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Lee LW, Shafiani S, Crossley B, Emerson RO, Williamson D, Bunin A, Vargas J, Han AS, Kaplan IM, Green PHR, Kirsch I, Bhagat G. Characterisation of T cell receptor repertoires in coeliac disease. J Clin Pathol 2024; 77:116-124. [PMID: 36522177 PMCID: PMC10850686 DOI: 10.1136/jcp-2022-208541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/23/2022] [Indexed: 12/16/2022]
Abstract
AIMS Characterise T-cell receptor gene (TR) repertoires of small intestinal T cells of patients with newly diagnosed (active) coeliac disease (ACD), refractory CD type I (RCD I) and patients with CD on a gluten-free diet (GFD). METHODS Next-generation sequencing of complementarity-determining region 3 (CDR3) of rearranged T cell receptor β (TRB) and γ (TRG) genes was performed using DNA extracted from intraepithelial cell (IEC) and lamina propria cell (LPC) fractions and a small subset of peripheral blood mononuclear cell (PBMC) samples obtained from CD and non-CD (control) patients. Several parameters were assessed, including relative abundance and enrichment. RESULTS TRB and TRG repertoires of CD IEC and LPC samples demonstrated lower clonality but higher frequency of rearranged TRs compared with controls. No CD-related differences were detected in the limited number of PBMC samples. Previously published LP gliadin-specific TRB sequences were more frequently detected in LPC samples from patients with CD compared with non-CD controls. TRG repertoires of IECs from both ACD and GFD patients demonstrated increased abundance of certain CDR3 amino acid (AA) motifs compared with controls, which were encoded by multiple nucleotide variants, including one motif that was enriched in duodenal IECs versus the PBMCs of CD patients. CONCLUSIONS Small intestinal TRB and TRG repertoires of patients with CD are more diverse than individuals without CD, likely due to mucosal recruitment and accumulation of T cells because of protracted inflammation. Enrichment of the unique TRG CDR3 AA sequence in the mucosa of patients with CD may suggest disease-associated changes in the TCRγδ IE lymphocyte (IEL) landscape.
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Affiliation(s)
- Lik Wee Lee
- Computational Biology and Translational Medicine, Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - Shahin Shafiani
- Computational Biology and Translational Medicine, Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - Beryl Crossley
- Computational Biology and Translational Medicine, Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - Ryan O Emerson
- Computational Biology and Translational Medicine, Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - David Williamson
- Computational Biology and Translational Medicine, Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - Anna Bunin
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Justin Vargas
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Arnold S Han
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Ian M Kaplan
- Computational Biology and Translational Medicine, Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - Peter H R Green
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Ilan Kirsch
- Computational Biology and Translational Medicine, Adaptive Biotechnologies Corp, Seattle, Washington, USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology and Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
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Ramasamy K, Avet-Loiseau H, Hveding Blimark C, Delforge M, Gay F, Manier S, Martinez-Lopez J, Mateos MV, Mohty M, van de Donk NW, Weisel K. Measurable Residual Disease Testing in Multiple Myeloma Routine Clinical Practice: A Modified Delphi Study. Hemasphere 2023; 7:e942. [PMID: 37663672 PMCID: PMC10470794 DOI: 10.1097/hs9.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
We used a modified Delphi approach to establish areas of consensus and nonconsensus regarding the utility of determining measurable residual disease (MRD) to assess multiple myeloma (MM) treatment response, which may inform disease management and design of future clinical trials. This modified Delphi study incorporated 2 iterative rounds of surveys to evaluate the opinions of an expert panel of 61 practicing hematological oncologists from across 14 countries in Europe concerning the use of MRD testing in MM management. Survey 1 assessed experts' opinions on MRD testing in different clinical situations and associated challenges. Survey 2 focused on the lack of consensus areas identified in survey 1. Consensus to an individual question was defined a priori as 75% agreement or disagreement by the panel. From the 2 rounds of surveys, the experts reached consensus agreement that MRD testing should be performed in newly diagnosed or relapsed patients who achieved complete response (CR) or better after transplantation. In transplant-ineligible patients, experts recommended MRD testing in those who are ≤70 years old and in CR. If a patient was previously positive on positron-emission tomography and computed tomography (PET/CT), both MRD and PET/CT should be assessed at CR. MRD testing should be performed ≤6 months after transplantation and every 6-12 months in continuously treated patients in CR. There was no consensus on making treatment decisions based on MRD status. MRD testing is an important component of clinical management in MM. Additional data will further clarify the role of MRD in guiding treatment decisions.
