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Jimenez-Chillon C, Othman J, Taussig D, Jimenez-Vicente C, Martinez-Roca A, Tiong IS, Jain M, Aries J, Cakmak S, Knapper S, Kristensen DT, Murthy V, Galani JZ, Kallmeyer C, Ngu L, Veale D, Bolam S, Orfali N, Parker A, Manson C, Parker J, Erblich T, Richardson D, Mokretar K, Potter N, Overgaard UM, Roug AS, Wei AH, Esteve J, Jädersten M, Russell N, Dillon R. Venetoclax-based low intensity therapy in molecular failure of NPM1-mutated AML. Blood Adv 2024; 8:343-352. [PMID: 38039513 PMCID: PMC10788851 DOI: 10.1182/bloodadvances.2023011106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
ABSTRACT Molecular failure in NPM1-mutated acute myeloid leukemia (AML) inevitably progresses to frank relapse if untreated. Recently published small case series show that venetoclax combined with low-dose cytarabine or azacitidine can reduce or eliminate measurable residual disease (MRD). Here, we report on an international multicenter cohort of 79 patients treated for molecular failure with venetoclax combinations and report an overall molecular response (≥1-log reduction in MRD) in 66 patients (84%) and MRD negativity in 56 (71%). Eighteen of 79 patients (23%) required hospitalization, and no deaths were reported during treatment. Forty-one patients were bridged to allogeneic transplant with no further therapy, and 25 of 41 were MRD negative assessed by reverse transcription quantitative polymerase chain reaction before transplant. Overall survival (OS) for the whole cohort at 2 years was 67%, event-free survival (EFS) was 45%, and in responding patients, there was no difference in survival in those who received a transplant using time-dependent analysis. Presence of FLT3-ITD mutation was associated with a lower response rate (64 vs 91%; P < .01), worse OS (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.06-5.86; P = .036), and EFS (HR, 1.87; 95% CI, 1.06-3.28; P = .03). Eighteen of 35 patients who did not undergo transplant became MRD negative and stopped treatment after a median of 10 months, with 2-year molecular relapse free survival of 62% from the end of treatment. Venetoclax-based low intensive chemotherapy is a potentially effective treatment for molecular relapse in NPM1-mutated AML, either as a bridge to transplant or as definitive therapy.
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Affiliation(s)
- Carlos Jimenez-Chillon
- Servicio de Hematología y Hemoterapia, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
| | - Jad Othman
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
- Guy’s and St Thomas Hospital, London, United Kingdom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David Taussig
- Department of Haematology, Royal Marsden Hospital, Sutton, United Kingdom
| | | | - Alexandra Martinez-Roca
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ing Soo Tiong
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Alfred Hospital and Monash University, Melbourne, VIC, Australia
- Austin Health and Olivia Newton John Cancer Research Institute, Melbourne, VIC, Australia
| | - Manish Jain
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - James Aries
- Department of Haemato-Oncology, St Bartholomew’s Hospital, London, United Kingdom
| | - Seda Cakmak
- Department of Haemato-Oncology, St Bartholomew’s Hospital, London, United Kingdom
| | - Steven Knapper
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Daniel Tuyet Kristensen
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Vidhya Murthy
- Department of Haematology, University Hospitals of Birmingham, Birmingham, United Kingdom
| | | | | | - Loretta Ngu
- Department of Haematology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - David Veale
- Department of Haematology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Simon Bolam
- Department of Haematology, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Nina Orfali
- Department of Haematology, St. James's Hospital, Dublin, Ireland
| | - Anne Parker
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Cara Manson
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jane Parker
- Department of Haematology, Northampton General Hospital, Northampton, United Kingdom
| | - Thomas Erblich
- Department of Haematology, The London Clinic, London, United Kingdom
| | - Deborah Richardson
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | | | - Nicola Potter
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
| | - Ulrik Malthe Overgaard
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
- Department of Haematology, National Hospital, Copenhagen, Denmark
| | - Anne Stidsholt Roug
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew H. Wei
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jordi Esteve
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Martin Jädersten
- Department of Medicine, Center for Haematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Nigel Russell
- Guy’s and St Thomas Hospital, London, United Kingdom
| | - Richard Dillon
- Department of Medical & Molecular Genetics, King’s College London, London, United Kingdom
- Guy’s and St Thomas Hospital, London, United Kingdom
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2
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Gomez-Arteaga A, Orfali N, Pasciolla M, Baptiste A, Guindine I, Hsu J, Lin J, Mayer SA, Phillips AA, Shore TB, Simonson PD, DiCarlo E, Yoon S, Muthukumar T, van Besien K. Haploidentical allogeneic stem cell transplantation with post-transplant cyclophosphamide and subsequent kidney transplant for patients with severe sickle cell disease with end-stage kidney disease (ESKD). Bone Marrow Transplant 2023; 58:835-838. [PMID: 37045941 DOI: 10.1038/s41409-023-01981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Alexandra Gomez-Arteaga
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Nina Orfali
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Haematology, St James Hospital, Dublin, Ireland
| | - Michelle Pasciolla
- Department of Pharmacy, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ayanna Baptiste
- Division of Hematology and Oncology, NewYork-Presbyterian Hospital Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Inna Guindine
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jingmei Hsu
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jonathan Lin
- Division of Nephrology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
- The Rogosin Institute, New York, NY, USA
| | - Sebastian A Mayer
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Adrienne A Phillips
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tsiporah B Shore
