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He J, Munir F, Catueno S, Connors JS, Gibson A, Robusto L, McCall D, Nunez C, Roth M, Tewari P, Garces S, Cuglievan B, Garcia MB. Biological Markers of High-Risk Childhood Acute Lymphoblastic Leukemia. Cancers (Basel) 2024; 16:858. [PMID: 38473221 DOI: 10.3390/cancers16050858] [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: 01/21/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
Childhood acute lymphoblastic leukemia (ALL) has witnessed substantial improvements in prognosis; however, a subset of patients classified as high-risk continues to face higher rates of relapse and increased mortality. While the National Cancer Institute (NCI) criteria have traditionally guided risk stratification based on initial clinical information, recent advances highlight the pivotal role of biological markers in shaping the prognosis of childhood ALL. This review delves into the emerging understanding of high-risk childhood ALL, focusing on molecular, cytogenetic, and immunophenotypic markers. These markers not only contribute to unraveling the underlying mechanisms of the disease, but also shed light on specific clinical patterns that dictate prognosis. The paradigm shift in treatment strategies, exemplified by the success of tyrosine kinase inhibitors in Philadelphia chromosome-positive leukemia, underscores the importance of recognizing and targeting precise risk factors. Through a comprehensive exploration of high-risk childhood ALL characteristics, this review aims to enhance our comprehension of the disease, offering insights into its molecular landscape and clinical intricacies in the hope of contributing to future targeted and tailored therapies.
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Affiliation(s)
- Jiasen He
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Faryal Munir
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Samanta Catueno
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeremy S Connors
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Amber Gibson
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lindsay Robusto
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David McCall
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cesar Nunez
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Priti Tewari
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sofia Garces
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Branko Cuglievan
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Miriam B Garcia
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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2
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Pourmontaseri H, Habibzadeh N, Entezari S, Samadian F, Kiyani S, Taheri M, Ahmadi A, Fallahi MS, Sheikhzadeh F, Ansari A, Tamimi A, Deravi N. Monoclonal antibodies for the treatment of acute lymphocytic leukemia: A literature review. Hum Antibodies 2022; 30:117-130. [PMID: 35662114 DOI: 10.3233/hab-211511] [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: 11/15/2022]
Abstract
BACKGROUND Acute lymphocytic leukemia (ALL) is a type of blood cancer that is more prevalent in children. Several treatment methods are available for ALL, including chemotherapy, upfront treatment regimens, and pediatric-inspired regimens for adults. Monoclonal antibodies (Mabs) are the novel Food and Drug Administration (FDA) approved remedies for the relapsed/refractory (R/R) adult ALL. In this article, we aimed to review studies that investigated the efficacy and safety of Mabs on ALL. METHODS We gathered studies through a complete search with all proper related keywords in ISI Web of Science, SID, Scopus, Google Scholar, Science Direct, and PubMed for English language publications up to 2020. RESULTS The most commonly studied Mabs for ALL therapies are CD-19, CD-20, CD-22, and CD-52. The best results have been reported in the administration of blinatumomab, rituximab, ofatumumab, and inotuzumab with acceptable low side effects. CONCLUSION Appling personalized approach for achieving higher efficacy is one of the most important aspects of treatment. Moreover, we recommend that the wide use of these Mabs depends on designing further cost-effectiveness trials in this field.