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Affiliation(s)
- Karthik Ramasamy
- Oxford University Hospitals NHS Foundation Trust, Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Hervé Avet-Loiseau
- University Institute of Cancer Toulouse, University Hospital of Toulouse, Toulouse, France
| | | | | | | | | | | | - Maria Victoria Mateos
- University Hospital of Salamanca, Salamanca Biomedical Research Institute (IBSAL), CIC, Ciberonc, Salamanca, Spain
| | - Mohamad Mohty
- Hospital Saint-Antoine, Sorbonne University, INSERM UMRs 938, Paris, France
| | | | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Short NJ, Jabbour E, Macaron W, Ravandi F, Jain N, Kanagal-Shamanna R, Patel KP, Loghavi S, Haddad FG, Yilmaz M, Issa GC, Kebriaei P, Kornblau SM, Pelletier S, Flores W, Matthews J, Garris R, Kantarjian H. Ultrasensitive NGS MRD assessment in Ph+ ALL: Prognostic impact and correlation with RT-PCR for BCR::ABL1. Am J Hematol 2023. [PMID: 37183966 DOI: 10.1002/ajh.26949] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Abstract
Reverse transcription polymerase chain reaction (RT-PCR) for BCR::ABL1 is the most common and widely accepted method of measurable residual disease (MRD) assessment in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL); however, RT-PCR may not be an optimal measure of MRD in many cases of Ph+ ALL. We evaluated the clinical impact of a highly sensitive next-generation sequencing (NGS) MRD assay (sensitivity of 10-6 ) and its correlation with RT-PCR for BCR::ABL1 in patients with Ph+ ALL. Overall, 32% of patients had a discordance between MRD assessment by RT-PCR and NGS, and 31% of patients who achieved NGS MRD negativity were PCR+ at the same timepoint. Among eight patients with long-term detectable BCR::ABL1 by PCR, six were PCR+/NGS-. These patients generally had stable PCR levels that persisted despite therapeutic interventions, and none subsequently relapsed; in contrast, patients who were PCR+/NGS+ had more variable PCR values that responded to therapeutic intervention. In a separate cohort of prospectively collected clinical samples, 11 of 65 patients (17%) with Ph+ ALL who achieved NGS MRD negativity had detectable BCR::ABL1 by PCR, and none of these patients relapsed. Relapse-free survival and overall survival were similar in patients who were PCR+/NGS- and PCR-/NGS-, suggesting that PCR for BCR::ABL1 did not provide additional prognostic information in patients who achieved NGS MRD negativity. NGS-based assessment of MRD is prognostic in Ph+ ALL and identifies patients with low-level detectable BCR::ABL1 who are unlikely to relapse nor to benefit from therapeutic interventions.