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Paul D Simonson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Edward DiCarlo
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Sung Yoon
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Thangamani Muthukumar
- Division of Nephrology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
- The Rogosin Institute, New York, NY, USA
| | - Koen van Besien
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
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3
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Patel C, Pasciolla M, Abramova R, Salerno D, Gomez-Arteaga A, Shore TB, Orfali N, Mayer S, Hsu J, Phillips AA, Chaekal OK, Satlin MJ, Soave R, Kodiyanplakkal RPL, Drelick A, Plate M, Besien KV. Pre-Hematopoietic Stem Cell Transplantation Rituximab for Epstein-Barr Virus and Post-Lymphoproliferative Disorder Prophylaxis in Alemtuzumab Recipients. Transplant Cell Ther 2023; 29:132.e1-132.e5. [PMID: 36334653 DOI: 10.1016/j.jtct.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
Epstein-Barr virus (EBV) reactivation and EBV-related post-transplantation lymphoproliferative disorder (PTLD) are often fatal complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The risk of EBV reactivation may be mitigated by depletion of B cells with rituximab. Starting in January 2020, allo-HSCT recipients undergoing T-cell depletion with alemtuzumab received 1 dose of rituximab before transplantation. The objective of this study was to evaluate the cumulative incidence of EBV reactivation and EBV-PTLD in recipients of allo-HSCT and in vivo T-cell depletion with alemtuzumab who received pre-HSCT rituximab compared to patients who did not. This was a single-center retrospective analysis of adult patients who consecutively received an HLA-identical allo-HSCT between January 2019 and May 2021 and in vivo T-cell depletion with alemtuzumab. Patients were included in the rituximab cohort if they received rituximab within 6 months before their transplantation. The primary endpoint was incidence of EBV reactivation at day 180 among those receiving pre-HSCT rituximab versus those not receiving rituximab. Secondary endpoints included cumulative incidence of EBV-PTLD at 1 year, time to engraftment, immune reconstitution, and incidence of infections and acute graft-versus-host disease (aGVHD) at day 180. Eighty-six consecutive patients who received an allo-HSCT with alemtuzumab T-cell depletion were reviewed; 43 patients who received pre-HSCT rituximab after our protocol modification were compared to 43 patients who did not receive pre-HSCT rituximab before this change. Median age was 57 (interquartile range [IQR] 40-69) years, and the majority of patients had acute myeloid leukemia or myelodysplastic syndrome. Baseline characteristics were similar between the cohorts. EBV reactivation at day 180 occurred in 23 (53%) patients without prior rituximab exposure versus 0 patients with pre-HSCT rituximab exposure (P < .0001). Similarly, 6 patients without prior rituximab exposure developed PTLD at 1 year compared to no cases of PTLD among patients receiving pre-HSCT rituximab. There was no difference in neutrophil engraftment, incidence of infections, or aGVHD at day 180 between the 2 cohorts. There was a delay in time to platelet engraftment in the rituximab cohort (median 16 [IQR 15-20] days versus 15 [IQR 14-17] days; P = .04). Administration of pre-HSCT rituximab before allo-HSCT in patients receiving T-cell depletion with alemtuzumab was associated with a significant decrease in the risk for EBV reactivation and EBV-PTLD, without increasing aGVHD or infection rates.
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Affiliation(s)
- Chandni Patel
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, Department of Pharmacy, New York, New York
| | - Michelle Pasciolla
- New York-Presbyterian Hospital/Weill Cornell Medical Center, Department of Pharmacy, New York, New York
| | - Rachel Abramova
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, Department of Pharmacy, New York, New York
| | - David Salerno
- New York-Presbyterian Hospital/Weill Cornell Medical Center, Department of Pharmacy, New York, New York
| | - Alexandra Gomez-Arteaga
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Tsiporah B Shore
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Nina Orfali
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Sebastian Mayer
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Jingmei Hsu
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Adrienne A Phillips
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Ok-Kyong Chaekal
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Michael J Satlin
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | - Rosemary Soave
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | | | - Alexander Drelick
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | - Markus Plate
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | - Koen Van Besien
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
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4
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Elhadad S, Chadburn A, Magro C, Van Besien K, Roberson EDO, Atkinson JP, Terry H, Greenberg J, Reid W, Chapin J, Copertino D, Geramfard S, Rodriguez LB, Orfali N, Gerghis U, Shore T, Mayer S, Ahamed J, Laurence J. C5b-9 and MASP2 deposition in skin and bone marrow microvasculature characterize hematopoietic stem cell transplant-associated thrombotic microangiopathy. Bone Marrow Transplant 2022; 57:1445-1447. [PMID: 35661836 DOI: 10.1038/s41409-022-01723-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Sonia Elhadad
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Koen Van Besien
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Elisha D O Roberson
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - John P Atkinson
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hunter Terry
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - June Greenberg
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Whitney Reid
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - John Chapin
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
- CRISPR Therapeutics, Cambridge, MA, USA
| | - Dennis Copertino
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Sahar Geramfard
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Lizamarie Bachier Rodriguez
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
- Montefiore Medical Center, New York, NY, USA
| | - Nina Orfali
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Usama Gerghis
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | | | - Jeffrey Laurence
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA.
