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Balla B, Tripon F, Candea M, Banescu C. Copy Number Variations and Gene Mutations Identified by Multiplex Ligation-Dependent Probe Amplification in Romanian Chronic Lymphocytic Leukemia Patients. J Pers Med 2023; 13:1239. [PMID: 37623489 PMCID: PMC10455273 DOI: 10.3390/jpm13081239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is known for its wide-ranging clinical and genetic diversity. The study aimed to assess the associations between copy number variations (CNVs) and various biological and clinical features, as well as the survival rates of CLL patients and to evaluate the effectiveness of the multiplex ligation-dependent probe amplification (MLPA) technique in CLL patients.DNA was extracted from 110 patients, and MLPA was performed. Mutations in NOTCH1, SF3B1, and MYD88 were also analyzed. A total of 52 patients showed at least one CNV, 26 had at least one somatic mutation, and 10 presented both, CNVs, and somatic mutations. The most commonly identified CNVs were del(114.3), del(11q22.3), and dup(12q23.2). Other CNVs identified included del(17p13.1), del(14q32.33), dup(10q23.31), and del(19p13.2). One patient was identified with concomitant trisomy 12, 13, and 19. NOTCH1 and SF3B1 mutations were found in 13 patients each, either alone or in combination with other mutations or CNVs, while MYD88 mutation was identified in one patient. Forty-two patients had normal results. Associations between the investigated CNVs and gene mutations and patients' overall survival were found. The presence of NOTCH1 and SF3B1 mutations or the combination of NOTCH1 mutation and CNVs significantly influenced the survival of patients with CLL. Both mutations are frequently associated with different CNVs. Del(13q) is associated with the longest survival rate, while the shortest survival is found in patients with del(17p). Even if MLPA has constraints, it may be used as the primary routine analysis in patients with CLL.
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Affiliation(s)
- Beata Balla
- Department of Medical Genetics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (B.B.); (C.B.)
- Center for Advanced Medical and Pharmaceutical Research, Genetics Laboratory, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Florin Tripon
- Department of Medical Genetics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (B.B.); (C.B.)
- Center for Advanced Medical and Pharmaceutical Research, Genetics Laboratory, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Marcela Candea
- Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Claudia Banescu
- Department of Medical Genetics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (B.B.); (C.B.)
- Center for Advanced Medical and Pharmaceutical Research, Genetics Laboratory, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Medical Genetics Laboratory, Emergency County Hospital of Targu Mures, 540136 Targu Mures, Romania
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2
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Catapano R, Sepe L, Toscano E, Paolella G, Chiurazzi F, Barbato SP, Bruzzese D, Arianna R, Grosso M, Romano S, Romano MF, Costanzo P, Cesaro E. Biological relevance of ZNF224 expression in chronic lymphocytic leukemia and its implication IN NF-kB pathway regulation. Front Mol Biosci 2022; 9:1010984. [PMID: 36425656 PMCID: PMC9681601 DOI: 10.3389/fmolb.2022.1010984] [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: 08/03/2022] [Accepted: 10/20/2022] [Indexed: 12/21/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a heterogeneous disease, whose presentation and clinical course are highly variable. Identification of novel prognostic factors may contribute to improving the CLL classification and providing indications for treatment options. The zinc finger protein ZNF224 plays a key role in cell transformation, through the control of apoptotic and survival pathways. In this study, we evaluated the potential application of ZNF224 as a novel marker of CLL progression and therapy responsiveness. To this aim, we analyzed ZNF224 expression levels in B lymphocytes from CLL patients at different stages of the disease and in patients showing different treatment outcomes. The expression of ZNF224 was significantly increased in disease progression and dramatically decreased in patients in complete remission after chemotherapy. Gene expression correlation analysis performed on datasets of CLL patients revealed that ZNF224 expression was well correlated with that of some prognostic and predictive markers. Moreover, bioinformatic analysis coupled ZNF224 to NF-κB pathway, and experimental data demonstrated that RNA interference of ZNF224 reduced the activity of the NF-κB survival pathway in CLL cells. Consistently with a pro-survival role, ZNF224 knockdown raised spontaneous and drug-induced apoptosis and inhibited the proliferation of peripheral blood mononuclear cells from CLL patients. Our findings provide evidence for the involvement of ZNF224 in the survival of CLL cells via NF-κB pathway modulation, and also suggest ZNF224 as a prognostic and predictive molecular marker of CLL disease.
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Affiliation(s)
- Rosa Catapano
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Leandra Sepe
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Ceinge Advanced Technologies, Naples, Italy
| | - Elvira Toscano
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Ceinge Advanced Technologies, Naples, Italy
| | - Giovanni Paolella
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Ceinge Advanced Technologies, Naples, Italy
| | - Federico Chiurazzi
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy
| | - Serafina Patrizia Barbato
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Rosa Arianna
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Michela Grosso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Ceinge Advanced Technologies, Naples, Italy
| | - Simona Romano
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Maria Fiammetta Romano
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Paola Costanzo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Elena Cesaro
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
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3
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Wu X, Fajardo-Despaigne JE, Zhang C, Neppalli V, Banerji V, Johnston JB, Gibson SB, Marshall AJ. Altered T Follicular Helper Cell Subsets and Function in Chronic Lymphocytic Leukemia. Front Oncol 2021; 11:674492. [PMID: 33996605 PMCID: PMC8113764 DOI: 10.3389/fonc.2021.674492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Follicular helper T cells (TFH) have specialized properties in promoting normal B cell activation but their role in chronic lymphocytic leukemia (CLL) is unknown. We find that TFH cells are elevated in CLL patients and are phenotypically abnormal, expressing higher levels of PD-1, TIGIT, CD40L, IFNγ and IL-21, and exhibiting abnormal composition of TFH1, TFH2 and TFH17 subsets. Frequencies of CD4-positive T cells expressing TFH1 markers and IL-21 were positively correlated with patient lymphocyte counts and RAI stage, suggesting that accumulation of abnormal TFH cells is concomitant with expansion of the leukemic B cell clone. Treatment with ibrutinib led to normalization of TFH frequencies and phenotype. TFH cells identified in CLL bone marrow display elevated expression of several functional markers compared to blood TFH cells. CLL T cell-B cell co-culture experiments revealed a correlation of patient TFH frequencies with functional ability of their CD4-positive T cells to promote CLL proliferation. Conversely, CLL cells can preferentially activate the TFH cell subset in co-culture. Together our results indicate that CLL development is associated with expansion of abnormal TFH populations that produce elevated levels of cytokines and costimulatory molecules which may help support CLL proliferation.
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Affiliation(s)
- Xun Wu
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - J Ernesto Fajardo-Despaigne
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Zhang
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Vishala Neppalli
- Hematopathology Laboratory, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Versha Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James B Johnston
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Spencer B Gibson
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Aaron J Marshall
- Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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4
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Jafroodifar A, Thibodeau R, Goel A, Coelho M, Bryant S, Nguyen Q, Mirchia K, Zaccarini DJ, Wojtowycz AR. Chronic lymphoid leukemia metastasis to the gallbladder as a focal mass: A case report. Radiol Case Rep 2021; 16:1477-1484. [PMID: 33936353 PMCID: PMC8079244 DOI: 10.1016/j.radcr.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/02/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the second most common hematologic malignancy, and it is characterized by lymphocytic leukocytosis and secondary hematologic deficiencies. While it most commonly presents as a systemic disease, extramedullary involvement may rarely occur. The literature surrounding CLL metastatic disease to the gallbladder is particularly sparse. Interestingly, we describe a case of a 67-year-old female who presented with painless jaundice and was found to have a rapidly growing gallbladder wall mass which was determined to be CLL metastatic disease after extensive surgical resection. It is important for radiologists to recognize the possibility of CLL metastatic disease to the gallbladder when evaluating potential cases of cholecystitis due to the overlapping spectrum of imaging findings. Cognizant radiologists can potentially save patients from surgical intervention as CLL is classically treated with chemotherapy.
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Affiliation(s)
- Abtin Jafroodifar
- Department of Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Ryan Thibodeau
- Department of Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Atin Goel
- Department of Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Marlon Coelho
- Department of Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Stephanie Bryant
- Department of Pathology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Quoc Nguyen
- Department of Pathology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Kavya Mirchia
- Department of Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Daniel J Zaccarini
- Department of Pathology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Andrij R Wojtowycz
- Department of Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
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5
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Giudice V, Vecchione C, Selleri C. Cardiotoxicity of Novel Targeted Hematological Therapies. Life (Basel) 2020; 10:life10120344. [PMID: 33322351 PMCID: PMC7763613 DOI: 10.3390/life10120344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy-related cardiac dysfunction, also known as cardiotoxicity, is a group of drug-related adverse events negatively affecting myocardial structure and functions in patients who received chemotherapy for cancer treatment. Clinical manifestations can vary from life-threatening arrythmias to chronic conditions, such as heart failure or hypertension, which dramatically reduce quality of life of cancer survivors. Standard chemotherapy exerts its toxic effect mainly by inducing oxidative stress and genomic instability, while new targeted therapies work by interfering with signaling pathways important not only in cancer cells but also in myocytes. For example, Bruton’s tyrosine kinase (BTK) inhibitors interfere with class I phosphoinositide 3-kinase isoforms involved in cardiac hypertrophy, contractility, and regulation of various channel forming proteins; thus, off-target effects of BTK inhibitors are associated with increased frequency of arrhythmias, such as atrial fibrillation, compared to standard chemotherapy. In this review, we summarize current knowledge of cardiotoxic effects of targeted therapies used in hematology.
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Affiliation(s)
- Valentina Giudice
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.V.); (C.S.)
- Clinical Pharmacology, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy
- Correspondence: ; Tel.: +39-089-672-493
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.V.); (C.S.)
- IRCCS Neuromed (Mediterranean Neurological Institute), 86077 Pozzilli, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.V.); (C.S.)
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy
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6
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Yokus O, Saglam EN, Goze H, Sametoglu F, Serin I. Prognostic Role of Lymphocyte/Monocyte Ratio in Chronic Lymphocytic Leukemia. J Hematol 2020; 9:116-122. [PMID: 33224391 PMCID: PMC7665864 DOI: 10.14740/jh730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Chronic lymphocytic leukemia (CLL) is a B-lymphoproliferative disease with varying clinical characteristics, which occurs mostly in older ages. In studies from literature, we see that different parameters are examined to determine the prognosis of CLL. The main purpose of our study is to determine the relationship of lymphocyte/monocyte ratio (LMR) value in CLL, which has been previously shown to be a prognostic factor in various solid organ tumors and some hematological malignancies. Methods A total of 173 patients who were followed up between 2005 and 2019 were retrospectively analyzed. The diagnostic age, gender, laboratory, absolute lymphocyte and monocyte count, LMR and overall survival (OS), treatment and responses, recurrence, cytogenetic subtype and mortality rates were examined. Results The median LMR was 26.7 and it was considered as cut-off value of 26. A positive correlation was found between LMR and Rai Stage. LMR was significantly higher in patients who have an indication for treatment or who died. Conclusions In our study, in CLL, LMR has been shown to be over 26 in advanced stages, in relapse or with indication of a treatment. With the increase of LMR, it was found that survival and disease-free gap decreased.
