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Du Y, Zhang Y, Xu X, Cai Y, Wei Y, Huang C, Yang J, Qiu H, Niu J, Zhou K, Xia X, Shen C, Tong Y, Dong B, Wan L, Song X. Low-dose anti-thymocyte globulin plus low-dose posttransplant cyclophosphamide-based regimen for prevention of graft-versus-host disease in haploidentical peripheral blood stem cell transplantation for pediatric patients with hematologic malignancies. Ann Hematol 2024; 103:3765-3774. [PMID: 38981923 DOI: 10.1007/s00277-024-05883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024]
Abstract
The low-dose anti-thymocyte globulin (ATG) plus low-dose post transplantation cyclophosphamide (PTCy) -based (low-dose ATG/PTCy-based) regimen had a promising activity in preventing of graft-versus-host disease (GVHD) in adult patients. However, its efficacy in pediatric patients remain to be defined. Here, we presented the findings from 35 pediatric patients undergoing haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with the new regimen for GVHD prophylaxis. The cumulative incidences (CIs) of grades II-III and III-IV acute GVHD (aGVHD) were 34% (95% CI, 17-48%) and 11% (95% CI, 0-21%) within 180 days post-transplantation, respectively. The CIs of chronic GVHD (cGVHD) and moderate-to-severe cGVHD within 2 years were 26% (95% CI, 7-41%) and 12% (95% CI, 0-25%), respectively. The 2-year probabilities of overall survival, relapse-free survival, and graft-versus-host disease and relapse-free survival were 89% (95% CI, 78-100%), 82% (95% CI, 68-98%) and 59% (95% CI, 43-80%), respectively. The CIs of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation by day 180 were 37% (95% CI, 19-51%) and 20% (95% CI, 6-32%) respectively. These results strongly advocate for the efficacy of the low-dose ATG/PTCy-based regimen as a robust strategy for GVHD prevention in haplo-PBSCT for pediatric patients.
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Affiliation(s)
- Yanlu Du
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Ying Zhang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Xiaowei Xu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Yu Cai
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Yu Wei
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Chongmei Huang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Jun Yang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Huiying Qiu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Jiahua Niu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Kun Zhou
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Xinxin Xia
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Chang Shen
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Yin Tong
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Baoxia Dong
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China
| | - Liping Wan
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China.
| | - Xianmin Song
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No.100 Haining Road, Shanghai, 200080, China.
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Gökbuget N, Boissel N, Chiaretti S, Dombret H, Doubek M, Fielding A, Foà R, Giebel S, Hoelzer D, Hunault M, Marks DI, Martinelli G, Ottmann O, Rijneveld A, Rousselot P, Ribera J, Bassan R. Diagnosis, prognostic factors, and assessment of ALL in adults: 2024 ELN recommendations from a European expert panel. Blood 2024; 143:1891-1902. [PMID: 38295337 DOI: 10.1182/blood.2023020794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/02/2024] Open
Abstract
ABSTRACT Working groups of the European LeukemiaNet have published several important consensus guidelines. Acute lymphoblastic leukemia (ALL) has many different clinical and biological subgroups and the knowledge on disease biology and therapeutic options is increasing exponentially. The European Working Group for Adult ALL has therefore summarized the current state of the art and provided comprehensive consensus recommendations for diagnostic approaches, biologic and clinical characterization, prognostic factors, and risk stratification as well as definitions of endpoints and outcomes. Aspects of treatment, management of subgroups and specific situations, aftercare, and supportive care are covered in a separate publication. The present recommendation intends to provide guidance for the initial management of adult patients with ALL and to define principles as a basis for future collaborative research.
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Affiliation(s)
- Nicola Gökbuget
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Nicolas Boissel
- Hospital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Hervé Dombret
- Leukemia Department, University Hospital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Saint-Louis Research Institute, Université Paris Cité, Paris, France
| | - Michael Doubek
- Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Dieter Hoelzer
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Mathilde Hunault
- Maladies du Sang University Hospital of Angers, FHU Goal, INSERM, National Centre for Scientific Research, Angers, France
| | - David I Marks
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Giovanni Martinelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Oliver Ottmann
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | - Philippe Rousselot
- Clinical Hematology Department, Centre Hospitalier de Versailles, Université Paris-Saclay, Versailles, France
| | - Josep Ribera
- Clinical Hematology Department, Institut Catala d'Oncologia-Hospital Germans Trias I Pujol, Josep Carreras Research Institute, Badalona, Spain
| | - Renato Bassan
- Division of Hematology, Ospedale dell'Angelo, Mestre-Venice, Italy
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3
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Verbeek MWC, van der Velden VHJ. The Evolving Landscape of Flowcytometric Minimal Residual Disease Monitoring in B-Cell Precursor Acute Lymphoblastic Leukemia. Int J Mol Sci 2024; 25:4881. [PMID: 38732101 PMCID: PMC11084622 DOI: 10.3390/ijms25094881] [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] [Received: 03/29/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Detection of minimal residual disease (MRD) is a major independent prognostic marker in the clinical management of pediatric and adult B-cell precursor Acute Lymphoblastic Leukemia (BCP-ALL), and risk stratification nowadays heavily relies on MRD diagnostics. MRD can be detected using flow cytometry based on aberrant expression of markers (antigens) during malignant B-cell maturation. Recent advances highlight the significance of novel markers (e.g., CD58, CD81, CD304, CD73, CD66c, and CD123), improving MRD identification. Second and next-generation flow cytometry, such as the EuroFlow consortium's eight-color protocol, can achieve sensitivities down to 10-5 (comparable with the PCR-based method) if sufficient cells are acquired. The introduction of targeted therapies (especially those targeting CD19, such as blinatumomab or CAR-T19) introduces several challenges for flow cytometric MRD analysis, such as the occurrence of CD19-negative relapses. Therefore, innovative flow cytometry panels, including alternative B-cell markers (e.g., CD22 and CD24), have been designed. (Semi-)automated MRD assessment, employing machine learning algorithms and clustering tools, shows promise but does not yet allow robust and sensitive automated analysis of MRD. Future directions involve integrating artificial intelligence, further automation, and exploring multicolor spectral flow cytometry to standardize MRD assessment and enhance diagnostic and prognostic robustness of MRD diagnostics in BCP-ALL.
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Affiliation(s)
| | - Vincent H. J. van der Velden
- Laboratory for Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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Jabbour E, Zugmaier G, Agrawal V, Martínez-Sánchez P, Rifón Roca JJ, Cassaday RD, Böll B, Rijneveld A, Abdul-Hay M, Huguet F, Cluzeau T, Díaz MT, Vucinic V, González-Campos J, Rambaldi A, Schwartz S, Berthon C, Hernández-Rivas JM, Gordon PR, Brüggemann M, Hamidi A, Chen Y, Wong HL, Panwar B, Katlinskaya Y, Markovic A, Kantarjian H. Single agent subcutaneous blinatumomab for advanced acute lymphoblastic leukemia. Am J Hematol 2024; 99:586-595. [PMID: 38317420 DOI: 10.1002/ajh.27227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
Blinatumomab is a BiTE® (bispecific T-cell engager) molecule that redirects CD3+ T-cells to engage and lyse CD19+ target cells. Here we demonstrate that subcutaneous (SC) blinatumomab can provide high efficacy and greater convenience of administration. In the expansion phase of a multi-institutional phase 1b trial (ClinicalTrials.gov, NCT04521231), heavily pretreated adults with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) received SC blinatumomab at two doses: (1) 250 μg once daily (QD) for week 1 and 500 μg three times weekly (TIW) thereafter (250 μg/500 μg) or (2) 500 μg QD for week 1 and 1000 μg TIW thereafter (500 μg/1000 μg). The primary endpoint was complete remission/complete remission with partial hematologic recovery (CR/CRh) within two cycles. At the data cutoff of September 15, 2023, 29 patients were treated: 14 at the 250 μg/500 μg dose and 13 at 500 μg/1000 μg dose. Data from two ineligible patients were excluded. At the end of two cycles, 12 of 14 patients (85.7%) from the 250 μg/500 μg dose achieved CR/CRh of which nine patients (75.0%) were negative for measurable residual disease (MRD; <10-4 leukemic blasts). At the 500 μg/1000 μg dose, 12 of 13 patients (92.3%) achieved CR/CRh; all 12 patients (100.0%) were MRD-negative. No treatment-related grade 4 cytokine release syndrome (CRS) or neurologic events (NEs) were reported. SC injections were well tolerated and all treatment-related grade 3 CRS and NEs responded to standard-of-care management, interruption, or discontinuation. Treatment with SC blinatumomab resulted in high efficacy, with high MRD-negativity rates and acceptable safety profile in heavily pretreated adults with R/R B-ALL.
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Affiliation(s)
- Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Vaibhav Agrawal
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope National Medical Center, Duarte, California, USA
| | - Pilar Martínez-Sánchez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - José J Rifón Roca
- Hematology and Hemotherapy Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ryan D Cassaday
- Division of Hematology and Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Boris Böll
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Anita Rijneveld
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Maher Abdul-Hay
- Perlmutter Cancer Center, New York University Langone Health, New York, New York, USA
| | - Françoise Huguet
- Department of Hematology, Institut Universitaire du Cancer-Oncopole CHU de Toulouse, Toulouse, France
| | | | - Mar Tormo Díaz
- Hematology Department, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Vladan Vucinic
- Department of Hematology and Cell Therapy, University Hospital Leipzig, Leipzig, Germany
| | | | - Alessandro Rambaldi
- Department of Oncology-Hematology, University of Milan, Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefan Schwartz
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Céline Berthon
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jesús María Hernández-Rivas
- IBSAL, IBMCC, CSIC, Cancer Research Center, University of Salamanca, Salamanca, Spain
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
- CIBERONC, Research Group CB16/12/00233, Salamanca, Spain
| | | | - Monika Brüggemann
- Department of Hematology, University of Schleswig-Holstein, Kiel, Germany
| | - Ali Hamidi
- Amgen Inc., Thousand Oaks, California, USA
| | - Yuqi Chen
- Amgen Inc., Thousand Oaks, California, USA
| | - Hansen L Wong
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., South San Francisco, California, USA
| | | | | | | | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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5
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Zarling LC, Stevenson PA, Soma LA, Martino CH, Percival MEM, Halpern AB, Ghiuzeli CM, Becker PS, Oehler VG, Cooper JP, Orozco JJ, Hendrie PC, Walter RB, Estey EH, Cassaday RD. Hyper-CVAD versus dose-adjusted EPOCH as initial treatment for adults with acute lymphoblastic leukemia. Eur J Haematol 2023; 111:863-871. [PMID: 37670560 DOI: 10.1111/ejh.14089] [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] [Received: 06/19/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES We recently performed a single-arm phase II trial of DA-EPOCH in adults with acute lymphoblastic leukemia (ALL). We sought to compare these results to those with standard Hyper-CVAD. METHODS We created a retrospective matched cohort of patients who received Hyper-CVAD (n = 69) at our center and otherwise met eligibility criteria for the DA-EPOCH trial (n = 53). RESULTS Our outcomes support the use of Hyper-CVAD over DA-EPOCH in Ph- disease for both overall survival (OS; HR 0.18, p = .004) and event-free survival (EFS; HR 0.51, p = .06). In contrast, outcomes were similar in Ph+ disease (OS HR 0.97, p = .96; EFS HR 0.65, p = .21). Rates of morphologic remission and measurable residual-disease negativity were similar between the regimens. Hyper-CVAD was associated with significantly more febrile neutropenia (OR 1.9, p = .03) and a greater incidence of Grade 4 or 5 adverse events (20% vs. 6%). Average transfusions per cycle of both red blood cells (p < .001) and platelets (p < .001) were five-fold higher with Hyper-CVAD. CONCLUSIONS Our findings support continued use of Hyper-CVAD for Ph- ALL but suggest that DA-EPOCH may be a reasonable alternative for Ph+ ALL. These data also highlight a potential role for DA-EPOCH in resource-limited settings or when more intense therapy is not feasible.
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Affiliation(s)
- Lucas C Zarling
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
| | - Philip A Stevenson
- Clinical Statistics Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Lorinda A Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Christen H Martino
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Mary-Elizabeth M Percival
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Anna B Halpern
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Cristina M Ghiuzeli
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Pamela S Becker
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Vivian G Oehler
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Jason P Cooper
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Johnnie J Orozco
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Paul C Hendrie
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Roland B Walter
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Elihu H Estey
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Ryan D Cassaday
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
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6
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Chen H, Gu M, Liang J, Song H, Zhang J, Xu W, Zhao F, Shen D, Shen H, Liao C, Tang Y, Xu X. Minimal residual disease detection by next-generation sequencing of different immunoglobulin gene rearrangements in pediatric B-ALL. Nat Commun 2023; 14:7468. [PMID: 37978187 PMCID: PMC10656538 DOI: 10.1038/s41467-023-43171-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
While the prognostic role of immunoglobulin heavy chain locus (IGH) rearrangement in minimal residual disease (MRD) in pediatric B-acute lymphoblastic leukemia (B-ALL) has been reported, the contribution of light chain loci (IGK/IGL) remains elusive. This study is to evaluate the prognosis of IGH and IGK/IGL rearrangement-based MRD detected by next-generation sequencing in B-ALL at the end of induction (EOI) and end of consolidation (EOC). IGK/IGL rearrangements identify 5.5% of patients without trackable IGH clones. Concordance rates for IGH and IGK/IGL are 79.9% (cutoff 0.01%) at EOI and 81.0% (cutoff 0.0001%) at EOC, respectively. Patients with NGS-MRD < 0.01% at EOI or <0.0001% at EOC present excellent outcome, with 3-year event-free survival rates higher than 95%. IGH-MRD is prognostic at EOI/EOC, while IGK-MRD at EOI/EOC and IGL-MRD at EOI are not. At EOI, NGS identifies 26.2% of higher risk patients whose MRD < 0.01% by flow cytometry. However, analyzing IGK/IGL along with IGH fails to identify additional higher risk patients both at EOI and at EOC. In conclusion, IGH is crucial for MRD monitoring while IGK and IGL have relatively limited value.
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Affiliation(s)
- Haipin Chen
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Miner Gu
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Juan Liang
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Hua Song
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Jingying Zhang
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Weiqun Xu
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Fenying Zhao
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Diying Shen
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Heping Shen
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Chan Liao
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China
| | - Yongmin Tang
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China.
| | - Xiaojun Xu
- Division/Center of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, The Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Yan'an Street, 310003, Hangzhou, People's Republic of China.
