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Wang X, Deng Y, He G, Lai S, Li Y, Zhang S, He Y, Han Y, Zhang L, Su Y, Liu F, Yi H. A retrospective study of an irradiation-based conditioning regimen and chidamide maintenance therapy in T-ALL/LBL. Hematology 2024; 29:2356300. [PMID: 38776229 DOI: 10.1080/16078454.2024.2356300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/11/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVES T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL/LBL) are highly malignant and aggressive hematologic tumors for which there is no standard first-line treatment. Chidamide, a novel histone deacetylase inhibitor, shows great promise. We assessed the efficacy and safety of an irradiation-containing conditioning regimen for allogeneic hematopoietic stem cell transplantation (allo-HSCT) and post-transplantation chidamide maintenance in patients with T-ALL/LBL. METHODS We retrospectively analyzed the clinical data of six patients with T-ALL/LBL who underwent allo-HSCT with a radiotherapy-containing pretreatment regimen and post-transplant chidamide maintenance therapy. The endpoints were relapse, graft-versus-host disease (GVHD), transplant-related mortality (TRM), progression-free survival (PFS), overall survival (OS), and adverse events (AEs). RESULTS All of the patients had uneventful post-transplant hematopoietic reconstitution, and all achieved complete molecular remission within 30 days. All six patients survived, and two relapsed with a median relapse time of 828.5 (170-1335) days. The 1-year OS rate was 100%, the 2-year PFS rate was 66.7%, and the TRM rate was 0%. After transplantation, two patients developed grade I-II acute GVHD (2/6); grade III-IV acute and chronic GVHD were not observed. The most common AEs following chidamide administration were hematological AEs, which occurred to varying degrees in all patients; liver function abnormalities occurred in two patients (grade 2), and symptoms of malaise occurred in one patient (grade 1). CONCLUSION Chidamide maintenance therapy after T-ALL/LBL transplantation is safe, but the efficacy needs to be further investigated.
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Affiliation(s)
- Xueying Wang
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Yan Deng
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Guangcui He
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Sihan Lai
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Yecheng Li
- Department of Hematology, Chengdu BOE Hospital, Chengdu, People's Republic of China
| | - Shan Zhang
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Ying He
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Ying Han
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Lilan Zhang
- Department of Hematology, The Affiliated Hospital of Chengdu University, Chengdu, People's Republic of China
| | - Yi Su
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
| | - Fang Liu
- Department of Hematology, Chengdu BOE Hospital, Chengdu, People's Republic of China
| | - Hai Yi
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, People's Republic of China
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Wu ST, Wang CL, Wang L, Zhang CY. A network meta-analysis of the effectiveness of different basic preconditioning regiments in allogeneic hematopoietic stem cell transplantation. Hematology 2024; 29:2374127. [PMID: 39007736 DOI: 10.1080/16078454.2024.2374127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE To investigate and compare the effects of basic preconditioning regimens Bu/Cy, Cy/TBI and Flu/Bu for the treatment of patients in allogeneic hematopoietic stem cell transplantation. METHODS It comprised exploring the published literature in the databases of PubMed, EMBASE, Cochrane Library, and Web of Science, using suitable keywords pertaining to various basic pretreatments Bu/Cy, Cy/TBI, and Flu/Bu, prior to allogeneic hematopoietic stem cell transplantation, and then extracting the searched outcome indicators of Overall Survival (OS) and survival (herein represented as OS and survival). Further, the results were estimated with meta-analysis using R, where the incidence of GVHD was reported in odds ratio (OR) with its 95% confidence interval (95%CI). RESULTS AND DISCUSSION A total of 14 papers were included in this study, including 1436 cases were treated with Bu/Cy, 1816 cases with Cy/TBI, and 549 cases with Flu/Bu in the preconditioning regimen. After OS was the outcome pooled, compared with Flu/Bu in the preconditioning group, the results (Cy/TBI HR = 1.12 (95% Cl:1.04,1.61), Bu/Cy HR = 1.24 (95% Cl. 1.13,2.06)) showed that Flu/Bu preconditioning regimen significantly improved the overall survival rate of allogeneic HSCT patients. With the incidence of GVHD as the outcome summary, compared with Flu/Bu in the pretreatment group, the results (Cy/TBI HR = 1.24 (95% Cl:1.12, 1.82), Bu/Cy HR = 1.14 (95% Cl. 1.03, 2.12)) indicated that Flu/Bu in the pretreatment regimen group also significantly reduced the incidence of GVHD after allogeneic HSCT. CONCLUSION Patients who received the basal preconditioning regimen Flu/Bu before allogeneic hematopoietic stem cell transplantation had the lowest hazard ratio for overall survival (OS) development. This indicates that the use of the basal preconditioning regimen Flu/Bu for the treatment of patients was the most effective, although the quality of the studies included needs to be confirmed by high-quality randomized controlled trials.