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5
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Dillon J, Mykytiv V, Keenan C, Mullaney B, Orfali N, Ryan K, Duggan C, Crowley MP. Management of a patient with acute myeloid leukaemia with a diagnosis of type 2 von Willebrand disease and a novel variant within the von Willebrand factor (VWF) gene. Br J Haematol 2022; 199:e5-e7. [PMID: 35903954 DOI: 10.1111/bjh.18390] [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: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- James Dillon
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Vitaliy Mykytiv
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Catriona Keenan
- Haemostasis Molecular Diagnostics Laboratory, National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | - Brendan Mullaney
- Haemostasis Molecular Diagnostics Laboratory, National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | - Nina Orfali
- National Adult Allogeneic Stem Cell Transplant Unit, St. James's Hospital, Dublin, Ireland
| | - Kevin Ryan
- Haemostasis Molecular Diagnostics Laboratory, National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | - Cleona Duggan
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Maeve P Crowley
- Department of Haematology, Cork University Hospital, Cork, Ireland
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6
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Benjamin DN, O'Donovan TR, Laursen KB, Orfali N, Cahill MR, Mongan NP, Gudas LJ, McKenna SL. All- Trans-Retinoic Acid Combined With Valproic Acid Can Promote Differentiation in Myeloid Leukemia Cells by an Autophagy Dependent Mechanism. Front Oncol 2022; 12:848517. [PMID: 35280824 PMCID: PMC8907478 DOI: 10.3389/fonc.2022.848517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive blood cancer with an overall survival of 30%. One form of AML, acute promyelocytic leukemia (APL) has become more than 90% curable with differentiation therapy, consisting of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO). Application of differentiation therapy to other AML subtypes would be a major treatment advance. Recent studies have indicated that autophagy plays a key role in the differentiation of ATRA-responsive APL cells. In this study, we have investigated whether differentiation could be enhanced in ATRA resistant cells by promoting autophagy induction with valproic acid (VPA). ATRA sensitive (NB4) and resistant leukemia cells (NB4R and THP-1) were co-treated with ATRA and valproic acid, followed by assessment of autophagy and differentiation. The combination of VPA and ATRA induced autophagic flux and promoted differentiation in ATRA-sensitive and -resistant cell lines. shRNA knockdown of ATG7 and TFEB autophagy regulators impaired both autophagy and differentiation, demonstrating the importance of autophagy in the combination treatment. These data suggest that ATRA combined with valproic acid can promote differentiation in myeloid leukemia cells by mechanism involving autophagy.
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Affiliation(s)
- Dalyia N Benjamin
- Cancer Research, University College Cork, Cork, Ireland.,Department of Haematology, Tallaght University Hospital, Dublin, Ireland.,Department of Pharmacology, Weill Cornell Medical College of Cornell University, New York, NY, United States
| | | | - Kristian B Laursen
- Department of Pharmacology, Weill Cornell Medical College of Cornell University, New York, NY, United States
| | - Nina Orfali
- Department of Haematology, St James's Hospital, Dublin, Ireland
| | - Mary R Cahill
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Nigel P Mongan
- Department of Pharmacology, Weill Cornell Medical College of Cornell University, New York, NY, United States.,Faculty of Medicine and Health Science, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medical College of Cornell University, New York, NY, United States
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7
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Chaekal OK, Soave R, Chen Z, Shore T, Mayer S, Phillips A, Mei Hsu J, Gomez-Arteaga A, Rennert H, Drelick A, Orfali N, Walsh TJ, Small CB, Kodiyanplakkal RPL, Plate M, Satlin MJ, van Besien K. Adenovirus viremia after in vivo T-cell depleted allo-transplant in adults: low lymphocyte counts are associated with uncontrolled viremia and fatal outcomes. Leuk Lymphoma 2021; 63:435-442. [PMID: 34643477 DOI: 10.1080/10428194.2021.1978088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The incidence of adenovirus viremia and the role of screening in preventing adenovirus disease in adult transplant recipients are not well defined. Between January 2017 and May 2020, 262 allogeneic transplants were performed using in vivo T-cell depletion. Adenovirus viremia was found in 59 patients for a cumulative incidence of 10% by one hundred days and 23% (95% CI 20-26%) by one year. There was a higher incidence of viremia associated with cord blood transplant (p = .04). No other patient, donor or transplant characteristics were identified that predicted for viremia. In 47 patients (80%), viremia remained well below 200,000 copies/mL and resolved. Twelve patients developed high level viremia. Treatment with antivirals and in some cases adoptive cell therapy, was often ineffective and only two survived. Low lymphocyte count at initial detection of adenovirus viremia was the best predictor of uncontrolled disease.