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Nachmias B, Krichevsky S, Gatt ME, Gross Even-Zohar N, Shaulov A, Haran A, Aumann S, Vainstein V. Standardization of Molecular MRD Levels in AML Using an Integral Vector Bearing ABL and the Mutation of Interest. Cancers (Basel) 2023; 15:5360. [PMID: 38001621 PMCID: PMC10670136 DOI: 10.3390/cancers15225360] [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: 10/11/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Quantitative PCR for specific mutation is being increasingly used in Acute Myeloid Leukemia (AML) to assess Measurable Residual Disease (MRD), allowing for more tailored clinical decisions. To date, standardized molecular MRD is limited to typical NPM1 mutations and core binding factor translocations, with clear prognostic and clinical implications. The monitoring of other identified mutations lacks standardization, limiting its use and incorporation in clinical trials. To overcome this problem, we designed a plasmid bearing both the sequence of the mutation of interest and the ABL reference gene. This allows the use of commercial standards for ABL to determine the MRD response in copy number. We provide technical aspects of this approach as well as our experience with 19 patients with atypical NPM1, RUNX1 and IDH1/2 mutations. In all cases, we demonstrate a correlation between response and copy number. We further demonstrate how copy number monitoring can modulate the clinical management. Taken together, we provide proof of concept of a novel yet simple tool, which allows in-house MRD monitoring for identified mutations, with ABL-based commercial standards. This approach would facilitate large multi-center studies assessing the clinical relevance of selected MRD monitoring.
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8
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Li X, Yang J, Cai Y, Huang C, Xu X, Qiu H, Niu J, Zhou K, Zhang Y, Xia X, Wei Y, Shen C, Tong Y, Dong B, Wan L, Song X. Low-dose anti-thymocyte globulin plus low-dose post-transplant cyclophosphamide-based regimen for prevention of graft-versus-host disease after haploidentical peripheral blood stem cell transplants: a large sample, long-term follow-up retrospective study. Front Immunol 2023; 14:1252879. [PMID: 37954615 PMCID: PMC10639171 DOI: 10.3389/fimmu.2023.1252879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The novel low-dose anti-thymocyte (ATG, 5 mg/kg) plus low-dose post-transplant cyclophosphamide (PTCy, 50 mg/kg) (low-dose ATG/PTCy)-based regimen had promising activity for prevention of graft-versus-host disease (GVHD) in haploidentical-peripheral blood stem cell transplantation (haplo-PBSCT), but its impacts on long-term outcomes remain to be defined. Methods We performed a large sample, long-term follow-up retrospective study to evaluate its efficacy for GVHD prophylaxis. Results The study enrolled 260 patients, including 162 with myeloid malignancies and 98 with lymphoid malignancies. The median follow-up time was 27.0 months. For the entire cohort, the cumulative incidences (CIs) of grade II-IV and III-IV acute GVHD (aGVHD) by 180 days were 13.46% (95% CI, 9.64%-17.92%) and 5.77% (95% CI, 3.37%-9.07%); while total and moderate/severe chronic GVHD (cGVHD) by 2 years were 30.97% (95% CI, 25.43%-36.66%) and 18.08% (95% CI, 13.68%-22.98%), respectively. The 2-year overall survival (OS), relapse-free survival (RFS), GVHD-free, relapse-free survival (GRFS), non-relapse mortality (NRM), and CIs of relapse were 60.7% (95% CI, 54.8%-67.10%), 58.1% (95% CI, 52.2%-64.5%), 50.6% (95% CI, 44.8-57.1%), 23.04% (95% CI, 18.06%-28.40%), and 18.09% (95% CI, 14.33%-23.97%, respectively. The 1-year CIs of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation were 43.46% (95% CI, 37.39%-49.37%) and 18.08% (95% CI, 13.68%-22.98%), respectively. In multivariate analysis, the disease status at transplantation was associated with inferior survivor outcomes for all patients and myeloid and lymphoid malignancies, while cGVHD had superior outcomes for all patients and myeloid malignancies, but not for lymphoid malignancies. Discussion The results demonstrated that the novel regimen could effectively prevent the occurrence of aGVHD in haplo-PBSCT.
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Affiliation(s)
- Xingying Li
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Jun Yang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Yu Cai
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Chongmei Huang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Xiaowei Xu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Huiying Qiu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Jiahua Niu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Kun Zhou
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Ying Zhang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Xinxin Xia
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Yu Wei
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Chang Shen
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Yin Tong
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Baoxia Dong
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Liping Wan
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
| | - Xianmin Song
- Department of Hematology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China
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9
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Hunger SP, Tran TH, Saha V, Devidas M, Valsecchi MG, Gastier-Foster JM, Cazzaniga G, Reshmi SC, Borowitz MJ, Moorman AV, Heerema NA, Carroll AJ, Martin-Regueira P, Loh ML, Raetz EA, Schultz KR, Slayton WB, Cario G, Schrappe M, Silverman LB, Biondi A. Dasatinib with intensive chemotherapy in de novo paediatric Philadelphia chromosome-positive acute lymphoblastic leukaemia (CA180-372/COG AALL1122): a single-arm, multicentre, phase 2 trial. Lancet Haematol 2023; 10:e510-e520. [PMID: 37407142 DOI: 10.1016/s2352-3026(23)00088-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The outcome of children with Philadelphia chromosome-positive (Ph-positive) acute lymphoblastic leukaemia significantly improved with the combination of imatinib and intensive chemotherapy. We aimed to investigate the efficacy of dasatinib, a second-generation ABL-class inhibitor, with intensive chemotherapy in children with newly diagnosed Ph-positive acute lymphoblastic leukaemia. METHODS CA180-372/COG AALL1122 was a joint Children's Oncology Group (COG) and European intergroup study of post-induction treatment of Ph-positive acute lymphoblastic leukaemia (EsPhALL) open-label, single-arm, phase 2 study. Eligible patients (aged >1 year to <18 years) with newly diagnosed Ph-positive acute lymphoblastic leukaemia and performance status of at least 60% received EsPhALL chemotherapy plus dasatinib 60 mg/m2 orally once daily from day 15 of induction. Patients with minimal residual disease of at least 0·05% after induction 1B or who were positive for minimal residual disease after the three consolidation blocks were classified as high risk and allocated to receive haematopoietic stem-cell transplantation (HSCT) in first complete remission. The remaining patients were considered standard risk and received chemotherapy plus dasatinib for 2 years. The primary endpoint was the 3-year event-free survival of dasatinib plus chemotherapy compared with external historical controls. The trial was considered positive if one of the following conditions was met: superiority over chemotherapy alone in the AIEOP-BFM 2000 high-risk group; or non-inferiority (with a margin of -5%) or superiority to imatinib plus chemotherapy in the EsPhALL 2010 cohort. All participants who received at least one dose of dasatinib were included in the safety and efficacy analyses. This trial was registered with ClinicalTrials.gov, NCT01460160, and recruitment is closed. FINDINGS Between March 13, 2012, and May 27, 2014, 109 patients were enrolled at 69 sites (including 51 COG sites in the USA, Canada, and Australia, and 18 EsPhALL sites in Italy and the UK). Three patients were ineligible and did not receive dasatinib. 106 patients were treated and included in analyses (49 [46%] female and 57 [54%] male; 85 [80%] White, 13 [12%] Black or African American, five [5%] Asian, and three [3%] other races; 24 [23%] Hispanic or Latino ethnicity). All 106 treated patients reached complete remission; 87 (82%) were classified as standard risk and 19 (18%) met HSCT criteria and were classified as high risk, but only 15 (14%) received HSCT in first complete remission. The 3-year event-free survival of dasatinib plus chemotherapy was superior to chemotherapy alone (65·5% [90% Clopper-Pearson CI 57·7 to 73·7] vs 49·2% [38·0 to 60·4]; p=0·032), and was non-inferior to imatinib plus chemotherapy (59·1% [51·8 to 66·2], 90% CI of the treatment difference: -3·3 to 17·2), but not superior to imatinib plus chemotherapy (65·5% vs 59·1%; p=0·27). The most frequent grade 3-5 adverse events were febrile neutropenia (n=93) and bacteraemia (n=21). Nine remission deaths occurred, which were due to infections (n=5), transplantation-related (n=2), due to cardiac arrest (n=1), or had an unknown cause (n=1). No dasatinib-related deaths occurred. INTERPRETATION Dasatinib plus EsPhALL chemotherapy is safe and active in paediatric Ph-positive acute lymphoblastic leukaemia. 3-year event-free survival was similar to that of previous Ph-positive acute lymphoblastic leukaemia trials despite the limited use of HSCT in first complete remission. FUNDING Bristol Myers Squibb.
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Affiliation(s)
- Stephen P Hunger
- Department of Pediatrics and The Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Thai Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Vaskar Saha
- Children's Cancer Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Maria Grazia Valsecchi
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Julie M Gastier-Foster
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA; Department of Pathology, Ohio State University College of Medicine, Columbus, OH, USA
| | - Giovanni Cazzaniga
- Tettamanti Center, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Genetics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Shalini C Reshmi
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael J Borowitz
- Department of Pathology and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony V Moorman
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nyla A Heerema
- Department of Pathology, Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Mignon L Loh
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Elizabeth A Raetz
- Department of Pediatrics and Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA
| | - Kirk R Schultz
- Pediatric Hematology-Oncology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - William B Slayton
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gunnar Cario
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Martin Schrappe
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Andrea Biondi
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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10
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Faulk KE, Kairalla JA, Dreyer ZE, Carroll AJ, Heerema NA, Devidas M, Carroll WL, Raetz EA, Loh ML, Hunger SP, Borowitz M, Wang C, Guest E, Brown PA. Minimal residual disease predicts outcomes in KMT2A-rearranged but not KMT2A-germline infant acute lymphoblastic leukemia: Report from Children's Oncology Group study AALL0631. Pediatr Blood Cancer 2023; 70:e30467. [PMID: 37259259 PMCID: PMC10687300 DOI: 10.1002/pbc.30467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
We measured minimal residual disease (MRD) by multiparameter flow cytometry at three time points (TP) in 117 infants with KMT2A (lysine [K]-specific methyltransferase 2A)-rearranged and 58 with KMT2A-germline acute lymphoblastic leukemia (ALL) on Children's Oncology Group AALL0631 study. For KMT2A-rearranged patients, 3-year event-free survival (EFS) by MRD-positive (≥0.01%) versus MRD-negative (<0.01%) was: TP1: 25% (±6%) versus 49% (±7%; p = .0009); TP2: 21% (±8%) versus 47% (±7%; p < .0001); and TP3: 22% (±14%) versus 51% (±6%; p = .0178). For KMT2A-germline patients, 3-year EFS was: TP1: 88% (±12%) versus 87% (±5%; p = .73); TP2: 100% versus 88% (±5%; p = .24); and TP3: 100% versus 87% (±5%; p = .53). MRD was a strong independent outcome predictor in KMT2A-rearranged, but not KMT2A-germline infant ALL.
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Affiliation(s)
- Kelly E. Faulk
- University of Colorado Anschutz Medical Campus, Pediatric Oncology, Denver, CO, USA
| | | | - ZoAnn E. Dreyer
- Texas Children’s Hospital, Pediatric Oncology, Houston, TX, USA
| | | | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - William L. Carroll
- Perlmutter Cancer Center, and the New York University Grossman School of Medicine, Division of Pediatric Hematology/Oncology, New York, NY, USA
| | - Elizabeth A. Raetz
- Perlmutter Cancer Center, and the New York University Grossman School of Medicine, Division of Pediatric Hematology/Oncology, New York, NY, USA
| | - Mignon L. Loh
- University of Washington, Pediatric Oncology, Seattle, WA, USA
| | - Stephen P. Hunger
- Division of Oncology and the Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Cindy Wang
- University of Florida, Biostatistics, Gainesville, FL, USA
| | - Erin Guest
- Division of Hematology, Oncology, Blood and Marrow Transplantation, Children’s Mercy Kansas City, Kansas City, MO, USA
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11
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Cassaday RD, Zarling LC, Garcia KLA, Sala-Torra O, Stevenson PA, Martino CH, Liu YJ, Fang M, Percival MEM, Halpern AB, Becker PS, Oehler VG, Shustov AR, Cooper JP, Orozco JJ, Hendrie PC, Walter RB, Radich JP, Soma LA, Estey EH. Phase II study of dose-adjusted EPOCH as initial therapy for adults with high-risk acute lymphoblastic leukemia. Leuk Lymphoma 2023; 64:927-937. [PMID: 36938892 PMCID: PMC10357946 DOI: 10.1080/10428194.2023.2189803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/15/2023] [Accepted: 02/25/2023] [Indexed: 03/21/2023]
Abstract
Treatments for adults with newly-diagnosed acute lymphoblastic leukemia (ALL) may be prohibitively toxic and/or resource-intense. To address this, we performed a phase II study of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH). Imatinib or dasatinib was added for Ph + disease; rituximab was added when CD20+. Fifty-three patients were evaluable: 28 with Ph + disease, and 25 with Ph-. All patients had ≥1 high-risk clinical feature. Measurable residual disease-negativity by multiparameter flow cytometry within 4 cycles was achieved in 71% in patients with Ph + ALL and 64% in Ph - ALL. Median overall survival (OS) was 49 months, with a 2-year OS of 71%. Median relapse-free survival (RFS) in the 47 patients that attained morphologic remission was 24 months, with a 2-year RFS of 57%. Early mortality was 2%. In summary, DA-EPOCH yields deep and durable remissions in adults with ALL comparable to some resource-intense strategies but with a low rate of treatment-related death.