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Affiliation(s)
- Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.,Bitab knowledge enterprise, Fasa University of Medical Sciences, Fasa, Iran
| | - Niloofar Habibzadeh
- Student Research Committee, School of Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sarina Entezari
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Samadian
- Nursing Department, Shahid Beheshti University of Medical science, Tehran, Iran
| | - Shamim Kiyani
- Midwifery Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Taheri
- Student Research Committee, School of Pharmacy Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Ahmadi
- Faculty of Biological Sciences and Technologies, Islamic Azad University Sari Branch, Sari, Iran
| | | | - Farzad Sheikhzadeh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arina Ansari
- Student Research Committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Amirhossein Tamimi
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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3
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Vicioso Y, Gram H, Beck R, Asthana A, Zhang K, Wong DP, Letterio J, Parameswaran R. Combination Therapy for Treating Advanced Drug-Resistant Acute Lymphoblastic Leukemia. Cancer Immunol Res 2019; 7:1106-1119. [PMID: 31138521 DOI: 10.1158/2326-6066.cir-19-0058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/05/2019] [Accepted: 05/21/2019] [Indexed: 12/23/2022]
Abstract
Drug-resistant acute lymphoblastic leukemia (ALL) patients do not respond to standard chemotherapy, and an urgent need exists to develop new treatment strategies. Our study exploited the presence of B-cell activating factor receptor (BAFF-R) on the surface of drug-resistant B-ALL cells as a therapeutic target. We used anti-BAFF-R (VAY736), optimized for natural killer (NK) cell-mediated antibody-dependent cellular cytotoxicity (ADCC), to kill drug-resistant ALL cells. VAY736 antibody and NK cell treatments significantly decreased ALL disease burden and provided survival benefit in vivo However, if the disease was advanced, the ADCC efficacy of NK cells was inhibited by microenvironmental transforming growth factor-beta (TGFβ). Inhibiting TGFβ signaling in NK cells using the TGFβ receptor 1 (R1) inhibitor (EW-7197) significantly enhanced VAY736-induced NK cell-mediated ALL killing. Our results highlight the potential of using a combination of VAY736 antibody with EW-7197 to treat advance-stage, drug-resistant B-ALL patients.
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Affiliation(s)
- Yorleny Vicioso
- Department of pathology, Case Western Reserve University, Cleveland, Ohio
| | - Hermann Gram
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Rose Beck
- Department of pathology, Case Western Reserve University, Cleveland, Ohio.,Department of Pathology, University Hospitals, Cleveland, Ohio
| | - Abhishek Asthana
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Keman Zhang
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Derek P Wong
- Department of pathology, Case Western Reserve University, Cleveland, Ohio
| | - John Letterio
- The Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Pediatric Hematology and Oncology, The Angie Fowler Adolescent and Young Adult Cancer Institute, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Reshmi Parameswaran
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio. .,The Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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4
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Mohseni M, Uludag H, Brandwein JM. Advances in biology of acute lymphoblastic leukemia (ALL) and therapeutic implications. AMERICAN JOURNAL OF BLOOD RESEARCH 2018; 8:29-56. [PMID: 30697448 PMCID: PMC6334189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/06/2018] [Indexed: 06/09/2023]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer and also occurs in adults. Although the outcomes of multi-agent chemotherapy regimens have greatly improved, high toxicity and relapses in many patients necessitate the development of novel therapeutic approaches. Advances in molecular profiling and cytogenetics have identified a broad range of genetic abnormalities, including gene mutations, chromosome translocations and aneuploidy, which has provided a more comprehensive understanding of the biology and pathogenesis of ALL. This understanding has also led to new targeted therapeutic approaches, including the use of selective small molecule inhibitors, nucleic acid-based therapies and immune-based therapies mediated by specific monoclonal antibodies and cellular immunotherapy, which are poised to revolutionize the treatment of various ALL subtypes. The main focus of this review is to highlight the latest advances in ALL biology, including the identification of prognostic factors and putative therapeutic targets. We also review the current status of, and ongoing progress in, the development of targeted therapies for ALL.
