1
|
Bahlis NJ, Costello CL, Raje NS, Levy MY, Dholaria B, Solh M, Tomasson MH, Damore MA, Jiang S, Basu C, Skoura A, Chan EM, Trudel S, Jakubowiak A, Gasparetto C, Chu MP, Dalovisio A, Sebag M, Lesokhin AM. Elranatamab in relapsed or refractory multiple myeloma: the MagnetisMM-1 phase 1 trial. Nat Med 2023; 29:2570-2576. [PMID: 37783970 PMCID: PMC10579053 DOI: 10.1038/s41591-023-02589-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Abstract
Multiple myeloma (MM) is a plasma cell malignancy expressing B cell maturation antigen (BCMA). Elranatamab, a bispecific antibody, engages BCMA on MM and CD3 on T cells. The MagnetisMM-1 trial evaluated its safety, pharmacokinetics and efficacy. Primary endpoints, including the incidence of dose-limiting toxicities as well as objective response rate (ORR) and duration of response (DOR), were met. Secondary efficacy endpoints included progression-free survival (PFS) and overall survival (OS). Eighty-eight patients with relapsed or refractory MM received elranatamab monotherapy, and 55 patients received elranatamab at efficacious doses. Patients had received a median of five prior regimens; 90.9% were triple-class refractory, 29.1% had high cytogenetic risk and 23.6% received prior BCMA-directed therapy. No dose-limiting toxicities were observed during dose escalation. Adverse events included cytopenias and cytokine release syndrome. Exposure was dose proportional. With a median follow-up of 12.0 months, the ORR was 63.6% and 38.2% of patients achieving complete response or better. For responders, the median DOR was 17.1 months. All 13 patients evaluable for minimal residual disease achieved negativity. Even after prior BCMA-directed therapy, 53.8% achieved response. For all 55 patients, median PFS was 11.8 months, and median OS was 21.2 months. Elranatamab achieved durable responses, manageable safety and promising survival for patients with MM. ClinicalTrials.gov Identifier: NCT03269136 .
Collapse
Affiliation(s)
- Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada.
| | - Caitlin L Costello
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Noopur S Raje
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Moshe Y Levy
- Department of Medical Oncology, Baylor Scott and White Health, Dallas, TX, USA
| | | | - Melhem Solh
- Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Michael H Tomasson
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Michael A Damore
- Oncology Research and Development, Pfizer Inc., San Diego, CA, USA
| | - Sibo Jiang
- Early Clinical Development, Pfizer Inc., San Diego, CA, USA
| | - Cynthia Basu
- Early Clinical Development, Pfizer Inc., San Diego, CA, USA
| | | | - Edward M Chan
- Oncology Research and Development, Pfizer Inc., South San Francisco, CA, USA
| | - Suzanne Trudel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrzej Jakubowiak
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | | | | | - Andrew Dalovisio
- Department of Hematology and Oncology, Ochsner Health, New Orleans, LA, USA
| | - Michael Sebag
- Cedars Cancer Center, McGill University Health Center, Montreal, QC, Canada
| | - Alexander M Lesokhin
- Division of Hematology and Oncology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
2
|
Lesokhin AM, Tomasson MH, Arnulf B, Bahlis NJ, Miles Prince H, Niesvizky R, Rodrίguez-Otero P, Martinez-Lopez J, Koehne G, Touzeau C, Jethava Y, Quach H, Depaus J, Yokoyama H, Gabayan AE, Stevens DA, Nooka AK, Manier S, Raje N, Iida S, Raab MS, Searle E, Leip E, Sullivan ST, Conte U, Elmeliegy M, Czibere A, Viqueira A, Mohty M. Elranatamab in relapsed or refractory multiple myeloma: phase 2 MagnetisMM-3 trial results. Nat Med 2023; 29:2259-2267. [PMID: 37582952 PMCID: PMC10504075 DOI: 10.1038/s41591-023-02528-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
Elranatamab is a humanized B-cell maturation antigen (BCMA)-CD3 bispecific antibody. In the ongoing phase 2 MagnetisMM-3 trial, patients with relapsed or refractory multiple myeloma received subcutaneous elranatamab once weekly after two step-up priming doses. After six cycles, persistent responders switched to biweekly dosing. Results from cohort A, which enrolled patients without prior BCMA-directed therapy (n = 123) are reported. The primary endpoint of confirmed objective response rate (ORR) by blinded independent central review was met with an ORR of 61.0% (75/123); 35.0% ≥complete response. Fifty responders switched to biweekly dosing, and 40 (80.0%) improved or maintained their response for ≥6 months. With a median follow-up of 14.7 months, median duration of response, progression-free survival and overall survival (secondary endpoints) have not been reached. Fifteen-month rates were 71.5%, 50.9% and 56.7%, respectively. Common adverse events (any grade; grade 3-4) included infections (69.9%, 39.8%), cytokine release syndrome (57.7%, 0%), anemia (48.8%, 37.4%), and neutropenia (48.8%, 48.8%). With biweekly dosing, grade 3-4 adverse events decreased from 58.6% to 46.6%. Elranatamab induced deep and durable responses with a manageable safety profile. Switching to biweekly dosing may improve long-term safety without compromising efficacy. ClinicalTrials.gov identifier: NCT04649359 .
Collapse
Affiliation(s)
- Alexander M Lesokhin
- Division of Hematology and Oncology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York City, NY, USA.
| | | | | | - Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - H Miles Prince
- Epworth Healthcare and University of Melbourne, Melbourne, Victoria, Australia
| | - Ruben Niesvizky
- Weill Cornell Medical College/New York Presbyterian Hospital, New York City, NY, USA
| | | | | | | | | | - Yogesh Jethava
- Indiana Blood & Marrow Transplant, Indianapolis, IN, USA
| | - Hang Quach
- University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julien Depaus
- Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | | | | | | | | | - Salomon Manier
- Lille University Hospital and INSERM UMR-S1277, Lille, France
| | - Noopur Raje
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Shinsuke Iida
- Department of Hematology & Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Marc-Steffen Raab
- Heidelberg Myeloma Center, Department of Hematology/Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Emma Searle
- The Christie Hospital, The University of Manchester, Manchester, UK
| | | | | | | | | | | | | | - Mohamad Mohty
- Sorbonne University, Hôpital Saint-Antoine, and INSERM UMRs938, Paris, France
| |
Collapse
|
3
|
Zhang Z, Kalra H, Delzell MC, Jedlicka CR, Vasilyev M, Vasileva A, Tomasson MH, Bates ML. CORP: Sources and degrees of variability in whole animal intermittent hypoxia experiments. J Appl Physiol (1985) 2023; 134:1207-1215. [PMID: 36958346 PMCID: PMC10151045 DOI: 10.1152/japplphysiol.00643.2022] [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: 10/27/2022] [Revised: 02/17/2023] [Accepted: 03/12/2023] [Indexed: 03/25/2023] Open
Abstract
Chamber exposures are commonly used to evaluate the physiological and pathophysiological consequences of intermittent hypoxia in animal models. Researchers in this field use both commercial and custom-built chambers in their experiments. The purpose of this Cores of Reproducibility in Physiology paper is to demonstrate potential sources of variability in these systems that researchers should consider. Evaluating the relationship between arterial oxygen saturation and inspired oxygen concentration, we found that there are important sex-dependent differences in the commonly used C57BL6/J mouse model. The time delay of the oxygen sensor that provides feedback to the system during the ramp-down and ramp-up phases was different, limiting the number of cycles per hour that can be conducted and the overall stability of the oxygen concentration. The time to reach the hypoxic and normoxic hold stages, and the overall oxygen concentration, were impacted by the cycle number. These variables were further impacted by whether there are animals present in the chamber, highlighting the importance of verifying the cycling frequency with animals in the chamber. At ≤14 cycles/h, instability in the chamber oxygen concentration did not impact arterial oxygen saturation but may be important at higher cycle numbers. Taken together, these data demonstrate the important sources of variability that justify reporting and verifying the target oxygen concentration, cycling frequency, and arterial oxygen concentration, particularly when comparing different animal models and chamber configurations.NEW & NOTEWORTHY Intermittent hypoxia exposures are commonly used in physiology and many investigators use chamber systems to perform these studies. Because of the variety of chamber systems and protocols used, it is important to understand the sources of variability in intermittent hypoxia experiments that can impact reproducibility. We demonstrate sources of variability that come from the animal model, the intermittent hypoxia protocol, and the chamber system that can impact reproducibility.
Collapse
Affiliation(s)
- Zishan Zhang
- Interdisciplinary Graduate Program in Molecular Medicine, University of Iowa, Iowa City, Iowa, United States
- Division of Hematology, Oncology, and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Hardik Kalra
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Matthew C Delzell
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, Missouri, United States
| | - Charles R Jedlicka
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Mikhail Vasilyev
- Division of Hematology, Oncology, and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Anastasiia Vasileva
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Michael H Tomasson
- Interdisciplinary Graduate Program in Molecular Medicine, University of Iowa, Iowa City, Iowa, United States
- Division of Hematology, Oncology, and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Melissa L Bates
- Interdisciplinary Graduate Program in Molecular Medicine, University of Iowa, Iowa City, Iowa, United States
- Division of Hematology, Oncology, and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| |
Collapse
|
4
|
Bates ML, Vasileva A, Flores LDM, Pryakhina Y, Buckman M, Tomasson MH, DeRuisseau LR. Sex differences in cardiovascular disease and dysregulation in Down syndrome. Am J Physiol Heart Circ Physiol 2023; 324:H542-H552. [PMID: 36800509 PMCID: PMC10042600 DOI: 10.1152/ajpheart.00544.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
This meta-analysis, which consisted of a scoping review and retrospective medical record review, is focused on potential sex differences in cardiovascular diseases in patients with Down syndrome. We limited our review to peer-reviewed, primary articles in the English language, in the PubMed and Web of Science databases from 1965 to 2021. Guidelines for scoping reviews were followed throughout the process. Four categorical domains were identified and searched using additional keywords: 1) congenital heart disease, 2) baseline physiology and risk factors, 3) heart disease and hypertension, and 4) stroke and cerebrovascular disease. Articles were included if they reported male and female distinct data, participants with Down syndrome, and one of our keywords. The retrospective medical record review was completed using 75 participating health care organizations to identify the incidence of congenital and cardiovascular diseases and to quantify cardiovascular risk factors in male and female patients. Female patients with Down syndrome are at higher risk of hypertension, ischemic heart disease, and cerebrovascular disease. The risk of congenital heart disease is higher in males with Down syndrome at all ages included in our analyses. Some of the male-to-female sex differences in cardiovascular disease risk in the general patient population are not present, or reversed in the Down syndrome population. This information should be considered for future investigations and ongoing patient care.NEW & NOTEWORTHY In patients with Down syndrome (DS), CHD is the leading cause of death <20 yr old and cardiovascular disease is a leading cause of death in individuals >20 yr old. Men with DS live longer than women. It is unknown if sex differences are present in cardiovascular disease and dysregulation in DS across the lifespan. We observed higher risk of hypertension, ischemic heart disease, and cerebrovascular disease in females and a higher risk of CHD in males with DS.
Collapse
Affiliation(s)
- Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Anastasiia Vasileva
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Laura D M Flores
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Yana Pryakhina
- Department of Basic Sciences, University of Health Sciences and Pharmacy, St. Louis, Missouri, United States
| | - Michelle Buckman
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Michael H Tomasson
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Lara R DeRuisseau
- Department of Basic Sciences, University of Health Sciences and Pharmacy, St. Louis, Missouri, United States
| |
Collapse
|
5
|
Dhakal P, Bates M, Tomasson MH, Sutamtewagul G, Dupuy A, Bhatt VR. Acute myeloid leukemia resistant to venetoclax-based therapy: What does the future hold? Blood Rev 2022. [PMID: 36549969 DOI: 10.1016/j.blre.2022.101036.101036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Venetoclax is a highly selective B-cell lymphoma-2 (BCL-2) inhibitor, which, combined with a DNA hypomethylating agent or low dose cytarabine, results in high rates of initial responses in patients with acute myeloid leukemia (AML). However, the disease relapses in most patients. Mechanisms of resistance to venetoclax-based therapy include TP53 gene mutations or inactivation of p53 protein, activating kinase mutations such as FLT3 and RAS, and upregulation of other BCL-2 family apoptotic proteins. Current clinical trials are exploring strategies such as doublet or triplet regimens incorporating a p53 activator, an anti-CD47 antibody, or other novel agents that target genes and proteins responsible for resistance to venetoclax. Further studies should focus on identifying predictive biomarkers of response to venetoclax-based therapy and incorporating immunotherapeutic approaches such as checkpoint inhibitors, bispecific antibodies, antibody-drug conjugates, and CAR T-cell therapy to improve outcomes for patients with AML.
Collapse
Affiliation(s)
- Prajwal Dhakal
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Melissa Bates
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Michael H Tomasson
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Grerk Sutamtewagul
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Adam Dupuy
- Department of Anatomy & Cell Biology, University of Iowa, 375 Newton Road, 3202 MERF, Iowa City, IA 52242, United States of America.
| | - Vijaya Raj Bhatt
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, United States of America; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, 986840 Nebraska Medical Center, Omaha, NE 68198, United States of America.
| |
Collapse
|
6
|
Dhakal P, Bates M, Tomasson MH, Sutamtewagul G, Dupuy A, Bhatt VR. Acute myeloid leukemia resistant to venetoclax-based therapy: What does the future hold? Blood Rev 2022; 59:101036. [PMID: 36549969 DOI: 10.1016/j.blre.2022.101036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Venetoclax is a highly selective B-cell lymphoma-2 (BCL-2) inhibitor, which, combined with a DNA hypomethylating agent or low dose cytarabine, results in high rates of initial responses in patients with acute myeloid leukemia (AML). However, the disease relapses in most patients. Mechanisms of resistance to venetoclax-based therapy include TP53 gene mutations or inactivation of p53 protein, activating kinase mutations such as FLT3 and RAS, and upregulation of other BCL-2 family apoptotic proteins. Current clinical trials are exploring strategies such as doublet or triplet regimens incorporating a p53 activator, an anti-CD47 antibody, or other novel agents that target genes and proteins responsible for resistance to venetoclax. Further studies should focus on identifying predictive biomarkers of response to venetoclax-based therapy and incorporating immunotherapeutic approaches such as checkpoint inhibitors, bispecific antibodies, antibody-drug conjugates, and CAR T-cell therapy to improve outcomes for patients with AML.