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Affiliation(s)
- Osman Yokus
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Esma Nur Saglam
- Department of Internal Medicine, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Hasan Goze
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Fettah Sametoglu
- Department of Internal Medicine, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Istemi Serin
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
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7
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Wang C, Li L, Li M, Shen X, Liu Y, Wang S. Inactivated STAT5 pathway underlies a novel inhibitory role of EBF1 in chronic lymphocytic leukemia. Exp Cell Res 2020; 398:112371. [PMID: 33188849 DOI: 10.1016/j.yexcr.2020.112371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022]
Abstract
B-cell chronic lymphocytic leukemia (CLL) is a disease caused by gradual accumulation of functionally incompetent lymphocytes. The majority of CLL cases are accompanied by chemoresistance. Early B cell factor 1 (EBF1) is a crucial contributor to B-cell lymphopoiesis. This study is to explore the effect of EBF1 on CLL cell progression and its involvement in regulating the signal transducers and activators of transcription 5 (STAT5) pathway. We conducted a correlation analysis between EBF1 and the clinical characteristics of CLL patients. Subsequently, EBF1 was overexpressed by transfection with EBF1 overexpression plasmid and the STAT5 pathway was also blocked by treatment with SH-4-54 in isolated CD20+ B lymphocytes to investigate their roles in the regulation of cellular functions. STAT5, Janus kinase 2 (JAK2) expression and their phosphorylation levels were determined by quantitative PCR and Western blot analyses. The in vivo effects of EBF1 on tumor growth were evaluated using a xenotransplant model. Downregulation of EBF1 was observed in CD20+ B lymphocytes of CLL patients. EBF1 overexpression disrupted the activation of STAT5 pathway, as evidenced by decreased expression and phosphorylation levels of STAT5 and JAK2. Furthermore, overexpression of EBF1 repressed viability and cell cycle entry, and increased apoptosis of CD20+ B lymphocytes by inhibiting the STAT5 pathway. Finally, EBF1 exerted antitumor effects in nude mice. Overall, our study elucidates the inhibitory role of EBF1 in CLL through inactivation of the STAT5 pathway, which may provide new targets for CLL treatment.
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Affiliation(s)
- Chong Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
| | - Lingling Li
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
| | - Mengya Li
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
| | - Xiaohui Shen
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
| | - Yanfang Liu
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
| | - Shujuan Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China.
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8
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Pérez-Carretero C, Hernández-Sánchez M, González T, Quijada-Álamo M, Martín-Izquierdo M, Hernández-Sánchez JM, Vidal MJ, de Coca AG, Aguilar C, Vargas-Pabón M, Alonso S, Sierra M, Rubio-Martínez A, Dávila J, Díaz-Valdés JR, Queizán JA, Hernández-Rivas JÁ, Benito R, Rodríguez-Vicente AE, Hernández-Rivas JM. Chronic lymphocytic leukemia patients with IGH translocations are characterized by a distinct genetic landscape with prognostic implications. Int J Cancer 2020; 147:2780-2792. [PMID: 32720348 DOI: 10.1002/ijc.33235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/19/2020] [Accepted: 07/07/2020] [Indexed: 12/29/2022]
Abstract
Chromosome 14q32 rearrangements/translocations involving the immunoglobulin heavy chain (IGH) are rarely detected in chronic lymphocytic leukemia (CLL). The prognostic significance of the IGH translocation is controversial and its mutational profile remains unknown. Here, we present for the first time a comprehensive next-generation sequencing (NGS) analysis of 46 CLL patients with IGH rearrangement (IGHR-CLLs) and we demonstrate that IGHR-CLLs have a distinct mutational profile with recurrent mutations in NOTCH1, IGLL5, POT1, BCL2, FBXW7, ZMYM3, MGA, BRAF and HIST1H1E genes. Interestingly, BCL2 and FBXW7 mutations were significantly associated with this subgroup and almost half of BCL2, IGLL5 and HISTH1E mutations reported were previously identified in non-Hodgkin lymphomas. Notably, IGH/BCL2 rearrangements were associated with a lower mutation frequency and carried BCL2 and IGLL5 mutations, while the other IGHR-CLLs had mutations in genes related to poor prognosis (NOTCH1, SF3B1 and TP53) and shorter time to first treatment (TFT). Moreover, IGHR-CLLs patients showed a shorter TFT than CLL patients carrying 13q-, normal fluorescence in situ hybridization (FISH) and +12 CLL, being this prognosis particularly poor when NOTCH1, SF3B1, TP53, BIRC3 and BRAF were also mutated. The presence of these mutations not only was an independent risk factor within IGHR-CLLs, but also refined the prognosis of low-risk cytogenetic patients (13q-/normal FISH). Hence, our study demonstrates that IGHR-CLLs have a distinct mutational profile from the majority of CLLs and highlights the relevance of incorporating NGS and the status of IGH by FISH analysis to refine the risk-stratification CLL model.
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Affiliation(s)
- Claudia Pérez-Carretero
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - María Hernández-Sánchez
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Teresa González
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Miguel Quijada-Álamo
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Marta Martín-Izquierdo
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jesús-María Hernández-Sánchez
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Carlos Aguilar
- Servicio de Hematología, Complejo Hospitalario de Soria, Soria, Spain
| | | | - Sara Alonso
- Servicio de Hematología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Magdalena Sierra
- Servicio de Hematología, Hospital Virgen de la Concha, Zamora, Spain
| | | | - Julio Dávila
- Servicio de Hematología, Hospital Nuestra Señora de Sonsoles, Ávila, Spain
| | | | | | | | - Rocío Benito
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ana E Rodríguez-Vicente
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jesús-María Hernández-Rivas
- Universidad de Salamanca, IBSAL, Centro de Investigación del Cáncer, IBMCC-CSIC, Salamanca, Spain.,Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
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9
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Kreuzberger N, Damen JA, Trivella M, Estcourt LJ, Aldin A, Umlauff L, Vazquez-Montes MD, Wolff R, Moons KG, Monsef I, Foroutan F, Kreuzer KA, Skoetz N. Prognostic models for newly-diagnosed chronic lymphocytic leukaemia in adults: a systematic review and meta-analysis. Cochrane Database Syst Rev 2020; 7:CD012022. [PMID: 32735048 PMCID: PMC8078230 DOI: 10.1002/14651858.cd012022.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chronic lymphocytic leukaemia (CLL) is the most common cancer of the lymphatic system in Western countries. Several clinical and biological factors for CLL have been identified. However, it remains unclear which of the available prognostic models combining those factors can be used in clinical practice to predict long-term outcome in people newly-diagnosed with CLL. OBJECTIVES To identify, describe and appraise all prognostic models developed to predict overall survival (OS), progression-free survival (PFS) or treatment-free survival (TFS) in newly-diagnosed (previously untreated) adults with CLL, and meta-analyse their predictive performances. SEARCH METHODS We searched MEDLINE (from January 1950 to June 2019 via Ovid), Embase (from 1974 to June 2019) and registries of ongoing trials (to 5 March 2020) for development and validation studies of prognostic models for untreated adults with CLL. In addition, we screened the reference lists and citation indices of included studies. SELECTION CRITERIA We included all prognostic models developed for CLL which predict OS, PFS, or TFS, provided they combined prognostic factors known before treatment initiation, and any studies that tested the performance of these models in individuals other than the ones included in model development (i.e. 'external model validation studies'). We included studies of adults with confirmed B-cell CLL who had not received treatment prior to the start of the study. We did not restrict the search based on study design. DATA COLLECTION AND ANALYSIS We developed a data extraction form to collect information based on the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Independent pairs of review authors screened references, extracted data and assessed risk of bias according to the Prediction model Risk Of Bias ASsessment Tool (PROBAST). For models that were externally validated at least three times, we aimed to perform a quantitative meta-analysis of their predictive performance, notably their calibration (proportion of people predicted to experience the outcome who do so) and discrimination (ability to differentiate between people with and without the event) using a random-effects model. When a model categorised individuals into risk categories, we pooled outcome frequencies per risk group (low, intermediate, high and very high). We did not apply GRADE as guidance is not yet available for reviews of prognostic models. MAIN RESULTS From 52 eligible studies, we identified 12 externally validated models: six were developed for OS, one for PFS and five for TFS. In general, reporting of the studies was poor, especially predictive performance measures for calibration and discrimination; but also basic information, such as eligibility criteria and the recruitment period of participants was often missing. We rated almost all studies at high or unclear risk of bias according to PROBAST. Overall, the applicability of the models and their validation studies was low or unclear; the most common reasons were inappropriate handling of missing data and serious reporting deficiencies concerning eligibility criteria, recruitment period, observation time and prediction performance measures. We report the results for three models predicting OS, which had available data from more than three external validation studies: CLL International Prognostic Index (CLL-IPI) This score includes five prognostic factors: age, clinical stage, IgHV mutational status, B2-microglobulin and TP53 status. Calibration: for the low-, intermediate- and high-risk groups, the pooled five-year survival per risk group from validation studies corresponded to the frequencies observed in the model development study. In the very high-risk group, predicted survival from CLL-IPI was lower than observed from external validation studies. Discrimination: the pooled c-statistic of seven external validation studies (3307 participants, 917 events) was 0.72 (95% confidence interval (CI) 0.67 to 0.77). The 95% prediction interval (PI) of this model for the c-statistic, which describes the expected interval for the model's discriminative ability in a new external validation study, ranged from 0.59 to 0.83. Barcelona-Brno score Aimed at simplifying the CLL-IPI, this score includes three prognostic factors: IgHV mutational status, del(17p) and del(11q). Calibration: for the low- and intermediate-risk group, the pooled survival per risk group corresponded to the frequencies observed in the model development study, although the score seems to overestimate survival for the high-risk group. Discrimination: the pooled c-statistic of four external validation studies (1755 participants, 416 events) was 0.64 (95% CI 0.60 to 0.67); 95% PI 0.59 to 0.68. MDACC 2007 index score The authors presented two versions of this model including six prognostic factors to predict OS: age, B2-microglobulin, absolute lymphocyte count, gender, clinical stage and number of nodal groups. Only one validation study was available for the more comprehensive version of the model, a formula with a nomogram, while seven studies (5127 participants, 994 events) validated the simplified version of the model, the index score. Calibration: for the low- and intermediate-risk groups, the pooled survival per risk group corresponded to the frequencies observed in the model development study, although the score seems to overestimate survival for the high-risk group. Discrimination: the pooled c-statistic of the seven external validation studies for the index score was 0.65 (95% CI 0.60 to 0.70); 95% PI 0.51 to 0.77. AUTHORS' CONCLUSIONS Despite the large number of published studies of prognostic models for OS, PFS or TFS for newly-diagnosed, untreated adults with CLL, only a minority of these (N = 12) have been externally validated for their respective primary outcome. Three models have undergone sufficient external validation to enable meta-analysis of the model's ability to predict survival outcomes. Lack of reporting prevented us from summarising calibration as recommended. Of the three models, the CLL-IPI shows the best discrimination, despite overestimation. However, performance of the models may change for individuals with CLL who receive improved treatment options, as the models included in this review were tested mostly on retrospective cohorts receiving a traditional treatment regimen. In conclusion, this review shows a clear need to improve the conducting and reporting of both prognostic model development and external validation studies. For prognostic models to be used as tools in clinical practice, the development of the models (and their subsequent validation studies) should adapt to include the latest therapy options to accurately predict performance. Adaptations should be timely.
