51
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Salhotra A, Yang D, Mokhtari S, Hui S, Al Malki MM, Armenian S, Sigala B, Aldoss I, Pullarkat V, Forman S, Marcucci G, Nakamura R, Artz A, Wong J, Stein A. Long-term follow-up of patients with poor-risk acute leukemia treated on a phase 2 trial undergoing intensified conditioning regimen prior to allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2021; 63:1220-1226. [PMID: 34879769 DOI: 10.1080/10428194.2021.2012661] [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: 10/19/2022]
Abstract
Patients with acute leukemia who undergo allogenic hematopoietic cell transplantation with active disease have high rates of relapse and poor overall survival (OS) post-transplant compared to patients undergoing HCT in remission. Here, we report the long-term outcomes in 32 patients who received a high-intensity conditioning regimen comprising fractionated total body irradiation (FTBI; 1200 cGy) with pharmacokinetic (PK) dosing of intravenous Busulfan (IV BU) targeted to first dose area under curve (AUC) of 700-900 µM/min and etoposide (30 mg/kg) in a prospective phase 2 clinical trial. The median age of the patients at the time of HCT was 37 years (range: 18-50) presenting with high-risk (n = 6) and relapsed/refractory(r/r) acute leukemias (n = 26). All but one patient underwent HCT using peripheral blood stem cells from matched sibling donors. At a median follow-up of 17.3 years (range 14.4-19.0), 11 patients remained alive. The disease-free survival and OS at 15 years was 34% (versus 40% at 5-years post-HCT). The 15-year cumulative incidence of relapse was 26% and non-relapse mortality (NRM) was 38% (95% CI: 21-54%) and the cumulative incidence of chronic GVHD at 15 years was 33% using a prophylactic regimen of cyclosporine A and mycophenolate mofetil. The most common life-threatening late effects were secondary malignancies, metabolic, or cardiac complications with a cumulative incidence of 6.6%, 6.6%, and 13.3%, respectively. No unusual late effects or patterns of relapse were noted on longer followed on patients treated with intensified myeloablative condition regimen. Results from this study supports continued development of intensive conditioning regimens in patients with r/r acute leukemias to improve leukemia free (LFS) and OS in this high-risk population.
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Affiliation(s)
- Amandeep Salhotra
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope National Medical Center, Duarte, CA, USA
| | - Susanta Hui
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Saro Armenian
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Brianna Sigala
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen Forman
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Andrew Artz
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Jeffery Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Anthony Stein
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
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52
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Aldoss I, Advani A, Pullarkat V. Will immunotherapy lead to a breakthrough in the treatment of older adults with ALL? Best Pract Res Clin Haematol 2021; 34:101319. [PMID: 34865691 DOI: 10.1016/j.beha.2021.101319] [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: 11/29/2022]
Abstract
Historically, older adults with B-cell acute lymphoblastic leukemia (ALL) have done poorly with chemotherapy-based treatment. Therefore, new innovative approaches are urgently needed to improve outcomes for this population. CD19-targeted immunotherapies such as blinatumomab and chimeric antigen receptor (CAR) T cell therapy have produced remarkable responses in relapsed/refractory (r/r) B-cell ALL, including clearance of minimal residual disease (MRD). Available data support the efficacy and safety of blinatumomab in older adults with advanced B-cell ALL. Therefore, its application is being extended to frontline regimens for B-cell ALL, particularly in older adults. There are several studies actively examining the role of blinatumomab alone or in combination with attenuated dosing of conventional chemotherapy or novel agents in older adults with newly diagnosed ALL and early data are encouraging. While CD19-targeted CAR (CD19CAR) T cell therapy is active in children and young adults with r/r B-cell ALL, data supporting its efficacy and safety in older adults with ALL is scarce. Furthermore, the commercially FDA approved CD19CAR T cell therapy product for r/r ALL is restricted only to patients ≤25 years of age. Although there are concerns about older adults tolerating the expected toxicities associated with CAR T cell therapy, which may be life threatening, tailored approaches for prophylactic and pre-emptive interventions combined with utilization of safer CAR T cell platforms may improve tolerability and further extend the use of this promising treatment to older patients with ALL. In this review, we will discuss the progress in immunotherapies for older adults with B-cell ALL and their potential for transforming frontline therapy for newly diagnosed patients.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.
| | - Anjali Advani
- Department of Leukemia, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
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53
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Yao JM, Yang D, Clark MC, Otoukesh S, Cao T, Ali H, Arslan S, Aldoss I, Artz A, Amanam I, Salhotra A, Pullarkat V, Sandhu K, Stein A, Marcucci G, Forman SJ, Nakamura R, Al Malki MM. Tacrolimus initial steady state level in post-transplant cyclophosphamide-based GvHD prophylaxis regimens. Bone Marrow Transplant 2021; 57:232-242. [PMID: 34802049 PMCID: PMC8825746 DOI: 10.1038/s41409-021-01528-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022]
Abstract
Post-transplant cyclophosphamide (PTCy) combined with tacrolimus (TAC) as graft-versus-host disease (GvHD) prophylaxis post-hematopoietic cell transplantation (HCT) is safe and effective. Optimal serum levels of TAC in this combination remain undetermined. We hypothesized that TAC at initial steady state (TISS) of <10 ng/mL could promote optimal transplant outcomes and prevent TAC-associated toxicities. We retrospectively analyzed a consecutive case series of 210 patients who received PTCy/TAC-based prophylaxis post-HCT from 1/2013–6/2018. Patients received HCT from haploidentical (n=172) or mismatched donors (n=38), and flat dose (FD) or weight-based dose (WBD) TAC. Twenty-four-month overall survival (OS), disease free survival (DFS), and relapse rate (RR) were 61%, 56%, and 22%, respectively, in TISS <10 ng/mL cohort (n=176), and 50%, 43%, and 35%, respectively, in TISS ≥10 ng/mL cohort (n=34) (OS, P=0.71; DFS, P=0.097; RR, P=0.031). OS, DFS, RR, non-relapse mortality, acute GvHD grade II-IV, grade III-IV or chronic GvHD by TISS were similar in multivariable analysis. TISS ≥10 ng/mL conferred increased risk of viral infection (P=0.003). More patients receiving FD vs. WBD had TISS <10 ng/mL (P=0.001). Overall, TISS <10 ng/mL early post HCT conferred similar survival outcomes and lowered risk of viral infection and toxicities compared to TISS ≥10 ng/mL.
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Affiliation(s)
- Janny M Yao
- Department of Pharmacy, City of Hope National Medical Center, Duarte, CA, USA
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, Division of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA
| | - Mary C Clark
- Department of Clinical and Translational Project Development, City of Hope National Medical Center, Duarte, CA, USA
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Thai Cao
- Bone Marrow Transplant Department, Kaiser Permanente, Los Angeles, CA, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Idoroenyi Amanam
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Anthony Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.
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54
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Quiroz E, Venkateswaran AR, Nelson R, Aldoss I, Pullarkat V, Rego E, Marcucci G, Douer D. Immunophenotype of acute lymphoblastic leukemia in minorities- analysis from the SEER database. Hematol Oncol 2021; 40:105-110. [PMID: 34766363 DOI: 10.1002/hon.2945] [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: 07/05/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022]
Abstract
Acute Lymphocytic Leukemia (ALL) is a malignancy that originates from immature lymphoid cells and is clinically established with flow cytometry through disease-specific markers. Variation between ethnic groups is an epidemiological aspect of ALL. Higher incidence rates have been observed in Latin American patients and ALL in Latinos carries a dismal prognosis. The cell of origin in ALL is derived from immature cells of either the B or T lineage. Most reported data among Latinos either exclusively looks at B cell precursor ALL or do not distinguish between subtypes. We used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to delineate the differences in incidence rates of B-ALL and T-ALL across ethnic groups in the United States. Data from SEER-18 was used to compare incidence rates of T-ALL and B-ALL. Due to the utilization of cytogenetics and subsequent changes in ICD coding over the years examined the most recent data reported from 2002 to 2017. We compared rates in Non-Hispanic Whites (NHWs), Latinos, Blacks and Asian-Pacific Islanders (API). Age-adjusted incidence rates per 100,000 person-years were calculated. The incidence rate of B-ALL in the Latino population was consistently higher than other race/ethnicities throughout the years, ranging from 1.0 per 100,000 in 2002 to 2.5 per 100,000 in 2017. Blacks had the lowest age adjusted incidence rate (AAIR) of B-ALL overall, with rates approximately one third of those found in Latinos and the highest AAIR of T-ALL with an AAIR of 0.5 per 100,000.
