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Pascual-Pasto G, Resa-Pares C, Castillo-Ecija H, Aschero R, Baulenas-Farres M, Vila-Ubach M, Burgueño V, Balaguer-Lluna L, Cuadrado-Vilanova M, Olaciregui NG, Martinez-Velasco N, Perez-Jaume S, de Alava E, Tirado OM, Lavarino C, Mora J, Carcaboso AM. Low Bcl-2 is a robust biomarker of sensitivity to nab-paclitaxel in Ewing sarcoma. Biochem Pharmacol 2023; 208:115408. [PMID: 36603685 DOI: 10.1016/j.bcp.2022.115408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Nanoparticle albumin-bound paclitaxel (nab-paclitaxel) shows potent preclinical anticancer activity in pediatric solid tumors such as Ewing sarcoma, rhabdomyosarcoma and neuroblastoma, but responses in clinical trials have been modest. In this work, we aimed to discover a rational biomarker-based approach to select the right candidate patients for this treatment. We assessed the efficacy of nab-paclitaxel in 27 patient-derived xenografts (PDX), including 14 Ewing sarcomas, five rhabdomyosarcomas and several other pediatric solid tumors. Response rate (partial or complete response) was remarkable in rhabdomyosarcomas (four of five) and Ewing sarcomas (four of 14). We addressed several predictive factors of response to nab-paclitaxel such as the expression of the secreted protein acidic and rich in cysteine (SPARC), chromosomal stability of cancer cells and expression of antiapoptotic members of the B-cell lymphoma-2 (Bcl-2) family of proteins such as Bcl-2, Bcl-xL, Bcl-W and Mcl-1. Protein (immunoblotting) and gene expression of SPARC correlated positively, while immunoblotting and immunohistochemistry expression of Bcl-2 correlated negatively with the efficacy of nab-paclitaxel in Ewing sarcoma PDX. The negative correlation of Bcl-2 immunoblotting signal and activity was especially robust (r = 0.8352; P = 0.0007; Pearson correlation). Consequently, we evaluated pharmacological strategies to inhibit Bcl-2 during nab-paclitaxel treatment. We observed that the Bcl-2 inhibitor venetoclax improved the activity of nab-paclitaxel in highly resistant Bcl-2-expressing Ewing sarcoma PDX. Overall, our results suggest that low Bcl-2 expression could be used to select patients with Ewing sarcoma sensitive to nab-paclitaxel, and Bcl-2 inhibitors could improve the activity of this drug in Bcl-2-expressing Ewing sarcoma.
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Affiliation(s)
- Guillem Pascual-Pasto
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Claudia Resa-Pares
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Helena Castillo-Ecija
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Rosario Aschero
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Merce Baulenas-Farres
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Monica Vila-Ubach
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Victor Burgueño
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Leire Balaguer-Lluna
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Maria Cuadrado-Vilanova
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Nagore G Olaciregui
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Nuria Martinez-Velasco
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Sara Perez-Jaume
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Enrique de Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, 41013 Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Oscar M Tirado
- Sarcoma Research Group, Oncobell Program, Institut d'Investigació Biomédica de Bellvitge (IDIBELL)/CIBERONC, Barcelona, Spain
| | - Cinzia Lavarino
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Jaume Mora
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Angel M Carcaboso
- SJD Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain.