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MESH Headings
- Adult
- Age Factors
- Bias
- Biomarkers, Tumor
- Calibration
- Confidence Intervals
- Discriminant Analysis
- Disease-Free Survival
- Female
- Genes, p53/genetics
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Models, Theoretical
- Neoplasm Staging
- Prognosis
- Progression-Free Survival
- Receptors, Antigen, B-Cell/genetics
- Reproducibility of Results
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Nina Kreuzberger
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Johanna Aag Damen
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Umlauff
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Karl-Anton Kreuzer
- Center of Integrated Oncology Cologne-Bonn, Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Kholodnyuk I, Rivkina A, Hippe L, Svirskis S, Kozireva S, Ventina I, Spaka I, Soloveichika M, Pavlova J, Murovska M, Lejniece S. Chemokine Receptors CCR1 and CCR2 on Peripheral Blood Mononuclear Cells of Newly Diagnosed Patients with the CD38-Positive Chronic Lymphocytic Leukemia. J Clin Med 2020; 9:E2312. [PMID: 32708233 PMCID: PMC7408836 DOI: 10.3390/jcm9072312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 01/29/2023] Open
Abstract
Chemokines and their receptors direct migration and infiltration of immune cells. CCR1 and CCR2 maintain sequence similarity and respond to a number of the same chemokines secreted in lymphoid organs. Expression of CD38 on leukemic cells has been associated with poor clinical outcomes in patients with chronic lymphocytic leukemia (CLL) and is considered as the negative predictor of progression. In our study of newly diagnosed CLL patients, which included 39 CD38-positive and 22 CD38-negative patients, CCR1 and/or CCR2 were always detected, using flow cytometry, on the peripheral blood (PB) CD19+CD5+ lymphocytes in patients with >30% of the CD38+ CD19+CD5+ lymphocytes (n = 16). Spearman's rank correlation analysis determined correlations between the frequency of the CCR1- and CCR2-expressing PB CD19+CD5+ lymphocytes and the frequency of the CD38-positive CD19+CD5+ lymphocytes (rs = 0.50 and rs = 0.38, respectively). No significant correlations were observed between ZAP70 mRNA expression levels in PB mononuclear cells and the frequency of the circulating CCR1+ or CCR2+ CD19+CD5+ lymphocytes. Further association studies are needed to verify prognostic relevance of the CCR1/CCR2 expression on leukemic cells in CLL patients at diagnosis. We suggest that CCR1/CCR2 signaling pathways could represent attractive targets for development of CLL anti-progression therapeutics.
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Affiliation(s)
- Irina Kholodnyuk
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Alla Rivkina
- Department of Internal Diseases, Riga Stradins University, Riga LV-1038, Latvia; (A.R.); (S.L.)
- Riga East University Hospital, Clinic of Chemotherapy and Hematology, Riga LV-1038, Latvia;
| | - Laura Hippe
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Simons Svirskis
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Svetlana Kozireva
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Ildze Ventina
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Irina Spaka
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Marina Soloveichika
- Riga East University Hospital, Clinic of Chemotherapy and Hematology, Riga LV-1038, Latvia;
| | - Jelena Pavlova
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Modra Murovska
- Institute of Microbiology and Virology, Riga Stradins University, Riga LV-1067, Latvia; (L.H.); (S.S.); (S.K.); (I.V.); (I.S.); (J.P.); (M.M.)
| | - Sandra Lejniece
- Department of Internal Diseases, Riga Stradins University, Riga LV-1038, Latvia; (A.R.); (S.L.)
- Riga East University Hospital, Clinic of Chemotherapy and Hematology, Riga LV-1038, Latvia;
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11
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Roy Chowdhury S, Bouchard EDJ, Saleh R, Nugent Z, Peltier C, Mejia E, Hou S, McFall C, Squires M, Hewitt D, Davidson L, Shen GX, Johnston JB, Doucette C, Hatch GM, Fernyhough P, Marshall A, Gibson SB, Dawe DE, Banerji V. Mitochondrial Respiration Correlates with Prognostic Markers in Chronic Lymphocytic Leukemia and Is Normalized by Ibrutinib Treatment. Cancers (Basel) 2020; 12:cancers12030650. [PMID: 32168755 PMCID: PMC7139649 DOI: 10.3390/cancers12030650] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
Mitochondrial bioenergetics profiling, a measure of oxygen consumption rates, correlates with prognostic markers and can be used to assess response to therapy in chronic lymphocytic leukemia (CLL) cells. In this study, we measured mitochondrial respiration rates in primary CLL cells using respirometry to evaluate mitochondrial function. We found significant increases in mitochondrial respiration rates in CLL versus control B lymphocytes. We also observed amongst CLL patients that advanced age, female sex, zeta-chain-associated protein of 70 kD (ZAP-70+), cluster of differentiation 38 (CD38+), and elevated β2-microglobulin (β2-M) predicted increased maximal respiration rates. ZAP-70+ CLL cells exhibited significantly higher bioenergetics than B lymphocytes or ZAP-70− CLL cells and were more sensitive to the uncoupler, carbonyl cyanide-p-trifluoro-methoxyphenylhydrazone (FCCP). Univariable and multivariable linear regression analysis demonstrated that ZAP-70+ predicted increased maximal respiration. ZAP-70+ is a surrogate for B cell receptor (BCR) activation and can be targeted by ibrutinib, which is a clinically approved Bruton’s tyrosine kinase (BTK) inhibitor. Therefore, we evaluated the oxygen consumption rates (OCR) of CLL cells and plasma chemokine (C-C motif) ligands 3 and 4 (CCL3/CCL4) levels from ibrutinib-treated patients and demonstrated decreased OCR similar to control B lymphocytes, suggesting that ibrutinib treatment resets the mitochondrial bioenergetics, while diminished CCL3/CCL4 levels indicate the down regulation of the BCR signaling pathway in CLL. Our data support evaluation of mitochondrial respiration as a preclinical tool for the response assessment of CLL cells.
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Affiliation(s)
- Subir Roy Chowdhury
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Eric D. J. Bouchard
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Ryan Saleh
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Zoann Nugent
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Cheryl Peltier
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Edgard Mejia
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
| | - Sen Hou
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
| | - Carly McFall
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Mandy Squires
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Donna Hewitt
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Linda Davidson
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
| | - Garry X. Shen
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada; (C.D.); (G.M.H.)
| | - James B. Johnston
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Christine Doucette
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada; (C.D.); (G.M.H.)
- Departments of Physiology & Pathophysiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Grant M. Hatch
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada; (C.D.); (G.M.H.)
- St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada
| | - Paul Fernyhough
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Departments of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
| | - Aaron Marshall
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
| | - Spencer B. Gibson
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; (E.M.); (S.H.); (A.M.)
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
| | - David E. Dawe
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Versha Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3V 0V9, Canada; (S.R.C.); (E.D.J.B.); (R.S.); (Z.N.); (C.P.); (C.M.); (M.S.); (D.H.); (L.D.); (J.B.J.); (S.B.G.); (D.E.D.)
- Departments of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
- Departments of Pharmacology and Therapeutics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Correspondence: ; Tel.: +1-204-7871-884; Fax: +1-204-7870-196
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Basabaeen AA, Abdelgader EA, BaHashwan OS, Babekir EA, Abdelateif NM, Bamusa SA, Abdelrahim SO, Altayeb OA, Fadul EA, Ibrahim IK. Combined analysis of ZAP-70 and CD38 expression in sudanese patients with B-cell chronic lymphocytic leukemia. BMC Res Notes 2019; 12:282. [PMID: 31122288 PMCID: PMC6533771 DOI: 10.1186/s13104-019-4319-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the ZAP-70 and CD38 expressions and their combined expressions in Sudanese B-CLL patients and their relationships with clinical and hematological characteristics as well as the disease staging at presentation. Results In the present cross-sectional descriptive study, analysis of ZAP-70 expression showed that 36/110 (32.7%) patients positively expressed ZAP-70 and insignificant higher presentation in intermediate and at advanced stages as well as no correlation was seen with hematological parameters and clinical features compared with negatively ZAP-70, on the other hand, 41/110 (37.3%) were CD38+ and no significant correlation was shown with the stage at presentation, clinical characteristics (except Splenomegaly, P = 0.02) and hematological parameters. However, in combined expressions of both ZAP-70 and CD38 together, 20/110 (18.2%) were concordantly ZAP-70+/CD38+, 53/110 (48.2%) concordantly ZAP-70−/CD38− and 37/110 (33.6%) either ZAP-70+ or CD38+, and these three groups showed insignificant correlation with clinical (except Splenomegaly, P = 0.03) and hematological parameters, and the stage at presentation. Our data showed the combined analysis of these two markers, lead to classify our patients into three subgroups (either concordant positive, negative or discordant expressions) with statistically insignificant correlation with clinical presentation (except Splenomegaly), hematological parameters and stage at presentation of B-CLL patients. Electronic supplementary material The online version of this article (10.1186/s13104-019-4319-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ameen Abdulaziz Basabaeen
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan. .,Ministry of Health & Population, Hadhramout, Yemen.
| | | | - Othman Saeed BaHashwan
- Department of Family Medicine, Faculty of Medicine, University of Gezira, Wad Medani, Sudan
| | - Ebtihal Ahmed Babekir
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
| | - Nour Mahmoud Abdelateif
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
| | | | - Saadia Osman Abdelrahim
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
| | - Osama Ali Altayeb
- Flow Cytometry Laboratory for Leukemia & Lymphoma Diagnosis, Khartoum, Sudan
| | - Eman Abbass Fadul
- Flow Cytometry Laboratory for Leukemia & Lymphoma Diagnosis, Khartoum, Sudan
| | - Ibrahim Khider Ibrahim
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan.,Department of Hematology, School of Medical Sciences, University Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
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Abdelgader EA, Eltayeb NH, Eltahir TA, Altayeb OA, Fadul EA, Abdel Rahman EM, Merghani TH. Evaluation of CD38 expression in Sudanese patients with chronic lymphocytic leukemia. BMC Res Notes 2018; 11:815. [PMID: 30442182 PMCID: PMC6238334 DOI: 10.1186/s13104-018-3926-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/09/2018] [Indexed: 01/19/2023] Open
Abstract
Objective The objective of this study was to evaluate the cluster of differentiation-38 (CD38) expression in Sudanese patients with chronic lymphocytic leukemia (CLL) and to determine its association with clinical and laboratory characteristics of the disease. Results We conducted a cross-sectional study on 99 patients diagnosed with CLL in Khartoum Oncology Hospital in Khartoum, Sudan. Immunophenotyping and CD38 expression levels were measured with four-color flowcytometry. The results of physical examination and blood analyses were used for assigning a modified Rai clinical staging system. The collected data were analyzed using the Statistical Package for the Social Science, version 22 (SPSS Inc., Chicago, IL, USA). According to our findings, the frequencies of 7%, 20%, and 30% cutoff levels of CD38 expressions were 68.7%, 41.4%, and 36.4% respectively. CD38 cutoff level of 7% showed a significant association with hemoglobin concentration (P = 0.04), whereas other cutoff levels showed insignificant results. All the three cutoff levels showed insignificant associations with the other clinical and laboratory variables. In conclusion, the CD38 expression at a cutoff level of 7% seems to be more valuable clinically than higher cutoff levels in Sudanese CLL patients.