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Affiliation(s)
| | | | | | | | | | | | | | - Dan Douer
- University of Southern California, Los Angeles, California, USA
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55
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Aldoss I, Clark M, Marcucci G, Forman SJ. Donor derived leukemia in allogeneic transplantation. Leuk Lymphoma 2021; 62:2823-2830. [PMID: 34713775 DOI: 10.1080/10428194.2021.1929966] [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
Allogeneic hematopoietic cell transplantation (alloHCT) is a curative option for the treatment of eligible patients with hematological malignancies. This modality confers a risk for life-threatening complications, including the rare and underdiagnosed complication of donor-derived leukemia (DDL). DDL differs from relapse of the original malignancy in that DDL originates from the donor stem cells and is unrelated to the original diagnosis. Because DDL may be the same lineage as the original diagnosis, it is difficult to identify these cases and many remain unrecognized. There is no consensus of how to approach the treatment of patients with DDL, and their prognosis is poor considering that patients with DDL have already been treated for their original leukemia and have undergone alloHCT. DDL occurs following transplants using any donor stem cell source (bone marrow, peripheral blood and cord blood) and any donor type (matched/unmatched, related/unrelated and haploidentical). Both donor and recipient factors contribute to the development of DDL, and a better understanding of these factors is crucial to reduce the risk for the development of DDL. In this review, we provide an overview of DDL, including the incidence, diagnosis, etiology, prognosis, and treatment.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Mary Clark
- Department of Clinical and Translational Project Development, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Hematology Malignancies and Stem Cell Transplantation Institute, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
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56
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Aldoss I, Otoukesh S, Zhang J, Mokhtari S, Ngo D, Mojtahedzadeh M, Al Malki MM, Salhotra A, Ali H, Aribi A, Sandhu KS, Arslan S, Koller P, Ball B, Stewart F, Curtin P, Artz A, Nakamura R, Marcucci G, Forman SJ, Stein AS, Pullarkat V. Extramedullary disease relapse and progression after blinatumomab therapy for treatment of acute lymphoblastic leukemia. Cancer 2021; 128:529-535. [PMID: 34633671 DOI: 10.1002/cncr.33967] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/16/2021] [Revised: 08/20/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Blinatumomab has demonstrated encouraging activity in relapsed/refractory (r/r) and minimal residual disease-positive (MRD+) acute lymphoblastic leukemia (ALL). Extramedullary disease (EMD) relapse or relapse with CD19- disease has been observed after blinatumomab therapy in patients with r/r or MRD+ ALL. However, the pathophysiology and risk factors of treatment failure are not fully understood. METHODS This study retrospectively reviewed the outcomes of adult patients with B-cell ALL treated with blinatumomab (n = 132) for either r/r (n = 103) or MRD+ disease (n = 29) at the authors' center (2013-2021) and analyzed factors associated with treatment response and EMD failure. RESULTS The overall response rate was 64%. A lower marrow blast burden before blinatumomab (P = .049) and no history of previous EMD (P = .019) were significantly associated with a higher response. Among the patients who responded to blinatumomab, 56% underwent consolidation with allogeneic transplantation. Blinatumomab failure was observed in 89 patients; 43% of these patients (n = 38) either progressed or relapsed at extramedullary sites. A history of extramedullary involvement (53% vs 24%; P = .005) and retention of CD19 expression at the time of relapse/progression (97% vs 74%; P = .012) were associated with a higher risk for extramedullary failure. Central nervous system (CNS) failure after blinatumomab was encountered in 39% of the patients with EMD. CONCLUSIONS A history of EMD predicted an inferior response to blinatumomab therapy with a higher risk for relapse/progression at extramedullary sites (particularly CNS). Consolidation with allogenic transplantation in patients who primarily responded to blinatumomab did not abrogate the risk of extramedullary relapse. The incorporation of extramedullary assessment and the intensification of CNS prophylaxis may help in addressing extramedullary failure. LAY SUMMARY Extramedullary failure is common during blinatumomab therapy for relapsed/refractory acute lymphoblastic leukemia. A history of extramedullary disease predicts an inferior response to blinatumomab therapy and a higher risk for relapse/progression at extramedullary sites. Most extramedullary failure cases retain CD19 expression.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Jianying Zhang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California
| | - Sally Mokhtari
- Department of Clinical and Translational Project Development, City of Hope National Medical Center, Duarte, California
| | - Dat Ngo
- Department of Pharmacy, City of Hope National Medical Center, Duarte, California
| | - Mona Mojtahedzadeh
- Department of Clinical Supportive Care, City of Hope National Medical Center, Duarte, California
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Karamjeet S Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Paul Koller
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Brian Ball
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Forrest Stewart
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Peter Curtin
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
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57
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Lazaryan A, Dolan M, Zhang MJ, Wang HL, Kharfan-Dabaja MA, Marks DI, Bejanyan N, Copelan E, Majhail NS, Waller EK, Chao N, Prestidge T, Nishihori T, Kebriaei P, Inamoto Y, Hamilton B, Hashmi SK, Kamble RT, Bacher U, Hildebrandt GC, Stiff PJ, McGuirk J, Aldoss I, Beitinjaneh AM, Muffly L, Vij R, Olsson RF, Byrne M, Schultz KR, Aljurf M, Seftel M, Savoie ML, Savani BN, Verdonck LF, Cairo MS, Hossain N, Bhatt VR, Frangoul HA, Abdel-Azim H, Al Malki M, Munker R, Rizzieri D, Khera N, Nakamura R, Ringdén O, Van der Poel M, Murthy HS, Liu H, Mori S, De Oliveira S, Bolaños-Meade J, Elsawy M, Barba P, Nathan S, George B, Pawarode A, Grunwald M, Agrawal V, Wang Y, Assal A, Caro PC, Kuwatsuka Y, Seo S, Ustun C, Politikos I, Lazarus HM, Saber W, Sandmaier BM, De Lima M, Litzow M, Bachanova V, Weisdorf D. Impact of cytogenetic abnormalities on outcomes of adult Philadelphia-negative acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: a study by the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research. Haematologica 2021; 106:2295-2296. [PMID: 34333962 PMCID: PMC8327734 DOI: 10.3324/haematol.2021.279046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Michelle Dolan
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mei-Jie Zhang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Edward Copelan
- Levine Cancer Institute, Atrium Health, Carolinas HealthCare System, Charlotte, NC, USA
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Nelson Chao
- Division of Cell Therapy and Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Betty Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, MN, USA; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Switzerland
| | | | | | | | - Ibrahim Aldoss
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, the Netherlands
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Nasheed Hossain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Monzr Al Malki
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Olle Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm Sweden
| | | | | | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | - Shahram Mori
- Blood and Marrow Transplant Center, Florida Hospital Medical Group, Orlando, FL, USA
| | | | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mahmoud Elsawy
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pere Barba
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Vaibhav Agrawal
- Division of Hematology- Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Youjin Wang
- National Cancer Institute (NCI), Rockville, MD, USA
| | - Amer Assal
- New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL, USA
| | | | | | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcos De Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Mac S, Ngo D, Yang D, Chen J, Ali H, Arslan S, Dadwal S, Salhotra A, Cao T, Karras N, Aldoss I, Koller P, Artz A, Aribi A, Sandhu K, Pullarkat V, Stein A, Marcucci G, Forman SJ, Nakamura R, Al Malki MM. Use of high-dose mesna and hyperhydration leads to lower incidence of hemorrhagic cystitis after posttransplant cyclophosphamide-based allogeneic transplantation. Bone Marrow Transplant 2021; 56:2464-2470. [PMID: 34108676 DOI: 10.1038/s41409-021-01364-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/09/2022]
Abstract
Currently, there is no consensus on best practices to prevent hemorrhagic cystitis (HC) in patients receiving posttransplant cyclophosphamide (PTCy). We retrospectively reviewed 194 patients undergoing their first hematopoietic cell transplant (HCT) who received PTCy from 2014 to 2018 to describe the incidence and severity of HC, identify potential risk factors, and impact of HC on HCT outcomes. Standard HC prophylaxis was hyperhydration with forced diuresis and mesna at 320% the daily dose of PTCy. Incidence of HC was 31.4% at day +100 of HCT. Median onset of HC was 12 days with 11.5% grade 3 HC and no Grade 4 HC. Patients with chemical HC experienced earlier onset (7 days vs. 34 days, p < 0.001) with a shorter median resolution time (5 days vs. 14 days, p = 0.001) when compared to BK-associated HC. In multivariate analysis, age above 60 years (HR 4.16, p = 0.006) and myeloablative conditioning (HR 2.44, p = 0.054) were associated with higher risk for HC, but overall, HC did not affect nonrelapse mortality or overall survival. In conclusion, hyperhydration with forced diuresis combined with aggressive mesna dosing is an effective strategy in preventing severe PTCy-associated HC, subsequently preventing any negative impact on transplant outcome.
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Affiliation(s)
- Stephanie Mac
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Dat Ngo
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Dongyun Yang
- Department of Information Sciences, City of Hope, Duarte, CA, USA
| | - Jason Chen
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Sanjeet Dadwal
- Department of Infectious Diseases, City of Hope, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Thai Cao
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Nicole Karras
- Department of Pediatrics, City of Hope, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Paul Koller
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Anthony Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.
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59
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Arslan S, Pullarkat V, Aldoss I. Indications for Allogeneic HCT in Adults with Acute Lymphoblastic Leukemia in First Complete Remission. Curr Treat Options Oncol 2021; 22:63. [PMID: 34097131 DOI: 10.1007/s11864-021-00860-1] [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] [Accepted: 03/31/2021] [Indexed: 01/12/2023]
Abstract
OPINION STATEMENT Acute lymphoblastic leukemia (ALL) in adults is associated with poor outcomes as compared to children when treated with chemotherapy, leading to a considerably inferior cure rate. Historically, consolidation with allogeneic hematopoietic cell transplant (alloHCT) was routinely recommended for eligible adults with ALL in first complete remission (CR1) if a donor was available, since randomized studies showed superiority over continuing chemotherapy. With the increasing use of pediatric-inspired frontline regimens in young adults with ALL and the availability of novel salvage agents for relapsed/refractory B-cell ALL that have high potential in inducing a second CR, the role of early alloHCT in the treatment paradigm for ALL needs to be reevaluated, and the decision should be individualized for each patient. Simultaneously, alloHCT has evolved considerably lately, and historical randomized studies that have proven the benefit of alloHCT in adults with ALL in CR1 did not included the increasing use of reduced intensity conditioning and haploidentical transplants, and therefore, data may not entirely apply. Nowadays, detectable minimal residual disease (MRD) is the most prognostic determinant of ALL outcome and should be a major consideration in the decision to perform alloHcT in CR1. Nonetheless, other biological and clinical factors remain relevant and can support the complex decision-making. Such factors include high-risk leukemia genetics, the type of administered chemotherapy regimen and the ability of the patient to tolerate all key components of the regimen, and the availability of effective salvage therapies that allow alloHCT to be performed in CR2 in case of relapse after chemotherapy.
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Affiliation(s)
- Shukaib Arslan
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.
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60
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Salhotra A, Aribi A, Ngo D, Zhang J, Sandhu K, Al‐Malki M, Ali H, Koller P, Arslan S, Budde E, Khaled S, Dadwal S, Snyder DS, Artz A, Forman S, Nakamura R, Stein A, Marcucci G, Aldoss I, Pullarkat V. Outcome of secondary acute myeloid leukemia treated with hypomethylating agent plus venetoclax (HMA-Ven) or liposomal daunorubicin-cytarabine (CPX-351). Am J Hematol 2021; 96:E196-E200. [PMID: 33719090 DOI: 10.1002/ajh.26157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Amandeep Salhotra
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Ahmed Aribi
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Dat Ngo
- Department of Clinical Pharmacology City of Hope National Medical Center Duarte California
| | - Jianying Zhang
- Department of Information Sciences City of Hope National Medical Center Duarte California
| | - Karamjeet Sandhu
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Monzr Al‐Malki
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Haris Ali
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Paul Koller
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Shukaib Arslan
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Elizabeth Budde
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Samer Khaled
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Sanjeet Dadwal
- Division of Infectious Disease City of Hope National Medical Center Duarte California
| | - David S. Snyder
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Andrew Artz
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Stephen Forman
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Ryotaro Nakamura
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Anthony Stein
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Guido Marcucci
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Ibrahim Aldoss
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
| | - Vinod Pullarkat
- Department of Hematology and HCT City of Hope National Medical Center Duarte California
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61
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Borthakur G, Odenike O, Aldoss I, Rizzieri DA, Prebet T, Chen C, Popovic R, Modi DA, Joshi RH, Wolff JE, Jonas BA. A phase 1 study of the pan-bromodomain and extraterminal inhibitor mivebresib (ABBV-075) alone or in combination with venetoclax in patients with relapsed/refractory acute myeloid leukemia. Cancer 2021; 127:2943-2953. [PMID: 33934351 PMCID: PMC8360206 DOI: 10.1002/cncr.33590] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 11/02/2020] [Revised: 02/12/2021] [Accepted: 03/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a heterogenous malignancy driven by genetic and epigenetic factors. Inhibition of bromodomain and extraterminal (BET) proteins, epigenetic readers that play pivotal roles in the regulation of genes relevant to cancer pathogenesis, constitutes a novel AML treatment approach. METHODS In this first-in-human study of the pan-BET inhibitor mivebresib as monotherapy (MIV-mono) or in combination with venetoclax (MIV-Ven), the safety profile, efficacy, and pharmacodynamics of mivebresib were determined in patients with relapsed/refractory AML (ClinicalTrials.gov identifier NCT02391480). Mivebresib was administered at 3 monotherapy dose levels (1.5, 2.0, or 2.5 mg) or in combination with venetoclax (400 or 800 mg). RESULTS Forty-four patients started treatment: of 19 who started MIV-mono, 5 went on to receive MIV-Ven combination therapy after disease progression and a washout period. Twenty-five patients started MIV-Ven, resulting in a total of 30 patients treated with the combination. The most common mivebresib-related treatment-emergent adverse events were dysgeusia (74%), decreased appetite (42%), and diarrhea (42%) in the MIV-mono group and decreased appetite (44%), vomiting (44%), and nausea (40%) in the MIV-Ven group. Serious adverse events occurred in 14 patients (74%) who received MIV-mono and in 22 patients (88%) who received MIV-Ven. In the MIV-mono group, responses were complete remission with incomplete blood count recovery in 1 patient and resistant disease in 15 patients. In the MIV-Ven group, responses were complete remission in 2 patients, partial remission in 2 patients, morphologic leukemia-free state in 2 patients, resistant disease in 12 patients, and aplasia in 1 patient. The pharmacodynamic effects of mivebresib were proportional to dose and drug exposure. CONCLUSIONS Mivebresib was tolerated and showed antileukemic effects as monotherapy and in combination with venetoclax in patients with relapsed/refractory AML. LAY SUMMARY Mivebresib is a novel drug that influences the way cancer cells read genetic information. Mivebresib was tested together with venetoclax in patients with acute myeloid leukemia after standard medicines failed and the disease returned, or when standard medicine was unavailable. Adverse effects were described for different drug doses, and the dose that is tolerable was determined. In some patients, their leukemia improved for some time. More studies are necessary to determine whether mivebresib can be used to treat acute myeloid leukemia.