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Affiliation(s)
- Ok-Kyong Chaekal
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Rosemary Soave
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Zhengming Chen
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Adrienne Phillips
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Jing Mei Hsu
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Alexandra Gomez-Arteaga
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Hanna Rennert
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Alex Drelick
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Nina Orfali
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Thomas J Walsh
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Catherine B Small
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Rosy Priya L Kodiyanplakkal
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Markus Plate
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Michael J Satlin
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Koen van Besien
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
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8
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Orfali N, Zhang MJ, Allbee-Johnson M, Boelens JJ, Artz AS, Brunstein CG, McNiece IK, Milano F, Abid MB, Chee L, Diaz MA, Grunwald MR, Hematti P, Hsu J, Lazarus HM, Munshi PN, Prestidge T, Ringden O, Rizzieri D, Riches ML, Seo S, Solh M, Solomon S, Szwajcer D, Yared J, Besien KV, Eapen M. Planned Granulocyte Colony-Stimulating Factor Adversely Impacts Survival after Allogeneic Hematopoietic Cell Transplantation Performed with Thymoglobulin for Myeloid Malignancy. Transplant Cell Ther 2021; 27:993.e1-993.e8. [PMID: 34507002 DOI: 10.1016/j.jtct.2021.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
The in vivo depletion of recipient and donor T lymphocytes using antithymocyte globulin (ATG; Thymoglobulin) is widely adopted in allogeneic hematopoietic stem cell transplantation (HCT) to reduce the incidence of both graft failure and graft-versus-host disease (GVHD). However, excess toxicity to donor lymphocytes may hamper immune reconstitution, compromising antitumor effects and increasing infection. Granulocyte-colony stimulating factor (G-CSF) administered early after HCT may increase ATG-mediated lymphotoxicity. This study aimed to investigate the effect of an interaction between ATG and post-transplantation granulocyte colony-stimulating factor (G-CSF) on allogeneic HCT outcomes, using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry. We studied patients age ≥18 years with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) who received Thymoglobulin-containing preparative regimens for HLA-matched sibling/unrelated or mismatched unrelated donor HCT between 2010 and 2018. The effect of planned G-CSF that was started between pretransplantation day 3 and post-transplantation day 12 was studied in comparison with transplantations that did not include G-CSF. Cox regression models were built to identify risk factors associated with outcomes at 1 year after transplantation. A total of 874 patients met the study eligibility criteria, of whom 459 (53%) received planned G-CSF. HCT with planned G-CSF was associated with a significantly increased risk for nonrelapse mortality (NRM) (hazard ratio [HR] 2.03; P <.0001; 21% versus 12%) compared to HCT without G-CSF. The 6-month incidence of viral infection was higher with G-CSF (56% versus 47%; P = .007), with a particular increase in Epstein-Barr virus infections (19% versus 11%; P = .002). The observed higher NRM with planned G-CSF led to lower overall survival (HR, 1.52; P = .0005; 61% versus 72%). There was no difference in GVHD risk between the treatment groups. We performed 2 subgroup analyses showing that our findings held true in patients age ≥50 years and in centers where G-CSF was used in some, but not all, patients. In allogeneic peripheral blood HCT performed with Thymoglobulin for AML and MDS, G-CSF administered early post-transplantation resulted in a 2-fold increase in NRM and a 10% absolute decrement in survival. The use of planned G-CSF in the early post-transplantation period should be carefully considered on an individual patient basis, weighing any perceived benefits against these risks.
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Affiliation(s)
- Nina Orfali
- Haematology Department, St. James's Hospital, Dublin, Ireland; Department of Medicine, Weill Cornell Medicine, New York, New York.
| | - Mei-Jie Zhang
- Division of Biostatistics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mariam Allbee-Johnson
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jaap Jan Boelens
- Pediatric Transplantation and Cellular Therapy Division, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew S Artz
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Claudio G Brunstein
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Ian K McNiece
- Stem Cell Transplantation and Cellular Therapy Clinical Laboratory, MD Anderson Cancer Center, Houston, Texas
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Muhammad Bilal Abid
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lynette Chee
- Haematology Department, Peter MacCallum Cancer Centre, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Miguel A Diaz
- Pediatric Haematology Division, Hospital Infantil Universitario "Niño Jesus" Madrid, Spain
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Peiman Hematti
- Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, Wisconsin
| | - Jingmei Hsu
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Hillard M Lazarus
- Department of Hematologic Oncology, Case Western Reserve University, Cleveland, Ohio
| | - Pashna N Munshi
- Stem Cell Transplant and Cellular Immunotherapy division, MedStar Georgetown University Hospital, Washington, DC
| | - Timothy Prestidge
- Blood and Cancer Centre, Starship Hospital, University of Auckland, Auckland, New Zealand
| | - Olle Ringden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David Rizzieri
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marcie L Riches
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Melhem Solh
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Scott Solomon
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - David Szwajcer
- Department of Hematology and Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Jean Yared
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Koen van Besien
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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9
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Orfali N, Jhanwar Y, Koo C, Pasciolla M, Baldo M, Cuvilly E, Furman R, Gergis U, Greenberg J, Guarneri D, Hsu JM, Leonard JP, Mark T, Mayer S, Maignan K, Martin P, Opong A, Pearse R, Phillips A, Rossi A, Ruan J, Rutherford SC, Ryan J, Suhu G, Van Besien K, Shore T. Sequential intensive chemotherapy followed by autologous or allogeneic transplantation for refractory lymphoma. Leuk Lymphoma 2021; 62:1629-1638. [PMID: 33586581 DOI: 10.1080/10428194.2021.1881516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We evaluate the safety of bendamustine as a bridge to stem cell transplantation (SCT) in patients with relapsed/refractory lymphoma and residual disease after salvage therapy. Thirty-four subjects without complete responses (CR) received bendamustine 200 mg/m2/day for 2 days followed 14 days later by SCT. Sixteen subjects in partial remission (PR) with maximal FDG-PET SUVs ≤8 prior to bendamustine received autologous SCT, while 13 with suboptimal responses were allografted. Five subjects did not proceed to transplant. No bendamustine toxicities precluded transplantation and no detrimental effect on engraftment or early treatment-related mortality (TRM) was attributable to bendamustine. At 1 year, 75% of auto-recipients and 31% of allo-recipients were alive with CR. Two subjects in the autologous arm developed therapy-related myeloid neoplasia (t-MN). In conclusion, a bendamustine bridge to SCT can be administered without early toxicity to patients with suboptimal responses to salvage chemotherapy. However this approach may increase the risk of t-MN. (NCT02059239).Supplemental data for this article is available online at here.