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Affiliation(s)
| | - Nada Hassan Eltayeb
- Department of Physiology, Faculty of Medicine, Al Neelain University, Khartoum, Sudan
| | | | - Osama Ali Altayeb
- Flow Cytometry Laboratory for Leukemia & Lymphoma Diagnosis, Khartoum, Sudan
| | - Eman Abbass Fadul
- Flow Cytometry Laboratory for Leukemia & Lymphoma Diagnosis, Khartoum, Sudan
| | | | - Tarig H Merghani
- Department of Physiology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Daugaard I, Hussmann D, Kristensen L, Kristensen T, Kjeldsen TE, Nyvold CG, Larsen TS, Møller MB, Hansen LL, Wojdacz TK. Chronic lymphocytic leukemia patients with heterogeneously or fully methylated LPL promotor display longer time to treatment. Epigenomics 2018; 10:1155-1166. [PMID: 30182737 DOI: 10.2217/epi-2018-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM We investigated whether DNA methylation regulates expression of LPL and PI3K complex genes in chronic lymphocytic leukemia (CLL) and evaluated the prognostic significance of LPL promoter methylation in CLL patients. Patients & methods: Methylation of LPL promoter was assessed in 112 patients using methylation-sensitive high-resolution melting (MS-HRM). RESULTS Patients with a fully or heterogeneously methylated LPL promoter had significantly longer median time to treatment (p < 0.001) and 75% lower (hazard ratio: 0.25; 95% CI: 0.15-0.42; p < 0.001) risk of requirement for treatment as opposed to patients with nonmethylated promoter. Multivariate modeling confirmed independent prognostic value of these findings. CONCLUSION Chronic lymphocytic leukemia patients with a fully or heterogeneously methylated LPL gene promoter display indolent disease course and acquisition of heterogeneous methylation of LPL promoter is insufficient to induce gene expression.
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Affiliation(s)
- Iben Daugaard
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Dianna Hussmann
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Louise Kristensen
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense C, Denmark
| | - Thomas Kristensen
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense C, Denmark
| | - Tina E Kjeldsen
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Charlotte G Nyvold
- Department of Haematology, Odense University Hospital, Sdr. Bouldvard 29, 5000 Odense C, Denmark
| | - Thomas S Larsen
- Department of Haematology, Odense University Hospital, Sdr. Bouldvard 29, 5000 Odense C, Denmark
| | - Michael B Møller
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense C, Denmark
| | - Lise Lotte Hansen
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Tomasz K Wojdacz
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark.,Aarhus Institute of Advanced Studies, Høegh-Guldbergs Gade 6B, DK-8000 Aarhus C, Denmark
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15
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Abur Ü, Oğur G, Akar ÖS, Altundağ E, Aymelek HS, Özatlı D, Turgut M. Impact of Fluorescent In Situ Hybridization Aberrations and CLLU1 Expression on the Prognosis of Chronic Lymphocytic Leukemia: Presentation of 156 Patients from Turkey. Turk J Haematol 2018; 35:61-65. [PMID: 29129824 PMCID: PMC5843776 DOI: 10.4274/tjh.2017.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE This study evaluates the impact of CLLU1 expression and fluorescent in situ hybridization (FISH) analysis of a group of Turkish chronic lymphocytic leukemia (CLL) patients. MATERIALS AND METHODS A total of 156 CLL patients were analyzed by FISH method; 47 of them were also evaluated for CLLU1 expression. Results were correlated with clinical parameters. RESULTS FISH aberrations were found in 62% of patients. These aberrations were del13q14 (67%), trisomy 12 (27%), del11q22 (19%), del17p (8%), and 14q32 rearrangements (20%). Overall del11q22 and del17p were associated with the highest mortality rates, shortest overall survival (OS), and highest need for medication. Homozygous del13q14, 14q32 rearrangements, and higher CLLU1 expression correlated with shorter OS. CONCLUSION Cytogenetics/FISH analysis is still indicated for routine evaluation of CLL. Special consideration is needed for the poor prognostic implications of del11q22, del17p, 14q32 rearrangements, and homozygous del13q14. The impact of CLLU1 expression is not yet clear and it requires more data before becoming routine in genetic testing in CLL patients.
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Affiliation(s)
- Ümmet Abur
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Gönül Oğur
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Ömer Salih Akar
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Engin Altundağ
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Huri Sema Aymelek
- Ondokuz Mayıs University Faculty of Medicine, Department of Medical Genetics, Samsun, Turkey
| | - Düzgün Özatlı
- Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
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16
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Rodríguez-Vicente AE, Bikos V, Hernández-Sánchez M, Malcikova J, Hernández-Rivas JM, Pospisilova S. Next-generation sequencing in chronic lymphocytic leukemia: recent findings and new horizons. Oncotarget 2017; 8:71234-71248. [PMID: 29050359 PMCID: PMC5642634 DOI: 10.18632/oncotarget.19525] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
The rapid progress in next-generation sequencing technologies has significantly contributed to our knowledge of the genetic events associated with the development, progression and treatment resistance of chronic lymphocytic leukemia patients. Together with the discovery of new driver mutations, next-generation sequencing has revealed an immense degree of both intra- and inter-tumor heterogeneity and enabled us to describe marked clonal evolution. Advances in immunogenetics may be implemented to detect minimal residual disease more sensitively and to track clonal B cell populations, their dynamics and molecular characteristics. The interpretation of these aspects is indispensable to thoroughly examine the genetic background of chronic lymphocytic leukemia. We review and discuss the recent results provided by the different next-generation sequencing techniques used in studying the chronic lymphocytic leukemia genome, as well as future perspectives in the methodologies and applications.
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Affiliation(s)
- Ana E Rodríguez-Vicente
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom.,IBSAL, IBMCC, Centro de Investigación del Cáncer, Universidad de Salamanca, CSIC, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Vasilis Bikos
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - María Hernández-Sánchez
- IBSAL, IBMCC, Centro de Investigación del Cáncer, Universidad de Salamanca, CSIC, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jitka Malcikova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, Medical Faculty MU and University Hospital, Brno, Czech Republic
| | - Jesús-María Hernández-Rivas
- IBSAL, IBMCC, Centro de Investigación del Cáncer, Universidad de Salamanca, CSIC, Hospital Universitario de Salamanca, Salamanca, Spain.,Hematology Department, Hospital Universitario, Salamanca, Spain.,Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Sarka Pospisilova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, Medical Faculty MU and University Hospital, Brno, Czech Republic
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17
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Sandoval-Sus JD, Chavez JC, Dalia S, Naqvi SMH, Talati C, Nodzon L, Kharfan-Dabaja MA, Pinilla-Ibarz J. Association between immunoglobulin heavy-chain variable region mutational status and isolated favorable baseline genomic aberrations in chronic lymphocytic leukemia. Leuk Lymphoma 2017. [PMID: 28641468 DOI: 10.1080/10428194.2017.1323271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Immunoglobulin heavy-chain variable region (IGHV) mutational status and karyotype abnormalities are important prognostic factors in chronic lymphocytic leukemia (CLL). The goal was to assess the impact of IGHV in CLL patients with isolated favorable genetic aberrations (del13q, trisomy 12, or negative fluorescence in situ hybridization [FISH]). We studied 273 CLL patients with both IGHV mutational status and cytogenetic information: 145 with isolated del13q 49 with sole trisomy 12 and 79 with negative FISH. After a median follow-up of 7.8 years, patients with del13q-unmutated IGHV had a shorter time to first treatment (TFT) (2.98 vs. 17.44 years; p < .001) and shorter overall survival (10.45 years vs. not reached; p = .0026). Patients with negative FISH-unmutated IGHV had shorter TFT (p = .02) (3.10 vs. 9.75 years, p = .053). IGHV status did not influence clinical outcomes in trisomy 12 CLL. In conclusion, IGHV mutational status shows prognostic impact in CLL patients with good prognosis genomic features.
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Affiliation(s)
- Jose D Sandoval-Sus
- a H. Lee Moffitt Cancer Center and Research Institute, University of South Florida , Tampa , FL , USA
| | - Julio C Chavez
- b Department of Malignant Hematology , H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA
| | - Samir Dalia
- c Mercy Clinic Oncology and Hematology , Joplin , MO , USA
| | - Syeda Mahrukh Hussnain Naqvi
- d Department of Biostatistics and Bioinformatics , H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA
| | - Chetasi Talati
- a H. Lee Moffitt Cancer Center and Research Institute, University of South Florida , Tampa , FL , USA
| | - Lisa Nodzon
- b Department of Malignant Hematology , H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA
| | - Mohamed A Kharfan-Dabaja
- e Department of Blood and Marrow Transplantation , H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA
| | - Javier Pinilla-Ibarz
- b Department of Malignant Hematology , H. Lee Moffitt Cancer Center and Research Institute , Tampa , FL , USA
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18
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Salamh PA, Reiman M, Cleland J, Mintken P, Rodeghero J, Cook CE. Risk Stratification for 4,837 Individuals with Knee Pain Who Receive Physical Therapy Treatment. Musculoskeletal Care 2017; 15:122-130. [PMID: 27374889 DOI: 10.1002/msc.1150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Risk stratification is a modelling method that is designed to target interventions toward patients with specific needs. The objective of the present study was to identify predictive characteristics related to patients with knee impairments who had a high risk of a bad prognosis (exceptional non-responders) as well as those who were at low risk of a bad prognosis (exceptional responders). A cohort of 4,837 patients with knee pain seen for physical therapy was retrospective analysed using univariate and multivariate multinomial regression analyses. Modelling was used to identify characteristics associated with those who were exceptional responders and those who were exceptional non-responders. Exceptional non-responders were significantly associated with older age, female gender, longer duration of symptoms, surgical history, lower functional status at baseline and a payer type. Exceptional responders were significantly associated with younger age, no previous surgical history, higher functional status at baseline and a payer type. Findings may be used for managing processes involving intensity of care service and in understanding probable prognoses for each patient. Future research should continue to examine variables predictive of treatment response in patients with knee pain. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Paul Mintken
- University of Colorado School of Medicine, Aurora, CO, USA
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19
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Nabhan C, Mato AR, Feinberg BA. Clinical pathways in chronic lymphocytic leukemia: Challenges and solutions. Am J Hematol 2017; 92:5-6. [PMID: 27766676 DOI: 10.1002/ajh.24589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Chadi Nabhan
- Cardinal Health Specialty Solutions; Cardinal Health, Inc; Dublin Ohio
| | | | - Bruce A. Feinberg
- Cardinal Health Specialty Solutions; Cardinal Health, Inc; Dublin Ohio
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20
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Nazir A, Fawad, Ali S, Badar F, Siddique N, Hameed A. Outcomes of first line chemotherapy in patients with chronic lymphocytic leukemia. Pak J Med Sci 2016; 32:1213-1217. [PMID: 27882024 PMCID: PMC5103136 DOI: 10.12669/pjms.325.10480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/14/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Chronic lymphocytic leukemia (CLL) is a heterogeneous disease in terms of survival with and without treatment. Many chemo and immunotherapeutic agents are available to treat this indolent disease. Aim of this study was to determine the outcomes of patients with chronic lymphocytic leukemia treated with different available chemotherapeutic regimens. METHODS All patients with diagnosis of CLL from 2008 to 2013 were included. Data were collected from hospital information system. Objective response rate (ORR) in terms of complete or partial response (CR, PR), stable or progressive disease (SD, PD), overall survival (OS), and progression free survival (PFS) were calculated. RESULTS Fifty seven patients were included; 42 (74%) male and 15 (26%) were female. Patients with Binet stage A 10 (18%); B 20 (35%) and C were 27(47%). Median age was 50.9 years. Forty six (80%) were treated and 11(20%) remained on watch and wait. Treatment indications were B symptoms 14 (30%), symptomatic nodal disease 18(39%), thrombocytopenia 4(9%), anemia 7(15%) and doubling of lymphocyte count 3 (7%). Chemotherapy regimens used were FC in 38 (83%), FCR 5(11%), chlorambucil 2(4%) and CVP in 1(2%) patient. Twenty two (56%) patients had CR, 13(33%) PR, 3(7.6 %) SD, and 1(2.5%) had PD. ORR was 89%. Median PFS was 23.1 months and median 3 years OS was 55%. CONCLUSION Majority of patients was in a relatively younger age group and presented with advanced stage disease requiring treatment. Small number of patients received rituximab due to cost. PFS and OS are comparable with published literature.
