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Vonk CM, Boertjes EL, Kavelaars FG, Rijken M, Konijnenburg JML, Cromwell RE, Löwenberg B, Grob T, Valk PJM. Prognostic relevance of molecular measurable residual disease detection in AML with mutated CEBPA. Hemasphere 2024; 8:e141. [PMID: 39148661 PMCID: PMC11326717 DOI: 10.1002/hem3.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024] Open
Affiliation(s)
- Christian M Vonk
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Emma L Boertjes
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Francois G Kavelaars
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Melissa Rijken
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Jolinda M L Konijnenburg
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Roxanne E Cromwell
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Tim Grob
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
| | - Peter J M Valk
- Department of Hematology, Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands
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2
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Imus PH, Pasca S, Tsai HL, Aljawai YM, Cooke KR, Walston JD, Gocke CD, Varadhan R, Jones RJ, Gondek LP. Recipient clonal hematopoiesis in allogeneic bone marrow transplantation for lymphoid malignancies. Blood Adv 2024; 8:3849-3858. [PMID: 38640196 DOI: 10.1182/bloodadvances.2023011761] [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: 09/22/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 04/21/2024] Open
Abstract
ABSTRACT Allogeneic blood and marrow transplantation (alloBMT) is increasingly being used in older patients with blood cancer. Aging is associated with an increasing incidence of clonal hematopoiesis (CH). Although the effects of donor CH on alloBMT has been reported, the impact of recipient CH on alloBMT outcomes is unknown. In this retrospective study, alloBMT recipients age 60 and older with lymphoid malignancies were included. Among 97 consecutive patients who received alloBMT between 2017 and 2022, CH was detected in 60 (62%; 95% confidence interval [CI], 51-72). CH was found in 45% (95% CI, 28-64) of patients aged 60 to 64, 64% (95% CI, 44-81) of patients aged 65% to 69%, and 73% (95% CI, 59-87) in those above 70. Pretransplant CH was associated with worse survival after alloBMT: 3-year overall survival (OS) was 78% (95% CI, 65-94) for patients without CH vs 47% (95% CI, 35-63) for those with CH, (unadjusted HR, 3.1; [95% CI, 1.4-6.8; P < .001]). Nonrelapse mortality (NRM) was higher in patients with CH; cumulative incidence of NRM at 1-year was 11% (95% CI, 1-22) vs 35% (95% CI, 23-48), (HR, 3.4; [95% CI, 1.4-8.5], P = .009]). Among CH patients, worse OS and NRM was associated with CH burden and number of mutations. Recipient CH had no effect on relapse. In conclusion, older patients with CH experience worse outcomes after alloBMT, almost exclusively attributable to increased NRM. CH is a strong, independent predictor of outcomes. Novel strategies to ameliorate the adverse impacts of patient CH on transplant outcomes are being evaluated.
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Affiliation(s)
- Philip H Imus
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Sergiu Pasca
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Hua-Ling Tsai
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Yosra M Aljawai
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
- Department of Stem Cell Transplantation & Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kenneth R Cooke
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Jeremy D Walston
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
- Division of Geriatric Medicine, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Christopher D Gocke
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Ravi Varadhan
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Richard J Jones
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Lukasz P Gondek
- Division of Hematologic Malignancy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
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Seipel K, Frey M, Nilius H, Akhoundova D, Banz Y, Bacher U, Pabst T. Low-Frequency PPM1D Gene Mutations Affect Treatment Response to CD19-Targeted CAR T-Cell Therapy in Large B-Cell Lymphoma. Curr Oncol 2023; 30:10463-10476. [PMID: 38132396 PMCID: PMC10742331 DOI: 10.3390/curroncol30120762] [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: 10/23/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Chimeric antigen receptor T (CAR T)-cell therapy has become a standard treatment option for patients with relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL). Mutations in the PPM1D gene, a frequent driver alteration in clonal hematopoiesis (CH), lead to a gain of function of PPM1D/Wip1 phosphatase, impairing p53-dependent G1 checkpoint and promoting cell proliferation. The presence of PPM1D mutations has been correlated with reduced response to standard chemotherapy in lymphoma patients. In this study, we analyzed the impact of low-frequency PPM1D mutations on the safety and efficacy of CD19-targeted CAR T-cell therapy in a cohort of 85 r/r DLBCL patients. In this cohort, the prevalence of PPM1D gene mutations was 20% with a mean variant allele frequency (VAF) of 0.052 and a median VAF of 0.036. CAR T-induced cytokine release syndrome (CRS) and immune effector cell-associated neuro-toxicities (ICANS) occurred at similar frequencies in patients with and without PPM1D mutations. Clinical outcomes were globally worse in the PPM1D mutated (PPM1Dmut) vs. PPM1D wild type (PPM1Dwt) subset. While the prevalent treatment outcome within the PPM1Dwt subgroup was complete remission (56%), the majority of patients within the PPM1Dmut subgroup had only partial remission (60%). Median progression-free survival (PFS) was 3 vs. 12 months (p = 0.07) and median overall survival (OS) was 5 vs. 37 months (p = 0.004) for the PPM1Dmut and PPM1Dwt cohort, respectively. Our data suggest that the occurrence of PPM1D mutations in the context of CH may predict worse outcomes after CD19-targeted CAR T-cell therapy in patients with r/r DLBCL.