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Affiliation(s)
- Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Walid Macaron
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fadi G Haddad
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Musa Yilmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven M Kornblau
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Pelletier
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wilmer Flores
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jairo Matthews
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rebecca Garris
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Walzer S, Krenberger S, Vollmer L, Hewitt T, Eckert B. A Cost Impact Analysis of clonoSEQ ® as a Valid and CE-Certified Minimal Residual Disease (MRD) Diagnostic Compared to No MRD Testing in Multiple Myeloma in Germany. Oncol Ther 2021; 9:607-619. [PMID: 34480748 PMCID: PMC8593124 DOI: 10.1007/s40487-021-00169-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/25/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The measurement of minimal residual disease (MRD) with clonoSEQ® can be used in the assessment of B-cell lymphoid tumor burden throughout treatment with accuracy, sensitivity and standardization when compared to traditional cytomorphology. With the approval of novel treatments, standardized MRD assessment with improved performance is increasingly important. The aim of this analysis is to estimate the cost-effectiveness of MRD testing with clonoSEQ® compared to no MRD testing for patients with multiple myeloma (MM) on maintenance therapy in Germany. METHODS The cost impact of clonoSEQ® was analyzed from the German statutory insurance perspective. Clinical data were derived from the literature and expert opinions. Cost input was utilized based on publicly available data and literature. Patients in the MRD arm were tested every 6 months. The deterministic Markov model consists of six health states, and every patient begins at the start of maintenance. Included therapies are lenalidomide for maintenance and carfilzomib, lenalidomide and dexamethasone for relapse. RESULTS For a time horizon of 10 years, the deterministic cost impact analysis shows total cost of €279,483 for patients using clonoSEQ® in comparison to €356,623 for simulated patients without MRD testing. The main drivers of the cost differences are saved cost of drug holiday. The savings per patient in 1 year are €18,396. Savings after 3 years are €69,991 per patient. Savings after 10 years are €77,140 per patient. CONCLUSIONS Based on the underlying model, clonoSEQ® can support German health insurance funds to use high-cost drugs more efficiently in the treatment of myeloma.
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Affiliation(s)
- Stefan Walzer
- MArS Market Access & Pricing Strategy GmbH, Geffelbachstraße 6, 79576, Weil am Rhein, Germany
- State University Baden-Wuerttemberg, Lörrach, Germany
- University of Applied Sciences Ravensburg-Weingarten, Württemberg, Germany
| | - Sebastian Krenberger
- MArS Market Access & Pricing Strategy GmbH, Geffelbachstraße 6, 79576, Weil am Rhein, Germany.
| | - Lutz Vollmer
- MArS Market Access & Pricing Strategy GmbH, Geffelbachstraße 6, 79576, Weil am Rhein, Germany
- University of Applied Sciences Rottenburg/Neckar, Rottenburg, Germany
- University of Tübingen, Tübingen, Germany
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Wolf KJ, Emerson RO, Pingel J, Buller RM, DiPaolo RJ. Conventional and Regulatory CD4+ T Cells That Share Identical TCRs Are Derived from Common Clones. PLoS One 2016; 11:e0153705. [PMID: 27100298 PMCID: PMC4839724 DOI: 10.1371/journal.pone.0153705] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/03/2016] [Indexed: 11/18/2022] Open
Abstract
Results from studies comparing the diversity and specificity of the TCR repertoires expressed by conventional (Tconv) and regulatory (Treg) CD4+ T cell have varied depending on the experimental system employed. We developed a new model in which T cells express a single fixed TCRα chain, randomly rearranged endogenous TCRβ chains, and a Foxp3-GFP reporter. We purified CD4+Foxp3- and CD4+Foxp3+ cells, then performed biased controlled multiplex PCR and high throughput sequencing of endogenous TCRβ chains. We identified >7,000 different TCRβ sequences in the periphery of 5 individual mice. On average, ~12% of TCR sequences were expressed by both conventional and regulatory populations within individual mice. The CD4+ T cells that expressed shared TCR sequences were present at higher frequencies compared to T cells expressing non-shared TCRs. Furthermore, nearly all (>90%) of the TCR sequences that were shared within mice were identical at the DNA sequence level, indicating that conventional and regulatory T cells that express shared TCRs are derived from common clones. Analysis of TCR repertoire overlap in the thymus reveals that a large proportion of Tconv and Treg sharing observed in the periphery is due to clonal expansion in the thymus. Together these data show that there are a limited number of TCR sequences shared between Tconv and Tregs. Also, Tconv and Tregs sharing identical TCRs are found at relatively high frequencies and are derived from common progenitors, of which a large portion are generated in the thymus.
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Affiliation(s)
- Kyle J. Wolf
- Department of Molecular Microbiology and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, United States of America
| | - Ryan O. Emerson
- Adaptive Biotechnologies Corporation, Seattle, Washington, United States of America
| | - Jeanette Pingel
- Department of Molecular Microbiology and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, United States of America
| | - R. Mark Buller
- Department of Molecular Microbiology and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, United States of America
| | - Richard J. DiPaolo
- Department of Molecular Microbiology and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, United States of America
- * E-mail:
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