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Affiliation(s)
- Ryan D Cassaday
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lucas C Zarling
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Olga Sala-Torra
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Philip A Stevenson
- Clinical Statistics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christen H Martino
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Yajuan J Liu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Min Fang
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Mary-Elizabeth M Percival
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Anna B Halpern
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Pamela S Becker
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vivian G Oehler
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Andrei R Shustov
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jason P Cooper
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Johnnie J Orozco
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Paul C Hendrie
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Roland B Walter
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jerald P Radich
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lorinda A Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Elihu H Estey
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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12
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Shirai R, Osumi T, Keino D, Nakabayashi K, Uchiyama T, Sekiguchi M, Hiwatari M, Yoshida M, Yoshida K, Yamada Y, Tomizawa D, Takae S, Kiyokawa N, Matsumoto K, Yoshioka T, Hata K, Hori T, Suzuki N, Kato M. Minimal residual disease detection by mutation-specific droplet digital PCR for leukemia/lymphoma. Int J Hematol 2023; 117:910-918. [PMID: 36867356 DOI: 10.1007/s12185-023-03566-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
Minimal residual disease (MRD) is usually defined as the small number of cancer cells that remain in the body after treatment. The clinical significance of MRD kinetics is well recognized in treatment of hematologic malignancies, particularly acute lymphoblastic leukemia (ALL). Real time quantitative PCR targeting immunoglobulin (Ig) or T-cell receptor (TCR) rearrangement (PCR-MRD), as well as multiparametric flow cytometric analysis targeting antigen expression, are widely used in MRD detection. In this study, we devised an alternative method to detect MRD using droplet digital PCR (ddPCR), targeting somatic single nucleotide variants (SNVs). This ddPCR-based method (ddPCR-MRD) had sensitivity up to 1E-4. We assessed ddPCR-MRD at 26 time points from eight T-ALL patients, and compared it to the results of PCR-MRD. Almost all results were concordant between the two methods, but ddPCR-MRD detected micro-residual disease that was missed by PCR-MRD in one patient. We also measured MRD in stored ovarian tissue of four pediatric cancer patients, and detected 1E-2 of submicroscopic infiltration. Considering the universality of ddPCR-MRD, the methods can be used as a complement for not only ALL, but also other malignant diseases regardless of tumor-specific Ig/TCR or surface antigen patterns.
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Affiliation(s)
- Ryota Shirai
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Tomoo Osumi
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Dai Keino
- Department of Pediatrics, St. Marianna University School of Medicine Hospital, Kawasaki, Japan.,Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Toru Uchiyama
- Department of Human Genetics, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Masahiro Sekiguchi
- Department of Pediatrics, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Mitsuteru Hiwatari
- Department of Pediatrics, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.,Department of Pediatrics, School of Medicine, Teikyo University, Tokyo, Japan
| | - Masanori Yoshida
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Kaoru Yoshida
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yuji Yamada
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seido Takae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Nobutaka Kiyokawa
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kimikazu Matsumoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Human Molecular Genetics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toshinori Hori
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan. .,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan. .,Department of Pediatrics, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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13
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Schilhabel A, Szczepanowski M, van Gastel-Mol EJ, Schillalies J, Ray J, Kim D, Nováková M, Dombrink I, van der Velden VHJ, Boettcher S, Brüggemann M, Kneba M, van Dongen JJM, Langerak AW, Ritgen M. Patient specific real-time PCR in precision medicine - Validation of IG/TR based MRD assessment in lymphoid leukemia. Front Oncol 2023; 12:1111209. [PMID: 36727082 PMCID: PMC9885152 DOI: 10.3389/fonc.2022.1111209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Detection of patient- and tumor-specific clonally rearranged immune receptor genes using real-time quantitative (RQ)-PCR is an accepted method in the field of precision medicine for hematologic malignancies. As individual primers are needed for each patient and leukemic clone, establishing performance specifications for the method faces unique challenges. Results for series of diagnostic assays for CLL and ALL patients demonstrate that the analytic performance of the method is not dependent on patients' disease characteristics. The calibration range is linear between 10-1 and 10-5 for 90% of all assays. The detection limit of the current standardized approach is between 1.8 and 4.8 cells among 100,000 leukocytes. RQ-PCR has about 90% overall agreement to flow cytometry and next generation sequencing as orthogonal methods. Accuracy and precision across different labs, and above and below the clinically applied cutoffs for minimal/measurable residual disease (MRD) demonstrate the robustness of the technique. The here reported comprehensive, IVD-guided analytical validation provides evidence that the personalized diagnostic methodology generates robust, reproducible and specific MRD data when standardized protocols for data generation and evaluation are used. Our approach may also serve as a guiding example of how to accomplish analytical validation of personalized in-house diagnostics under the European IVD Regulation.
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Affiliation(s)
- Anke Schilhabel
- Hämatologie Labor Kiel, Medical Department II, Hematology and Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany,*Correspondence: Anke Schilhabel,
| | - Monika Szczepanowski
- Hämatologie Labor Kiel, Medical Department II, Hematology and Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ellen J. van Gastel-Mol
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Janina Schillalies
- Hämatologie Labor Kiel, Medical Department II, Hematology and Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jill Ray
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, CA, United States
| | - Doris Kim
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, CA, United States
| | - Michaela Nováková
- Childhood Leukemia Investigation Prague (CLIP)-Department of Pediatric Hematology and Oncology, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czechia
| | - Isabel Dombrink
- Hämatologie Labor Kiel, Medical Department II, Hematology and Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Vincent H. J. van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sebastian Boettcher
- Department of Medicine III Hematology, Oncology and Palliative Care, University Hospital, Rostock, Germany
| | - Monika Brüggemann
- Hämatologie Labor Kiel, Medical Department II, Hematology and Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Michael Kneba
- Hämatologie Labor Kiel, Medical Department II, Hematology and Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jacques J. M. van Dongen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Anton W. Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Matthias Ritgen
- Hämatologie Labor Kiel, Medical Department II, Hematology and Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
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14
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Antigen Receptors Gene Analysis for Minimal Residual Disease Detection in Acute Lymphoblastic Leukemia: The Role of High Throughput Sequencing. HEMATO 2023. [DOI: 10.3390/hemato4010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The prognosis of adult acute lymphoblastic leukemia (ALL) is variable but more often dismal. Indeed, its clinical management is challenging, current therapies inducing complete remission in 65–90% of cases, but only 30–40% of patients being cured. The major determinant of treatment failure is relapse; consequently, measurement of residual leukemic blast (minimal residual disease, MRD) has become a powerful independent prognostic indicator in adults. Numerous evidences have also supported the clinical relevance of MRD assessment for risk class assignment and treatment selection. MRD can be virtually evaluated in all ALL patients using different technologies, such as polymerase chain reaction amplification of fusion transcripts and clonal rearrangements of antigen receptor genes, flow cytometric study of leukemic immunophenotypes and, the most recent, high throughput sequencing (HTS). In this review, the authors focused on the latest developments on MRD monitoring with emphasis on the use of HTS, as well as on the clinical impact of MRD monitoring.
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15
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Boissel N, Chiaretti S, Papayannidis C, Ribera JM, Bassan R, Sokolov AN, Alam N, Brescianini A, Pezzani I, Kreuzbauer G, Zugmaier G, Foà R, Rambaldi A. Real-world use of blinatumomab in adult patients with B-cell acute lymphoblastic leukemia in clinical practice: results from the NEUF study. Blood Cancer J 2023; 13:2. [PMID: 36599847 DOI: 10.1038/s41408-022-00766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 01/05/2023] Open
Abstract
This retrospective observational study (NEUF) included adult patients with B-cell acute lymphoblastic leukemia (B-cell ALL) who had received blinatumomab for the treatment of minimal residual disease-positive (MRD+) or relapsed/refractory (R/R) B-cell ALL via an expanded access program (EAP). Patients were eligible if blinatumomab was initiated via the EAP between January 2014 and June 2017. Patients were followed from blinatumomab initiation until death, entry into a clinical trial, the end of follow-up, or the end of the study period (December 31, 2017), whichever occurred first. Of the 249 adult patients included, 109 were MRD+ (83 Philadelphia chromosome-negative [Ph-] and 26 Philadelphia chromosome-positive [Ph+]) and 140 had a diagnosis of R/R B-cell ALL (106 Ph- and 34 Ph+). In the MRD+ group, within the first cycle of blinatumomab treatment, 93% (n = 49/53) of Ph- and 64% (n = 7/11) of Ph+ patients with evaluable MRD achieved an MRD response (MRD <0.01%). Median overall survival (OS) was not reached over a median follow-up time of 18.5 months (Ph-, 18.8 [range: 5.1-34.8] months; Ph+, 16.5 [range: 1.8-31.6] months). In the R/R group, within two cycles of blinatumomab, 51% of Ph- and 41% of Ph+ patients achieved complete hematologic remission (CR/CRh/CRi), and 83% of Ph- and 67% of Ph+ MRD-evaluable patients in CR/CRh/CRi achieved an MRD response. Median (95% confidence interval) OS was 12.2 (7.3-24.2) months in the R/R Ph- subgroup and 16.3 (5.3-not estimated) months in the R/R Ph+ subgroup. This large, real-world data set of adults with B-cell ALL treated with blinatumomab confirms efficacy outcomes from published studies.
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Affiliation(s)
- Nicolas Boissel
- Division of Hematology, EA3518 Saint-Louis Institute for Research, Saint-Louis Hospital, Paris, France.
| | - Sabina Chiaretti
- Hematology Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Cristina Papayannidis
- IRCCS, Azienda Ospedaliero Universitaria di Bologna, Institute of Hematology "Seràgnoli", Bologna, Italy
| | - Josep-Maria Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Renato Bassan
- Complex Operative Unit of Hematology, dell'Angelo Hospital and Santissimi Giovanni and Paolo Hospital, Mestre and Venice, Venezia-Mestre, Italy
| | - Andrey N Sokolov
- National Research Center for Hematology, Moscow, Russian Federation
| | | | | | | | | | | | - Robin Foà
- Hematology Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Alessandro Rambaldi
- Department of Oncology and Haematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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16
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Tecchio C, Russignan A, Krampera M. Immunophenotypic measurable residual disease monitoring in adult acute lymphoblastic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation. Front Oncol 2023; 13:1047554. [PMID: 36910638 PMCID: PMC9992536 DOI: 10.3389/fonc.2023.1047554] [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: 09/18/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) offers a survival benefit to adult patients affected by acute lymphoblastic leukemia (ALL). However, to avoid an overt disease relapse, patients with pre or post transplant persistence or occurrence of measurable residual disease (MRD) may require cellular or pharmacological interventions with eventual side effects. While the significance of multiparametric flow cytometry (MFC) in the guidance of ALL treatment in both adult and pediatric patients is undebated, fewer data are available regarding the impact of MRD monitoring, as assessed by MFC analysis, in the allo-HSCT settings. Aim of this article is to summarize and discuss currently available information on the role of MFC detection of MRD in adult ALL patients undergoing allo-HSCT. The significance of MFC-based MRD according to sensitivity level, timing, and in relation to molecular techniques of MRD and chimerism assessment will be also discussed.
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Affiliation(s)
- Cristina Tecchio
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
| | - Anna Russignan
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
| | - Mauro Krampera
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
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17
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Popov A, Henze G, Roumiantseva J, Budanov O, Belevtsev M, Verzhbitskaya T, Boyakova E, Movchan L, Tsaur G, Fadeeva M, Lagoyko S, Zharikova L, Miakova N, Litvinov D, Khlebnikova O, Streneva O, Stolyarova E, Ponomareva N, Novichkova G, Fechina L, Aleinikova O, Karachunskiy A. One-point flow cytometric MRD measurement to identify children with excellent outcome after intermediate-risk BCP-ALL: results of the ALL-MB 2008 study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04378-3. [PMID: 36169717 DOI: 10.1007/s00432-022-04378-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Measurement of minimal residual disease (MRD) with multicolor flow cytometry (MFC) has become an important tool in childhood acute lymphoblastic leukemia (ALL), mainly to identify rapid responders and reduce their therapy intensity. Protocols of the Moscow-Berlin (MB) group use a comparatively low (for standard risk; SR) or moderate (for intermediate risk; ImR) treatment intensity from the onset, based on initial patient characteristics. Recently, we reported that 90% of SR patients-50% B cell precursor (BCP-ALL)-MFC-MRD negative at end of induction (EOI)-had 95% event-free survival (EFS). METHODS: In the present study, we applied this method to children with initial ImR features. RESULTS In study MB 2008, 1105 children-32% of BCP-ALL patients-were assigned to the ImR group. Of these, 227 were treated in clinics affiliated with MFC laboratories of the MB group network, and included in this MFC-MRD pilot study. A single-point MFC-MRD measurement at the EOI with the threshold of 0.01% identified 65% of patients-20% of all BCP-ALL patients-with EFS of 93.5%. CONCLUSION Taking both studies together, the combination of clinical parameters and a one-point MRD measurement identifies 70% of BCP-ALL patients with an excellent outcome after low- or moderate-intensity therapy and avoids overtreatment of a significant proportion of patients.
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Affiliation(s)
- Alexander Popov
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation.
| | - Guenter Henze
- Department of Pediatric Oncology Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Roumiantseva
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | - Oleg Budanov
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation.,Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Mikhail Belevtsev
- Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Tatiana Verzhbitskaya
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Elena Boyakova
- Moscow City Blood Center Named After OK Gavrilov, Moscow, Russian Federation
| | - Liudmila Movchan
- Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Grigory Tsaur
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Maria Fadeeva
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | - Svetlana Lagoyko
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | - Liudmila Zharikova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | - Natalia Miakova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | - Dmitry Litvinov
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | | | - Olga Streneva
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Elena Stolyarova
- Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | | | - Galina Novichkova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | - Larisa Fechina
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Olga Aleinikova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
| | - Alexander Karachunskiy
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1, S. Mashela st, Moscow, 117998, Russian Federation
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18
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Yurttaş NÖ, Eşkazan AE. Clinical Application of Biomarkers for Hematologic Malignancies. Biomark Med 2022. [DOI: 10.2174/9789815040463122010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Over the last decade, significant advancements have been made in the
molecular mechanisms, diagnostic methods, prognostication, and treatment options in
hematologic malignancies. As the treatment landscape continues to expand,
personalized treatment is much more important.
With the development of new technologies, more sensitive evaluation of residual
disease using flow cytometry and next generation sequencing is possible nowadays.
Although some conventional biomarkers preserve their significance, novel potential
biomarkers accurately detect the mutational landscape of different cancers, and also,
serve as prognostic and predictive biomarkers, which can be used in evaluating therapy
responses and relapses. It is likely that we will be able to offer a more targeted and
risk-adapted therapeutic approach to patients with hematologic malignancies guided by
these potential biomarkers. This chapter summarizes the biomarkers used (or proposed
to be used) in the diagnosis and/or monitoring of hematologic neoplasms.;
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Affiliation(s)
- Nurgül Özgür Yurttaş
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine,
Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine,
Istanbul University-Cerrahpasa, Istanbul, Turkey
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19
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Dai Q, Liu R, Wang Y, Ye L, Peng L, Shi R, Guo S, He J, Yang H, Zhang G, Jiang Y. Longer Time Intervals From Symptom Onset to Diagnosis Affect the Overall Survival in Children With Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2022; 44:285-292. [PMID: 34699460 DOI: 10.1097/mph.0000000000002344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Early diagnosis and timely treatment are essential for effective cancer control and have been widely analyzed in childhood cancer. However, few studies have described the time to diagnosis and treatment in children with ALL. This study investigated delays in diagnosis and treatment initiation and their impact on survival. METHODS This retrospective cohort study included 419 patients 0 to 14 years old at a tertiary hospital between 2011 and 2015. The optimal cutoff values for delays were determined by X-tile software. The Kaplan-Meier method and Cox regression models were used to evaluate the impact of delays on survival. RESULTS The median diagnosis, treatment, and total delays were 21 (interquartile range [IQR]: 11-35), 4 (IQR: 2-7), and 26 (IQR: 16-43) days, respectively. The results of multivariate analyses showed that diagnosis delay, risk stratification, and minimal residual disease level were independent predictors for treatment outcome in childhood ALL. CONCLUSIONS These findings suggested that a longer time to diagnosis negatively affected the clinical outcome of childhood ALL. Reducing the time to diagnosis could help to improve survival in these patients.