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Affiliation(s)
- Nina Orfali
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Yuliya Jhanwar
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Calvin Koo
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Michelle Pasciolla
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Baldo
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Edwidge Cuvilly
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Richard Furman
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Usama Gergis
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - June Greenberg
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Danielle Guarneri
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jing-Mei Hsu
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - John P Leonard
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Tomer Mark
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Sebastian Mayer
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Kathleen Maignan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Peter Martin
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adomah Opong
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Roger Pearse
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adrienne Phillips
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adriana Rossi
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jia Ruan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Sarah C Rutherford
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jessy Ryan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Grace Suhu
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Koen Van Besien
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Tsiporah Shore
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
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10
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Plate M, Kodiyanplakkal RP, Satlin MJ, Soave R, Drelick AC, Orfali N, Helfgott D, Niesvizky R, Roboz GJ, Shore TB, Van Besien K, Small CB, Walsh TJ. 532. COVID-19 Pneumonia in Patients with Hematologic Malignancies – A Report from the US Epicenter. Open Forum Infect Dis 2020. [PMCID: PMC7776253 DOI: 10.1093/ofid/ofaa439.726] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Limited data are available for risk assessment and outcome of COVID-19 in patients with hematologic malignancies (HM). We present a single center study of COVID-19 pneumonia in a cohort of 31 patients with HM.
Methods
Data were abstracted from electronic medical records for patients admitted to NYPH between 3/5/20 and 4/17/20 and entered into a REDCap database.
Results
Twenty (64.5%) were male; median age was 71 years. There were 8 patients with Multiple Myeloma (MM), 8 with Chronic Lymphocytic Leukemia (CLL), 6 (19.4%) had AML, 5 (16.1%) NHL, 2 (3.2%) ALL; CML, MDS and Polycythemia Vera occurred in 1 patient each. Twenty-four (77.4%) had active HM; 6 (19.4%) were in remission; and 1 relapsed. Nineteen patients (61.3%) received recent chemotherapy and 11 (35.5%) immunosuppressive therapies. There were 7 (22.6%) hematopoietic stem cell transplant (HSCT) recipients (4 allogeneic and 3 autologous). Comorbidities were evenly distributed among all malignancies: 18 (58.1%) had hypertension, 9 (38.7%) obesity, 7 (22.6%) diabetes mellitus, and 11 (35.5%) were former smokers. The most common symptoms included cough (90.3%), fever (83.9%) and dyspnea (61.3%); 7 (22.6%) had nausea and vomiting; 7 (22.6%) had diarrhea. On presentation, hypoxia (O2 sat ≤94% on room air) occurred in 64.5%; median ALC was 330/ml; 23 (74.2%) had ALC< 1000/ml; median CRP was 15.9 mg/dl (2.5–40.4), ferritin 1162 ng/ml (264 - > 16500), and D-dimers 456 ng/ml (< 150–2418). Thirteen patients (41.9%) required ICU admission and were intubated; among those 9 (69.2%) had either MM or CLL. Co-infections were uncommon; two patients developed HSV1 pneumonitis and one of these also had CMV pneumonitis. Twenty-eight (90.3%) were treated with hydroxychloroquine, 5 (16.1%) remdesivir, 2 (6.5%) tocilizumab, 1 (3.2%) sarilumab, and 4 (12.9%) with methylprednisolone 0.5mg/kg Q12h. Seventeen patients (54.8%) recovered and were discharged, 12 (38.7%) died; 2 (6.5%) were still hospitalized but left the ICU.
Conclusion
In our cohort, there were predominantly more patients with MM and CLL and 56% of these were intubated; larger cohort studies will further define the risk and outcome for COVID-19 in patients with HM.