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Affiliation(s)
- Si-Ting Wu
- Department of Stem Cell Transplantation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Chun-Li Wang
- Department of Nursing, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Li Wang
- Department of Nursing, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Cai-Yun Zhang
- Department of Hematological Treatment Room, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
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Simonin M, Vasseur L, Lengliné E, Lhermitte L, Cabannes-Hamy A, Balsat M, Schmidt A, Dourthe ME, Touzart A, Graux C, Grardel N, Cayuela JM, Arnoux I, Gandemer V, Huguet F, Ducassou S, Lhéritier V, Chalandon Y, Ifrah N, Dombret H, Macintyre E, Petit A, Rousselot P, Lambert J, Baruchel A, Boissel N, Asnafi V. NGS-based stratification refines the risk stratification in T-ALL and identifies a very-high-risk subgroup of patients. Blood 2024; 144:1570-1580. [PMID: 38848537 DOI: 10.1182/blood.2023023754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
ABSTRACT We previously reported a better outcome in adult and pediatric T-cell acute lymphoblastic leukemia (T-ALL) harboring NOTCH1 and/or FBXW7 mutations without alterations of K-N-RAS and PTEN genes. Availability of high-throughput next-generation sequencing (NGS) strategies led us to refine the outcome prediction in T-ALL. Targeted whole-exome sequencing of 72 T-ALL-related oncogenes was performed in 198 adults with T-ALLs in first remission from the GRAALL-2003/2005 protocols and 242 pediatric patients with T-ALLs from the FRALLE2000T. This approach enabled the identification of, to our knowledge, the first NGS-based classifier in T-ALL, categorizing low-risk patients as those with N/F, PHF6, or EP300 mutations, excluding N-K-RAS, PI3K pathway (PTEN, PIK3CA, and PIK3R1), TP53, DNMT3A, IDH1/2, and IKZF1 alterations, with a 5-year cumulative incidence of relapse (CIR) estimated at 21%. Conversely, the remaining patients were classified as high risk, exhibiting a 5-year CIR estimated at 47%. We externally validated this stratification in the pediatric cohort. NGS-based classifier was highly prognostic independently of minimal residual disease (MRD) and white blood cell (WBC) counts, in both adult and pediatric cohorts. Integration of the NGS-based classifier into a comprehensive risk-stratification model, including WBC count at diagnosis and MRD at the end of induction, enabled the identification of an adverse-risk subgroup (25%) with a 5-year CIR estimated at 51%, and a favorable-risk group (32%) with a 5-year CIR estimated at 12%. NGS-based stratification combined with WBC and MRD sharpens the prognostic classification in T-ALL and identifies a new subgroup of patients who may benefit from innovative therapeutic approaches. The GRAALL-2003/2005 studies were registered at www.ClinicalTrials.gov as #NCT00222027 and #NCT00327678.
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Affiliation(s)
- Mathieu Simonin
- Laboratory of Onco-Hematology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151, Paris, France
- Department of Pediatric Hematology and Oncology, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Loïc Vasseur
- Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation, INSERM U1153, Université Paris Cité, Paris, France
- Adolescent and Young Adult Hematology Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Etienne Lengliné
- Institut de Recherche Saint-Louis, EA-3518, Université Paris Cité, Paris, France
- Department of Hematology, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ludovic Lhermitte
- Laboratory of Onco-Hematology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151, Paris, France
| | | | - Marie Balsat
- Clinical Hematology Department, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Aline Schmidt
- Hematology Department, Angers University Hospital, Angers, France
- PRES LUNAM, INSERM U 892, Angers University, Angers, France
| | - Marie-Emilie Dourthe
- Laboratory of Onco-Hematology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151, Paris, France
- Department of Pediatric Hematology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Aurore Touzart
- Laboratory of Onco-Hematology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151, Paris, France
| | - Carlos Graux
- Department of Hematology, Université Catholique de Louvain, CHU UCL Namur-site Godinne, Yvoir, Belgium
| | - Nathalie Grardel
- Department of Hematology, University Hospital Claude Huriez, Lille, France
| | - Jean-Michel Cayuela
- Institut de Recherche Saint-Louis, EA-3518, Université Paris Cité, Paris, France
- Laboratory of Hematology, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Arnoux
- Laboratory of Hematology, La Timone University Hospital, Assitance Publique des Hôpitaux de Marseille, Marseille, France
| | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France
| | - Françoise Huguet
- Department of Hematology, Toulouse University Hospital, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Stéphane Ducassou
- Department of Pediatric Oncology and Hematology, Bordeaux University Hospital, Bordeaux, France
| | - Véronique Lhéritier
- Coordination of the Group for Research on Adult Acute Lymphoblastic Leukemia, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Yves Chalandon
- Department of Oncology, Hematology Service, Geneva University Hospitals and Medical School, University of Geneva, Geneva, Switzerland
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Norbert Ifrah
- Hematology Department, Angers University Hospital, Angers, France
- PRES LUNAM, INSERM U 892, Angers University, Angers, France
| | - Hervé Dombret
- Institut de Recherche Saint-Louis, EA-3518, Université Paris Cité, Paris, France
- Department of Hematology, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elizabeth Macintyre