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Cuadrado‐Vilanova M, Burgueño V, Balaguer‐Lluna L, Aschero R, Castillo‐Ecija H, Liu J, Perez‐Jaume S, Pascual‐Pasto G, Olaciregui NG, Gomez‐Gonzalez S, Correa G, Suñol M, Schaiquevich P, Radvanyi F, Lavarino C, Mora J, Catala‐Mora J, Chantada GL, Carcaboso AM. Follow-up of intraocular retinoblastoma through the quantitative analysis of conserved nuclear DNA sequences in aqueous humor from patients. J Pathol Clin Res 2022; 9:32-43. [PMID: 36148636 PMCID: PMC9732679 DOI: 10.1002/cjp2.296] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/30/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022]
Abstract
Fundoscopy is the standard method for diagnosis and follow-up of intraocular retinoblastoma, but it is sometimes insufficient to discern whether tumors are inactivated following treatments. In this work, we hypothesized that the amount of conserved nuclear DNA sequences in the cell-free DNA (cfDNA) fraction of the aqueous humor (AH) might complement fundoscopy for retinoblastoma follow-up. To address our hypothesis, we developed highly sensitive droplet digital polymerase chain reaction (ddPCR) methods to quantify highly conserved DNA sequences of nucleus-encoded genes (GAPDH and B4GALNT1) and of a mitochondrial gene, MT-ATP6. We obtained AH samples during intravitreal treatments. We analyzed 42 AH samples from 25 patients with intraocular retinoblastoma and 11 AH from controls (non-cancer patients). According to clinical criteria, we grouped patients as having progression-free or progressive retinoblastoma. cfDNA concentration in the AH was similar in both retinoblastoma groups. Copy counts for nucleus-derived sequences of GAPDH and B4GALNT1 were significantly higher in the AH from patients with progressive disease, compared to the AH from progression-free patients and control non-cancer patients. The presence of mitochondrial DNA in the AH explained that both retinoblastoma groups had similar cfDNA concentration in AH. The optimal cut-off point for discriminating between progressive and progression-free retinoblastomas was 108 GAPDH copies per reaction. Among patients having serial AH samples analyzed during their intravitreal chemotherapy, GAPDH copies were high and decreased below the cut-off point in those patients responding to chemotherapy. In contrast, one non-responder patient remained with values above the cut-off during follow-up, until enucleation. We conclude that the measurement of conserved nuclear gene sequences in AH allows follow-up of intraocular retinoblastoma during intravitreal treatment. The method is applicable to all patients and could be relevant for those in which fundoscopy evaluation is inconclusive.
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Affiliation(s)
- Maria Cuadrado‐Vilanova
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Victor Burgueño
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Leire Balaguer‐Lluna
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Rosario Aschero
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Helena Castillo‐Ecija
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Jing Liu
- Institut CurieCNRS, UMR144, SIREDO Oncology CenterParisFrance,Institut CuriePSL Research UniversityParisFrance
| | - Sara Perez‐Jaume
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Guillem Pascual‐Pasto
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Nagore G Olaciregui
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Soledad Gomez‐Gonzalez
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | | | | | - Paula Schaiquevich
- Hospital de Pediatria JP GarrahanBuenos AiresArgentina,CONICETBuenos AiresArgentina
| | - François Radvanyi
- Institut CurieCNRS, UMR144, SIREDO Oncology CenterParisFrance,Institut CuriePSL Research UniversityParisFrance
| | - Cinzia Lavarino
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | - Jaume Mora
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
| | | | - Guillermo L Chantada
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain,CONICETBuenos AiresArgentina
| | - Angel M Carcaboso
- Institut de Recerca Sant Joan de DeuBarcelonaSpain,SJD Pediatric Cancer Center BarcelonaHospital Sant Joan de DeuBarcelonaSpain
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3
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Cuadrado‐Vilanova M, Liu J, Paco S, Aschero R, Burgueño V, Sirab N, Pascual‐Pasto G, Correa G, Balaguer‐Lluna L, Castillo‐Ecija H, Perez‐Jaume S, Muñoz‐Aznar O, Roldan M, Suñol M, Schaiquevich P, Aerts I, Doz F, Cassoux N, Lubieniecki F, Benitez‐Ribas D, Lavarino C, Mora J, Chantada GL, Catala‐Mora J, Radvanyi F, Carcaboso AM. Identification of immunosuppressive factors in retinoblastoma cell secretomes and aqueous humor from patients. J Pathol 2022; 257:327-339. [DOI: 10.1002/path.5893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/10/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Cuadrado‐Vilanova