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Affiliation(s)
- Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Olatoyosi Odenike
- Section of Hematology/Oncology, The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Thomas Prebet
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut
| | | | | | | | | | | | - Brian A Jonas
- Division of Hematology and Oncology, Department of Internal Medicine, University of California-Davis School of Medicine, Sacramento, California
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Othman TA, Mei M, Zhang J, Aldoss I, Stein A, Forman SJ, Marcucci G, Pullarkat V. Rebound thrombocytosis is associated with response in AML patients treated with venetoclax and hypomethylating agents. Am J Hematol 2021; 96:E140-E143. [PMID: 33524204 DOI: 10.1002/ajh.26117] [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] [Received: 01/04/2021] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Tamer A. Othman
- University of California Davis Comprehensive Cancer Center Sacramento CA USA
| | - Matthew Mei
- Department of Hematology and HCT, Gehr Center for Leukemia Research City of Hope, Duarte CA USA
| | - Jianying Zhang
- Department of Hematology and HCT, Gehr Center for Leukemia Research City of Hope, Duarte CA USA
| | - Ibrahim Aldoss
- Department of Hematology and HCT, Gehr Center for Leukemia Research City of Hope, Duarte CA USA
| | - Anthony Stein
- Department of Hematology and HCT, Gehr Center for Leukemia Research City of Hope, Duarte CA USA
| | - Stephen J. Forman
- Department of Hematology and HCT, Gehr Center for Leukemia Research City of Hope, Duarte CA USA
| | - Guido Marcucci
- Department of Hematology and HCT, Gehr Center for Leukemia Research City of Hope, Duarte CA USA
| | - Vinod Pullarkat
- Department of Hematology and HCT, Gehr Center for Leukemia Research City of Hope, Duarte CA USA
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63
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Badar T, Szabo A, Litzow M, Burkart M, Yurkiewicz I, Dinner S, Hefazi M, Shallis RM, Podoltsev N, Patel AA, Curran E, Wadleigh M, Balasubramanian S, Yang J, Arslan S, Aldoss I, Mattison R, Cenin D, Siebenaller C, Advani A, Liedtke M, Atallah E. Multi-institutional study evaluating clinical outcome with allogeneic hematopoietic stem cell transplantation after blinatumomab in patients with B-cell acute lymphoblastic leukemia: real-world data. Bone Marrow Transplant 2021; 56:1998-2004. [PMID: 33824440 DOI: 10.1038/s41409-021-01279-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 11/09/2022]
Abstract
Safety and efficacy of allogeneic hematopoietic stem cell transplantation (alloHCT) consolidation after blinatumomab is largely undetermined. To address this issue, we assembled multi-center data of relapsed refractory (RR) acute lymphocytic leukemia (ALL) patients who received alloHCT after blinatumomab. From December 2014 to May 2019, 223 patients who received blinatumomab for RR ALL outside clinical trials were identified. Among them, 106 (47%) patients transplanted post blinatumomab were evaluated for response and toxicity. Ninety-two (87%) patients received alloHCT after achieving CR, while remaining received subsequent salvage prior to undergoing alloHCT. Progression free survival (PFS) and overall survival (OS) at 2 years post alloHCT was 48% (95% CI: 36-59%) and 58% (95% CI: 45-69%), respectively. The cumulative incidence of GIII-IV aGVHD at 3 months was 9.9% (95% CI: 5.0-16.6%). Similarly, cumulative incidence of moderate to severe cGVHD at 2 years was 34.4% (95% CI: 23.7-45.3%). The overall survival at 2 years was not significantly different in patient who achieved CR with MRD negative (68.4% [95% CI: 28.5-89.1%]) compared to CR with MRD positive (63.4% [95% CI: 47.8-75.4%]) prior to alloHCT (p = 0.8). Our real-world analysis suggests that alloHCT is feasible and effective post blinatumomab in patients with RR ALL.
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Affiliation(s)
- Talha Badar
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Aniko Szabo
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Madelyn Burkart
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, IL, USA
| | | | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, IL, USA
| | | | - Rory M Shallis
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Nikolai Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | - Anand A Patel
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Emily Curran
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Jay Yang
- Karmanos Cancer Institute, Detroit, MI, USA
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ryan Mattison
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Danielle Cenin
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Caitlin Siebenaller
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anjali Advani
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ehab Atallah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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64
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Ali H, Salhotra A, Stein AS, Nakamura R, Marcucci G, Forman SJ, Pullarkat V, Aldoss I. Efficacy of blinatumomab for MRD relapse in ALL post allogenic HCT. Leuk Res 2021; 104:106579. [PMID: 33831656 DOI: 10.1016/j.leukres.2021.106579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Haris Ali
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Amandeep Salhotra
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Stephen J Forman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States.
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65
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Jeyakumar N, Aldoss I, Yang D, Mokhtari S, Gendzekhadze K, Khaled S, O'Donnell M, Palmer J, Song JY, Marcucci G, Stein AS, Forman SJ, Pullarkat VA, Chen W, Wu X, Nakamura R. Cytokine gene polymorphisms are associated with response to blinatumomab in B-cell acute lymphoblastic leukemia. Eur J Haematol 2021; 106:851-858. [PMID: 33721333 DOI: 10.1111/ejh.13622] [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: 12/16/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
Blinatumomab is a bispecific T cell-engaging antibody approved for treatment of relapsed/refractory (r/r) ALL, with 40%-50% complete response (CR)/CR with incomplete count recovery (CRi). Cytokine release syndrome (CRS) as a major adverse effect after blinatumomab therapy. Here, we evaluated the possible association between single-nucleotide polymorphisms (SNPs) in cytokine genes, disease response, and CRS in r/r ALL patients who received blinatumomab between 2012 and 2017 at our center (n = 66), using patients' archived DNA samples. With a median duration of 9.5 months (range: 1-37), 37 patients (56.1%) achieved CR/CRi, 54 (81.8%) experienced CRS (G1: n = 35, G2: n = 14, G3: n = 5), and 9 (13.6%) developed neurotoxicity. By multivariable analysis, after adjusting for high disease burden, one SNP on IL2 (rs2069762), odds ratio (OR) = 0.074 (95% CI: NE-0.43, P = .01) and one SNP on IL17A (rs4711998), OR = 0.28 (95% CI: 0.078-0.92, P = .034) were independently associated with CR/CRi. None of the analyzed SNPs were associated with CRS. To our knowledge, this is the first study demonstrating a possible association between treatment response to blinatumomab and SNPs. Our hypothesis-generated data suggest a potential role for IL-17 and IL-2 in blinatumomab response and justify a larger confirmatory study, which may lead to personalized blinatumomab immunotherapy for B-ALL.
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Affiliation(s)
- Nikeshan Jeyakumar
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Dongyun Yang
- Department of Computational Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Samer Khaled
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Margaret O'Donnell
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Joycelynne Palmer
- Department of Computational Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Joo Y Song
- Department of Molecular and Cellular Biology/Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod A Pullarkat
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Wei Chen
- Department of Molecular and Cellular Biology/Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA, USA
| | - Xiwei Wu
- Department of Molecular and Cellular Biology/Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
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66
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Arslan S, Zhang J, Dhakal P, Moran J, Naidoo N, Lombardi J, Pullarkat V, Stein AS, Marcucci G, Yaghmour G, Bhatt VR, Fathi AT, Aldoss I. Outcomes of therapy with venetoclax combined with a hypomethylating agent in favorable-risk acute myeloid leukemia. Am J Hematol 2021; 96:E59-E63. [PMID: 33227142 DOI: 10.1002/ajh.26057] [Citation(s) in RCA: 3] [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: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - Jianying Zhang
- Department of Information Sciences City of Hope Medical Center Duarte California USA
| | - Prajwal Dhakal
- Department of Hematology and Oncology University of Nebraska Medical Center Omaha Nebraska USA
| | - Jenna Moran
- Division of Hematology/Oncology Massachusetts General Hospital Boston Massachusetts USA
| | - Nuthana Naidoo
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease University of Southern California Los Angeles California USA
| | - Jennifer Lombardi
- Division of Hematology/Oncology Massachusetts General Hospital Boston Massachusetts USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the study of Blood disease University of Southern California Los Angeles California USA
| | - Vijaya R. Bhatt
- Department of Hematology and Oncology University of Nebraska Medical Center Omaha Nebraska USA
| | - Amir T. Fathi
- Division of Hematology/Oncology Massachusetts General Hospital Boston Massachusetts USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Duarte California USA
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Abstract
Venetoclax in combination with hypomethylating agents (HMAs) or low-dose cytarabine (LDAC) has demonstrated exceptional activity in elderly and unfit patients with newly diagnosed acute myeloid leukemia (AML). Notably, the safety profile of venetoclax-based induction regimens was favorable, with a low rate of early treatment-related mortality, even in frail study participants. Thus, the introduction of venetoclax has transformed the landscape of AML therapy in elderly patients. Given these promising results, venetoclax in combination with other agents is now being studied as a frontline therapy in younger patients with AML, as well as in relapsed/refractory AML patients. Here, we review clinical data for venetoclax-based therapy in AML, both from prospective as well as retrospective studies, and highlight ongoing novel studies of venetoclax-containing regimens and discuss future research directions.
