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Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, Gonzalez Arias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG. Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK. Br J Haematol 2024. [PMID: 38594876 DOI: 10.1111/bjh.19453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - S Chaganti
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - S Lugthart
- University Hospitals Bristol and Weston, Bristol, UK
| | - W Osborne
- Freeman Hospital, Newcastle, UK
- Newcastle University, Newcastle, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | | | - A Latif
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - D Springell
- University College London Hospitals, London, UK
| | - J L Brady
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Illidge
- Cancer Sciences, University of Manchester Christie NHS Trust, Manchester NIHR BRC, Manchester, UK
| | - A Stevens
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - L Hawley
- University Hospitals Bristol and Weston, Bristol, UK
| | - N O'Rourke
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Bedi
- Western General Hospital, Edinburgh, UK
| | | | - J Frew
- Freeman Hospital, Newcastle, UK
| | - D Burns
- Queen Elizabeth Hospital, Birmingham, UK
| | - M O'Reilly
- University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | | | - N G Mikhaeel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Kuhnl A, Kirkwood AA, Roddie C, Menne T, Tholouli E, Bloor A, Besley C, Chaganti S, Osborne W, Norman J, Gibb A, Sharplin K, Cuadrado M, Correia de Farias M, Cheok K, Neill L, Latif AL, González Arias C, Uttenthal B, Jones C, Johnson R, McMillan A, Sanderson R, Townsend W. CAR T in patients with large B-cell lymphoma not fit for autologous transplant. Br J Haematol 2023. [PMID: 37082780 DOI: 10.1111/bjh.18810] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
Large B-cell lymphoma (LBCL) patients with comorbidities and/or advanced age are increasingly considered for treatment with CD19 CAR T, but data on the clinical benefit of CAR T in the less fit patient population are still limited. We analysed outcomes of consecutive patients approved for treatment with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) by the UK National CAR T Clinical Panel, according to fitness for autologous stem cell transplant (ASCT). 81/404 (20%) of approved patients were deemed unfit for ASCT. Unfit patients were more likely to receive tisa-cel versus axi-cel (52% vs. 48%) compared to 20% versus 80% in ASCT-fit patients; p < 0.0001. The drop-out rate from approval to infusion was significantly higher in the ASCT-unfit group (34.6% vs. 23.5%; p = 0.042). Among infused patients, response rate, progression-free and overall survival were similar in both cohorts. CAR T was well-tolerated in ASCT-unfit patients with an incidence of grade ≥3 cytokine release syndrome and neurotoxicity of 2% and 11%, respectively. Results from this multicentre real-world cohort demonstrate that CD19 CAR T can be safely delivered in carefully selected older patients and patients with comorbidities who are not deemed suitable for transplant.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - E Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - K Sharplin
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - M Cuadrado
- Department of Haematology, King's College Hospital, London, UK
| | | | - K Cheok
- Department of Haematology, University College London Hospitals, London, UK
| | - L Neill
- Department of Haematology, University College London Hospitals, London, UK
| | - A L Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | | | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - R Johnson
- Department of Haematology, St. James's Hospital, Leeds, UK
| | - A McMillan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - W Townsend
- Department of Haematology, University College London Hospitals, London, UK
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3
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Choquet S, Uttenthal B, Chaganti S, Comoli P, Trappe R, Friedetzky A, Xing B, Li X, Polak T, Gamelin L, Terwey JH, Dierickx D. P1457: DEMOGRAPHICS AND TREATMENT OUTCOMES IN PATIENTS WITH EBV+ PTLD TREATED WITH OFF-THE-SHELF EBV-SPECIFIC CTL (TABELECLEUCEL) UNDER AN ONGOING EXPANDED ACCESS PROGRAM IN EUROPE: FIRST ANALYSES. Hemasphere 2022. [PMCID: PMC9429700 DOI: 10.1097/01.hs9.0000848684.24968.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Kuhnl A, Roddie C, Kirkwood AA, Tholouli E, Menne T, Patel A, Besley C, Chaganti S, Sanderson R, O'Reilly M, Norman J, Osborne W, Bloor A, Lugthart S, Malladi R, Patten PEM, Neill L, Martinez-Cibrian N, Kennedy H, Phillips EH, Jones C, Sharplin K, El-Sharkawi D, Latif AL, Mathew A, Uttenthal B, Stewart O, Marzolini MAV, Townsend W, Cwynarski K, Ardeshna K, Ardavan A, Robinson K, Pagliuca A, Collins GP, Johnson R, McMillan A. A national service for delivering CD19 CAR-Tin large B-cell lymphoma - The UK real-world experience. Br J Haematol 2022; 198:492-502. [PMID: 35485402 DOI: 10.1111/bjh.18209] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 01/01/2023]