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Jing Liu
- Institut Curie, CNRS, UMR144, SIREDO Oncology Center Paris France
- Institut Curie PSL Research University Paris France
| | - Sonia Paco
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Rosario Aschero
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Victor Burgueño
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Nanor Sirab
- Institut Curie, CNRS, UMR144, SIREDO Oncology Center Paris France
- Institut Curie PSL Research University Paris France
| | - Guillem Pascual‐Pasto
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Genoveva Correa
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Leire Balaguer‐Lluna
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Helena Castillo‐Ecija
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Sara Perez‐Jaume
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Oscar Muñoz‐Aznar
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Monica Roldan
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Genetic and Molecular Medicine ‐ IPER, Hospital Sant Joan de Deu, Esplugues de Llobregat Barcelona Spain
| | - Mariona Suñol
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pathology, Hospital Sant Joan de Deu Barcelona Spain
| | - Paula Schaiquevich
- Precision Medicine, Hospital de Pediatria JP Garrahan Buenos Aires Argentina
- CONICET Buenos Aires Argentina
| | - Isabelle Aerts
- Institut Curie, CNRS, UMR144, SIREDO Oncology Center Paris France
| | - François Doz
- Institut Curie, CNRS, UMR144, SIREDO Oncology Center Paris France
- University of Paris Paris France
| | - Nathalie Cassoux
- University of Paris Paris France
- Institut Curie, Ophthalmic Oncology Paris France
| | | | | | - Cinzia Lavarino
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Jaume Mora
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
| | - Guillermo L. Chantada
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
- CONICET Buenos Aires Argentina
- Universidad Austral‐CONICET Institute for Research in Translational Medicine (IIMT) Pilar Argentina
| | | | - François Radvanyi
- Institut Curie, CNRS, UMR144, SIREDO Oncology Center Paris France
- Institut Curie PSL Research University Paris France
| | - Angel M. Carcaboso
- Institut de Recerca Sant Joan de Deu Barcelona Spain
- Pediatric Oncology, Hospital Sant Joan de Deu Barcelona Spain
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4
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Castillo‐Ecija H, Pascual‐Pasto G, Perez‐Jaume S, Resa‐Pares C, Vila‐Ubach M, Monterrubio C, Jimenez‐Cabaco A, Baulenas‐Farres M, Muñoz‐Aznar O, Salvador N, Cuadrado‐Vilanova M, Olaciregui NG, Balaguer‐Lluna L, Burgueño V, Vicario FJ, Manzanares A, Castañeda A, Santa‐Maria V, Cruz O, Celis V, Morales La Madrid A, Garraus M, Gorostegui M, Vancells M, Carrasco R, Krauel L, Torner F, Suñol M, Lavarino C, Mora J, Carcaboso AM. Prognostic value of patient-derived xenograft engraftment in pediatric sarcomas. J Pathol Clin Res 2021; 7:338-349. [PMID: 33837665 PMCID: PMC8185364 DOI: 10.1002/cjp2.210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/11/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022]
Abstract
The goals of this work were to identify factors favoring patient-derived xenograft (PDX) engraftment and study the association between PDX engraftment and prognosis in pediatric patients with Ewing sarcoma, osteosarcoma, and rhabdomyosarcoma. We used immunodeficient mice to establish 30 subcutaneous PDX from patient tumor biopsies, with a successful engraftment rate of 44%. Age greater than 12 years and relapsed disease were patient factors associated with higher engraftment rate. Tumor type and biopsy location did not associate with engraftment. PDX models retained histology markers and most chromosomal aberrations of patient samples during successive passages in mice. Model treatment with irinotecan resulted in significant activity in 20 of the PDXs and replicated the response of rhabdomyosarcoma patients. Successive generations of PDXs responded similarly to irinotecan, demonstrating functional stability of these models. Importantly, out of 68 tumor samples from 51 patients with a median follow-up of 21.2 months, PDX engraftment from newly diagnosed patients was a prognostic factor significantly associated with poor outcome (p = 0.040). This association was not significant for relapsed patients. In the subgroup of patients with newly diagnosed Ewing sarcoma classified as standard risk, we found higher risk of relapse or refractory disease associated with those samples that produced stable PDX models (p = 0.0357). Overall, our study shows that PDX engraftment predicts worse outcome in newly diagnosed pediatric sarcoma patients.
