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Vangala N, Divya P, Uppin M, Uppin S, Gundeti S, Bacchu S, Radhika KK, Parvathi A, Paul T. Utility of CD200 expression by flow cytometry in lymphoproliferative disorders and plasma cell dyscrasias. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_373_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Are we finally getting personal? Moving towards a personalized approach in chronic lymphocytic leukemia. Semin Cancer Biol 2022; 84:329-338. [DOI: 10.1016/j.semcancer.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/21/2022]
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Wang W, Li Y, Ali H, Zhao L, Mei D, Hu W, Jiang B. Aberrant expression of CD54 detected by flow cytometry is a characteristic of B-lymphoma cells in bone marrow specimens. BMC Cancer 2021; 21:1315. [PMID: 34879826 PMCID: PMC8653582 DOI: 10.1186/s12885-021-09061-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Flow cytometry (FC) is a popular method to detect bone marrow (BM) involvement in patients with B-cell non-Hodgkin lymphoma (B-NHL). The majority of screen panels of FC still rely on finding monoclonal B-cells, e.g., B-cells with immunoglobin (Ig) light-chain restriction, which has many limitations. Therefore, exploring new markers is warranted. Methods A total of 52 cases of B-NHL with BM involvement were collected. The median age was 60 years. Out of these 52 cases, 34 were male, and 18 were female. A 10-color FC panel was used to detect the expression of CD54 on lymphoma cells. The expression of CD54 was calculated as the mean fluorescence index ratio (MFIR) and was described as the mean ± standard error of the mean (SEM). Results Up to 18/52 (34.62%) of BM specimens abnormally expressed an increased level of CD54, including 1/10 cases of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), 9/13 cases of mantle cell lymphoma (MCL), 2/14 cases of follicular lymphoma (FL), 5/9 cases of marginal zone lymphoma (MZL), and 1/3 cases of high-grade B-NHL (HG B-NHL). The expression level of CD54 was significantly increased in MCL cases (53.41 ± 11.04) compared with CLL/SLL cases (11.66 ± 2.79) and FL cases (13.49 ± 2.81). The lowest percentage of CD54-positive B-cells attained 0.13%. In 5/9 cases of MZL and 1/3 cases of HG B-NHL, increased expression of CD54 was the only abnormal immunophenotype detected besides Ig light-chain restriction. No aberrant CD54 expression was identified by FC in lymphoplasmacytic lymphoma (LPL) (0/2) and Burkitt lymphoma (BL) (0/1) cases. Aberrant expression of CD54 was not related to plasma cell differentiation. Conclusion Lymphoma cells, especially in MCL and MZL cases, frequently show increased expression of CD54. Such aberrant expression is not related to plasma cell differentiation. We highly recommend adding CD54 to the FC screening panel to detect BM involvement in patients with B-NHL.
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Affiliation(s)
- Wei Wang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Yan Li
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Haval Ali
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA
| | - Linjun Zhao
- Department of Lymphoma, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Di Mei
- Department of Lymphoma, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Wenqing Hu
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Bin Jiang
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China.
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Yang S, Kay NE, Shi M, Ossenkoppele G, Walter RB, Gale RP. Measurable residual disease testing in chronic lymphocytic leukaemia: hype, hope neither or both? Leukemia 2021; 35:3364-3370. [PMID: 34580401 DOI: 10.1038/s41375-021-01419-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Shenmiao Yang
- Peking University Peoples Hospital, Peking University Institute of Hematology, Beijing, China
| | - Neil E Kay
- Mayo Clinic, Department of Medicine, Division of Hematology, Rochester, MN, USA
| | - Min Shi
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Gert Ossenkoppele
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Roland B Walter
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK.
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Hallek M, Al‐Sawaf O. Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol 2021; 96:1679-1705. [PMID: 34625994 DOI: 10.1002/ajh.26367] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 12/26/2022]
Abstract
DISEASE OVERVIEW Chronic lymphocytic leukemia (CLL) is one of the most frequent types of leukemia. It typically occurs in elderly patients and has a highly variable clinical course. Leukemic transformation is initiated by specific genomic alterations that interfere with the regulation of proliferation and of apoptosis in clonal B-cells. DIAGNOSIS The diagnosis is established by blood counts, blood smears, and immunophenotyping of circulating B-lymphocytes, which identify a clonal B-cell population carrying the CD5 antigen as well as typical B-cell markers. PROGNOSIS AND STAGING The clinical staging systems provide prognostic information by using the results of physical examination and blood counts. Various biological and genetic markers provide additional prognostic information. Deletions of the short arm of chromosome 17 (del[17p]) and/or mutations of the TP53 gene predict resistance to chemoimmunotherapy and a shorter time to progression with most targeted therapies. The CLL international prognostic index integrates genetic, biological, and clinical variables to identify distinct risk groups of patients with CLL. THERAPY Only patients with active or symptomatic disease or with advanced Binet or Rai stages require therapy. When treatment is indicated, several therapeutic options exist: a combination of the B-cell lymphoma 2 (BCL2) inhibitor venetoclax with obinutuzumab, monotherapy with inhibitors of Bruton tyrosine kinase (BTK) such as ibrutinib and acalabrutinib, or chemoimmunotherapy. At relapse, the initial treatment may be repeated, if the treatment-free interval exceeds 3 years. If the disease relapses earlier, therapy should be changed using an alternative regimen. Patients with a del(17p) or TP53 mutation are usually resistant to chemotherapy and should, therefore, be treated with targeted agents. FUTURE CHALLENGES Combinations of targeted agents are now being investigated to create efficient, potentially curative therapies of CLL with fixed duration. One of the most relevant questions currently addressed in clinical trials is the comparison of monotherapies with BTK inhibitors with fixed duration combination therapies. Moreover, the optimal sequencing of targeted therapies remains to be determined. Alternative therapies are needed for patients with BTK and BCL2 inhibitor double-refractory disease.
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Affiliation(s)
- Michael Hallek
- Department I of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Center of Excellence on “Cellular Stress Responses in Aging‐Associated Diseases” University of Cologne Köln Germany
| | - Othman Al‐Sawaf
- Department I of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Center of Excellence on “Cellular Stress Responses in Aging‐Associated Diseases” University of Cologne Köln Germany
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D'Arena G, Volpe S, Amodeo R, Tirino V, D'Auria F, Annamaria G, Pietrantuono G, Laurenti L, Aiello A, Musto P. Italian Cytometry Society (GIC) endorsement of consensus recommendations for measurable residual disease in chronic lymphocytic leukemia. Int J Lab Hematol 2021; 44:e120-e122. [PMID: 34796668 DOI: 10.1111/ijlh.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Giovanni D'Arena
- Hematology, P.O. S. Luca, ASL Salerno, Vallo della Lucania, Italy
| | - Silvestro Volpe
- Immunohematology Unit, AORN Giuseppe Moscati, Avellino, Italy
| | - Rachele Amodeo
- Flow Cytometry Unit, Clinical Laboratory, Sant'Andrea Hospital, Roma, Italy
| | - Virginia Tirino
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Fiorella D'Auria
- Laboratory of Clinical and Advanced Diagnostics, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Giordano Annamaria
- Hematology Unit and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
| | - Giuseppe Pietrantuono
- Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Luca Laurenti
- Hematology Unit IRCCS Fondazione Policlinico Gemelli, Catholic University of "Sacred Heart", Roma, Italy
| | - Antonella Aiello
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation, Aldo Moro" University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
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Cabeçadas J, Nava VE, Ascensao JL, Gomes da Silva M. How to Diagnose and Treat CD5-Positive Lymphomas Involving the Spleen. Curr Oncol 2021; 28:4611-4633. [PMID: 34898558 PMCID: PMC8628806 DOI: 10.3390/curroncol28060390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with CD5-expressing lymphomas presenting with splenomegaly are frequently diagnosed with chronic lymphocytic leukemia. The most important differential diagnosis is mantle cell lymphoma, both in its classical and leukemic, non-nodal forms, given its prognostic and therapeutic implications. Other small B-cell neoplasms that frequently involve the spleen and occasionally express CD5 include the splenic marginal zone lymphoma, hairy cell leukemia and, rarely, lymphoplasmacytic lymphoma. The frequency of CD5 positivity depends in part on the sensitivity of the detection methods employed. Usually, a combination of morphological, immunophenotypic and molecular findings allows for a precise sub-classification of CD5-positive, low-grade B-cell lymphomas of the spleen. Some of these tumors may display a mixture of small and larger B cells, raising the possibility of more aggressive lymphomas, such as diffuse large B-cell lymphomas (DLBCL). Approximately 5-10% of DLBCL are CD5-positive and some may manifest as primary splenic lesions. When available, the morphology of DLBCL in the splenic tissue is distinctive and a leukemic picture is very rare. In conclusion, the appropriate morphological and clinical context assisted by flow cytometry panels and/or immunohistochemistry allows the differential diagnosis of CD5-positive, non-Hodgkin, B-cell lymphomas involving the spleen.
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Affiliation(s)
- José Cabeçadas
- Department of Pathology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal;
| | - Victor E. Nava
- Department of Pathology, The George Washington University, Washington, DC 20037, USA;
- Department of Pathology, Veterans Health Administration Medical Center, Washington, DC 20422, USA
| | - Joao L. Ascensao
- School of Medicine, The George Washington University, Washington, DC 20037, USA;
| | - Maria Gomes da Silva
- Department of Hematology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal
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Woyach JA. Minimal Residual Disease Assessment in CLL/SLL: Is It Ready for Routine Clinical Practice? J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2021.5107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Minimal residual disease (MRD) in chronic lymphocytic leukemia (CLL) is defined as <1 CLL cell per 10,000 leukocytes (0.01%; <10−4). Flow cytometry and next-generation sequencing have demonstrated high sensitivity in MRD detection. MRD assessment may help to determine prognosis after fixed-duration regimens; this has been established in the contexts of chemoimmunotherapy and venetoclax/antibody combinations. In the short term, MRD status does not seem to inform prognosis in patients treated with a BTK inhibitor plus venetoclax-based regimens; however, long-term data will be needed to determine whether it is beneficial in this population. Numerous trials have demonstrated that MRD may be used to guide therapy. It is unclear whether using an MRD-guided treatment strategy is better than using fixed-duration therapy; ongoing and future studies are warranted.
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59
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Wierda WG, Rawstron A, Cymbalista F, Badoux X, Rossi D, Brown JR, Egle A, Abello V, Cervera Ceballos E, Herishanu Y, Mulligan SP, Niemann CU, Diong CP, Soysal T, Suzuki R, Tran HTT, Wu SJ, Owen C, Stilgenbauer S, Ghia P, Hillmen P. Measurable residual disease in chronic lymphocytic leukemia: expert review and consensus recommendations. Leukemia 2021; 35:3059-3072. [PMID: 34168283 PMCID: PMC8550962 DOI: 10.1038/s41375-021-01241-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 12/16/2022]
Abstract
Assessment of measurable residual disease (often referred to as "minimal residual disease") has emerged as a highly sensitive indicator of disease burden during and at the end of treatment and has been correlated with time-to-event outcomes in chronic lymphocytic leukemia. Undetectable-measurable residual disease status at the end of treatment demonstrated independent prognostic significance in chronic lymphocytic leukemia, correlating with favorable progression-free and overall survival with chemoimmunotherapy. Given its utility in evaluating depth of response, determining measurable residual disease status is now a focus of outcomes in chronic lymphocytic leukemia clinical trials. Increased adoption of measurable residual disease assessment calls for standards for nomenclature and outcomes data reporting. In addition, many basic questions have not been systematically addressed. Here, we present the work of an international, multidisciplinary, 174-member panel convened to identify critical questions on key issues pertaining to measurable residual disease in chronic lymphocytic leukemia, review evaluable data, develop unified answers in conjunction with local expert input, and provide recommendations for future studies. Recommendations are presented regarding methodology for measurable residual disease determination, assay requirements and in which tissue to assess measurable residual disease, timing and frequency of assessment, use of measurable residual disease in clinical practice versus clinical trials, and the future usefulness of measurable residual disease assessment. Nomenclature is also proposed. Adoption of these recommendations will work toward standardizing data acquisition and interpretation in future studies with new treatments with the ultimate objective of improving outcomes and curing chronic lymphocytic leukemia.