- Laboratory of Onco-Hematology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151, Paris, France
| | - Arnaud Petit
- Department of Pediatric Hematology and Oncology, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | | | - Jérôme Lambert
- Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation, INSERM U1153, Université Paris Cité, Paris, France
- Biostatistics and Medical Information Department, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - André Baruchel
- Department of Pediatric Hematology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nicolas Boissel
- Adolescent and Young Adult Hematology Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut de Recherche Saint-Louis, EA-3518, Université Paris Cité, Paris, France
| | - Vahid Asnafi
- Laboratory of Onco-Hematology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151, Paris, France
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Gong X, Fang Q, Gu R, Qiu S, Liu K, Lin D, Zhou C, Zhang G, Gong B, Liu Y, Li Y, Liu B, Wang Y, Wei H, Mi Y, Wang J. A pediatric-inspired regimen for adolescent and adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia: a prospective study from China. Haematologica 2024; 109:3146-3156. [PMID: 38235508 PMCID: PMC11443404 DOI: 10.3324/haematol.2023.284228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Indexed: 01/19/2024] Open
Abstract
Several international centers have used and reported on pediatric-inspired regimens to treat adolescent and adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph- ALL). However, there is a lack of prospective data from the Chinese population. We performed a prospective study with a pediatric-inspired regimen (IH-2014 regimen) to treat adolescent and adult Ph- ALL patients in our center. From 2014 to 2021, a total of 415 patients aged between 14 and 65 years (median age, 27 years) were included in this study. After a median follow-up of 40.8 months, the 5-year overall survival, disease-free survival, and event-free survival rates were 53.8%, 51.1% and 45.0%, respectively. The regimen was generally well tolerated and safe, and the overall chemotherapy-related mortality was 3.6%. Age ≥40 years and persistent detectable minimal residual disease (MRD) after induction were independent prognostic factors. Traditional risk factors for adult patients combined with post-induction MRD had predictive significance for survival and relapse, which is helpful in the selection of subsequent treatment. Patients with high-risk factors who can achieve a deep MRD response after induction do not derive benefit from allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Xiaoyuan Gong
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Qiuyun Fang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Runxia Gu
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Shaowei Qiu
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Kaiqi Liu
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Dong Lin
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Chunlin Zhou
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Guangji Zhang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Benfa Gong
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Yuntao Liu
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Yan Li
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Bingcheng Liu
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Ying Wang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Hui Wei
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Yingchang Mi
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600
| | - Jianxiang Wang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China; Tianjin Institutes of Health Science, Tianjin 301600.
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Yan Z, Xia J, Cao Z, Zhang H, Wang J, Feng T, Shu Y, Zou L. Multi-omics integration reveals potential stage-specific druggable targets in T-cell acute lymphoblastic leukemia. Genes Dis 2024; 11:100949. [PMID: 39071111 PMCID: PMC11282411 DOI: 10.1016/j.gendis.2023.03.022] [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: 10/20/2022] [Accepted: 03/11/2023] [Indexed: 07/30/2024] Open
Abstract
T-cell acute lymphoblastic leukemia (T-ALL), a heterogeneous hematological malignancy, is caused by the developmental arrest of normal T-cell progenitors. The development of targeted therapeutic regimens is impeded by poor knowledge of the stage-specific aberrances in this disease. In this study, we performed multi-omics integration analysis, which included mRNA expression, chromatin accessibility, and gene-dependency database analyses, to identify potential stage-specific druggable targets and repositioned drugs for this disease. This multi-omics integration helped identify 29 potential pathological genes for T-ALL. These genes exhibited tissue-specific expression profiles and were enriched in the cell cycle, hematopoietic stem cell differentiation, and the AMPK signaling pathway. Of these, four known druggable targets (CDK6, TUBA1A, TUBB, and TYMS) showed dysregulated and stage-specific expression in malignant T cells and may serve as stage-specific targets in T-ALL. The TUBA1A expression level was higher in the early T cell precursor (ETP)-ALL cells, while TUBB and TYMS were mainly highly expressed in malignant T cells arrested at the CD4 and CD8 double-positive or single-positive stage. CDK6 exhibited a U-shaped expression pattern in malignant T cells along the naïve to maturation stages. Furthermore, mebendazole and gemcitabine, which target TUBA1A and TYMS, respectively, exerted stage-specific inhibitory effects on T-ALL cell lines, indicating their potential stage-specific antileukemic role in T-ALL. Collectively, our findings might aid in identifying potential stage-specific druggable targets and are promising for achieving more precise therapeutic strategies for T-ALL.