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Affiliation(s)
- Mahsa Mohseni
- Department of Medicine, University of Alberta Edmonton, Alberta, Canada
| | - Hasan Uludag
- Department of Chemical and Materials Engineering, University of Alberta Edmonton, Alberta, Canada
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5
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Zhang X, Song X, Lopez-Gonzalez L, Jariwala-Parikh K, Cong Z. Economic burden associated with adverse events of special interest in patients with relapsed Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia in the United States. Expert Rev Pharmacoecon Outcomes Res 2018; 18:573-580. [DOI: 10.1080/14737167.2018.1490645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Xinke Zhang
- Amgen Inc., Global Health Economics, Thousand Oaks, CA, USA
| | - Xue Song
- Truven Health Analytics, an IBM Company, Cambridge, MA, USA
| | | | | | - Ze Cong
- Amgen Inc., Global Health Economics, Thousand Oaks, CA, USA
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6
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Shen L, Tenzer S, Storck W, Hobernik D, Raker VK, Fischer K, Decker S, Dzionek A, Krauthäuser S, Diken M, Nikolaev A, Maxeiner J, Schuster P, Kappel C, Verschoor A, Schild H, Grabbe S, Bros M. Protein corona-mediated targeting of nanocarriers to B cells allows redirection of allergic immune responses. J Allergy Clin Immunol 2018; 142:1558-1570. [PMID: 29382591 DOI: 10.1016/j.jaci.2017.08.049] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/26/2017] [Accepted: 08/26/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nanoparticle (NP)-based vaccines are attractive immunotherapy tools because of their capability to codeliver antigen and adjuvant to antigen-presenting cells. Their cellular distribution and serum protein interaction ("protein corona") after systemic administration and their effect on the functional properties of NPs is poorly understood. OBJECTIVES We analyzed the relevance of the protein corona on cell type-selective uptake of dextran-coated NPs and determined the outcome of vaccination with NPs that codeliver antigen and adjuvant in disease models of allergy. METHODS The role of protein corona constituents for cellular binding/uptake of dextran-coated ferrous nanoparticles (DEX-NPs) was analyzed both in vitro and in vivo. DEX-NPs conjugated with the model antigen ovalbumin (OVA) and immunostimulatory CpG-rich oligodeoxynucleotides were administered to monitor the induction of cellular and humoral immune responses. Therapeutic effects of this DEX-NP vaccine in mouse models of OVA-induced anaphylaxis and allergic asthma were assessed. RESULTS DEX-NPs triggered lectin-induced complement activation, yielding deposition of activated complement factor 3 on the DEX-NP surface. In the spleen DEX-NPs targeted predominantly B cells through complement receptors 1 and 2. The DEX-NP vaccine elicited much stronger OVA-specific IgG2a production than coadministered soluble OVA plus CpG oligodeoxynucleotides. B-cell binding of the DEX-NP vaccine was critical for IgG2a production. Treatment of OVA-sensitized mice with the DEX-NP vaccine prevented induction of anaphylactic shock and allergic asthma accompanied by IgE inhibition. CONCLUSIONS Opsonization of lectin-coated NPs by activated complement components results in selective B-cell targeting. The intrinsic B-cell targeting property of lectin-coated NPs can be exploited for treatment of allergic immune responses.
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Affiliation(s)
- Limei Shen
- Department of Dermatology, University of Mainz Medical Center, Mainz, Germany
| | - Stefan Tenzer
- Institute for Immunology, University of Mainz Medical Center, Mainz, Germany
| | - Wiebke Storck
- Institute for Immunology, University of Mainz Medical Center, Mainz, Germany
| | - Dominika Hobernik
- Department of Dermatology, University of Mainz Medical Center, Mainz, Germany
| | | | - Karl Fischer
- Department of Physical Chemistry, University of Mainz, Mainz, Germany
| | - Sandra Decker
- Department of Physical Chemistry, University of Mainz, Mainz, Germany
| | | | | | - Mustafa Diken
- TRON-Translational Oncology at the University Medical Center of the Johannes Gutenberg University gGmbH, Mainz, Germany
| | - Alexej Nikolaev
- Institute for Molecular Medicine, University of Mainz Medical Center, Mainz, Germany
| | - Joachim Maxeiner
- Asthma Core Facility, Research Center for Immunotherapy, University of Mainz Medical Center, Mainz, Germany
| | - Petra Schuster
- Asthma Core Facility, Research Center for Immunotherapy, University of Mainz Medical Center, Mainz, Germany
| | - Cinja Kappel
- Department of Dermatology, University of Mainz Medical Center, Mainz, Germany
| | - Admar Verschoor
- Institute for Systemic Inflammation Research, Universität zu Lübeck, Lübeck, Germany
| | - Hansjörg Schild
- Institute for Immunology, University of Mainz Medical Center, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University of Mainz Medical Center, Mainz, Germany.