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Affiliation(s)
- Qingkai Dai
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Rui Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yuefang Wang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Lei Ye
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Luyun Peng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Rui Shi
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Siqi Guo
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Jiajing He
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Hao Yang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Ge Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yongmei Jiang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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20
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Späth C, Schönau M, Gaubert S, Neumann T, Schmidt CA, Heidel FH, Krüger WH. Rhabdomyolysis induced by nelarabine. Ann Hematol 2022; 101:2111-2112. [PMID: 35715705 PMCID: PMC9375754 DOI: 10.1007/s00277-022-04879-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Christian Späth
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Mandy Schönau
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Sophie Gaubert
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Thomas Neumann
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Christian A Schmidt
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Florian H Heidel
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - William H Krüger
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
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21
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Sartor C, Arpinati M, Chirumbolo G, Dozza L, Cristiano G, Nanni J, Marconi G, Robustelli V, Vigliotta I, Parisi S, Terragna C, Testoni N, Paolini S, Martinelli G, Curti A, Cavo M, Papayannidis C. Baseline CD22 fluorescent intensity correlates with patient outcome after Inotuzumab Ozogamicin treatment. Hematol Oncol 2022; 40:734-742. [PMID: 35618655 DOI: 10.1002/hon.3029] [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: 04/02/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/07/2022]
Abstract
Antigen-directed target therapy for B-cell acute lymphoblastic leukemia (B-ALL) is now the standard of care for relapsed/refractory (R/R) disease. A comprehensive determination of the target itself is mandatory to aid physician's choice. We determined baseline CD22 expression percentage and fluorescent intensity (FI) on lymphoblasts of 30 patients with R/R B-ALL treated with anti-CD22 immunoconjugate drug Inotuzumab Ozogamicin (INO) and analyzed the impact of both parameters on patient outcome.Most patients (24/30, 80%) had a high leukemic blast CD22-positivity defined as ≥90%. We did not observe a benefit in terms of CR, OS and DoR for patients with CD22 ≥90% vs CD22<90%.Concerning CD22-FI quartile analysis we appreciated a trend for superior response rates in higher quartiles (Q2 -Q4 ) compared to Q1 and a significant benefit in terms of OS and DoR for patients with higher CD22-FI.INO demonstrates to be effective also in patients with lower CD22 expression, but therapeutical benefits are more evident in patients with higher CD22-FI. The evaluation of both CD22 percentage and CD22-FI of the leukemic blast may help physicians in therapeutic choices for R/R B-ALL patients when multiple treatment options are available, although no CD22 expression threshold can currently be identified below which INO should be considered not effective. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chiara Sartor
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Mario Arpinati
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Gabriella Chirumbolo
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Luca Dozza
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Gianluca Cristiano
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Jacopo Nanni
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Giovanni Marconi
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy.,Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014, Meldola (FC), Bologna, Italy
| | - Valentina Robustelli
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Ilaria Vigliotta
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Sarah Parisi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Carolina Terragna
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Nicoletta Testoni
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Stefania Paolini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014, Meldola (FC), Bologna, Italy
| | - Antonio Curti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Michele Cavo
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Università degli Studi di Bologna, Diagnostica e Sperimentale, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
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22
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Marks DI, Kirkwood AA, Rowntree CJ, Aguiar M, Bailey KE, Beaton B, Cahalin P, Castleton AZ, Clifton-Hadley L, Copland M, Goldstone AH, Kelly R, Lawrie E, Lee S, McMillan AK, McMullin MF, Menne TF, Mitchell RJ, Moorman AV, Patel B, Patrick P, Smith P, Taussig D, Yallop D, Alapi KZ, Fielding AK. Addition of four doses of rituximab to standard induction chemotherapy in adult patients with precursor B-cell acute lymphoblastic leukaemia (UKALL14): a phase 3, multicentre, randomised controlled trial. Lancet Haematol 2022; 9:e262-e275. [PMID: 35358441 PMCID: PMC8969057 DOI: 10.1016/s2352-3026(22)00038-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment for adults with acute lymphoblastic leukaemia requires improvement. UKALL14 was a UK National Cancer Research Institute Adult ALL group study that aimed to determine the benefit of adding the anti-CD20 monoclonal antibody, rituximab, to the therapy of adults with de novo B-precursor acute lymphoblastic leukaemia. METHODS This was an investigator-initiated, phase 3, randomised controlled trial done in all UK National Health Service Centres treating patients with acute lymphoblastic leukaemia (65 centres). Patients were aged 25-65 years with de-novo BCR-ABL1-negative acute lymphoblastic leukaemia. Patients with de-novo BCR-ABL1-positive acute lymphoblastic leukaemia were eligible if they were aged 19-65 years. Participants were randomly assigned (1:1) to standard-of-care induction therapy or standard-of-care induction therapy plus four doses of intravenous rituximab (375 mg/m2 on days 3, 10, 17, and 24). Randomisation used minimisation and was stratified by sex, age, and white blood cell count. No masking was used for patients, clinicians, or staff (including the trial statistician), although the central laboratory analysing minimal residual disease and CD20 was masked to treatment allocation. The primary endpoint was event-free survival in the intention-to-treat population. Safety was assessed in all participants who started trial treatment. This study is registered with ClincialTrials.gov, NCT01085617. FINDINGS Between April 19, 2012, and July 10, 2017, 586 patients were randomly assigned to standard of care (n=292) or standard of care plus rituximab (n=294). Nine patients were excluded from the final analysis due to misdiagnosis (standard of care n=4, standard of care plus rituximab n=5). In the standard-of-care group, median age was 45 years (IQR 22-65), 159 (55%) of 292 participants were male, 128 (44%) were female, one (<1%) was intersex, and 143 (59%) of 244 participants had high-risk cytogenetics. In the standard-of-care plus rituximab group, median age was 46 years (IQR 23-65), 159 (55%) of 294 participants were male, 130 (45%) were female, and 140 (60%) of 235 participants had high-risk cytogenetics. After a median follow-up of 53·7 months (IQR 40·3-70·4), 3-year event-free survival was 43·7% (95% CI 37·8-49·5) for standard of care versus 51·4% (45·4-57·1) for standard of care plus rituximab (hazard ratio [HR] 0·85 [95% CI 0·69-1·06]; p=0·14). The most common adverse events were infections and cytopenias, with no difference between the groups in the rates of adverse events. There were 11 (4%) fatal (grade 5) events in induction phases 1 and 2 in the standard-of-care group and 13 (5%) events in the standard-of-care plus rituximab group). 3-year non-relapse mortality was 23·7% (95% CI 19·0-29·4) in the standard-of-care group versus 20·6% (16·2-25·9) in the standard-of-care plus rituximab group (HR 0·88 [95% CI 0·62-1·26]; p=0·49). INTERPRETATION Standard of care plus four doses of rituximab did not significantly improve event-free survival over standard of care. Rituximab is beneficial in acute lymphoblastic leukaemia but four doses during induction is likely to be insufficient. FUNDING Cancer Research UK and Blood Cancer UK.
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Affiliation(s)
| | - Amy A Kirkwood
- CR UK and UCL Cancer Trial Centre, Cancer Institute, University College London, London, UK
| | | | | | | | | | - Paul Cahalin
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Laura Clifton-Hadley
- CR UK and UCL Cancer Trial Centre, Cancer Institute, University College London, London, UK
| | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Emma Lawrie
- CR UK and UCL Cancer Trial Centre, Cancer Institute, University College London, London, UK
| | - SooWah Lee
- University College London Cancer Institute, London, UK
| | - Andrew K McMillan
- Centre for Clinical Haematology, Nottingham City Hospital, Nottingham, UK
| | | | - Tobias F Menne
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Anthony V Moorman
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Bela Patel
- Barts Cancer Institute, The London School of Medicine, Queen Mary University of London, London, UK
| | - Pip Patrick
- CR UK and UCL Cancer Trial Centre, Cancer Institute, University College London, London, UK
| | - Paul Smith
- CR UK and UCL Cancer Trial Centre, Cancer Institute, University College London, London, UK
| | - David Taussig
- Haemato-Oncology Section, Royal Marsden Hospital, Sutton, UK
| | - Deborah Yallop
- King's College Hospital NHS Foundation Trust, London, UK
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23
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Moorman AV, Barretta E, Butler ER, Ward EJ, Twentyman K, Kirkwood AA, Enshaei A, Schwab C, Creasey T, Leongamornlert D, Papaemmanuil E, Patrick P, Clifton-Hadley L, Patel B, Menne T, McMillan AK, Harrison CJ, Rowntree CJ, Marks DI, Fielding AK. Prognostic impact of chromosomal abnormalities and copy number alterations in adult B-cell precursor acute lymphoblastic leukaemia: a UKALL14 study. Leukemia 2022; 36:625-636. [PMID: 34657128 PMCID: PMC8885405 DOI: 10.1038/s41375-021-01448-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/22/2022]
Abstract
Chromosomal abnormalities are established prognostic markers in adult ALL. We assessed the prognostic impact of established chromosomal abnormalities and key copy number alterations (CNA) among 652 patients with B-cell precursor ALL treated on a modern MRD driven protocol. Patients with KMT2A-AFF1, complex karyotype (CK) and low hypodiploidy/near-triploidy (HoTr) had high relapse rates 50%, 60% & 53% and correspondingly poor survival. Patients with BCR-ABL1 had an outcome similar to other patients. JAK-STAT abnormalities (CRLF2, JAK2) occurred in 6% patients and were associated with a high relapse rate (56%). Patients with ABL-class fusions were rare (1%). A small group of patients with ZNF384 fusions (n = 12) had very good survival. CNA affecting IKZF1, CDKN2A/B, PAX5, BTG1, ETV6, EBF1, RB1 and PAR1 were assessed in 436 patients. None of the individual deletions or profiles were associated with survival, either in the cohort overall or within key subgroups. Collectively these data indicate that primary genetic abnormalities are stronger prognostic markers than secondary deletions. We propose a revised UKALL genetic risk classification based on key established chromosomal abnormalities: (1) very high risk: CK, HoTr or JAK-STAT abnormalities; (2) high risk: KMT2A fusions; (3) Tyrosine kinase activating: BCR-ABL1 and ABL-class fusions; (4) standard risk: all other patients.
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Affiliation(s)
- Anthony V Moorman
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Emilio Barretta
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ellie R Butler
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eleanor J Ward
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Twentyman
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Amir Enshaei
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Schwab
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tom Creasey
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Pip Patrick
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Laura Clifton-Hadley
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Bela Patel
- Department of Haematology, Queen Mary University of London, London, UK
| | - Tobias Menne
- Department of Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew K McMillan
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Christine J Harrison
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare J Rowntree
- Department of Haematology, Cardiff And Vale University Health Board, Cardiff, UK
| | - David I Marks
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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24
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Singh J, Gorniak M, Grigoriadis G, Westerman D, McBean M, Venn N, Law T, Sutton R, Morgan S, Fleming S. Correlation between a 10-color flow cytometric measurable residual disease (MRD) analysis and molecular MRD in adult B-acute lymphoblastic leukemia. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2022; 102:115-122. [PMID: 34806309 DOI: 10.1002/cyto.b.22043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/21/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Measurable residual disease (MRD) monitoring in acute lymphoblastic leukemia (ALL) is an important predictive factor for patient outcome and treatment intensification. Molecular monitoring, particularly with quantitative polymerase chain reaction (qPCR) to measure immunoglobin heavy or kappa chain (Ig) or T-cell receptor (TCR) gene rearrangements, offers high sensitivity but accessibility is limited by expertise, cost, and turnaround time. Flow cytometric assays are cheaper and more widely available, and sensitivity is improved with multi-parameter flow cytometry at eight or more colors. METHODS We developed a 10-color single tube flow cytometry assay. Samples were subject to bulk ammonium chloride lysis to maximize cell yields with a target of 1 × 106 events. Once normal maturation patterns were established, patient samples were analyzed in parallel to standard molecular monitoring. RESULTS Flow cytometry was performed on 114 samples. An informative immunophenotype was identifiable in all 22 patients who had a diagnostic sample. MRD analysis was performed on 87 samples. The median lower limits of detection and quantification were 0.004% (range 0.0005%-0.028%) and 0.01% (range 0.001%-0.07%) respectively. Sixty-five samples had concurrent molecular MRD testing, with good correlation (r = 0.83, p < 0.001). Results were concordant in 52 samples, and discordant in 13 samples, including one case where impending relapse was detected by flow cytometry but not Ig/TCR qPCR. CONCLUSIONS Our 10-color flow cytometric MRD assay provided adequate sensitivity and good correlation with molecular assays. This technique offers rapid and affordable testing in B-ALL patients, including cases where a suitable molecular assay cannot be developed or has reduced sensitivity.