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Affiliation(s)
- Zijun Yan
- Clinical Research Unit, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
| | - Jie Xia
- Bioinformatics and BioMedical Bigdata Mining Laboratory, School of Big Health, Guizhou Medical University, Guiyang, Guizhou 554300, China
| | - Ziyang Cao
- Clinical Research Unit, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
| | - Hongyang Zhang
- Clinical Research Unit, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
| | - Jinxia Wang
- Clinical Research Unit, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
| | - Tienan Feng
- Clinical Research Unit, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yi Shu
- Center for Clinical Molecular Laboratory Medicine of Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Lin Zou
- Clinical Research Unit, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
- Center for Clinical Molecular Laboratory Medicine of Children's Hospital of Chongqing Medical University, Chongqing 400014, China
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Feng Y, Wu L, Gu T, Hu Y, Huang H. How can we improve the successful identification of patients suitable for CAR-T cell therapy? Expert Rev Mol Diagn 2024; 24:777-792. [PMID: 39258858 DOI: 10.1080/14737159.2024.2399152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/28/2024] [Indexed: 09/12/2024]
Abstract
INTRODUCTION In recent years, chimeric antigen receptor T (CAR-T) cell therapy has resulted in a breakthrough in the treatment of patients with refractory or relapsed hematological malignancies. However, the identification of patients suitable for CAR-T cell therapy needs to be improved. AREAS COVERED CAR-T cell therapy has demonstrated excellent efficacy in hematological malignancies; however, views on determining when to apply CAR-T cells in terms of the evaluation of patient characteristics remain controversial. EXPERT OPINION We reviewed the current feasibility and challenges of CAR-T cell therapy in the most common hematological malignancies and classified them according to the disease type and treatment priority, to guide clinicians and researchers in applying and investigating CAR-T cells furtherly.
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Affiliation(s)
- Youqin Feng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - Longyuan Wu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - Tianning Gu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - Yongxian Hu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China
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Jen WY, Jabbour E, Kantarjian HM, Short NJ. SOHO State of the Art Updates and Next Questions | Novel Agents and the Diminishing Role of Allogeneic Stem Cell Transplant in B-Acute Lymphoblastic Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:565-572. [PMID: 38538495 DOI: 10.1016/j.clml.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 08/27/2024]
Abstract
Outcomes of patients with B-acute lymphoblastic leukemia (B-ALL) have improved remarkably in the past decade. This has largely been due to the development and introduction of novel immunotherapies such as blinatumomab, inotuzumab ozogamicin, chimeric antigen receptor T (CAR-T) cells, highly potent tyrosine kinase inhibitors, and improved risk stratification, including better understanding of high risk genomic subgroups and better methods of measurable residual disease (MRD) detection. Historically, allogeneic stem cell transplant (allo-SCT) has been the consolidative treatment of choice in first complete remission for fit adults with B-ALL. However, allo-SCT is associated with significant treatment-related mortality and morbidity. Current research is directed at the incorporation of novel immunotherapies into frontline regimens to improve depth and durability of responses and ultimately increase cure rates. In this review, we will discuss the emerging role of novel immune-based treated strategies in both the frontline and relapsed/refractory settings. We present our approach to newly diagnosed patients with B-ALL and illustrate how the incorporation of novel agents and use of high-sensitivity MRD assays can abrogate the need for allo-SCT in most patients with B-ALL.
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Affiliation(s)
- Wei-Ying Jen
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.
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8
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Schwartz MS, Muffly LS. Predicting relapse in acute lymphoblastic leukemia. Leuk Lymphoma 2024:1-7. [PMID: 39216505 DOI: 10.1080/10428194.2024.2387728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
Outcomes in adult and pediatric patients with acute lymphoblastic leukemia (ALL) have improved over successive generations due to rigorously conducted clinical trials and incorporation of novel therapeutic agents. Despite these advances, approximately 20% of high-risk pediatric patients and 50% of adults with ALL will fail to achieve long-term remission with frontline chemotherapy protocols, mostly due to relapse. The ability to predict which patients with ALL are more likely to relapse allows for early intensification of therapy and/or incorporation of novel immunotherapies with the goal of relapse prevention. In this review, we outline the most robust clinical predictors of relapse in ALL with a focus on measurable residual disease (MRD) and genomics. We also discuss application of these prognostic tools in different clinical settings including frontline treatment, pre-/post-allogeneic stem cell transplant, and pre-/post-Chimeric Antigen Receptor T-cell therapy.