Collapse
Affiliation(s)
- Prajwal Dhakal
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Melissa Bates
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Michael H Tomasson
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Grerk Sutamtewagul
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, 200 Hawkins Dr. C 21GH, Iowa City, IA 52245, United States of America.
| | - Adam Dupuy
- Department of Anatomy & Cell Biology, University of Iowa, 375 Newton Road, 3202 MERF, Iowa City, IA 52242, United States of America.
| | - Vijaya Raj Bhatt
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, United States of America; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, 986840 Nebraska Medical Center, Omaha, NE 68198, United States of America.
| |
Collapse
|
7
|
Lesokhin AM, Arnulf B, Niesvizky R, Mohty M, Bahlis NJ, Tomasson MH, Rodrguez-Otero P, Quach H, Raje NS, Iida S, Raab M, Czibere A, Sullivan S, Leip E, Viqueira A, Blunk V, Leleu X. A PHASE 2 TRIAL OF ELRANATAMAB, A B-CELL MATURATION ANTIGEN (BCMA)-CD3 BISPECIFIC ANTIBODY, IN PATIENTS (PTS) WITH RELAPSED/REFRACTORY (R/R) MULTIPLE MYELOMA (MM): INITIAL SAFETY RESULTS FOR MAGNETISMM-3. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.415] [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: 11/05/2022] Open
|
8
|
Lesokhin AM, Arnulf B, Niesvizky R, Mohty M, Bahlis NJ, Tomasson MH, Rodríguez-Otero P, Quach H, Raje NS, Iida S, Raab MS, Czibere A, Sullivan S, Leip E, Viqueira A, Leleu X. Initial safety results for MagnetisMM-3: A phase 2 trial of elranatamab, a B-cell maturation antigen (BCMA)-CD3 bispecific antibody, in patients (pts) with relapsed/refractory (R/R) multiple myeloma (MM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8006 Background: Elranatamab (PF-06863135) is a humanized bispecific antibody that targets both BCMA-expressing MM cells and CD3-expressing T cells. MagnetisMM-3 (NCT04649359) is an open-label, multicenter, non-randomized, phase 2 study to evaluate the safety and efficacy of elranatamab monotherapy in pts with R/R MM. Initial safety results are presented. Methods: MagnetisMM-3 enrolled pts who are refractory to at least 1 proteasome inhibitor, 1 immunomodulatory drug, and 1 anti-CD38 antibody. Pts were assigned to 1 of 2 independent, parallel cohorts: those naïve to BCMA-directed therapies (Cohort A) and those with previous exposure to BCMA-directed antibody-drug conjugates or CAR-T cells (Cohort B). Pts received subcutaneous elranatamab 76 mg QW on a 28-d cycle with a 2-step-up priming dose regimen administered during the first week. Dose modifications were permitted for toxicity. Treatment-emergent adverse events (TEAEs) were graded by CTCAE (v5.0), and cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) by ASTCT criteria. Results: As of the data cutoff on Dec 31, 2021, 60 pts in Cohort A had received ≥1 dose of elranatamab; the last pt’s first dose was ̃2 months prior to the cutoff. Median age was 69.0 y (range, 44−89), 48.3% were male, 63.3% were white, 18.3% were Asian and 11.7% were Black/African American. At baseline, 60.0% of pts had an ECOG performance status 1−2 and pts had received a median of 5 (range, 2−12) prior therapies. Median duration of elranatamab treatment was 9.57 wks (range, 0.1−46.1); median relative dose intensity was 87.4% (range, 23.1−101.4). TEAEs were reported in 100% (Grade [G] 3/4, 75.0%) of pts. Most common (≥30%) hematologic TEAEs were neutropenia (36.7% [G3/4, 35.0%]), anemia (36.7% [G3/4, 30.0%]) and thrombocytopenia (30.0% [G3/4, 21.7%]). Among pts who received the 2-step-up priming regimen (n = 56), CRS and ICANS, respectively, were reported in 58.9% (G3/4, 0%) and 3.6% (G3/4: 0%); of those pts, 57.6% (n = 19/33) and 100% (n = 2/2) received tocilizumab and/or steroids. Most common (≥30%) non-hematologic TEAE, other than CRS/ICANS, was fatigue (31.7% [G3/4, 3.3%]). Infections were reported in 46.7% (G3/4: 18.3%) of pts; most frequently reported were upper respiratory tract infections (11.7% [G3/4: 0%]). Discontinuations due to adverse events were reported in 5.0% of pts. No pts permanently discontinued treatment due to CRS or ICANS. There were 10 deaths; causes were MM progression (n = 8), septic shock (n = 1) and unknown (n = 1). Data will be updated at the time of presentation to include ̃90 pts. Conclusions: Preliminary results of MagnetisMM-3 in pts with R/R MM and no prior BCMA-targeted treatment suggest that 76 mg QW elranatamab with a 2-step-up priming regimen is well tolerated, with no G ≥3 CRS or ICANS observed. Clinical trial information: NCT04649359.
Collapse
Affiliation(s)
- Alexander M. Lesokhin
- Division of Hematology and Oncology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York, NY
| | | | - Ruben Niesvizky
- Weill Cornell Medical College - New York Presbyterian Hospital, New York, NY
| | - Mohamad Mohty
- Sorbonne University, Hôpital Saint-Antoine, and INSERM UMRs938, Paris, France
| | - Nizar J. Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada
| | | | | | - Hang Quach
- University of Melbourne, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Noopur S. Raje
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Shinsuke Iida
- Department of Hematology & Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Marc-Steffen Raab
- Heidelberg Myeloma Center, Department of Hematology/Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | | | | | - Xavier Leleu
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| |
Collapse
|
9
|
Jakubowiak AJ, Bahlis NJ, Raje NS, Costello C, Dholaria BR, Solh MM, Levy MY, Tomasson MH, Dube H, Damore MA, Jiang S, Basu C, Skoura A, Chan EM, Trudel S, Chu MP, Gasparetto CJ, Dalovisio AP, Sebag M, Lesokhin AM. Elranatamab, a BCMA-targeted T-cell redirecting immunotherapy, for patients with relapsed or refractory multiple myeloma: Updated results from MagnetisMM-1. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
8014 Background: Elranatamab (PF-06863135) is a bispecific molecule that activates and redirects the T-cell mediated immune response against multiple myeloma (MM), a plasma cell dyscrasia characterized by expression of B-cell maturation antigen (BCMA). MagnetisMM-1 (NCT03269136), the ongoing Phase 1 first-in-human study for elranatamab, was designed to characterize safety, pharmacokinetics (PK), pharmacodynamics, and efficacy for patients (pts) with relapsed or refractory MM. Methods: Elranatamab was given subcutaneously (SC) at doses from 80 to 1000µg/kg either weekly or every 2 weeks (Q2W). Treatment-emergent adverse events (TEAEs) were graded by Common Terminology Criteria for Adverse Events (v4.03) and cytokine release syndrome (CRS) by American Society for Transplantation and Cellular Therapy criteria. PK, cytokine and soluble BCMA profiling, and lymphocyte subset analyses were performed. Response was assessed by International Myeloma Working Group (IMWG) criteria. Minimal residual disease (MRD) was assessed by next generation sequencing at a sensitivity of 1×10-5 in accordance with IMWG criteria. Results: A total of 55 pts received single-agent elranatamab SC at a dose ≥215μg/kg as of 1-Nov-2021. Median age was 64 (range 42-80) years, and 27% of pts were Black/African American or Asian. Median number of prior regimens was 6 (range 2-15), 91% were triple-class refractory, 56% had prior stem cell transplantation, 27% had high cytogenetic risk, and 22% received prior BCMA-targeted therapy. The most common TEAEs regardless of causality included CRS, neutropenia, anemia, injection site reaction, and lymphopenia. With pre-medication and a single priming dose (600µg/kg or 44mg), the overall incidence of CRS at the recommended dose (1000µg/kg or 76mg) was 67% and limited to Grade 1 (33%) or Grade 2 (33%), with no events Grade 3 or higher. Exposure was dose dependent and Q2W dosing achieved exposure associated with anti-myeloma efficacy. Cytokine increases occurred with the first dose and were reduced by pre-medication. Soluble BCMA decreased with disease response, elranatamab therapy was associated with increased peripheral T cell proliferation, and median time to response was 36 days (range 7-73). With a median follow-up of 8.1 months (range 0.3-21) and including only IMWG confirmed responses, 31% of pts achieved complete response or better and the overall response rate was 64% (95% CI 50-75%). For responders (n = 35), median duration of response was not yet reached, but the probability of being event-free at 6 months was 91% (95% CI 73-97%). Single-agent elranatamab induces durable clinical and molecular responses, and updated data including MRD assessment will be presented. Conclusions: Elranatamab shows a manageable safety profile and achieves durable clinical and molecular responses for pts with relapsed or refractory MM. Clinical trial information: NCT03269136.
Collapse
Affiliation(s)
| | - Nizar J. Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada
| | - Noopur S. Raje
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Caitlin Costello
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Melhem M. Solh
- Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | - Moshe Y. Levy
- Department of Medical Oncology, Baylor Scott and White Health, Dallas, TX
| | | | - Harman Dube
- Oncology Research and Development, Pfizer, San Diego, CA
| | | | - Sibo Jiang
- Early Clinical Development, Pfizer, San Diego, CA
| | - Cynthia Basu
- Early Clinical Development, Pfizer, San Diego, CA
| | | | | | - Suzanne Trudel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Michael Sebag
- Cedars Cancer Center, McGill University Health Center, Montreal, QC, Canada
| | - Alexander M. Lesokhin
- Division of Hematology and Oncology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York, NY
| |
Collapse
|
10
|
Zhang Z, Berschel M, Delloro D, Delzell M, Jedlicka C, Lane C, Vasilyev M, Vasileva A, Tomasson MH, Bates ML. Chronic Intermittent Hypoxia Impacts Bone Marrow Macrophages. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2289] [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: 11/11/2022]
Affiliation(s)
- Zishan Zhang
- Department of Internal MedicineUniversity of IowaIowa CityIA
| | - Mackenzie Berschel
- Department of Health and Human PhysiologyUniversity of IowaBensenvilleIL
| | - Derick Delloro
- Department of Health and Human PhysiologyUniversity of IowaChristchurchVA
| | - Matthew Delzell
- Department of Health and Human PhysiologyUniversity of IowaKirksvilleMO
| | | | - Carter Lane
- Department of Health and Human PhysiologyUniversity of IowaGowrieIA
| | | | | | | | | |
Collapse
|
11
|
Flores LD, Pryakhina Y, Tomasson MH, Bates ML, DeRuisseau LR. Sex Differences and Cardiovascular Diseases in Down Syndrome. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2715] [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: 11/11/2022]
Affiliation(s)
| | | | | | - Melissa L. Bates
- Health and Human Physiology, Internal Medicine, PediatricsUniversity of IowaIowa CityIA
| | | |
Collapse
|
12
|
Jedlicka CR, Bhagwat S, Tomasson MH, Bates ML. Opioid Analgesic Use in Patients with Sleep Disorders: A Retrospective Cohort Study Using Electronic Health Records. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4706] [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: 11/11/2022]
|
13
|
Pottebaum E, Warmoth A, Ayyappan S, Dickens DS, Jethava Y, Modi A, Tomasson MH, Carr LJ, Bates ML. Wearable Monitors Facilitate Exercise in Adult and Pediatric Stem Cell Transplant. Exerc Sport Sci Rev 2021; 49:205-212. [PMID: 33927164 DOI: 10.1249/jes.0000000000000258] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematopoietic stem cell transplant (HSCT) is a potentially curative treatment for hematopoietic malignancies, complicated by decreased performance status and quality of life. Exercise therapy improves outcomes in HSCT, but several barriers have prevented exercise from becoming routine clinical practice. Based on existing data that wearable technologies facilitate exercise participation in other sedentary and chronic illness populations, we propose the novel hypothesis that wearable technologies are a valuable tool in transcending barriers and developing exercise therapy programs for HSCT patients.
Collapse
|
14
|
Bahlis NJ, Raje NS, Costello C, Dholaria BR, Solh MM, Levy MY, Tomasson MH, Dube H, Liu F, Liao KH, Basu C, Skoura A, Chan EM, Trudel S, Jakubowiak AJ, Chu MP, Gasparetto C, Dalovisio A, Sebag M, Lesokhin AM. Efficacy and safety of elranatamab (PF-06863135), a B-cell maturation antigen (BCMA)-CD3 bispecific antibody, in patients with relapsed or refractory multiple myeloma (MM). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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
8006 Background: Elranatamab (PF-06863135) is a humanized bispecific monoclonal antibody (IgG2a) that targets BCMA, a member of the tumor necrosis factor receptor superfamily expressed in MM, and CD3 on T cells. We reported results for intravenous (IV) dosing (Raje et al. Blood. 2019;134(S1):1869) and now update for subcutaneous (SC) dosing from the ongoing Phase 1 study (MagnetisMM-1). Methods: Patients (pts) received elranatamab at 80, 130, 215, 360, 600, and 1000μg/kg SC weekly. A modified toxicity probability interval method was used for escalation, with monitoring for dose-limiting toxicity (DLT) to end of the first cycle. Treatment-emergent adverse events (TEAEs) were graded by Common Terminology Criteria for Adverse Events (v4.03), and cytokine release syndrome (CRS) by American Society for Transplantation and Cellular Therapy criteria (Lee et al. Biol Blood Marrow Transplant. 2019;25:625). Response was assessed by International Myeloma Working Group criteria. Pharmacokinetics, cytokine profiling, and T cell immunophenotyping were performed. Results: 30 pts had received elranatamab as of 4-Aug-2020 at 80 (n = 6), 130 (n = 4), 215 (n = 4), 360 (n = 4), 600 (n = 6), or 1000 (n = 6) μg/kg SC weekly. Pts had a median of 8 prior treatments; 87% had triple refractory disease, 97% had prior anti-CD38 therapy, and 23% had prior BCMA-directed antibody drug conjugate or chimeric antigen receptor T cell therapy. The most common all causality TEAEs included lymphopenia (n = 24, 80%; 20% G3, 60% G4), CRS (n = 22, 73%; none > G2), anemia (n = 17, 57%; 43% G3, 3% G4), injection site reaction (n = 16, 53%; none > G2), thrombocytopenia (n = 16, 53%; 23% G3, 17% G4), and neutropenia (n = 12, 40%; 17% G3, 17% G4). Both CRS and immune effector cell-associated neurotoxicity syndrome (n = 6, 20%) were limited to ≤G2 with median durations of 2 and 1.5 days, respectively. No DLT was observed. Exposure increased with dose, and Tmax ranged from 3–7 days. Cytokine increases occurred with the first dose, and increased T-cell proliferation was observed in peripheral blood. The overall response rate (ORR) for doses ≥215μg/kg was 75% (n = 15/20) including partial response (PR; n = 6), very good PR (VGPR; n = 3), complete response (CR; n = 1), and stringent CR (sCR; n = 5). Median time to response was 22 days, and 3 of 4 pts (75%) with prior BCMA-directed therapy achieved response (VGPR, n = 2 and sCR, n = 1). Updated data, including duration of response, will be presented. Conclusions: Elranatamab demonstrated a manageable safety profile, and SC doses ≥215μg/kg achieved ORR of 75% with CR/sCR rate of 30%. These results demonstrate the safety and efficacy of SC elranatamab in this relapsed/refractory population and support ongoing development of elranatamab for pts with MM, both as monotherapy and in combination with standard or novel therapies. Clinical trial information: NCT03269136.
Collapse
Affiliation(s)
- Nizar J. Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada
| | - Noopur S. Raje
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Caitlin Costello
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Melhem M. Solh
- Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | - Moshe Y. Levy
- Department of Medical Oncology, Baylor Scott and White Health, Dallas, TX
| | | | - Harman Dube
- Oncology Research and Development, Pfizer, San Diego, CA
| | - Feng Liu
- Oncology Research and Development, Pfizer, San Diego, CA
| | - Kai Hsin Liao
- Oncology Research and Development, Pfizer, San Diego, CA
| | - Cynthia Basu
- Early Clinical Development, Pfizer, San Diego, CA
| | | | | | - Suzanne Trudel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Andrew Dalovisio
- Department of Hematology and Oncology, Ochsner Health, Jefferson, LA
| | - Michael Sebag
- Cedars Cancer Center, McGill University Health Center, Montreal, QC, Canada
| | - Alexander M. Lesokhin
- Division of Hematology and Oncology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York, NY
| |
Collapse
|
15
|
Amaza I, Kalra H, Eberlein M, Jethava Y, McDonell J, Wolfe B, Tomasson MH, Bates ML. Case Studies in Physiology: Untangling the cause of hypoxemia in a patient with obesity with acute leukemia. J Appl Physiol (1985) 2021; 131:788-793. [PMID: 33955261 DOI: 10.1152/japplphysiol.00867.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diagnosing the cause of hypoxemia and dyspnea can be complicated in complex patients with multiple comorbidities. This "Case Study in Physiology" describes an man with obesity admitted to the hospital for relapse of acute lymphoblastic leukemia, who experienced progressive hypoxemia, shortness of breath, and dyspnea on exertion during his hospitalization. After initial empirical treatment with diuresis and antibiotics failed to improve his symptoms and because an arterial blood gas measurement was not readily available, we applied a novel, recently described physiological method to estimate the arterial partial pressure of oxygen from the peripheral saturation measurement and calculate the alveolar-arterial oxygen difference to discern the source of his hypoxemia and dyspnea. Using basic physiological principles, we describe how hypoventilation, anemia, and the use of a β blocker and furosemide, collaborated to create a "perfect storm" in this patient that impaired oxygen delivery and limited utilization. This case illustrates the application of innovative physiology methodology in medicine and provides a strong rationale for continuing to integrate physiology education in medical education.NEW & NOTEWORTHY Discerning the cause of dyspnea and hypoxemia in complex patients can be difficult. We describe the "real world" application of an innovative methodology to untangle the underlying physiology in a patient with multiple comorbidities. This case further demonstrates the importance of applying physiology to interrogate the underlying cause of a patient's symptoms when treatment based on probability fails.