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Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, City of Hope, 1500 Duarte Road, Duarte, CA 91010, USA
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69
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Uy GL, Aldoss I, Foster MC, Sayre PH, Wieduwilt MJ, Advani AS, Godwin JE, Arellano ML, Sweet KL, Emadi A, Ravandi F, Erba HP, Byrne M, Michaelis L, Topp MS, Vey N, Ciceri F, Carrabba MG, Paolini S, Huls GA, Jongen-Lavrencic M, Wermke M, Chevallier P, Gyan E, Récher C, Stiff PJ, Pettit KM, Löwenberg B, Church SE, Anderson E, Vadakekolathu J, Santaguida M, Rettig MP, Muth J, Curtis T, Fehr E, Guo K, Zhao J, Bakkacha O, Jacobs K, Tran K, Kaminker P, Kostova M, Bonvini E, Walter RB, Davidson-Moncada JK, Rutella S, DiPersio JF. Flotetuzumab as salvage immunotherapy for refractory acute myeloid leukemia. Blood 2021; 137:751-762. [PMID: 32929488 PMCID: PMC7885824 DOI: 10.1182/blood.2020007732] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [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: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
Approximately 50% of acute myeloid leukemia (AML) patients do not respond to induction therapy (primary induction failure [PIF]) or relapse after <6 months (early relapse [ER]). We have recently shown an association between an immune-infiltrated tumor microenvironment (TME) and resistance to cytarabine-based chemotherapy but responsiveness to flotetuzumab, a bispecific DART antibody-based molecule to CD3ε and CD123. This paper reports the results of a multicenter, open-label, phase 1/2 study of flotetuzumab in 88 adults with relapsed/refractory AML: 42 in a dose-finding segment and 46 at the recommended phase 2 dose (RP2D) of 500 ng/kg per day. The most frequent adverse events were infusion-related reactions (IRRs)/cytokine release syndrome (CRS), largely grade 1-2. Stepwise dosing during week 1, pretreatment dexamethasone, prompt use of tocilizumab, and temporary dose reductions/interruptions successfully prevented severe IRR/CRS. Clinical benefit accrued to PIF/ER patients showing an immune-infiltrated TME. Among 30 PIF/ER patients treated at the RP2D, the complete remission (CR)/CR with partial hematological recovery (CRh) rate was 26.7%, with an overall response rate (CR/CRh/CR with incomplete hematological recovery) of 30.0%. In PIF/ER patients who achieved CR/CRh, median overall survival was 10.2 months (range, 1.87-27.27), with 6- and 12-month survival rates of 75% (95% confidence interval [CI], 0.450-1.05) and 50% (95% CI, 0.154-0.846). Bone marrow transcriptomic analysis showed that a parsimonious 10-gene signature predicted CRs to flotetuzumab (area under the receiver operating characteristic curve = 0.904 vs 0.672 for the European LeukemiaNet classifier). Flotetuzumab represents an innovative experimental approach associated with acceptable safety and encouraging evidence of activity in PIF/ER patients. This trial was registered at www.clinicaltrials.gov as #NCT02152956.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cytokine Release Syndrome/chemically induced
- Cytokine Release Syndrome/drug therapy
- Dose-Response Relationship, Immunologic
- Drug Administration Schedule
- Drug Resistance, Neoplasm
- Female
- Follow-Up Studies
- Hematopoiesis/drug effects
- Humans
- Immunotherapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Male
- Maximum Tolerated Dose
- Middle Aged
- Nausea/chemically induced
- Protein Interaction Maps
- Salvage Therapy
- Survival Rate
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Affiliation(s)
- Geoffrey L Uy
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Peter H Sayre
- Division of Hematology and Blood and Marrow Transplantation, University of California San Francisco, San Francisco, CA
| | | | - Anjali S Advani
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Kendra L Sweet
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Ashkan Emadi
- Marlene & Stewart Greenebaum Cancer, School of Medicine, University of Maryland, Baltimore, MD
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harry P Erba
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Centre, Durham, NC
| | - Michael Byrne
- Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Laura Michaelis
- Division of Hematology/Oncology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI
| | - Max S Topp
- Medizinische Klinik Und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Norbert Vey
- Hematologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Matteo Giovanni Carrabba
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Stefania Paolini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology L. and A. Seràgnoli, University of Bologna, Bologna, Italy
| | - Gerwin A Huls
- Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Martin Wermke
- Universitätsklinikum Carl Gustav Carus an der Technische Universität, Dresden, Germany
| | - Patrice Chevallier
- Institut Universitaire du Cancer Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Gyan
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Christian Récher
- Hôpital Bretonneau, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | | | - Kristen M Pettit
- Michigan Medicine Bone Marrow Transplant and Leukemia, C. S. Mott Children's Hospital, Ann Arbor, MI
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Jayakumar Vadakekolathu
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Michael P Rettig
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | | | | | - Kuo Guo
- MacroGenics Inc, Rockville, MD
| | | | | | | | | | | | | | | | | | | | - Sergio Rutella
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
- Centre for Health, Ageing and Understanding Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - John F DiPersio
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
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70
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Zhao Y, Aldoss I, Qu C, Crawford JC, Gu Z, Allen EK, Zamora AE, Alexander TB, Wang J, Goto H, Imamura T, Akahane K, Marcucci G, Stein AS, Bhatia R, Thomas PG, Forman SJ, Mullighan CG, Roberts KG. Tumor-intrinsic and -extrinsic determinants of response to blinatumomab in adults with B-ALL. Blood 2021; 137:471-484. [PMID: 32881995 PMCID: PMC7845009 DOI: 10.1182/blood.2020006287] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [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: 04/09/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Blinatumomab, a bispecific antibody that directs CD3+ T cells to CD19+ tumor cells, shows variable efficacy in B-progenitor acute lymphoblastic leukemia (B-ALL). To determine tumor-intrinsic and -extrinsic determinants of response, we studied 44 adults with relapsed or refractory B-ALL (including 2 minimal residual disease positive) treated with blinatumomab using bulk tumor and single-cell sequencing. The overall response rate in patients with hematological disease was 55%, with a high response rate in those with CRLF2-rearranged Philadelphia chromosome-like ALL (12 [75%] of 16). Pretreatment samples of responders exhibited a tumor-intrinsic transcriptomic signature of heightened immune response. Multiple mechanisms resulted in loss of CD19 expression, including CD19 mutations, CD19-mutant allele-specific expression, low CD19 RNA expression, and mutations in CD19 signaling complex member CD81. Patients with low hypodiploid ALL were prone to CD19- relapse resulting from aneuploidy-mediated loss of the nonmutated CD19 allele. Increased expression of a CD19 isoform with intraexonic splicing of exon 2, CD19 ex2part, at baseline or during therapy was associated with treatment failure. These analyses demonstrate both tumor-intrinsic and -extrinsic factors influence blinatumomab response. We show that CD19 mutations are commonly detected in CD19- relapse during blinatumomab treatment. Identification of the CD19 ex2part splice variant represents a new biomarker predictive of blinatumomab therapy failure.
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MESH Headings
- Adolescent
- Adult
- Aged
- Amino Acid Sequence
- Aneuploidy
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/pharmacology
- Antibodies, Bispecific/therapeutic use
- Antigens, CD19/biosynthesis
- Antigens, CD19/genetics
- Antigens, CD19/immunology
- Antigens, Neoplasm/biosynthesis
- Antigens, Neoplasm/genetics
- Antigens, Neoplasm/immunology
- Antineoplastic Agents, Immunological/immunology
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- B-Lymphocytes/drug effects
- B-Lymphocytes/immunology
- Cytotoxicity, Immunologic/drug effects
- Drug Resistance, Neoplasm/physiology
- Female
- Gene Expression Profiling
- Humans
- Male
- Middle Aged
- Mutation
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Protein Isoforms/antagonists & inhibitors
- Protein Isoforms/genetics
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- RNA, Neoplasm/biosynthesis
- RNA, Neoplasm/genetics
- Recurrence
- Retrospective Studies
- Salvage Therapy
- Sequence Alignment
- Sequence Homology, Amino Acid
- Single-Cell Analysis
- T-Lymphocyte Subsets/drug effects
- T-Lymphocyte Subsets/immunology
- Young Adult
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Affiliation(s)
- Yaqi Zhao
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | - Chunxu Qu
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Zhaohui Gu
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Emma K Allen
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN
| | - Anthony E Zamora
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Jeremy Wang
- Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Hiroaki Goto
- Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshi Akahane
- Department of Pediatrics, School of Medicine, University of Yamanashi, Chuo, Japan; and
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | - Ravi Bhatia
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Paul G Thomas
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA
| | | | - Kathryn G Roberts
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
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71
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Aldoss I, Yang D, Malki MMA, Mei M, Mokhtari S, Artz A, Cao T, Salhotra A, Ali H, Aribi A, Khaled S, Arslan S, Sandhu K, Koller P, Mansour J, Spielberger R, Stein A, Snyder D, Marcucci G, Forman SJ, Nakamura R, Pullarkat V. Allogeneic Hematopoietic Cell Transplantation for Relapsed and Refractory Philadelphia Negative B Cell ALL in the Era of Novel Salvage Therapies. Transplant Cell Ther 2020; 27:255.e1-255.e9. [PMID: 33781525 DOI: 10.1016/j.jtct.2020.12.020] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022]
Abstract
Introduction of novel salvage therapies and expansion of the donor pool within the past decade have allowed more patients with relapsed/refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL) to receive allogeneic hematopoietic cell transplantation (alloHCT). The impact of each salvage therapy on transplant outcomes have not been compared. Our primary objective was to determine post-HCT relapse-free survival (RFS) in adult patients with r/r Philadelphia-chromosome negative (Phneg) B-ALL. We retrospectively studied alloHCT outcomes in 108 adult patients with r/r Phneg B-ALL transplanted in morphological remission achieved by salvage therapy. Salvage therapies were chemotherapy-based combination (n = 45, 42%), blinatumomab (n=43, 40%), inotuzumab (n = 14, 13%), or CAR T cells (n = 6, 6%). The 2-year RFS and overall survival (OS) were 44% and 50%, respectively. In multivariable analysis, conditioning with reduced-intensity or non-myeloablative regimens (hazard ratio [HR] = 2.23, 95% confidence interval [CI], 1.31-3.80; P = .003), having received ≥3 lines of therapies prior to transplant (HR = 2.66, 95% CI, 1.56-4.54; P < .001), and inotuzumab (HR = 2.42, 95% CI, 1.14-5.12; Wald P value = .021) were independently associated with lower RFS. Blinatumomab (HR = 1.10, 95% CI, 0.62-1.96) had comparable RFS to chemotherapy. Incidence of hepatic sinusoidal syndrome was highest with inotuzumab (P < .001); however, 30-day mortality and intensive care unit admissions were not different per salvage therapy. The alloHCT in r/r Phneg B-ALL after remission induction with blinatumomab or chemotherapy led to encouraging outcomes if morphologic CR was achieved. In contrast, pretransplantation inotuzumab therapy was associated with inferior RFS. Larger studies are warranted to confirm our observations. Early transplantation after relapse and the utilization of myeloablative conditioning, when feasible, were key factors associated with improved outcomes after alloHCT in these patients.
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Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California
| | - Monzr M Al Malki
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Matthew Mei
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope National Medical Center, Duarte, California
| | - Andrew Artz
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Thai Cao
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Amandeep Salhotra
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Haris Ali
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ahmed Aribi
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Samer Khaled
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Shukaib Arslan
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Karamjeet Sandhu
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Paul Koller
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Joshua Mansour
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ricardo Spielberger
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Anthony Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - David Snyder
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Stephen J Forman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
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72
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Badar T, Szabo A, Dinner S, Liedtke M, Burkart M, Shallis RM, Yurkiewicz IR, Kuo E, Khan MA, Balasubramanian S, Yang J, Hefazi M, Podoltsev N, Patel A, Curran E, Wang A, Arslan S, Aldoss I, Siebenaller C, Mattison RJ, Litzow MR, Wadleigh M, Advani AS, Atallah E. Sequencing of novel agents in relapsed/refractory B-cell acute lymphoblastic leukemia: Blinatumomab and inotuzumab ozogamicin may have comparable efficacy as first or second novel agent therapy in relapsed/refractory acute lymphoblastic leukemia. Cancer 2020; 127:1039-1048. [PMID: 33259056 DOI: 10.1002/cncr.33340] [Citation(s) in RCA: 14] [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: 05/11/2020] [Revised: 09/25/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND The availability of novel agents (NAs), including blinatumomab and inotuzumab ozogamicin (InO), has improved the outcomes of patients with relapsed/refractory (RR) B-cell acute lymphoblastic leukemia (ALL). Because of the relative effectiveness, it is often a challenge for clinicians to determine how to best sequence these NAs with respect to efficacy and toxicity. METHODS In this multicenter, retrospective study of patients with RR ALL treated with blinatumomab, InO, or both, their efficacy as a first or second NA was compared. RESULTS Among 276 patients, 221 and 55 received blinatumomab and InO, respectively, as a first NA therapy. The complete remission (CR)/complete remission with incomplete count recovery (CRi) rate was 65% and 67% for the blinatumomab and InO groups, respectively (P = .73). The rate of treatment discontinuation due to adverse events was 4% and 7% in the blinatumomab and InO groups, respectively. Ninety-two patients (43%) in the blinatumomab group and 13 patients (29%) in the InO group proceeded with allogeneic hematopoietic stem cell transplantation. The median overall survival (OS) was 15 and 11.6 months in the blinatumomab and InO groups, respectively. A subset analysis was performed for 61 patients who received both NAs (blinatumomab and then InO [n = 40] or InO and then blinatumomab [n = 21]). The CR/CRi rate was 58% for patients who received InO as the second NA and 52% for patients who received blinatumomab as the second NA. The median OS was 10.5 for patients who received InO as the second NA and 5.9 months for patients who received blinatumomab as the second NA (P = .09). CONCLUSIONS Although the limited power of this study to detect a significant difference between subgroups is acknowledged, the data suggest that blinatumomab and InO may have comparable efficacy as a first or second NA therapy in RR ALL.