| | - Matthias Bros
- Department of Dermatology, University of Mainz Medical Center, Mainz, Germany
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7
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Inotuzumab ozogamicin in adults with relapsed or refractory CD22-positive acute lymphoblastic leukemia: a phase 1/2 study. Blood Adv 2017; 1:1167-1180. [PMID: 29296758 DOI: 10.1182/bloodadvances.2016001925] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/27/2017] [Indexed: 12/20/2022] Open
Abstract
This study evaluated the safety, antitumor activity, pharmacokinetics, and pharmacodynamics of inotuzumab ozogamicin (InO) for CD22-positive relapsed/refractory acute lymphoblastic leukemia. In phase 1, patients received InO 1.2 (n = 3), 1.6 (n = 12), or 1.8 (n = 9) mg/m2 per cycle on days 1, 8, and 15 over a 28-day cycle (≤6 cycles). The recommended phase 2 dose (RP2D) was confirmed (expansion cohort; n = 13); safety and activity of InO were assessed in patients receiving the RP2D in phase 2 (n = 35) and in all treated patients (n = 72). The RP2D was 1.8 mg/m2 per cycle (0.8 mg/m2 on day 1; 0.5 mg/m2 on days 8 and 15), with reduction to 1.6 mg/m2 per cycle after complete remission (CR) or CR with incomplete marrow recovery (CRi). Treatment-related toxicities were primarily cytopenias. Four patients experienced treatment-related venoocclusive disease/sinusoidal obstruction syndrome (VOD/SOS; 1 fatal). Two VOD/SOS events occurred during treatment without intervening transplant; of 24 patients proceeding to poststudy transplant, 2 experienced VOD/SOS after transplant. Forty-nine (68%) patients had CR/CRi, with 41 (84%) achieving minimal residual disease (MRD) negativity. Median progression-free survival was 3.9 (95% confidence interval, 2.9-5.4) months; median overall survival was 7.4 (5.7-9.2) months for all treated patients, with median 23.7 (range, 6.8-29.8) months of follow-up for all treated patients alive at data cutoff. Achievement of MRD negativity was associated with higher InO exposure. InO was well tolerated and demonstrated high single-agent activity and MRD-negativity rates. This trial was registered at www.clinicaltrials.gov as #NCT01363297.
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8
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Ibrutinib inhibits pre-BCR + B-cell acute lymphoblastic leukemia progression by targeting BTK and BLK. Blood 2016; 129:1155-1165. [PMID: 28031181 DOI: 10.1182/blood-2016-06-722900] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/19/2016] [Indexed: 12/14/2022] Open
Abstract
Targeting B-cell receptor (BCR) signaling is a successful therapeutic strategy in mature B-cell malignancies. Precursor BCR (pre-BCR) signaling, which is critical during normal B lymphopoiesis, also plays an important role in pre-BCR+ B cell acute lymphoblastic leukemia (B-ALL). Here, we investigated the activity and mechanism of action of the BTK inhibitor ibrutinib in preclinical models of B-ALL. Pre-BCR+ ALL cells were exquisitely sensitive to ibrutinib at therapeutically relevant drug concentrations. In pre-BCR+ ALL, ibrutinib thwarted autonomous and induced pre-BCR signaling, resulting in deactivation of PI3K/Akt signaling. Ibrutinib modulated the expression of pre-BCR regulators (PTPN6, CD22, CD72, and PKCβ) and substantially reduced BCL6 levels. Ibrutinib inhibited ALL cell migration toward CXCL12 and beneath marrow stromal cells and reduced CD44 expression. CRISPR-Cas9 gene editing revealed that both BTK and B lymphocyte kinase (BLK) are relevant targets of ibrutinib in pre-BCR+ ALL. Consequently, in mouse xenograft models of pre-BCR+ ALL, ibrutinib treatment significantly prolonged survival. Combination treatment of ibrutinib with dexamethasone or vincristine demonstrated synergistic activity against pre-BCR+ ALL. These data corroborate ibrutinib as a promising targeted agent for pre-BCR+ ALL and highlight the importance of ibrutinib effects on alternative kinase targets.