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Affiliation(s)
- Marc S Schwartz
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Lori S Muffly
- Division of Blood and Marrow Transplantation & Cellular Therapy, Stanford University School of Medicine, Palo Alto, CA, USA
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9
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Otoukesh S, Yang D, Mokhtari S, Pourhassan H, Agrawal V, Arslan S, Amanam I, Ball B, Koller P, Salhotra A, Sandhu K, Aribi A, Artz A, Aldoss I, Pullarkat V, Ali H, Blackmon A, Becker P, Curtin P, Stewart F, Smith E, Stein A, Marcucci G, Forman SJ, Nakamura R, Al Malki MM. Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings. Bone Marrow Transplant 2024:10.1038/s41409-024-02378-0. [PMID: 39147891 DOI: 10.1038/s41409-024-02378-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024]
Abstract
The optimal myeloablative conditioning regimen for ALL patients undergoing hematopoietic cell transplant (HCT) with an alternative donor is unknown. We analyzed HCT outcomes ALL patients (n = 269) who underwent HCT at our center from 2010 to 2020 in complete remission (CR) after FTBI-etoposide and CNI-based GvHD prophylaxis for matched donor HCT (ETOP-package; n = 196) or FTBI-Fludarabine and post-transplant cyclophosphamide (PTCy)-based prophylaxis for HLA- mismatched (related or unrelated) donors (FLU-package; n = 64). Patients in FLU-package showed a significant delay in engraftment (p < 0.001) and lower cumulative incidence (CI) of any and extensive chronic GVHD (p = 0.009 and 0.001, respectively). At the median follow up of 4.6 years (range 1-12 years); non-relapse mortality, overall or leukemia-free survival and GVHD-free/relapse-free survival were not significantly impacted by the choice of conditioning. However, in patients at CR2 or with measurable residual disease (MRD+), there was a trend towards higher relapse after FLU-package (p = 0.08 and p = 0.07, respectively), while patients at CR1 regardless of MRD status had similar outcomes despite the package/donor type (p = 0.9 and 0.7, respectively). Our data suggests that FLU-package for alternative donors offers comparable outcomes to ETOP-package for matched donor HCT to treat ALL. Disease status and depth of remission at HCT were independent predictors for better outcomes.
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Affiliation(s)
- Salman Otoukesh
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Sally Mokhtari
- Department of Clinical and Translational Project Development, City of Hope National Medical Center, Duarte, CA, USA
| | - Hoda Pourhassan
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Vaibhav Agrawal
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Shukaib Arslan
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Idoroenyi Amanam
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Brian Ball
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Paul Koller
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Karamjeet Sandhu
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Ahmed Aribi
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Andrew Artz
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Haris Ali
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Amanda Blackmon
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Pamela Becker
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Peter Curtin
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Forrest Stewart
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Eileen Smith
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Anthony Stein
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematologic Malignancies and Translational Science, City of Hope National Medical Center, Duarte, CA, USA.
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10
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Jing J, Ma Y, Xie Z, Wang B, Chen Y, Chi E, Wang J, Zhang K, Wang Z, Li S. Acute T-cell lymphoblastic leukemia: chimeric antigen receptor technology may offer a new hope. Front Immunol 2024; 15:1410519. [PMID: 39192970 PMCID: PMC11347323 DOI: 10.3389/fimmu.2024.1410519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/15/2024] [Indexed: 08/29/2024] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a prevalent malignancy affecting the hematopoietic system, encompassing both B-cell ALL (B-ALL) and T-cell ALL (T-ALL). T-ALL, characterized by the proliferation of T-cell progenitors in the bone marrow, presents significant treatment challenges, with patients often experiencing high relapse rates and poor long-term survival despite advances in chemotherapy and hematopoietic stem cell transplantation (HSCT). This review explores the pathogenesis and traditional treatment strategies of T-ALL, emphasizing the promising potential of chimeric antigen receptor (CAR) technology in overcoming current therapeutic limitations. CAR therapy, leveraging genetically modified immune cells to target leukemia-specific antigens, offers a novel and precise approach to T-ALL treatment. The review critically analyzes recent developments in CAR-T and CAR-NK cell therapies, their common targets, optimization strategies, clinical outcomes, and the associated challenges, providing a comprehensive overview of their clinical prospects in T-ALL treatment.
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Affiliation(s)
- Jiajie Jing
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Yuan Ma
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Ziwen Xie
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Bingyan Wang
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Yueming Chen
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Enjie Chi
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Jiadong Wang
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Kejin Zhang
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
| | - Zhujun Wang
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sisi Li
- Department of Clinical Medicine, Hangzhou City University School of Medicine, Hangzhou, China
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11
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Litzow MR, Sun Z, Mattison RJ, Paietta EM, Roberts KG, Zhang Y, Racevskis J, Lazarus HM, Rowe JM, Arber DA, Wieduwilt MJ, Liedtke M, Bergeron J, Wood BL, Zhao Y, Wu G, Chang TC, Zhang W, Pratz KW, Dinner SN, Frey N, Gore SD, Bhatnagar B, Atallah EL, Uy GL, Jeyakumar D, Lin TL, Willman CL, DeAngelo DJ, Patel SB, Elliott MA, Advani AS, Tzachanis D, Vachhani P, Bhave RR, Sharon E, Little RF, Erba HP, Stone RM, Luger SM, Mullighan CG, Tallman MS. Blinatumomab for MRD-Negative Acute Lymphoblastic Leukemia in Adults. N Engl J Med 2024; 391:320-333. [PMID: 39047240 PMCID: PMC11334054 DOI: 10.1056/nejmoa2312948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Many older adults with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) have a relapse despite having a measurable residual disease (MRD)-negative complete remission with combination chemotherapy. The addition of blinatumomab, a bispecific T-cell engager molecule that is approved for the treatment of relapsed, refractory, and MRD-positive BCP-ALL, may have efficacy in patients