Collapse
Affiliation(s)
- Iliya Amaza
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa
| | - Hardik Kalra
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa.,Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Michael Eberlein
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa
| | - Yogesh Jethava
- Department of Internal Medicine, Division of Hematology, Oncology, and Bone Marrow Transplant, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Joseph McDonell
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa.,Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Bobby Wolfe
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Michael H Tomasson
- Department of Internal Medicine, Division of Hematology, Oncology, and Bone Marrow Transplant, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Melissa L Bates
- Department of Internal Medicine, Division of Hematology, Oncology, and Bone Marrow Transplant, University of Iowa, Iowa City, Iowa.,Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa.,Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| |
Collapse
|
16
|
Vasilyev M, Berschel MR, Tomasson MH, Bates ML. Viewpoint: Time to stop treating the heart as a single organ? Exp Physiol 2021; 106:1315-1316. [PMID: 33728739 DOI: 10.1113/ep089497] [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: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Mikhail Vasilyev
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Mackenzie R Berschel
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Michael H Tomasson
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Melissa L Bates
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.,Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
17
|
Altrock PM, Ferlic J, Galla T, Tomasson MH, Michor F. Computational Model of Progression to Multiple Myeloma Identifies Optimum Screening Strategies. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652561 PMCID: PMC6873949 DOI: 10.1200/cci.17.00131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose Recent advances have uncovered therapeutic interventions that might reduce the risk of progression of premalignant diagnoses, such as monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). It remains unclear how to best screen populations at risk and how to evaluate the ability of these interventions to reduce disease prevalence and mortality at the population level. To address these questions, we developed a computational modeling framework. Materials and Methods We used individual-based computational modeling of MGUS incidence and progression across a population of diverse individuals to determine best screening strategies in terms of screening start, intervals, and risk-group specificity. Inputs were life tables, MGUS incidence, and baseline MM survival. We measured MM-specific mortality and MM prevalence after MGUS detection from simulations and mathematic modeling predictions. Results Our framework is applicable to a wide spectrum of screening and intervention scenarios, including variation of the baseline MGUS to MM progression rate and evolving MGUS, in which progression increases over time. Given the currently available point estimate of progression risk reduction to 61% risk, starting screening at age 55 years and performing follow-up screening every 6 years reduced total MM prevalence by 19%. The same reduction could be achieved with starting screening at age 65 years and performing follow-up screening every 2 years. A 40% progression risk reduction per patient with MGUS per year would reduce MM-specific mortality by 40%. Specifically, screening onset age and screening frequency can change disease prevalence, and progression risk reduction changes both prevalence and disease-specific mortality. Screening would generally be favorable in high-risk individuals. Conclusion Screening efforts should focus on specifically identified groups with high lifetime risk of MGUS, for which screening benefits can be significant. Screening low-risk individuals with MGUS would require improved preventions.
Collapse
Affiliation(s)
- Philipp M Altrock
- Philipp M. Altrock, Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL; Jeremy Ferlic and Franziska Michor, Dana-Farber Cancer Institute and Harvard University; Harvard T.H. Chan School of Public Health, Boston; Franziska Michor, Center for Cancer Evolution, Dana-Farber Cancer Institute, and The Ludwig Center at Harvard, Boston; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA; Tobias Galla, University of Manchester, Manchester, United Kingdom; and Michael H. Tomasson, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Jeremy Ferlic
- Philipp M. Altrock, Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL; Jeremy Ferlic and Franziska Michor, Dana-Farber Cancer Institute and Harvard University; Harvard T.H. Chan School of Public Health, Boston; Franziska Michor, Center for Cancer Evolution, Dana-Farber Cancer Institute, and The Ludwig Center at Harvard, Boston; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA; Tobias Galla, University of Manchester, Manchester, United Kingdom; and Michael H. Tomasson, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Tobias Galla
- Philipp M. Altrock, Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL; Jeremy Ferlic and Franziska Michor, Dana-Farber Cancer Institute and Harvard University; Harvard T.H. Chan School of Public Health, Boston; Franziska Michor, Center for Cancer Evolution, Dana-Farber Cancer Institute, and The Ludwig Center at Harvard, Boston; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA; Tobias Galla, University of Manchester, Manchester, United Kingdom; and Michael H. Tomasson, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Michael H Tomasson
- Philipp M. Altrock, Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL; Jeremy Ferlic and Franziska Michor, Dana-Farber Cancer Institute and Harvard University; Harvard T.H. Chan School of Public Health, Boston; Franziska Michor, Center for Cancer Evolution, Dana-Farber Cancer Institute, and The Ludwig Center at Harvard, Boston; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA; Tobias Galla, University of Manchester, Manchester, United Kingdom; and Michael H. Tomasson, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Franziska Michor
- Philipp M. Altrock, Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL; Jeremy Ferlic and Franziska Michor, Dana-Farber Cancer Institute and Harvard University; Harvard T.H. Chan School of Public Health, Boston; Franziska Michor, Center for Cancer Evolution, Dana-Farber Cancer Institute, and The Ludwig Center at Harvard, Boston; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA; Tobias Galla, University of Manchester, Manchester, United Kingdom; and Michael H. Tomasson, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
| |
Collapse
|
18
|
Oliveira V, Mahajan N, Bates ML, Tripathi C, Kim KQ, Zaher HS, Maggi Jr LB, Tomasson MH. The snoRNA target of t(4;14) in multiple myeloma regulates ribosome biogenesis. FASEB Bioadv 2019; 1:404-414. [PMID: 32095781 PMCID: PMC6996358 DOI: 10.1096/fba.2018-00075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/10/2018] [Revised: 12/10/2018] [Accepted: 04/08/2019] [Indexed: 12/31/2022] Open
Abstract
The orphan small nucleolar RNA (snoRNA) ACA11 is overexpressed as a result of the t(4;14) chromosomal translocation in multiple myeloma (MM), increases reactive oxygen species, and drives cell proliferation. Like other snoRNAs, ACA11 is predominantly localized to a sub-nuclear organelle, the nucleolus. We hypothesized that increased ACA11 expression would increase ribosome biogenesis and protein synthesis. We found that ACA11 overexpression in MM cells increased nucleolar area and number as well as silver-binding nucleolar organizing regions (AgNORs). Supporting these data, samples from t(4;14)-positive patients had higher AgNORs scores than t(4;14)-negative samples. ACA11 also upregulated ribosome production, pre-47S rRNA synthesis, and protein synthesis in a ROS-dependent manner. Lastly, ACA11 overexpression enhanced the response to proteasome inhibitor in MM cells, while no effect was found in response to high doses of melphalan. Together, these data demonstrate that ACA11 stimulates ribosome biogenesis and influences responses to chemotherapy. ACA11 may be a useful target to individualize the treatment for t(4;14)-positive myeloma patients.
Collapse
Affiliation(s)
- Vanessa Oliveira
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal MedicineUniversity of IowaIowa CityIowa
| | - Nitin Mahajan
- Division of Oncology, Department of MedicineSiteman Cancer Center, Washington University School of MedicineSt. LouisMissouri
| | - Melissa L. Bates
- Department of Health and Human PhysiologyUniversity of IowaIowa CityIowa
- Stead Family Department of PediatricsUniversity of IowaIowa CityIowa
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIowa
| | - Chakrapani Tripathi
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal MedicineUniversity of IowaIowa CityIowa
| | - Kyusik Q. Kim
- Department of BiologyWashington UniversitySt. LouisMissouri
| | - Hani S. Zaher
- Department of BiologyWashington UniversitySt. LouisMissouri
| | - Leonard B. Maggi Jr
- Division of Oncology, Department of MedicineSiteman Cancer Center, Washington University School of MedicineSt. LouisMissouri
| | - Michael H. Tomasson
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal MedicineUniversity of IowaIowa CityIowa
- Holden Comprehensive Cancer CenterUniversity of IowaIowa CityIowa
| |
Collapse
|
19
|
Sun F, Cheng Y, Walsh SA, Acevedo MR, Jing X, Han SS, Pisano MD, Tomasson MH, Lichtenstein AK, Zhan F, Hari P, Janz S. Osteolytic disease in IL-6 and Myc dependent mouse model of human myeloma. Haematologica 2019; 105:e111-e115. [PMID: 31221780 DOI: 10.3324/haematol.2019.221127] [Citation(s) in RCA: 3] [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: 12/13/2022] Open
Affiliation(s)
- Fumou Sun
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Yan Cheng
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Susan A Walsh
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Michael R Acevedo
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Xuefang Jing
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Seong Su Han
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Michael D Pisano
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Interdisciplinary Graduate Program in Immunology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - Michael H Tomasson
- Internal Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.,Holden Comprehensive Cancer Center, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - Alan K Lichtenstein
- Department of Hematology-Oncology, University of California at Los Angeles, Los Angeles, CA
| | - Fenghuang Zhan
- Internal Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.,Holden Comprehensive Cancer Center, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - Parameswaran Hari
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Siegfried Janz
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI .,Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
20
|
Ali M, Kowkuntla S, Delloro DJ, Galambos C, Hathi D, Janz S, Shokeen M, Tripathi C, Xu H, Yuk J, Zhan F, Tomasson MH, Bates ML. Chronic intermittent hypoxia enhances disease progression in myeloma-resistant mice. Am J Physiol Regul Integr Comp Physiol 2019; 316:R678-R686. [PMID: 30892915 DOI: 10.1152/ajpregu.00388.2018] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obesity is the only known modifiable risk factor for multiple myeloma (MM), an incurable cancer of bone marrow plasma cells. The mechanism linking the two is unknown. Obesity is associated with an increased risk of sleep apnea, which results in chronic intermittent hypoxia (CIH), and drives solid tumor aggressiveness. Given the link between CIH and solid tumor progression, we tested the hypothesis that CIH drives the proliferation of MM cells in culture and their engraftment and progression in vivo. Malignant mouse 5TGM1 cells were cultured in CIH, static hypoxia, or normoxia as a control in custom, gas-permeable plates. Typically MM-resistant C57BL/6J mice were exposed to 10 h/day CIH (AHI = 12/h), static hypoxia, or normoxia for 7 days, followed by injection with 5TGM1 cells and an additional 28 days of exposure. CIH and static hypoxia slowed the growth of 5TGM1 cells in culture. CIH-exposed mice developed significantly more MM than controls (67 vs. 12%, P = 0.005), evidenced by hindlimb paralysis, gammopathy, bone lesions, and bone tumor formation. Static hypoxia was not a significant driver of MM progression and did not reduce survival (P = 0.117). Interestingly, 5TGM1 cells preferentially engrafted in the bone marrow and promoted terminal disease in CIH mice, despite a lower tumor burden, compared with the positive controls. These first experiments in the context of hematological cancer demonstrate that CIH promotes MM through mechanisms distinct from solid tumors and that sleep apnea may be a targetable risk factor in patients with or at risk for blood cancer.
Collapse
Affiliation(s)
- Mahmoud Ali
- Department of Internal Medicine, Hematology and Oncology Division, University of Iowa , Iowa City, Iowa
| | - Sandeep Kowkuntla
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa
| | - Derick J Delloro
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa
| | - Csaba Galambos
- Department of Pathology and Laboratory Medicine, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
| | - Deep Hathi
- Department of Radiology, Washington University , St. Louis, Missouri
| | - Siegfried Janz
- Department of Pathology, University of Iowa , Iowa City, Iowa
| | - Monica Shokeen
- Department of Radiology, Washington University , St. Louis, Missouri
| | - Chakrapani Tripathi
- Department of Internal Medicine, Hematology and Oncology Division, University of Iowa , Iowa City, Iowa
| | - Hongwei Xu
- Department of Internal Medicine, Hematology and Oncology Division, University of Iowa , Iowa City, Iowa
| | - Jisung Yuk
- Department of Health and Human Physiology, University of Iowa , Iowa City, Iowa
| | - Fenghuang Zhan
- Department of Internal Medicine, Hematology and Oncology Division, University of Iowa , Iowa City, Iowa
| | - Michael H Tomasson
- Department of Internal Medicine, Hematology and Oncology Division, University of Iowa , Iowa City, Iowa
| | - Melissa L Bates
- Department of Internal Medicine, Hematology and Oncology Division, University of Iowa , Iowa City, Iowa.,Stead Family Department of Pediatrics, University of Iowa , Iowa City, Iowa
| |
Collapse
|
21
|
Glenn MJ, Madsen MJ, Davis E, Garner CD, Curtin K, Jones B, Williams JA, Tomasson MH, Camp NJ. Elevated IgM and abnormal free light chain ratio are increased in relatives from high-risk chronic lymphocytic leukemia pedigrees. Blood Cancer J 2019; 9:25. [PMID: 30808891 PMCID: PMC6391432 DOI: 10.1038/s41408-019-0186-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/19/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 02/07/2023] Open
Abstract
Abnormal serum immunoglobulin (Ig) free light chains (FLC) are established biomarkers of early disease in multiple B-cell lymphoid malignancies, including chronic lymphocytic leukemia (CLL). Heavy chains have also been shown to be biomarkers in plasma cell disorders. An unanswered question is whether these Ig biomarkers are heritable, i.e., influenced by germline factors. CLL is heritable but highly heterogeneous. Heritable biomarkers could elucidate steps of disease pathogenesis that are affected by germline factors, and may help partition heterogeneity and identify genetic pleiotropies across malignancies. Relatives in CLL pedigrees present an opportunity to identify heritable biomarkers. We compared FLCs and heavy chains between relatives in 23 high-risk CLL pedigrees and population controls. Elevated IgM (eIgM) and abnormal FLC (aFLC) ratio was significantly increased in relatives, suggesting that these Ig biomarkers are heritable and could offer risk stratification in pedigree relatives. Within high-risk CLL pedigrees, B-cell lymphoid malignancies were five times more prevalent in close relatives of individuals with eIgM, prostate cancer was three times more prevalent in relatives of individuals with aFLC, and monoclonal B-cell lymphocytosis increased surrounding individuals with normal Ig levels. These different clustering patterns suggest Ig biomarkers have the potential to partition genetic heterogeneity in CLL and provide insight into distinct heritable pleiotropies associated with CLL.
