 (28%) patients achieved platelet transfusion independence with peak platelet counts of 40–91 K/uL. Conclusions: Clinically significant increases in platelet counts were seen in all 3 clinical trials examined. These data suggest that Bex improves platelet counts in patients with a variety of cancer types, both as monotherapy and with concurrent chemotherapy. Its effect on megakaryopoiesis and its potential role as a supportive care measure should be further evaluated. [Table: see text]
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Affiliation(s)
- D. E. Tsai
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
| | - W. Wang
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
| | - R. Reshef
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
| | - D. Vogl
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
| | - E. Stadtmauer
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
| | - C. Andreadis
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
| | - A. Carlson
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
| | - S. Luger
- University of Pennsylvania Cancer Center, Philadelphia, PA; Eisai Inc, Woodcliff Lake, NJ; University of California, San Diego, CA
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