Abstract
CD19 CAR-T have emerged as a new standard treatment for relapsed/refractory (r/r) large B-cell lymphoma (LBCL). CAR-T real-world (RW) outcomes published to date suggest significant variability across countries. We provide results of a large national cohort of patients intended to be treated with CAR-T in the UK. Consecutive patients with r/r LBCL approved for CAR-T by the National CAR-T Clinical Panel between December 2018 and November 2020 across all UK CAR-T centres were included. 404/432 patients were approved [292 axicabtagene ciloleucel (axi-cel), 112 tisagenlecleucel (tisa-cel)], 300 (74%) received the cells. 110/300 (38.3%) patients achieved complete remission (CR) at 6 months (m). The overall response rate was 77% (52% CR) for axi-cel, 57% (44% CR) for tisa-cel. The 12-month progression-free survival was 41.8% (axi-cel) and 27.4% (tisa-cel). Median overall survival for the intention-to-treat population was 10.5 m, 16.2 m for infused patients. The incidence of grade ≥3 cytokine release syndrome and neurotoxicity were 7.6%/19.6% for axi-cel and 7.9%/3.9% for tisa-cel. This prospective RW population of CAR-T eligible patients offers important insights into the clinical benefit of CD19 CAR-T in LBCL in daily practice. Our results confirm long-term efficacy in patients receiving treatment similar to the pivotal trials, but highlight the significance of early CAR-T failure.
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Affiliation(s)
- Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Amit Patel
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - Caroline Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Robin Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
| | - Jane Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Adrian Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - Sanne Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - Ram Malladi
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK.,Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - Piers E M Patten
- Department of Haematology, King's College Hospital, London, UK.,Comprehensive Cancer Centre, King's College London, London, UK
| | - Lorna Neill
- Department of Haematology, University College London Hospitals, London, UK
| | | | - Hannah Kennedy
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Elizabeth H Phillips
- Department of Medical Oncology, The Christie Hospital, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ceri Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Kirsty Sharplin
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | | | | | - Amrith Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Orla Stewart
- Department of Haematology, King's College Hospital, London, UK
| | | | - William Townsend
- Department of Haematology, University College London Hospitals, London, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospitals, London, UK
| | - Arzhang Ardavan
- NCRI Consumer Forum, London, UK.,Department of Physics, University of Oxford, UK
| | | | | | - Graham P Collins
- Department of Haematology, Oxford University Hospital, Oxford, UK
| | | | - Andrew McMillan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK
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Carr R, Davies A, Uttenthal B, Lamb M, Fidalgo J, Carpenter B. A UK POPULATION‐BASED STUDY OF NON‐HODGKIN LYMPHOMA IN TEENAGERS AND YOUNG ADULTS (TYA) ‐ INCIDENCE, TREATMENT AND OUTCOMES. Hematol Oncol 2021. [DOI: 10.1002/hon.39_2879] [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] [Indexed: 11/06/2022]
Affiliation(s)
- R Carr
- Guy's & St Thomas' Hospital Haematology London UK
| | - A Davies
- Southampton NCRI/CR UK Experimental Cancer Medicines Centre Haematology Southampton UK
| | - B Uttenthal
- Addenbrookes Hospital Paediatric Oncology Cambridge UK
| | - M Lamb
- Department of Health Sciences University of York Haematological Malignancy Research Network York UK
| | - J Fidalgo
- Guy's & St Thomas' Hospital Haematology London UK
| | - B Carpenter
- University College Hospital Haematology London UK
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6