Collapse
Affiliation(s)
- Martha J Glenn
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA
| | - Michael J Madsen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
| | - Ethan Davis
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA
| | | | - Karen Curtin
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA
| | - Brandt Jones
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
| | - Justin A Williams
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
| | - Michael H Tomasson
- Carver College of Medicine, University ofIowa, Iowa City, IA, 52242, USA
| | - Nicola J Camp
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA. .,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA.
| |
Collapse
|
22
|
Tomasson MH, Ali M, De Oliveira V, Xiao Q, Jethava Y, Zhan F, Fitzsimmons AM, Bates ML. Prevention Is the Best Treatment: The Case for Understanding the Transition from Monoclonal Gammopathy of Undetermined Significance to Myeloma. Int J Mol Sci 2018; 19:E3621. [PMID: 30453544 PMCID: PMC6274834 DOI: 10.3390/ijms19113621] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 09/28/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma is an invariably fatal cancer of plasma cells. Despite tremendous advances in treatment, this malignancy remains incurable in most individuals. We postulate that strategies aimed at prevention have the potential to be more effective in preventing myeloma-related death than additional pharmaceutical strategies aimed at treating advanced disease. Here, we present a rationale for the development of prevention therapy and highlight potential target areas of study.
Collapse
Affiliation(s)
- Michael H Tomasson
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Mahmoud Ali
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Vanessa De Oliveira
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Qian Xiao
- Department of Health Human Physiology, University of Iowa, Iowa City, IA 52242, USA.
| | - Yogesh Jethava
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Fenghuang Zhan
- Department of Internal Medicine, Hematology, Oncology, and Bone Marrow Transplant Division, University of Iowa, Iowa City, IA 52242, USA.
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Adam M Fitzsimmons
- Graduate Program in Molecular Medicine, University of Iowa, Iowa City, IA 52242, USA.
| | - Melissa L Bates
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
- Department of Health Human Physiology, University of Iowa, Iowa City, IA 52242, USA.
- Stead Family Department of Pediatrics, University of Iowa, Iowa, IA 52242, USA.
| |
Collapse
|
23
|
White BS, Lanc I, O'Neal J, Gupta H, Fulton RS, Schmidt H, Fronick C, Belter EA, Fiala M, King J, Ahmann GJ, DeRome M, Mardis ER, Vij R, DiPersio JF, Levy J, Auclair D, Tomasson MH. A multiple myeloma-specific capture sequencing platform discovers novel translocations and frequent, risk-associated point mutations in IGLL5. Blood Cancer J 2018; 8:35. [PMID: 29563506 PMCID: PMC5862875 DOI: 10.1038/s41408-018-0062-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 12/28/2022] Open
Abstract
Multiple myeloma (MM) is a disease of copy number variants (CNVs), chromosomal translocations, and single-nucleotide variants (SNVs). To enable integrative studies across these diverse mutation types, we developed a capture-based sequencing platform to detect their occurrence in 465 genes altered in MM and used it to sequence 95 primary tumor-normal pairs to a mean depth of 104×. We detected cases of hyperdiploidy (23%), deletions of 1p (8%), 6q (21%), 8p (17%), 14q (16%), 16q (22%), and 17p (4%), and amplification of 1q (19%). We also detected IGH and MYC translocations near expected frequencies and non-silent SNVs in NRAS (24%), KRAS (21%), FAM46C (17%), TP53 (9%), DIS3 (9%), and BRAF (3%). We discovered frequent mutations in IGLL5 (18%) that were mutually exclusive of RAS mutations and associated with increased risk of disease progression (p = 0.03), suggesting that IGLL5 may be a stratifying biomarker. We identified novel IGLL5/IGH translocations in two samples. We subjected 15 of the pairs to ultra-deep sequencing (1259×) and found that although depth correlated with number of mutations detected (p = 0.001), depth past ~300× added little. The platform provides cost-effective genomic analysis for research and may be useful in individualizing treatment decisions in clinical settings.
Collapse
Affiliation(s)
- Brian S White
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA.,Sage Bionetworks, Seattle, WA, 91809, USA
| | - Irena Lanc
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA
| | - Julie O'Neal
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA
| | - Harshath Gupta
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA
| | - Robert S Fulton
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, 63108, MO, USA
| | - Heather Schmidt
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, 63108, MO, USA
| | - Catrina Fronick
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, 63108, MO, USA
| | - Edward A Belter
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, 63108, MO, USA
| | - Mark Fiala
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA
| | - Justin King
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA
| | - Greg J Ahmann
- Division of Hematology-Oncology, Mayo Clinic, Rochester, 55905, MN, USA
| | - Mary DeRome
- Multiple Myeloma Research Foundation, Norwalk, CT, 06851, USA
| | - Elaine R Mardis
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, 63108, MO, USA.,Genomics Institute, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Ravi Vij
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA
| | - John F DiPersio
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA
| | - Joan Levy
- Multiple Myeloma Research Foundation, Norwalk, CT, 06851, USA.,Chordoma Foundation, Durham, NC, 27702, USA
| | - Daniel Auclair
- Multiple Myeloma Research Foundation, Norwalk, CT, 06851, USA
| | - Michael H Tomasson
- Department of Medicine, Washington University School of Medicine, St. Louis, 63110, MO, USA. .,Division of Hematology, Oncology and Bone Marrow Transplantation, 5204 MERF, University of Iowa, Iowa City, IA, 52242, USA.
| |
Collapse
|
24
|
Rand KA, Song C, Dean E, Serie DJ, Curtin K, Sheng X, Hu D, Huff CA, Bernal-Mizrachi L, Tomasson MH, Ailawadhi S, Singhal S, Pawlish K, Peters ES, Bock CH, Stram A, Van Den Berg DJ, Edlund CK, Conti DV, Zimmerman T, Hwang AE, Huntsman S, Graff J, Nooka A, Kong Y, Pregja SL, Berndt SI, Blot WJ, Carpten J, Casey G, Chu L, Diver WR, Stevens VL, Lieber MR, Goodman PJ, Hennis AJM, Hsing AW, Mehta J, Kittles RA, Kolb S, Klein EA, Leske C, Murphy AB, Nemesure B, Neslund-Dudas C, Strom SS, Vij R, Rybicki BA, Stanford JL, Signorello LB, Witte JS, Ambrosone CB, Bhatti P, John EM, Bernstein L, Zheng W, Olshan AF, Hu JJ, Ziegler RG, Nyante SJ, Bandera EV, Birmann BM, Ingles SA, Press MF, Atanackovic D, Glenn MJ, Cannon-Albright LA, Jones B, Tricot G, Martin TG, Kumar SK, Wolf JL, Deming Halverson SL, Rothman N, Brooks-Wilson AR, Rajkumar SV, Kolonel LN, Chanock SJ, Slager SL, Severson RK, Janakiraman N, Terebelo HR, Brown EE, De Roos AJ, Mohrbacher AF, Colditz GA, Giles GG, Spinelli JJ, Chiu BC, Munshi NC, Anderson KC, Levy J, Zonder JA, Orlowski RZ, Lonial S, Camp NJ, Vachon CM, Ziv E, Stram DO, Hazelett DJ, Haiman CA, Cozen W. A Meta-analysis of Multiple Myeloma Risk Regions in African and European Ancestry Populations Identifies Putatively Functional Loci. Cancer Epidemiol Biomarkers Prev 2016; 25:1609-1618. [PMID: 27587788 PMCID: PMC5524541 DOI: 10.1158/1055-9965.epi-15-1193] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Genome-wide association studies (GWAS) in European populations have identified genetic risk variants associated with multiple myeloma. METHODS We performed association testing of common variation in eight regions in 1,318 patients with multiple myeloma and 1,480 controls of European ancestry and 1,305 patients with multiple myeloma and 7,078 controls of African ancestry and conducted a meta-analysis to localize the signals, with epigenetic annotation used to predict functionality. RESULTS We found that variants in 7p15.3, 17p11.2, 22q13.1 were statistically significantly (P < 0.05) associated with multiple myeloma risk in persons of African ancestry and persons of European ancestry, and the variant in 3p22.1 was associated in European ancestry only. In a combined African ancestry-European ancestry meta-analysis, variation in five regions (2p23.3, 3p22.1, 7p15.3, 17p11.2, 22q13.1) was statistically significantly associated with multiple myeloma risk. In 3p22.1, the correlated variants clustered within the gene body of ULK4 Correlated variants in 7p15.3 clustered around an enhancer at the 3' end of the CDCA7L transcription termination site. A missense variant at 17p11.2 (rs34562254, Pro251Leu, OR, 1.32; P = 2.93 × 10-7) in TNFRSF13B encodes a lymphocyte-specific protein in the TNF receptor family that interacts with the NF-κB pathway. SNPs correlated with the index signal in 22q13.1 cluster around the promoter and enhancer regions of CBX7 CONCLUSIONS: We found that reported multiple myeloma susceptibility regions contain risk variants important across populations, supporting the use of multiple racial/ethnic groups with different underlying genetic architecture to enhance the localization and identification of putatively functional alleles. IMPACT A subset of reported risk loci for multiple myeloma has consistent effects across populations and is likely to be functional. Cancer Epidemiol Biomarkers Prev; 25(12); 1609-18. ©2016 AACR.
Collapse
Affiliation(s)
- Kristin A Rand
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Chi Song
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | | | - Karen Curtin
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Xin Sheng
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Donglei Hu
- University of California at San Francisco, San Francisco, California
| | - Carol Ann Huff
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael H Tomasson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, Missouri
| | | | - Seema Singhal
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | - Karen Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey
| | - Edward S Peters
- Louisiana State University School of Public Health, Louisiana State University, New Orleans, Louisiana
| | - Cathryn H Bock
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Alex Stram
- Genomic Health, Inc., Redwood City, California
| | - David J Van Den Berg
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Christopher K Edlund
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - David V Conti
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | - Amie E Hwang
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Scott Huntsman
- University of California at San Francisco, San Francisco, California
| | - John Graff
- Rutgers-Robert Wood Johnson Medical School, Rutgers State University of New Jersey, New Brunswick, New Jersey
| | - Ajay Nooka
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Yinfei Kong
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Silvana L Pregja
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | - William J Blot
- International Epidemiology Institute, Rockville, Maryland
- Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - John Carpten
- The Translational Genomics Research Institute, Phoenix, Arizona
| | - Graham Casey
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Lisa Chu
- Cancer Prevention Institute of California, Fremont, California
- Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California
| | | | | | - Michael R Lieber
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | - Anselm J M Hennis
- Stony Brook University, Stony Brook, New York
- Chronic Disease Research Centre and Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados
| | - Ann W Hsing
- Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California
| | - Jayesh Mehta
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | - Rick A Kittles
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Suzanne Kolb
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Eric A Klein
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Adam B Murphy
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | - Sara S Strom
- The University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Ravi Vij
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, Missouri
| | | | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lisa B Signorello
- Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - John S Witte
- Institute for Human Genetics, University of California, San Francisco, San Francisco, California
| | | | - Parveen Bhatti
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, California
- Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, California
| | - Wei Zheng
- International Epidemiology Institute, Rockville, Maryland
| | - Andrew F Olshan
- Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer J Hu
- Sylvester Comprehensive Cancer Center and Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida
| | - Regina G Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | - Sarah J Nyante
- Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Elisa V Bandera
- Rutgers-Robert Wood Johnson Medical School, Rutgers State University of New Jersey, New Brunswick, New Jersey
| | - Brenda M Birmann
- Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - Sue A Ingles
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Michael F Press
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | | | - Martha J Glenn
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Brandt Jones
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Thomas G Martin
- University of California at San Francisco, San Francisco, California
| | | | - Jeffrey L Wolf
- University of California at San Francisco, San Francisco, California
| | | | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | | | | | - Laurence N Kolonel
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, Hawaii
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, U.S. NIH, Bethesda, Maryland
| | | | - Richard K Severson
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | | | | | | | | | - Ann F Mohrbacher
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Graham A Colditz
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, Missouri
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, Victoria, Australia
- School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
- Monash University, Melbourne, Melbourne, Victoria, Australia
| | - John J Spinelli
- BC Cancer Agency, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Nikhil C Munshi
- Dana Farber Cancer Institute, Harvard School of Medicine, Harvard University, Boston, Massachusetts
| | - Kenneth C Anderson
- Dana Farber Cancer Institute, Harvard School of Medicine, Harvard University, Boston, Massachusetts
| | - Joan Levy
- Multiple Myeloma Research Foundation, Norwalk, Connecticut
| | - Jeffrey A Zonder
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Robert Z Orlowski
- The University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nicola J Camp
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Elad Ziv
- University of California at San Francisco, San Francisco, California
| | - Daniel O Stram
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Dennis J Hazelett
- Center for Bioinformatics and Computational Biology, Cedars Sinai Medical Center, Los Angeles, California.
| | - Christopher A Haiman
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
| | - Wendy Cozen
- Keck School of Medicine of USC and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
| |
Collapse
|
25
|
Welch JS, Petti AA, Miller CA, Fronick CC, O'Laughlin M, Fulton RS, Wilson RK, Baty JD, Duncavage EJ, Tandon B, Lee YS, Wartman LD, Uy GL, Ghobadi A, Tomasson MH, Pusic I, Romee R, Fehniger TA, Stockerl-Goldstein KE, Vij R, Oh ST, Abboud CN, Cashen AF, Schroeder MA, Jacoby MA, Heath SE, Luber K, Janke MR, Hantel A, Khan N, Sukhanova MJ, Knoebel RW, Stock W, Graubert TA, Walter MJ, Westervelt P, Link DC, DiPersio JF, Ley TJ. TP53 and Decitabine in Acute Myeloid Leukemia and Myelodysplastic Syndromes. N Engl J Med 2016; 375:2023-2036. [PMID: 27959731 PMCID: PMC5217532 DOI: 10.1056/nejmoa1605949] [Citation(s) in RCA: 596] [Impact Index Per Article: 74.5] [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: 12/11/2022]
Abstract
BACKGROUND The molecular determinants of clinical responses to decitabine therapy in patients with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) are unclear. METHODS We enrolled 84 adult patients with AML or MDS in a single-institution trial of decitabine to identify somatic mutations and their relationships to clinical responses. Decitabine was administered at a dose of 20 mg per square meter of body-surface area per day for 10 consecutive days in monthly cycles. We performed enhanced exome or gene-panel sequencing in 67 of these patients and serial sequencing at multiple time points to evaluate patterns of mutation clearance in 54 patients. An extension cohort included 32 additional patients who received decitabine in different protocols. RESULTS Of the 116 patients, 53 (46%) had bone marrow blast clearance (<5% blasts). Response rates were higher among patients with an unfavorable-risk cytogenetic profile than among patients with an intermediate-risk or favorable-risk cytogenetic profile (29 of 43 patients [67%] vs. 24 of 71 patients [34%], P<0.001) and among patients with TP53 mutations than among patients with wild-type TP53 (21 of 21 [100%] vs. 32 of 78 [41%], P<0.001). Previous studies have consistently shown that patients with an unfavorable-risk cytogenetic profile and TP53 mutations who receive conventional chemotherapy have poor outcomes. However, in this study of 10-day courses of decitabine, neither of these risk factors was associated with a lower rate of overall survival than the rate of survival among study patients with intermediate-risk cytogenetic profiles. CONCLUSIONS Patients with AML and MDS who had cytogenetic abnormalities associated with unfavorable risk, TP53 mutations, or both had favorable clinical responses and robust (but incomplete) mutation clearance after receiving serial 10-day courses of decitabine. Although these responses were not durable, they resulted in rates of overall survival that were similar to those among patients with AML who had an intermediate-risk cytogenetic profile and who also received serial 10-day courses of decitabine. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT01687400 .).
