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Herling M, Dearden C, Zaja F, El-Sharkawi D, Ding W, Bellido M, Khot A, Tick L, Jacobsen E, Eyre TA, Roos-Weil D, Kadia T, Lucchini E, Pflug N, Davids MS, Pena G, Mukherjee N, Badawi M, Vizkelety T, Staber PB. Limited efficacy for ibrutinib and venetoclax in T-prolymphocytic leukemia: results from a phase 2 international study. Blood Adv 2024; 8:842-845. [PMID: 38190628 PMCID: PMC10874748 DOI: 10.1182/bloodadvances.2023012248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Marco Herling
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
- Department of Hematology, Cell Therapy, and Hemostaseology, University of Leipzig, Leipzig, Germany
| | - Claire Dearden
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Francesco Zaja
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
- DSM University of Trieste, Trieste, Italy
| | | | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mar Bellido
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Amit Khot
- Department of Clinical Haematology, Peter MacCallum Cancer Center, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | - Lidwine Tick
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
| | - Eric Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Toby A. Eyre
- Oxford Cancer & Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Damien Roos-Weil
- Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Service Hematologie Clinique, Hopital Pitie Salpetriere, Paris, France
| | - Tapan Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elisa Lucchini
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Natali Pflug
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - German Pena
- Department of Global Medical Affairs, Oncology, AbbVie, North Chicago, IL
| | | | - Mohamed Badawi
- Department of CPPM Clinical PK/PD, AbbVie, North Chicago, IL
| | - Tamas Vizkelety
- Department of Global Medical Affairs, Oncology, AbbVie, North Chicago, IL
| | - Philipp B. Staber
- Universitaetsklinik fuer Innere Medizin I, Klinische Abteilung fuer Haematologie und Haemostaseologie, Medizinische Universitaet Wien, Vienna, Austria
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Brothers J, Castillo DR, Jeon WJ, Joung B, Linhares Y. Partial response to venetoclax and ruxolitinib combination in a case of refractory T-prolymphocytic leukemia. Hematology 2023; 28:2237342. [PMID: 37485976 DOI: 10.1080/16078454.2023.2237342] [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: 04/19/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background: T-prolymphocytic leukemia (T-PLL) is an aggressive hematologic malignancy. A portion of patients can be cured with alemtuzumab induction followed by allogeneic hematopoietic stem cell transplant, but patients who relapse after transplant have a poor prognosis, and there is no standard of care.Methods: We report a case of a 64-year-old man with relapsed JAK3-mutant T-PLL following allogeneic transplant who was treated with ruxolitinib and venetoclax.Results: Treatment with ruxolitinib and venetoclax resulted in a partial response including stabilization of the peripheral lymphocyte count, improvement in thrombocytopenia, decrease in splenomegaly, and a numerical reduction in the percentage of bone marrow involved by T-PLL. The combination was well tolerated with the exception of neutropenic infections.Conclusion: This case adds to the growing body of literature supporting venetoclax and rituximab as a viable treatment option for relapsed/refractory T-PLL with JAK-STAT alterations.
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Yan Z, Zeng M, Chen X, Yin Y, Liu Y. Clinical analysis of prolymphoblastic leukemia: the rare hematological malignancy in the elderly. Am J Transl Res 2023; 15:5653-5663. [PMID: 37854229 PMCID: PMC10579035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/13/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To discuss and analyze the clinical and prognostic characteristics of rare prolymphocytic leukemia (PLL), in order to provide new references for the clinical diagnosis and treatment and basic research of PLL. METHODS The clinical data of 8 patients with PLL admitted to the Department of Hematology in Fujian Medical University Union Hospital from January 1, 2011 to May 31, 2023 were collected and retrospectively studied, and the clinical treatment and prognosis were analyzed. Meanwhile, the latest literature from PubMed was retrieved to systematically discuss the research progress in the diagnosis and treatment of PLL. RESULTS In this study, of the 8 patients with PLL, 6 were males and 2 were females; the ages ranged from 52 to 80 years, with a median age of 70.5 years. The immunophenotypes were divided into B-PLL (7 cases) and T-PLL (1 case). Morphological, flow cytometric, cytogenetic and molecular biological tests of bone marrow cells were performed in all patients. Among them, 1 case refused chemotherapy after diagnosis and died in a short time, the other 7 cases received standard chemotherapy. Among the 7 patients, one patient died of severe infection caused by myelosuppression after chemotherapy, one patient died within 3 months after chemotherapy; two patients died of progression at 4 and 7 months after chemotherapy. A total of 3 patients achieved complete remission (CR) after chemotherapy, and 1 patient underwent allogeneic hematopoietic stem cell transplantation without disease progression or recurrence. CONCLUSION PLL is a rare lymphoid malignancy with an extremely poor prognosis, which tends to occur in the elderly, and the clinical manifestations of PLL lack specificity. Chemotherapy combined with targeted drugs or epigenetic drugs may benefit PLL patients. Hematopoietic stem cell transplantation should be performed after CR is obtained to improve the prognosis to the greatest extent.