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Affiliation(s)
- Talha Badar
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, Illinois
| | | | - Madelyn Burkart
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, Illinois
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Eric Kuo
- Stanford University Cancer Center, Stanford, California
| | - Muhammad Ali Khan
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jay Yang
- Karmanos Cancer Institute, Detroit, Michigan
| | - Mehrdad Hefazi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Nikolai Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Anand Patel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Emily Curran
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy Wang
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Caitlin Siebenaller
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J Mattison
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anjali S Advani
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ehab Atallah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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73
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Aldoss I, Zhang J, Mei M, Al Malki MM, Arslan S, Ngo D, Aribi A, Ali H, Sandhu K, Salhotra A, Koller P, Khaled S, Artz A, Snyder D, Nakamura R, Forman SJ, Stein AS, Marcucci G, Pullarkat V. Venetoclax and hypomethylating agents in FLT3-mutated acute myeloid leukemia. Am J Hematol 2020; 95:1193-1199. [PMID: 32628327 DOI: 10.1002/ajh.25929] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023]
Abstract
FMS-like tyrosine kinase 3 (FLT3) mutations are prevalent in acute myeloid leukemia (AML), and their presence confers adverse risk. FLT3-mutated (FLT3m) AML is a challenging leukemia to manage, particularly in older and unfit patients as well as patients with relapsed/refractory (r/r) disease. We retrospectively analyzed the outcomes of 50 FLT3m AML patients (17 treatment-naïve, 33 r/r) treated with venetoclax (VEN) and hypomethylating agents (HMA). The overall CR/CRi rate with VEN-HMA was 60% (94% in treatment-naïve AML and 42% in r/r AML). Early (60-days) treatment related mortality was 2%. The r/r AML setting was an independent predictor of lower complete response (OR: 0.08; 95%CI: 0.00-0.60, P = .03). Cytogenetics-molecular risk, concurrent mutations, the type of FLT3 mutation (ITD vs TKD), the ITD allelic ratio, the type of HMA, age, prior exposure to HMA and receipt of prior allogeneic transplant did not independently impact response or leukemia-free survival (LFS). Concurrent IDH mutations were associated with lower CR/CRi (P = .01), while ASXL1 or TET2 mutations showed a non-significant association toward higher CR/CRi (P = .07, for both). However, none of the concurrent mutations were an independent predictor for response when adjusted to AML setting. In conclusion, VEN-HMA is associated with encouraging efficacy in FLT3m AML among both newly diagnosed unfit and r/r patients.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Jianying Zhang
- Department of Information Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Dat Ngo
- Department of Pharmacy, City of Hope Medical Center, Duarte, California, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Paul Koller
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Samer Khaled
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - David Snyder
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Gehr Family Center for Leukemia Research, Duarte, California, USA
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Qin H, Dong Z, Wang X, Cheng WA, Wen F, Xue W, Sun H, Walter M, Wei G, Smith DL, Sun X, Fei F, Xie J, Panagopoulou TI, Chen CW, Song JY, Aldoss I, Kayembe C, Sarno L, Müschen M, Inghirami GG, Forman SJ, Kwak LW. CAR T cells targeting BAFF-R can overcome CD19 antigen loss in B cell malignancies. Sci Transl Med 2020; 11:11/511/eaaw9414. [PMID: 31554741 DOI: 10.1126/scitranslmed.aaw9414] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/03/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023]
Abstract
CAR T cells targeting CD19 provide promising options for treatment of B cell malignancies. However, tumor relapse from antigen loss can limit efficacy. We developed humanized, second-generation CAR T cells against another B cell-specific marker, B cell activating factor receptor (BAFF-R), which demonstrated cytotoxicity against human lymphoma and acute lymphoblastic leukemia (ALL) lines. Adoptively transferred BAFF-R-CAR T cells eradicated 10-day preestablished tumor xenografts after a single treatment and retained efficacy against xenografts deficient in CD19 expression, including CD19-negative variants within a background of CD19-positive lymphoma cells. Four relapsed, primary ALLs with CD19 antigen loss obtained after CD19-directed therapy retained BAFF-R expression and activated BAFF-R-CAR, but not CD19-CAR, T cells. BAFF-R-CAR, but not CD19-CAR, T cells also demonstrated antitumor effects against an additional CD19 antigen loss primary patient-derived xenograft (PDX) in vivo. BAFF-R is amenable to CAR T cell therapy, and its targeting may prevent emergence of CD19 antigen loss variants.
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Affiliation(s)
- Hong Qin
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Zhenyuan Dong
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Xiuli Wang
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Wesley A Cheng
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Feng Wen
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.,Department of Medical Oncology Cancer Center, West China Hospital, Sichuan University, Sichuan 910041, China
| | - Weili Xue
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.,The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Han Sun
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Miriam Walter
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Guowei Wei
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - D Lynne Smith
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Xiuhua Sun
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Fan Fei
- Department of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, CA 90007, USA
| | - Jianming Xie
- Department of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Southern California, CA 90007, USA
| | - Theano I Panagopoulou
- Department of Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Chun-Wei Chen
- Department of Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Clarisse Kayembe
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Luisa Sarno
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Markus Müschen
- Department of Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Giorgio G Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Stephen J Forman
- Center for CAR T Cell Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.
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Othman TA, Zhang J, Mei M, Stein AS, Forman SJ, Marcucci G, Pullarkat V, Aldoss I. Retreatment with venetoclax and hypomethylating agents among AML patients who have relapsed after initial response and subsequent interruption of therapy. Leuk Lymphoma 2020; 61:3532-3533. [DOI: 10.1080/10428194.2020.1808213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tamer A. Othman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Jianying Zhang
- Department of Information Sciences, City of Hope Medical Center, Duarte, CA, USA
| | - Matthew Mei
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Anthony S. Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Stephen J. Forman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
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76
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Trang E, Ngo D, Chen J, Aldoss I, Salhotra A, Pullarkat V. Levocarnitine for pegasparaginase-induced hepatotoxicity in acute lymphoblastic leukemia. Leuk Lymphoma 2020; 61:3161-3164. [PMID: 32787645 DOI: 10.1080/10428194.2020.1805108] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pegasparaginase (PEG-Asp), commonly used in acute lymphoblastic leukemia (ALL), is associated with hyperbilirubinemia and elevated transaminases. Treatment of acute hepatotoxicity is limited to case studies reporting success with levocarnitine (LC). In a retrospective analysis, 25 ALL patients experienced Grade ≥3 hyperbilirubinemia and/or elevated transaminases following a single dose of PEG-Asp where 12 patients received LC compared to 13 patients with no intervention. Median LC dose was 50 mg/kg/day for a median of 11 days. Median values were greater in the LC group: total bilirubin 5.2 mg/dL vs 4.5 mg/dL (p = 0.19), AST 75.5 units/L vs. 30 units/L (p = 0.05), and ALT 263.5 units/L vs 47 units/L (p = 0.003). Time to resolution (TTR) did not significantly differ between LC and control (p = 0.08), however, patients on LC did resume therapy sooner (p = 0.17). Although significant limitations exist in the study, LC did not result in a clinically significant impact when used to treat PEG-Asp-induced hepatotoxicity.
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Affiliation(s)
- Elena Trang
- Department of Pharmacy, City of Hope National Medical Center, Duarte, CA, USA
| | - Dat Ngo
- Department of Pharmacy, City of Hope National Medical Center, Duarte, CA, USA
| | - Jason Chen
- Department of Pharmacy, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
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77
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Abstract
The IL-3 alpha chain receptor (CD123) is a cell surface protein that is widely expressed by various subtypes of acute leukemia, including acute myeloid leukemia (AML), acute lymphoblastic leukemia and blastic plasmacytoid dendritic cell neoplasm. Notably, CD123 is preferentially overexpressed in leukemia stem cells (LSC) in contrast to normal hematopoietic stem cells, and this differential expression allows for the selective eradication of LSC and leukemic blasts through therapeutic targeting of CD123, with less impact on hematopoietic cells. The level of CD123 expression in AML correlates with both treatment response and outcomes. Therefore, targeting CD123 represents a promising universal therapeutic target in advanced acute leukemias irrespective of the individual leukemia phenotype. There are currently 31 ongoing clinical trials examining the utility of CD123-based targeted therapies. Here we focus our review on current efforts to target CD123 in acute leukemia through various therapeutic constructs.
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Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center , Duarte, CA, USA
| | - Mary Clark
- Department of Clinical and Translational Project Development, City of Hope National Medical Center , Duarte, CA, USA
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center , Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center , Duarte, CA, USA
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78
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Malki MMA, Song JY, Yang D, Cao T, Aldoss I, Mokhtari S, Dadwal S, Marcucci G, Karanes C, Snyder D, Nademanee A, Forman SJ, Nakamura R, Pullarkat V. Iron Overload Is Associated with Delayed Engraftment and Increased Nonrelapse Mortality in Recipients of Umbilical Cord Blood Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:1697-1703. [PMID: 32534103 DOI: 10.1016/j.bbmt.2020.06.002] [Citation(s) in RCA: 4] [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] [Received: 04/01/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022]
Abstract
The negative impact of iron overload (IO) on outcomes of allogeneic hematopoietic cell transplantation (HCT) is well recognized, but its impact on umbilical cord blood (UCB) transplant outcome is unknown. We retrospectively analyzed outcomes of 150 patients who received UCB-HCT at our institution, stratified by pre-HCT serum ferritin (SF) level of 2000 ng/mL. Two-year overall survival rate among patients with SF >2000 and ≤2000 ng/mL was 26.1% (95% CI, 10.6% to 44.7%) and 52.1% (95% CI, 40.1% to 62.8%), respectively; hazard ratio (HR) = 2.26 (95% CI, 1.28 to 4.00, P = .005). Two-year nonrelapse mortality rate was higher among patients with SF >2000 ng/mL (56.5%; 95% CI, 33.3% to 74.4%) compared to SF ≤2000 ng/mL (30.1%; 95% CI, 20.0% to 40.9%); HR = 2.18 (95% CI, 1.10 to 4.31, P = .025). Neutrophil engraftment at 42 days was 78.3% (95% CI, 53.5% to 90.8%) in patients with SF >2000 ng/mL versus 91.8% (95% CI, 82.1% to 96.4%) in patients with SF ≤2000 ng/mL; HR = 0.58 (95% CI, 0.35 to 0.96, P = .034). A significant difference in platelet engraftment at 3 months was also observed: 52.2% (95% CI, 29.4% to 70.8%) for SF >2000 ng/mL versus 80.8% (95% CI, 69.5% to 88.3%) for SF ≤2000 ng/mL; HR = 0.48 (95% CI, 0.23 to 0.98, P = .044). In conclusion, IO defined by SF of 2000 ng/mL is a strong adverse prognostic factor for UCB-HCT and should be considered when UCB is chosen as the graft source for patients without a fully matched donor.