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Affiliation(s)
- Jasmine Singh
- Laboratory Haematology, Alfred Pathology, Melbourne, Victoria, Australia
| | - Malgorzata Gorniak
- Laboratory Haematology, Alfred Pathology, Melbourne, Victoria, Australia
| | - George Grigoriadis
- Laboratory Haematology, Alfred Pathology, Melbourne, Victoria, Australia.,Clinical Haematology, Monash Health, Clayton, Victoria, Australia
| | - David Westerman
- Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michelle McBean
- Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicola Venn
- Children's Cancer Institute and School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Tamara Law
- Children's Cancer Institute and School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Rosemary Sutton
- Children's Cancer Institute and School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Sue Morgan
- Laboratory Haematology, Alfred Pathology, Melbourne, Victoria, Australia
| | - Shaun Fleming
- Laboratory Haematology, Alfred Pathology, Melbourne, Victoria, Australia.,Clinical Haematology, Monash Health, Clayton, Victoria, Australia
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25
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Popov A, Tsaur G, Verzhbitskaya T, Riger T, Permikin Z, Demina A, Mikhailova E, Shorikov E, Arakaev O, Streneva O, Khlebnikova O, Makarova O, Miakova N, Fominikh V, Boichenko E, Kondratchik K, Ponomareva N, Novichkova G, Karachunskiy A, Fechina L. Comparison of minimal residual disease measurement by multicolour flow cytometry and PCR for fusion gene transcripts in infants with acute lymphoblastic leukaemia with KMT2A gene rearrangements. Br J Haematol 2021; 201:510-519. [PMID: 34970734 DOI: 10.1111/bjh.18021] [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: 10/12/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
This study aimed to evaluate the concordance between minimal residual disease (MRD) results obtained by multicolour flow cytometry (MFC) and polymerase chain reaction for fusion gene transcripts (FGTs) in infants with acute lymphoblastic leukaemia (ALL) associated with rearrangement of the KMT2A gene (KMT2A-r). A total of 942 bone marrow (BM) samples from 123 infants were studied for MFC-MRD and FGT-MRD. In total, 383 samples (40.7%) were concordantly MRD-negative. MRD was detected by the two methods in 441 cases (46.8%); 99 samples (10.5%) were only FGT-MRD-positive and 19 (2.0%) were only MFC-MRD-positive. A final concordance rate of 87.4% was established. Most discordance occurred if residual leukaemia was present at levels close to the sensitivity limits. Neither the type of KMT2A fusion nor a new type of treatment hampering MFC methodology had an influence on the concordance rate. The prognostic value of MFC-MRD and FGT-MRD differed. MFC-MRD was able to identify a rapid response at early time-points, whereas FGT-MRD was a reliable relapse predictor at later treatment stages. Additionally, the most precise risk definition was obtained when combining the two methods. Because of the high comparability in results, these two rather simple and inexpensive approaches could be good options of high clinical value.
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Affiliation(s)
- Alexander Popov
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Grigory Tsaur
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation.,Ural State Medical University, Ekaterinburg, Russian Federation
| | - Tatiana Verzhbitskaya
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Tatiana Riger
- Regional Children's Hospital, Ekaterinburg, Russian Federation
| | - Zhan Permikin
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Ural State Medical University, Ekaterinburg, Russian Federation
| | - Anna Demina
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Ekaterina Mikhailova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Egor Shorikov
- PET-Technology Center of Nuclear Medicine, Ekaterinburg, Russian Federation
| | - Oleg Arakaev
- Regional Children's Hospital, Ekaterinburg, Russian Federation
| | - Olga Streneva
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | | | - Olga Makarova
- Regional Children's Hospital, Ekaterinburg, Russian Federation
| | - Natalia Miakova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Veronika Fominikh
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Elmira Boichenko
- City Children's Hospital №1, Saint-Petersburg, Russian Federation
| | | | | | - Galina Novichkova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexander Karachunskiy
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Larisa Fechina
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
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26
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Gökbuget N. MRD in adult Ph/BCR-ABL-negative ALL: how best to eradicate? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:718-725. [PMID: 35158373 PMCID: PMC8824253 DOI: 10.1182/hematology.2021000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Evaluation of minimal residual disease (MRD) during first-line treatment and after salvage therapy is part of the standard management of acute lymphoblastic leukemia (ALL). Persistent or recurrent MRD is one of the most relevant prognostic factors and identifies a group of patients with resistance to standard chemotherapy. These patients have a high risk of relapse despite continued first-line therapy. Although stem cell transplantation (SCT) is an appropriate strategy, patients with high MRD show an increased relapse rate even after SCT. Approximately one-quarter of adult ALL patients develop an MRD failure, defined as MRD above 0.01% after standard induction and consolidation. The best time point and level of MRD for treatment modification are matters of debate. In order to eradicate MRD and thereby improve chances for a cure, new targeted compounds with different mechanisms of action compared to chemotherapy are being utilized. These compounds include monoclonal antibodies, chimeric antigen receptor T cells, and molecular targeted compounds. Essential factors for decision-making, available compounds, and follow-up therapies are discussed.
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Affiliation(s)
- Nicola Gökbuget
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany
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27
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Maurer-Granofszky M, Schumich A, Buldini B, Gaipa G, Kappelmayer J, Mejstrikova E, Karawajew L, Rossi J, Suzan AÇ, Agriello E, Anastasiou-Grenzelia T, Barcala V, Barna G, Batinić D, Bourquin JP, Brüggemann M, Bukowska-Strakova K, Burnusuzov H, Carelli D, Deniz G, Dubravčić K, Feuerstein T, Gaillard MI, Galeano A, Giordano H, Gonzalez A, Groeneveld-Krentz S, Hevessy Z, Hrusak O, Iarossi MB, Jáksó P, Kloboves Prevodnik V, Kohlscheen S, Kreminska E, Maglia O, Malusardi C, Marinov N, Martin BM, Möller C, Nikulshin S, Palazzi J, Paterakis G, Popov A, Ratei R, Rodríguez C, Sajaroff EO, Sala S, Samardzija G, Sartor M, Scarparo P, Sędek Ł, Slavkovic B, Solari L, Svec P, Szczepanski T, Taparkou A, Torrebadell M, Tzanoudaki M, Varotto E, Vernitsky H, Attarbaschi A, Schrappe M, Conter V, Biondi A, Felice M, Campbell M, Kiss C, Basso G, Dworzak MN. An Extensive Quality Control and Quality Assurance (QC/QA) Program Significantly Improves Inter-Laboratory Concordance Rates of Flow-Cytometric Minimal Residual Disease Assessment in Acute Lymphoblastic Leukemia: An I-BFM-FLOW-Network Report. Cancers (Basel) 2021; 13:cancers13236148. [PMID: 34885257 PMCID: PMC8656726 DOI: 10.3390/cancers13236148] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Standardization of flow-cytometric assessment of minimal residual disease in acute lymphoid leukemia (ALL) is necessary to allow concordant multicentric application of the methodology. This is a prerequisite for internationally collaborative trials, such as the AIEOP-BFM-ALL and the ALL IC-BFM trial. We developed and applied a comprehensive training and quality control program involving a large number of international laboratories within the I-BFM consortium to complement standardization of the methodology with an educational component as well as with persistent quality control measures to allow large ALL treatment trials which use multi-laboratory FCM-MRD assessments for risk stratification of pediatric patients with ALL. Abstract Monitoring of minimal residual disease (MRD) by flow cytometry (FCM) is a powerful prognostic tool for predicting outcomes in acute lymphoblastic leukemia (ALL). To apply FCM-MRD in large, collaborative trials, dedicated laboratory staff must be educated to concordantly high levels of expertise and their performance quality should be continuously monitored. We sought to install a unique and comprehensive training and quality control (QC) program involving a large number of reference laboratories within the international Berlin-Frankfurt-Münster (I-BFM) consortium, in order to complement the standardization of the methodology with an educational component and persistent quality control measures. Our QC and quality assurance (QA) program is based on four major cornerstones: (i) a twinning maturation program, (ii) obligatory participation in external QA programs (spiked sample send around, United Kingdom National External Quality Assessment Service (UK NEQAS)), (iii) regular participation in list-mode-data (LMD) file ring trials (FCM data file send arounds), and (iv) surveys of independent data derived from trial results. We demonstrate that the training of laboratories using experienced twinning partners, along with continuous educational feedback significantly improves the performance of laboratories in detecting and quantifying MRD in pediatric ALL patients. Overall, our extensive education and quality control program improved inter-laboratory concordance rates of FCM-MRD assessments and ultimately led to a very high conformity of risk estimates in independent patient cohorts.
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Affiliation(s)
| | - Angela Schumich
- Children’s Cancer Research Institute, Medical University of Vienna, 1090 Vienna, Austria; (M.M.-G.); (A.S.)
| | - Barbara Buldini
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Giuseppe Gaipa
- M. Tettamanti Foundation Research Center, Department of Pediatrics, University of Milano-Bicocca, 20900 Monza, Italy; (G.G.); (O.M.); (S.S.)
| | - Janos Kappelmayer
- Department of Laboratory Medicine, University of Debrecen, 4032 Debrecen, Hungary; (J.K.); (Z.H.)
| | - Ester Mejstrikova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, 150 06 Prague, Czech Republic; (E.M.); (O.H.)
| | - Leonid Karawajew
- Department of Pediatric Oncology and Hematology, Charité Berlin, 10117 Berlin, Germany; (L.K.); (S.G.-K.)
| | - Jorge Rossi
- Cellular Immunology Laboratory, Hospital de Pediatria “Dr. Juan P. Garrahan”, Buenos Aires C1245, Argentina; (J.R.); (E.O.S.)
| | - Adın Çınar Suzan
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, 34452 Istanbul, Turkey; (A.Ç.S.); (G.D.)
| | - Evangelina Agriello
- LEB Laboratorio, Servicio de Hematologia Hospital Penna, Bahia Blanca B8000, Argentina;
| | | | - Virna Barcala
- Laboratory—Flow Cytometry, Citomlab, Buenos Aires C1406AWK, Argentina;
| | - Gábor Barna
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary;
| | - Drago Batinić
- Division of Laboratory Immunology, Department of Laboratory Diagnostics, University Hospital Centre Zagreb & School of Medicine, 10000 Zagreb, Croatia; (D.B.); (K.D.)
| | - Jean-Pierre Bourquin
- Department of Oncology and Children’s Cancer Research Center, University Children’s Hospital, 8032 Zurich, Switzerland; (J.-P.B.); (C.M.)
| | - Monika Brüggemann
- Department of Hematology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.B.); (S.K.)
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Hasan Burnusuzov
- Center of Competence “PERIMED”, Department of Pediatrics, Department of Microbiology and Clinical Immunology, Medical University Plovdiv, 4002 Plovdiv, Bulgaria;
| | | | - Günnur Deniz
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, 34452 Istanbul, Turkey; (A.Ç.S.); (G.D.)
| | - Klara Dubravčić
- Division of Laboratory Immunology, Department of Laboratory Diagnostics, University Hospital Centre Zagreb & School of Medicine, 10000 Zagreb, Croatia; (D.B.); (K.D.)
| | - Tamar Feuerstein
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider’s Children’s Medical Center, Petah Tikva 4920235, Israel;
| | - Marie Isabel Gaillard
- Bioquimica, Inmunologia, Hospital de Ninos Rocardo Gutierrez, Buenos Aires C1425EFD, Argentina;
| | - Adriana Galeano
- Flow Cytometry Laboratory, FUNDALEU, Buenos Aires C1114, Argentina;
| | - Hugo Giordano
- Fundación Pérez Scremini, Pediatric Hematology-Oncology Service, Pereira Rossell Hospital, Montevideo 11600, Uruguay;
| | | | - Stefanie Groeneveld-Krentz
- Department of Pediatric Oncology and Hematology, Charité Berlin, 10117 Berlin, Germany; (L.K.); (S.G.-K.)
| | - Zsuzsanna Hevessy
- Department of Laboratory Medicine, University of Debrecen, 4032 Debrecen, Hungary; (J.K.); (Z.H.)
| | - Ondrej Hrusak
- Department of Paediatric Haematology and Oncology, University Hospital Motol, 150 06 Prague, Czech Republic; (E.M.); (O.H.)
| | - Maria Belen Iarossi
- Flow Cytometry Laboratory, Provincial Histocompatibility Reference Centre, CUCAIBA, Buenos Aires C1114, Argentina;
| | - Pál Jáksó
- Flow Cytometry Laboratory, Department of Pathology, Clinical Centre, University of Pécs, 7622 Pécs, Hungary;
| | - Veronika Kloboves Prevodnik
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Saskia Kohlscheen
- Department of Hematology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.B.); (S.K.)
| | - Elena Kreminska
- Clinical Laboratory Diagnostics and Metrology of NCSH “OHMATDYT”, Ministry of Heath of Ukraine, 01601 Kiev, Ukraine;
| | - Oscar Maglia
- M. Tettamanti Foundation Research Center, Department of Pediatrics, University of Milano-Bicocca, 20900 Monza, Italy; (G.G.); (O.M.); (S.S.)
| | - Cecilia Malusardi
- Hospital de Clinica Jose de San Martin, Buenos Aires C1120, Argentina;
| | - Neda Marinov
- PINDA, Chilean National Pediatric Oncology Group, Hospital Roberto del Rio, Universidad de Chile, Santiago 8380418, Chile; (N.M.); (M.C.)
| | | | - Claudia Möller
- Department of Oncology and Children’s Cancer Research Center, University Children’s Hospital, 8032 Zurich, Switzerland; (J.-P.B.); (C.M.)
| | - Sergey Nikulshin
- Hematopathology and Flow Cytometry Division, Children’s Clinical University Hospital, LV-1004 Riga, Latvia;
| | | | | | - Alexander Popov
- Laboratory of Leukemia Immunophenotyping, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117997 Moscow, Russia;
| | - Richard Ratei
- Clinic for Hematology and Tumor Immunology, HELIOS Klinikum Berlin-Buch, 13125 Berlin, Germany;
| | - Cecilia Rodríguez
- Hospital Nacional de Clínicas, Universidad Nacional de Córdoba, Cordoba X5000HUA, Argentina;
| | - Elisa Olga Sajaroff
- Cellular Immunology Laboratory, Hospital de Pediatria “Dr. Juan P. Garrahan”, Buenos Aires C1245, Argentina; (J.R.); (E.O.S.)
| | - Simona Sala
- M. Tettamanti Foundation Research Center, Department of Pediatrics, University of Milano-Bicocca, 20900 Monza, Italy; (G.G.); (O.M.); (S.S.)
| | - Gordana Samardzija
- Laboratory for Flow Cytometry and Immunology, Institute for Health and Protection of Mother and Child of Serbia, 11070 Belgrade, Serbia; (G.S.); (B.S.)
| | - Mary Sartor
- The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia;
| | - Pamela Scarparo
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Łukasz Sędek
- Department of Microbiology and Immunology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Bojana Slavkovic
- Laboratory for Flow Cytometry and Immunology, Institute for Health and Protection of Mother and Child of Serbia, 11070 Belgrade, Serbia; (G.S.); (B.S.)
| | - Liliana Solari
- Servicio de Bioquimica, Hospital Posadas, Buenos Aires B1684, Argentina;
| | - Peter Svec
- National Institute of Children’s Diseases, 831 01 Bratislava, Slovakia;
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Anna Taparkou
- Department of Pediatric Oncology Hippokration General Hospital, 546 42 Thessaloniki, Greece;
| | | | - Marianna Tzanoudaki
- Department of Immunology & Histocompatibility, “Agia Sophia” Children’s Hospital, 115 27 Athens, Greece;
| | - Elena Varotto
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Helly Vernitsky
- Hematology Lab, Sheba Medical Center, Ramat Gan 52621, Israel;
| | - Andishe Attarbaschi
- St. Anna Children’s Hospital, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
| | - Martin Schrappe
- Department of Pediatrics, University Medical Center SchleswigHolstein, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany;
| | - Valentino Conter
- Clinica Pediatrica University degli Studi di Milano Biococca, Fondazione MBBM, 20900 Monza, Italy; (V.C.); (A.B.)
| | - Andrea Biondi
- Clinica Pediatrica University degli Studi di Milano Biococca, Fondazione MBBM, 20900 Monza, Italy; (V.C.); (A.B.)
| | - Marisa Felice
- Department of Hematology and Oncology, Hospital de Pediatria “Dr. Juan P. Garrahan”, Buenos Aires C1245, Argentina;
| | - Myriam Campbell
- PINDA, Chilean National Pediatric Oncology Group, Hospital Roberto del Rio, Universidad de Chile, Santiago 8380418, Chile; (N.M.); (M.C.)
| | - Csongor Kiss
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Giuseppe Basso
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Michael N. Dworzak
- Children’s Cancer Research Institute, Medical University of Vienna, 1090 Vienna, Austria; (M.M.-G.); (A.S.)