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Follows G, Santarsieri A, Sturgess K, Menne T, Osborne W, Creasey T, Ardeshna K, Behan S, Booth S, Collins G, Cwynarski K, Iyengar S, Jones S, Martinez-Calle N, McKay P, Nagumantry S, O'Mahony D, Rudge J, Shah N, Stafford G, Sternberg A, Uttenthal B, McMillan A. MODIFICATION OF ESCALATED BEACOPP WITH DACARBAZINE / PROCARBAZINE SUBSTITUTION REDUCES RED CELL TRANSFUSION REQUIREMENTS AND MAY SHORTEN TIME TO MENSTRUAL PERIOD RECOVERY. Hematol Oncol 2019. [DOI: 10.1002/hon.168_2631] [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] [Indexed: 11/09/2022]
Affiliation(s)
- G. Follows
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. Santarsieri
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - K. Sturgess
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - T. Menne
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - W. Osborne
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - T. Creasey
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - K.M. Ardeshna
- Haematology; University College London Hospital; London United Kingdom
| | - S. Behan
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - S. Booth
- Haematology; Royal Berkshire NHS Foundation Trust; Reading United Kingdom
| | - G. Collins
- Haematology; Oxford University Hospitals NHSFT; Oxford United Kingdom
| | - K. Cwynarski
- Haematology; University College London Hospital; London United Kingdom
| | - S. Iyengar
- Haematology; The Royal Marsden; London United Kingdom
| | - S. Jones
- Haematology; Sherwood Forest Hospitals; Sutton in Ashfield United Kingdom
| | - N. Martinez-Calle
- Haematology; Nottingham University Hospital NHS Trust; Nottingham United Kingdom
| | - P. McKay
- Haematology; Beatson West of Scotland Cancer Centre; Glasgow United Kingdom
| | - S.K. Nagumantry
- Haematology; Peterborough City Hospital; Peterborough United Kingdom
| | - D. O'Mahony
- Haematology; Cork University Hospital; Wilton Republic of Ireland
| | - J.F. Rudge
- Department of Earth Sciences; University of Cambridge.; Cambridge United Kingdom
| | - N. Shah
- Haematology; Norfolk and Norwich University Hospitals; Norwich United Kingdom
| | - G. Stafford
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. Sternberg
- Haematology; Great Western Hospital NHS Foundation Trust; Swindon United Kingdom
| | - B. Uttenthal
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. McMillan
- Haematology; Nottingham University Hospital NHS Trust; Nottingham United Kingdom
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7
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Fox TA, Chakraverty R, Burns S, Carpenter B, Thomson K, Lowe D, Fielding A, Peggs K, Kottaridis P, Uttenthal B, Bigley V, Buckland M, Grandage V, Denovan S, Grace S, Dahlstrom J, Workman S, Symes A, Mackinnon S, Hough R, Morris E. Successful outcome following allogeneic hematopoietic stem cell transplantation in adults with primary immunodeficiency. Blood 2018; 131:917-931. [PMID: 29279357 PMCID: PMC6225386 DOI: 10.1182/blood-2017-09-807487] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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: 09/20/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022] Open
Abstract
The primary immunodeficiencies (PIDs), rare inherited diseases characterized by severe dysfunction of immunity, have been successfully treated by allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in childhood. Controversy exists regarding optimal timing and use of Allo-HSCT in adults, due to lack of experience and previous poor outcomes. Twenty-nine consecutive adult patients, with a mean age at transplant of 24 years (range, 17-50 years), underwent Allo-HSCT. Reduced-intensity conditioning (RIC) included fludarabine (Flu)/melphalan/alemtuzumab (n = 20), Flu/busulfan (Bu)/alemtuzumab (n = 8), and Flu/Bu/antithymocyte globulin (n = 1). Stem cell donors were matched unrelated donors or mismatched unrelated donors (n = 18) and matched related donors (n = 11). Overall survival (OS), event-free survival, transplant-related mortality (TRM), acute and chronic graft-versus-host disease incidence and severity, time to engraftment, lineage-specific chimerism, immune reconstitution, and discontinuation of immunoglobulin replacement therapy were recorded. OS at 3 years for the whole cohort was 85.2%. The rarer PID patients without chronic granulomatous disease (CGD) achieved an OS at 3 years of 88.9% (n = 18), compared with 81.8% for CGD patients (n = 11). TRM was low with only 4 deaths observed at a median follow-up of 3.5 years. There were no cases of early or late rejection. In all surviving patients, either stable mixed chimerism or full donor chimerism were observed. At last follow-up, 87% of the surviving patients had no evidence of persistent or recurrent infections. Allo-HSCT is safe and effective in young adult patients with severe PID and should be considered the treatment of choice where an appropriate donor is available.