Collapse
MESH Headings
- 5-Methylcytosine/analysis
- Adult
- Aged
- Aged, 80 and over
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Azacitidine/administration & dosage
- Azacitidine/adverse effects
- Azacitidine/analogs & derivatives
- Biomarkers, Tumor/analysis
- Bone Marrow/chemistry
- Bone Marrow/pathology
- Decitabine
- Exome
- Female
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Mutation
- Myelodysplastic Syndromes/drug therapy
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Prospective Studies
- Risk Factors
- Survival Rate
- Tumor Suppressor Protein p53/genetics
Collapse
Affiliation(s)
- John S Welch
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Allegra A Petti
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Christopher A Miller
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Catrina C Fronick
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Michelle O'Laughlin
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Robert S Fulton
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Richard K Wilson
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Jack D Baty
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Eric J Duncavage
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Bevan Tandon
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Yi-Shan Lee
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Lukas D Wartman
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Geoffrey L Uy
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Armin Ghobadi
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Michael H Tomasson
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Iskra Pusic
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Rizwan Romee
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Todd A Fehniger
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Keith E Stockerl-Goldstein
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Ravi Vij
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Stephen T Oh
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Camille N Abboud
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Amanda F Cashen
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Mark A Schroeder
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Meagan A Jacoby
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Sharon E Heath
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Kierstin Luber
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Megan R Janke
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Andrew Hantel
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Niloufer Khan
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Madina J Sukhanova
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Randall W Knoebel
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Wendy Stock
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Timothy A Graubert
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Matthew J Walter
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Peter Westervelt
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Daniel C Link
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - John F DiPersio
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| | - Timothy J Ley
- the Department of Internal Medicine, Division of Oncology (J.S.W., L.D.W., G.L.U., A.G., M.H.T., I.P., R.R., T.A.F., K.E.S.-G., R.V., S.T.O., C.N.A., A.F.C., M.A.S., M.A.J., S.E.H., K.L., M.R.J., M.J.W., P.W., D.C.L., J.F.D., T.J.L.), and the Division of Biostatistics (J.D.B.), and the Department of Pathology and Immunology (E.J.D., B.T., Y.-S.L.), Washington University School of Medicine, and McDonnell Genome Institute, Washington University in St. Louis (A.A.P., C.A.M., C.C.F., M.O., R.S.F., R.K.W., L.D.W., T.J.L.) - both in St. Louis; the Departments of Internal Medicine (A.H., N.K., M.J.S., W.S.) and Pharmacy (R.W.K.), University of Chicago, Chicago; and the Department of Internal Medicine (T.A.G.), Massachusetts General Hospital, Boston
| |
Collapse
|
26
|
Mahajan N, Wu HJ, Bennett RL, Troche C, Licht JD, Weber JD, Maggi LB, Tomasson MH. Sabotaging of the oxidative stress response by an oncogenic noncoding RNA. FASEB J 2016; 31:482-490. [PMID: 28148777 DOI: 10.1096/fj.201600654r] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/30/2016] [Accepted: 10/04/2016] [Indexed: 12/27/2022]
Abstract
Overexpression of the multiple myeloma set domain (MMSET) Wolf-Hirschhorn syndrome candidate 1 gene, which contains an orphan box H/ACA class small nucleolar RNA, ACA11, in an intron, is associated with several cancer types, including multiple myeloma (MM). ACA11 and MMSET are overexpressed cotranscriptionally as a result of the t(4;14) chromosomal translocation in a subset of patients with MM. RNA sequencing of CD138+ tumor cells from t(4;14)-positive and -negative MM patient bone marrow samples revealed an enhanced oxidative phosphorylation mRNA signature. Supporting these data, ACA11 overexpression in a t(4;14)-negative MM cell line, MM1.S, demonstrated enhanced reactive oxygen species (ROS) levels. In addition, an enhancement of cell proliferation, increased soft agar colony size, and elevated ERK1/2 phosphorylation were observed. This ACA11-driven hyperproliferative phenotype depended on increased ROS levels as exogenously added antioxidants attenuate the increased proliferation. A major transcriptional regulator of the cellular antioxidant response, nuclear factor (erythroid-derived 2)-like 2 (NRF2), shuttled to the nucleus, as expected, in response to ACA11-driven increases in ROS; however, transcriptional up-regulation of some of NRF2's antioxidant target genes was abrogated in the presence of ACA11 overexpression. These data show for the first time that ACA11 promotes proliferation through inhibition of NRF2 function resulting in sustained ROS levels driving cancer cell proliferation.-Mahajan, N., Wu, H.-J., Bennett, R. L., Troche, C., Licht, J. D., Weber, J. D., Maggi, L. B., Jr., Tomasson, M. H. Sabotaging of the oxidative stress response by an oncogenic noncoding RNA.
Collapse
Affiliation(s)
- Nitin Mahajan
- Division of Oncology, Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hua-Jun Wu
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; and
| | - Richard L Bennett
- Division of Hematology and Oncology, Department of Medicine, University of Florida Health Cancer Center, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Catalina Troche
- Division of Hematology and Oncology, Department of Medicine, University of Florida Health Cancer Center, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jonathan D Licht
- Division of Hematology and Oncology, Department of Medicine, University of Florida Health Cancer Center, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jason D Weber
- Division of Oncology, Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leonard B Maggi
- Division of Oncology, Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA;
| | - Michael H Tomasson
- Division of Oncology, Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA;
| |
Collapse
|
27
|
Tang M, Zhao R, van de Velde H, Tross JG, Mitsiades C, Viselli S, Neuwirth R, Esseltine DL, Anderson K, Ghobrial IM, San Miguel JF, Richardson PG, Tomasson MH, Michor F. Myeloma Cell Dynamics in Response to Treatment Supports a Model of Hierarchical Differentiation and Clonal Evolution. Clin Cancer Res 2016; 22:4206-4214. [PMID: 27006493 DOI: 10.1158/1078-0432.ccr-15-2793] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/06/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE Since the pioneering work of Salmon and Durie, quantitative measures of tumor burden in multiple myeloma have been used to make clinical predictions and model tumor growth. However, such quantitative analyses have not yet been performed on large datasets from trials using modern chemotherapy regimens. EXPERIMENTAL DESIGN We analyzed a large set of tumor response data from three randomized controlled trials of bortezomib-based chemotherapy regimens (total sample size n = 1,469 patients) to establish and validate a novel mathematical model of multiple myeloma cell dynamics. RESULTS Treatment dynamics in newly diagnosed patients were most consistent with a model postulating two tumor cell subpopulations, "progenitor cells" and "differentiated cells." Differential treatment responses were observed with significant tumoricidal effects on differentiated cells and less clear effects on progenitor cells. We validated this model using a second trial of newly diagnosed patients and a third trial of refractory patients. When applying our model to data of relapsed patients, we found that a hybrid model incorporating both a differentiation hierarchy and clonal evolution best explains the response patterns. CONCLUSIONS The clinical data, together with mathematical modeling, suggest that bortezomib-based therapy exerts a selection pressure on myeloma cells that can shape the disease phenotype, thereby generating further inter-patient variability. This model may be a useful tool for improving our understanding of disease biology and the response to chemotherapy regimens. Clin Cancer Res; 22(16); 4206-14. ©2016 AACR.
Collapse
Affiliation(s)
- Min Tang
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Rui Zhao
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | | | - Jennifer G Tross
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.,Harvard Medical School, Harvard-MIT Division of Health Sciences and Technology, Boston, MA 02115, USA
| | | | - Suzanne Viselli
- Oncology R&D, Janssen Research & Development LLC, Raritan, USA
| | | | | | | | | | - Jesús F San Miguel
- Hospital Universitario Salamanca, CIC, IBMCC (USAL-CSIC), Salamanca, Spain
| | | | - Michael H Tomasson
- Division of Oncology, School of Medicine, Washington University in St. Louis
| | - Franziska Michor
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| |
Collapse
|
28
|
Soodgupta D, Zhou H, Beaino W, Lu L, Rettig M, Snee M, Skeath J, DiPersio JF, Akers WJ, Laforest R, Anderson CJ, Tomasson MH, Shokeen M. Ex Vivo and In Vivo Evaluation of Overexpressed VLA-4 in Multiple Myeloma Using LLP2A Imaging Agents. J Nucl Med 2016; 57:640-5. [PMID: 26742713 DOI: 10.2967/jnumed.115.164624] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 08/06/2015] [Accepted: 11/25/2015] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED Very-late-antigen-4 (VLA-4, α4β1 integrin, CD49d/CD29) is a transmembrane adhesion receptor that plays an important role in cancer and immune responses. Enhanced VLA-4 expression has been observed in multiple myeloma (MM) cells and surrounding stroma. VLA-4 conformational activation has been associated with MM pathogenesis. VLA-4 is a promising MM imaging and therapeutic biomarker. METHODS Specificity of (64)Cu-LLP2A ((64)Cu-CB-TE1A1P-PEG4-LLP2A), a high-affinity VLA-4 peptidomimetic-based radiopharmaceutical, was evaluated in α4 knock-out mice and by competitive blocking in wild-type tumor-bearing mice. (64)Cu-LLP2A PET/CT (static and dynamic) imaging was conducted in C57BL6/KaLwRij mice bearing murine 5TGM1-GFP syngeneic tumors generated after intravenous injection via the tail. Blood samples were collected for serum protein electrophoresis. Bone marrow and splenic cells extracted from tumor-bearing and control mice (n= 3/group) were coincubated with the optical analog LLP2A-Cy5 and mouse B220, CD4, Gr1, and Mac1 antibodies and analyzed by fluorescence-activated cell sorting. Human radiation dose estimates for (64)Cu-LLP2A were extrapolated from mouse biodistribution data (6 time points, 0.78 MBq/animal, n= 4/group). Ten formalin-fixed paraffin-embedded bone marrow samples from deceased MM patients were stained with LLP2A-Cy5. RESULTS (64)Cu-LLP2A and LLP2A-Cy5 demonstrated high specificity for VLA-4-positive mouse 5TGM1-GFP myeloma and nonmalignant inflammatory host cells such as T cells and myeloid/monocytic cells. Ex vivo flow cytometric analysis supported a direct effect of myeloma on increased VLA-4 expression in host hematopoietic microenvironmental elements. SUVs and the number of medullar lesions detected by (64)Cu-LLP2A PET corresponded with increased monoclonal (M) protein (g/dL) in tumor-bearing mice over time (3.29 ± 0.58 at week 0 and 9.97 ± 1.52 at week 3). Dynamic PET with (64)Cu-LLP2A and (18)F-FDG demonstrated comparable SUV in the prominent lesions in the femur. Human radiation dose estimates indicated urinary bladder wall as the dose-limiting organ (0.200 mGy/MBq), whereas the dose to the red marrow was 0.006 mGy/MBq. The effective dose was estimated to be 0.017 mSv/MBq. Seven of the ten human samples displayed a high proportion of cells intensely labeled with LLP2A-Cy5 probe. CONCLUSION (64)Cu-LLP2A and LLP2A-Cy5 demonstrated binding specificity for VLA-4 in an immune-competent murine MM model. (64)Cu-LLP2A displayed favorable dosimetry for human studies and is a potential imaging candidate for overexpressed VLA-4.
Collapse
Affiliation(s)
- Deepti Soodgupta
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Haiying Zhou
- Mallinckrodt Institute of Radiology, Washington University Medical School, St. Louis, Missouri
| | - Wissam Beaino
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Lan Lu
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Michael Rettig
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Mark Snee
- Department of Genetics, Washington University Medical School, St. Louis, Missouri
| | - James Skeath
- Department of Genetics, Washington University Medical School, St. Louis, Missouri
| | - John F DiPersio
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Walter J Akers
- Mallinckrodt Institute of Radiology, Washington University Medical School, St. Louis, Missouri
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University Medical School, St. Louis, Missouri
| | - Carolyn J Anderson
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Michael H Tomasson
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Monica Shokeen
- Mallinckrodt Institute of Radiology, Washington University Medical School, St. Louis, Missouri
| |
Collapse
|
29
|
He Z, O'Neal J, Wilson WC, Mahajan N, Luo J, Wang Y, Su MY, Lu L, Skeath JB, Bhattacharya D, Tomasson MH. Deletion of Rb1 induces both hyperproliferation and cell death in murine germinal center B cells. Exp Hematol 2015; 44:161-5.e4. [PMID: 26607597 DOI: 10.1016/j.exphem.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/21/2015] [Accepted: 11/07/2015] [Indexed: 12/18/2022]
Abstract
The retinoblastoma gene (RB1) has been implicated as a tumor suppressor in multiple myeloma (MM), yet its role remains unclear because in the majority of cases with 13q14 deletions, un-mutated RB1 remains expressed from the retained allele. To explore the role of Rb1 in MM, we examined the functional consequences of single- and double-copy Rb1 loss in germinal center B cells, the cells of origin of MM. We generated mice without Rb1 function in germinal center B cells by crossing Rb1(Flox/Flox) with C-γ-1-Cre (Cγ1) mice expressing the Cre recombinase in class-switched B cells in a p107(-/-) background to prevent p107 from compensating for Rb1 loss (Cγ1-Rb1(F/F)-p107(-/-)). All mice developed normally, but B cells with two copies of Rb1 deleted (Cγ1-Rb1(F/F)-p107(-/-)) exhibited increased proliferation and cell death compared with Cγ1-Rb1(+/+)-p107(-/-) controls ex vivo. In vivo, Cγ1-Rb1(F/F)-p107(-/-) mice had a lower percentage of splenic B220+ cells and reduced numbers of bone marrow antigen-specific secreting cells compared with control mice. Our data indicate that Rb1 loss induces both cell proliferation and death in germinal center B cells. Because no B-cell malignancies developed after 1 year of observation, our data also suggest that Rb1 loss is not sufficient to transform post-germinal center B cells and that additional, specific mutations are likely required to cooperate with Rb1 loss to induce malignant transformation.
Collapse
Affiliation(s)
- Zhiwen He
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie O'Neal
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - William C Wilson
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Nitin Mahajan
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jun Luo
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Yinan Wang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Mack Y Su
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Lan Lu
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - James B Skeath
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Deepta Bhattacharya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Michael H Tomasson
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO.
| |
Collapse
|
30
|
Pan D, Kim B, Hu G, Gupta DS, Senpan A, Yang X, Schmieder A, Swain C, Wickline SA, Tomasson MH, Lanza GM. A strategy for combating melanoma with oncogenic c-Myc inhibitors and targeted nanotherapy. Nanomedicine (Lond) 2015; 10:241-51. [PMID: 25600969 DOI: 10.2217/nnm.14.101] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 11/21/2022] Open
Abstract
AIMS The activity of the transcription factor c-Myc is dependent upon heterodimerization with Max to control target gene transcription. Small-molecule inhibitors of c-Myc-Max have exhibited low potency and poor water solubility and are therefore unsuitable for in vivo application. We hypothesized that a nanomedicine approach incorporating a cryptic c-Myc inhibitor prodrug could be delivered and enzymatically released in order to effectively inhibit melanoma. MATERIALS & METHODS An Sn-2 lipase-labile Myc inhibitor prodrug was synthesized and included in two αvβ3-targeted nanoparticle platforms (20 and 200 nm). The inherent antiproliferate potency was compared with the lipid-free compound using human and mouse melanoma cell lines. RESULTS & CONCLUSION These data demonstrate for the first time a successful nanodelivery of c-Myc inhibitors and their potential use to prevent melanoma.
Collapse
Affiliation(s)
- Dipanjan Pan
- Department of Medicine, Washington University School of Medicine, 4320 Forest Park Avenue, Saint Louis, MO 63108, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Gupta DS, Pan D, Hu G, Senpan A, Yang X, Prochownik EV, Lanza GM, Tomasson MH. Abstract B46: VLA-4 targeted nanoparticles carrying a novel anti-Myc prodrug prolongs survival in a mouse model of multiple myeloma. Clin Cancer Res 2015. [DOI: 10.1158/1557-3265.hemmal14-b46] [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
The MYC oncoprotein drives multiple myeloma (MM) pathogenesis, but the utility of small molecule inhibitors of MYC-MAX dimerization is limited by poor efficacy. We determined the efficacy of lipase labile MYC-MAX inhibitor prodrug (MI1-PD) loaded nanoparticles targeted via integrin {alpha 4 beta1 α4β1) or Very Late Antigen-1 (VLA-4)} in myeloma mice. We hypothesized that NPs containing specific targeting to myeloma cells, would enhance the therapeutic efficacy of MI1-PD containing NPs. The antiproliferative activity of intergin VLA-4-Targeted MI-1PD NPs (iTM-NPs) was determined in mouse cell line (5TGM1) in vitro and its effect on the survival in C57Bl/KaLwRij-5TGM1 murine model of myeloma in vivo. iTM-NPs (approximately 20 nm in diameter, 5% w/w MI1-PD loading) under in vitro conditions exhibited inhibition of cell growth compared to the controls. Also, C57Bl/KaLwRij-5TGM1 mice that received intravenous injection of iTM-NPs demonstrated greater survival rate over the controls. These results demonstrate the feasibility of using VLA-4 targeted nanotherapy approach to improve the availability of anti-Myc small molecule inhibitors for multiple myeloma and other cancers.