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Affiliation(s)
| | | | - Florence Cymbalista
- Hôpital Avicenne, AP-HP, UMR Université Paris13/INSERM U978, Bobigny, France
| | | | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Jennifer R Brown
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Salzburg, Austria
| | | | | | - Yair Herishanu
- Tel-Aviv Sourasky Medical Center and Sackler Medical School, Tel Aviv, Israel
| | | | | | | | - Teoman Soysal
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Shang-Ju Wu
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Stephan Stilgenbauer
- Internal Medicine III, Ulm University, Ulm and Internal Medicine 1, Saarland University, Homburg, Germany
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
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Agathangelidis A, Vlachonikola E, Davi F, Langerak AW, Chatzidimitriou A. High-Throughput immunogenetics for precision medicine in cancer. Semin Cancer Biol 2021; 84:80-88. [PMID: 34757183 DOI: 10.1016/j.semcancer.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 01/20/2023]
Abstract
Cancer is characterized by an extremely complex biological background, which hinders personalized therapeutic interventions. Precision medicine promises to overcome this obstacle through integrating information from different 'subsystems', including the host, the external environment, the tumor itself and the tumor micro-environment. Immunogenetics is an essential tool that allows dissecting both lymphoid cancer ontogeny at both a cell-intrinsic and a cell-extrinsic level, i.e. through characterizing micro-environmental interactions, with a view to precision medicine. This is particularly thanks to the introduction of powerful, high-throughput approaches i.e. next generation sequencing, which allow the comprehensive characterization of immune repertoires. Indeed, NGS immunogenetic analysis (Immune-seq) has emerged as key to both understanding cancer pathogenesis and improving the accuracy of clinical decision making in oncology. Immune-seq has applications in lymphoid malignancies, assisting in the diagnosis e.g. through differentiating from reactive conditions, as well as in disease monitoring through accurate assessment of minimal residual disease. Moreover, Immune-seq facilitates the study of T cell receptor clonal dynamics in critical clinical contexts, including transplantation as well as innovative immunotherapy for solid cancers. The clinical utility of Immune-seq represents the focus of the present contribution, where we highlight what can be achieved but also what must be addressed in order to maximally realize the promise of Immune-seq in precision medicine in cancer.
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Affiliation(s)
- Andreas Agathangelidis
- Centre for Research and Technology Hellas, Institute of Applied Biosciences, Thessaloniki, Greece; Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisavet Vlachonikola
- Centre for Research and Technology Hellas, Institute of Applied Biosciences, Thessaloniki, Greece; Department of Genetics and Molecular Biology, Faculty of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Frederic Davi
- Department of Hematology, APHP, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - Anton W Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - Anastasia Chatzidimitriou
- Centre for Research and Technology Hellas, Institute of Applied Biosciences, Thessaloniki, Greece; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala 75236, Sweden.
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Al-Sawaf O, Zhang C, Lu T, Liao MZ, Panchal A, Robrecht S, Ching T, Tandon M, Fink AM, Tausch E, Schneider C, Ritgen M, Böttcher S, Kreuzer KA, Chyla B, Miles D, Wendtner CM, Eichhorst B, Stilgenbauer S, Jiang Y, Hallek M, Fischer K. Minimal Residual Disease Dynamics after Venetoclax-Obinutuzumab Treatment: Extended Off-Treatment Follow-up From the Randomized CLL14 Study. J Clin Oncol 2021; 39:4049-4060. [PMID: 34709929 DOI: 10.1200/jco.21.01181] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The CLL14 study has established one-year fixed-duration treatment of venetoclax and obinutuzumab (Ven-Obi) for patients with previously untreated chronic lymphocytic leukemia. With all patients off treatment for at least three years, we report a detailed analysis of minimal residual disease (MRD) kinetics and long-term outcome of patients treated in the CLL14 study. PATIENTS AND METHODS Patients were randomly assigned to receive six cycles of obinutuzumab with 12 cycles of venetoclax or 12 cycles of chlorambucil (Clb-Obi). Progression-free survival (PFS) was the primary end point. Key secondary end points included rates of undetectable MRD and overall survival. To analyze MRD kinetics, a population-based growth model with nonlinear mixed effects approach was developed. RESULTS Of 432 patients, 216 were assigned to Ven-Obi and 216 to Clb-Obi. Three months after treatment completion, 40% of patients in the Ven-Obi arm (7% in the Clb-Obi arm) had undetectable MRD levels < 10-6 by next-generation sequencing in peripheral blood. Median MRD doubling time was longer after Ven-Obi than Clb-Obi therapy (median 80 v 69 days). At a median follow-up of 52.4 months, a sustained significant PFS improvement was observed in the Ven-Obi arm compared with Clb-Obi (median not reached v 36.4 months; hazard ratio 0.33; 95% CI, 0.25 to 0.45; P < .0001). The estimated 4-year PFS rate was 74.0% in the Ven-Obi and 35.4% in the Clb-Obi arm. No difference in overall survival was observed (hazard ratio 0.85; 95% CI, 0.54 to 1.35; P = .49). No new safety signals occurred. CONCLUSION Appearance of MRD after Ven-Obi is significantly slower than that after Clb-Obi with more effective MRD reduction. These findings translate into a superior long-term efficacy with the majority of Ven-Obi-treated patients remaining in remission.
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Affiliation(s)
- Othman Al-Sawaf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany.,The Francis Crick Institute, London, United Kingdom.,UCL Cancer Institute, University College London, London, United Kingdom
| | - Can Zhang
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany
| | - Tong Lu
- Genentech, San Francisco, CA
| | | | - Anesh Panchal
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - Sandra Robrecht
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany
| | | | | | - Anna-Maria Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | | | - Matthias Ritgen
- Department II of Internal Medicine, University of Schleswig- Holstein, Kiel, Germany
| | - Sebastian Böttcher
- Clinic III, Special Hematology Laboratory, Rostock University Medical School, Rostock, Germany
| | - Karl-Anton Kreuzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany
| | | | | | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Munich Clinic Schwabing, Munich, Germany
| | - Barbara Eichhorst
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Ulm University, Ulm, Germany.,Department of Internal Medicine I, Saarland University Medical Center, Homburg, Germany
| | | | - Michael Hallek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany
| | - Kirsten Fischer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Germany
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Biavati L, Huff CA, Ferguson A, Sidorski A, Stevens MA, Rudraraju L, Zucchinetti C, Ali SA, Imus P, Gocke CB, Gittelman RM, Johnson S, Sanders C, Vignali M, Gandhi A, Ye X, Noonan KA, Borrello I. An Allogeneic Multiple Myeloma GM-CSF-Secreting Vaccine with Lenalidomide Induces Long-term Immunity and Durable Clinical Responses in Patients in Near Complete Remission. Clin Cancer Res 2021; 27:6696-6708. [PMID: 34667029 DOI: 10.1158/1078-0432.ccr-21-1916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/29/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This proof-of-principle clinical trial evaluated whether an allogeneic multiple myeloma GM-CSF-secreting vaccine (MM-GVAX) in combination with lenalidomide could deepen the clinical response in patients with multiple myeloma in sustained near complete remission (nCR). PATIENTS AND METHODS Fifteen patients on lenalidomide were treated with MM-GVAX and pneumococcal conjugate vaccine (PCV; Prevnar) at 1, 2, 3, and 6 months. RESULTS Eight patients (53.3%) achieved a true CR. With a median follow-up of 5 years, the median progression-free survival had not been reached, and the median overall survival was 7.8 years from enrollment. MM-GVAX induced clonal T-cell expansion and measurable cytokine responses that persisted up to 7 years in all patients. At baseline, a higher minimal residual disease was predictive of early relapse. After vaccination, a lack of both CD27-DNAM1-CD8+ T cells and antigen-presenting cells was associated with disease progression. CONCLUSIONS MM-GVAX, along with lenalidomide, effectively primed durable immunity and resulted in long-term disease control, as suggested by the reappearance of a detectable, fluctuating M-spike without meeting the criteria for clinical relapse. For patients in a nCR, MM-GVAX administration was safe and resulted in prolonged clinical responses.
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Affiliation(s)
- Luca Biavati
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Anna Ferguson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Amy Sidorski
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - M Amanda Stevens
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Lakshmi Rudraraju
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Cristina Zucchinetti
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Syed Abbas Ali
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Philip Imus
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Christian B Gocke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | - Xiaobu Ye
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Kimberly A Noonan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ivan Borrello
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland.
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Kharfan-Dabaja MA, Yassine F, Gadd ME, Qin H. Driving Out Chronic Lymphocytic Leukemia With CAR T Cells. Transplant Cell Ther 2021; 28:5-17. [PMID: 34656807 DOI: 10.1016/j.jtct.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the Western hemisphere. The recent availability of novel targeted therapies, namely Bruton's tyrosine kinase, phosphoinositide-3 kinase, and BCL-2 inhibitors, have revolutionized the treatment algorithm for CLL but have not yet resulted in cure. Advances in the field of immuno-oncology and T cell engineering brought chimeric antigen receptor (CAR) T cell therapy from the laboratory to the clinic for treatment of B cell lymphoid malignancies and has improved the disease response and survival outcomes of various types of relapsed and/or refractory B cell lymphomas. While acknowledging that there are no approved CAR T cell therapies for CLL at this time, in this comprehensive review we explore novel targets for CAR T cell therapy in CLL and highlight the promising results of CAR T cell trials reported to date. Furthermore, we shed light on future areas of development, including multitarget CAR T cell products for this disease.
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Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida.
| | - Farah Yassine
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida
| | - Martha E Gadd
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida
| | - Hong Qin
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida
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Multiparametric Flow Cytometry for MRD Monitoring in Hematologic Malignancies: Clinical Applications and New Challenges. Cancers (Basel) 2021; 13:cancers13184582. [PMID: 34572809 PMCID: PMC8470441 DOI: 10.3390/cancers13184582] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In hematologic cancers, Minimal Residual Disease (MRD) monitoring, using either molecular (PCR) or immunophenotypic (MFC) diagnostics, allows the identification of rare cancer cells, readily detectable either in the bone marrow or in the peripheral blood at very low levels, far below the limit of classic microscopy. In this paper, we outlined the state-of-the-art of MFC-based MRD detection in different hematologic settings, highlighting main recommendations and new challenges for using such method in patients with acute leukemias or chronic hematologic neoplasms. The combination of new molecular technologies with advanced flow cytometry is progressively allowing clinicians to design a personalized therapeutic path, proportionate to the biological aggressiveness of the disease, in particular by using novel immunotherapies, in view of a modern decision-making process, based on precision medicine. Abstract Along with the evolution of immunophenotypic and molecular diagnostics, the assessment of Minimal Residual Disease (MRD) has progressively become a keystone in the clinical management of hematologic malignancies, enabling valuable post-therapy risk stratifications and guiding risk-adapted therapeutic approaches. However, specific prognostic values of MRD in different hematological settings, as well as its appropriate clinical uses (basically, when to measure it and how to deal with different MRD levels), still need further investigations, aiming to improve standardization and harmonization of MRD monitoring protocols and MRD-driven therapeutic strategies. Currently, MRD measurement in hematological neoplasms with bone marrow involvement is based on advanced highly sensitive methods, able to detect either specific genetic abnormalities (by PCR-based techniques and next-generation sequencing) or tumor-associated immunophenotypic profiles (by multiparametric flow cytometry, MFC). In this review, we focus on the growing clinical role for MFC-MRD diagnostics in hematological malignancies—from acute myeloid and lymphoblastic leukemias (AML, B-ALL and T-ALL) to chronic lymphocytic leukemia (CLL) and multiple myeloma (MM)—providing a comparative overview on technical aspects, clinical implications, advantages and pitfalls of MFC-MRD monitoring in different clinical settings.