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Affiliation(s)
- Adil Nazir
- Dr. Adil Nazir, MBBS, FCPS Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore - Pakistan
| | - Fawad
- Dr. Fawad MBBS, FCPS Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore - Pakistan
| | - Sheeraz Ali
- Dr. Sheeraz Ali, MBBS, FCPS Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore - Pakistan
| | - Farhana Badar
- Dr. Farhana Badar, Sr. Biostatistician & Cancer Epidemiologist Cancer Registry & Clinical Data Management, Department of Cancer Registry and Clinical Data Management
| | - Neelam Siddique
- Dr. Neelam Siddiqui, MBBS, FRCP (Glasgow), CCST (Medical Oncology) UK, Consultant medical oncologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore - Pakistan
| | - Abdul Hameed
- Dr. Abdul Hameed MBBS, MD, FRCP (Edin), Consultant Hematologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore - Pakistan
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21
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Affiliation(s)
| | - Eva Kassi
- Deparment of Biological Chemistry, Medical Scholl, National and Kapodistrian University of Athens, Athens, Greece
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22
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Frey S, Blankart CR, Stargardt T. Economic Burden and Quality-of-Life Effects of Chronic Lymphocytic Leukemia: A Systematic Review of the Literature. PHARMACOECONOMICS 2016; 34:479-98. [PMID: 26739956 DOI: 10.1007/s40273-015-0367-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is the most prevalent type of leukemia in the Western hemisphere. The disease affects quality of life (QOL) and poses an economic burden on patients, payers, and society. The objective of this review was to quantify the economic burden and quality-of-life effects and identify the gaps that should be addressed by future research. METHODS Free-text and subject heading searches in MEDLINE, EMBASE, the Cochrane Library, the University of York Centre for Reviews and Dissemination Database, and the Web of Science Core Collection database were conducted to identify observational and interventional studies reporting costs and/or quality-of-life effects published up to 2 October 2015. Studies were included irrespective of whether they were conducted prospectively or retrospectively. The focus population consisted of adult patients aged 18 years or older affected by any stage of CLL. Studies were included regardless of whether the underlying population was treated at baseline or not. Risk of bias was assessed using a quality checklist developed by the Effective Public Health Practice Project for (randomized) controlled trials, cohort studies, and cross-sectional studies. Economic evaluations were rated using a checklist developed by Stuhldreher et al. (Int J Eat Disord 45:476-91, 2012). RESULTS From 2451 records identified, 27 studies were found to be eligible for inclusion. Studies were heterogeneous with respect to methodology, perspective, and data used. Annual direct costs per person ranged from US$4491 in Germany to US$43,913 in the USA. The share of costs attributable to drug treatment varied between 26.2 and 79 %. Indirect costs amounted to US$4208. Severity of disease was a predictor for quality of life, whereas differences by age and sex were mainly present in subdomains. Comparisons of treated and untreated populations resulted in an increase of quality of life in favor of treated populations in the long-term perspective. Differences between treatments were small. Consequently, cost effectiveness in decision-analytic models did not depend on whether quality of life or survival are used to describe the benefits of treatment. CONCLUSIONS Although the quantity and the quality of health economic and quality-of-life evidence have substantially increased, there is still a need for studies that take a patient or societal perspective. Factors that influence costs and the quality of life of patients seem to be well-established, while longitudinal lifetime cost studies at the population level are still scarce.
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Affiliation(s)
- Simon Frey
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany
| | - Carl R Blankart
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI, USA
| | - Tom Stargardt
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany.
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23
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Grygalewicz B, Woroniecka R, Rygier J, Borkowska K, Rzepecka I, Łukasik M, Budziłowska A, Rymkiewicz G, Błachnio K, Nowakowska B, Bartnik M, Gos M, Pieńkowska-Grela B. Monoallelic and biallelic deletions of 13q14 in a group of CLL/SLL patients investigated by CGH Haematological Cancer and SNP array (8x60K). Mol Cytogenet 2016; 9:1. [PMID: 26740820 PMCID: PMC4702365 DOI: 10.1186/s13039-015-0212-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/30/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Deletion of 13q14 is the most common cytogenetic change in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and is detected in about 50 % of patients by fluorescence in situ hybridization (FISH), which can reveal presence of del(13)(q14) and mono- or biallelic deletion status without information about the size of the lost region. Array-comparative genomic hybridization (aCGH) and single nucleotide polymorphism (SNP) can detect submicroscopic copy number changes, loss of heterozygosity (LOH) and uniparental disomy (UPD) regions. The purpose of this study was detection of the size of del(13)(q14) deletion in our group of patients, comparing the size of the monoallelic and biallelic deletions, detection of LOH and UPD regions. RESULTS We have investigated 40 CLL/SLL patients by karyotype, FISH and CGH and SNP array. Mutational status was of immunoglobulin heavy-chain variable-region (IGVH) was also examined. The size of deletion ranged from 348,12 Kb to 38.97 Mb. Detected minimal deleted region comprised genes: TRIM13, miR-3613, KCNRG, DLEU2, miR-16-1, miR-15a, DLEU1. The RB1 deletions were detected in 41 % of cases. The average size in monoallelic 13q14 deletion group was 7,2 Mb while in biallelic group was 4,8 Mb. In two cases 13q14 deletions were located in the bigger UPD regions. CONCLUSIONS Our results indicate that bigger deletion including RB1 or presence of biallelic 13q14 deletion is not sufficient to be considered as adverse prognostic factor in CLL/SLL. CytoSure Haematological Cancer and SNP array (8x60k) can precisely detect recurrent copy number changes with known prognostic significance in CLL/SLL as well as other chromosomal imbalances. The big advantage of this array is simultaneous detection of LOH and UPD regions during the same test.
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Affiliation(s)
- Beata Grygalewicz
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
- />Department of Pathology and Laboratory Diagnostics, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, 15B Wawelska Str, 02-034, Warsaw, Poland
| | - Renata Woroniecka
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Jolanta Rygier
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Klaudia Borkowska
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Iwona Rzepecka
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Martyna Łukasik
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Agnieszka Budziłowska
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Grzegorz Rymkiewicz
- />Flow Cytometry Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Katarzyna Błachnio
- />Flow Cytometry Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
| | - Beata Nowakowska
- />Department of Medical Genetics, Mother and Child Institute, Warsaw, Poland
| | - Magdalena Bartnik
- />Department of Medical Genetics, Mother and Child Institute, Warsaw, Poland
| | - Monika Gos
- />Department of Medical Genetics, Mother and Child Institute, Warsaw, Poland
| | - Barbara Pieńkowska-Grela
- />Cancer Genetic Laboratory, Pathology and Laboratory Diagnostics Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warsaw, Poland
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24
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Skoetz N, Trivella M, Kreuzer KA, Collins G, Köhler N, Wolff R, Moons K, Estcourt LJ. Prognostic models for chronic lymphocytic leukaemia: an exemplar systematic review and meta-analysis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50937
| | - Marialena Trivella
- University of Oxford; Centre for Statistics in Medicine; Botnar Research Centre Windmill Road Oxford UK OX3 7LD
| | - Karl-Anton Kreuzer
- University Hospital of Cologne; Department I of Internal Medicine; Cologne Germany
| | - Gary Collins
- University of Oxford; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road Oxford UK OX3 7LD
| | - Nicola Köhler
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50937
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd; Unit 6 Escrick Business Park Riccall Road, Escrick York North Yorkshire UK YO19 6FD
| | - Karel Moons
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care; PO Box 85500 Utrecht Netherlands 3508 GA
| | - Lise J Estcourt
- NHS Blood and Transplant; Haematology/Transfusion Medicine; Level 2, John Radcliffe Hospital Headington Oxford UK OX3 9BQ
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25
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Kristensen L, Kristensen T, Abildgaard N, Royo C, Frederiksen M, Mourits-Andersen T, Campo E, Møller MB. LPL gene expression is associated with poor prognosis in CLL and closely related to NOTCH1 mutations. Eur J Haematol 2015; 97:175-82. [PMID: 26558352 DOI: 10.1111/ejh.12700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Chronic lymphocytic leukemia is a heterogeneous yet incurable disease. Whole-genome and whole-exome sequencing studies have revealed recurrently occurring somatic mutations in some genes. Several other prognostic markers have previously been tested for their prognostic value in CLL. LPL is among these markers. AIM To evaluate LPL gene expression together with the well-established prognostic markers of CLL and investigate correlations with more recently identified prognostic markers, NOTCH1 and TP53 mutations. METHODS On 149 patients, LPL gene expression was analyzed by real-time RT-PCR. Exon 34 of NOTCH1 was PCR-amplified and directly sequenced. RESULTS LPL gene expression could be measured as a categorical variable (LPL+/LPL-) and was associated with time to treatment (P < 0.001) and overall survival (P = 0.007). In patients otherwise classified as having a good prognosis according to established and new prognostic markers, 3 of 4 patients, who received treatment within 24 months after diagnosis, were LPL+ (P = 0.03). There was a strong correlation between NOTCH1 mutation and LPL+ (P = 0.005). The unfavorable prognosis of LPL+ was maintained in CLL with wild-type NOTCH1. CONCLUSIONS NOTCH1 mutations are tightly associated with LPL gene expression. LPL expression is independently associated with poor outcome in CLL and can be measured as a categorical variable.