Citation Format: Deepti Sood Gupta, Dipanjan Pan, Grace Hu, Anagana Senpan, Xiaoxiao Yang, Edward V. Prochownik, Gregory M. Lanza, Michael H. Tomasson. VLA-4 targeted nanoparticles carrying a novel anti-Myc prodrug prolongs survival in a mouse model of multiple myeloma. [abstract]. In: Proceedings of the AACR Special Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; Sep 20-23, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(17 Suppl):Abstract nr B46.
Collapse
Affiliation(s)
| | - Dipanjan Pan
- 2University of Illinois at Urbana-Champaign, Urbana, IL,
| | - Grace Hu
- 1Washington University in St. Louis, St. Louis, MO,
| | - Anagana Senpan
- 2University of Illinois at Urbana-Champaign, Urbana, IL,
| | | | | | | | | |
Collapse
|
32
|
Pan D, Pham CTN, Weilbaecher KN, Tomasson MH, Wickline SA, Lanza GM. Contact-facilitated drug delivery with Sn2 lipase labile prodrugs optimize targeted lipid nanoparticle drug delivery. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2015; 8:85-106. [PMID: 26296541 PMCID: PMC4709477 DOI: 10.1002/wnan.1355] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/18/2015] [Indexed: 01/10/2023]
Abstract
Sn2 lipase labile phospholipid prodrugs in conjunction with contact-facilitated drug delivery offer an important advancement in Nanomedicine. Many drugs incorporated into nanosystems, targeted or not, are substantially lost during circulation to the target. However, favorably altering the pharmacokinetics and volume of distribution of systemic drug delivery can offer greater efficacy with lower toxicity, leading to new prolonged-release nanoexcipients. However, the concept of achieving Paul Erhlich's inspired vision of a 'magic bullet' to treat disease has been largely unrealized due to unstable nanomedicines, nanosystems achieving low drug delivery to target cells, poor intracellular bioavailability of endocytosed nanoparticle payloads, and the substantial biological barriers of extravascular particle penetration into pathological sites. As shown here, Sn2 phospholipid prodrugs in conjunction with contact-facilitated drug delivery prevent premature drug diffusional loss during circulation and increase target cell bioavailability. The Sn2 phospholipid prodrug approach applies equally well for vascular constrained lipid-encapsulated particles and micelles the size of proteins that penetrate through naturally fenestrated endothelium in the bone marrow or thin-walled venules of an inflamed microcirculation. At one time Nanomedicine was considered a 'Grail Quest' by its loyal opposition and even many in the field adsorbing the pains of a long-learning curve about human biology and particles. However, Nanomedicine with innovations like Sn2 phospholipid prodrugs has finally made 'made the turn' toward meaningful translational success.
Collapse
Affiliation(s)
- Dipanjan Pan
- Departments of Bioengineering, Materials Science and Engineering, Beckman Institute, University of Illinois, Urbana-Champaign, IL, USA
| | - Christine T N Pham
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine N Weilbaecher
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, MO, USA
| | - Michael H Tomasson
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, MO, USA
| | - Samuel A Wickline
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory M Lanza
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
33
|
Mahajan N, Maggi LB, Tomasson MH, Weber JD. Abstract LB-298: The multiple-myeloma associated snoRNA, ACA11 increases oxidative stress and cell proliferation. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-lb-298] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Multiple myeloma (MM) is an incurable malignancy of antibody secreting plasma B cells. The t(4;14) translocation is detected in 20% of MM and is associated with shortened patient survival. Although the t(4;14) is known to up regulate the MMSET proteins, its role in MM remains unclear. Previously, we identified a novel orphan box H/ACA class small nucleolar RNA (snoRNA), that is located within intron 19 of MMSET, and is expressed in MM cells harboring the t(4;14) translocation. H/ACA small RNAs are an evolutionarily conserved class of abundant noncoding RNAs (ncRNA) involved in a diverse range of processes including posttranslational modifications of functional RNAs, preribosomal RNA processing, and telomere maintenance, yet their contribution to human disease remains largely unexplored. In this study, t(4:14) positive and negative MM patient tumor cells were analyzed by RNA sequencing. This revealed a unique signature of up regulated genes involved in mitochondrial respiration and oxidative stress. Our hypothesis is ACA11 plays critical role in MM cell proliferation and cell transformation by increasing oxidative stress. We found that acute ACA11 overexpression leads to the increased oxidative stress in primary splenic B-cells, established myeloma cell lines, as well as embryonic fibroblasts. In particular, cells overexpressing ACA11 showed enhanced proliferation, significantly larger colony sizes in soft agar assays, and elevated ERK1/2 phosphorylation, a downstream consequence of oxidative stress. In addition, we found that the transcription factor nuclear factor erythroid-derived 2-related factor 2 (Nrf2), which regulates anti-oxidant signaling, dissociated from Keap1 and translocated to the nucleus, but failed to activate anti-oxidant downstream targets in ACA11 overexpressing cells. Furthermore, ACA11 up regulated TXNIP, which encodes an inhibitor of ROS scavenger thioredoxin. In conclusion, we propose that acute overexpression of ACA11 up regulates TXNIP and suppresses the ability of Nrf2 to induce target anti-oxidants genes, resulting in increased oxidative stress and cell proliferation. These changes may be critical events in the development and/or progression of multiple myeloma.
Citation Format: Nitin Mahajan, Leonard B. Maggi, Michael H. Tomasson, Jason D. Weber. The multiple-myeloma associated snoRNA, ACA11 increases oxidative stress and cell proliferation. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-298. doi:10.1158/1538-7445.AM2015-LB-298
Collapse
|
34
|
Rand KA, Song C, Dean E, Serie D, Curtin K, Hazelett D, Hwang AE, Sheng X, Stram A, Van Den Berg DJ, Huff CA, Bernal-Mizrachi L, Tomasson MH, Ailawadhi S, De Roos A, Singhal S, Pawlish K, Peters E, Bock C, Conti DV, Colditz G, Zimmerman T, Huntsman S, Graff J, Chanock SJ, Lieber M, Mehta J, Klein EA, Janakiraman N, Severson RK, Brooks-Wilson AR, Rajkumar V, Brown EE, Kolonel L, Slager S, Henderson BE, Giles GG, Spinelli JJ, Chiu B, Anderson KC, Zonder J, Orlowski RZ, Lonial S, Camp N, Vachon C, Ziv E, Stram DO, Haiman CA, Cozen W. Abstract 4629: Multiple myeloma susceptibility loci examined in African and European ancestry populations. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-4629] [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
Genome-wide association studies (GWAS) of multiple myeloma (MM) in Northern Europeans have identified seven novel risk loci (2p23.3, 3p22.1, 3q26.2, 6p21.33, 7p15.3, 17p11.2, 22q13.1). We performed a multiethnic meta-analysis of these regions in 1,274 MM patients and 1,486 controls of European ancestry (EA) and 1,049 MM patients and 7,080 controls of African ancestry (AA), leveraging the differential linkage-disequilibrium of these populations in order to better localize the putative functional variants. We observed directionally consistent effects for all seven index SNPs in both populations, with four significantly associated (p<0.05) with risk in EAs (3p22.1, 7p15.3, 17p11.2, 22q13.1), and two significantly associated with risk in AAs (7p15.3 and 22q13.1). In a fixed effects meta-analysis of six regions (excluding the HLA region on chromosome 6), variation in five of the regions (2p33.3, 3p22.1, 7p15.3, 17p11.2, 22q13.1) had statistically significant associations with risk (Table 1). In one region, the index variant had the strongest association [rs4487645 at 7p15.3, (OR = 1.30, p = 8.7×10−8)]. Five of the six most significantly associated variants identified in the multiethnic analyses overlapped with biologically relevant features indicating regulatory activity based on CD20+ (B lymphocyte) cells, showing evidence of potential function; those included a missense variant in (17p11.2, rs34562254, Pro251Leu) in TNFRSF13B, which encodes a lymphocyte-specific protein in the tumor necrosis factor receptor family that interacts with the NF-kb pathway. Our study shows that these regions are important in MM risk across ethnicities and further supports the use of multiple ethnic groups in genetic studies to enhance identification of risk variants.
Table 1.Most significant associations for each region in the multiethnic meta-analysis.Individuals of European AncestryIndividuals of African AncestryMulitethnic Metar2 with IndexcCHRSNPRAaFreqbORP-valueFreqbORP-valueORP-valueP-het2rs732075G0.591.222.0×10−30.621.122.0×10−21.162.6×10−40.280.09/0.283rs73069394A0.191.243.0×10−30.621.181.5×10−21.201.3×10−50.550.77/0.963rs12637184G0.761.136.0×10−20.921.192.7×10−11.151.0×10−20.640.94/1.007rs4487645C0.671.237.0×10−40.891.485.5×10−51.308.7×10−80.07-d17rs34562254A0.121.452.4×10−50.131.212.2×10−31.312.5×10−60.120.33/0.9022rs139400T0.491.224.0×10−40.531.172.1×10−31.191.2×10−60.630.63/0.96aRisk allelebFrequency of the risk allele in European and African ancestry studiescr2 metrics based on 1000 Genomes Project AFR/EUR populationsdIndex SNP
Citation Format: Kristin A. Rand, Chi Song, Eric Dean, Daniel Serie, Karen Curtin, Dennis Hazelett, Amie E. Hwang, Xin Sheng, Alex Stram, David J. Van Den Berg, Carol Ann Huff, Leon Bernal-Mizrachi, Michael H. Tomasson, Sikander Ailawadhi, Anneclaire De Roos, Seema Singhal, Karen Pawlish, Edward Peters, Catherine Bock, David V. Conti, Graham Colditz, Todd Zimmerman, Scott Huntsman, John Graff, African Ancestry Prostate Cancer GWAS Consortium,African Ancestry Breast Cancer GWAS Consortium, Stephen J. Chanock, Michael Lieber, Jayesh Mehta, Eric A. Klein, Nalini Janakiraman, Richard K. Severson, Angela R. Brooks-Wilson, Vincent Rajkumar, Elizabeth E. Brown, Laurence Kolonel, Susan Slager, Brian E. Henderson, Graham G. Giles, John J. Spinelli, Brian Chiu, Kenneth C. Anderson, Jeffrey Zonder, Robert Z. Orlowski, Sagar Lonial, Nicola Camp, Celine Vachon, Elad Ziv, Dan O. Stram, Christopher A. Haiman, Wendy Cozen. Multiple myeloma susceptibility loci examined in African and European ancestry populations. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4629. doi:10.1158/1538-7445.AM2015-4629
Collapse
Affiliation(s)
- Kristin A. Rand
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Chi Song
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Eric Dean
- 2University of California San Francisco, San Francisco, CA
| | | | - Karen Curtin
- 4University of Utah School of Medicine, Salt Lake City, UT
| | - Dennis Hazelett
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Amie E. Hwang
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Xin Sheng
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Alex Stram
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - David J. Van Den Berg
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Michael H. Tomasson
- 7Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | | | - Seema Singhal
- 9Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
| | - Karen Pawlish
- 10New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ
| | - Edward Peters
- 11Louisiana State University School of Public Health, New Orleans, LA
| | - Catherine Bock
- 12Karmanos Cancer Institute, Wayne State University of Medicine, Detroit, MI
| | - David V. Conti
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Graham Colditz
- 7Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - Scott Huntsman
- 2University of California San Francisco, San Francisco, CA
| | - John Graff
- 14Rutgers-Robert Wood Johnson Medical School, Rutgers State University of New Jersey, New Brunswick, NJ
| | - Stephen J. Chanock
- 15Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Michael Lieber
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Jayesh Mehta
- 9Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
| | | | | | - Richard K. Severson
- 12Karmanos Cancer Institute, Wayne State University of Medicine, Detroit, MI
| | | | | | | | | | | | - Brian E. Henderson
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Graham G. Giles
- 22Cancer Council of Victoria, University of Melbourne, and Monash University, Melbourne, Australia
| | - John J. Spinelli
- 23Cancer Control Research and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Jeffrey Zonder
- 12Karmanos Cancer Institute, Wayne State University of Medicine, Detroit, MI
| | - Robert Z. Orlowski
- 25The University of Texas MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Sagar Lonial
- 6Emory University School of Medicine, Atlanta, GA
| | - Nicola Camp
- 4University of Utah School of Medicine, Salt Lake City, UT
| | | | - Elad Ziv
- 2University of California San Francisco, San Francisco, CA
| | - Dan O. Stram
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Christopher A. Haiman
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Wendy Cozen
- 1Keck School of Medicine of USC and Norris Comprehensive Cancer Center, Los Angeles, CA
| | | |
Collapse
|
35
|
Amend SR, Wilson WC, Chu L, Lu L, Liu P, Serie D, Su X, Xu Y, Wang D, Gramolini A, Wen XY, O’Neal J, Hurchla M, Vachon CM, Colditz G, Vij R, Weilbaecher KN, Tomasson MH. Whole Genome Sequence of Multiple Myeloma-Prone C57BL/KaLwRij Mouse Strain Suggests the Origin of Disease Involves Multiple Cell Types. PLoS One 2015; 10:e0127828. [PMID: 26020268 PMCID: PMC4447437 DOI: 10.1371/journal.pone.0127828] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 02/02/2015] [Accepted: 03/10/2015] [Indexed: 01/06/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is the requisite precursor to multiple myeloma (MM), a malignancy of antibody-producing plasma B-cells. The genetic basis of MGUS and its progression to MM remains poorly understood. C57BL/KaLwRij (KaLwRij) is a spontaneously-derived inbred mouse strain with a high frequency of benign idiopathic paraproteinemia (BIP), a phenotype with similarities to MGUS including progression to MM. Using mouse haplotype analysis, human MM SNP array data, and whole exome and whole genome sequencing of KaLwRij mice, we identified novel KaLwRij gene variants, including deletion of Samsn1 and deleterious point mutations in Tnfrsf22 and Tnfrsf23. These variants significantly affected multiple cell types implicated in MM pathogenesis including B-cells, macrophages, and bone marrow stromal cells. These data demonstrate that multiple cell types contribute to MM development prior to the acquisition of somatic driver mutations in KaLwRij mice, and suggest that MM may an inherently non-cell autonomous malignancy.