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Steiner M, Gassner FJ, Parigger T, Neureiter D, Egle A, Geisberger R, Greil R, Zaborsky N. A POLE Splice Site Deletion Detected in a Patient with Biclonal CLL and Prostate Cancer: A Case Report. Int J Mol Sci 2021; 22:ijms22179410. [PMID: 34502317 PMCID: PMC8431722 DOI: 10.3390/ijms22179410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 02/01/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is considered a clonal B cell malignancy. Sporadically, CLL cases with multiple productive heavy and light-chain rearrangements were detected, thus leading to a bi- or oligoclonal CLL disease with leukemic cells originating either from different B cells or otherwise descending from secondary immunoglobulin rearrangement events. This suggests a potential role of clonal hematopoiesis or germline predisposition in these cases. During the screening of 75 CLL cases for kappa and lambda light-chain rearrangements, we could detect a single case with CLL cells expressing two distinct kappa and lambda light chains paired with two separate immunoglobulin heavy-chain variable regions. Furthermore, this patient also developed a prostate carcinoma. Targeted genome sequencing of highly purified light-chain specific CLL clones from this patient and from the prostate carcinoma revealed the presence of a rare germline polymorphism in the POLE gene. Hence, our data suggest that the detected SNP may predispose for cancer, particularly for CLL.
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MESH Headings
- Alternative Splicing
- DNA Polymerase II/genetics
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Poly-ADP-Ribose Binding Proteins/genetics
- Polymorphism, Single Nucleotide
- Prognosis
- Prostatic Neoplasms/complications
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/pathology
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Affiliation(s)
- Markus Steiner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (T.P.); (A.E.); (R.G.); (R.G.)
| | - Franz J. Gassner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (T.P.); (A.E.); (R.G.); (R.G.)
| | - Thomas Parigger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (T.P.); (A.E.); (R.G.); (R.G.)
- Department of Biosciences, Paris-Lodron-University Salzburg, 5020 Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (T.P.); (A.E.); (R.G.); (R.G.)
| | - Roland Geisberger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (T.P.); (A.E.); (R.G.); (R.G.)
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (T.P.); (A.E.); (R.G.); (R.G.)
| | - Nadja Zaborsky
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (T.P.); (A.E.); (R.G.); (R.G.)
- Correspondence:
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Venetoclax and ibrutinib for patients with relapsed/refractory chronic lymphocytic leukemia. Blood 2021; 137:1117-1120. [PMID: 33027809 DOI: 10.1182/blood.2020008608] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/26/2020] [Indexed: 11/20/2022] Open
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67
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Ho C, Rothberg PG. Next-Generation Sequencing-Based Antigen-Receptor Gene Clonality Assays: Will They Become the Clinical Standard? J Mol Diagn 2021; 23:1043-1046. [PMID: 34293488 DOI: 10.1016/j.jmoldx.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Caleb Ho
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Paul G Rothberg
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
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Tournilhac O, Le Garff-Tavernier M, Nguyen Quoc S, Forcade E, Chevallier P, Legrand-Izadifar F, Laurent Damaj G, Michonneau D, Tomowiak C, Borel C, Orvain C, Turlure P, Redjou R, Guillerm G, Vincent L, Simand C, Lemal R, Quiney C, Combes P, Pereira B, Calvet L, Cabrespine A, Bay JO, Leblond V, Dhédin N, Organization Filo FIL, De Moelle Et de Thérapie Cellulaire Sfgm-Tc SFDG. Efficacy of minimal residual disease driven immune-intervention after allogeneic hematopoietic stem cell transplantation for high-risk chronic lymphocytic leukemia: results of a prospective multicenter trial. Haematologica 2021; 106:1867-1875. [PMID: 32527951 PMCID: PMC8252930 DOI: 10.3324/haematol.2019.239566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 12/13/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) remains a potentially curative and useful strategy in high-risk relapsing chronic lymphocytic leukemia (CLL). Minimal residual disease (MRD) assessment at 12 months (M12) post-HSCT is predictive of relapse. This phase II study aimed to achieve M12 MRD negativity (MRDneg) using an MRD-driven immune-intervention (Md-PII) algorithm based on serial flow-cytometry blood MRD, involving cyclosporine tapering followed in case of failure by donor lymphocytes infusions. Patients had high-risk CLL according to the 2006 European Society for Blood and Marrow Transplantation consensus, in complete or partial response with lymphadenopathy <5 cm and comorbidity score ≤2. Donors were HLA-matched sibling or matched unrelated (10/10). Fortytwo enrolled patients with either 17p deletion (front-line, n=11; relapse n=16) or other high-risk relapse (n=15) received reduced intensity-conditioning regimen before HSCT and were submitted to Md-PII. M12- MRDneg status was achieved in 27 of 42 patients (64%) versus 6 of 42 (14.2%) before HSCT. With a median follow-up of 36 months (range, 19-53), 3-year overall survival, non-relapse mortality and cumulative incidence of relapse are 86.9% (95% Confidence Interval [CI]: 70.8-94.4), 9.5% (95% CI: 3.7-23.4) and 29.6% (95% CI: 17.3-47.7). Incidence of 2-year limited and extensive chronic graft versus host disease (cGVHD) is 38% (95% CI: 23-53) and 23% (95% CI: 10-36) including two cases post Md-PII. Fifteen patients converted to MRDneg either after cyclosporine A withdrawal (n=12) or after cGvHD (n=3). As a time-dependent variable, MRDneg achievement at any time-point correlates with reduced relapse (Hazard ratio [HR] 0.14 [range, 0.04-0.53], P=0.004) and improvement of both progression free (HR 0.18 [range, 0.06-0.6], P<0.005) and overall (HR 0.18 [range, 0.03-0.98], P=0.047) survival. These data highlight the value of MRD-driven immune-intervention to induce prompt MRD clearance in the therapy of CLL (clinicaltrials gov. Identifier: NCT01849939).
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Affiliation(s)
- Olivier Tournilhac
- Hematologie Clinique et Therapie Cellulaire, CHU Estaing, Université Clermont-Ferrand, France
| | | | - Stéphanie Nguyen Quoc
- Service Hematologie Clinique, Groupe Hospitalier Pitié-Salpetriere, APHP, Paris, France
| | - Edouard Forcade
- Service Hematologie Clinique et de Thérapie cellulaire, CHU Bordeaux, Bordeaux, France
| | | | | | - Gandhi Laurent Damaj
- Hematologie Clinique, Institut d'Hematologie de Basse-Normandie, CHU Cote de Nacre, Caen, France
| | - David Michonneau
- Service Hematologie Greffe, Hopital Saint-Louis, APHP ; Université Paris Diderot, Paris, France
| | - Cécile Tomowiak
- Service Oncologie Hematologique et Therapie Cellulaire, CHU Poitiers, Poitiers, France
| | - Cécile Borel
- Service Hematologie, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | | | - Pascal Turlure
- Service Hematologie Clinique, CHU Dupuytren, Limoges, France
| | - Rabah Redjou
- Service Hematologie Clinique, Hopital Henri Mondor, APHP, Creteil, France
| | - Gaëlle Guillerm
- Service Hematologie Clinique, Institut de Cancero-Hematologie, Hopital Morvan, Brest, France
| | - Laure Vincent
- Departement Hematologie Clinique, Hopital St Eloi, Montpellier, France
| | | | - Richard Lemal
- Service 'Histocompatibilité, CHU, UCA, EA7453 and CIC1405, Clermont-Ferrand, France
| | - Claire Quiney
- Service Hematologie Biologique, Groupe Hospitalier Pitié-Salpetriere, APHP, Paris France
| | | | - Bruno Pereira
- Unité de Biostatistiques, (DRCI), CHU, Clermont-Ferrand, France
| | - Laure Calvet
- Service de Reanimation Medicale, Hopital Gabriel Monpied, CHU, Clermont-Ferrand, France
| | - Aurélie Cabrespine
- Hematologie Clinique et Therapie Cellulaire, CHU, UCA EA 7453 ; CIC1405, Clermont-Ferrand, France
| | - Jacques-Olivier Bay
- Hematologie Clinique et Therapie Cellulaire, CHU, UCA EA 7453 ; CIC1405, Clermont-Ferrand, France
| | - Véronique Leblond
- Service Hematologie Clinique, Groupe Hospitalier Pitié-Salpetriere, APHP, Paris, France
| | - Nathalie Dhédin
- Unité Adolescents et Jeunes Adultes, Hopital St Louis, Hopitaux de Paris, France
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69
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Affiliation(s)
- M Hallek
- University Hospital of Cologne Department I of Internal Medicine Cologne Germany
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70
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Roerden M, Wirths S, Sökler M, Bethge WA, Vogel W, Walz JS. Impact of Mantle Cell Lymphoma Contamination of Autologous Stem Cell Grafts on Outcome after High-Dose Chemotherapy. Cancers (Basel) 2021; 13:cancers13112558. [PMID: 34071000 PMCID: PMC8197101 DOI: 10.3390/cancers13112558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Simple Summary High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (Auto-HSCT) is a standard frontline treatment for fit mantle cell lymphoma (MCL) patients. As there is a need for predictive factors to identify patients unlikely to benefit from this therapy, we investigated the prognostic impact of lymphoma cell contamination of autologous stem cell grafts. Analyzing a cohort of 36 MCL patients, we show that lymphoma cell contamination of stem cell grafts is associated with poor outcomes after Auto-HSCT. Its analysis might thus improve risk assessment and enable risk-stratified treatment strategies for MCL patients. Abstract Novel predictive factors are needed to identify mantle cell lymphoma (MCL) patients at increased risk for relapse after high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HDCT/Auto-HSCT). Although bone marrow and peripheral blood involvement is commonly observed in MCL and lymphoma cell contamination of autologous stem cell grafts might facilitate relapse after Auto-HSCT, prevalence and prognostic significance of residual MCL cells in autologous grafts are unknown. We therefore performed a multiparameter flow cytometry (MFC)-based measurable residual disease (MRD) assessment in autologous stem cell grafts and analyzed its association with clinical outcome in an unselected retrospective cohort of 36 MCL patients. MRD was detectable in four (11%) autologous grafts, with MRD levels ranging from 0.002% to 0.2%. Positive graft-MRD was associated with a significantly shorter progression-free and overall survival when compared to graft-MRD negative patients (median 9 vs. 56 months and 25 vs. 132 months, respectively) and predicted early relapse after Auto-HSCT (median time to relapse 9 vs. 44 months). As a predictor of outcome after HDCT/Auto-HSCT, MFC-based assessment of graft-MRD might improve risk stratification and support clinical decision making for risk-oriented treatment strategies in MCL.
