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Thurgood LA, Best OG, Rowland A, Lower KM, Brooks DA, Kuss BJ. Lipid uptake in chronic lymphocytic leukemia. Exp Hematol 2021; 106:58-67. [PMID: 34896245 DOI: 10.1016/j.exphem.2021.12.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022]
Abstract
Many cancers rely on glucose as an energy source, but it is becoming increasingly apparent that some cancers use alternate substrates to fuel their proliferation. Chronic lymphocytic leukaemia (CLL) is one such cancer. Through the use of flow cytometry and confocal microscopy, low levels of glucose uptake were observed in the OSU-CLL and HG3 CLL cell lines relative to highly glucose-avid Raji cells (Burkitt's lymphoma). Glucose uptake in CLL cells correlated with low expression of the GLUT1 and GLUT3 receptors. In contrast, both CLL cell lines and primary CLL cells, but not healthy B cells, were found to rapidly internalise medium- and long-chain, but not short-chain, fatty acids (FAs). Differential FA uptake was also observed in primary cells taken from patients with unmutated immunoglobulin heavy variable chain usage (IGHV) compared with patients with mutated IGHV. Delipidation of serum in the culture medium slowed the proliferation and significantly reduced the viability of OSU-CLL and HG3 cells, effects that were partially reversed by supplementation with a chemically defined lipid concentrate. These observations highlight the potential importance of FAs in the pathogenesis of CLL and raise the possibility that targeting FA utilisation may represent a novel therapeutic and prognostic approach in this disease.
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Affiliation(s)
- Lauren A Thurgood
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
| | - Oliver G Best
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Ashley Rowland
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Karen M Lower
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Doug A Brooks
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Bryone J Kuss
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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2
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Nierman P. Acalabrutinib: Nursing Considerations for Use in Patients With Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma. Clin J Oncol Nurs 2021; 25:687-696. [PMID: 34800101 DOI: 10.1188/21.cjon.687-696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acalabrutinib is a next-generation Bruton tyrosine kinase inhibitor (BTKi) that has moved to the forefront of treatment options for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). Patients with CLL/SLL can experience adverse events and toxicities unique to BTKi therapy. OBJECTIVES This article provides an overview of nursing considerations for the treatment of patients with CLL/SLL with acalabrutinib, focusing on safety, toxicity management, and adherence. METHODS A review of information identified through structured searches of key publications and websites and data from pivotal clinical trials was performed. FINDINGS Increased awareness of the unique disease characteristics of patients with CLL/SLL and of the efficacy and safety profile of acalabrutinib allows nurses to play a vital role in improving patient outcomes. With this knowledge, nurses can support patients through education on potential side effects, drug-drug interactions, and treatment adherence, as well as monitor for clinical symptoms and laboratory findings requiring intervention.
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3
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Primary Epicardial Malt Lymphoma: A New Physiopathologic Entity Mimicking a Pericardial Compressive Syndrome. JACC Case Rep 2021; 3:1711-1715. [PMID: 34766024 PMCID: PMC8572141 DOI: 10.1016/j.jaccas.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
MALT lymphoma is a non-Hodgkin lymphoma developing from B cells and is a type of marginal zone lymphoma. It can develop in any organs, but no case of primary cardiac location has yet been reported. We report the first observation of a primary epicardial MALT lymphoma mimicking a compressive pericardial syndrome. (Level of Difficulty: Advanced.)