Collapse
Affiliation(s)
- Sarah R. Amend
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - William C. Wilson
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Liang Chu
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Lan Lu
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Pengyuan Liu
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Daniel Serie
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Xinming Su
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Yalin Xu
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Dingyan Wang
- Department of Physiology, University of Toronto, Toronto, Canada
| | | | - Xiao-Yan Wen
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Julie O’Neal
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Michelle Hurchla
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Celine M. Vachon
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Graham Colditz
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Ravi Vij
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Katherine N. Weilbaecher
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Michael H. Tomasson
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States of America
| |
Collapse
|
36
|
Soodgupta D, Pan D, Cui G, Senpan A, Yang X, Lu L, Weilbaecher KN, Prochownik EV, Lanza GM, Tomasson MH. Small Molecule MYC Inhibitor Conjugated to Integrin-Targeted Nanoparticles Extends Survival in a Mouse Model of Disseminated Multiple Myeloma. Mol Cancer Ther 2015; 14:1286-1294. [PMID: 25824336 DOI: 10.1158/1535-7163.mct-14-0774-t] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/23/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED Multiple myeloma pathogenesis is driven by the MYC oncoprotein, its dimerization with MAX, and the binding of this heterodimer to E-Boxes in the vicinity of target genes. The systemic utility of potent small molecule inhibitors of MYC-MAX dimerization was limited by poor bioavailability, rapid metabolism, and inadequate target site penetration. We hypothesized that new lipid-based MYC-MAX dimerization inhibitor prodrugs delivered via integrin-targeted nanoparticles (NP) would overcome prior shortcomings of MYC inhibitor approaches and prolong survival in a mouse model of cancer. An Sn 2 lipase-labile prodrug inhibitor of MYC-MAX dimerization (MI1-PD) was developed which decreased cell proliferation and induced apoptosis in cultured multiple myeloma cell lines alone (P < 0.05) and when incorporated into integrin-targeted lipid-encapsulated NPs (P < 0.05). Binding and efficacy of NPs closely correlated with integrin expression of the target multiple myeloma cells. Using a KaLwRij metastatic multiple myeloma mouse model, VLA-4-targeted NPs (20 nm and 200 nm) incorporating MI1-PD (D) NPs conferred significant survival benefits compared with respective NP controls, targeted (T) no-drug (ND), and untargeted (NT) control NPs (T/D 200: 46 days vs. NT/ND 28 days, P < 0.05 and T/D 20: 52 days vs. NT/ND 29 days, P = 0.001). The smaller particles performed better of the two sizes. Neither MI1 nor MI1-PD provided survival benefit when administered systemically as free compounds. These results demonstrate for the first time that a small molecule inhibitor of the MYC transcription factor can be an effective anticancer agent when delivered using a targeted nanotherapy approach.
Collapse
Affiliation(s)
- Deepti Soodgupta
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Dipanjan Pan
- Department of Bioengineering, University of Illinois, Urbana-Champaign, Illinois
| | - Grace Cui
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Angana Senpan
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Xiaoxia Yang
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Lan Lu
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Katherine N Weilbaecher
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Edward V Prochownik
- Division of Pediatric Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania
| | - Gregory M Lanza
- Division of Cardiology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| | - Michael H Tomasson
- Division of Oncology, Department of Medicine, Washington University Medical School, St. Louis, Missouri
| |
Collapse
|
37
|
Fiala MA, Finney JD, Stockerl-Goldstein KE, Tomasson MH, DiPersio JF, Vij R, Wildes TM. Re: Disparities in Utilization of Autologous Hematopoietic Cell Transplantation for Treatment of Multiple Myeloma. Biol Blood Marrow Transplant 2015; 21:1153-4. [PMID: 25771403 DOI: 10.1016/j.bbmt.2015.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 02/16/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
Costa et al. recently reported that racial disparities prevented nearly 40% of non-Hispanic blacks with multiple myeloma (MM) from undergoing stem cell transplantation (SCT), but the authors were unable to provide an explanation for the disparities because of limitations of their datasets. They hypothesized that socioeconomic status (SES) and/or insurance providers might account for the disparity. To examine the issue raised by Costa et al., we performed a secondary analysis using hierarchical multivariate logistic regression with data previously collected to determine if age at diagnosis, sex, SES, primary insurance provider at diagnosis, and comorbidity score help explain the racial disparities in SCT utilization. A model of race, age, sex, SES, insurance provider, and comorbidity score was the most accurate model in predicting stem cell utilization status (χ(2)[12] = 193.859; P < .001; area under the curve = .837; P < .001). After controlling for the covariates, black patients were less likely to undergo SCT than white patients (adjusted odds ratio, .49; 95% confidence interval, .27 to .89; P = .013). In conclusion, we also observed racial disparities between black and white patients with MM in SCT utilization and these are not fully accounted for by the covariates age, sex, SES, insurance provider, and comorbidity score.
Collapse
Affiliation(s)
- Mark A Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
| | - Joseph D Finney
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Keith E Stockerl-Goldstein
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael H Tomasson
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - John F DiPersio
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ravi Vij
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Tanya M Wildes
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
38
|
Fiala MA, Finney JD, Liu J, Stockerl-Goldstein KE, Tomasson MH, Vij R, Wildes TM. Socioeconomic status is independently associated with overall survival in patients with multiple myeloma. Leuk Lymphoma 2015; 56:2643-9. [PMID: 25651424 DOI: 10.3109/10428194.2015.1011156] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Population-based studies suggest that black patients with multiple myeloma (MM) have a higher mortality rate than white patients. However, other studies suggest that this disparity is related to socioeconomic status (SES) rather than race. To provide clarity on this topic, we reviewed 562 patients diagnosed with MM at our institution. Patients with high SES had a median overall survival (OS) of 62.8 months (95% confidence interval [CI] 43.1-82.6 months), compared to 53.7 months (45.2-62.3 months) and 48.6 months (40.4-56.8 months) for middle and low SES, respectively (p = 0.015). After controlling for race, age, year of diagnosis, severity of comorbidities, stem cell transplant utilization and insurance provider, patients with low SES had a 54% increase in mortality rate relative to patients with high SES. To support our findings, we performed a similar analysis of 45,505 patients with MM from the Surveillance, Epidemiology and End Results-18 (SEER) database. Low SES is independently associated with poorer OS in MM.
Collapse
Affiliation(s)
- Mark A Fiala
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Joseph D Finney
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Jingxia Liu
- b Division of Biostatistics, Department of Medicine , Washington University School of Medicine , St. Louis , MO , USA
| | | | - Michael H Tomasson
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Ravi Vij
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Tanya M Wildes
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| |
Collapse
|
39
|
Soodgupta D, Pan D, Cui G, Senpan A, Yang X, Wickline SA, Prochownik EV, Weilbaecher KN, Tomasson MH, Lanza GM. Abstract 5381: VLA-4 targeted nanoparticles deliver a cMYC-MAX prodrug antagonist extends survival a metastatic myeloma mouse model. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5381] [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
Background: While it is well known that MYC oncoprotein drives multiple myeloma (MM) pathogenesis, the development of several small-molecule inhibitors of the c-MYC/MAX interaction has been limited by rapid systemic metabolism, poor bioavailability and the inability of the drug to reach inhibitory concentrations in the tumor.
Objective: The goal of this study was to develop and deliver an effective VLA-4-targeted Sn 2 lipase-labile Myc-inhibitor nanotherapy.
Experimental Methods: A novel Sn 2 phosphatidylcholine-cMyc-Max antagonist prodrug (M1-PD) was designed, synthesized, characterized and evaluated in vitro and in vivo. In vitro, titrated free M1-PD was compared to free Myc-antagonist in human MM cell lines (H929 and U266) and mouse MM (5TGM1). M1-PD was incorporated into two lipid-based nanoparticle genera (<20nm and ∼200nm) that were functionalized for MM targeting using a peptidomimetic VLA-4-lipid ligand. The nanoparticles were physico-chemically characterized and evaluated for their relative pharmacokinetics in vivo. Effectiveness of the two VLA-4-targeted M1-PD nanotherapies were evaluated in MM cell cultures, correlated with VLA-4 expression levels, and then studied in C57BL/KaLwRij mice with metastatic 5TGM1.
Results: Bioactivity of free M1-PD was several orders magnitude more potent that the free cMyc antagonist in cell culture. Binding and efficacy of M1-PD nanoparticles correlated with integrin expression in target cells. VLA-4-M1-PD nanoparticles (<20nm and ∼200nm) equivalently inhibited MM cell growth in vitro compared to controls. In C57BL/KaLwRij mice with metastatic 5TGM1, VLA-4-MI1-PD 20nm micelles conferred significant survival benefit (T/D) over the 20nm targeted no drug (T/ND) or untreated controls (NT/ND) (52 days vs. 29 days, p=0.001) and versus the 200nm VLA-4-MI1-PD nanocolloid and its controls.
Conclusion: These finding support the feasibility of a new VLA-4-directed nanotherapy to deliver lipase-labile cMyc prodrug to disrupt MYC-MAX dimerization and improve MM survival.
Citation Format: Deepti Soodgupta, Dipanjan Pan, Grace Cui, Angana Senpan, Xiaoxia Yang, Samuel A. Wickline, Edward V. Prochownik, Katherine N. Weilbaecher, Michael H. Tomasson, Gregory M. Lanza. VLA-4 targeted nanoparticles deliver a cMYC-MAX prodrug antagonist extends survival a metastatic myeloma mouse model. [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 5381. doi:10.1158/1538-7445.AM2014-5381
Collapse
Affiliation(s)
| | | | - Grace Cui
- 1Washington University Medical School, St. Louis, MO
| | | | - Xiaoxia Yang
- 1Washington University Medical School, St. Louis, MO
| | | | | | | | | | | |
Collapse
|
40
|
Miller CA, White BS, Dees ND, Griffith M, Welch JS, Griffith OL, Vij R, Tomasson MH, Graubert TA, Walter MJ, Ellis MJ, Schierding W, DiPersio JF, Ley TJ, Mardis ER, Wilson RK, Ding L. SciClone: inferring clonal architecture and tracking the spatial and temporal patterns of tumor evolution. PLoS Comput Biol 2014; 10:e1003665. [PMID: 25102416 PMCID: PMC4125065 DOI: 10.1371/journal.pcbi.1003665] [Citation(s) in RCA: 300] [Impact Index Per Article: 30.0] [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: 09/04/2013] [Accepted: 04/28/2014] [Indexed: 01/06/2023] Open
Abstract
The sensitivity of massively-parallel sequencing has confirmed that most cancers are oligoclonal, with subpopulations of neoplastic cells harboring distinct mutations. A fine resolution view of this clonal architecture provides insight into tumor heterogeneity, evolution, and treatment response, all of which may have clinical implications. Single tumor analysis already contributes to understanding these phenomena. However, cryptic subclones are frequently revealed by additional patient samples (e.g., collected at relapse or following treatment), indicating that accurately characterizing a tumor requires analyzing multiple samples from the same patient. To address this need, we present SciClone, a computational method that identifies the number and genetic composition of subclones by analyzing the variant allele frequencies of somatic mutations. We use it to detect subclones in acute myeloid leukemia and breast cancer samples that, though present at disease onset, are not evident from a single primary tumor sample. By doing so, we can track tumor evolution and identify the spatial origins of cells resisting therapy.
Collapse
Affiliation(s)
- Christopher A. Miller
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
| | - Brian S. White
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Nathan D. Dees
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
| | - Malachi Griffith
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University, St. Louis, Missouri, United States of America
| | - John S. Welch
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Obi L. Griffith
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Ravi Vij
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Michael H. Tomasson
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Timothy A. Graubert
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Matthew J. Walter
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Matthew J. Ellis
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | | | - John F. DiPersio
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Timothy J. Ley
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Elaine R. Mardis
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Richard K. Wilson
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Li Ding
- The Genome Institute, Washington University, St. Louis, Missouri, United States of America
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, United States of America
| |
Collapse
|
41
|
Fiala MA, Finney JD, Liu J, Stockerl-Goldstein K, Tomasson MH, Vij R, Wildes TM. The impact of race and socioeconomic status on survival in multiple myeloma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17554] [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: 11/20/2022] Open
Affiliation(s)
- Mark A Fiala
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Joseph D Finney
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jingxia Liu
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | - Ravi Vij
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | |
Collapse
|
42
|
Beason TS, Chang SH, Sanfilippo KM, Luo S, Colditz GA, Vij R, Tomasson MH, Dipersio JF, Stockerl-Goldstein K, Ganti A, Wildes T, Carson KR. Influence of body mass index on survival in veterans with multiple myeloma. Oncologist 2013; 18:1074-9. [PMID: 24048366 DOI: 10.1634/theoncologist.2013-0015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We investigated the association between body mass index (BMI) at the time of multiple myeloma (MM) diagnosis and overall survival in a cohort of patients within the Veterans Health Administration system. We also evaluated the association between weight loss in the year prior to diagnosis and survival. PATIENTS AND METHODS Prospective analysis was performed on a retrospectively assembled cohort of 2,968 U.S. veterans diagnosed and treated for MM between September 1, 1999, and September 30, 2009, with follow-up information through October 22, 2011. Cox modeling controlling for patient- and disease-related prognostic variables was used to analyze the data. RESULTS Underweight patients (BMI <18.5 kg/m2) had increased mortality, whereas patients who were overweight (BMI 25-29.9 kg/m2) and obese (BMI ≥30 kg/m2) had lower mortality compared with healthy-weight patients (BMI 18.5-24.9 kg/m2). Weight loss ≥10% of baseline in the year before diagnosis was also associated with increased mortality and made the association between increased BMI and survival nonsignificant. CONCLUSION Disease-related weight loss may be an important and heretofore unknown indicator of poor prognosis in MM. Assessment of weight loss prior to MM diagnosis should become a standard component of the clinical history in patients with newly diagnosed MM. Further research may identify relationships between disease-related weight loss and currently used prognostic factors in MM, further defining the role of this clinical factor in prognostic stratification.
Collapse
Affiliation(s)
- Tracey S Beason
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Wang TF, Ahluwalia R, Fiala MA, Trinkaus KM, Cox DP, Jaenicke M, Moliske CC, Carson KR, Wildes TM, Tomasson MH, Stockerl-Goldstein KE, Vij R. The characteristics and outcomes of patients with multiple myeloma dual refractory or intolerant to bortezomib and lenalidomide in the era of carfilzomib and pomalidomide. Leuk Lymphoma 2013; 55:337-41. [PMID: 23662990 DOI: 10.3109/10428194.2013.803547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patients with multiple myeloma who are refractory or intolerant to both bortezomib and lenalidomide have a poor prognosis. Next-generation therapies carfilzomib and pomalidomide have shown promising activity in this dual refractory population. Here we describe the clinical characteristics and ascertain the effects of carfilzomib and pomalidomide on survival in this patient cohort. We retrospectively reviewed the records of 65 patients with dual refractory/intolerant myeloma diagnosed between January 2007 and May 2012 at a single institution. The median overall survival (OS) from the time patients became dual refractory/intolerant was 10.2 months. Patients who received carfilzomib or pomalidomide after they became dual refractory/intolerant had a better OS compared to those who did not (12.6 vs. 6.8 months, p = 0.03 by Wilcoxon test). Prospective randomized control trials are needed for confirmation.