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9
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Kantarjian HM, DeAngelo DJ, Stelljes M, Martinelli G, Liedtke M, Stock W, Gökbuget N, O’Brien S, Wang K, Wang T, Paccagnella ML, Sleight B, Vandendries E, Advani AS. Inotuzumab Ozogamicin versus Standard Therapy for Acute Lymphoblastic Leukemia. N Engl J Med 2016; 375:740-53. [PMID: 27292104 PMCID: PMC5594743 DOI: 10.1056/nejmoa1509277] [Citation(s) in RCA: 907] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prognosis for adults with relapsed acute lymphoblastic leukemia is poor. We sought to determine whether inotuzumab ozogamicin, an anti-CD22 antibody conjugated to calicheamicin, results in better outcomes in patients with relapsed or refractory acute lymphoblastic leukemia than does standard therapy. METHODS In this phase 3 trial, we randomly assigned adults with relapsed or refractory acute lymphoblastic leukemia to receive either inotuzumab ozogamicin (inotuzumab ozogamicin group) or standard intensive chemotherapy (standard-therapy group). The primary end points were complete remission (including complete remission with incomplete hematologic recovery) and overall survival. RESULTS Of the 326 patients who underwent randomization, the first 218 (109 in each group) were included in the primary intention-to-treat analysis of complete remission. The rate of complete remission was significantly higher in the inotuzumab ozogamicin group than in the standard-therapy group (80.7% [95% confidence interval {CI}, 72.1 to 87.7] vs. 29.4% [95% CI, 21.0 to 38.8], P<0.001). Among the patients who had complete remission, a higher percentage in the inotuzumab ozogamicin group had results below the threshold for minimal residual disease (0.01% marrow blasts) (78.4% vs. 28.1%, P<0.001); the duration of remission was longer in the inotuzumab ozogamicin group (median, 4.6 months [95% CI, 3.9 to 5.4] vs. 3.1 months [95% CI, 1.4 to 4.9]; hazard ratio, 0.55 [95% CI, 0.31 to 0.96]; P=0.03). In the survival analysis, which included all 326 patients, progression-free survival was significantly longer in the inotuzumab ozogamicin group (median, 5.0 months [95% CI, 3.7 to 5.6] vs. 1.8 months [95% CI, 1.5 to 2.2]; hazard ratio, 0.45 [97.5% CI, 0.34 to 0.61]; P<0.001); the median overall survival was 7.7 months (95% CI, 6.0 to 9.2) versus 6.7 months (95% CI, 4.9 to 8.3), and the hazard ratio was 0.77 (97.5% CI, 0.58 to 1.03) (P=0.04). In the safety population, the most frequent grade 3 or higher nonhematologic adverse events with inotuzumab ozogamicin were liver-related. Veno-occlusive liver disease of any grade occurred in 15 patients (11%) who received inotuzumab ozogamicin and in 1 patient (1%) who received standard therapy. CONCLUSIONS The rate of complete remission was higher with inotuzumab ozogamicin than with standard therapy, and a higher percentage of patients in the inotuzumab ozogamicin group had results below the threshold for minimal residual disease. Both progression-free and overall survival were longer with inotuzumab ozogamicin. Veno-occlusive liver disease was a major adverse event associated with inotuzumab ozogamicin. (Funded by Pfizer; INO-VATE ALL ClinicalTrials.gov number, NCT01564784.).
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Affiliation(s)
- Hagop M. Kantarjian
- MD Anderson Cancer Center, Houston, TX, USA
- Address correspondence to: Hagop M. Kantarjian, MD, Department of Leukemia, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, Tel: (713) 792-7026, Fax: (713) 794-4297,
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10
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Dubrovsky L, Brea EJ, Pankov D, Casey E, Dao T, Liu C, Scheinberg DA. Mechanisms of leukemia resistance to antibody dependent cellular cytotoxicity. Oncoimmunology 2016; 5:e1211221. [PMID: 27757306 DOI: 10.1080/2162402x.2016.1211221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/04/2016] [Indexed: 01/22/2023] Open
Abstract
Specific immunotherapy for acute leukemia remains a great unmet need. Native unmodified monoclonal antibody therapies, while promising, are inadequately effective for these malignancies, and multiple mechanisms for failure have been described. Antibody-dependent cellular cytotoxicity or phagocytosis is the primary modality of mAb-mediated cell killing in vivo, but ultimately leads to relapse of the leukemias, in model systems and in humans. By use of a T-cell receptor mimic mAb ESKM, derived against a WT1 peptide expressed in complex with HLA-A*02:01, whose only mechanism of therapeutic action is ADCC, we evaluated the mechanisms of leukemic relapse from its potent therapeutic action in mouse xenograft models of human leukemia. Leukemia escape was not associated with loss of the antigenic target, downregulation of cell surface HLA, antibody pharmacokinetic or biodistribution issues, or development of leukemia cell-intrinsic resistance to ADCC. Interestingly, the rapidity of leukemic growth determined whether leukemia was able to evade cytotoxicity independent of the presence of sufficient effector cells. By engineering leukemia cells with upregulated p27Kip1 and slower cell cycling times, we show that relapse was inversely correlated with growth rates resulting in the eventual inadequacy of effector to target ratio. Moreover, lack of migration of effector cells into lymphomatous pockets of ALL also allowed local escape. Successful leukemia therapy with mAb might therefore be improved in similar situations by combination with measures to reduce burden and slow leukemia cell growth.