Disclosures
Michael J. Satlin, MD, MS, Achaogen (Consultant)Allergan (Grant/Research Support)Merck (Grant/Research Support)Shionogi Inc. (Consultant)
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11
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van Besien K, Orfali N, Shore T. Allogeneic Transplant Conditioning Regimens for Patients With Non-Hodgkin Lymphoma. JAMA Oncol 2020; 6:1983-1984. [PMID: 33151264 DOI: 10.1001/jamaoncol.2020.5158] [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: 11/14/2022]
Affiliation(s)
- Koen van Besien
- Stem Cell Transplant and Cell Therapy Program, Division of Hematology Oncology, Weill Cornell Medical College/NYP Hospital, New York, New York
| | - Nina Orfali
- Stem Cell Transplant and Cell Therapy Program, Division of Hematology Oncology, Weill Cornell Medical College/NYP Hospital, New York, New York
| | - Tsiporah Shore
- Stem Cell Transplant and Cell Therapy Program, Division of Hematology Oncology, Weill Cornell Medical College/NYP Hospital, New York, New York
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12
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Salvatore M, Laplante JM, Soave R, Orfali N, Plate M, Besien K, St. George K. Baloxavir for the treatment of Influenza in allogeneic hematopoietic stem cell transplant recipients previously treated with oseltamivir. Transpl Infect Dis 2020; 22:e13336. [DOI: 10.1111/tid.13336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jennifer M. Laplante
- Laboratory of Viral Diseases Wadsworth Center New York State Department of Health Albany NY USA
| | - Rosemary Soave
- Department of Medicine Weill Cornell Medicine New York NY USA
| | - Nina Orfali
- Department of Medicine Weill Cornell Medicine New York NY USA
| | - Markus Plate
- Department of Medicine Weill Cornell Medicine New York NY USA
| | - Koen Besien
- Meyer Cancer Center Weill Cornell Medicine New York NY USA
| | - Kirsten St. George
- Laboratory of Viral Diseases Wadsworth Center New York State Department of Health Albany NY USA
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13
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Affiliation(s)
- Koen W. van Besien
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Nina Orfali
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
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14
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Orfali N, Shan-Krauer D, O'Donovan TR, Mongan NP, Gudas LJ, Cahill MR, Tschan MP, McKenna SL. Inhibition of UBE2L6 attenuates ISGylation and impedes ATRA-induced differentiation of leukemic cells. Mol Oncol 2020; 14:1297-1309. [PMID: 31820845 PMCID: PMC7266268 DOI: 10.1002/1878-0261.12614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/29/2019] [Accepted: 12/06/2019] [Indexed: 01/18/2023] Open
Abstract
Ubiquitin/ISG15‐conjugating enzyme E2L6 (UBE2L6) is a critical enzyme in ISGylation, a post‐translational protein modification that conjugates the ubiquitin‐like modifier, interferon‐stimulated gene 15 (ISG15), to target substrates. Previous gene expression studies in acute promyelocytic leukemia (APL) cells showed that all‐trans‐retinoic acid (ATRA) altered the expression of many genes, including UBE2L6 (200‐fold) and other members of the ISGylation pathway. Through gene expression analyses in a cohort of 98 acute myeloid leukemia (AML) patient samples and in primary neutrophils from healthy donors, we found that UBE2L6 gene expression is reduced in primary AML cells compared with normal mature granulocytes. To assess whether UBE2L6 expression is important for leukemic cell differentiation—two cell line models were employed: the human APL cell line NB4 and its ATRA‐resistant NB4R counterpart, as well as the ATRA‐sensitive human AML HL60 cells along with their ATRA‐resistant subclone—HL60R. ATRA strongly induced UBE2L6 in NB4 APL cells and in ATRA‐sensitive HL60 AML cells, but not in the ATRA‐resistant NB4R and HL60R cells. Furthermore, short hairpin (sh)RNA‐mediated UBE2L6 depletion in NB4 cells impeded ATRA‐mediated differentiation, suggesting a functional role for UBE2L6 in leukemic cell differentiation. In addition, ATRA induced ISG15 gene expression in NB4 APL cells, leading to increased levels of both free ISG15 protein and ISG15 conjugates. UBE2L6 depletion attenuated ATRA‐induced ISG15 conjugation. Knockdown of ISG15 in NB4 APL cells inhibited ISGylation and also attenuated ATRA‐induced differentiation. In summary, we demonstrate the functional importance of UBE2L6 in ATRA‐induced neutrophil differentiation of APL cells and propose that this may be mediated by its catalytic role in ISGylation.
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Affiliation(s)
- Nina Orfali
- Cork Cancer Research Centre & Cancer Research at UCC, University College Cork, Ireland.,Department of Hematology, Cork University Hospital, Ireland.,Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
| | - Deborah Shan-Krauer
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Switzerland
| | - Tracey R O'Donovan
- Cork Cancer Research Centre & Cancer Research at UCC, University College Cork, Ireland
| | - Nigel P Mongan
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA.,Faculty of Medicine and Health Science, School of Veterinary Medicine and Science, University of Nottingham, UK
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
| | - Mary R Cahill
- Cork Cancer Research Centre & Cancer Research at UCC, University College Cork, Ireland.,Department of Hematology, Cork University Hospital, Ireland
| | - Mario P Tschan
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Switzerland
| | - Sharon L McKenna
- Cork Cancer Research Centre & Cancer Research at UCC, University College Cork, Ireland
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15
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Orfali N, Mokhtar AE, Guarneri D, Hsu J, Phillips A, Gergis U, Shore TB, Mayer S, Van Besien K. Seven Years of Haplo-Cord Transplantation: Immune Reconstitution and Outcomes Using Anti-Thymocyte Globulin. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Orfali N, van Besien K. Combining haplo-identical and cord blood stem cell grafts - might the whole be greater than the sum of its parts? Leuk Lymphoma 2020; 61:753-756. [PMID: 32048529 DOI: 10.1080/10428194.2020.1725509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nina Orfali
- Department of Bone Marrow Transplantation, Weill Cornell Medicine, New York, NY, USA
| | - Koen van Besien
- Department of Bone Marrow Transplantation, Weill Cornell Medicine, New York, NY, USA
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17
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Orfali N, O'Donovan TR, Cahill MR, Benjamin D, Nanus DM, McKenna SL, Gudas LJ, Mongan NP. All-trans retinoic acid (ATRA)-induced TFEB expression is required for myeloid differentiation in acute promyelocytic leukemia (APL). Eur J Haematol 2020; 104:236-250. [PMID: 31811682 DOI: 10.1111/ejh.13367] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In acute promyelocytic leukemia (APL), normal retinoid signaling is disrupted by an abnormal PML-RARα fusion oncoprotein, leading to a block in cell differentiation. Therapeutic concentrations of all-trans-retinoic acid (ATRA) can restore retinoid-induced transcription and promote degradation of the PML-RARα protein. Autophagy is a catabolic pathway that utilizes lysosomal machinery to degrade intracellular material and facilitate cellular re-modeling. Recent studies have identified autophagy as an integral component of ATRA-induced myeloid differentiation. METHODS As the molecular communication between retinoid signaling and the autophagy pathway is not defined, we performed RNA sequencing of NB4 APL cells treated with ATRA and examined autophagy-related transcripts. RESULTS ATRA altered the expression of >80 known autophagy-related transcripts, including the key transcriptional regulator of autophagy and lysosomal biogenesis, TFEB (11.5-fold increase). Induction of TFEB and its transcriptional target, sequestosome 1 (SQSTM1, p62), is reduced in ATRA-resistant NB4R cells compared to NB4 cells. TFEB knockdown in NB4 cells alters the expression of transcriptional targets of TFEB and reduces CD11b transcript levels in response to ATRA. CONCLUSIONS We show for the first time that TFEB plays an important role in ATRA-induced autophagy during myeloid differentiation and that autophagy induction potentiates leukemic cell differentiation (Note: this study includes data obtained from NCT00195156, https://clinicaltrials.gov/show/NCT00195156).