Collapse
|
44
|
Ley TJ, Miller C, Ding L, Raphael BJ, Mungall AJ, Robertson AG, Hoadley K, Triche TJ, Laird PW, Baty JD, Fulton LL, Fulton R, Heath SE, Kalicki-Veizer J, Kandoth C, Klco JM, Koboldt DC, Kanchi KL, Kulkarni S, Lamprecht TL, Larson DE, Lin L, Lu C, McLellan MD, McMichael JF, Payton J, Schmidt H, Spencer DH, Tomasson MH, Wallis JW, Wartman LD, Watson MA, Welch J, Wendl MC, Ally A, Balasundaram M, Birol I, Butterfield Y, Chiu R, Chu A, Chuah E, Chun HJ, Corbett R, Dhalla N, Guin R, He A, Hirst C, Hirst M, Holt RA, Jones S, Karsan A, Lee D, Li HI, Marra MA, Mayo M, Moore RA, Mungall K, Parker J, Pleasance E, Plettner P, Schein J, Stoll D, Swanson L, Tam A, Thiessen N, Varhol R, Wye N, Zhao Y, Gabriel S, Getz G, Sougnez C, Zou L, Leiserson MDM, Vandin F, Wu HT, Applebaum F, Baylin SB, Akbani R, Broom BM, Chen K, Motter TC, Nguyen K, Weinstein JN, Zhang N, Ferguson ML, Adams C, Black A, Bowen J, Gastier-Foster J, Grossman T, Lichtenberg T, Wise L, Davidsen T, Demchok JA, Shaw KRM, Sheth M, Sofia HJ, Yang L, Downing JR, Eley G. Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia. N Engl J Med 2013; 368:2059-74. [PMID: 23634996 PMCID: PMC3767041 DOI: 10.1056/nejmoa1301689] [Citation(s) in RCA: 3590] [Impact Index Per Article: 326.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many mutations that contribute to the pathogenesis of acute myeloid leukemia (AML) are undefined. The relationships between patterns of mutations and epigenetic phenotypes are not yet clear. METHODS We analyzed the genomes of 200 clinically annotated adult cases of de novo AML, using either whole-genome sequencing (50 cases) or whole-exome sequencing (150 cases), along with RNA and microRNA sequencing and DNA-methylation analysis. RESULTS AML genomes have fewer mutations than most other adult cancers, with an average of only 13 mutations found in genes. Of these, an average of 5 are in genes that are recurrently mutated in AML. A total of 23 genes were significantly mutated, and another 237 were mutated in two or more samples. Nearly all samples had at least 1 nonsynonymous mutation in one of nine categories of genes that are almost certainly relevant for pathogenesis, including transcription-factor fusions (18% of cases), the gene encoding nucleophosmin (NPM1) (27%), tumor-suppressor genes (16%), DNA-methylation-related genes (44%), signaling genes (59%), chromatin-modifying genes (30%), myeloid transcription-factor genes (22%), cohesin-complex genes (13%), and spliceosome-complex genes (14%). Patterns of cooperation and mutual exclusivity suggested strong biologic relationships among several of the genes and categories. CONCLUSIONS We identified at least one potential driver mutation in nearly all AML samples and found that a complex interplay of genetic events contributes to AML pathogenesis in individual patients. The databases from this study are widely available to serve as a foundation for further investigations of AML pathogenesis, classification, and risk stratification. (Funded by the National Institutes of Health.).
Collapse
|
45
|
Dees ND, Miller CA, White BS, Schierding W, Vij R, Tomasson MH, Welch JS, Graubert TA, Walter MJ, Ley TJ, DiPersio JF, Mardis ER, Wilson RK, Ding L. Abstract LB-232: Tumor clonality detection using next generation sequencing data. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-lb-232] [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
A tumor's somatic variants, regardless of their significance in disease etiology, serve as genetic markers that capture the evolutionary history of clones and thus may be used for identifying them. We have previously identified steps along this evolutionary trajectory by discovering a broad range of variants, including exonic, intronic, and intergenic mutations, using whole genome sequencing (WGS) and by obtaining deep read counts of those variants using capture-based, targeted re-sequencing. Most of these variants, in most of the tumors analyzed, form clusters. This has revealed that most tumors are multi-clonal in composition with cellular sub-populations having distinct genomes harboring diverse somatic variants. Understanding the clonal diversity and composition of a tumor sample may have implications for clinical treatment, while the clonal evolution across tumor and relapse samples provides insight into disease progression.
Here we describe our approach for inferring clones using standard single nucleotide variant (SNV) and copy number alteration (CNA) data obtained from next-generation sequencing of a normal sample and one or more diseased (e.g., tumor or relapse) samples. Variants are clustered according to their deep-read-count-derived frequencies using a variational Bayesian approach to Beta mixture modeling, through which outliers and the number of clusters are identified automatically. The method's probabilistic interpretation provides a quantifiable measure of confidence in a resulting cluster, for example, through a standard error of the mean. We show that amplifications and deletions may induce artifactual clones, thus highlighting the importance of accounting for copy number events in interpreting SNV data for inferring clones. We demonstrate the performance of our approach using published acute myeloid leukemia tumor and relapse pairs as well as unpublished multiple myeloma WGS data sets. However, the approach is applicable to solid tumors as well and has been used to cluster six-dimensional variant data from a breast tumor and five relapses originating from the same patient.
Citation Format: Nathan D. Dees, Christopher A. Miller, Brian S. White, William Schierding, Ravi Vij, Michael H. Tomasson, John S. Welch, Timothy A. Graubert, Matthew J. Walter, Timothy J. Ley, John F. DiPersio, Elaine R. Mardis, Richard K. Wilson, Li Ding. Tumor clonality detection using next generation sequencing data. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-232. doi:10.1158/1538-7445.AM2013-LB-232
Collapse
Affiliation(s)
| | | | | | | | - Ravi Vij
- Washington University, St Louis, MO
| | | | | | | | | | | | | | | | | | - Li Ding
- Washington University, St Louis, MO
| |
Collapse
|
46
|
Soodgupta D, Hurchla MA, Jiang M, Zheleznyak A, Weilbaecher KN, Anderson CJ, Tomasson MH, Shokeen M. Very late antigen-4 (α(4)β(1) Integrin) targeted PET imaging of multiple myeloma. PLoS One 2013; 8:e55841. [PMID: 23409060 PMCID: PMC3568146 DOI: 10.1371/journal.pone.0055841] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 10/12/2012] [Accepted: 01/02/2013] [Indexed: 02/04/2023] Open
Abstract
Biomedical imaging techniques such as skeletal survey and (18)F-fluorodeoxyglucose (FDG)/Positron Emission Tomography (PET) are frequently used to diagnose and stage multiple myeloma (MM) patients. However, skeletal survey has limited sensitivity as it can detect osteolytic lesions only after 30-50% cortical bone destruction, and FDG is a marker of cell metabolism that has limited sensitivity for intramedullary lesions in MM. Targeted, and non-invasive novel probes are needed to sensitively and selectively image the unique molecular signatures and cellular processes associated with MM. Very late antigen-4 (VLA-4; also called α(4)β(1) integrin) is over-expressed on MM cells, and is one of the key mediators of myeloma cell adhesion to the bone marrow (BM) that promotes MM cell trafficking and drug resistance. Here we describe a proof-of-principle, novel molecular imaging strategy for MM tumors using a VLA-4 targeted PET radiopharmaceutical, (64)Cu-CB-TE1A1P-LLP2A. Cell uptake studies in a VLA-4-positive murine MM cell line, 5TGM1, demonstrated receptor specific uptake (P<0.0001, block vs. non-block). Tissue biodistribution at 2 h of (64)Cu-CB-TE1A1P-LLP2A in 5TGM1 tumor bearing syngeneic KaLwRij mice demonstrated high radiotracer uptake in the tumor (12±4.5%ID/g), and in the VLA-4 rich organs, spleen (8.8±1.0%ID/g) and marrow (11.6±2.0%ID/g). Small animal PET/CT imaging with (64)Cu-CB-TE1A1P-LLP2A demonstrated high uptake in the 5TGM1 tumors (SUV 6.6±1.1). There was a 3-fold reduction in the in vivo tumor uptake in the presence of blocking agent (2.3±0.4). Additionally, (64)Cu-CB-TE1A1P-LLP2A demonstrated high binding to the human MM cell line RPMI-8226 that was significantly reduced in the presence of the cold targeting agent. These results provide pre-clinical evidence that VLA-4-targeted imaging using (64)Cu-CB-TE1A1P-LLP2A is a novel approach to imaging MM tumors.
Collapse
Affiliation(s)
- Deepti Soodgupta
- Department of Medicine, Washington University, St. Louis, Missouri, United States of America
| | - Michelle A. Hurchla
- Department of Medicine, Washington University, St. Louis, Missouri, United States of America
| | - Majiong Jiang
- Department of Chemistry, Washington University, St. Louis, Missouri, United States of America
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States of America
| | - Alexander Zheleznyak
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States of America
| | | | - Carolyn J. Anderson
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States of America
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pennsylvania, United States of America
| | - Michael H. Tomasson
- Department of Medicine, Washington University, St. Louis, Missouri, United States of America
- * E-mail: (MHT); (MS)
| | - Monica Shokeen
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States of America
- * E-mail: (MHT); (MS)
| |
Collapse
|
47
|
Hucthagowder V, Meyer R, Mullins C, Nagarajan R, DiPersio JF, Vij R, Tomasson MH, Kulkarni S. Resequencing analysis of the candidate tyrosine kinase and RAS pathway gene families in multiple myeloma. Cancer Genet 2012; 205:474-8. [PMID: 22939401 DOI: 10.1016/j.cancergen.2012.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 06/21/2012] [Accepted: 06/23/2012] [Indexed: 10/27/2022]
Abstract
Multiple myeloma (MM) is an incurable, B-cell malignancy characterized by the clonal proliferation and accumulation of malignant plasma cells in bone marrow. Despite recent advances in the understanding of genomic aberrations, a comprehensive catalogue of clinically actionable mutations in MM is just beginning to emerge. The tyrosine kinase (TK) and RAS oncogenes, which encode important regulators of various signaling pathways, are among the most frequently altered gene families in cancer. To clarify the role of TK and RAS genes in the pathogenesis of MM, we performed a systematic, targeted screening of mutations on prioritized RAS and TK genes, in CD138-sorted bone marrow specimens from 42 untreated patients. We identified a total of 24 mutations in the KRAS, PIK3CA, INSR, LTK, and MERTK genes. In particular, seven novel mutations in addition to known KRAS mutations were observed. Prediction analysis tools PolyPhen and Sorting Intolerant from Tolerant (SIFT) were used to assess the functional significance of these novel mutations. Our analysis predicted that these mutations may have a deleterious effect, resulting in the functional alteration of proteins involved in the pathogenesis of myeloma. While further investigation is needed to determine the functional consequences of these proteins, mutational testing of the RAS and TK genes in larger myeloma cohorts might also be useful to establish the recurrent nature of these mutations.
Collapse
Affiliation(s)
- Vishwanathan Hucthagowder
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Welch JS, Ley TJ, Link DC, Miller CA, Larson DE, Koboldt DC, Wartman LD, Lamprecht TL, Liu F, Xia J, Kandoth C, Fulton RS, McLellan MD, Dooling DJ, Wallis JW, Chen K, Harris CC, Schmidt HK, Kalicki-Veizer JM, Lu C, Zhang Q, Lin L, O'Laughlin MD, McMichael JF, Delehaunty KD, Fulton LA, Magrini VJ, McGrath SD, Demeter RT, Vickery TL, Hundal J, Cook LL, Swift GW, Reed JP, Alldredge PA, Wylie TN, Walker JR, Watson MA, Heath SE, Shannon WD, Varghese N, Nagarajan R, Payton JE, Baty JD, Kulkarni S, Klco JM, Tomasson MH, Westervelt P, Walter MJ, Graubert TA, DiPersio JF, Ding L, Mardis ER, Wilson RK. The origin and evolution of mutations in acute myeloid leukemia. Cell 2012; 150:264-78. [PMID: 22817890 DOI: 10.1016/j.cell.2012.06.023] [Citation(s) in RCA: 1192] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/27/2012] [Accepted: 06/24/2012] [Indexed: 10/28/2022]
Abstract
Most mutations in cancer genomes are thought to be acquired after the initiating event, which may cause genomic instability and drive clonal evolution. However, for acute myeloid leukemia (AML), normal karyotypes are common, and genomic instability is unusual. To better understand clonal evolution in AML, we sequenced the genomes of M3-AML samples with a known initiating event (PML-RARA) versus the genomes of normal karyotype M1-AML samples and the exomes of hematopoietic stem/progenitor cells (HSPCs) from healthy people. Collectively, the data suggest that most of the mutations found in AML genomes are actually random events that occurred in HSPCs before they acquired the initiating mutation; the mutational history of that cell is "captured" as the clone expands. In many cases, only one or two additional, cooperating mutations are needed to generate the malignant founding clone. Cells from the founding clone can acquire additional cooperating mutations, yielding subclones that can contribute to disease progression and/or relapse.
Collapse
Affiliation(s)
- John S Welch
- Department of Medicine, Washington University, St. Louis, MO 63110, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Hurchla MA, Garcia-Gomez A, Hornick MC, Ocio EM, Li A, Blanco JF, Collins L, Kirk CJ, Piwnica-Worms D, Vij R, Tomasson MH, Pandiella A, San Miguel JF, Garayoa M, Weilbaecher KN. The epoxyketone-based proteasome inhibitors carfilzomib and orally bioavailable oprozomib have anti-resorptive and bone-anabolic activity in addition to anti-myeloma effects. Leukemia 2012; 27:430-40. [PMID: 22763387 DOI: 10.1038/leu.2012.183] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Proteasome inhibitors (PIs), namely bortezomib, have become a cornerstone therapy for multiple myeloma (MM), potently reducing tumor burden and inhibiting pathologic bone destruction. In clinical trials, carfilzomib, a next generation epoxyketone-based irreversible PI, has exhibited potent anti-myeloma efficacy and decreased side effects compared with bortezomib. Carfilzomib and its orally bioavailable analog oprozomib, effectively decreased MM cell viability following continual or transient treatment mimicking in vivo pharmacokinetics. Interactions between myeloma cells and the bone marrow (BM) microenvironment augment the number and activity of bone-resorbing osteoclasts (OCs) while inhibiting bone-forming osteoblasts (OBs), resulting in increased tumor growth and osteolytic lesions. At clinically relevant concentrations, carfilzomib and oprozomib directly inhibited OC formation and bone resorption in vitro, while enhancing osteogenic differentiation and matrix mineralization. Accordingly, carfilzomib and oprozomib increased trabecular bone volume, decreased bone resorption and enhanced bone formation in non-tumor bearing mice. Finally, in mouse models of disseminated MM, the epoxyketone-based PIs decreased murine 5TGM1 and human RPMI-8226 tumor burden and prevented bone loss. These data demonstrate that, in addition to anti-myeloma properties, carfilzomib and oprozomib effectively shift the bone microenvironment from a catabolic to an anabolic state and, similar to bortezomib, may decrease skeletal complications of MM.
Collapse
Affiliation(s)
- M A Hurchla
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St Louis, MO, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Chu L, Su MY, Maggi LB, Lu L, Mullins C, Crosby S, Huang G, Chng WJ, Vij R, Tomasson MH. Multiple myeloma-associated chromosomal translocation activates orphan snoRNA ACA11 to suppress oxidative stress. J Clin Invest 2012; 122:2793-806. [PMID: 22751105 DOI: 10.1172/jci63051] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/02/2012] [Indexed: 12/20/2022] Open
Abstract
The histone methyltransferase WHSC1 (also known as MMSET) is overexpressed in multiple myeloma (MM) as a result of the t(4;14) chromosomal translocation and in a broad variety of other cancers by unclear mechanisms. Overexpression of WHSC1 did not transform wild-type or tumor-prone primary hematopoietic cells. We found that ACA11, an orphan box H/ACA class small nucleolar RNA (snoRNA) encoded within an intron of WHSC1, was highly expressed in t(4;14)-positive MM and other cancers. ACA11 localized to nucleoli and bound what we believe to be a novel small nuclear ribonucleoprotein (snRNP) complex composed of several proteins involved in postsplicing intron complexes. RNA targets of this uncharacterized snRNP included snoRNA intermediates hosted within ribosomal protein (RP) genes, and an RP gene signature was strongly associated with t(4;14) in patients with MM. Expression of ACA11 was sufficient to downregulate RP genes and other snoRNAs implicated in the control of oxidative stress. ACA11 suppressed oxidative stress, afforded resistance to chemotherapy, and increased the proliferation of MM cells, demonstrating that ACA11 is a critical target of the t(4;14) translocation in MM and suggesting an oncogenic role in other cancers as well.
Collapse
Affiliation(s)
- Liang Chu
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|