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Affiliation(s)
- Thomas A Fox
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
| | - Ronjon Chakraverty
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Siobhan Burns
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
| | - Benjamin Carpenter
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Kirsty Thomson
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - David Lowe
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Adele Fielding
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Karl Peggs
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Panagiotis Kottaridis
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
| | - Benjamin Uttenthal
- Department of Haematology, Addenbrookes' Hospital, Cambridge, United Kingdom; and
| | - Venetia Bigley
- Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom
| | - Matthew Buckland
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Victoria Grandage
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Shari Denovan
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Sarah Grace
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Julia Dahlstrom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Sarita Workman
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Andrew Symes
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Stephen Mackinnon
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Rachael Hough
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Emma Morris
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
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8
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Caddy SL, Wang M, Krishnamurthy P, Uttenthal B, Chandra A, Crawley C, James LC. Characterization of innate immune viral sensors in patients following allogeneic hematopoietic stem cell transplantation. Innate Immun 2018; 24:112-121. [PMID: 29433372 PMCID: PMC6830896 DOI: 10.1177/1753425918757898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Viral infection is a major cause of morbidity and mortality following allogeneic
hematopoietic stem cell transplant (HSCT), with up to one in four deaths
directly linked to viral disease. Whilst awaiting lymphocyte reconstitution
post-HSCT, the innate antiviral immune response is the first line of defense
against invading viruses. Several novel innate viral-sensing pathways have
recently been characterized, but their physiological importance in humans is
poorly understood. We analyzed a panel of innate viral-sensor genes in HSCT
patients, and assessed whether differences in innate antiviral responses could
account for variation in susceptibility to viral infections. Expression levels
of innate viral sensors in HSCT patients with active viral infections, HSCT
patients without active infections and healthy volunteers were highly
homogenous. Although IFN-α expression was up-regulated in actively infected
patients relative to controls, a corresponding up-regulation of innate viral
sensor expression was not observed. IFN-α stimulation of patient PBMCs
in vitro showed intact IFN-α signaling, but actively
infected patients' PBMCs had reduced up-regulation of innate viral sensors. We
show that the aberrant IFN-α responses in HSCT patients were not due to
calcineurin inhibition. Our data therefore raises the possibility of an
intrinsic defect in innate viral sensor up-regulation in HSCT patients following
viral infection.
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Affiliation(s)
- Sarah L Caddy
- 1 MRC Laboratory of Molecular Biology, Cambridge, UK
| | - Meng Wang
- 2 Department of Haematology, 2153 Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Pramila Krishnamurthy
- 2 Department of Haematology, 2153 Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Benjamin Uttenthal
- 2 Department of Haematology, 2153 Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Anita Chandra
- 3 Department of Immunology, 2153 Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Charles Crawley
- 2 Department of Haematology, 2153 Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Leo C James
- 1 MRC Laboratory of Molecular Biology, Cambridge, UK
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9
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Russell J, Collins A, Fowler A, Karanth M, Saha C, Shyamsundar V, Docherty S, Kirkwood A, Maw K, Cooke L, Hodson A, Shah N, Sadullah S, Grigoropoulos N, Uttenthal B, Follows G. Advanced Hodgkin lymphoma in the east of England cancer network: A 10-year comparative analysis of outcomes for ABVD and escalated-BEACOPP treated patients aged 16 to 59. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J. Russell
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - A. Collins
- Clinical Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - A. Fowler
- Clinical Haematology; Peterborough City Hospital; Peterborough UK
| | - M. Karanth