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Affiliation(s)
- Leonid Dubrovsky
- Molecular Pharmacology Program, Sloan-Kettering Institute, New York, NY, USA; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Elliott Joseph Brea
- Molecular Pharmacology Program, Sloan-Kettering Institute, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Dmitry Pankov
- Molecular Pharmacology Program, Sloan-Kettering Institute, New York, NY, USA; Immunology Program, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Emily Casey
- Molecular Pharmacology Program, Sloan-Kettering Institute , New York, NY, USA
| | - Tao Dao
- Molecular Pharmacology Program, Sloan-Kettering Institute , New York, NY, USA
| | - Cheng Liu
- Eureka Therapeutics , Emeryville, CA, USA
| | - David A Scheinberg
- Molecular Pharmacology Program, Sloan-Kettering Institute, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
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11
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Satake N, Duong C, Yoshida S, Oestergaard M, Chen C, Peralta R, Guo S, Seth PP, Li Y, Beckett L, Chung J, Nolta J, Nitin N, Tuscano JM. Novel Targeted Therapy for Precursor B Cell Acute Lymphoblastic Leukemia: anti-CD22 Antibody-MXD3 Antisense Oligonucleotide Conjugate. Mol Med 2016; 22:632-642. [PMID: 27455414 DOI: 10.2119/molmed.2015.00210] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 07/13/2016] [Indexed: 12/17/2022] Open
Abstract
The exponential rise in molecular and genomic data has generated a vast array of therapeutic targets. Oligonucleotide-based technologies to down regulate these molecular targets have promising therapeutic efficacy. However, there is relatively limited success in translating this into effective in vivo cancer therapeutics. The primary challenge is the lack of effective cancer cell-targeted delivery methods, particularly for a systemic disease such as leukemia. We developed a novel leukemia-targeting compound composed of a monoclonal antibody directly conjugated to an antisense oligonucleotide (ASO). Our compound uses an ASO that specifically targets the transcription factor MAX dimerization protein 3 (MXD3), which was previously identified to be critical for precursor B cell (preB) acute lymphoblastic leukemia (ALL) cell survival. The MXD3 ASO was conjugated to an anti-CD22 antibody (αCD22 Ab) that specifically targets most preB ALL. We demonstrated that the αCD22 Ab-ASO conjugate treatment showed MXD3 protein knockdown and leukemia cell apoptosis in vitro. We also demonstrated that the conjugate treatment showed cytotoxicity in normal B cells, but not in other hematopoietic cells, including hematopoietic stem cells. Furthermore, the conjugate treatment at the lowest dose tested (0.2mg/kg Ab for 6 doses - twice a week for 3 weeks) more than doubled the mouse survival time in both Reh (median survival time 20.5 vs. 42.5 days, p<0.001) and primary preB ALL (median survival time 29.3 vs. 63 days, p<0.001) xenograft models. Our conjugate that uses αCD22 Ab to target the novel molecule MXD3, which is highly expressed in preB ALL cells, appears to be a promising novel therapeutic approach.
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Affiliation(s)
| | | | | | | | - Cathy Chen
- Department of Pediatrics.,Stem Cell Program
| | | | | | | | - Yueju Li
- Department of Public Health Sciences
| | | | | | | | - Nitin Nitin
- Departments of Food Science & Technology and Biological & Agricultural Engineering
| | - Joseph M Tuscano
- Department of Internal Medicine, University of California, Davis
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12
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Jaime-Perez JC, Colunga-Pedraza PR, Gutiérrez-Aguirre CH, Pinzón-Uresti MA, Cantú-Rodríguez OG, Herrera-Garza JL, Gómez-Almaguer D. Efficacy of mitoxantrone as frontline anthracycline during induction therapy in adults with newly diagnosed acute lymphoblastic leukemia: a single-center experience. Leuk Lymphoma 2015; 56:2524-8. [PMID: 25629985 DOI: 10.3109/10428194.2015.1009058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Remission induction regimens for acute lymphoblastic leukemia (ALL) in adults induce complete remission (CR) in 60-90% and cure in 20-40%. A cohort study of newly diagnosed patients with ALL treated with mitoxantrone versus doxorubicin was conducted from 2005 to 2013. The primary endpoint was the proportion of CR. Eighty-five patients were included. Fifty-three received induction with doxorubicin and 32 with mitoxantrone. Median follow-up in the cohort was 40.2 months (range 2-95). Twenty-nine patients (90.6%) achieved CR in the mitoxantrone arm compared with 37 (69.8%) in the doxorubicin group (p = 0.032). There was no difference in death or relapse rate (p = 0.095 and 0.075), hematological recovery (p = 0.654), incidence of adverse events (p = 0.6), in-hospital days during induction (p = 0.456) or overall survival (p = 0.105). Induction toxicities were comparable. Mitoxantrone can be safely and effectively used as a frontline anthracycline in adults newly diagnosed with ALL.