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Affiliation(s)
- Malte Roerden
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, 72076 Tübingen, Germany
- Correspondence:
| | - Stefan Wirths
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Martin Sökler
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Wolfgang A. Bethge
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Wichard Vogel
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Juliane S. Walz
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, 72076 Tübingen, Germany
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology (IKP) and Robert Bosch Center for Tumor Diseases (RBCT), Auerbachstr. 112, 70376 Stuttgart, Germany
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Bazinet A, Rys RN, Barry A, Greenwood CMT, Young YK, Mendoza A, LaPorta I, Wever CM, Mercier FE, Johnson NA. A 10-color flow cytometry panel for diagnosis and minimal residual disease in chronic lymphocytic leukemia. Leuk Lymphoma 2021; 62:2352-2359. [PMID: 34020575 DOI: 10.1080/10428194.2021.1919658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Diagnosis and minimal residual disease (MRD) monitoring of chronic lymphocytic leukemia (CLL) by flow cytometry currently requires multiple antibody panels. We added CD23 and CD200 to the EuroFlowTM lymphoid screening tube (LST) to create a 10-color modified LST (mLST) capable of diagnosing typical CLL in a single tube. We then explored if the mLST could be used for MRD by comparing its performance to the European Research Initiative on CLL (ERIC) panel using spiked cryopreserved and fresh patient samples. Over 1 year of use in our clinical laboratory, the mLST diagnosed CLL without further immunophenotyping in 56% of samples with an abnormal clone. There was good agreement in MRD results between the mLST and ERIC panels. Therefore, the mLST can streamline CLL diagnosis by reducing technician time and the number of panels required. It may have the potential to screen for MRD in laboratories without access to dedicated panels (ERIC).
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Affiliation(s)
- Alexandre Bazinet
- Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.,Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Ryan N Rys
- Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada
| | - Amadou Barry
- Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - Celia M T Greenwood
- Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada.,Department of Human Genetics, McGill University, Montreal, Canada
| | - Yoon Kow Young
- Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada
| | - Alma Mendoza
- Clinical Flow Cytometry, Jewish General Hospital, Montreal, Canada
| | - Ida LaPorta
- Clinical Flow Cytometry, Jewish General Hospital, Montreal, Canada
| | | | - François E Mercier
- Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.,Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nathalie A Johnson
- Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.,Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
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Al-Sawaf O, Seymour JF, Kater AP, Fischer K. Should Undetectable Minimal Residual Disease Be the Goal of Chronic Lymphocytic Leukemia Therapy? Hematol Oncol Clin North Am 2021; 35:775-791. [PMID: 34102145 DOI: 10.1016/j.hoc.2021.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With the advent of highly effective novel therapies for chronic lymphocytic leukemia, conventional response assessment is not able to sensitively capture depth of response. To achieve a more precise assessment of response, minimal residual disease has been introduced to more accurately classify and quantify treatment outcomes. It is now considered a strong predictor of outcome in chronic lymphocytic leukemia, although its interpretation depends on the therapeutic context. This review discusses available methods of minimal residual disease measurement. It summarizes minimal residual disease data from pivotal clinical trials and discusses potential implications for future studies and minimal residual disease-based clinical strategies.
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Affiliation(s)
- Othman Al-Sawaf
- Department of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital, German CLL Study Group, Gleueler Strasse 176, 50935 Cologne, Germany
| | - John F Seymour
- Department of Hematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Research Center Amsterdam (LYMMCARE), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Kirsten Fischer
- Department of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital, German CLL Study Group, Gleueler Strasse 176, 50935 Cologne, Germany
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73
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Undetectable peripheral blood MRD should be the goal of venetoclax in CLL, but attainment plateaus after 24 months. Blood Adv 2021; 4:165-173. [PMID: 31935286 DOI: 10.1182/bloodadvances.2019000864] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/03/2019] [Indexed: 12/25/2022] Open
Abstract
The highly selective BCL2 inhibitor venetoclax achieves deep responses in patients with relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL), including undetectable minimal residual disease (uMRD). We retrospectively reviewed 62 patients with CLL treated with venetoclax to investigate the performance of peripheral blood (PB) compared with bone marrow (BM) assessment of MRD; the kinetics, clinicopathological associations, and longer-term outcomes of uMRD attainment and recrudescence; and the ability of venetoclax dose escalation to deepen responses. Among 16 patients who achieved PB uMRD and had contemporaneous BM assessments, 13 (81%) had confirmed BM uMRD, and patients with PB uMRD had outcomes at least as favorable as those with BM uMRD for time to progression, overall survival, and MRD recrudescence. Excluding 2 patients lacking earlier assessment, the median time to PB uMRD was 18 (range, 5-26) months, with 90% of instances achieved by 24 months. There was no new PB uMRD attainment after 24 months without treatment intensification. The dominant association with earlier attainment of uMRD was concurrent rituximab (P = .012). Complex karyotype was associated with inferior uMRD attainment after 12 months of therapy (P = .015), and patients attaining uMRD whose disease harbored TP53 abnormalities demonstrated a trend toward earlier recrudescence (P = .089). Of patients who received venetoclax dose escalations, 4 (27%) of 15 achieved improvements in response. For patients with R/R CLL receiving venetoclax, PB uMRD commonly correlates with BM uMRD and is associated with a comparable longer-term prognosis. Concurrent rituximab augments uMRD attainment, but dose escalation and further treatment beyond 24 months infrequently deepen responses.
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Hansen MH, Cédile O, Larsen TS, Abildgaard N, Nyvold CG. Perspective: sensitive detection of residual lymphoproliferative disease by NGS and clonal rearrangements-how low can you go? Exp Hematol 2021; 98:14-24. [PMID: 33823225 DOI: 10.1016/j.exphem.2021.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 01/12/2023]
Abstract
Malignant lymphoproliferative disorders collectively constitute a large fraction of the hematological cancers, ranging from indolent to highly aggressive neoplasms. Being a diagnostically important hallmark, clonal gene rearrangements of the immunoglobulins enable the detection of residual disease in the clinical course of patients down to a minute fraction of malignant cells. The introduction of next-generation sequencing (NGS) has provided unprecedented assay specificity, with a sensitivity matching that of polymerase chain reaction-based measurable residual disease (MRD) detection down to the 10-6 level. Although reaching 10-6 to 10-7 is theoretically feasible, employing a sufficient amount of DNA and sequencing coverage is placed in the perspective of the practical challenges when relying on clinical samples in contrast to controlled serial dilutions. As we discuss, the randomness of subsampling must be taken into account to accommodate the sensitivity threshold-in terms of both the required number of cells and sequencing coverage. As a substantial part of the reviewed studies do not state the depth of coverage or even amount of DNA in some cases, we call for increased transparency to enable critical assessment of the MRD assays for clinical implementation and feasibility.
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Affiliation(s)
- Marcus H Hansen
- Hematology-Pathology Research Laboratory, Research Unit for Hematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark; Department of Hematology, Odense University Hospital, Odense, Denmark.
| | - Oriane Cédile
- Hematology-Pathology Research Laboratory, Research Unit for Hematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark; Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Thomas S Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Hematology-Pathology Research Laboratory, Research Unit for Hematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark; Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Charlotte G Nyvold
- Hematology-Pathology Research Laboratory, Research Unit for Hematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark; Department of Hematology, Odense University Hospital, Odense, Denmark
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75
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Solman IG, Blum LK, Burger JA, Kipps TJ, Dean JP, James DF, Mongan A. Impact of long-term ibrutinib treatment on circulating immune cells in previously untreated chronic lymphocytic leukemia. Leuk Res 2021; 102:106520. [PMID: 33611131 DOI: 10.1016/j.leukres.2021.106520] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/12/2021] [Accepted: 01/30/2021] [Indexed: 12/22/2022]
Abstract
This study evaluated long-term immunophenotypic changes in circulating levels of 24 immune cell subsets through 4 years of continuous treatment with first-line ibrutinib (420 mg once daily) in 31 patients with chronic lymphocytic leukemia (CLL) from the RESONATE-2 study, and compared them with untreated age-matched healthy donors (n = 20). Ibrutinib progressively decreased total B-cell counts and preferentially targeted malignant CLL B cells over normal B cells. Elevated counts of chronically activated, exhausted, and effector memory T cells were normalized within 6-16 months, while naive T cells remained mostly within healthy donor range (HDR). Immunosuppressive regulatory T cells and myeloid-derived suppressor cells were normalized within the first 1-2 years and then plateaued. Additionally, ibrutinib restored low counts of innate cell populations associated with antitumor immunity: plasmacytoid dendritic cells were restored to HDR after 2 years, and classical monocyte counts progressively and continuously increased toward HDR. Ibrutinib also consistently preserved circulating mature natural killer cell counts. The data indicate that ibrutinib continuously exerted positive effects on immune cell populations throughout 4 years of treatment, consistent with improved clinical outcomes observed in patients. The normalization of adaptive and innate immune cell populations suggests that long-term ibrutinib treatment mediates restoration of immunity.
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Affiliation(s)
| | - Lisa K Blum
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Jan A Burger
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - James P Dean
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | | | - Ann Mongan
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA.
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76
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Abstract
Patients with chronic lymphocytic leukemia can be divided into three categories: those who are minimally affected by the problem, often never requiring therapy; those that initially follow an indolent course but subsequently progress and require therapy; and those that from the point of diagnosis exhibit an aggressive disease necessitating treatment. Likewise, such patients pass through three phases: development of the disease, diagnosis, and need for therapy. Finally, the leukemic clones of all patients appear to require continuous input from the exterior, most often through membrane receptors, to allow them to survive and grow. This review is presented according to the temporal course that the disease follows, focusing on those external influences from the tissue microenvironment (TME) that support the time lines as well as those internal influences that are inherited or develop as genetic and epigenetic changes occurring over the time line. Regarding the former, special emphasis is placed on the input provided via the B-cell receptor for antigen and the C-X-C-motif chemokine receptor-4 and the therapeutic agents that block these inputs. Regarding the latter, prominence is laid upon inherited susceptibility genes and the genetic and epigenetic abnormalities that lead to the developmental and progression of the disease.
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MESH Headings
- Disease Progression
- Humans
- Immunotherapy
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Mutation
- PAX5 Transcription Factor/metabolism
- Receptors, Antigen, B-Cell
- Signal Transduction
- Tumor Microenvironment
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Affiliation(s)
- Nicholas Chiorazzi
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Shih-Shih Chen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Kanti R Rai
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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77
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Gauthier J, Bezerra ED, Hirayama AV, Fiorenza S, Sheih A, Chou CK, Kimble EL, Pender BS, Hawkins RM, Vakil A, Phi TD, Steinmetz RN, Jamieson AW, Bar M, Cassaday RD, Chapuis AG, Cowan AJ, Green DJ, Kiem HP, Milano F, Shadman M, Till BG, Riddell SR, Maloney DG, Turtle CJ. Factors associated with outcomes after a second CD19-targeted CAR T-cell infusion for refractory B-cell malignancies. Blood 2021; 137:323-335. [PMID: 32967009 PMCID: PMC7819764 DOI: 10.1182/blood.2020006770] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023] Open
Abstract
CD19-targeted chimeric antigen receptor-engineered (CD19 CAR) T-cell therapy has shown significant efficacy for relapsed or refractory (R/R) B-cell malignancies. Yet, CD19 CAR T cells fail to induce durable responses in most patients. Second infusions of CD19 CAR T cells (CART2) have been considered as a possible approach to improve outcomes. We analyzed data from 44 patients with R/R B-cell malignancies (acute lymphoblastic leukemia [ALL], n = 14; chronic lymphocytic leukemia [CLL], n = 9; non-Hodgkin lymphoma [NHL], n = 21) who received CART2 on a phase 1/2 trial (NCT01865617) at our institution. Despite a CART2 dose increase in 82% of patients, we observed a low incidence of severe toxicity after CART2 (grade ≥3 cytokine release syndrome, 9%; grade ≥3 neurotoxicity, 11%). After CART2, complete response (CR) was achieved in 22% of CLL, 19% of NHL, and 21% of ALL patients. The median durations of response after CART2 in CLL, NHL, and ALL patients were 33, 6, and 4 months, respectively. Addition of fludarabine to cyclophosphamide-based lymphodepletion before the first CAR T-cell infusion (CART1) and an increase in the CART2 dose compared with CART1 were independently associated with higher overall response rates and longer progression-free survival after CART2. We observed durable CAR T-cell persistence after CART2 in patients who received cyclophosphamide and fludarabine (Cy-Flu) lymphodepletion before CART1 and a higher CART2 compared with CART1 cell dose. The identification of 2 modifiable pretreatment factors independently associated with better outcomes after CART2 suggests strategies to improve in vivo CAR T-cell kinetics and responses after repeat CAR T-cell infusions, and has implications for the design of trials of novel CAR T-cell products after failure of prior CAR T-cell immunotherapies.