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Key Words
- CT, computed tomography
- ECG, electrocardiogram
- FDG PET, fluorodeoxyglucose positron emission tomography
- MALT, mucosa-associated lymphoid tissue
- MCL, mantle cell lymphoma
- MRI, magnetic resonance imaging
- MZ, marginal zone
- RA, right atrium
- RV, right ventricle
- SCAD, spontaneous coronary artery dissection
- cardiac MALT lymphoma
- compressive hematoma
- immunohistochemical characterization
- marginal zone
- non-Hodgkin lymphoma
- pericardiectomy
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4
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Dadashian EL, McAuley EM, Liu D, Shaffer AL, Young RM, Iyer JR, Kruhlak MJ, Staudt LM, Wiestner A, Herman SEM. TLR Signaling Is Activated in Lymph Node-Resident CLL Cells and Is Only Partially Inhibited by Ibrutinib. Cancer Res 2019; 79:360-371. [PMID: 30498085 PMCID: PMC6342512 DOI: 10.1158/0008-5472.can-18-0781] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/01/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is a malignancy of mature B cells driven by B-cell receptor (BCR) signaling and activated primarily in the lymph node. The Bruton's tyrosine kinase (BTK) inhibitor ibrutinib effectively inhibits BCR-dependent proliferation and survival signals and has emerged as a breakthrough therapy for CLL. However, complete remissions are uncommon and are achieved only after years of continuous therapy. We hypothesized that other signaling pathways that sustain CLL cell survival are only partially inhibited by ibrutinib. In normal B cells, Toll-like receptor (TLR) signaling cooperates with BCR signaling to activate prosurvival NF-κB. Here, we show that an experimentally validated gene signature of TLR activation is overexpressed in lymph node-resident CLL cells compared with cells in the blood. Consistent with TLR activation, we detected phosphorylation of NF-κB, STAT1, and STAT3 in lymph node-resident CLL cells and in cells stimulated with CpG oligonucleotides in vitro. CpG promoted IRAK1 degradation, secretion of IL10, and extended survival of CLL cells in culture. CpG-induced TLR signaling was significantly inhibited by both an IRAK1/4 inhibitor and ibrutinib. Although inhibition of TLR signaling was incomplete with either drug, the combination achieved superior results, including more effective inhibition of TLR-mediated survival signaling. Our data suggest an important role for TLR signaling in CLL pathogenesis and in sustaining the viability of CLL cells during ibrutinib therapy. The combination of ibrutinib with a TLR pathway inhibitor could provide superior antitumor activity and should be investigated in clinical studies. SIGNIFICANCE: CLL relies on the concomitant cooperation of B-cell receptor and Toll-like receptor signaling; inhibition of both pathways is superior to inhibition of either pathway alone. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/79/2/360/F1.large.jpg.
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MESH Headings
- Adenine/analogs & derivatives
- Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors
- Agammaglobulinaemia Tyrosine Kinase/metabolism
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymph Nodes/drug effects
- Lymph Nodes/metabolism
- Lymph Nodes/pathology
- Oligodeoxyribonucleotides/pharmacology
- Piperidines
- Protein Kinase Inhibitors/pharmacology
- Pyrazoles/pharmacology
- Pyrimidines/pharmacology
- Receptor Cross-Talk
- Receptors, Antigen, B-Cell/antagonists & inhibitors
- Receptors, Antigen, B-Cell/metabolism
- Signal Transduction/drug effects
- Toll-Like Receptors/antagonists & inhibitors
- Toll-Like Receptors/metabolism
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Affiliation(s)
- Eman L Dadashian
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Erin M McAuley
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Delong Liu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Arthur L Shaffer
- Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ryan M Young
- Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jessica R Iyer
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael J Kruhlak
- Experimental Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Louis M Staudt
- Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sarah E M Herman
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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5
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Pleyer C, Wiestner A, Sun C. Immunological changes with kinase inhibitor therapy for chronic lymphocytic leukemia. Leuk Lymphoma 2018; 59:2792-2800. [PMID: 29764250 PMCID: PMC6237652 DOI: 10.1080/10428194.2018.1457147] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 01/10/2023]
Abstract
Ibrutinib and idelalisib are kinase inhibitors that have revolutionized the treatment of chronic lymphocytic leukemia (CLL). Capable of inducing durable remissions, these agents also modulate the immune system. Both ibrutinib and idelalisib abrogate the tumor-supporting microenvironment by disrupting cell-cell interactions, modulating the T-cell compartment, and altering the cytokine milieu. Ibrutinib also partially restores T-cell and myeloid defects associated with CLL. In contrast, immune-related adverse effects, including pneumonitis, colitis, hepatotoxicity, and infections are of particular concern with idelalisib. While opportunistic infections and viral reactivations occur with both ibrutinib and idelalisib, these complications are less common and less severe with ibrutinib, especially when used as monotherapy without additional immunosuppressive agents. This review discusses the impact of ibrutinib and idelalisib on the immune system, including infectious and auto-immune complications as well as their specific effects on the B-cell, T-cell, and myeloid compartment.