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Affiliation(s)
- Louise Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Thomas Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Cristina Royo
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mikael Frederiksen
- Department of Hematology, Hospital of Southern Jutland, Aabenraa, Denmark
| | | | - Elias Campo
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
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Cook C, Rodeghero J, Cleland J, Mintken P. A Preliminary Risk Stratification Model for Individuals with Neck Pain. Musculoskeletal Care 2015; 13:169-178. [PMID: 25735904 DOI: 10.1002/msc.1098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The aim of the present study was to identify predictive characteristics related to patients with neck impairments who have a high risk of a poor prognosis (lowest functional recovery compared to visit utilization) as well as those who are at low risk of a poor prognosis (highest functional recovery compared to visit utilization). METHODS A retrospective cohort of 3,137 patients with neck pain who were seen for physiotherapy care was included in the study. All patients were seen at physiotherapy clinics in the United States and were provided with care in a manner in which the physiotherapists felt was appropriate and necessary. Univariate and multivariate multinomial regression analyses were used to identify significant patient characteristics predictive of treatment response. RESULTS Statistically significant predictors of high-risk categorization included longer duration of symptoms, surgical history and lower comparative levels of disability at baseline. Statistically significant predictors of low-risk categorization were younger age, shorter duration of symptoms, no surgical history, fewer comorbidities and higher comparative disability levels of function at baseline. DISCUSSION Few studies have analysed risk stratification models for neck pain, and the findings of the present study suggest that predictors of poor success are similar to those in most musculoskeletal prognostic models. Limitations of the study included those inherent in secondary analysis and the inability to identify the diagnoses of the patients. CONCLUSIONS Future research should continue to examine the variables predictive of treatment response in patients with neck pain. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Jason Rodeghero
- OSF Saint James - John W. Albrecht Medical Center, Pontiac, IL, USA
| | | | - Paul Mintken
- University of Colorado, School of Medicine, Aurora, CO, USA
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Kristensen L, Kristensen T, Abildgaard N, Thomassen M, Frederiksen M, Mourits-Andersen T, Møller MB. High expression of PI3K core complex genes is associated with poor prognosis in chronic lymphocytic leukemia. Leuk Res 2015; 39:555-60. [PMID: 25840748 DOI: 10.1016/j.leukres.2015.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 11/16/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in the Western world. Autophagy is a highly conserved process in eukaryotic cells. In CLL autophagy is involved in mediating the effect of chemotherapy but the role of autophagy in CLL pathogenesis remains unknown. In the present study, we used real-time RT-PCR to analyze expression of the PIK3C3, PIK3R4, and BECN1 genes. These genes encode the components of the PI3K core complex, which is central to initiation of autophagy. A consecutive series of 149 well-characterized CLL cases from Region of Southern Denmark were included in the study. All three genes were observed to be independent markers of prognosis in CLL with high expression being associated with more aggressive disease. With this clear association with outcome in CLL, these genes thereby represent promising candidates for future functional studies on the role of autophagy in CLL, and they may further represent targets of treatment.
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Affiliation(s)
- Louise Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Thomas Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Mads Thomassen
- Department of Genetics, Odense University Hospital, Odense, Denmark
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Farren TW, Giustiniani J, Fanous M, Liu F, Macey MG, Wright F, Prentice A, Nathwani A, Agrawal SG. Minimal residual disease detection with tumor-specific CD160 correlates with event-free survival in chronic lymphocytic leukemia. Blood Cancer J 2015; 5:e273. [PMID: 25615279 PMCID: PMC4314455 DOI: 10.1038/bcj.2014.92] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 10/29/2014] [Indexed: 12/21/2022] Open
Abstract
In chronic lymphocytic leukemia (CLL), the detection of minimal residual disease (MRD) correlates with outcome in the trial setting. However, MRD assessment does not guide routine clinical management and its assessment remains complex. We incorporated detection of the B cell, tumor-specific antigen CD160 to develop a single-tube, flow cytometry assay (CD160FCA) for CLL MRD to a threshold of 10−4 to 10−5. One hundred and eighty-seven patients treated for CLL were enrolled. Utilizing the CD160FCA methodology, there was a high level of comparison between blood and bone marrow (R=0.87, P<0.001). In a validation cohort, CD160FCA and the international standardised approach of the European Research Initiative on CLL group demonstrated high concordance (R=0.91, P<0.01). Patients in complete remission (CR) and CD160FCA negative had longer event-free survival (EFS) (63 vs 16 months, P<0.01) and prolonged time to next treatment (60 vs 15 months, P<0.001) vs MRD positive patients; with a median time to MRD positivity of 36 months. In multivariate analysis, CD160FCA MRD detection was independently predictive of EFS in patients in CR and even predicted EFS in the good-risk cytogenetic subgroup. CD160FCA offers a simple assay for MRD detection in CLL and gives prognostic information across different CLL risk groups.
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Affiliation(s)
- T W Farren
- 1] Department of Haemato-Oncology and Immunophenotyping Section, Barts Health NHS Trust, London, UK [2] Pathology Group, Blizard Institute, Queen Mary University of London, London, UK
| | - J Giustiniani
- Laboratoire de Thérapie Cellulaire, Institut Jean Godinot, 1 Avenue du Général Koenig, Reims, France
| | - M Fanous
- Pathology Group, Blizard Institute, Queen Mary University of London, London, UK
| | - F Liu
- Pathology Group, Blizard Institute, Queen Mary University of London, London, UK
| | - M G Macey
- Department of Haemato-Oncology and Immunophenotyping Section, Barts Health NHS Trust, London, UK
| | - F Wright
- Department of Haematology, The Royal Free Hospital, London, UK
| | - A Prentice
- Department of Haematology, The Royal Free Hospital, London, UK
| | - A Nathwani
- UCL Cancer Institute, University College London, London, UK
| | - S G Agrawal
- 1] Department of Haemato-Oncology and Immunophenotyping Section, Barts Health NHS Trust, London, UK [2] Pathology Group, Blizard Institute, Queen Mary University of London, London, UK
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Abstract
Chronic lymphocytic leukemia (CLL) displays remarkable ethnic predisposition for whites, with relative sparing of African-American and Asian populations. In addition, CLL displays among the highest familial predispositions of all hematologic malignancies, yet the genetic basis for these differences is not clearly defined. The highly polymorphic HLA genes of the major histocompatibility complex play a central role in immune surveillance and confer risk for autoimmune and infectious diseases and several different cancers, the role for which in the development of CLL has not been extensively investigated. The National Marrow Donor Program/Be The Match has collected HLA typing from CLL patients in need of allogeneic hematopoietic stem cell transplant and has recruited millions of volunteers to potentially donate hematopoietic stem cells. HLA genotypes for 3491 US white, 397 African-American, and 90 Hispanic CLL patients were compared with 50 000 controls per population from the donor registry. We identified several HLA alleles associated with CLL susceptibility in each population, reconfirming predisposing roles of HLA-A*02:01 and HLA-DRB4*01:01 in whites. Associations for haplotype DRB4*01:01∼DRB1*07:01∼DQB1*03:03 were replicated across all 3 populations. These findings provide a comprehensive assessment of the role of HLA in the development of severe CLL.
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Nabhan C, Aschebrook-Kilfoy B, Chiu BCH, Smith SM, Shanafelt TD, Evens AM, Kay NE. The impact of race, ethnicity, age and sex on clinical outcome in chronic lymphocytic leukemia: a comprehensive Surveillance, Epidemiology, and End Results analysis in the modern era. Leuk Lymphoma 2014; 55:2778-84. [DOI: 10.3109/10428194.2014.898758] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Huang PY, Best OG, Almazi JG, Belov L, Davis ZA, Majid A, Dyer MJ, Pascovici D, Mulligan SP, Christopherson RI. Cell surface phenotype profiles distinguish stable and progressive chronic lymphocytic leukemia. Leuk Lymphoma 2014; 55:2085-92. [DOI: 10.3109/10428194.2013.867486] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Monserrat J, Sánchez MÁ, de Paz R, Díaz D, Mur S, Reyes E, Prieto A, de la Hera A, Martínez-A C, Alvarez-Mon M. Distinctive patterns of naïve/memory subset distribution and cytokine expression in CD4 T lymphocytes in ZAP-70 B-chronic lymphocytic patients. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 86:32-43. [PMID: 24166938 DOI: 10.1002/cyto.b.21120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/28/2013] [Accepted: 07/16/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND ZAP-70 upregulation in B chronic lymphocytic leukemia (B-CLL) cells is a recognized marker of poor prognosis in these patients; the biological basis of this differential clinical outcome nonetheless remains unknown. ZAP-70 overexpression is considered a surrogate marker of a B-CLL cell subset. To test whether the differential biological characteristics of these patients also include the T helper population, we studied naïve, non-terminated memory (NTEM), terminated memory (TEM) and central memory (CM) cells, and cytokine expression by CD4 T lymphocytes from ZAP-70(+) and ZAP-70(-) B-CLL patients. METHODS Expression of CD3, CD8, CD45RA, CD27, and CD28 antigens and intracytoplasmic cytokine production (IFNγ, IL-2, IL-4, IL-10, and TNFα) were assessed simultaneously by nine-color flow-cytometry in peripheral blood lymphocytes from B-CLL patients. B cell ZAP-70 expression in B-CLL cells was also analyzed by flow cytometry. RESULTS Compared to ZAP-70(-) B-CLL patients, ZAP-70(+) B-CLL patients showed 1) significant reduction in the naïve T helper subset and expansion of NTEM and TEM subsets, 2) a decrease in the percentage of activated CD4 T lymphocytes expressing IFNγ, TNFα, and IL-2, and 3) an increase in the percentage of CD4 T lymphocytes expressing IL-4 or IL-10. CONCLUSIONS In conclusion, in early stage B-CLL patients, ZAP-70 upregulation is associated with distinct patterns of activation/differentiation stage subset distribution and of cytokine expression in CD4 T lymphocytes.
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Affiliation(s)
- Jorge Monserrat
- Laboratory of Immune System Diseases and Oncology, Department of Medicine (CNB/CSIC Associated Unit), University of Alcalá, Alcala de Henares, 28871, Madrid, Spain
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Ratterman M, Kruczek K, Sulo S, Shanafelt TD, Kay NE, Nabhan C. Extramedullary chronic lymphocytic leukemia: systematic analysis of cases reported between 1975 and 2012. Leuk Res 2013; 38:299-303. [PMID: 24064196 DOI: 10.1016/j.leukres.2013.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 11/26/2022]
Abstract
The prognostic significance of extra-medullary chronic lymphocytic leukemia (EM-CLL) is unknown. We conducted a Medline database systematic search analyzing English language articles published between 1975 and 2012 identifying 192 cases. Patients with EM-CLL were more commonly treated than not (p < .001). Skin and central nervous system (CNS) were the most commonly reported sites of organ involvement. Survival after diagnosis of EM-CLL appeared to depend on the site of EM involvement. Prospective evaluation and further studies of EM-CLL are warranted.
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Affiliation(s)
- Megan Ratterman
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Kimberly Kruczek
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Suela Sulo
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, United States
| | - Tait D Shanafelt
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Chadi Nabhan
- Department of Medicine, Section of Hematology and Oncology, The University of Chicago, Chicago, IL, United States.
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Alley CL, Wang E, Dunphy CH, Gong JZ, Lu CM, Boswell EL, Burchette J, Lagoo AS. Diagnostic and clinical considerations in concomitant bone marrow involvement by plasma cell myeloma and chronic lymphocytic leukemia/monoclonal B-cell lymphocytosis: a series of 15 cases and review of literature. Arch Pathol Lab Med 2013; 137:503-17. [PMID: 23544940 DOI: 10.5858/arpa.2011-0696-oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Plasma cell myeloma and chronic lymphocytic leukemia are both common hematologic malignancies, sharing many epidemiologic features. Concomitant detection of the 2 conditions poses special diagnostic challenges for the pathologist. OBJECTIVE To describe the pathologic findings in cases of concomitant bone marrow involvement by myeloma and CD5(+) monoclonal B cells and to outline the differential diagnostic possibilities, suggest a workup for correct diagnosis, and examine clinical outcome. DESIGN Fifteen cases that met the diagnostic criteria were identified from pathology databases at 4 participating institutions. Morphologic findings were reviewed, additional immunohistochemical stains performed, and flow cytometric, cytogenetic, and relevant laboratory and clinical information was summarized. Previously published cases were searched from electronic databases and cross-references. RESULTS Most patients (13 of 15) were older males. Often (11 of 15) they presented clinically with myeloma, yet had both monotypic plasma cells and B cells in the diagnostic marrow. In 4 patients, myeloma developed 24 months or later after chronic lymphocytic leukemia. In 7 patients, myeloma and CD5(+) B cells showed identical immunoglobulin light-chain restriction. Primary differential diagnoses include lymphoplasmacytic lymphoma, marginal zone lymphoma, and chronic lymphocytic leukemia with plasmacytoid differentiation. CD56 and/or cyclin D1 expression by plasma cells was helpful for correct diagnosis. Most patients in our cohort and published reports were treated for plasma cell myeloma. CONCLUSIONS Concomitant detection of myeloma and chronic lymphocytic leukemia in the bone marrow is a rare event, which must be carefully differentiated from lymphomas with lymphoplasmacytic differentiation for correct treatment.