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Affiliation(s)
- José Carlos Jaime-Perez
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - Perla R Colunga-Pedraza
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - César Homero Gutiérrez-Aguirre
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - Mónica Andrea Pinzón-Uresti
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - Olga G Cantú-Rodríguez
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - José Luis Herrera-Garza
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - David Gómez-Almaguer
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
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Satake N, Duong C, Chen C, Barisone GA, Diaz E, Tuscano J, Rocke DM, Nolta J, Nitin N. Targeted therapy with MXD3 siRNA, anti-CD22 antibody and nanoparticles for precursor B-cell acute lymphoblastic leukaemia. Br J Haematol 2014; 167:487-99. [PMID: 25196579 DOI: 10.1111/bjh.13066] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/02/2014] [Indexed: 01/18/2023]
Abstract
Conventional chemotherapy for precursor B-cell (preB) acute lymphoblastic leukaemia (ALL) has limitations that could be overcome by targeted therapy. Previously, we discovered a potential therapeutic molecular target, MDX3 (MAX dimerization protein 3), in preB ALL. In this study, we hypothesize that an effective siRNA therapy for preB ALL can be developed using antiCD22 antibody (αCD22 Ab) and nanoparticles. We composed nanocomplexes with super paramagnetic iron oxide nanoparticles (SPIO NPs), αCD22 Abs and MXD3 siRNA molecules based on physical interactions between the molecules. We demonstrated that the MXD3 siRNA-αCD22 Ab-SPIO NP complexes entered leukaemia cells and knocked down MXD3, leading the cells to undergo apoptosis and resulting in decreased live cell counts in the cell line Reh and in primary preB ALL samples in vitro. Furthermore, the cytotoxic effects of the MXD3 siRNA-αCD22 Ab-SPIO NP complexes were significantly enhanced by addition of the chemotherapy drugs vincristine or doxorubicin. We also ruled out potential cytotoxic effects of the MXD3 siRNA-αCD22 Ab-SPIO NP complexes on normal primary haematopoietic cells. Normal B cells were affected while CD34-positive haematopoietic stem cells and non-B cells were not. These data suggest that MXD3 siRNA-αCD22 Ab-SPIO NP complexes have the potential to be a new targeted therapy for preB ALL.