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Affiliation(s)
- Christopher Pleyer
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Clare Sun
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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6
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Ren S, Gaykalova D, Wang J, Guo T, Danilova L, Favorov A, Fertig E, Bishop J, Khan Z, Flam E, Wysocki PT, DeJong P, Ando M, Liu C, Sakai A, Fukusumi T, Haft S, Sadat S, Califano JA. Discovery and development of differentially methylated regions in human papillomavirus-related oropharyngeal squamous cell carcinoma. Int J Cancer 2018; 143:2425-2436. [PMID: 30070359 DOI: 10.1002/ijc.31778] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/30/2018] [Accepted: 07/04/2018] [Indexed: 12/15/2022]
Abstract
Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) exhibits a different composition of epigenetic alterations. In this study, we identified differentially methylated regions (DMRs) with potential utility in screening for HPV-positive OPSCC. Genome wide DNA methylation was measured using methyl-CpG binding domain protein-enriched genome sequencing (MBD-seq) in 50 HPV-positive OPSCC tissues and 25 normal tissues. Fifty-one DMRs were defined with maximal methylation specificity to cancer samples. The Cancer Genome Atlas (TCGA) methylation array data was used to evaluate the performance of the proposed candidates. Supervised hierarchical clustering of 51 DMRs found that HPV-positive OPSCC had significantly higher DNA methylation levels compared to normal samples, and non-HPV-related head and neck squamous cell carcinoma (HNSCC). The methylation levels of all top 20 DNA methylation biomarkers in HPV-positive OPSCC were significantly higher than those in normal samples. Further confirmation using quantitative methylation specific PCR (QMSP) in an independent set of 24 HPV-related OPSCCs and 22 controls showed that 16 of the 20 candidates had significant higher methylation levels in HPV-positive OPSCC samples compared with controls. One candidate, OR6S1, had a sensitivity of 100%, while 17 candidates (KCNA3, EMBP1, CCDC181, DPP4, ITGA4, BEND4, ELMO1, SFMBT2, C1QL3, MIR129-2, NID2, HOXB4, ZNF439, ZNF93, VSTM2B, ZNF137P and ZNF773) had specificities of 100%. The prediction accuracy of the 20 candidates rang from 56.2% to 99.8% by receiver operating characteristic analysis. We have defined 20 highly specific DMRs in HPV-related OPSCC, which can potentially be applied to molecular-based detection tests and improve disease management.
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Affiliation(s)
- Shuling Ren
- Moores Cancer Center, University of California San Diego, La Jolla, CA.,Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Daria Gaykalova
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jennifer Wang
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX
| | - Theresa Guo
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ludmila Danilova
- Division of Oncology Biostatistics, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD.,Laboratory of Systems Biology and Computational Genetics, Vavilov Institute of General Genetics, RAS, Moscow, Russia
| | - Alexander Favorov
- Division of Oncology Biostatistics, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD.,Laboratory of Systems Biology and Computational Genetics, Vavilov Institute of General Genetics, RAS, Moscow, Russia
| | - Elana Fertig
- Division of Oncology Biostatistics, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Justin Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Zubair Khan
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Emily Flam
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Piotr T Wysocki
- Laboratory of Human Cancer Genetics, Center of New Technologies, University of Warsaw, Warsaw, Poland.,The Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - Peter DeJong
- Moores Cancer Center, University of California San Diego, La Jolla, CA.,College of Human Medicine, Michigan State University, East Lansing, MI
| | - Mizuo Ando
- Moores Cancer Center, University of California San Diego, La Jolla, CA.,Department of Otolaryngology-Head and Neck Surgery, Tokyo University, Tokyo, Japan
| | - Chao Liu
- Moores Cancer Center, University of California San Diego, La Jolla, CA.,Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Akihiro Sakai
- Moores Cancer Center, University of California San Diego, La Jolla, CA.,Department of Otolaryngology, Center of Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Takahito Fukusumi
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Sunny Haft
- Moores Cancer Center, University of California San Diego, La Jolla, CA.,Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA
| | - Sayed Sadat
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Joseph A Califano