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MESH Headings
- Adult
- Aged
- Antigens, CD19/metabolism
- Cell Proliferation
- Cyclophosphamide/therapeutic use
- Cytokine Release Syndrome/complications
- Female
- Humans
- Immunotherapy, Adoptive
- Leukemia, B-Cell/immunology
- Leukemia, B-Cell/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Multivariate Analysis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Progression-Free Survival
- T-Lymphocytes/immunology
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- Jordan Gauthier
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | | | | | | | | | - Cassie K Chou
- Clinical Research Division and
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | | | | | | | | | | | - Merav Bar
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | | | - Aude G Chapuis
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Andrew J Cowan
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Damian J Green
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Hans-Peter Kiem
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Filippo Milano
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Mazyar Shadman
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Brian G Till
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Stanley R Riddell
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - David G Maloney
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
| | - Cameron J Turtle
- Clinical Research Division and
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA; and
- Department of Medicine and
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Abstract
Objectives: CD43 can be useful in routine flow cytometry. We conducted a systematic review aiming to describe when CD43 is used by flow cytometry in malignant hematology and to determine its value in these settings. Methods: Systematic review of MEDLINE (search 'CD43' AND 'flow cytometry,' starting in 2010). Results: Twenty-one of 103 entries retrieved were included in this systematic review. CD43 is used in three settings: 1) in the classification of mature B cell lymphoproliferative disorders, 2) as part of a strategy to quantify residual disease in chronic lymphocytic leukemia (CLL) and 3) to help classify CD10-positive B cell populations. In this section, the published data is summarized, the clinical usefulness in each of these settings is evaluated and illustrative cases are shown. Conclusion: CD43 has a growing role in the diagnosis and management of B cell malignancies; it has become essential for the classification of B cell lymphoproliferative disorders and may be of help in the differential diagnosis of CD10-positive lymphomas by FC. It is also required for optimal quantification of CLL residual disease, which will soon be used to guide therapeutic decisions.
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Affiliation(s)
- Marc Sorigue
- Hematology Laboratory, ICO-Hospital Germans Trias I Pujol, Functional Cytomics- IJC, Universitat Autònoma De Barcelona , Badalona, Spain
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79
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Hampel PJ, Parikh SA, Call TG. Incorporating molecular biomarkers into the continuum of care in chronic lymphocytic leukemia. Leuk Lymphoma 2021; 62:1289-1301. [PMID: 33410372 DOI: 10.1080/10428194.2020.1869966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is a mature B-cell malignancy characterized by marked heterogeneity. Discoveries in disease biology over the past two decades have helped explain clinical variability and heralded the arrival of the targeted therapy era. In this article, we review improvements in risk stratification which have coincided with this progress, including individual biomarkers and their incorporation into prognostic models. Amidst an ever-expanding list of biomarkers, we seek to bring focus to the essential tests to improve patient care and counseling at particular times in the disease course, beginning with prognosis at diagnosis. The majority of patients do not require treatment at the time of diagnosis, making time-to-first-treatment a key initial prognostic concern. Prognostic and predictive biomarkers are then considered at subsequent major junctures, including at the time of treatment initiation, while on therapy, and at the time of relapse on novel agents.
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Affiliation(s)
- Paul J Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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80
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Howard DR, Hockaday A, Brown JM, Gregory WM, Todd S, Munir T, Oughton JB, Dimbleby C, Hillmen P. A platform trial in practice: adding a new experimental research arm to the ongoing confirmatory FLAIR trial in chronic lymphocytic leukaemia. Trials 2021; 22:38. [PMID: 33419469 PMCID: PMC7792072 DOI: 10.1186/s13063-020-04971-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The FLAIR trial in chronic lymphocytic leukaemia has a randomised, controlled, open-label, confirmatory, platform design. FLAIR was successfully amended to include an emerging promising experimental therapy to expedite its assessment, greatly reducing the time to reach the primary outcome compared to running a separate trial and without compromising the validity of the research or the ability to recruit to the trial and report the outcomes. The methodological and practical issues are presented, describing how they were addressed to ensure the amendment was a success. METHODS FLAIR was designed as a two-arm trial requiring 754 patients. In stage 2, two new arms were added: a new experimental arm and a second control arm to protect the trial in case of a change in practice. In stage 3, the original experimental arm was closed as its planned recruitment target was reached. In total, 1516 participants will be randomised to the trial. RESULTS The changes to the protocol and randomisation to add and stop arms were made seamlessly without pausing recruitment. The statistical considerations to ensure the results for the original and new hypotheses are unbiased were approved following peer review by oversight committees, Cancer Research UK, ethical and regulatory committees and pharmaceutical partners. These included the use of concurrent comparators in case of any stage effect, appropriate control of the type I error rate and consideration of analysis methods across trial stages. The operational aspects of successfully implementing the amendments are described, including gaining approvals and additional funding, data management requirements and implementation at centres. CONCLUSIONS FLAIR is an exemplar of how an emerging experimental therapy can be assessed within an existing trial structure without compromising the conduct, reporting or validity of the trial. This strategy offered considerable resource savings and allowed the new experimental therapy to be assessed within a confirmatory trial in the UK years earlier than would have otherwise been possible. Despite the clear efficiencies, treatment arms are rarely added to ongoing trials in practice. This paper demonstrates how this strategy is acceptable, feasible and beneficial to patients and the wider research community. TRIAL REGISTRATION ISRCTN Registry ISRCTN01844152 . Registered on August 08, 2014.
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Affiliation(s)
- Dena R Howard
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Anna Hockaday
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia M Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Walter M Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Susan Todd
- Department of Mathematics and Statistics, University of Reading, Reading, UK
| | - Tahla Munir
- St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - Jamie B Oughton
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire Dimbleby
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Hillmen
- St James's Institute of Oncology, St James's University Hospital, Leeds, UK
- Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
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81
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Farren TW, Sadanand KS, Agrawal SG. Highly Sensitive and Accurate Assessment of Minimal Residual Disease in Chronic Lymphocytic Leukemia Using the Novel CD160-ROR1 Assay. Front Oncol 2020; 10:597730. [PMID: 33344247 PMCID: PMC7744938 DOI: 10.3389/fonc.2020.597730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022] Open
Abstract
Undetectable minimal residual disease (MRD) in Chronic Lymphocytic Leukemia (CLL) has a favorable prognostic outcome compared with MRD that can be detected. This study investigated a flow cytometric assay (CD160-ROR1FCA) targeting the tumor-specific antigens CD160 and receptor tyrosine kinase-like orphan receptor 1 (ROR1), along with CD2, CD5, CD19, CD45. CD160-ROR1FCA was compared with the originally published 8-colour European Research Initiative for CLL (ERIC) gold-standard assay for CLL MRD detection. CD160-ROR1FCA had a limit of detection of 0.001% and showed strong correlation with ERIC (R = 0.98, p < 0.01) with negligible differences in MRD detection (bias -0.3152 95%CI 5.586 to -6.216). Using CD160-ROR1FCA, increased expression of both CD160 and ROR1 was found in Monoclonal B cell Lymphocytosis (MBL) compared to low-level polyclonal B-cell expansions (p < 0.01). Patients in CR and with undetectable MRD had a longer EFS (not reached) than those in CR but with detectable MRD (756 days, p < 0.01) versus 113 days in patients with partial remission (p < 0.01). Patients with MRD levels of >0.01 to 0.1% had a longer EFS (2,333 days), versus levels between 0.1 to 1% (1,049 days). CD160-ROR1FCA is a novel assay for routine CLL MRD measurement and for MBL detection. MRD status assessed by CD160-ROR1FCA after CLL treatment correlated with EFS.
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Affiliation(s)
- Timothy W Farren
- Department of Haemato-Oncology and Immunophenotyping (SIHMDS), Barts Health NHS Trust, London, United Kingdom.,Immunobiology, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Kaushik S Sadanand
- Immunobiology, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Samir G Agrawal
- Department of Haemato-Oncology and Immunophenotyping (SIHMDS), Barts Health NHS Trust, London, United Kingdom.,Immunobiology, Blizard Institute, Queen Mary University of London, London, United Kingdom
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82
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Uchiyama T, Yokoyama A, Aoki S. Measurable residual disease in the treatment of chronic lymphocytic leukemia. J Clin Exp Hematop 2020; 60:138-145. [PMID: 33148932 PMCID: PMC7810249 DOI: 10.3960/jslrt.20014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Treatment outcomes of chronic lymphocytic leukemia (CLL) have improved since
chemoimmunotherapy and novel drugs became available for CLL treatment; therefore, more
sensitive methods to evaluate residual CLL cells in patients are required. Measurable
residual disease (MRD) has been assessed in several clinical trials on CLL using flow
cytometry, real-time quantitative PCR (RQ-PCR) with allele-specific oligonucleotide (ASO)
primers, and high-throughput sequencing. MRD assessment is useful to predict the treatment
outcomes in the context of chemotherapy and treatment with novel drugs such as venetoclax.
In this review, we discuss major techniques for MRD assessment, data from relevant
clinical trials, and the future of MRD assessment in CLL treatment.
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Affiliation(s)
- Takayoshi Uchiyama
- Niigata University of Pharmacy and Applied Life Sciences, Faculty of Pharmaceutical Sciences, Department of Pathophysiology, Niigata, Japan
| | - Aki Yokoyama
- Niigata University of Pharmacy and Applied Life Sciences, Faculty of Pharmaceutical Sciences, Department of Pathophysiology, Niigata, Japan
| | - Sadao Aoki
- Niigata University of Pharmacy and Applied Life Sciences, Faculty of Pharmaceutical Sciences, Department of Pathophysiology, Niigata, Japan
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83
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Ho C, Syed M, Roshal M, Petrova-Drus K, Moung C, Yao J, Quesada AE, Benhamida J, Vanderbilt C, Liu Y, Zhu M, Yu W, Maciag L, Wang M, Ma Y, Gao Q, Rustad EH, Hultcrantz M, Diamond BT, Zheng-Lin B, Huang Y, Hutt K, Miller JE, Dogan A, Nafa K, Landgren O, Arcila ME. Routine Evaluation of Minimal Residual Disease in Myeloma Using Next-Generation Sequencing Clonality Testing: Feasibility, Challenges, and Direct Comparison with High-Sensitivity Flow Cytometry. J Mol Diagn 2020; 23:181-199. [PMID: 33217553 PMCID: PMC7874334 DOI: 10.1016/j.jmoldx.2020.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/13/2020] [Accepted: 10/22/2020] [Indexed: 01/12/2023] Open
Abstract
The 2016 International Myeloma Working Group consensus recommendations emphasize high-sensitivity methods for minimal residual disease (MRD) detection, treatment response assessment, and prognostication. Next-generation sequencing (NGS) of IGH gene rearrangements is highly specific and sensitive, but its description in routine clinical practice and performance comparison with high-sensitivity flow cytometry (hsFC) remain limited. In this large, single-institution study including 438 samples from 251 patients, the use of NGS targeting the IGH and IGK genes for clonal characterization and monitoring, with comparison to hsFC, is described. The index clone characterization success rate was 93.6% (235/251), which depended on plasma cell (PC) cellularity, reaching 98% when PC ≥10% and below 80% when PC <5%. A total of 85% of cases were successfully characterized using leader and FR1 primer sets, and most clones showed high somatic hypermutation rates (median, 8.1%). Among monitoring samples from 124 patients, 78.6% (147/187) had detectable disease by NGS. Concordance with hsFC was 92.9% (170/183). Discordant cases encompassed 8 of 124 hsFC MRD+/NGS MRD− patients (6.5%) and 4 of 124 hsFC MRD−/NGS MRD+ patients (3.2%), all with low-level disease near detection limits for both assays. Among concordant hsFC MRD−/NGS MRD− cases, only 5 of 24 patients (20.8%) showed subsequent overt relapse at 3-year follow-up. HsFC and NGS showed similar operational sensitivity, and the choice of test may depend on practical, rather than test performance, considerations.