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Affiliation(s)
- Nina Orfali
- Cork Cancer Research Centre & CancerResearch@UCC, Western Gateway Building, University College Cork, Cork, Ireland.,Department of Haematology, Cork University Hospital, Cork, Ireland.,Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA.,Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Tracey R O'Donovan
- Cork Cancer Research Centre & CancerResearch@UCC, Western Gateway Building, University College Cork, Cork, Ireland
| | - Mary R Cahill
- Cork Cancer Research Centre & CancerResearch@UCC, Western Gateway Building, University College Cork, Cork, Ireland.,Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Dalyia Benjamin
- Cork Cancer Research Centre & CancerResearch@UCC, Western Gateway Building, University College Cork, Cork, Ireland.,Department of Haematology, Cork University Hospital, Cork, Ireland.,Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - David M Nanus
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sharon L McKenna
- Cork Cancer Research Centre & CancerResearch@UCC, Western Gateway Building, University College Cork, Cork, Ireland
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Nigel P Mongan
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA.,University of Nottingham Biodiscovery Institute, Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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18
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Orfali N, Jeyapalan JN, Woodcock CL, O'Donovan TR, Benjamin D, Cahill M, McKenna S, Gudas LJ, Mongan NP. Lentiviral-Mediated shRNA Approaches: Applications in Cellular Differentiation and Autophagy. Methods Mol Biol 2019; 2019:33-49. [PMID: 31359387 DOI: 10.1007/978-1-4939-9585-1_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Acute myeloid leukemia (AML) is characterized by the accumulation of immature white blood cell precursors in the bone marrow and peripheral circulation. In essence, leukemic cells fail to differentiate and are stalled at a particular step of hematopoietic maturation and are unable to complete their development into functional blood cells with a finite life cycle. They are thus said to possess a "differentiation block." Pharmacological override of this block is one attractive avenue of therapy, termed "differentiation therapy." The most successful example of this therapeutic strategy is the use of the physiologic retinoid all-trans-retinoic acid (ATRA) in the treatment of acute promyelocytic leukemia (APL). In this chapter, we will outline the methods used to characterize the mechanisms mobilized by retinoid signaling and will use the activation of a key regulator of autophagy, ATG7, as an example of the functional characterization of a retinoid regulated gene during differentiation. We will discuss how lentiviral delivery of shRNA constructs into cultured APL cells, such as NB4, can be used to functionally deplete key proteins. We will also describe how the effect of protein knockdown on ATRA-induced differentiation and autophagy can be assessed using quantitative PCR, Western blotting, and flow cytometry.
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Affiliation(s)
- Nina Orfali
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
- Cork Cancer Research Centre, University College Cork, Cork, Ireland
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Jennie N Jeyapalan
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Corinne L Woodcock
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | | | - Dalyia Benjamin
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
- Cork Cancer Research Centre, University College Cork, Cork, Ireland
| | - Mary Cahill
- Cork Cancer Research Centre, University College Cork, Cork, Ireland
- Department of Haematology, Cork University Hospital, Cork, Ireland
| | - Sharon McKenna
- Cork Cancer Research Centre, University College Cork, Cork, Ireland
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Nigel P Mongan
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA.
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
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19
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Orfali N, O'Donovan TR, Nyhan MJ, Britschgi A, Tschan MP, Cahill MR, Mongan NP, Gudas LJ, McKenna SL. Induction of autophagy is a key component of all-trans-retinoic acid-induced differentiation in leukemia cells and a potential target for pharmacologic modulation. Exp Hematol 2015; 43:781-93.e2. [PMID: 25986473 PMCID: PMC4948855 DOI: 10.1016/j.exphem.2015.04.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 01/10/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022]
Abstract
Acute myeloid leukemia (AML) is characterized by the accumulation of immature blood cell precursors in the bone marrow. Pharmacologically overcoming the differentiation block in this condition is an attractive therapeutic avenue, which has achieved success only in a subtype of AML, acute promyelocytic leukemia (APL). Attempts to emulate this success in other AML subtypes have thus far been unsuccessful. Autophagy is a conserved protein degradation pathway with important roles in mammalian cell differentiation, particularly within the hematopoietic system. In the study described here, we investigated the functional importance of autophagy in APL cell differentiation. We found that autophagy is increased during all-trans-retinoic acid (ATRA)-induced granulocytic differentiation of the APL cell line NB4 and that this is associated with increased expression of LC3II and GATE-16 proteins involved in autophagosome formation. Autophagy inhibition, using either drugs (chloroquine/3-methyladenine) or short-hairpin RNA targeting the essential autophagy gene ATG7, attenuates myeloid differentiation. Importantly, we found that enhancing autophagy promotes ATRA-induced granulocytic differentiation of an ATRA-resistant derivative of the non-APL AML HL60 cell line (HL60-Diff-R). These data support the development of strategies to stimulate autophagy as a novel approach to promote differentiation in AML.