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Affiliation(s)
- Christopher L Alley
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Teimori H, Ashoori S, Akbari MT, Mojtabavi Naeini M, Hashemzade Chaleshtori M. FISH Analysis for del6q21 and del17p13 in B-cell Chronic Lymphocytic Leukemia in Iranians. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:107-12. [PMID: 23682321 PMCID: PMC3652496 DOI: 10.5812/ircmj.4990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 09/29/2012] [Accepted: 01/08/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND B-cell chronic lymphocytic leukemia (B-CLL) is the most common leukemia in the Western world. Major progress has been made in assessing typical chromosomal abnormalities and recognition of the correlation of these chromosomal abnormalities with laboratory features and clinical course of the disease. The most frequent genomic changes are deletions at 13q14, 11q22-23 and 17p13 and trisomy of chromosome 12. OBJECTIVES The aim of this study was to investigate the frequency of chromosomal aberrations in B-CLL patients' peripheral blood and/or bone marrow using a molecular cytogenetic method, interphase fluorescence in situ hybridization (I-FISH) and to evaluate the correlation between these genomic changes and clinical findings. PATIENTS AND METHODS I-FISH analyses were performed on bone marrow and blood samples of 66 B-CLL patients. RESULTS Deletion of 17p13 was found in 11 (16.6%) and deletion 6q21 was present in 5 (7.5%). Statistical analyses were performed to investigate the correlation of these molecular-cytogenetic findings with family history, Rai staging and CD38 marker. No clear differences in distribution was noted for del17p13 and del6q21 among patients with and without family history, and no direct correlation was noted between these genomic changes and CD38 marker, but the correlation of del17p13 and Rai stage was significant. There was a high frequency of Rai stage II within del17p13 patients. CONCLUSIONS It was demonstrated that the presence of del6q21 in B-CLL patients indicates poor prognosis and on the contrary, presence of del17p13 points at the good prognostic value of the disease.
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Affiliation(s)
- Hossein Teimori
- Cellular and Molecular Research Center, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
| | - Saeede Ashoori
- Cellular and Molecular Research Center, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
| | - Mohamad Taghi Akbari
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Marjan Mojtabavi Naeini
- Cellular and Molecular Research Center, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
| | - Morteza Hashemzade Chaleshtori
- Cellular and Molecular Research Center, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
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Gatt ME, Ben-Yehuda D, Izraeli S. Lymphoid leukemias. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rizzo D, Bouvier G, Youlyouz-Marfak I, Guerin E, Trimoreau F, Bordessoule D, Jaccard A, Gachard N, Feuillard J. T/B ratio does not reflect levels of ZAP70 expression in clonal CLL B-cells due to ZAP70 overexpression in patient T-cells. CYTOMETRY PART B-CLINICAL CYTOMETRY 2012; 84:125-32. [PMID: 23225571 DOI: 10.1002/cyto.b.21055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/22/2012] [Accepted: 10/29/2012] [Indexed: 11/10/2022]
Abstract
Flow cytometry is the reference technique for assessing ZAP70 expression, a marker of poor prognosis in CLL. One of the most common methods is to assess ZAP70 levels in CLL cells by calculating the ratio between ZAP70 mean fluorescence intensities (MFIs) in residual T-cells and CLL B-cells (ZAP70 T/B ratio). In this study, we developed a new method for ZAP70 labeling. Cells were labeled with a combination of anti ZAP70 phycoerythrin-conjugated SBZAP monoclonal antibody (mAb) and mAbs against CD45, CD19, and CD5. The latter three were used to specifically gate on different lymphocyte subsets. Staining was performed in absence (test) or in presence of excess unconjugated SBZAP mAb (isoclonic control). A so-called ZAP70 isoclonic ratio between SBZAP MFIs in the test and isoclonic control was calculated. A series of 32 patients with CLL and 10 normal controls were studied. Prediction of IGHV mutation status by ZAP70 isoclonic and T/B ratios was similar. By using the ZAP70 isoclonic ratio, we showed that ZAP70 expression was increased in T-cells from CLL patients. Nearly all cases with increased ZAP70 expression in CLL cells were associated with high ZAP70 expression in cognate T-cells. Therefore, the ZAP70 isoclonic ratio was more likely to closely reflect the biology of ZAP70 dysregulation rather than the T/B ratio. These results also explained why ZAP70 T/B ratios were artefactually close to normal in cells from CLL patients with high levels of ZAP70.
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Affiliation(s)
- David Rizzo
- Department of Biology, Laboratory of Haematology, University Hospital Dupuytren, Limoges, France
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Szerafin L, Jakó J, Riskó F, Hevessy Z. The prognostic value of smudge cells (Gumprecht shadows) in chronic lymphocytic leukaemia. Orv Hetil 2012; 153:1732-7. [DOI: 10.1556/oh.2012.29477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Smudge cells (Gumprecht shadows) are chronic lymphocytic leukaemic cells ruptured during peripherial blood smear preparation. It has been demonstrated to be linked to reduced expression of the cytoskeletal protein vimentin and its inverse correlation with the clinical outcome of the disease. Aims: Investigation of the percentage of smudge cells, CD38-, ZAP-70-positive cells and the time to treatment in patients with chronic lymphocytic leukaemia. Methods: Authors investigated the percentage of smudge cells, CD38- and ZAP-70-positive cells in the peripheral blood of 50 patients with chronic lymphocytic leukaemia and their correlation with the time to treatment. Results: 21 patients required treatment in the follow-up period. Their median smudge cell percentage was 9.9%, while it was 26.8% in the non-treated group. The cut-off value of smudge cell positivity was set to 20%. 59.3% of the patients with less than cut-off had to be treated in the follow-up time compared to 21.7% of patients with more smudge cells. These findings were similar to the prognostic value of CD38 and ZAP-70. The necessity of treatment increased to 75–77.8% with the combination of investigated markers. The time to treatment was 19 months when smudge cells were less than 20%, but above 20% it was 36.15 months. In case of low smudge cell percentage and CD38 positivity the time to treatment was 14.14 months and in case of high smudge cell percentage and CD38 negativity it was 32.92 months. In discordant cases the time to treatment was 18.43 months. The authors also present a case report that demonstrates the relationship between the percentage of smudge cells and apoptotic cells with annexin V and 7-AAD staining. Conclusions: Estimation of smudge cells on a blood smear could be a simple and cheap prognostic test in chronic lymphocytic leukaemia with sensitivity similar to CD38 and ZAP-70 estimation. Combination of these tests raised the sensitivity of their prognostic value. Orv. Hetil., 2012, 153, 1732–1737.
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Affiliation(s)
- László Szerafin
- Jósa András Oktatókórház Egészségügyi Szolgáltató Nonprofit Kft. Hematológiai Osztály Nyíregyháza Szent István u. 68. 4400
| | - János Jakó
- Jósa András Oktatókórház Egészségügyi Szolgáltató Nonprofit Kft. Hematológiai Osztály Nyíregyháza Szent István u. 68. 4400
| | - Ferenc Riskó
- Jósa András Oktatókórház Egészségügyi Szolgáltató Nonprofit Kft. Hematológiai Osztály Nyíregyháza Szent István u. 68. 4400
| | - Zsuzsanna Hevessy
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Laboratóriumi Medicina Intézet Debrecen
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Plander M, Skrapits J, Bozsó T, Szendrei T, Iványi JL. [Detection and impact of minimal residual disease on outcome of chronic lymphocytic leukemia]. Orv Hetil 2012; 153:1622-8. [PMID: 23045312 DOI: 10.1556/oh.2012.29458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Minimal residual disease is associated with longer overall survival in patients with chronic lymphocytic leukemia. AIM The aim of the authors was to determine the clinical significance of remission and minimal residual disease on the survival of patients with chronic lymphocytic leukemia. METHODS Data from 42 first-line treated patients with chronic lymphocytic leukemia were analyzed. Minimal residual disease was determined by flow cytometry. RESULTS Overall response and complete remission was achieved in 91%, 86%, 100% and 87%, 0%, 60% of patients with fludarabine-based combinations, single-agent fludarabine and cyclophosphamide + vincristin + prednisolone regimen, respectively. Minimal residual disease eradication was feasible only with fludarabine-based combinations in 60% of these cases. The ratio of minimal residual disease was 0.5% on average. During a median follow-up period lasting 30 months, the overall survival of patients with fludarabine-resistant disease proved to be significantly shorter (p = 0.04), while complete remission without minimal residual disease was associated with significantly longer progression free survival (p = 0.02). CONCLUSION Only fludarabine-based combinations were able to eradicate minimal residual disease in patients with chronic lymphocytic leukemia. Complete remission without minimal residual disease may predict longer progression free survival in these patients.
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Affiliation(s)
- Márk Plander
- Vas Megyei Markusovszky Kórház, Egyetemi Oktatókórház Nonprofit Zrt. Haematologiai és Haemostaseologiai Osztály, Szombathely.
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Gunn SR, Robetorye RS, Mohammed MS. Comparative Genomic Hybridization Arrays in Clinical Pathology. Mol Diagn Ther 2012; 11:73-7. [PMID: 17397242 DOI: 10.1007/bf03256225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Array-based comparative genomic hybridization (array CGH) genome scanning is a powerful method for the global detection of gains and losses of genetic material in both congenital and neoplastic disorders. When used as a clinical diagnostic test, array CGH combines the whole genome perspective of traditional G-banded cytogenetics with the targeted identification of cryptic chromosomal abnormalities characteristic of fluorescence in situ hybridization (FISH). However, the presence of structural variants in the human genome can complicate analysis of patient samples, and array CGH does not provide morphologic information about chromosome structure, balanced translocations, or the actual chromosomal location of segmental duplications. Identification of such anomalies has significant diagnostic and prognostic implications for the patient. We therefore propose that array CGH should be used as a guide to the presence of genomic structural rearrangements in germline and tumor genomes that can then be further characterized by FISH or G-banding, depending on the clinical scenario. In this article, we share some of our experiences with diagnostic array CGH and discuss recent progress and challenges involved with the integration of array CGH into clinical laboratory medicine.
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Affiliation(s)
- Shelly R Gunn
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA.