- Moores Cancer Center, University of California San Diego, La Jolla, CA.,Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD.,Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA
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7
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Sattari A, Siddiqui H, Moshiri F, Ngankeu A, Nakamura T, Kipps TJ, Croce CM. Upregulation of long noncoding RNA MIAT in aggressive form of chronic lymphocytic leukemias. Oncotarget 2018; 7:54174-54182. [PMID: 27527866 PMCID: PMC5338916 DOI: 10.18632/oncotarget.11099] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/14/2016] [Indexed: 12/11/2022] Open
Abstract
Long noncoding RNAs (lncRNAs) are non-proten-coding transcripts of more than 200 nucleotides generated by RNA polymerase II and their expressions are tightly regulated in cell type specific- and/or cellular differential stage specific- manner. MIAT, originally isolated as a candidate gene for myocardial infarction, encodes lncRNA (termed MIAT). Here, we determined the expression level of MIAT in established leukemia/lymphoma cell lines and found its upregulation in lymphoid but not in myeloid cell lineage with mature B cell phenotype. MIAT expression level was further determined in chronic lymphocytic leukemias (CLL), characterized by expansion of leukemic cells with mature B phenotype, to demonstrate relatively high occurrence of MIAT upregulation in aggressive form of CLL carrying either 17p-deletion, 11q-deletion, or Trisomy 12 over indolent form carrying 13p-deletion. Furthermore, we show that MIAT constitutes a regulatory loop with OCT4 in malignant mature B cell, as was previously reported in mouse pulripotent stem cell, and that both molecules are essential for cell survival.
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Affiliation(s)
- Arash Sattari
- Department of Molecular Virology, Immunology, and Medical Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,School of Medicine and Surgery, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.,Department of Medicine, Faculty of Medical sciences, Gorgan Branch, Islamic Azad University, Gorgan, Iran
| | - Hasan Siddiqui
- Department of Molecular Virology, Immunology, and Medical Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Center for Childhood Cancer & Blood Diseases, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Farzaneh Moshiri
- Department of Molecular Virology, Immunology, and Medical Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Department of Morphology, Experimental Medicine and Surgery, Section of Pathology, Oncology and Experimental Biology, University of Ferrara, Ferrara, Italy
| | - Apollinaire Ngankeu
- Department of Molecular Virology, Immunology, and Medical Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Tatsuya Nakamura
- Department of Molecular Virology, Immunology, and Medical Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Thomas J Kipps
- Department of Medicine, Moores Cancer Center, University of California at San Diego, La Jolla, CA, USA.,Chronic Lymphocytic Leukemia Research Consortium, San Diego, CA, USA
| | - Carlo M Croce
- Department of Molecular Virology, Immunology, and Medical Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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8
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Piccaluga PP, Agostinelli C, Righi S, Ciccone M, Re MC, Musumeci G, Diani E, Signoretto C, Bon I, Piccin O, Cuneo A, Tripodo C, Ponti C, Zipeto D, Landolfo S, Gibellini D. IFI16 reduced expression is correlated with unfavorable outcome in chronic lymphocytic leukemia. APMIS 2017; 125:511-522. [PMID: 28517553 DOI: 10.1111/apm.12692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/08/2017] [Indexed: 01/05/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. Its clinical course is typically indolent; however, based on a series of pathobiological, clinical, genetic, and phenotypic parameters, patient survival varies from less than 5 to more than 20 years. In this paper, we show for the first time that the expression of the interferon-inducible DNA sensor IFI16, a member of the PYHIN protein family involved in proliferation inhibition and apoptosis regulation, is associated with the clinical outcome in CLL. We studied 99 CLLs cases by immunohistochemistry and 10 CLLs cases by gene expression profiling. We found quite variable degrees of IFI16 expression among CLLs cases. Noteworthy, we observed that a reduced IFI16 expression was associated with a very poor survival, but only in cases with ZAP70/CD38 expression. Furthermore, we found that IFI16 expression was associated with a specific gene expression signature. As IFI16 can be easily detected by immunohistochemistry or flow cytometry, it may become a part of phenotypic screening in CLL patients if its prognostic role is confirmed in independent series.