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Affiliation(s)
- Caleb Ho
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.
| | - Mustafa Syed
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mikhail Roshal
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kseniya Petrova-Drus
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Christine Moung
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jinjuan Yao
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andres E Quesada
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jamal Benhamida
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Chad Vanderbilt
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ying Liu
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Menglei Zhu
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Wayne Yu
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Lidia Maciag
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Meiyi Wang
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Yuanyuan Ma
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Qi Gao
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Even H Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Benjamin T Diamond
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Binbin Zheng-Lin
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ying Huang
- Invivoscribe, Inc., San Diego, California
| | - Kasey Hutt
- Invivoscribe, Inc., San Diego, California
| | | | - Ahmet Dogan
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Khedoudja Nafa
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Maria E Arcila
- Hematopathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.
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Sorigue M, Cañamero E, Miljkovic MD. Systematic review of staging bone marrow involvement in B cell lymphoma by flow cytometry. Blood Rev 2020; 47:100778. [PMID: 33187810 DOI: 10.1016/j.blre.2020.100778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022]
Abstract
The clinical relevance of flow cytometry (FC)-based bone marrow involvement (BMI) in B cell non-Hodgkin lymphoma (B-NHL) is not well established. We conducted a systematic review of MEDLINE regarding the use of FC to establish BMI in B-NHL to determine the prevalence of BMI by FC, to understand the interrelation between FC and bone marrow biopsy (BMB), and to explore the prognostic impact of BMI by FC. Relevant exclusion criteria included publication before 2010. Eleven publications (of 18 screened) were included, with 2803 patients involved. Relevant methodological details were often unreported. The prevalence of BMI by FC varied based on histological subtypes included. The median kappa agreement between BMB and FC was 0.68 and the type of discordance (FC+/BMB- vs. FC-/BMB+) was highly variable across studies. Only 4 studies (all in diffuse large B cell lymphoma) assessed the prognostic impact of BMI by FC. Two found a worse prognosis for patients with FC+/BMB- than those without BMI. To conclude, studies assessing BMI by FC are retrospective, of low methodological quality and with heterogeneous findings.
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Affiliation(s)
- Marc Sorigue
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Functional cytomics-IJC, Universitat Autònoma de Barcelona, Badalona, Spain.
| | - Eloi Cañamero
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Functional cytomics-IJC, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Milos D Miljkovic
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
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85
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Levin MD, Kater AP, Mattsson M, Kersting S, Ranti J, Thi Tuyet Tran H, Nasserinejad K, Niemann CU. Protocol description of the HOVON 141/VISION trial: a prospective, multicentre, randomised phase II trial of ibrutinib plus venetoclax in patients with creatinine clearance ≥30 mL/min who have relapsed or refractory chronic lymphocytic leukaemia (RR-CLL) with or without TP53 aberrations. BMJ Open 2020; 10:e039168. [PMID: 33060089 PMCID: PMC7566731 DOI: 10.1136/bmjopen-2020-039168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Literature is scarce on the combination treatment of ibrutinib and venetoclax (IV) is scarce in relapsed or refractory chronic lymphocytic leukaemia (RR-CLL). Especially, the possibility of stopping ibrutinib in RR-CLL patients in deep remission is unclear. METHODS AND ANALYSIS In the HOVON 141/VISION trial, patients with RR-CLL are treated with 12 cycles of IV after a short induction with ibrutinib. Patients reaching undetectable minimal residual disease (uMRD) after 12 cycles of IV are randomised 1:2 to continue ibrutinib or stop treatment. The persistence of uMRD after stopping IV is studied. In addition, in patients who become positive for MRD again after stopping, IV treatment is reinitiated. The efficacy of this approach with regard to progression-free survival 12 months after randomisation is the primary endpoint of the study. ETHICS AND DISSEMINATION This protocol respects the Helsinki declaration and has been approved by the ethical committee of the Amsterdam Medical Center. Study findings will be disseminated through peer-reviewed papers. All patients who fulfil the inclusion criteria and no-exclusion criteria, and have signed the informed consent form are included in the study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03226301).
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Affiliation(s)
- Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital Location Dordwijk, Dordrecht, Zuid-Holland, The Netherlands
| | - Arnon P Kater
- Department of Hematology, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, The Netherlands
| | | | - Sabina Kersting
- Department of Hematology, Haga Hospital, Den Haag, Zuid-Holland, The Netherlands
| | - Juha Ranti
- Department of Hematology, University of Turku, Turku, Finland
| | - Hoa Thi Tuyet Tran
- Department of Hematology, Akershus University Hospital, Lorenskog, Norway
| | - Kazem Nasserinejad
- HOVON Data Center, Department of Hematology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
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Reading the B-cell receptor immunome in chronic lymphocytic leukemia: revelations and applications. Exp Hematol 2020; 93:14-24. [PMID: 32976948 DOI: 10.1016/j.exphem.2020.09.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/25/2020] [Accepted: 09/19/2020] [Indexed: 12/19/2022]
Abstract
B-Cell receptor (BCR) sequencing has been the force driving many recent advances in chronic lymphocytic leukemia (CLL) research. Here, we discuss the general principles, revelations, and applications of reading the BCR immunome in the context of CLL. First, IGHV mutational status, obtained by measuring the mutational imprint on the IGHV gene of the CLL clonotype, is the cornerstone of CLL risk stratification. Furthermore, the discovery of "BCR-stereotyped" groups of unrelated patients that share not only a highly similar BCR on their leukemic clone, but also certain clinical characteristics has provided insights key to understanding disease ontogeny. Additionally, whereas the BCR repertoire of most CLL patients is characterized by a single dominant rearrangement, next-generation sequencing (NGS) has revealed a rich subclonal landscape in a larger than previously expected proportion of CLL patients. We review the mechanisms underlying these "multiple dominant" cases, including V(D)J-recombination errors, failure of allelic exclusion, intraclonal diversification, and "true" bi- or oligoclonality, and their implications, in detail. Finally, BCR repertoire sequencing can be used for sensitive quantification of minimal residual disease to potentially unprecedented depth. To surmount pitfalls inherent to this approach and develop internationally harmonized protocols, the EuroClonality-NGS Working Group has been established.
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87
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Kotouza MT, Gemenetzi K, Galigalidou C, Vlachonikola E, Pechlivanis N, Agathangelidis A, Sandaltzopoulos R, Mitkas PA, Stamatopoulos K, Chatzidimitriou A, Psomopoulos FE. TRIP - T cell receptor/immunoglobulin profiler. BMC Bioinformatics 2020; 21:422. [PMID: 32993478 PMCID: PMC7525938 DOI: 10.1186/s12859-020-03669-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Antigen receptors are characterized by an extreme diversity of specificities, which poses major computational and analytical challenges, particularly in the era of high-throughput immunoprofiling by next generation sequencing (NGS). The T cell Receptor/Immunoglobulin Profiler (TRIP) tool offers the opportunity for an in-depth analysis based on the processing of the output files of the IMGT/HighV-Quest tool, a standard in NGS immunoprofiling, through a number of interoperable modules. These provide detailed information about antigen receptor gene rearrangements, including variable (V), diversity (D) and joining (J) gene usage, CDR3 amino acid and nucleotide composition and clonality of both T cell receptors (TR) and B cell receptor immunoglobulins (BcR IG), and characteristics of the somatic hypermutation within the BcR IG genes. TRIP is a web application implemented in R shiny. Results Two sets of experiments have been performed in order to evaluate the efficiency and performance of the TRIP tool. The first used a number of synthetic datasets, ranging from 250k to 1M sequences, and established the linear response time of the tool (about 6 h for 1M sequences processed through the entire BcR IG data pipeline). The reproducibility of the tool was tested comparing the results produced by the main TRIP workflow with the results from a previous pipeline used on the Galaxy platform. As expected, no significant differences were noted between the two tools; although the preselection process seems to be stricter within the TRIP pipeline, about 0.1% more rearrangements were filtered out, with no impact on the final results. Conclusions TRIP is a software framework that provides analytical services on antigen receptor gene sequence data. It is accurate and contains functions for data wrangling, cleaning, analysis and visualization, enabling the user to build a pipeline tailored to their needs. TRIP is publicly available at https://bio.tools/TRIP_-_T-cell_Receptor_Immunoglobulin_Profiler.
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Affiliation(s)
- Maria Th Kotouza
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Katerina Gemenetzi
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece
| | - Chrysi Galigalidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece
| | - Elisavet Vlachonikola
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece
| | - Nikolaos Pechlivanis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece
| | - Andreas Agathangelidis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece
| | - Raphael Sandaltzopoulos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Pericles A Mitkas
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece
| | - Anastasia Chatzidimitriou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece
| | - Fotis E Psomopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, 57001, Greece. .,Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Prognostic value of high-sensitivity measurable residual disease assessment after front-line chemoimmunotherapy in chronic lymphocytic leukemia. Leukemia 2020; 35:1597-1609. [PMID: 32934355 DOI: 10.1038/s41375-020-01009-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 12/21/2022]
Abstract
Measurable residual disease (MRD) status is widely adopted in clinical trials in patients with chronic lymphocytic leukemia (CLL). Findings from FILO group trials (CLL2007FMP, CLL2007SA, CLL2010FMP) enabled investigation of the prognostic value of high-sensitivity (0.7 × 10-5) MRD assessment using flow cytometry, in blood (N = 401) and bone marrow (N = 339), after fludarabine, cyclophosphamide, and rituximab (FCR)-based chemoimmunotherapy in a homogeneous population with long follow-up (median 49.5 months). Addition of low-level positive MRD < 0.01% to MRD ≥ 0.01% increased the proportion of cases with positive MRD in blood by 39% and in bone marrow by 27%. Compared to low-level positive MRD < 0.01%, undetectable MRD was associated with significantly longer progression-free survival (PFS) when using blood (72.2 versus 42.7 months; hazard ratio 0.40, p = 0.0003), but not when using bone marrow. Upon further stratification, positive blood MRD at any level, compared to undetectable blood MRD, was associated with shorter PFS irrespective of clinical complete or partial remission, and a lower 5-year PFS rate irrespective of IGHV-mutated or -unmutated status (all p < 0.05). In conclusion, high-sensitivity (0.0007%) MRD assessment in blood yielded additional prognostic information beyond the current standard sensitivity (0.01%). Our approach provides a model for future determination of the optimal MRD investigative strategy for any regimen.
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89
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Fu Y, Zhang Y, Khoo BL. Liquid biopsy technologies for hematological diseases. Med Res Rev 2020; 41:246-274. [PMID: 32929726 DOI: 10.1002/med.21731] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
Since the discovery of circulating tumor cells in 1869, technological advances in studying circulating biomarkers from patients' blood have made the diagnosis of nonhematologic cancers less invasive. Technological advances in the detection and analysis of biomarkers provide new opportunities for the characterization of other disease types. When compared with traditional biopsies, liquid biopsy markers, such as exfoliated bladder cancer cells, circulating cell-free DNA (cfDNA), and extracellular vesicles (EV), are considered more convenient than conventional biopsies. Liquid biopsy markers undoubtedly have the potential to influence disease management and treatment dynamics. Our main focuses of this review will be the cell-based, gene-based, and protein-based key liquid biopsy markers (including EV and cfDNA) in disease detection, and discuss the research progress of these biomarkers used in conjunction with liquid biopsy. First, we highlighted the key technologies that have been broadly adopted used in hematological diseases. Second, we introduced the latest technological developments for the specific detection of cardiovascular disease, leukemia, and coronavirus disease. Finally, we concluded with perspectives on these research areas, focusing on the role of microfluidic technology and artificial intelligence in point-of-care medical applications. We believe that the noninvasive capabilities of these technologies have great potential in the development of diagnostics and can influence treatment options, thereby advancing precision disease management.