with MRD-negative remission. METHODS In a phase 3 trial, we randomly assigned patients 30 to 70 years of age with BCR::ABL1-negative BCP-ALL (with :: indicating fusion) who had MRD-negative remission (defined as <0.01% leukemic cells in bone marrow as assessed on flow cytometry) after induction and intensification chemotherapy to receive four cycles of blinatumomab in addition to four cycles of consolidation chemotherapy or to receive four cycles of consolidation chemotherapy alone. The primary end point was overall survival, and relapse-free survival was a secondary end point. RESULTS The data and safety monitoring committee reviewed the results from the third efficacy interim analysis and recommended that they be reported. Complete remission with or without full count recovery was observed in 395 of 488 enrolled patients (81%). Of the 224 patients with MRD-negative status, 112 were assigned to each group. The characteristics of the patients were balanced between the groups. At a median follow-up of 43 months, an advantage was observed in the blinatumomab group as compared with the chemotherapy-only group with regard to overall survival (at 3 years: 85% vs. 68%; hazard ratio for death, 0.41; 95% confidence interval [CI], 0.23 to 0.73; P = 0.002), and the 3-year relapse-free survival was 80% with blinatumomab and 64% with chemotherapy alone (hazard ratio for relapse or death, 0.53; 95% CI, 0.32 to 0.87). A higher incidence of neuropsychiatric events was reported in the blinatumomab group than in the chemotherapy-only group. CONCLUSIONS The addition of blinatumomab to consolidation chemotherapy in adult patients in MRD-negative remission from BCP-ALL significantly improved overall survival. (Funded by the National Institutes of Health and others; E1910 ClinicalTrials.gov number, NCT02003222.).
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Affiliation(s)
- Mark R Litzow
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Zhuoxin Sun
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Ryan J Mattison
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Elisabeth M Paietta
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Kathryn G Roberts
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Yanming Zhang
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Janis Racevskis
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Hillard M Lazarus
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Jacob M Rowe
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Daniel A Arber
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Matthew J Wieduwilt
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Michaela Liedtke
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Julie Bergeron
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Brent L Wood
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Yaqi Zhao
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Gang Wu
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Ti-Cheng Chang
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Wenchao Zhang
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Keith W Pratz
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Shira N Dinner
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Noelle Frey
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Steven D Gore
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Bhavana Bhatnagar
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Ehab L Atallah
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Geoffrey L Uy
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Deepa Jeyakumar
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Tara L Lin
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Cheryl L Willman
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Daniel J DeAngelo
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Shejal B Patel
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Michelle A Elliott
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Anjali S Advani
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Dimitrios Tzachanis
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Pankit Vachhani
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Rupali R Bhave
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Elad Sharon
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Richard F Little
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Harry P Erba
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Richard M Stone
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Selina M Luger
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Charles G Mullighan
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
| | - Martin S Tallman
- From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina
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Krishan S, Asad ZUA, Quiroga D, Ghazi SM, Quartermaine C, Braunstein Z, Kola-Kehinde O, Shaaban A, Habib A, Khan S, Cheng R, Brammer JE, Addison D. Comparison of atrial fibrillation prevalence and in-hospital cardiovascular outcomes between patients undergoing allogeneic versus autologous hematopoietic stem cell transplantation: insights from the national inpatient sample. Sci Rep 2024; 14:16829. [PMID: 39039091 PMCID: PMC11263704 DOI: 10.1038/s41598-024-65294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant hematologic conditions. However, patients undergoing HSCT are at increased risk of developing serious cardiovascular events. Whether cardiovascular risks differ by the type of transplantation strategy used, allogeneic versus autologous HSCT, is unknown. Leveraging the National Inpatient Sample (2016-2019), we assessed the incidence of early cardiovascular events by HSCT mode (allogeneic vs autologous). The primary outcome was the incidence of atrial fibrillation (AF). The secondary outcome was the occurrence of any major adverse cardiac events (MACE), defined as acute heart failure, myocardial infarction (MI), symptomatic atrial or ventricular arrhythmia or heart block, and cardiovascular death. Outcomes were compared between those undergoing allogeneic versus autologous HSCT. Multivariable regression, adjusting for cardiovascular and cancer-related factors, was used to define the association between pre-HSCT factors and MACE. We further assessed the effect of acute cardiovascular events on in-patient mortality by calculating adjusted odds ratio (aOR) with corresponding 95% confidence intervals (CI) and p-values. Overall, 64,705 weighted hospitalizations for HSCT were identified, of which 22,655 (35.0%) were allogeneic HSCT and 42,050 (65.0%) were autologous HSCT. The prevalence of AF was 9.1%, and 12.1% for any arrhythmia. In multivariable regression, allogeneic HSCT was associated with higher adjusted odds of peri-HSCT acute heart failure (aOR 2.64; 1.86-3.76; p < 0.0001), QT prolongation (aOR 1.40; 1.04-1.88; p = 0.025), MI (aOR 2.87; 1.16-7.11; p = 0.023), any major cardiovascular complication (aOR 1.16; 1.03-1.32; p = 0.016), and inpatient mortality (aOR 4.87; 3.60-6.58; p < 0.0001). Following cerebrovascular events, AF was the strongest predictor of mortality. Allogeneic HSCT was associated with higher odds of in-hospital cardiovascular complications among patients undergoing HSCT.