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MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/metabolism
- Adenine/analogs & derivatives
- Adenine/pharmacology
- Antineoplastic Agents/pharmacology
- Antirheumatic Agents/pharmacology
- Autophagy/drug effects
- Autophagy-Related Protein 7
- Autophagy-Related Protein 8 Family
- Cell Differentiation/drug effects
- Chloroquine/pharmacology
- Granulocytes/metabolism
- Granulocytes/pathology
- HL-60 Cells
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Leukemia, Promyelocytic, Acute/pathology
- Microfilament Proteins/genetics
- Microfilament Proteins/metabolism
- Microtubule-Associated Proteins/genetics
- Microtubule-Associated Proteins/metabolism
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Tretinoin/pharmacology
- Ubiquitin-Activating Enzymes/antagonists & inhibitors
- Ubiquitin-Activating Enzymes/genetics
- Ubiquitin-Activating Enzymes/metabolism
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Affiliation(s)
- Nina Orfali
- Cork Cancer Research Centre, Leslie C. Quick, Jr., Laboratory, Biosciences Institute, University College Cork, Cork, Ireland; Department of Hematology, Cork University Hospital, Cork, Ireland; Department of Pharmacology, Weill Cornell Medical College, New York, New York, USA
| | - Tracey R O'Donovan
- Cork Cancer Research Centre, Leslie C. Quick, Jr., Laboratory, Biosciences Institute, University College Cork, Cork, Ireland
| | - Michelle J Nyhan
- Cork Cancer Research Centre, Leslie C. Quick, Jr., Laboratory, Biosciences Institute, University College Cork, Cork, Ireland
| | - Adrian Britschgi
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Mario P Tschan
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Mary R Cahill
- Department of Hematology, Cork University Hospital, Cork, Ireland
| | - Nigel P Mongan
- Department of Pharmacology, Weill Cornell Medical College, New York, New York, USA; Faculty of Medicine and Health Science, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medical College, New York, New York, USA
| | - Sharon L McKenna
- Cork Cancer Research Centre, Leslie C. Quick, Jr., Laboratory, Biosciences Institute, University College Cork, Cork, Ireland.
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20
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Orfali N, McKenna SL, Cahill MR, Gudas LJ, Mongan NP. Retinoid receptor signaling and autophagy in acute promyelocytic leukemia. Exp Cell Res 2014; 324:1-12. [PMID: 24694321 DOI: 10.1016/j.yexcr.2014.03.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 02/17/2014] [Revised: 03/20/2014] [Accepted: 03/22/2014] [Indexed: 12/18/2022]
Abstract
Retinoids are a family of signaling molecules derived from vitamin A with well established roles in cellular differentiation. Physiologically active retinoids mediate transcriptional effects on cells through interactions with retinoic acid (RARs) and retinoid-X (RXR) receptors. Chromosomal translocations involving the RARα gene, which lead to impaired retinoid signaling, are implicated in acute promyelocytic leukemia (APL). All-trans-retinoic acid (ATRA), alone and in combination with arsenic trioxide (ATO), restores differentiation in APL cells and promotes degradation of the abnormal oncogenic fusion protein through several proteolytic mechanisms. RARα fusion-protein elimination is emerging as critical to obtaining sustained remission and long-term cure in APL. Autophagy is a degradative cellular pathway involved in protein turnover. Both ATRA and ATO also induce autophagy in APL cells. Enhancing autophagy may therefore be of therapeutic benefit in resistant APL and could broaden the application of differentiation therapy to other cancers. Here we discuss retinoid signaling in hematopoiesis, leukemogenesis, and APL treatment. We highlight autophagy as a potential important regulator in anti-leukemic strategies.
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Affiliation(s)
- Nina Orfali
- Cork Cancer Research Center, University College Cork, Cork, Ireland; Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Sharon L McKenna
- Cork Cancer Research Center, University College Cork, Cork, Ireland
| | - Mary R Cahill
- Department of Hematology, Cork University Hospital, Cork, Ireland
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA..
| | - Nigel P Mongan
- Faculty of Medicine and Health Science, School of Veterinary Medicine and Science, University of Nottingham, LE12 5RD, United Kingdom; Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA..
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Nyhan M, Elzinga B, Crowley L, O'Donovan T, Orfali N, O'Sullivan G, Cahill M, McKenna S. 94 Induction of Autophagy by Imatinib Sequesters BCR-ABL in Autophagosomes and Reduces BCR-ABL Expression. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71892-0] [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: 11/25/2022]
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22
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Kloesel B, Musibay ED, Pedersen K, Orfali N, Mattingley J, Vassallo R. A 64-year-old man with progressive dyspnea and cough productive of copious amounts of clear sputum. Chest 2012; 141:1622-1625. [PMID: 22670026 DOI: 10.1378/chest.11-2136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | | | | | - Nina Orfali
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer Mattingley
- Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert Vassallo
- Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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