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Affiliation(s)
- Yatian Fu
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong, China
| | - Yiyuan Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong, China
| | - Bee Luan Khoo
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong, China
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90
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Goshaw JM, Gao Q, Wardrope J, Dogan A, Roshal M. 14-Color single tube for flow cytometric characterization of CD5+ B-LPDs and high sensitivity automated minimal residual disease quantitation of CLL/SLL. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:509-518. [PMID: 32896973 DOI: 10.1002/cyto.b.21953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/09/2020] [Accepted: 08/19/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The diagnosis of CLL/SLL relies on flow cytometric immunophenotyping. Increasing emphasis is being placed on precise detection of the minimal residual disease. Following antigen recommendations of ERIC and ESCCA's Harmonization Project, we validated a 14-color assay for the characterization CD5+ lymphoproliferative neoplasms and CLL MRD with a sensitivity of at least 10-4 . METHODS The assay was designed based on ERIC/ESCCA recommended antigens with the addition of CD40 for alternate gating when CD19 expression is reduced. Lower limit of quantitation/lower limit of detection, assay procedural precision, linearity, and limit of blank were established. Then, 52 CD5+ B-cell lymphoproliferative neoplasms (41 CLL/11 non-CLL) and 29 normal samples were used for parallel evaluation. Automated cluster identification and quantitation of CLL clones in MRD setting was performed using Barned-Hutt SNE. Separation analysis between CLL and non-CLL phenotypes was performed by PCA and bh-SNE. RESULTS Separation ratios for each antigen exceeded ERIC/ESCCA guidelines. Precision was <20% at LLOQ (0.01%). The limit of blank was <10/500,000 cells. Concordance between the 14-color and legacy assay (Deming regression y = 1.01x, r2 = .99) was seen. All 20 samples with MRD levels 0.5%-0.006% (median 0.04%) showed an abnormal cell cluster by bh-SNE, with concordant results between manual and automated quantitation (y = x, r2 = 1). CLL cases clustered together and away from mantle cell lymphoma by bh-SNE and PCA with outlier atypical phenotype CLL cases posing diagnostic challenges by both manual and automated analysis. CONCLUSION The 14-color CD5+ LPD assay provides a robust standardization platform for MRD and disease characterization using both manual and automated analysis.
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Affiliation(s)
- Jennifer M Goshaw
- Memorial Sloan Kettering Cancer Center, Department of Pathology, Hematopathology Service, New York, New York, USA
| | - Qi Gao
- Memorial Sloan Kettering Cancer Center, Department of Pathology, Hematopathology Service, New York, New York, USA
| | - Jessica Wardrope
- Memorial Sloan Kettering Cancer Center, Department of Pathology, Hematopathology Service, New York, New York, USA
| | - Ahmet Dogan
- Memorial Sloan Kettering Cancer Center, Department of Pathology, Hematopathology Service, New York, New York, USA
| | - Mikhail Roshal
- Memorial Sloan Kettering Cancer Center, Department of Pathology, Hematopathology Service, New York, New York, USA
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91
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Abstract
The evaluation of minimal residual disease (MRD) in chronic lymphocytic leukemia (CLL) has evolved in parallel with the enormous progresses in the therapeutic armamentarium and the application of cutting-edge diagnostic techniques the CLL community witnessed in the past few years. Minimal residual disease is considered an objective measure of disease status defined by the number of residual leukemic cells detected in a sample of peripheral blood and/or bone marrow as proportion of the total white blood cells and defined undetectable if fewer than 1 CLL cell among 10,000 white blood cells (10 or 0.01%) is detected. In this review, we aim at shedding light on how to evaluate MRD, what we already know about MRD from the experience with chemoimmunotherapy, and why MRD evaluation remains still relevant in the era of targeted agents.
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92
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Rogers KA, Huang Y, Ruppert AS, Abruzzo LV, Andersen BL, Awan FT, Bhat SA, Dean A, Lucas M, Banks C, Grantier C, Heerema NA, Lozanski G, Maddocks KJ, Valentine TR, Weiss DM, Jones JA, Woyach JA, Byrd JC. Phase II Study of Combination Obinutuzumab, Ibrutinib, and Venetoclax in Treatment-Naïve and Relapsed or Refractory Chronic Lymphocytic Leukemia. J Clin Oncol 2020; 38:3626-3637. [PMID: 32795224 DOI: 10.1200/jco.20.00491] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The development of highly effective targeted agents for chronic lymphocytic leukemia offers the potential for fixed-duration combinations that achieve deep remissions without cytotoxic chemotherapy. PATIENTS AND METHODS This phase II study tested a combination regimen of obinutuzumab, ibrutinib, and venetoclax for a total of 14 cycles in both patients with treatment-naïve (n = 25) and relapsed or refractory (n = 25) chronic lymphocytic leukemia to determine the response to therapy and safety. RESULTS The primary end point was the rate of complete remission with undetectable minimal residual disease by flow cytometry in both the blood and bone marrow 2 months after completion of treatment, which was 28% in both groups. The overall response rate at that time was 84% in treatment-naïve patients and 88% in relapsed or refractory patients. At that time, 67% of treatment-naïve patients and 50% of relapsed or refractory patients had undetectable minimal residual disease in both the blood and marrow. At a median follow-up of 24.2 months in treatment-naïve patients and 21.5 months in relapsed or refractory patients, the median progression-free and overall survival times were not yet reached, with only 1 patient experiencing progression and 1 death. Neutropenia and thrombocytopenia were the most frequent adverse events, followed by hypertension. Grade 3 or 4 neutropenia was experienced by 66% of patients, with more events in the relapsed or refractory cohort. There was only 1 episode of neutropenic fever. A favorable impact on both perceived and objective cognitive performance during treatment was observed. CONCLUSION The combination regimen of obinutuzumab, ibrutinib, and venetoclax offers time-limited treatment that results in deep remissions and is now being studied in phase III cooperative group trials.
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Affiliation(s)
- Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Lynne V Abruzzo
- Department of Pathology, The Ohio State University, Columbus, OH
| | | | - Farrukh T Awan
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Allison Dean
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Margaret Lucas
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Christin Banks
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Cara Grantier
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Kami J Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH
| | | | - David M Weiss
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Jeffrey A Jones
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Obiorah IE, Francischetti IMB, Wang HW, Ahn IE, Wang W, Raffeld M, Kreitman RJ, Wiestner A, Calvo KR. Concurrent chronic lymphocytic leukemia/small lymphocytic lymphoma and hairy cell leukemia: clinical, pathologic and molecular features. Leuk Lymphoma 2020; 61:3177-3187. [PMID: 32755330 DOI: 10.1080/10428194.2020.1797007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Simultaneous occurrence of hairy cell leukemia (HCL) and chronic lymphocytic leukemia/small lymphocytic lymphoma (termed CLL) is very rare. Clinical characteristics, pathology and management of these cases have not been well described. We present six patients with CLL and HCL or HCL variant (HCL-v). Of six patients, three were initially diagnosed with CLL and later developed concurrent HCL. Two patients had concurrent HCL or HCL-v and CLL at initial diagnosis. One had HCL first, followed by concurrent CLL. Polymerase chain reaction analysis demonstrated B-cell clonality in all cases, with two distinct clonal populations in four cases, and three clonal populations in one case. Five patients were treated with a combination of a purine analog such as fludarabine, cladribine, and pentostastin with either rituximab or ibrutinib, while one received dabrefenib and trametinib. All patients achieved a durable response to either CLL or HCL-directed therapy with reduction or ablation of coexisting B-cell clones.
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Affiliation(s)
- Ifeyinwa Emmanuela Obiorah
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.,Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ivo M B Francischetti
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.,Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Hao-Wei Wang
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.,Flow Cytometry Unit, Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD, USA
| | - Inhye E Ahn
- Hematology Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, MD, USA
| | - Weixin Wang
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Mark Raffeld
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Adrian Wiestner
- Hematology Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, MD, USA
| | - Katherine R Calvo
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Issue Highlights - July 2019. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 96:253-255. [PMID: 31321907 DOI: 10.1002/cyto.b.21836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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95
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Bayly E, Nguyen V, Binek A, Piggin A, Baldwin K, Westerman D, Came N. Validation of a modified pre-lysis sample preparation technique for flow cytometric minimal residual disease assessment in multiple myeloma, chronic lymphocytic leukemia, and B-non Hodgkin lymphoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:385-398. [PMID: 32530574 DOI: 10.1002/cyto.b.21893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Minimal residual disease (MRD) assessment of hematopoietic neoplasia below 10-4 requires more leukocytes than is usually attainable by post-lysis preparation. However, not all laboratories are resourced for consensus Euroflow pre-lysis methodology. Our study aim was to validate a modified pre-lysis protocol against our standard post-lysis method for MRD detection of multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and B-non Hodgkin lymphoma (B-NHL), to meet demand for deeper MRD assessment by flow cytometry. METHOD Clinical samples for MRD assessment of MM, CLL, and B-NHL (50, 30, and 30 cases, respectively) were prepared in parallel by pre and post-lysis methods for the initial validation. Total leukocytes, MRD, and median fluorescence intensity of antigen expression were compared as measures of sensitivity and antigen stability. Lymphocyte and granulocyte composition were compared, assessing relative sample processing stability. Sensitivity of the pre-lysis assay was monitored post validation for a further 18 months. RESULTS Pre-lysis achieved at least 10-4 sensitivity in 85% MM, 81% CLL, and 90% B-NHL samples versus 24%, 48%, and 26% by post-lysis, respectively, with stable antigen expression and leukocyte composition. Post validation over 18 months with technical expertise improving, pre-lysis permitted 10-5 MRD assessment in 69%, 86%, and 82% of the respective patient groups. CONCLUSION This modified pre-lysis procedure provides a sensitive, robust, time efficient, and relatively cost-effective alternative for MRD testing by MFC at 10-5 , facilitating clinically meaningful deeper response assessment for MM, CLL, and B-NHL. This method adaptation may facilitate more widespread adoption of highly sensitive flow cytometry-based MRD assessment.