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Affiliation(s)
- Zhimin Yan
- Department of Hematology, The First Affiliated Hospital of Gannan Medical UniversityGanzhou 341000, Jiangxi, China
| | - Minjuan Zeng
- The School of Basic Medicine, Guangdong Medical UniversityDongguan 523808, Guangdong, China
| | - Xiaojun Chen
- Department of Hematology, The Affiliated Hospital of Putian UniversityPutian 351100, Fujian, China
| | - Yue Yin
- Fujian Institute of Hematology, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
| | - Yanquan Liu
- Department of Hematology, The First School of Clinical Medicine, Guangdong Medical UniversityDongguan 523808, Guangdong, China
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Gutierrez M, Bladek P, Goksu B, Murga-Zamalloa C, Bixby D, Wilcox R. T-Cell Prolymphocytic Leukemia: Diagnosis, Pathogenesis, and Treatment. Int J Mol Sci 2023; 24:12106. [PMID: 37569479 PMCID: PMC10419310 DOI: 10.3390/ijms241512106] [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: 06/19/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive neoplasm of mature T-cells. Most patients with T-PLL present with lymphocytosis, anemia, thrombocytopenia, and hepatosplenomegaly. Correct identification of T-PLL is essential because treatment for this disease is distinct from that of other T-cell neoplasms. In 2019, the T-PLL International Study Group (TPLL-ISG) established criteria for the diagnosis, staging, and assessment of response to treatment of T-PLL with the goal of harmonizing research efforts and supporting clinical decision-making. T-PLL pathogenesis is commonly driven by T-cell leukemia 1 (TCL1) overexpression and ATM loss, genetic alterations that are incorporated into the TPLL-ISG diagnostic criteria. The cooperativity between TCL1 family members and ATM is seemingly unique to T-PLL across the spectrum of T-cell neoplasms. The role of the T-cell receptor, its downstream kinases, and JAK/STAT signaling are also emerging themes in disease pathogenesis and have obvious therapeutic implications. Despite improved understanding of disease pathogenesis, alemtuzumab remains the frontline therapy in the treatment of naïve patients with indications for treatment given its high response rate. Unfortunately, the responses achieved are rarely durable, and the majority of patients are not candidates for consolidation with hematopoietic stem cell transplantation. Improved understanding of T-PLL pathogenesis has unveiled novel therapeutic vulnerabilities that may change the natural history of this lymphoproliferative neoplasm and will be the focus of this concise review.
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Affiliation(s)
- Marc Gutierrez
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Patrick Bladek
- Department of Pathology, University of Illinois Chicago, Chicago, IL 60607, USA; (P.B.); (B.G.); (C.M.-Z.)
| | - Busra Goksu
- Department of Pathology, University of Illinois Chicago, Chicago, IL 60607, USA; (P.B.); (B.G.); (C.M.-Z.)
| | - Carlos Murga-Zamalloa
- Department of Pathology, University of Illinois Chicago, Chicago, IL 60607, USA; (P.B.); (B.G.); (C.M.-Z.)