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Affiliation(s)
- Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, California
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, Division of Biostatistics, City of Hope, Duarte, California
| | - Thai Cao
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sally Mokhtari
- Department of Clinical Translational Program Development, City of Hope, Duarte, California
| | - Sanjeet Dadwal
- Department of Infectious Disease, City of Hope, Duarte, California
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Chatchada Karanes
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - David Snyder
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Auayporn Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
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79
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Gupta R, Othman T, Uche A, Amanam I, Chen C, Celles L, Lane G, Mei M, Aldoss I, Pullarkat V, Kim P, Yeh J. Characteristics and Trends of Adult Acute Lymphoblastic Leukemia in a Large, Public Safety-Net Hospital. Clinical Lymphoma Myeloma and Leukemia 2020; 20:e320-e327. [DOI: 10.1016/j.clml.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/17/2019] [Accepted: 11/01/2019] [Indexed: 10/24/2022]
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80
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Mei M, Tsai NC, Mokhtari S, Al Malki MM, Ali H, Salhotra A, Sandhu K, Khaled S, Smith E, Snyder D, Marcucci G, Forman SJ, Pullarkat V, Stein A, Aldoss I, Nakamura R. Long-Term Outcomes of Allogeneic Hematopoietic Cell Transplant with Fludarabine and Melphalan Conditioning and Tacrolimus/Sirolimus as Graft-versus-Host Disease Prophylaxis in Patients with Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant 2020; 26:1425-1432. [PMID: 32416253 DOI: 10.1016/j.bbmt.2020.04.015] [Citation(s) in RCA: 4] [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] [Received: 03/03/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is associated with poor survival in older adults, and allogeneic hematopoietic cell transplant (HCT) with reduced-intensity conditioning (RIC) has been an increasingly used strategy in this population. At City of Hope we conducted a retrospective analysis of 72 patients who underwent allogeneic HCT with fludarabine and melphalan (FluMel) as the conditioning regimen between 2005 and 2018, from either a matched sibling or fully matched unrelated donor while in complete remission. Tacrolimus and sirolimus (T/S) were used as graft-versus-host disease (GVHD) prophylaxis. Overall survival and progression-free survival at 4 years post-HCT were 58% and 44%, respectively. The cumulative incidences of relapse/progression and nonrelapse mortality at 4 years were 34% and 22%, respectively. Patients with Philadelphia chromosome-positive (Ph+) ALL had a significantly lower cumulative incidence of relapse/progression (20% versus 48% for patients with Ph-negative status, P = .007). In conclusion, RIC HCT with FluMel conditioning and T/S GVHD prophylaxis was associated with favorable outcomes in patients with Ph+ ALL and should be considered as a viable consolidative therapy for adult patients with ALL.
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Affiliation(s)
- Matthew Mei
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Ni-Chun Tsai
- Department of Computational Quantitative Medicine/BRI, City of Hope, Duarte, California
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope, Duarte, California
| | - Monzr M Al Malki
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Haris Ali
- Department of Hematology and HCT, City of Hope, Duarte, California
| | | | - Karamjeet Sandhu
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Samer Khaled
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Eileen Smith
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - David Snyder
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Guido Marcucci
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Vinod Pullarkat
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Anthony Stein
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and HCT, City of Hope, Duarte, California; Department of Computational Quantitative Medicine/BRI, City of Hope, Duarte, California.
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81
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Aldoss I, Marcucci G. More options for older patients with acute myeloid leukemia: venetoclax in combination with low dose cytarabine. Chin Clin Oncol 2020; 8:S25. [PMID: 31684734 DOI: 10.21037/cco.2019.09.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA.
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82
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Otoukesh S, Zhang J, Nakamura R, Stein AS, Forman SJ, Marcucci G, Pullarkat V, Aldoss I. The efficacy of venetoclax and hypomethylating agents in acute myeloid leukemia with extramedullary involvement. Leuk Lymphoma 2020; 61:2020-2023. [PMID: 32191144 DOI: 10.1080/10428194.2020.1742908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Salman Otoukesh
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Jianying Zhang
- Department of Information Sciences, City of Hope Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Anthony S Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
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83
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Badar T, Szabo A, Wadleigh M, Liedtke M, Arslan S, Siebenaller C, Aldoss I, Schultz E, Hefazi M, Litzow MR, Kuo E, Wang A, Curran E, Shallis RM, Podoltsev N, Balasubramanian S, Yang J, Mattison R, Burkart M, Dinner S, Advani A, Atallah E. Real-World Outcomes of Adult B-Cell Acute Lymphocytic Leukemia Patients Treated With Inotuzumab Ozogamicin. Clin Lymphoma Myeloma Leuk 2020; 20:556-560.e2. [PMID: 32291234 DOI: 10.1016/j.clml.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inotuzumab ozogamicin (InO) is an anti-CD22 monoclonal antibody-drug (calicheamicin) conjugate that has shown superior efficacy compared to conventional chemotherapy in relapsed/refractory (RR) B-cell acute lymphocytic leukemia (ALL) patients. We sought to find the safety and efficacy of InO in a real-world setting. PATIENTS AND METHODS A multicenter cohort analysis on 84 RR ALL patients who received InO outside of clinical trials was conducted to evaluate response and toxicity. RESULTS The median (range) age of patients at InO initiation was 50 (20-87) years. Forty patients (48%) had ≥ 3 therapies and 23 patients (27%) underwent allogeneic hematopoietic stem-cell transplantation (allo-HCT) before InO. The median (range) number of cycles of InO provided was 2 (1-6), and cumulative dose was 3.3 (1.8-9.3) mg/m2. Overall response rate (complete remission/complete remission with incomplete count recovery) was 63%; 44% had complete remission with minimal residual disease negativity. Twenty-three patients (27%) with response received allo-HCT. The median duration of response was 11.5 months and when censored at allo-HCT was not reached (51% in remission at 2 years). The median overall survival after InO was 11.6 months and when censored at time of allo-HCT was 13.6 months. The most common grade 3 or higher adverse events observed were transaminitis (16%), hyperbilirubinemia (5%), bleeding (4%), veno-occlusive disease (2%), and hyperglycemia (2%). In multivariate analysis, allo-HCT after InO did not retain favorable significance for duration of response (hazard ratio = 1.27; 95% confidence interval, 0.89-1.61; P = .2) or overall survival (hazard ratio = 1.10; 95% confidence interval, 0.37-3.25; P = .85). CONCLUSION InO was well tolerated and had significant efficacy in RR B-cell ALL patients.
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Affiliation(s)
- Talha Badar
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Aniko Szabo
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Michaela Liedtke
- Department of Hematology and Oncology, Stanford University Cancer Center, Stanford, CA
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Caitlin Siebenaller
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Elizabeth Schultz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Eric Kuo
- Department of Hematology and Oncology, Stanford University Cancer Center, Stanford, CA
| | - Amy Wang
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Emily Curran
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Rory M Shallis
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Nikolai Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | | | - Jay Yang
- Karmanos Cancer Institute, Detroit, MI
| | - Ryan Mattison
- Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Madelyn Burkart
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, IL
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, IL
| | - Anjali Advani
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Ehab Atallah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI.
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84
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Aldoss I, La Rosa C, Baden LR, Longmate J, Ariza-Heredia EJ, Rida WN, Lingaraju CR, Zhou Q, Martinez J, Kaltcheva T, Dagis A, Hardwick N, Issa NC, Farol L, Nademanee A, Al Malki MM, Forman S, Nakamura R, Diamond DJ. Poxvirus Vectored Cytomegalovirus Vaccine to Prevent Cytomegalovirus Viremia in Transplant Recipients: A Phase 2, Randomized Clinical Trial. Ann Intern Med 2020; 172:306-316. [PMID: 32040960 PMCID: PMC9074089 DOI: 10.7326/m19-2511] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 11/22/2022] Open
Abstract
Background Triplex vaccine was developed to enhance cytomegalovirus (CMV)-specific T cells and prevent CMV reactivation early after hematopoietic stem cell transplant (HCT). Objective To determine the safety and efficacy of Triplex. Design First-in-patient, phase 2 trial. (ClinicalTrials.gov: NCT02506933). Setting 3 U.S. HCT centers. Participants 102 CMV-seropositive HCT recipients at high risk for CMV reactivation. Intervention Intramuscular injections of Triplex or placebo were given on days 28 and 56 after HCT. Triplex is a recombinant attenuated poxvirus (modified vaccinia Ankara) expressing immunodominant CMV antigens. Measurements The primary outcomes were CMV events (CMV DNA level ≥1250 IU/mL, CMV viremia requiring antiviral treatment, or end-organ disease), nonrelapse mortality, and severe (grade 3 or 4) graft-versus-host disease (GVHD), all evaluated through 100 days after HCT, and grade 3 or 4 adverse events (AEs) within 2 weeks after vaccination that were probably or definitely attributable to injection. Results A total of 102 patients (51 per group) received the first vaccination, and 91 (89.2%) received both vaccinations (46 Triplex and 45 placebo). Reactivation of CMV occurred in 5 Triplex (9.8%) and 10 placebo (19.6%) recipients (hazard ratio, 0.46 [95% CI, 0.16 to 1.4]; P = 0.075). No Triplex recipient died of nonrelapse causes during the first 100 days or had serious AEs, and no grade 3 or 4 AEs related to vaccination were observed within 2 weeks after vaccination. Incidence of severe acute GVHD after injection was similar between groups (hazard ratio, 1.1 [CI, 0.53 to 2.4]; P = 0.23). Levels of long-lasting, pp65-specific T cells with effector memory phenotype were significantly higher in Triplex than placebo recipients. Limitation The lower-than-expected incidence of CMV events in the placebo group reduced the power of the trial. Conclusion No vaccine-associated safety concerns were identified. Triplex elicited and amplified CMV-specific immune responses, and fewer Triplex-vaccinated patients had CMV viremia. Primary Funding Source National Cancer Institute and Helocyte.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Corinna La Rosa
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Lindsey R. Baden
- Division of Infectious Disease, Brigham and Women's Hospital & The Dana-Farber Cancer Institute, Boston, MA
| | - Jeffrey Longmate
- Division of Biostatistics of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Ella J. Ariza-Heredia
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Chetan Raj Lingaraju
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Qiao Zhou
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Joy Martinez
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Teodora Kaltcheva
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Andy Dagis
- Division of Biostatistics of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Nicola Hardwick
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Nicolas C. Issa
- Division of Infectious Disease, Brigham and Women's Hospital & The Dana-Farber Cancer Institute, Boston, MA
| | - Len Farol
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Auayporn Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Monzr M. Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Stephen Forman
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
| | - Don J. Diamond
- Department of Hematology and Hematopoietic Cell Transplantation of the City of Hope Comprehensive Cancer Center and the Beckman Research Institute of City of Hope, Duarte, CA
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85
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Al Malki MM, Tsai NC, Palmer J, Mokhtari S, Cao T, Ali H, Salhotra A, Arslan S, Aldoss I, Karras N, Zain J, Khaled SK, Stein AS, Snyder DS, Marcucci G, Forman SJ, Nademanee A, Nakamura R. A Phase II Trial of Post-Transplant Cyclophosphamide As Graft-Versus-Host Disease Prophylaxis in HLA-Mismatched Unrelated Donor Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.752] [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: 10/25/2022]
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86
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Badar T, Advani AS, Liedtke M, Arslan S, Khan MA, Aldoss I, Sienbenaller C, Schultz E, Hefazi M, Shallis RM, Yurkiewicz I, Podoltsev N, Patel A, Curran E, Kuo E, Wang A, Balasubramanian S, Yang J, Mattison R, Burkart M, Dinner S, Litzow MR, Wadleigh M, Atallah E. Clinical Outcome with Allogeneic Hematopoietic Stem Cell Transplantation after Blinatumomab or Inotuzumab Ozogamicin in Patients with B-Cell Acute Lymphoblastic Leukemia: Real World Experience. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.604] [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: 10/25/2022]
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87
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Salhotra A, Yang D, Mokhtari S, Malki MMA, Ali H, Sandhu KS, Aribi A, Khaled S, Mei M, Budde E, Snyder D, Cao T, Spielberger R, Marcucci G, Pullarkat V, Forman SJ, Nakamura R, Stein A, Aldoss I. Outcomes of Allogeneic Hematopoietic Cell Transplantation after Salvage Therapy with Blinatumomab in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant 2020; 26:1084-1090. [PMID: 32035275 DOI: 10.1016/j.bbmt.2020.01.029] [Citation(s) in RCA: 16] [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] [Received: 10/21/2019] [Revised: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
Historically, outcomes of adult patients with relapsed acute lymphoblastic leukemia (ALL) who fail to enter remission with conventional chemotherapy are very poor. Blinatumomab, a bispecific CD3/CD19 antibody, has shown remarkable activity in relapsed/refractory (r/r) ALL. Although allogeneic hematopoietic cell transplant (HCT) is the recommended consolidation therapy for patients with r/r ALL who respond to salvage therapy, HCT and toxicity outcomes for those who received blinatumomab salvage and HCT remain largely unknown. We treated 89 patients with r/r ALL with blinatumomab, of whom 43 patients (48%) achieved remission. Here we describe our single-center experience in the subset of patients who responded to blinatumomab salvage therapy for eradication of either gross (n = 24) or minimal residual disease (n = 11) before HCT. Overall survival at 1 and 2 years after allogeneic HCT was 77% and 52%, respectively. Leukemia-free survival at 1 and 2 years were 65% and 40%, respectively. Additionally, with blinatumomab administration pre-HCT, no unusual toxicities such as delayed neutrophil/platelet engraftment or graft failure were observed. Acute grades II to IV graft-versus-host disease (GVHD) at day +100 post-HCT was at 43% and 2-year chronic GVHD was 36%, both comparable with historic control subjects. Finally, results of our subset analysis based on pre-HCT minimal residual disease (MRD) status indicated no significant difference in survival outcomes among patients undergoing transplant in MRD-negative status and the entire cohort. In conclusion, based on results of this study, blinatumomab may be considered as a safe and effective agent for r/r ALL patients before HCT.