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MESH Headings
- Humans
- Immunotherapy, Adoptive/adverse effects
- Receptors, Chimeric Antigen
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/therapeutic use
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Treatment Outcome
- Antigens, CD19/genetics
- Antigens, CD19/therapeutic use
- Protein Phosphatase 2C/genetics
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Affiliation(s)
- Katja Seipel
- Department for Biomedical Research (DBMR), University of Bern, 3008 Bern, Switzerland;
- Department of Medical Oncology, University Hospital Bern, 3010 Bern, Switzerland;
| | - Michèle Frey
- Department of Medical Oncology, University Hospital Bern, 3010 Bern, Switzerland;
| | - Henning Nilius
- Department of Clinical Chemistry, University of Bern, 3010 Bern, Switzerland;
| | - Dilara Akhoundova
- Department for Biomedical Research (DBMR), University of Bern, 3008 Bern, Switzerland;
- Department of Medical Oncology, University Hospital Bern, 3010 Bern, Switzerland;
| | - Yara Banz
- Institute of Tissue Medicine and Pathology (IGMP), University of Bern, 3010 Bern, Switzerland;
| | - Ulrike Bacher
- Department of Hematology, University Hospital Bern, 3010 Bern, Switzerland;
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital Bern, 3010 Bern, Switzerland;
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Zhang L, Hsu JI, Goodell MA. PPM1D in Solid and Hematologic Malignancies: Friend and Foe? Mol Cancer Res 2022; 20:1365-1378. [PMID: 35657598 PMCID: PMC9437564 DOI: 10.1158/1541-7786.mcr-21-1018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 01/07/2023]
Abstract
In the face of constant genomic insults, the DNA damage response (DDR) is initiated to preserve genome integrity; its disruption is a classic hallmark of cancer. Protein phosphatase Mg2+/Mn2+-dependent 1D (PPM1D) is a central negative regulator of the DDR that is mutated or amplified in many solid cancers. PPM1D overexpression is associated with increased proliferative and metastatic behavior in multiple solid tumor types and patients with PPM1D-mutated malignancies have poorer prognoses. Recent findings have sparked an interest in the role of PPM1D in hematologic malignancies. Acquired somatic mutations may provide hematopoietic stem cells with a competitive advantage, leading to a substantial proportion of mutant progeny in the peripheral blood, an age-associated phenomenon termed "clonal hematopoiesis" (CH). Recent large-scale genomic studies have identified PPM1D to be among the most frequently mutated genes found in individuals with CH. While PPM1D mutations are particularly enriched in patients with therapy-related myeloid neoplasms, their role in driving leukemic transformation remains uncertain. Here, we examine the mechanisms through which PPM1D overexpression or mutation may drive malignancy by suppression of DNA repair, cell-cycle arrest, and apoptosis. We also discuss the divergent roles of PPM1D in the oncogenesis of solid versus hematologic cancers with a view to clinical implications and new therapeutic avenues.
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Affiliation(s)
- Linda Zhang
- Translational Biology and Molecular Medicine Graduate Program, Baylor College of Medicine, Houston, Texas
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas
| | - Joanne I. Hsu
- Translational Biology and Molecular Medicine Graduate Program, Baylor College of Medicine, Houston, Texas
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas
| | - Margaret A. Goodell
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
- Corresponding Author: Margaret A. Goodell, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030. E-mail:
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