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Affiliation(s)
- Pier Paolo Piccaluga
- Department of Experimental, Diagnostic, and Specialty Medicine; University of Bologna; Bologna Italy
- Section of Genomics and Personalized Medicine; Istituto Euro-Mediterraneo di Scienza e Tecnologia (IEMEST); Palermo Italy
| | - Claudio Agostinelli
- Department of Experimental, Diagnostic, and Specialty Medicine; University of Bologna; Bologna Italy
| | - Simona Righi
- Department of Experimental, Diagnostic, and Specialty Medicine; University of Bologna; Bologna Italy
| | - Maria Ciccone
- Department of Biomedical Sciences; Hematology Section; S. Anna Hospital; University of Ferrara; Ferrara Italy
| | - Maria Carla Re
- Department of Experimental, Diagnostic, and Specialty Medicine; Microbiology Unit; University of Bologna; Bologna Italy
| | - Giuseppina Musumeci
- Department of Experimental, Diagnostic, and Specialty Medicine; Microbiology Unit; University of Bologna; Bologna Italy
| | - Erica Diani
- Department of Diagnostic and Public Health; Unit of Microbiology; University of Verona; Verona Italy
| | - Caterina Signoretto
- Department of Diagnostic and Public Health; Unit of Microbiology; University of Verona; Verona Italy
| | - Isabella Bon
- Department of Experimental, Diagnostic, and Specialty Medicine; Microbiology Unit; University of Bologna; Bologna Italy
| | - Ottavio Piccin
- Department of Experimental, Diagnostic, and Specialty Medicine; Otolaryngology Unit; University of Bologna; Bologna Italy
| | - Antonio Cuneo
- Department of Biomedical Sciences; Hematology Section; S. Anna Hospital; University of Ferrara; Ferrara Italy
| | - Claudio Tripodo
- Section of Genomics and Personalized Medicine; Istituto Euro-Mediterraneo di Scienza e Tecnologia (IEMEST); Palermo Italy
- Department of Human Pathology; University of Palermo; Palermo Italy
| | - Cristina Ponti
- Department of Life Sciences; University of Trieste; Trieste Italy
| | - Donato Zipeto
- Department of Neurosciences, Biomedicine and Movement Sciences; University of Verona; Verona Italy
| | - Santo Landolfo
- Department of Public Health and Microbiology; University of Turin; Turin Italy
| | - Davide Gibellini
- Department of Diagnostic and Public Health; Unit of Microbiology; University of Verona; Verona Italy
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9
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Direct in vivo evidence for increased proliferation of CLL cells in lymph nodes compared to bone marrow and peripheral blood. Leukemia 2017; 31:1340-1347. [PMID: 28074063 PMCID: PMC5462849 DOI: 10.1038/leu.2017.11] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/28/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022]
Abstract
Chronic Lymphocytic Leukemia (CLL) is a progressive malignancy of mature B-cells that involves the peripheral blood (PB), lymph nodes (LNs) and bone marrow (BM). While the majority of CLL cells are in a resting state, small populations of proliferating cells exist; however, the anatomical site of active cell proliferation remains to be definitively determined. Based on findings that CLL cells in LNs have increased expression of B-cell activation genes, we tested the hypothesis that the fraction of “newly born” cells would be highest in the LNs. Using a deuterium oxide (2H) in vivo labeling method in which patients consumed deuterated (heavy) water (2H2O), we determined CLL cell kinetics in concurrently obtained samples from LN, PB, and BM. The LN was identified as the anatomical site harboring the largest fraction of newly born cells, compared to PB and BM. In fact, the calculated birth rate in the LN reached as high a 3.3% of the clone per day. Subdivision of the bulk CLL population by flow cytometry identified the subpopulation with the CXCR4dimCD5bright phenotype as containing the highest proportion of newly born cells within each compartment, including the LN, identifying this subclonal population as an important target for novel treatment approaches.