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Affiliation(s)
| | - Dongyun Yang
- Department of Computational Quantitative Medicine/BRI, City of Hope, Duarte, California
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope, Duarte, California
| | - Monzr M Al Malki
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Haris Ali
- Department of Hematology and HCT, City of Hope, Duarte, California
| | | | - Ahmed Aribi
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Samer Khaled
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Matthew Mei
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Elizabeth Budde
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - David Snyder
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Thai Cao
- Department of Hematology and HCT, City of Hope, Duarte, California
| | | | - Guido Marcucci
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Vinod Pullarkat
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Anthony Stein
- Department of Hematology and HCT, City of Hope, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and HCT, City of Hope, Duarte, California
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88
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Salhotra A, Hui S, Yang D, Mokhtari S, Mei M, Al Malki MM, Aldoss I, Ali H, Sandhu KS, Aribi A, Khaled S, Dandapani S, Peng K, Teh JB, Murata-Collins J, Budde E, Dadwal S, Pullarkat V, Snyder D, Spielberger R, Wong J, Armenian S, Marcucci G, Forman SJ, Nakamura R, Stein A. Long-Term Outcomes of Patients with Acute Myelogenous Leukemia Treated with Myeloablative Fractionated Total Body Irradiation TBI-Based Conditioning with a Tacrolimus- and Sirolimus-Based Graft-versus-Host Disease Prophylaxis Regimen: 6-Year Follow-Up from a Single Center. Biol Blood Marrow Transplant 2020; 26:292-299. [DOI: 10.1016/j.bbmt.2019.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 12/27/2022]
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89
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Aldoss I, Yang D, Pillai R, Sanchez JF, Mei M, Aribi A, Ali H, Sandhu K, Al Malki MM, Salhotra A, Khaled S, Sun W, O'Donnell M, Snyder D, Nakamura R, Stein AS, Forman SJ, Marcucci G, Pullarkat V. Association of leukemia genetics with response to venetoclax and hypomethylating agents in relapsed/refractory acute myeloid leukemia. Am J Hematol 2019; 94:E253-E255. [PMID: 31259427 DOI: 10.1002/ajh.25567] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Dongyun Yang
- Department of Information SciencesCity of Hope Medical Center Duarte California
| | - Raju Pillai
- Department of PathologyCity of Hope Medical Center Duarte California
| | - James F. Sanchez
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Matthew Mei
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Ahmed Aribi
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Haris Ali
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Karamjeet Sandhu
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Monzr M. Al Malki
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Amandeep Salhotra
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Samer Khaled
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Weili Sun
- Department of PediatricsCity of Hope Medical Center Duarte California
| | - Margaret O'Donnell
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - David Snyder
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Ryotaro Nakamura
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Anthony S. Stein
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Stephen J. Forman
- Department of PathologyCity of Hope Medical Center Duarte California
| | - Guido Marcucci
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
| | - Vinod Pullarkat
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
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90
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Lazaryan A, Dolan M, Zhang MJ, Wang HL, Kharfan-Dabaja MA, Marks DI, Bejanyan N, Copelan E, Majhail NS, Waller EK, Chao N, Prestidge T, Nishihori T, Kebriaei P, Inamoto Y, Hamilton B, Hashmi SK, Kamble RT, Bacher U, Hildebrandt GC, Stiff PJ, McGuirk J, Aldoss I, Beitinjaneh AM, Muffly L, Vij R, Olsson RF, Byrne M, Schultz KR, Aljurf M, Seftel M, Savoie ML, Savani BN, Verdonck LF, Cairo MS, Hossain N, Bhatt VR, Frangoul HA, Abdel-Azim H, Malki MA, Munker R, Rizzieri D, Khera N, Nakamura R, Ringdén O, van der Poel M, Murthy HS, Liu H, Mori S, De Oliveira S, Bolaños-Meade J, Elsawy M, Barba P, Nathan S, George B, Pawarode A, Grunwald M, Agrawal V, Wang Y, Assal A, Caro PC, Kuwatsuka Y, Seo S, Ustun C, Politikos I, Lazarus HM, Saber W, Sandmaier BM, De Lima M, Litzow M, Bachanova V, Weisdorf D. Impact of cytogenetic abnormalities on outcomes of adult Philadelphia-negative acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: a study by the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research. Haematologica 2019; 105:1329-1338. [PMID: 31558669 PMCID: PMC7193485 DOI: 10.3324/haematol.2019.220756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/12/2019] [Accepted: 09/20/2019] [Indexed: 11/11/2022] Open
Abstract
Cytogenetic risk stratification at diagnosis has long been one of the most useful tools to assess prognosis in acute lymphoblastic leukemia (ALL). To examine the prognostic impact of cytogenetic abnormalities on outcomes after allogeneic hematopoietic cell transplantation, we studied 1731 adults with Philadelphia-negative ALL in complete remission who underwent myeloablative or reduced intensity/non-myeloablative conditioning transplant from unrelated or matched sibling donors reported to the Center for International Blood and Marrow Transplant Research. A total of 632 patients had abnormal conventional metaphase cytogenetics. The leukemia-free survival and overall survival rates at 5 years after transplantation in patients with abnormal cytogenetics were 40% and 42%, respectively, which were similar to those in patients with a normal karyotype. Of the previously established cytogenetic risk classifications, modified Medical Research Council-Eastern Cooperative Oncology Group score was the only independent prognosticator of leukemia-free survival (P=0.03). In the multivariable analysis, monosomy 7 predicted post-transplant relapse [hazard ratio (HR)=2.11; 95% confidence interval (95% CI): 1.04-4.27] and treatment failure (HR=1.97; 95% CI: 1.20-3.24). Complex karyotype was prognostic for relapse (HR=1.69; 95% CI: 1.06-2.69), whereas t(8;14) predicted treatment failure (HR=2.85; 95% CI: 1.35-6.02) and overall mortality (HR=3.03; 95% CI: 1.44-6.41). This large study suggested a novel transplant-specific cytogenetic scheme with adverse [monosomy 7, complex karyotype, del(7q), t(8;14), t(11;19), del(11q), tetraploidy/near triploidy], intermediate (normal karyotype and all other abnormalities), and favorable (high hyperdiploidy) risks to prognosticate leukemia-free survival (P=0.02). Although some previously established high-risk Philadelphia-negative cytogenetic abnormalities in ALL can be overcome by transplantation, monosomy 7, complex karyotype, and t(8;14) continue to pose significant risks and yield inferior outcomes.
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Affiliation(s)
| | - Michelle Dolan
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mei-Jie Zhang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Edward Copelan
- Levine Cancer Institute, Atrium Health, Carolinas HealthCare System, Charlotte, NC, USA
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Nelson Chao
- Division of Cell Therapy and Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Betty Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, MN, USA.,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Switzerland
| | | | | | | | - Ibrahim Aldoss
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, the Netherlands
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Nasheed Hossain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Monzr Al Malki
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Olle Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm Sweden
| | | | | | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | - Shahram Mori
- Blood & Marrow Transplant Center, Florida Hospital Medical Group, Orlando, FL, USA
| | | | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mahmoud Elsawy
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pere Barba
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Youjin Wang
- National Cancer Institute (NCI), Rockville, MD, USA
| | - Amer Assal
- New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL, USA
| | | | | | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcos De Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
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91
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Aldoss I, Zhang J, Pillai R, Shouse G, Sanchez JF, Mei M, Nakamura R, Stein AS, Forman SJ, Marcucci G, Pullarkat V. Venetoclax and hypomethylating agents in TP53-mutated acute myeloid leukaemia. Br J Haematol 2019; 187:e45-e48. [PMID: 31441045 DOI: 10.1111/bjh.16166] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Jianying Zhang
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA, USA
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Geoffrey Shouse
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - James F Sanchez
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
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92
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Otoukesh S, Salhotra A, Marcucci G, Forman SJ, Pullarkat V, Aldoss I. The feasibility of venetoclax and decitabine in therapy-related acute myeloid leukemia with concurrent advanced non-hematological malignancies. Leuk Res 2019; 84:106196. [PMID: 31377457 DOI: 10.1016/j.leukres.2019.106196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/27/2019] [Indexed: 11/19/2022]
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Decitabine/administration & dosage
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Neoplasms/complications
- Neoplasms/diagnosis
- Neoplasms/drug therapy
- Neoplasms/mortality
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/mortality
- Sulfonamides/administration & dosage
- Treatment Outcome
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Affiliation(s)
- Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, United States
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, United States
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, United States
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, United States
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, United States
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, United States.
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93
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Wang H, Zhao D, Nguyen LX, Wu H, Li L, Dong D, Troadec E, Zhu Y, Hoang DH, Stein AS, Al Malki M, Aldoss I, Lin A, Ghoda LY, McDonald T, Pichiorri F, Carlesso N, Kuo YH, Zhang B, Jin J, Marcucci G. Targeting cell membrane HDM2: A novel therapeutic approach for acute myeloid leukemia. Leukemia 2019; 34:75-86. [PMID: 31337857 DOI: 10.1038/s41375-019-0522-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022]
Abstract
The E3 ligase human double minute 2 (HDM2) regulates the activity of the tumor suppressor protein p53. A p53-independent HDM2 expression has been reported on the membrane of cancer cells but not on that of normal cells. Herein, we first showed that membrane HDM2 (mHDM2) is exclusively expressed on human and mouse AML blasts, including leukemia stem cell (LSC)-enriched subpopulations, but not on normal hematopoietic stem cells (HSCs). Higher mHDM2 levels in AML blasts were associated with leukemia-initiating capacity, quiescence, and chemoresistance. We also showed that a synthetic peptide PNC-27 binds to mHDM2 and enhances the interaction of mHDM2 and E-cadherin on the cell membrane; in turn, E-cadherin ubiquitination and degradation lead to membrane damage and cell death of AML blasts by necrobiosis. PNC-27 treatment in vivo resulted in a significant killing of both AML "bulk" blasts and LSCs, as demonstrated respectively in primary and secondary transplant experiments, using both human and murine AML models. Notably, PNC-27 spares normal HSC activity, as demonstrated in primary and secondary BM transplant experiments of wild-type mice. We concluded that mHDM2 represents a novel and unique therapeutic target, and targeting mHDM2 using PNC-27 selectively kills AML cells, including LSCs, with minimal off-target hematopoietic toxicity.