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Affiliation(s)
- Satyam Krishan
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dionisia Quiroga
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Sanam M Ghazi
- Cardio-Oncology Program, Division of Cardiology, Davis Heart and Lung Research Institute, The Ohio State University Medical Center, 473 West 12th Avenue, Columbus, OH, USA
| | - Cooper Quartermaine
- Cardio-Oncology Program, Division of Cardiology, Davis Heart and Lung Research Institute, The Ohio State University Medical Center, 473 West 12th Avenue, Columbus, OH, USA
| | - Zachary Braunstein
- Division of Hospital Medicine, The Ohio State University Medical Center, Columbus, OH, USA
- Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Onaopepo Kola-Kehinde
- Cardio-Oncology Program, Division of Cardiology, Davis Heart and Lung Research Institute, The Ohio State University Medical Center, 473 West 12th Avenue, Columbus, OH, USA
| | - Adnan Shaaban
- Division of Hospital Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Alma Habib
- Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Sarah Khan
- Cardio-Oncology Program, Division of Cardiology, Davis Heart and Lung Research Institute, The Ohio State University Medical Center, 473 West 12th Avenue, Columbus, OH, USA
| | - Richard Cheng
- Cardio-Oncology Program, Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Jonathan E Brammer
- Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Davis Heart and Lung Research Institute, The Ohio State University Medical Center, 473 West 12th Avenue, Columbus, OH, USA.
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA.
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Burkart M, Dinner S. Advances in the treatment of Philadelphia chromosome negative acute lymphoblastic leukemia. Blood Rev 2024; 66:101208. [PMID: 38734488 DOI: 10.1016/j.blre.2024.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
There have been major paradigm shifts in the treatment of Philadelphia chromosome negative (Ph-) acute lymphoblastic leukemia (ALL) in the last decade with the introduction of new immunotherapies and targeted agents, adoption of pediatric-type chemotherapy protocols in younger adults as well as chemotherapy light approaches in older adults and the incorporation of measurable residual disease (MRD) testing to inform clinical decision making. With this, treatment outcomes in adult Ph- ALL have improved across all age groups. However, a subset of patients will still develop relapsed disease, which can be challenging to treat and associated with poor outcomes. Here we review the treatment of Ph- ALL in both younger and older adults, including the latest advancements and future directions.
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Affiliation(s)
- Madelyn Burkart
- Wake Forest Baptist Health, Winston Salem, NC, United States of America
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America.
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Munshi PN, McCurdy SR. Age barriers in allogeneic hematopoietic cell transplantation: Raising the silver curtain. Am J Hematol 2024; 99:922-937. [PMID: 38414188 DOI: 10.1002/ajh.27228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 01/01/2024] [Indexed: 02/29/2024]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is no longer exclusively for the young. With an aging population, development of non-intensive remission-inducing strategies for hematologic malignancies, and novel graft-versus-host disease-prevention platforms, an older population of patients is pursuing HCT. The evolving population of HCT recipients requires an overhaul in the way we risk-stratify and optimize patients prior to HCT. Here, we review the history and current state of HCT for older adults and propose an assessment and intervention flow to bridge the gaps in today's clinical guidelines.
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Affiliation(s)
- Pashna N Munshi
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shannon R McCurdy
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Yu J, Luo Y, Wang L, Wang T, Ye M, Chen J, Ni X, Chen L, Gao L, Yang J. Effect of sustained measurable residue disease negativity and post-remission treatment selection on the prognosis of acute lymphoblastic leukemia in adults. Cancer Med 2024; 13:e7310. [PMID: 38785213 PMCID: PMC11117453 DOI: 10.1002/cam4.7310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND To explore the effects of monitoring measurable residual disease and post-remission treatment selection on the clinical outcomes of B-cell acute lymphoblastic leukemia (B-ALL) in adults. METHODS Between September 2010 and January 2022, adult patients with B-ALL who received combination chemotherapy, with or without allogeneic hematopoietic stem cell transplantation (allo-HSCT), were included in the retrospective study, which was approved by the Ethics Committee and the observation of Declaration of Helsinki conditions. RESULTS One hundred and forty-three B-ALL patients achieved complete remission (CR) were included in the study, of whom 94 patients (65.7%) received allo-HSCT in first complete remission (CR1). Multivariate analysis showed that the most powerful factors affecting OS were transplantation (hazard ratio [HR] = 0.540, p = 0.037) and sustained measurable residue disease (MRD) negativity (HR = 0.508, p = 0.037). The subgroup analysis showed that the prognosis of the allo-HSCT group was better than that of the chemotherapy group, regardless of whether MRD was negative or positive after two courses of consolidation therapy. After consolidation therapy, the prognosis of patients with positive MRD remained significantly better in the allo-HSCT group than in the chemotherapy group. However, no significant difference was observed in the prognosis between the allo-HSCT and chemotherapy groups with negative MRD after consolidation therapy. CONCLUSIONS B-ALL patients who achieve sustained MRD negativity during consolidation therapy have excellent long-term outcomes even without allo-HSCT. Allo-HSCT is associated with a significant benefit in terms of OS and DFS for patients who were with positive MRD during consolidation therapy.