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Taralli S, Calcagni ML, Rufini V, Laurenti L, Sica S, Chiusolo P, Leone G, Giordano A. Role of 18F-FDG PET-CT for evaluating the response to reduced-intensity conditioning allogeneic transplant in heavily pre-treated patients with chronic lymphocytic leukemia: preliminary results in nine patients. Ann Nucl Med 2012; 26:764-8. [PMID: 22875575 DOI: 10.1007/s12149-012-0639-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/22/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of our preliminary study was to evaluate the potential role of 18F-FDG PET-CT in monitoring response to reduced-intensity conditioning (RIC) transplant in a small series of chronic lymphocytic leukemia (CLL) patients and to compare the results with those obtained by standard criteria. METHODS We retrospectively analyzed 9 consecutive refractory/relapsed CLL patients, who underwent RIC transplant from March 2004 until May 2009. PET-CT was planned at 6-8 months after transplant to assess response and at a mean of 6 months during follow-up. The mean long-term follow-up period was 38 months (range 12-74 months, median 29 months). RESULTS The first PET-CT showed abnormal 18F-FDG uptake in five patients, while by standard criteria eight patients showed persistent disease. At the end of follow-up (mean 38 months), all four patients with previously negative scan were still PET negative and in complete remission by standard criteria. All five patients with previously positive scan were still PET positive: one patient died for disease progression and four are alive with disease. CONCLUSIONS Our preliminary data, although in a small series of CLL patients, suggest that the metabolic findings revealed at first PET-CT after transplant seem to predict the patient outcome and to assess the metabolic disease status earlier than clinical evaluation by standard criteria. PET-CT performed during follow-up may be useful to early detect disease progression.
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Affiliation(s)
- Silvia Taralli
- Institute of Nuclear Medicine, Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
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Mozaheb Z, NazarAbadi MHH, Aghaee MA. Chronic Lymphocytic Leukemia and Prognostic Factors. Asian Pac J Cancer Prev 2012; 13:3009-13. [DOI: 10.7314/apjcp.2012.13.7.3009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Madden LA, Hayman YA, Underwood C, Vince RV, Greenman J, Allsup D, Ali S. Increased inducible heat shock protein 72 expression associated with PBMC isolated from patients with haematological tumours. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:380-6. [PMID: 22548611 DOI: 10.3109/00365513.2012.681683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Heat shock protein 72 (Hsp72) is a highly inducible stress protein and molecular chaperone. Cancers have been shown to be associated with increased Hsp72 expression within the tumour itself and this may lead to resistance to apoptosis. METHODS Peripheral blood mononuclear cells (PBMC) were isolated from patients diagnosed with chronic lymphocytic leukaemia (CLL) (n = 27) and chronic myelomonocytic leukaemia (CMML) (n = 16) and Hsp72 expression was characterized on both the cell surface and intracellularly by flow cytometry. To allow for comparison PBMC from breast cancer patients (n = 25) and healthy volunteers (n = 19) were included. RESULTS Both lymphocytes and monocytes from CLL and CMML patients showed high levels of total Hsp72 expression (4-6 fold increase) in comparison to breast cancer and healthy subjects. The majority of Hsp72 in these tumours was determined to be cell-surface expressed (64-93% of cell total Hsp72). CONCLUSIONS A correlation was observed between lymphocyte and monocyte total Hsp72 expression (p < 0.001) suggesting a common stress response pathway may exist in these blood cells and there are stress conditions present within the circulation. Hsp72 expression was not found to be related to white blood cell count.
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Affiliation(s)
- Leigh A Madden
- Postgraduate Medical Institute, University of Hull, Hull, UK.
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Degheidy HA, Venzon DJ, Farooqui MZ, Abbasi F, Arthur DC, Wilson WH, Wiestner A, Stetler-Stevenson MA, Marti GE. Combined normal donor and CLL: Single tube ZAP-70 analysis. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2012; 82:67-77. [PMID: 22031337 PMCID: PMC3407416 DOI: 10.1002/cyto.b.20622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 07/14/2011] [Accepted: 08/19/2011] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Zeta-chain-associated protein kinase 70 (ZAP-70) has been identified as an independent prognostic marker in chronic lymphocytic leukemia (CLL). Based on our previous studies, we have developed a combined one-tube technology with multiple internal controls to optimize ZAP-70 assessment. METHODS Forty-eight untreated CLL cases were examined for ZAP-70 expression using a modified 7-color one-tube assay. Normal donor (ND) whole blood is stained with CD3 APC-Cy7 and CD19 APC. In a second tube, patient whole blood is stained with CD5 PE-Cy7, CD19 PerCP-Cy5.5, and CD20 eFluor450. After surface staining and fixation, these two tubes are combined. After saponin permeabilization, the cells were stained with two anti-ZAP-70 clones (1E7.2/AF488 and SBZAP/PE). The results obtained from this modified tube were compared with those obtained concurrently using the non-mixed single sample tubes. Five different methods of ZAP-70 expression analysis were evaluated: percentage positive cells using ND T-cells as a reference; the internal patient T-cell/clone ratio; ND T-cell/clone ratio; clone/ND B-cell ratio; and modified Z-index. RESULT Overall, the combined patient and ND mix tube performed better than the non-mixed single sample tube. The strongest correlations between ZAP-70 expression and immunoglobulin heavy chain variable (IGHV) mutational status were seen with percentage positive ND T-cell, ND T-cell/clone ratio, and clone/ND B-cell ratio for both 1E7.2 and SBZAP clone (P < 0.0001). CONCLUSION The modified one tube method combining the ND and patient sample provides highly reliable results that correlate with the IGHV mutational status. This method should be considered as part of the next step in standardization of the ZAP-70 assay in CLL.
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Affiliation(s)
- Heba A. Degheidy
- Center for Biologics Evaluation and Research, FDA, Bethesda, MD, USA
| | | | | | - Fatima Abbasi
- Center for Biologics Evaluation and Research, FDA, Bethesda, MD, USA
| | | | | | | | | | - Gerald E. Marti
- Center for Biologics Evaluation and Research, FDA, Bethesda, MD, USA
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Malavasi F, Deaglio S, Damle R, Cutrona G, Ferrarini M, Chiorazzi N. CD38 and chronic lymphocytic leukemia: a decade later. Blood 2011; 118:3470-8. [PMID: 21765022 PMCID: PMC3574275 DOI: 10.1182/blood-2011-06-275610] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/28/2011] [Indexed: 11/20/2022] Open
Abstract
This review highlights a decade of investigations into the role of CD38 in CLL. CD38 is accepted as a dependable marker of unfavorable prognosis and as an indicator of activation and proliferation of cells when tested. Leukemic clones with higher numbers of CD38(+) cells are more responsive to BCR signaling and are characterized by enhanced migration. In vitro activation through CD38 drives CLL proliferation and chemotaxis via a signaling pathway that includes ZAP-70 and ERK1/2. Finally, CD38 is under a polymorphic transcriptional control after external signals. Consequently, CD38 appears to be a global molecular bridge to the environment, promoting survival/proliferation over apoptosis. Together, this evidence contributes to the current view of CLL as a chronic disease in which the host's microenvironment promotes leukemic cell growth and also controls the sequential acquisition and accumulation of genetic alterations. This view relies on the existence of a set of surface molecules, including CD38, which support proliferation and survival of B cells on their way to and after neoplastic transformation. The second decade of studies on CD38 in CLL will tell if the molecule is an effective target for antibody-mediated therapy in this currently incurable leukemia.
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MESH Headings
- ADP-ribosyl Cyclase 1/genetics
- ADP-ribosyl Cyclase 1/metabolism
- ADP-ribosyl Cyclase 1/physiology
- Animals
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Models, Biological
- Molecular Targeted Therapy/methods
- Molecular Targeted Therapy/trends
- Research/trends
- Time Factors
- Tumor Microenvironment/physiology
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Affiliation(s)
- Fabio Malavasi
- Department of Genetics, Biology and Biochemistry, University of Torino School of Medicine, Torino, Italy.
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Presenting features and outcome of chronic lymphocytic leukemia patients diagnosed at age 80 years or more. An ICLLSG study. Ann Hematol 2011; 90:1123-9. [DOI: 10.1007/s00277-011-1259-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
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Nabhan C, Dalal N, Mehta J, Kay NE. Biologic agent activity in chronic lymphocytic leukemia: a framework for future therapies. Leuk Lymphoma 2011; 52:374-86. [DOI: 10.3109/10428194.2010.545461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gonzalez-Rodriguez AP, Contesti J, Huergo-Zapico L, Lopez-Soto A, Fernández-Guizán A, Acebes-Huerta A, Gonzalez-Huerta AJ, Gonzalez E, Fernandez-Alvarez C, Gonzalez S. Prognostic significance of CD8 and CD4 T cells in chronic lymphocytic leukemia. Leuk Lymphoma 2011; 51:1829-36. [PMID: 20846097 DOI: 10.3109/10428194.2010.503820] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prognostic value of the number of T cells and NK cells at diagnosis in CLL was analyzed in a cohort of 256 patients with CLL diagnosed between 1997 and 2007. Patients with leukemia showed elevated NK cells and T cell populations and CD4/CD8 ratio was inverted in 39.7% cases. Prognostic significance of lymphocytes was analyzed as a ratio of relative number of T cells to the size of the malignant monoclonal B-cell pool (T/NK cells:Malignant monoclonal B-cells ratio). Patients showed higher relative number of CD4 (p = 0.03), CD8 (p = 0.02), and NK cells (p = 0.01) in early Rai stage of disease. The multivariate Cox analysis identified the relative number of CD8 (hazard ratio (HR) = 1.464; p = 0.006) and CD4 T cells (HR = 0.091; p < 0.01) as independent predictors for survival. Additionally, patients with relative CD8 count > 0.074 or CD4 count > 0.1 had higher 10-year overall survival than patients with CD8 count ≤0.074 or CD4 count ≤0.1 (p = 0.002). Higher CD8 count was associated with significantly higher median time of survival of patients (149.33 vs. 82.06 months). Finally, association of the good prognostic factor of leukemia cells (CD38⁻ with high relative CD8 count identified a group of patients with an indolent clinical course with an overall survival probability at 10 years of 95%.
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Progressive but previously untreated CLL patients with greater array CGH complexity exhibit a less durable response to chemoimmunotherapy. ACTA ACUST UNITED AC 2011; 203:161-8. [PMID: 21156228 DOI: 10.1016/j.cancergencyto.2010.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 08/31/2010] [Accepted: 09/01/2010] [Indexed: 11/23/2022]
Abstract
To better understand the implications of genomic instability and outcome in B-cell chronic lymphocytic leukemia (CLL), we sought to address genomic complexity as a predictor of chemosensitivity and ultimately clinical outcome in this disease. We used array-based comparative genomic hybridization (aCGH) with a one-million probe array and identified gains and losses of genetic material in 48 patients treated on a chemoimmunotherapy clinical trial. We identified chromosomal gain or loss in ≥6% of the patients on chromosomes 3, 8, 9, 10, 11, 12, 13, 14, and 17. Higher genomic complexity, as a mechanism favoring clonal selection, was associated with shorter progression-free survival, and predicted a poor response to treatment. Of interest, CLL cases with loss of p53 surveillance showed more complex genomic features and were found both in patients with a 17p13.1 deletion and in the more favorable genetic subtype characterized by the presence of 13q14.1 deletion. This aCGH study adds information on the association between poor trial response and increasing genetic complexity as CLL progresses.
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Merino A, Brugués R, García R, Kinder M, Torres F, Escolar G. Estudio comparativo de la morfología de sangre periférica analizada mediante el microscopio y el CellaVision DM96 en enfermedades hematológicas y no hematológicas. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.labcli.2010.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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