- St. Anna Children’s Hospital, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40470-4064
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28
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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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29
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Mitchell RJ, Kirkwood AA, Barretta E, Clifton-Hadley L, Lawrie E, Lee S, Leongamornlert D, Marks DI, McMillan AK, Menne TF, Papaemmanuil E, Patel B, Patrick P, Rowntree CJ, Zareian N, Alapi KZ, Moorman AV, Fielding AK. IKZF1 alterations are not associated with outcome in 498 adults with B-precursor ALL enrolled in the UKALL14 trial. Blood Adv 2021; 5:3322-3332. [PMID: 34477813 PMCID: PMC8525226 DOI: 10.1182/bloodadvances.2021004430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/03/2021] [Indexed: 11/20/2022] Open
Abstract
IKZF1 deletions (ΔIKZF1) are commonly detected in B-precursor acute lymphoblastic leukemia (ALL; B-ALL) and are widely assumed to have a significant impact on outcome. We compared the ability of multiplex ligand-dependent probe amplification (MLPA) and polymerase chain reaction (PCR) to detect ΔIKZF1 and to determine the impact on event-free survival of patients with precursor B-ALL aged 23 to 65 years recruited to the completed trial UKALL14 (ISRCTN 66541317). From 655 recruits with BCR-ABL1+ and BCR-ABL1- B-ALL, all available diagnostic DNA samples (76% of the recruited population) were screened by multiplex end point PCR covering 4 deletions: dominant-negative (DN) Δ4-7 or the loss of function Δ2-7, Δ4-8, and Δ2-8 (n = 498), MLPA (n = 436), or by both (n = 420). Although patients with BCR-ABL1- ΔIKZF1 were more likely to have minimal residual disease at the end of induction, we did not find any impact of ΔIKZF1 (including subgroup analysis for DN or loss-of-function lesions) or the IKZF1plus genotype on event-free, overall survival, or relapse risk by univariable or multivariable analyses. Consistent with the technical approach, MLPA not only detected a wider range of deletions than PCR but also failed to detect some PCR-detected lesions. The main difference between our study and others reporting an association between ΔIKZF1 and outcome is the older age of participants in our population. The impact of ΔIKZF1 in ALL may be less marked in an older population of patients. Our study underscores the need for analyses in large, harmonized data sets. This trial was registered at www.clinicaltrials.gov as #NCT01085617.
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Affiliation(s)
| | - Amy A Kirkwood
- Cancer Research UK (CRUK) and University College London (UCL) Cancer Trials Centre, UCL Cancer Institute, UCL, London, United Kingdom and
| | - Emilio Barretta
- Northern Institute for Cancer Research, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom and
| | - Laura Clifton-Hadley
- Cancer Research UK (CRUK) and University College London (UCL) Cancer Trials Centre, UCL Cancer Institute, UCL, London, United Kingdom and
| | - Emma Lawrie
- Cancer Research UK (CRUK) and University College London (UCL) Cancer Trials Centre, UCL Cancer Institute, UCL, London, United Kingdom and
| | | | | | - David I Marks
- United Bristol Healthcare Trust, Bristol, United Kingdom and
| | - Andrew K McMillan
- Centre for Clinical Haematology, Nottingham City Hospital, Nottingham, United Kingdom and
| | - Tobias F Menne
- Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne, United Kingdom and
| | | | - Bela Patel
- Barts Cancer Institute, The London School of Medicine, Queen Mary University of London, London, United Kingdom; and
| | - Pip Patrick
- Cancer Research UK (CRUK) and University College London (UCL) Cancer Trials Centre, UCL Cancer Institute, UCL, London, United Kingdom and
| | - Clare J Rowntree
- Cardiff and Vale University Health Board (UHB), Wales, United Kingdom
| | | | | | - Anthony V Moorman
- Northern Institute for Cancer Research, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom and
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30
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Ebach F, Hainmann I, Eis‐Hübinger AM, Escherisch G, Dilloo D, Reutter HM, Müller A. Successful ECMO therapy in a child with COVID-19-associated ARDS and acute lymphoblastic leukemia. Pediatr Blood Cancer 2021; 68:e29100. [PMID: 34022118 PMCID: PMC8209893 DOI: 10.1002/pbc.29100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/05/2022]
Affiliation(s)
- Fabian Ebach
- Department of Neonatology and Pediatric Intensive Care, Children's HospitalUniversity of BonnBonnGermany
| | - Ina Hainmann
- Department of Pediatric Hematology and Oncology, Children's HospitalUniversity of BonnBonnGermany
| | | | - Gabriele Escherisch
- Clinic of Paediatric Haematology and OncologyUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Dagmar Dilloo
- Department of Pediatric Hematology and Oncology, Children's HospitalUniversity of BonnBonnGermany
| | - Heiko M. Reutter
- Department of Neonatology and Pediatric Intensive Care, Children's HospitalUniversity of BonnBonnGermany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care, Children's HospitalUniversity of BonnBonnGermany
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31
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Minimal residual disease quantification in ovarian tissue collected from patients in complete remission of acute leukemia. Blood 2021; 137:1697-1701. [PMID: 33171484 DOI: 10.1182/blood.2020007782] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/18/2020] [Indexed: 11/20/2022] Open
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32
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Phase 2 study of pembrolizumab for measurable residual disease in adults with acute lymphoblastic leukemia. Blood Adv 2021; 4:3239-3245. [PMID: 32692850 DOI: 10.1182/bloodadvances.2020002403] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 12/26/2022] Open
Abstract
The presence of measurable residual disease (MRD) in acute lymphoblastic leukemia (ALL) confers a poor prognosis. CD19-targeted immunotherapy is effective against MRD but is logistically challenging, potentially toxic, and not applicable to T-cell ALL. We thus hypothesized that inhibition of PD-1 with pembrolizumab could also be effective for MRD, but without lineage restriction. The primary objective of this phase 2 study was to evaluate the efficacy of pembrolizumab in patients with ALL and MRD. Key eligibility criteria included adults with B- or T-cell ALL and MRD detectable by multiparameter flow cytometry or quantitative polymerase chain reaction from bone marrow aspirate (BMA) despite chemotherapy (plus ABL kinase inhibitor if Philadelphia chromosome positive). Pembrolizumab 200 mg IV was given every 3 weeks. Response was assessed by BMA using methods that previously detected MRD. The primary end point was complete MRD response rate. We stopped enrollment early; only 1 of 12 (8%) experienced a complete MRD response, which lasted 3 weeks. Interestingly, this patient had previously received hematopoietic cell transplantation and CD19-targeted chimeric antigen receptor-modified T-cell therapy and was the only patient to experience an immune-related adverse event from pembrolizumab (grade 3 Stevens-Johnson syndrome). Median overall survival from enrollment was 12.7 months. In summary, pembrolizumab had minimal activity against MRD but was generally well tolerated. These data can be compared with ongoing anti-PD-1 combination studies in ALL, and they further establish the role of trials specifically for patients with MRD. This trial was registered at www.clinicaltrials.gov as #NCT02767934.
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33
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Chemotherapy or allogeneic transplantation in high-risk Philadelphia chromosome-negative adult lymphoblastic leukemia. Blood 2021; 137:1879-1894. [PMID: 33150388 DOI: 10.1182/blood.2020007311] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/01/2020] [Indexed: 01/02/2023] Open
Abstract
The need for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adults with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) with high-risk (HR) features and adequate measurable residual disease (MRD) clearance remains unclear. The aim of the ALL-HR-11 trial was to evaluate the outcomes of HR Ph- adult ALL patients following chemotherapy or allo-HSCT administered based on end-induction and consolidation MRD levels. Patients aged 15 to 60 years with HR-ALL in complete response (CR) and MRD levels (centrally assessed by 8-color flow cytometry) <0.1% after induction and <0.01% after early consolidation were assigned to receive delayed consolidation and maintenance therapy up to 2 years in CR. The remaining patients were allocated to allo-HSCT. CR was attained in 315/348 patients (91%), with MRD <0.1% after induction in 220/289 patients (76%). By intention-to-treat, 218 patients were assigned to chemotherapy and 106 to allo-HSCT. The 5-year (±95% confidence interval) cumulative incidence of relapse (CIR), overall survival (OS), and event-free survival probabilities for the whole series were 43% ± 7%, 49% ± 7%, and 40% ± 6%, respectively, with CIR and OS rates of 45% ± 8% and 59% ± 9% for patients assigned to chemotherapy and of 40% ± 12% and 38% ± 11% for those assigned to allo-HSCT, respectively. Our results show that avoiding allo-HSCT does not hamper the outcomes of HR Ph- adult ALL patients up to 60 years with adequate MRD response after induction and consolidation. Better postremission alternative therapies are especially needed for patients with poor MRD clearance. This trial was registered at www.clinicaltrials.gov as # NCT01540812.
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34
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Topp MS, Stein AS, Gökbuget N, Horst HA, Boissel N, Martinelli G, Kantarjian H, Brüggemann M, Chen Y, Zugmaier G. Blinatumomab as first salvage versus second or later salvage in adults with relapsed/refractory B-cell precursor acute lymphoblastic leukemia: Results of a pooled analysis. Cancer Med 2021; 10:2601-2610. [PMID: 33734596 PMCID: PMC8026950 DOI: 10.1002/cam4.3731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/08/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Blinatumomab is a BiTE® immuno‐oncology therapy indicated for the treatment of patients with relapsed or refractory (r/r) B‐cell precursor (BCP) acute lymphoblastic leukemia (ALL).
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Affiliation(s)
- Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Anthony S Stein
- Gehr Leukemia Center, City of Hope Medical Center, Duarte, CA, USA
| | - Nicola Gökbuget
- Medizinische Klinik III (Hämatologie/Onkologie/Rheumatologie/Infektiologie, Universitätsklinikum, Frankfurt, Germany
| | - Heinz-August Horst
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nicolas Boissel
- Unité d'Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, Paris, France
| | - Giovanni Martinelli
- Scientific Directorate, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Monika Brüggemann
- Sektion für Hämatologische Spezialdiagnostik Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Yuqi Chen
- Global Biostatistical Science, Amgen Inc, Thousand Oaks, California, USA
| | - Gerhard Zugmaier
- Global Development, Amgen Research (Munich) GmbH, Munich, Germany
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35
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Locatelli F, Zugmaier G, Rizzari C, Morris JD, Gruhn B, Klingebiel T, Parasole R, Linderkamp C, Flotho C, Petit A, Micalizzi C, Mergen N, Mohammad A, Kormany WN, Eckert C, Möricke A, Sartor M, Hrusak O, Peters C, Saha V, Vinti L, von Stackelberg A. Effect of Blinatumomab vs Chemotherapy on Event-Free Survival Among Children With High-risk First-Relapse B-Cell Acute Lymphoblastic Leukemia: A Randomized Clinical Trial. JAMA 2021; 325:843-854. [PMID: 33651091 PMCID: PMC7926287 DOI: 10.1001/jama.2021.0987] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Blinatumomab is a CD3/CD19-directed bispecific T-cell engager molecule with efficacy in children with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL). OBJECTIVE To evaluate event-free survival in children with high-risk first-relapse B-ALL after a third consolidation course with blinatumomab vs consolidation chemotherapy before allogeneic hematopoietic stem cell transplant. DESIGN, SETTING, AND PARTICIPANTS In this randomized phase 3 clinical trial, patients were enrolled November 2015 to July 2019 (data cutoff, July 17, 2019). Investigators at 47 centers in 13 countries enrolled children older than 28 days and younger than 18 years with high-risk first-relapse B-ALL in morphologic complete remission (M1 marrow, <5% blasts) or with M2 marrow (blasts ≥5% and <25%) at randomization. INTERVENTION Patients were randomized to receive 1 cycle of blinatumomab (n = 54; 15 μg/m2/d for 4 weeks, continuous intravenous infusion) or chemotherapy (n = 54) for the third consolidation. MAIN OUTCOMES AND MEASURES The primary end point was event-free survival (events: relapse, death, second malignancy, or failure to achieve complete remission). The key secondary efficacy end point was overall survival. Other secondary end points included minimal residual disease remission and incidence of adverse events. RESULTS A total of 108 patients were randomized (median age, 5.0 years [interquartile range {IQR}, 4.0-10.5]; 51.9% girls; 97.2% M1 marrow) and all patients were included in the analysis. Enrollment was terminated early for benefit of blinatumomab in accordance with a prespecified stopping rule. After a median of 22.4 months of follow-up (IQR, 8.1-34.2), the incidence of events in the blinatumomab vs consolidation chemotherapy groups was 31% vs 57% (log-rank P < .001; hazard ratio [HR], 0.33 [95% CI, 0.18-0.61]). Deaths occurred in 8 patients (14.8%) in the blinatumomab group and 16 (29.6%) in the consolidation chemotherapy group. The overall survival HR was 0.43 (95% CI, 0.18-1.01). Minimal residual disease remission was observed in more patients in the blinatumomab vs consolidation chemotherapy group (90% [44/49] vs 54% [26/48]; difference, 35.6% [95% CI, 15.6%-52.5%]). No fatal adverse events were reported. In the blinatumomab vs consolidation chemotherapy group, the incidence of serious adverse events was 24.1% vs 43.1%, respectively, and the incidence of adverse events greater than or equal to grade 3 was 57.4% vs 82.4%. Adverse events leading to treatment discontinuation were reported in 2 patients in the blinatumomab group. CONCLUSIONS AND RELEVANCE Among children with high-risk first-relapse B-ALL, treatment with 1 cycle of blinatumomab compared with standard intensive multidrug chemotherapy before allogeneic hematopoietic stem cell transplant resulted in an improved event-free survival at a median of 22.4 months of follow-up. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02393859.