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10
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Wiestner A. The role of B-cell receptor inhibitors in the treatment of patients with chronic lymphocytic leukemia. Haematologica 2016; 100:1495-507. [PMID: 26628631 DOI: 10.3324/haematol.2014.119123] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chronic lymphocytic leukemia is a malignancy of mature auto-reactive B cells. Genetic and functional studies implicate B-cell receptor signaling as a pivotal pathway in its pathogenesis. Full B-cell receptor activation requires tumor-microenvironment interactions in lymphoid tissues. Spleen tyrosine kinase, Bruton's tyrosine kinase, and the phosphatidylinositol 3-kinase (PI3K) δ isoform are essential for B-cell receptor signal transduction but also mediate the effect of other pathways engaged in chronic lymphocytic leukemia cells in the tissue-microenvironment. Orally bioavailable inhibitors of spleen tyrosine kinase, Bruton's tyrosine kinase, or PI3Kδ, induce high rates of durable responses. Ibrutinib, a covalent inhibitor of Bruton's tyrosine kinase, and idelalisib, a selective inhibitor of PI3Kδ, have obtained regulatory approval in chronic lymphocytic leukemia. Ibrutinib and idelalisib are active in patients with high-risk features, achieving superior disease control in difficult-to-treat patients than prior best therapy, making them the preferred agents for chronic lymphocytic leukemia with TP53 aberrations and for patients resistant to chemoimmunotherapy. In randomized trials, both ibrutinib, versus ofatumumab, and idelalisib in combination with rituximab, versus placebo with rituximab improved survival in relapsed/refractory chronic lymphocytic leukemia. Responses to B-cell receptor inhibitors are mostly partial, and within clinical trials treatment is continued until progression or occurrence of intolerable side effects. Ibrutinib and idelalisib are, overall, well tolerated; notable adverse events include increased bruising and incidence of atrial fibrillation on ibrutinib and colitis, pneumonitis and transaminase elevations on idelalisib. Randomized trials investigate the role of B-cell receptor inhibitors in first-line therapy and the benefit of combinations. This review discusses the biological basis for targeted therapy of chronic lymphocytic leukemia with B-cell receptor inhibitors, and summarizes the clinical experience with these agents.
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Affiliation(s)
- Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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11
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Matuszak M, Lewandowski K, Czyż A, Kiernicka-Parulska J, Przybyłowicz-Chalecka A, Jarmuż-Szymczak M, Lewandowska M, Komarnicki M. The prognostic significance of surface dipeptidylpeptidase IV (CD26) expression in B-cell chronic lymphocytic leukemia. Leuk Res 2016; 47:166-71. [PMID: 27376546 DOI: 10.1016/j.leukres.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 04/03/2016] [Accepted: 06/13/2016] [Indexed: 12/12/2022]
Abstract
A number of factors related to B-cell chronic lymphocytic leukemia (B-CLL) patients' prognosis have been identified. However, still some factors better reflecting disease activity in individual cases are explored. The study aimed to evaluate prognostic significance of dipeptidylpeptidase IV/CD26 expression on B-CLL cells and its relationship with other well established prognostic factors. The study included 94 patients with newly diagnosed B-CLL and involved analysis of clinical, laboratory, flow-cytometry and cytogenetic data. Detailed analysis showed that CD26 expression on B-CLL cells correlates with Rai's clinical stage of the disease at diagnosis (p=0.034), β2-microglobulin concentration (p=0.012), lactic acid dehydrogenase activity (p=0.045) and absolute lymphocytes' count (p=0.027) in the blood. The multivariate analysis revealed that time to treatment (TTT) was significantly influenced by Rai clinical stage, LDH activity in blood and CD26 expression on B-CLL cell's. Moreover, in the multivariate analysis restricted to the group of patients with documented cytogenetic risk (n=36) CD26 expression, Rai clinical stage and cytogenetic profile remained their independent impact on TTT. The results of our study indicate that the CD26 expression should be incorporated in B-CLL patients risk assessment along with well known prognostic factors, since it seems to have a relationship with the tumor mass and influences TTT.
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Affiliation(s)
- Magdalena Matuszak
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Lewandowski
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland.
| | - Anna Czyż
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Jolanta Kiernicka-Parulska
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Przybyłowicz-Chalecka
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Jarmuż-Szymczak
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland; Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Maria Lewandowska
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Mieczysław Komarnicki
- Department of Haematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
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