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Affiliation(s)
- Noriko Satake
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA; Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, CA, USA
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Bartram I, Gökbuget N, Schlee C, Heesch S, Fransecky L, Schwartz S, Stuhlmann R, Schäfer-Eckhart K, Starck M, Reichle A, Hoelzer D, Baldus CD, Neumann M. Low expression of T-cell transcription factor BCL11b predicts inferior survival in adult standard risk T-cell acute lymphoblastic leukemia patients. J Hematol Oncol 2014; 7:51. [PMID: 25023966 PMCID: PMC4223626 DOI: 10.1186/s13045-014-0051-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/01/2014] [Indexed: 12/17/2022] Open
Abstract
Background Risk stratification, detection of minimal residual disease (MRD), and implementation of novel therapeutic agents have improved outcome in acute lymphoblastic leukemia (ALL), but survival of adult patients with T-cell acute lymphoblastic leukemia (T-ALL) remains unsatisfactory. Thus, novel molecular insights and therapeutic approaches are urgently needed. Methods We studied the impact of B-cell CLL/lymphoma 11b (BCL11b), a key regulator in normal T-cell development, in T-ALL patients enrolled into the German Multicenter Acute Lymphoblastic Leukemia Study Group trials (GMALL; n = 169). The mutational status (exon 4) of BCL11b was analyzed by Sanger sequencing and mRNA expression levels were determined by quantitative real-time PCR. In addition gene expression profiles generated on the Human Genome U133 Plus 2.0 Array (affymetrix) were used to investigate BCL11b low and high expressing T-ALL patients. Results We demonstrate that BCL11b is aberrantly expressed in T-ALL and gene expression profiles reveal an association of low BCL11b expression with up-regulation of immature markers. T-ALL patients characterized by low BCL11b expression exhibit an adverse prognosis [5-year overall survival (OS): low 35% (n = 40) vs. high 53% (n = 129), P = 0.02]. Within the standard risk group of thymic T-ALL (n = 102), low BCL11b expression identified patients with an unexpected poor outcome compared to those with high expression (5-year OS: 20%, n = 18 versus 62%, n = 84, P < 0.01). In addition, sequencing of exon 4 revealed a high mutation rate (14%) of BCL11b. Conclusions In summary, our data of a large adult T-ALL patient cohort show that low BCL11b expression was associated with poor prognosis; particularly in the standard risk group of thymic T-ALL. These findings can be utilized for improved risk prediction in a significant proportion of adult T-ALL patients, which carry a high risk of standard therapy failure despite a favorable immunophenotype.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Martin Neumann
- Department of Hematology and Oncology, Charité, University Hospital Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12203, Germany.
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Parameswaran R, Lim M, Fei F, Abdel-Azim H, Arutyunyan A, Schiffer I, McLaughlin ME, Gram H, Huet H, Groffen J, Heisterkamp N. Effector-mediated eradication of precursor B acute lymphoblastic leukemia with a novel Fc-engineered monoclonal antibody targeting the BAFF-R. Mol Cancer Ther 2014; 13:1567-77. [PMID: 24825858 DOI: 10.1158/1535-7163.mct-13-1023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
B-cell activating factor receptor (BAFF-R) is expressed on precursor B acute lymphoblastic leukemia (pre-B ALL) cells, but not on their pre-B normal counterparts. Thus, selective killing of ALL cells is possible by targeting this receptor. Here, we have further examined therapeutic targeting of pre-B ALL based on the presence of the BAFF-R. Mouse pre-B ALL cells lacking BAFF-R function had comparable viability and proliferation to wild-type cells, but were more sensitive to drug treatment in vitro. Viability of human pre-B ALL cells was further reduced when antibodies to the BAFF-R were combined with other drugs, even in the presence of stromal protection. This indicates that inhibition of BAFF-R function reduces fitness of stressed pre-B ALL cells. We tested a novel humanized anti-BAFF-R monoclonal antibody optimalized for FcRγIII-mediated, antibody-dependent cell killing by effector cells. Antibody binding to human ALL cells was inhibitable, in a dose-dependent manner, by recombinant human BAFF. There was no evidence for internalization of the antibodies. The antibodies significantly stimulated natural killer cell-mediated killing of different human patient-derived ALL cells. Moreover, incubation of such ALL cells with these antibodies stimulated phagocytosis by macrophages. When this was tested in an immunodeficient transplant model, mice that were treated with the antibody had a significantly decreased leukemia burden in bone marrow and spleen. In view of the restricted expression of the BAFF-R on normal cells and the multiple anti-pre-B ALL activities stimulated by this antibody, a further examination of its use for treatment of pre-B ALL is warranted.
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Affiliation(s)
- Reshmi Parameswaran
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Min Lim
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Fei Fei
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Hisham Abdel-Azim
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Anna Arutyunyan
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Isabelle Schiffer
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Margaret E McLaughlin
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Hermann Gram
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Heather Huet
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - John Groffen
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
| | - Nora Heisterkamp
- Authors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, SwitzerlandAuthors' Affiliations: Section of Molecular Carcinogenesis; Division of Hematology/Oncology and Bone Marrow Transplantation, The Saban Research Institute, Children's Hospital Los Angeles; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California; Oncology Translational Medicine and Oncology Research, Novartis Institutes for Biomedical Research, Novartis Pharmaceuticals, Cambridge, Massachusetts; and Autoimmunity, Transplantation and Inflammation, Novartis Institute for Biomedical Research, Basel, Switzerland
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