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Affiliation(s)
- Franco Locatelli
- IRCCS Ospedale Pediatrico Bambino Gesù and Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | - Rosanna Parasole
- Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Naples, Italy
| | | | | | - Arnaud Petit
- Sorbonne Université, Hôpital Armand Trousseau, AP-HP, Paris, France
| | | | | | | | | | | | - Anja Möricke
- Universitätsklinikum Schleswig–Holstein, Kiel, Germany
| | - Mary Sartor
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Ondrej Hrusak
- Charles University, Motol University Hospital, Prague, Czech Republic
| | | | - Vaskar Saha
- The University of Manchester, Manchester, United Kingdom
- Tata Translational Cancer Research Center, Tata Medical Center, Kolkata, West Bengal, India
| | - Luciana Vinti
- IRCCS Ospedale Pediatrico Bambino Gesù and Sapienza University of Rome, Rome, Italy
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36
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Tsaur G, Popov A, Riger T, Kustanovich A, Solodovnikov A, Shorikov E, Demina A, Verzhbitskaya T, Streneva O, Makarova O, Lapotentova E, Aleinikova O, Miakova N, Boichenko E, Kondratchik K, Ponomareva N, Karachunskiy A, Roumiantsev A, Fechina L. Prognostic value of minimal residual disease measured by fusion-gene transcript in infants with KMT2A-rearranged acute lymphoblastic leukaemia treated according to the MLL-Baby protocol. Br J Haematol 2021; 193:1151-1156. [PMID: 33583020 DOI: 10.1111/bjh.17304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/19/2023]
Abstract
The prognostic value of minimal residual disease (MRD) measured by fusion-gene transcript (FGT) detection was investigated in 76 infants (aged ≤1 year) with acute lymphoblastic leukaemia (ALL) with lysine methyltransferase 2A (KMT2A) rearrangements. Either at the end of induction or at later time-points, FGT-MRD-positivity was associated with poor outcome. FGT-MRD-positivity after first consolidation or first high-risk block detected 46·5% of infants with extremely poor outcome [disease-free survival (SE) 0·06 (0·06), cumulative incidence of relapse (SE) 0·91 (0·05)], which was also confirmed in multivariable analysis. Thus, FGT-MRD measurement at a single time-point clearly identifies infants with ALL who are curable with conventional chemotherapy and those who would benefit only from other treatment approaches.
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Affiliation(s)
- Grigory Tsaur
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation.,Ural State Medical University, Ekaterinburg, Russian Federation
| | - Alexander Popov
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Tatiana Riger
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Anatoly Kustanovich
- The Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Alexander Solodovnikov
- Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation.,Ural State Medical University, Ekaterinburg, Russian Federation
| | - Egor Shorikov
- PET-Technology Center of Nuclear Medicine, Ekaterinburg, Russian Federation
| | - Anna Demina
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Tatiana Verzhbitskaya
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Olga Streneva
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - Olga Makarova
- Regional Children's Hospital, Ekaterinburg, Russian Federation
| | - Elena Lapotentova
- Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Olga Aleinikova
- Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Natalia Miakova
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Elmira Boichenko
- City Children's Hospital, 1, Saint-Petersburg, Russian Federation
| | | | | | - Alexander Karachunskiy
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Alexander Roumiantsev
- National Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Larisa Fechina
- Regional Children's Hospital, Ekaterinburg, Russian Federation.,Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
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Biomarkers associated with blinatumomab outcomes in acute lymphoblastic leukemia. Leukemia 2021; 35:2220-2231. [PMID: 33542479 PMCID: PMC8324476 DOI: 10.1038/s41375-020-01089-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 08/08/2020] [Accepted: 10/31/2020] [Indexed: 01/29/2023]
Abstract
This study aimed to identify biomarkers for clinical outcomes in a phase 3 clinical study of blinatumomab or chemotherapy in adults with Philadelphia chromosome-negative relapsed/refractory B-cell precursor acute lymphoblastic leukemia. Patients were randomized 2:1 to receive blinatumomab, a BiTE® therapy, for 4 weeks (9 μg/day cycle 1 week 1, 28 μg/day thereafter) every 6 weeks, or chemotherapy. Baseline blood samples were evaluated to identify biomarkers prognostic (both treatment groups) or predictive (either treatment groups) for overall survival, event-free survival, hematologic remission, minimal residual disease (MRD) response, duration of response, or adverse events. Baseline values were balanced between treatment groups. Prognostic biomarkers were platelets, tumor burden, and percentage of T cells: each 1-log increase in platelets at baseline was prognostic for improved 6-month survival; lower tumor burden was prognostic for hematologic remission; and a higher percentage of CD3+ T-cells was prognostic for MRD response. Consistent with the BiTE mechanism of action, higher percentage of CD45+ CD3+ CD8+ T cells was associated with hematologic remission following blinatumomab. No examined biomarkers were significant for the risk of grade ≥3 adverse events. Incorporating baseline biomarkers into future studies may help to identify subgroups most likely to benefit from blinatumomab.
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Value of flow cytometry for MRD-based relapse prediction in B-cell precursor ALL in a multicenter setting. Leukemia 2020; 35:1894-1906. [PMID: 33318611 PMCID: PMC8257490 DOI: 10.1038/s41375-020-01100-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/07/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Abstract
PCR of TCR/Ig gene rearrangements is considered the method of choice for minimal residual disease (MRD) quantification in BCP-ALL, but flow cytometry analysis of leukemia-associated immunophenotypes (FCM-MRD) is faster and biologically more informative. FCM-MRD performed in 18 laboratories across seven countries was used for risk stratification of 1487 patients with BCP-ALL enrolled in the NOPHO ALL2008 protocol. When no informative FCM-marker was available, risk stratification was based on real-time quantitative PCR. An informative FCM-marker was found in 96.2% and only two patients (0.14%) had non-informative FCM and non-informative PCR-markers. The overall 5-year event-free survival was 86.1% with a cumulative incidence of relapse (CIR5y) of 9.5%. FCM-MRD levels on days 15 (HzR 4.0, p < 0.0001), 29 (HzR 2.7, p < 0.0001), and 79 (HzR 3.5, p < 0.0001) associated with hazard of relapse adjusted for age, cytogenetics, and WBC. The early (day 15) response associated with CIR5y adjusted for day 29 FCM-MRD, with higher levels in adults (median 2.4 × 10−2 versus 5.2 × 10−3, p < 0.0001). Undetectable FCM- and/or PCR-MRD on day 29 identified patients with a very good outcome (CIR5y = 3.2%). For patients who did not undergo transplantation, day 79 FCM-MRD > 10−4 associated with a CIR5y = 22.1%. In conclusion, FCM-MRD performed in a multicenter setting is a clinically useful method for MRD-based treatment stratification in BCP-ALL.
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Second- and third-generation tyrosine kinase inhibitors for Philadelphia-positive adult acute lymphoblastic leukemia relapsing post allogeneic stem cell transplantation-a registry study on behalf of the EBMT Acute Leukemia Working Party. Bone Marrow Transplant 2020; 56:1190-1199. [PMID: 33293597 DOI: 10.1038/s41409-020-01173-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 11/08/2022]
Abstract
Second- and third-generation tyrosine kinase inhibitors (TKI) play an important role in the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL). However, data on feasibility and efficacy of using these drugs for persisting or relapsed Ph + ALL after allogeneic stem cell transplantation (alloSCT) are scarce. Based on the EBMT Acute Leukemia Working Party registry, we evaluated the use of second-/third-generation TKI in 140 patients with Ph + ALL, suffering from measurable residual disease (MRD, n = 6), molecular relapse (MRel, n = 23), or hematological relapse (HRel, n = 111) following alloSCT. Treatment included dasatinib in 104, nilotinib in 18, or ponatinib in 18 patients. Forty-nine patients received TKI monotherapy, while 91 received additional treatment. Toxicity of second-/third-generation TKI post alloSCT was comparable to pretransplant use and could be managed with dose reduction or temporary discontinuation. Response rates were 71% (overall) and 61% (following TKI monotherapy). For the entire cohort, 2- and 5-year overall survival (OS) was 49% and 33%, respectively. OS was comparable among patients treated for persisting MRD/MRel and HRel. Among patients treated with TKI monotherapy, 2- and 5-year OS was 38% and 33%, respectively. The data underscore that second-/third-generation TKI are important compounds for the management of active Ph + ALL post alloSCT.
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40
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Minimal residual disease assessment in acute lymphoblastic leukemia by 4-color flow cytometry: Recommendations from the MRD Working Group of the Brazilian Society of Bone Marrow Transplantation. Hematol Transfus Cell Ther 2020; 43:332-340. [PMID: 33281111 PMCID: PMC8446261 DOI: 10.1016/j.htct.2020.09.148] [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: 06/28/2020] [Revised: 08/17/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction The minimal residual disease (MRD) status plays a crucial role in the treatment of acute lymphoblastic leukemia (ALL) and is currently used in most therapeutic protocols to guide the appropriate therapeutic decision. Therefore, it is imperative that laboratories offer accurate and reliable results through well standardized technical processes by establishing rigorous operating procedures. Method Our goal is to propose a monoclonal antibody (MoAb) panel for MRD detection in ALL and provide recommendations intended for flow cytometry laboratories that work on 4-color flow cytometry platforms. Results and conclusion The document includes pre-analytical and analytical procedures, quality control assurance, technical procedures, as well as the information that needs to be included in the reports for clinicians.
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Kim M, Park CJ. Minimal Residual Disease Detection in Pediatric Acute Lymphoblastic Leukemia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2020. [DOI: 10.15264/cpho.2020.27.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Miyoung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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42
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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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43
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Immature Immunoglobulin Gene Rearrangements Are Recurrent in B Precursor Adult Acute Lymphoblastic Leukemia Carrying TP53 Molecular Alterations. Genes (Basel) 2020; 11:genes11090960. [PMID: 32825230 PMCID: PMC7564830 DOI: 10.3390/genes11090960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
Here, we describe the immunoglobulin and T cell receptor (Ig/TCR) molecular rearrangements identified as a leukemic clone hallmark for minimal residual disease assessment in relation to TP53 mutational status in 171 Ph-negative Acute Lymphoblastic Leukemia (ALL) adult patients at diagnosis. The presence of a TP53 alterations, which represents a marker of poor prognosis, was strictly correlated with an immature DH/JH rearrangement of the immunoglobulin receptor (p < 0.0001). Furthermore, TP53-mutated patients were classified as pro-B ALL more frequently than their wild-type counterpart (46% vs. 25%, p = 0.05). Although the reasons for the co-presence of immature Ig rearrangements and TP53 mutation need to be clarified, this can suggest that the alteration in TP53 is acquired at an early stage of B-cell maturation or even at the level of pre-leukemic transformation.
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44
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Gökbuget N, Zugmaier G, Dombret H, Stein A, Bonifacio M, Graux C, Faul C, Brüggemann M, Taylor K, Mergen N, Reichle A, Horst HA, Havelange V, Topp MS, Bargou RC. Curative outcomes following blinatumomab in adults with minimal residual disease B-cell precursor acute lymphoblastic leukemia. Leuk Lymphoma 2020; 61:2665-2673. [PMID: 32619115 DOI: 10.1080/10428194.2020.1780583] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Minimal residual disease (MRD) is the strongest predictor of relapse in B-cell precursor acute lymphoblastic leukemia (BCP-ALL). In BLAST study (NCT01207388), adults with BCP-ALL in remission with MRD after chemotherapy received blinatumomab, a CD19 BiTE® immuno-oncotherapy, 15 µg/m2/day for up to four 6-week cycles (4 weeks continuous infusion, 2 weeks off). Survival was evaluated for 110 patients, including 74 who received HSCT in continuous complete remission. With a median follow-up of 59·8 months, median survival (months) was 36·5 (95% CI: 22.0-not reached [NR]). Median survival was NR (29.5-NR) for complete MRD responders (n = 84) and 14.4 (3.8-32.3) for MRD non-responders (n = 23; p = 0.002); after blinatumomab and HSCT, median survival was NR (25.7-NR) (n = 61) and 16.5 (1.1-NR) (n = 10; p = 0.065), respectively. This final analysis suggests complete MRD response during blinatumomab treatment is curative. Post-hoc analysis of study data suggests while post blinatumomab HSCT may be beneficial in appropriate patients, long-term survival without HSCT is also possible.
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Affiliation(s)
| | | | - Hervé Dombret
- University Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Anthony Stein
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - Carlos Graux
- CHU UCL Namur - Site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Christoph Faul
- University Hospital and Comprehensive Cancer Center Tübingen, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Monika Brüggemann
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | | | - Albrecht Reichle
- Department of Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Heinz-August Horst
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Violaine Havelange
- Department of Hematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany and
| | - Ralf C Bargou
- Comprehensive Cancer Center Mainfranken, Uniklinikum Würzburg, Würzburg, Germany
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45
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Chen F, Pang D, Guo H, Jiang X, Liu S, Huang L, Wei X, Liang Z, Wang X, Li W. Clinicopathological Characteristics and Mutational Profiling of Adult T-Cell Lymphoblastic Lymphoma in a Chinese Population. Cancer Manag Res 2020; 12:3003-3012. [PMID: 32431543 PMCID: PMC7198442 DOI: 10.2147/cmar.s242903] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/09/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose The purpose of this study is to perform a retrospective analysis of disease outcomes and mutational profiles in patients with adult T-cell lymphoblastic lymphoma (T-LBL). Patients and Methods A total of 43 patients were treated over a 9-year period at a single institution. The study examined treatment outcomes, clinical characteristics, and the use of circulating tumor DNA (ctDNA) and mutational profiling for patient diagnosis. Results The estimated overall survival (OS) and progression-free survival (PFS) time for all patients was 37.0 (95% CI: 17.7–56.2) and 28.1 (95% CI: 0.9–55.4) months, respectively. Chidamide maintenance was used in five patients exhibiting unfavorable genetic alterations, with no evidence of relapse. Next-generation sequencing of pretreatment tumor tissue was undertaken for 15 patients. NOTCH1 mutations were the most frequent genetic alterations, followed by mutations in PHF6, TP53, JAK1, JAK3, PTEN, and DNM2. The genetic profile of the blood was similar to that of the tumor. Kappa coefficient analysis (14 patients, 56 time points, kappa = 1.0, p = 0.00) indicated a 92.6% agreement between ctDNA response and tumor volume measurements at post treatment when compared with baseline. Detection of ctDNA predicted disease relapse in two patients. Conclusion The prognosis of patients with adult T-LBL remains very poor. Detection of tumor-associated sequences in ctDNA may be an effective method for diagnosing T-LBL and measuring treatment efficacy. Incorporation of new drugs such as histone deacetylase inhibitors (HDACi)has the potential to improve outcomes in these patients.