- Clinical Haematology; West Suffolk Hospital; Bury Saint Edmunds UK
| | - C. Saha
- Clinical Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - V. Shyamsundar
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - S. Docherty
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - A. Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - K. Maw
- Clinical Haematology; James Paget University Hospital; Great Yarmouth UK
| | - L. Cooke
- Clinical Haematology; Queen Elizabeth Hospital; King's Lynn UK
| | - A. Hodson
- Clinical Haematology; Ipswich Hospital; Ipswich UK
| | - N. Shah
- Clinical Haematology; Norfolk and Norwich University Hospital; Norwich UK
| | - S. Sadullah
- Clinical Haematology; James Paget University Hospital; Great Yarmouth UK
| | - N. Grigoropoulos
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - B. Uttenthal
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - G. Follows
- Clinical Haematology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
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Swayne R, Enoch D, Aliyu S, Crawley C, Krishnamurthy P, Craig J, Follows G, Uttenthal B, Babar J, Sander CR. P266 Outcomes from the introduction of fungal biomarkers to the neutropenic fever pathway in a tertiary haematology department. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Uttenthal B, Martinez-Davila I, Ivey A, Craddock C, Chen F, Virchis A, Kottaridis P, Grimwade D, Khwaja A, Stauss H, Morris EC. Wilms' Tumour 1 (WT1) peptide vaccination in patients with acute myeloid leukaemia induces short-lived WT1-specific immune responses. Br J Haematol 2013; 164:366-75. [PMID: 24422723 PMCID: PMC4253125 DOI: 10.1111/bjh.12637] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/06/2013] [Indexed: 12/04/2022]
Abstract
Wilms’ Tumour 1 (WT1) is a zinc finger transcription factor that is over-expressed in acute myeloid leukaemia (AML). Its restricted expression in normal tissues makes it a promising target for novel immunotherapies aiming to accentuate the cytotoxic T lymphocyte (CTL) response against AML. Here we report a phase I/II clinical trial of subcutaneous peptide vaccination with two separate HLA-A2-binding peptide epitopes derived from WT1, together with a pan-DR binding peptide epitope (PADRE), in Montanide adjuvant. Eight HLA-A2-positive patients with poor risk AML received five vaccination cycles at 3-weekly intervals. The three cohorts received 0·3, 0·6 and 1 mg of each peptide, respectively. In six patients, WT1-specific CTL responses were detected using enzyme-linked immunosorbent spot assays and pWT126/HLA-A*0201 tetramer staining, after ex vivo stimulation with the relevant WT1 peptides. However, re-stimulation of these WT1-specific T cells failed to elicit secondary expansion in all four patients tested, suggesting that the WT1-specific CD8+ T cells generated following vaccination may be functionally impaired. No correlation was observed between peptide dose, cellular immune response, reduction in WT1mRNA expression and clinical response. Larger studies are indicated to confirm these findings.
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Affiliation(s)
- Benjamin Uttenthal
- UCL Division of Infection and Immunity, Department of Immunology, University College London, London, UK
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Goulding C, Uttenthal B, Foroni L, Duke V, Traore A, Kottaridis P, Hoffbrand AV, Patch D, McNamara C. The JAK2(V617F) tyrosine kinase mutation identifies clinically latent myeloproliferative disorders in patients presenting with hepatic or portal vein thrombosis. Int J Lab Hematol 2009; 30:415-9. [PMID: 19046316 DOI: 10.1111/j.1751-553x.2007.00973.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinically latent myeloproliferative disorders (MPDs) are important causes of what would otherwise be considered idiopathic hepatic (HVT) or portal vein thrombosis (PVT). They may be difficult to diagnose initially because the peripheral blood count may be normal at the time of thrombosis. A strong association between an activating mutation of the gene encoding one of the Janus kinase family of tyrosine kinases (JAK2(V617F)) and the Philadelphia chromosome-negative MPDs has been identified. We have studied 19 patients with unexplained HVT or PVT and tested for JAK2(V617F). Fourteen (74%) of the 19 patients were heterozygous for JAK2(V617F) but did not meet diagnostic criteria for a MPD at the time of presentation with thrombosis. Prolonged follow-up established the presence of an overt MPD in 13 of the 14 patients after a median duration of 38 months. We recommend testing for JAK2(V617F) in all patients with unexplained HVT or PVT, to identify latent MPDs and prevent potential complications.
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Affiliation(s)
- C Goulding
- Department of Gastroenterology, The Royal Free Hospital, London, UK
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