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5
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Castillo-Ecija H, Monterrubio C, Pascual-Pasto G, Gomez-Gonzalez S, Garcia-Dominguez DJ, Hontecillas-Prieto L, Resa-Pares C, Burgueño V, Paco S, Olaciregui NG, Vila-Ubach M, Restrepo-Perdomo C, Cuadrado-Vilanova M, Balaguer-Lluna L, Perez-Jaume S, Castañeda A, Santa-Maria V, Roldan M, Suñol M, de Alava E, Mora J, Lavarino C, Carcaboso AM. Treatment-driven selection of chemoresistant Ewing sarcoma tumors with limited drug distribution. J Control Release 2020; 324:440-449. [PMID: 32497782 DOI: 10.1016/j.jconrel.2020.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/21/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Ewing sarcoma is a bone and soft tissue tumor predominantly affecting adolescents and young adults. To characterize changes in anticancer drug activity and intratumor drug distribution during the evolution of Ewing sarcomas, we used immunodeficient mice to establish pairs of patient-derived xenografts (PDX) at early (initial diagnosis) and late (relapse or refractory progression) stages of the disease from three patients. Analysis of copy number alterations (CNA) in early passage PDX tissues showed that two tumor pairs established from patients which responded initially to therapy and relapsed more than one year later displayed similar CNAs at early and late stages. For these two patients, PDX established from late tumors were more resistant to chemotherapy (irinotecan) than early counterparts. In contrast, the tumor pair established at refractory progression showed highly dissimilar CNA profiles, and the pattern of response to chemotherapy was discordant with those of relapsed cases. In mice receiving irinotecan infusions, the level of SN-38 (active metabolite of irinotecan) in the intracellular tumor compartment was reduced in tumors at later stages compared to earlier tumors for those pairs bearing similar CNAs, suggesting that distribution of anticancer drug shifted toward the extracellular compartment during clonal tumor evolution. Overexpression of the drug transporter P-glycoprotein in late tumor was likely responsible for this shift in drug distribution in one of the cases.
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Affiliation(s)
- Helena Castillo-Ecija
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Carles Monterrubio
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Guillem Pascual-Pasto
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Soledad Gomez-Gonzalez
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Daniel J Garcia-Dominguez
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville 41013, Spain
| | - Lourdes Hontecillas-Prieto
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville 41013, Spain
| | - Claudia Resa-Pares
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Victor Burgueño
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Sonia Paco
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Nagore G Olaciregui
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Monica Vila-Ubach
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Camilo Restrepo-Perdomo
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pathology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Maria Cuadrado-Vilanova
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Leire Balaguer-Lluna
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Sara Perez-Jaume
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Alicia Castañeda
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Vicente Santa-Maria
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Monica Roldan
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pathology, Hospital Sant Joan de Deu, Barcelona 08950, Spain; Confocal Microscopy Unit, Institut Pediàtric de Malalties Rares (IPER), Hospital Sant Joan de Déu, Barcelona 08950, Spain
| | - Mariona Suñol
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pathology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Enrique de Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville 41013, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville 41009, Spain
| | - Jaume Mora
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Cinzia Lavarino
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain
| | - Angel M Carcaboso
- Institut de Recerca Sant Joan de Deu, Barcelona 08950, Spain; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona 08950, Spain.
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