| | - Dale Bixby
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 60607, USA;
| | - Ryan Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 60607, USA;
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Braun T, Dechow A, Friedrich G, Seifert M, Stachelscheid J, Herling M. Advanced Pathogenetic Concepts in T-Cell Prolymphocytic Leukemia and Their Translational Impact. Front Oncol 2021; 11:775363. [PMID: 34869023 PMCID: PMC8639578 DOI: 10.3389/fonc.2021.775363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 12/29/2022] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is the most common mature T-cell leukemia. It is a typically aggressively growing and chemotherapy-resistant malignancy with a poor prognosis. T-PLL cells resemble activated, post-thymic T-lymphocytes with memory-type effector functions. Constitutive transcriptional activation of genes of the T-cell leukemia 1 (TCL1) family based on genomic inversions/translocations is recognized as a key event in T-PLL's pathogenesis. TCL1's multiple effector pathways include the enhancement of T-cell receptor (TCR) signals. New molecular dependencies around responses to DNA damage, including repair and apoptosis regulation, as well as alterations of cytokine and non-TCR activation signaling were identified as perturbed hallmark pathways within the past years. We currently witness these vulnerabilities to be interrogated in first pre-clinical concepts and initial clinical testing in relapsed/refractory T-PLL patients. We summarize here the current knowledge on the molecular understanding of T-PLL's pathobiology and critically assess the true translational progress around this to help appraisal by caregivers and patients. Overall, the contemporary concepts on T-PLL's pathobiology are condensed in a comprehensive mechanistic disease model and promising interventional strategies derived from it are highlighted.
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Affiliation(s)
- Till Braun
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne (UoC), Cologne, Germany
| | - Annika Dechow
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne (UoC), Cologne, Germany
| | - Gregor Friedrich
- Department of Hematology and Cellular Therapy, University of Leipzig, Leipzig, Germany
| | - Michael Seifert
- Institute for Medical Informatics and Biometry (IMB), Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Johanna Stachelscheid
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne (UoC), Cologne, Germany
| | - Marco Herling
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne (UoC), Cologne, Germany.,Department of Hematology and Cellular Therapy, University of Leipzig, Leipzig, Germany
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Siddiqui M, Konopleva M. Keeping up with venetoclax for leukemic malignancies: key findings, optimal regimens and clinical considerations. Expert Rev Clin Pharmacol 2021; 14:1497-1512. [PMID: 34791957 DOI: 10.1080/17512433.2021.2008239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Venetoclax has transformed the treatment landscape in hematologic malignancies, especially in elderly population. With high rates of remission, deep and durable responses, and safe toxicity profile, venetoclax in combination therapy has been extremely effective, garnering accelerated approval and becoming standard of care in lymphoid and myeloid malignancies. AREAS COVERED The role of venetoclax in the intrinsic apoptotic pathway is covered. This includes preclinical and clinical experience of venetoclax monotherapy and combination therapy in relapsed/refractory and frontline CLL, AML, ALL and high-risk MDS, with an emphasis on key clinical trials and efficacy of combination regimens in distinct mutational landscapes. Strategies to mitigate myelosuppression, manage dose adjustments and infectious complications are addressed. EXPERT OPINION Targeting BCL-2 offers a safe and highly effective adjunct to available therapies in hematologic malignancies. Despite success and frequent utilization of venetoclax, several resistance mechanisms have been elucidated, prompting development of novel combinatorial strategies. Further, on-target myelosuppression of venetoclax is a key obstacle in clinical practice, requiring diligent monitoring and practice-based knowledge of dose modifications. Despite these limitations, venetoclax has gained tremendous popularity in hematologic-oncology, becoming an integral component of numerous combination regimes, with ongoing plethora of clinical trials encompassing standard chemotherapy, targeted agents and immune-based approaches.
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Affiliation(s)
- Maria Siddiqui
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 428, Houston, TX, 77030, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 428, Houston, TX, 77030, USA
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Hijacking the Pathway: Perspectives in the Treatment of Mature T-cell Leukemias. Hemasphere 2021; 5:e573. [PMID: 34095757 PMCID: PMC8171373 DOI: 10.1097/hs9.0000000000000573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022] Open
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