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Affiliation(s)
- Feili Chen
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Diwen Pang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Hanguo Guo
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Xinmiao Jiang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Sichu Liu
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Ling Huang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Xiaojuan Wei
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Zhanli Liang
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
| | - Xiaoxia Wang
- Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, People's Republic of China
| | - Wenyu Li
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangdong, People's Republic of China
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46
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Wethmar K, Matern S, Eßeling E, Angenendt L, Pfeifer H, Brüggemann M, Stelmach P, Call S, Albring JC, Mikesch JH, Reicherts C, Groth C, Schliemann C, Berdel WE, Lenz G, Stelljes M. Monitoring minimal residual/relapsing disease after allogeneic haematopoietic stem cell transplantation in adult patients with acute lymphoblastic leukaemia. Bone Marrow Transplant 2020; 55:1410-1420. [PMID: 32001801 DOI: 10.1038/s41409-020-0801-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/14/2019] [Accepted: 01/16/2020] [Indexed: 12/22/2022]
Abstract
Relapse after allogeneic haematopoietic stem cell transplantation (SCT) is a major cause of death in patients with acute lymphoblastic leukaemia (ALL). Here, we retrospectively analysed the contributions of lineage-sorted donor cell chimerism (sDCC) and quantitative PCR (qPCR) targeting disease-specific genetic rearrangements to detect minimal residual/relapsing disease (MRD) and predict impending relapse in 94 adult ALL patients after SCT. With a median follow-up of surviving patients (n = 61) of 3.3 years, qPCR and/or sDCC measurements turned positive in 38 patients (40%). Of these, 22 patients relapsed and 16 remained in complete remission. At 3 years, qPCR and/or sDCC positive patients showed an increased incidence of relapse (50% vs. 4%, p < 0.0001), decreased relapse-free survival (RFS, 40% vs. 85%, p < 0.0001), and decreased overall survival (OS, 47% vs. 87%, p 0.004). Both, qPCR and sDCC pre-detected 11 of 21 relapses occurring within the first two years after SCT and, overall, complemented for each other method in four of the relapsing and four of the non-relapsing cases. Patients receiving pre-emptive MRD-driven interventions (n = 11) or not (n = 10) showed comparable median times until relapse, RFS, and OS. In our single centre cohort, qPCR and sDCC were similarly effective and complementary helpful to indicate haematological relapse of ALL after SCT.
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Affiliation(s)
- Klaus Wethmar
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Svenja Matern
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Eva Eßeling
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Linus Angenendt
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Heike Pfeifer
- Department of Haematology and Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Monika Brüggemann
- Department of Haematology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Patrick Stelmach
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Simon Call
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Jörn C Albring
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Christian Reicherts
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Christoph Groth
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany
| | - Matthias Stelljes
- Department of Medicine A/Haematology and Oncology, University of Muenster, Muenster, Germany.
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47
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Gökbuget N, Dombret H, Giebel S, Brüggemann M, Doubek M, Foa R, Hoelzer D, Kim C, Martinelli G, Parovichnikova E, Maria Ribera J, Schoonen M, Tuglus C, Zugmaier G, Bassan R. Blinatumomab vs historic standard-of-care treatment for minimal residual disease in adults with B-cell precursor acute lymphoblastic leukaemia. Eur J Haematol 2020; 104:299-309. [PMID: 31876009 PMCID: PMC7079006 DOI: 10.1111/ejh.13375] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Survival outcomes from a single-arm phase 2 blinatumomab study in patients with minimal residual disease (MRD)-positive B-cell precursor (BCP)-acute lymphoblastic leukaemia (ALL) were compared with those receiving standard of care (SOC) in a historic data set. METHODS The primary analysis comprised adult Philadelphia chromosome (Ph)-negative patients in first complete haematologic remission (MRD ≥ 10-3 ). Relapse-free survival (RFS) and overall survival (OS) were compared between blinatumomab- and SOC-treatment groups. Baseline differences between groups were adjusted by propensity scores. RESULTS The primary analysis included 73 and 182 patients from the blinatumomab and historic data sets, respectively. When weighted by age to the blinatumomab-treatment group, median RFS was 7.8 months and median OS was 25.9 months in the SOC-treated group. In the blinatumomab study, median RFS was 35.2 months; median OS was not evaluable. Propensity score weighting achieved balance with seven baseline prognostic factors. With adjustment for haematopoietic stem cell transplantation (HSCT) status, a 50% reduction in risk of relapse or death was observed with blinatumomab vs SOC. Median RFS, unadjusted for HSCT status, was 35.2 months with blinatumomab and 8.3 months with SOC. CONCLUSIONS These analyses suggest that blinatumomab improves RFS, and possibly OS, in adults with MRD-positive Ph-negative BCP-ALL vs SOC.
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Affiliation(s)
| | - Hervé Dombret
- Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Sebastian Giebel
- Maria Sklodowska-Curie Institute-Oncology Center, Gliwice, Poland
| | | | - Michael Doubek
- University Hospital and CEITEC Masaryk University, Brno, Czech Republic
| | - Robin Foa
- 'Sapienza' University of Rome, Rome, Italy
| | | | - Christopher Kim
- Center for Observational Research, Amgen Inc, Thousand Oaks, CA, USA
| | | | | | - Josep Maria Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Barcelona, Spain
| | | | | | | | - Renato Bassan
- UOC Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
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Fournier B, Balducci E, Duployez N, Clappier E, Cuccuini W, Arfeuille C, Caye-Eude A, Delabesse E, Bottollier-Lemallaz Colomb E, Nebral K, Chrétien ML, Derrieux C, Cabannes-Hamy A, Dumezy F, Etancelin P, Fenneteau O, Frayfer J, Gourmel A, Loosveld M, Michel G, Nadal N, Penther D, Tigaud I, Fournier E, Reismüller B, Attarbaschi A, Lafage-Pochitaloff M, Baruchel A. B-ALL With t(5;14)(q31;q32); IGH-IL3 Rearrangement and Eosinophilia: A Comprehensive Analysis of a Peculiar IGH-Rearranged B-ALL. Front Oncol 2019; 9:1374. [PMID: 31921638 PMCID: PMC6914849 DOI: 10.3389/fonc.2019.01374] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/21/2019] [Indexed: 02/03/2023] Open
Abstract
Background: B-cell acute lymphoblastic leukemia associated with t(5;14)(q31;q32); IGH-IL3 is an exceptional cause of eosinophilia. The IGH enhancer on 14q32 is juxtaposed to the IL3 gene on 5q31, leading to interleukin-3 overproduction and release of mature eosinophils in the blood. Clinical, biological and outcome data are extremely scarce in the literature. Except for eosinophilia, no relevant common feature has been highlighted in these patients. However, it has been classified as a distinct entity in the World Health Organization classification. Cases Presentation: Eight patients with t(5;14)(q31;q32) treated by French or Austrian protocols were retrospectively enrolled. Array comparative genomic hybridization, multiplex ligation-dependent probe amplification or genomic PCR search for IKZF1 deletion were performed in 7. Sixteen patients found through an exhaustive search in the literature were also analyzed. For those 24 patients, median age at diagnosis is 14.3 years with a male predominance (male to female ratio = 5). Eosinophilia-related symptoms are common (neurologic in 26%, thromboembolic in 26% or pulmonary in 50%). Median white blood cells count is high (72 × 109/L) and linked to eosinophilia (median: 32 × 109/L). Peripheral blasts are present at a low level or absent (median: 0 × 109/L; range: 0–37 × 109/L). Bone marrow morphology is marked by a low blast infiltration (median: 42%). We found an IKZF1 deletion in 5 out of 7 analyzable patients Outcome data are available for 14 patients (median follow-up: 28 months): 8 died and 6 are alive in complete remission. Some of these features are concordant with those seen in patients with other IGH-rearranged B-cell acute lymphoblastic leukemias: young age at onset, male sex, low blast count, high incidence of IKZF1 deletion and intermediate prognosis. Conclusion: Based on shared epidemiological and biological features, B-cell acute lymphoblastic leukemia with t(5;14)(q31;q32) is a peculiar subset of IGH-rearranged B-cell acute lymphoblastic leukemia with an intermediate prognosis and particular clinical features related to eosinophilia.
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Affiliation(s)
- Benjamin Fournier
- Department of Pediatric Hematology and Immunology, University Hospital Robert Debré, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Estelle Balducci
- Hematology Laboratory, University Hospital Paul-Brousse, Assistance Publique des Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Emmanuelle Clappier
- Hematology Laboratory, University Hospital Saint-Louis, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Wendy Cuccuini
- Hematology Laboratory, University Hospital Saint-Louis, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Chloé Arfeuille
- Department of Genetics, University Hospital Robert Debré, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Aurélie Caye-Eude
- Department of Genetics, University Hospital Robert Debré, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Eric Delabesse
- Department of Haematology, Institut Universitaire de Cancérologie de Toulouse, CHU de Toulouse, Toulouse, France
| | | | - Karin Nebral
- Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | | | | | - Aurélie Cabannes-Hamy
- Teenagers and Young Adults Hematology Unit, University Hospital Saint-Louis, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Florent Dumezy
- Department of Hematology, University Hospital, Lille, France
| | | | - Odile Fenneteau
- Hematology Laboratory, University Hospital Robert Debré, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Jamile Frayfer
- Department of Hematology, Hospital Saint Faron, Meaux, France
| | - Antoine Gourmel
- Department of Pediatric Oncology, Hematology, Immunology, University Hospital of Amiens, Amiens, France
| | - Marie Loosveld
- Hematology Laboratory, Timone Hospital, Assistance Publique-Hôpitaux de Marseille (APHM), CNRS, INSERM, Centre d'Immunologie de Marseille-Luminy (CIML), Aix Marseille University, Marseille, France
| | - Gérard Michel
- Department of Pediatric Hematology, Aix Marseille University, Marseille, France
| | - Nathalie Nadal
- Laboratory of Cytogenetics, University Hospital of Dijon, Dijon, France
| | - Dominique Penther
- Department of Oncology Genetics, Henri Becquerel Center, Rouen, France
| | | | - Elise Fournier
- Department of Hematology, University Hospital, Lille, France
| | - Bettina Reismüller
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Marina Lafage-Pochitaloff
- Hematological Cytogenetics Laboratory, Timone Hospital-Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Groupe Francophone de Cytogénétique Hématologique (GFCH), Marseille, France
| | - André Baruchel
- Department of Pediatric Hematology and Immunology, University Hospital Robert Debré, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France.,Institut Universitaire d'Hématologie, EA-3518, University Hospital Saint-Louis, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
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Freeman SD, Hourigan CS. MRD evaluation of AML in clinical practice: are we there yet? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:557-569. [PMID: 31808906 PMCID: PMC6913462 DOI: 10.1182/hematology.2019000060] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
MRD technologies increase our ability to measure response in acute myeloid leukemia (AML) beyond the limitations of morphology. When applied in clinical trials, molecular and immunophenotypic MRD assays have improved prognostic precision, providing a strong rationale for their use to guide treatment, as well as to measure its effectiveness. Initiatives such as those from the European Leukemia Network now provide a collaborative knowledge-based framework for selection and implementation of MRD assays most appropriate for defined genetic subgroups. For patients with mutated-NPM1 AML, quantitative polymerase chain reaction (qPCR) monitoring of mutated-NPM1 transcripts postinduction and sequentially after treatment has emerged as a highly sensitive and specific tool to predict relapse and potential benefit from allogeneic transplant. Flow cytometric MRD after induction is prognostic across genetic risk groups and can identify those patients in the wild-type NPM1 intermediate AML subgroup with a very high risk for relapse. In parallel with these data, advances in genetic profiling have extended understanding of the etiology and the complex dynamic clonal nature of AML, as well as created the opportunity for MRD monitoring using next-generation sequencing (NGS). NGS AML MRD detection can stratify outcomes and has potential utility in the peri-allogeneic transplant setting. However, there remain challenges inherent in the NGS approach of multiplex quantification of mutations to track AML MRD. Although further development of this methodology, together with orthogonal testing, will clarify its relevance for routine clinical use, particularly for patients lacking a qPCR genetic target, established validated MRD assays can already provide information to direct clinical practice.
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Affiliation(s)
- Sylvie D Freeman
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; and
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Czyz A, Nagler A. The Role of Measurable Residual Disease (MRD) in Hematopoietic Stem Cell Transplantation for Hematological Malignancies Focusing on Acute Leukemia. Int J Mol Sci 2019; 20:ijms20215362. [PMID: 31661875 PMCID: PMC6862140 DOI: 10.3390/ijms20215362] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 01/17/2023] Open
Abstract
The significance of measurable residual disease (MRD) in hematopoietic stem cell transplantation (HSCT) is well recognized in different hematological malignancies, but the evidence indicate that pre-transplant MRD status is of particular importance in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). In ALL, inadequate response at the level of MRD is a commonly accepted risk factor for relapse and thus an indication for allogeneic HSCT. Similarly, growing evidence from the literature strongly suggest that MRD detected by multiparameter flow cytometry or molecular techniques should be also used for risk stratification in AML at the time of HSCT. Despite the well-defined association of MRD and outcomes of HSCT in acute leukemias, there are still many open issues such as the role of additional pre-transplant consolidation for MRD eradication, the ability of HSCT to overcome negative influence of MRD positivity on survival, the impact of conditioning regimen intensity on MRD clearance post HSCT, and transplantation outcomes or the selection of optimal donor with regards to MRD status. In addition, the role of MRD assessment in guiding post-transplant maintenance treatment should also be addressed in prospective trials. These open issues mostly awaiting further clinical studies will be discussed in our current review.
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Affiliation(s)
- Anna Czyz
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Ludwik Pasteur 4, 50-367 Wroclaw, Poland.
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Derech Sheba 2, 52-621 Ramat Gan, Israel.
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