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Affiliation(s)
- Emma Bayly
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Clinical Haematology, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Vuong Nguyen
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Adrian Binek
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anna Piggin
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Clinical Haematology, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Kylie Baldwin
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Westerman
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Clinical Haematology, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Parkville, Victoria, Australia
| | - Neil Came
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Parkville, Victoria, Australia
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Panovská A, Němcová L, Nekvindová L, Špaček M, Šimkovič M, Papajík T, Brejcha M, Lysák D, Zuchnická J, Novák J, Starostka D, Poul H, Vrbacký F, Vodárek P, Urbanová R, Plevová K, Pospíšilová Š, Mašlejová S, Brychtová Y, Koriťáková E, Smolej L, Doubek M. Real-world data on efficacy and safety of obinutuzumab plus chlorambucil, rituximab plus chlorambucil, and rituximab plus bendamustine in the frontline treatment of chronic lymphocytic leukemia: The GO-CLLEAR Study by the Czech CLL Study Group. Hematol Oncol 2020; 38:509-516. [PMID: 32400885 DOI: 10.1002/hon.2744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/08/2022]
Abstract
Until recently, a combination of anti-CD20 antibody plus less intensive chemotherapy was a standard of care in elderly population with previously untreated chronic lymphocytic leukemia (CLL). The aim of this observational study was to retrospectively assess efficacy and safety of obinutuzumab + chlorambucil (G-Clb), rituximab + chlorambucil (R-Clb), and bendamustine + rituximab (BR) given as the frontline therapy within routine practice. The final analyzed dataset included 398 consecutive CLL patients from 10 hematology centers cooperating within the Czech CLL Study Group: 63 treated with G-Clb, 78 with R-Clb, and 257 with BR. There were no significant differences in prognostic and predictive markers among the groups. On the contrary, median age at the start of therapy and cumulative illness rating scale (CIRS) score was significantly higher in R-Clb group. Obinutuzumab plus chlorambucil regimen was preferably offered to elderly patients (compared to BR) with less severe comorbidities and lower CIRS score (compared to R-Clb). A time period when a treatment was indicated had also a strong impact on the choice of the regimen. The overall response rate reached 76% (30% complete remissions, CRs) in G-Clb, 75% (22% CRs) in R-Clb, and 85% (47% CRs) in BR group. Median event-free survival was 49.0 months for G-Clb, 20.3 months for R-Clb, and 37.0 months for BR group. Neutropenia grade ≥ 3 developed in 43% of G-Clb, 31% of R-Clb and in 49% of BR patients, grade ≥ 3 infections were recorded in 17% of G-Clb, 6.4% of R-Clb, and 17% of BR patients. In conclusion, real-world therapeutic activity of G-Clb appears to be at least comparable to prospective clinical trial data. R-Clb yields relatively good results in very old and severely comorbid patients.
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Affiliation(s)
- Anna Panovská
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Lucie Němcová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Lucie Nekvindová
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Martin Špaček
- 1st Department of Medicine-Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Šimkovič
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Tomáš Papajík
- Department of Hematooncology, University Hospital, Olomouc, Czech Republic
| | | | - Daniel Lysák
- Department of Hematology and Oncology, University Hospital, Plzeň, Czech Republic
| | - Jana Zuchnická
- Department of Hematology, University Hospital, Ostrava, Czech Republic
| | - Jan Novák
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Starostka
- Department of Hematology, Havirov Hospital and Polyclinic, Havířov, Czech Republic
| | - Hynek Poul
- Department of Hematology, Hospital Pelhřimov, Pelhřimov, Czech Republic
| | - Filip Vrbacký
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Pavel Vodárek
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Renata Urbanová
- Department of Hematooncology, University Hospital, Olomouc, Czech Republic
| | - Karla Plevová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Šárka Pospíšilová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Stanislava Mašlejová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Yvona Brychtová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Eva Koriťáková
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Lukáš Smolej
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Michael Doubek
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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97
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Lew TE, Anderson MA, Seymour JF. Promises and pitfalls of targeted agents in chronic lymphocytic leukemia. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2020; 3:415-444. [PMID: 35582452 PMCID: PMC8992498 DOI: 10.20517/cdr.2019.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 11/12/2022]
Abstract
Targeted agents have significantly improved outcomes for patients with chronic lymphocytic leukemia, particularly high-risk subgroups for whom chemoimmunotherapy previously offered limited efficacy. Two classes of agent in particular, the Bruton tyrosine kinase inhibitors (e.g., ibrutinib) and the B-cell lymphoma 2 inhibitor, venetoclax, induce high response rates and durable remissions in the relapsed/refractory and frontline settings. However, maturing clinical data have revealed promises and pitfalls for both agents. These drugs induce remissions and disease control in the majority of patients, often in situations where modest efficacy would be expected with traditional chemoimmunotherapy approaches. Unfortunately, in the relapsed and refractory setting, both agents appear to be associated with an inevitable risk of disease relapse and progression. Emerging patterns of resistance are being described for both agents but a common theme appears to be multiple sub-clonal drivers of disease progression. Understanding these mechanisms and developing effective and safe methods to circumvent the emergence of resistance will determine the longer-term utility of these agents to improve patients' quality and length of life. Rational drug combinations, optimised scheduling and sequencing of therapy will likely hold the key to achieving these important goals.
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Affiliation(s)
- Thomas E. Lew
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville 3050, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville 3050, Australia
| | - Mary Ann Anderson
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville 3050, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville 3050, Australia
| | - John F. Seymour
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville 3050, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville 3050, Australia
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98
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Gupta SK, Viswanatha DS, Patel KP. Evaluation of Somatic Hypermutation Status in Chronic Lymphocytic Leukemia (CLL) in the Era of Next Generation Sequencing. Front Cell Dev Biol 2020; 8:357. [PMID: 32509784 PMCID: PMC7248390 DOI: 10.3389/fcell.2020.00357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 01/22/2023] Open
Abstract
Somatic hypermutation (SHM) status provides an important prognostic indicator for chronic lymphocytic leukemia (CLL), a very common type of mature B-cell leukemia. Owing to the adverse prognosis associated with an unmutated immunoglobulin heavy chain variable (IGHV) status, SHM testing is performed as a standard of care in CLL. Conventionally, SHM testing has been performed using labor intensive and primarily analog Sanger sequencing method following PCR amplification of the clonal immunoglobulin heavy chain gene rearrangements in CLL cells. In comparison, recent availability of next generation sequencing (NGS) allows more versatile detection and direct identification of clonal immunoglobulin gene rearrangements in neoplastic B-cell populations. The ability to identify specific clonal IGHV signature(s) in both baseline (diagnostic) and post-treatment settings enables unique clinical applications of NGS such as determination of SHM status, minimal residual disease (MRD) monitoring, clonal heterogeneity and B cell receptor IG stereotypy. We provide a review of current practices and recommendations for SHM determination using NGS including examples of difficult cases.
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Affiliation(s)
- Sanjeev Kumar Gupta
- Laboratory Oncology Unit, Dr. B.R.A IRCH, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | | | - Keyur P. Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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99
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Gauthier J, Hirayama AV, Purushe J, Hay KA, Lymp J, Li DH, Yeung CCS, Sheih A, Pender BS, Hawkins RM, Vakil A, Phi TD, Steinmetz RN, Shadman M, Riddell SR, Maloney DG, Turtle CJ. Feasibility and efficacy of CD19-targeted CAR T cells with concurrent ibrutinib for CLL after ibrutinib failure. Blood 2020; 135:1650-1660. [PMID: 32076701 PMCID: PMC7205814 DOI: 10.1182/blood.2019002936] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/03/2020] [Indexed: 02/08/2023] Open
Abstract
We previously reported durable responses in relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL) patients treated with CD19-targeted chimeric antigen receptor-engineered (CD19 CAR) T-cell immunotherapy after ibrutinib failure. Because preclinical studies showed that ibrutinib could improve CAR T cell-antitumor efficacy and reduce cytokine release syndrome (CRS), we conducted a pilot study to evaluate the safety and feasibility of administering ibrutinib concurrently with CD19 CAR T-cell immunotherapy. Nineteen CLL patients were included. The median number of prior therapies was 5, and 17 patients (89%) had high-risk cytogenetics (17p deletion and/or complex karyotype). Ibrutinib was scheduled to begin ≥2 weeks before leukapheresis and continue for ≥3 months after CAR T-cell infusion. CD19 CAR T-cell therapy with concurrent ibrutinib was well tolerated; 13 patients (68%) received ibrutinib as planned without dose reduction. The 4-week overall response rate using 2018 International Workshop on CLL (iwCLL) criteria was 83%, and 61% achieved a minimal residual disease (MRD)-negative marrow response by IGH sequencing. In this subset, the 1-year overall survival and progression-free survival (PFS) probabilities were 86% and 59%, respectively. Compared with CLL patients treated with CAR T cells without ibrutinib, CAR T cells with concurrent ibrutinib were associated with lower CRS severity and lower serum concentrations of CRS-associated cytokines, despite equivalent in vivo CAR T-cell expansion. The 1-year PFS probabilities in all evaluable patients were 38% and 50% after CD19 CAR T-cell therapy, with and without concurrent ibrutinib, respectively (P = .91). CD19 CAR T cells with concurrent ibrutinib for R/R CLL were well tolerated, with low CRS severity, and led to high rates of MRD-negative response by IGH sequencing.
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MESH Headings
- Adenine/analogs & derivatives
- Adenine/therapeutic use
- Adult
- Aged
- Antigens, CD19/immunology
- Combined Modality Therapy
- Drug Resistance, Neoplasm
- Feasibility Studies
- Female
- Follow-Up Studies
- Humans
- Immunotherapy, Adoptive/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Piperidines/therapeutic use
- Prognosis
- Receptors, Antigen, T-Cell/immunology
- Retrospective Studies
- Salvage Therapy
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Affiliation(s)
- Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alexandre V Hirayama
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Janaki Purushe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kevin A Hay
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James Lymp
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA; and
| | - Daniel H Li
- Juno Therapeutics, a Bristol-Myers Squibb Company, Seattle, WA; and
| | - Cecilia C S Yeung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Pathology, University of Washington, Seattle, WA
| | - Alyssa Sheih
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Barbara S Pender
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Reed M Hawkins
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Aesha Vakil
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Tinh-Doan Phi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Rachel N Steinmetz
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Stanley R Riddell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cameron J Turtle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
- Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA
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100
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Mora A, Bosch R, Cuellar-García C, Blanco L, Sierra J, Nomdedeu J, Moreno C. Gene expression workflow to analyze residual leukemic cells in Chronic Lymphocytic Leukemia. Int J Lab Hematol 2020; 42:423-430. [PMID: 32333638 DOI: 10.1111/ijlh.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In chronic lymphocytic leukemia, a better understanding of leukemic cell characteristics after treatment would help to design specific therapeutic approaches aimed at preventing clinical relapse. Gene arrays have become a powerful approach to perform gene expression profiling; nevertheless, to work with residual cells entails an intensive labor. The aim of this study was to set forth an effective gene expression approach to analyze residual leukemic cells. METHODS Leukocytes from CLL patient's samples were sorted by flow cytometry using a 6-color panel. The quality and quantity of RNA isolated from different inputs of cells were compared by two silica column protocols: RNeasy Micro and RNeasy Mini. RNA amplifications were carried out according to two manufacturer's protocols: Ovation Pico SL and Ovation Pico WTA. A total of 3.5 μg of cDNA was labeled and hybridized to Human Gene 2.0 ST arrays. RESULTS RNA extracted from low number of input cells by RNeasy Micro showed similar RNA integrity number to that obtained from RNeasy Mini; however, the RNA quantity was higher using the RNeasy Micro Kit. In addition, those RNA samples obtained with RNeasy Micro and amplified with Ovation Pico WTA showed good quality to proceed for a gene array study, independently of the number of input cells (range: 1 × 104 -5 × 105 cells). CONCLUSIONS We observed that this workflow is a feasible approach to obtain genomic material extracted from leukemic cells as little as 1 × 104 cells and it can be useful to carry out gene expression profile experiments to characterize residual leukemic cells in chronic lymphocytic leukemia.
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Affiliation(s)
- Alba Mora
- Laboratory of Oncology/Hematology and Transplantation, Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain.,Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Deparment of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Joseph Carreras Leukemia Research Institute, Barcelona, Spain
| | - Rosa Bosch
- Laboratory of Oncology/Hematology and Transplantation, Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain.,Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina Cuellar-García
- Laboratory of Oncology/Hematology and Transplantation, Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain.,Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Joseph Carreras Leukemia Research Institute, Barcelona, Spain
| | - Laura Blanco
- Laboratory of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Laboratory of Oncology/Hematology and Transplantation, Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain.,Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Deparment of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Laboratory of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep Nomdedeu
- Laboratory of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carol Moreno
- Laboratory of Oncology/Hematology and Transplantation, Biomedical Research Institute, IIB Sant Pau, Barcelona, Spain.,Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Deparment of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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