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Affiliation(s)
- Huafeng Wang
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China.,Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.,Zhejiang Provincial Key Lab of Hematopoietic Malignancy, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Dandan Zhao
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Le Xuan Nguyen
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.,Department of Medical Biotechnology, Biotechnology Center of Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Herman Wu
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Ling Li
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Dan Dong
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.,Department of Pathophysiology, College of Basic Medical Science, China Medical University, Shenyang, PR China
| | - Estelle Troadec
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Yinghui Zhu
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Dinh Hoa Hoang
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Anthony S Stein
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Monzr Al Malki
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Ibrahim Aldoss
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Allen Lin
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Lucy Y Ghoda
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Tinisha McDonald
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Flavia Pichiorri
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Nadia Carlesso
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Ya-Huei Kuo
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Bin Zhang
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.
| | - Jie Jin
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China. .,Zhejiang Provincial Key Lab of Hematopoietic Malignancy, Zhejiang University, Hangzhou, Zhejiang, PR China.
| | - Guido Marcucci
- Hematologic Malignancies Translational Science, Gehr Family Center for Leukemia Research, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.
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94
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Salhotra A, Afkhami M, Yang D, Mokhtari S, Telatar M, Gu D, Pillai RK, Weisenburger DD, Murata-Collins J, Weigel D, Aoun P, Aldoss I, Al Malki MM, Khaled S, Mei M, Ali H, Aribi A, Budde E, Sandhu K, O’Donnell M, Snyder D, Pullarkat V, Forman SJ, Marcucci G, Nakamura R, Stein A. Allogeneic Hematopoietic Cell Transplantation Outcomes in Patients Carrying Isocitrate Dehydrogenase Mutations. Clinical Lymphoma Myeloma and Leukemia 2019; 19:e400-e405. [DOI: 10.1016/j.clml.2019.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/27/2019] [Accepted: 04/15/2019] [Indexed: 01/09/2023]
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95
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Kwak L, Qin H, Dong Z, Wang X, Cheng W, Smith D, Song J, Aldoss I, Muschen M, Forman S. Novel BAFF-R CAR T-cell Therapy for CD19 Antigen-loss Relapsed B Cell Tumors. Hematol Oncol 2019. [DOI: 10.1002/hon.123_2629] [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: 11/08/2022]
Affiliation(s)
- L.W. Kwak
- Toni Stephenson Lymphoma Center; City of Hope; Duarte United States
| | - H. Qin
- Toni Stephenson Lymphoma Center; City of Hope; Duarte United States
| | - Z. Dong
- Toni Stephenson Lymphoma Center; City of Hope; Duarte United States
| | - X. Wang
- Center for CAR T Cell Therapy; City of Hope; Duarte United States
| | - W.A. Cheng
- Toni Stephenson Lymphoma Center; City of Hope; Duarte United States
| | - D. Smith
- Toni Stephenson Lymphoma Center; City of Hope; Duarte United States
| | - J.Y. Song
- Department of Pathology; City of Hope; Duarte United States
| | - I. Aldoss
- Gehr Family Center for Leukemia Research; City of Hope; Duarte United States
| | - M. Muschen
- Department of Systems Biology; City of Hope; Duarte United States
| | - S.J. Forman
- Center for CAR T Cell Therapy; City of Hope; Duarte United States
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96
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Al-Kali A, Aldoss I, Strand C, Shah BD, Webster JA, Bhatnagar B, Akhtari M, Doyle LA, Kaufmann SH. A phase II study (NCI9775) of sapanisertib (MLN0128/TAK-228) in relapsed and/or refractory acute lymphoblastic leukemia (ALL): Interim analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18506] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18506 Background: Sapanisertib (SAP) is an oral small molecule dual mTOR complex 1 and 2 (TORC1/2) inhibitor that showed activity in lymphoid neoplasms. It blocks a feedback loop involving mTORC2 activation when TORC1 is selectively inhibited (Yun S et al, Blood 2016). SAP induces apoptosis of malignant lymphoid cells in vitro and in xenografts, with greatest effects in ALL cell lines. We aim to assess potential efficacy of SAP when used as a single agent in relapsed/refractory ALL. Methods: Adults (age ≥18) with ECOG performance status 0-2 and normal organ function (creatinine/total bilirubin <1.5 upper limit of normal) with relapsed and/or refractory ALL (B- or T-cell) were enrolled. Newly diagnosed patients (pts) unfit for aggressive treatments and BCR-ABL+ ALL were allowed if there was no suitable standard treatment. SAP was given at 3 mg orally daily for 21 days every 28 days. Dose escalation was allowed after 2 cycles. Hydroxyurea and corticosteroids were not allowed after starting SAP. The primary end point was complete remission (CR) or CR with incomplete count recovery (CRi). This is a one stage Simon design study with interim analysis after 11 pts completed treatment. Enrollment was continued until interim analysis was done. Results: A total of 16 pts were enrolled on the study with a median age of 46 years old, 56% being males. 1/16 (6%) was treatment naïve. Median number of prior therapies is 3 (range, 1-9). The mean duration on SAP was 14.7 days (range 1-22). Three pts were able to start cycle 2. Safety was evaluable in 14 pts. All 14 pts had at least one G3 AE, while 10 pts had at least one G4 AE. G3/4 related non-hematological adverse events (AE) included 3 mucositis, 1 hepatic failure, 1 sepsis, 3 hyperglycemia, 1 anorexia, 1 seizure, 1 confusion, and 1 pneumonitis. One pt had G5 AE with malignancy. G3/4 hematological AEs included 2 with lymphopenia, 1 thrombocytopenia, 3 with leukopenia, and 1 with neutropenia. No pt achieved a CR/CRi. Best response was stable disease in 2 (12.5%) pts. Five pts had progressive disease while 9 were not evaluable because of early removal. Conclusions: SAP exhibited the expected safety profile. Although several pts developed cytopenias on drug, there was no evidence of clinically meaningful single-agent activity against ALL. Analysis of paired bone marrow aspirates from this trial is being performed to assess whether mTOR was substantially inhibited at therapeutically achievable drug concentrations. Clinical trial information: NCT02484430.
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Affiliation(s)
| | | | | | - Bijal D. Shah
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | - Mojtaba Akhtari
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - L. Austin Doyle
- Investigational Drug Branch, Cancer Therapeutics Evaluation Program , NCI, Bethesda, MD
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97
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Aldoss I, Pullarkat V. Response to single agent dasatinib post allogeneic transplant in B-cell acute lymphoblastic leukemia with NUP214-ABL1. Leuk Lymphoma 2019; 60:2832-2834. [PMID: 31014138 DOI: 10.1080/10428194.2019.1605510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center, Duarte, CA, USA
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98
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Chang J, Douer D, Aldoss I, Vahdani G, Jeong AR, Ghaznavi Z, Zhang S, Yaghmour G, Lee KJ, Weissman A, Akhtari M. Combination chemotherapy plus dasatinib leads to comparable overall survival and relapse-free survival rates as allogeneic hematopoietic stem cell transplantation in Philadelphia positive acute lymphoblastic leukemia. Cancer Med 2019; 8:2832-2839. [PMID: 31016870 PMCID: PMC6558592 DOI: 10.1002/cam4.2153] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Background The Philadelphia chromosome is associated with a poor prognosis in acute lymphoblastic leukemia (ALL). While hematopoietic stem cell transplantation (HSCT) has been regarded as a favorable treatment option in adult Philadelphia‐positive (Ph+) ALL, its benefit is less clear in the era of newer generation tyrosine kinase inhibitors (TKIs) like dasatinib. Methods This was a retrospective study that analyzed the outcomes of adult patients with Ph+ ALL treated with either combination chemotherapy plus dasatinib or combination chemotherapy plus dasatinib followed by allogeneic HSCT. Results A total of 70 patients were included; 30 (42.9%) underwent allogeneic HSCT while 40 (57.1%) received only chemotherapy plus dasatinib. In comparing overall survival (OS) rates, results between the 2 groups were similar with a 1‐year OS of 93.3% versus 100% (P = 0.20), 2‐year OS of 89.8% versus 86.2% (P = 0.72), and 3‐year OS of 76% versus 71.3% (P = 0.56) in the transplant versus nontransplant groups, respectively. The 3‐year relapse‐free survival (RFS) rates were also similar at 70.5% in the transplant group and 80.1% in the nontransplant group (P = 0.94). Subgroup analyses were performed for patients with specific poor prognostic factors (higher white blood count, older age, positive minimal residual disease status), but results again showed no significant survival difference between transplant and nontransplant patients. Conclusions While HSCT has historically led to a survival advantage in Ph+ ALL, the results of our study demonstrate that it may have a less beneficial role in the era of newer generation TKIs such as dasatinib.
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Affiliation(s)
- Jeremy Chang
- Los Angeles County - University of Southern California, Los Angeles, California
| | - Dan Douer
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Norris Cancer Center, Los Angeles, California
| | | | - Golnaz Vahdani
- Los Angeles County - University of Southern California, Los Angeles, California
| | - Ah-Reum Jeong
- Los Angeles County - University of Southern California, Los Angeles, California
| | - Zunera Ghaznavi
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Norris Cancer Center, Los Angeles, California
| | - Sherry Zhang
- Harbor-UCLA Medical Center, Torrance, California
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Norris Cancer Center, Los Angeles, California
| | - Kum-Ja Lee
- University of Southern California School of Pharmacy, Los Angeles, California
| | - Ashley Weissman
- University of Southern California School of Pharmacy, Los Angeles, California
| | - Mojtaba Akhtari
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Norris Cancer Center, Los Angeles, California
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99
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Nakamura R, La Rosa C, Longmate J, Lingaraju CR, Zhou Q, Kaltcheva T, Aldoss I, Diamond DJ. Rapid Acquisition of Cytomegalovirus-Specific T Cells with a Differentiated Phenotype, in Non-Viremic Hematopoietic Stem Transplant Recipients Vaccinated with Cmvpepvax. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.157] [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: 10/27/2022]
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100
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Mei M, Aldoss I, Marcucci G, Pullarkat V. Hypomethylating agents in combination with venetoclax for acute myeloid leukemia: Update on clinical trial data and practical considerations for use. Am J Hematol 2019; 94:358-362. [PMID: 30499168 DOI: 10.1002/ajh.25369] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
One of the most promising developments in therapy for acute myeloid leukemia (AML) in recent years has been the combination of hypomethylating agents (HMA, either decitabine or 5-azacytidine) with the Bcl-2 inhibitor venetoclax (VEN). Although both classes of drugs have single-agent activity in AML, the combination has resulted in high rates of complete remission (CR) both in the frontline and relapsed settings suggesting synergy between these two agents. Recent data have suggested that CR + CR with incomplete count recovery rate may exceed 70% for frontline VEN-HMA. Moreover, this activity has been observed across various genetic subtypes of AML including those known to have very poor response to conventional chemotherapy. Although VEN has only recently obtained FDA approval for treatment of AML, there has been increasing on and off-label use of this combination given its striking efficacy and excellent toxicity profile. In this article, we summarize the current available data on this combination and offer practical guidelines for management of patients receiving VEN-HMA. Our recommendations are based on protocol guidelines, published data from clinical trials as well as from analysis of real world evidence from patients treated with this combination.
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Affiliation(s)
- Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center Duarte California
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center Duarte California
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center Duarte California
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope Medical Center Duarte California
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