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Affiliation(s)
- Jiechen Yu
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Yanrong Luo
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Libing Wang
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Tao Wang
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Mingyu Ye
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Jie Chen
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Xiong Ni
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Li Chen
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Lei Gao
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
| | - Jianmin Yang
- Department of HematologyInstitute of Hematology, Shanghai Changhai Hospital, Naval Medical UniversityShanghaiChina
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16
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Khera N, Edwards ML, Song Y, Sun R, Manghani R, Shin H, Simantov R, Signorovitch J, Sivaraman S, Gergis U. Projected Impact of Omidubicel-onlv on Racial/Ethnic Disparities in Allogeneic Hematopoietic Cell Transplantation (Allo-HCT) Outcomes in Hematologic Malignancies. Adv Ther 2024; 41:1637-1651. [PMID: 38427220 PMCID: PMC10960759 DOI: 10.1007/s12325-023-02771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/14/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION In a phase III clinical trial (NCT02730299), omidubicel-onlv, a nicotinamide-modified allogeneic hematopoietic progenitor cell therapy, showed rapid hematopoietic and immune recovery compared with standard umbilical cord blood (UCB) transplant across all racial/ethnic groups. METHODS A decision-tree model was used to project the effect of omidubicel-onlv availability on addressing health disparities in allogeneic hematopoietic cell transplantation (allo-HCT) access and outcomes for patients with hematologic malignancies. The model used a hypothetical population of 10,000 allo-HCT-eligible US adults, for whom matched related donors were not available. Patients received matched or mismatched unrelated donor, haploidentical, UCB transplant, or no transplant. Scenarios with omidubicel-onlv use of 0% (status quo), 10%, 15%, 20%, and 30% were modeled on the basis of proportional reductions in other allo-HCT sources or no transplant by racial/ethnic group. RESULTS Increased omidubicel-onlv use was associated with a higher proportion of patients undergoing allo-HCT, decreased time to allo-HCT, decreased 1-year non-relapse mortality, and increased 1-year overall survival, particularly among racial minorities. In the scenario modeling 20% omidubicel-onlv use, the proportion of Black patients receiving allo-HCT increased by 129%; increases were also observed in Asian (64%), Hispanic (45%), and other (42%) patient groups. Modeled time to allo-HCT improved among transplanted patients (23%) from 11.4 weeks to 8.8 weeks. One-year OS in the overall population increased by 3%, with improvements ranging from 3% for White patients to 5% for Black patients. CONCLUSION This study demonstrates that broad access to omidubicel-onlv could increase access to allo-HCT and improve outcomes for patients, with the greatest benefits seen among racial/ethnic minority groups.
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Affiliation(s)
- Nandita Khera
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Yan Song
- Analysis Group Inc., Boston, MA, USA
| | | | | | | | | | | | | | - Usama Gergis
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St, Ste 308, Philadelphia, PA, 19107, USA.
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17
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Metheny LL, Sobecks R, Cho C, Fu P, Margevicius S, Wang J, Ciarrone L, Kopp S, Convents RD, Majhail N, Caimi PF, Otegbeye F, Cooper BW, Gallogly M, Malek E, Tomlinson B, Gerds AT, Hamilton B, Giralt S, Perales MA, de Lima M. A multicenter study of posttransplantation low-dose inotuzumab ozogamicin to prevent relapse of acute lymphoblastic leukemia. Blood Adv 2024; 8:1384-1391. [PMID: 38170741 PMCID: PMC10945150 DOI: 10.1182/bloodadvances.2023011514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/15/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
ABSTRACT The curative potential of allogeneic hematopoietic transplantation (allo-HCT) in patients with acute lymphoblastic leukemia (ALL) is hampered by relapse. Inotuzumab ozogamicin (INO) is an anti-CD22 monoclonal antibody bound to calicheamicin, which has significant activity against ALL. We hypothesized that low-dose INO would be safe and feasible after allo-HCT. Therefore, we conducted a phase 1 study to determine the dose and safety in this setting. Patients were eligible if they were aged 16 to 75 years, had undergone allo-HCT for CD22+ ALL, were in complete remission (CR) after allo-HCT, had high risk of recurrence, were between day 40 and 100 after allo-HCT with adequate graft function, and did not have a history of sinusoidal obstruction syndrome (SOS). The objectives of this trial were to define INO maximum tolerated dose (MTD), to determine post-allo-HCT INO safety, and to measure 1-year progression-free survival (PFS). The trial design followed a "3+3" model. The treatment consisted of INO given on day 1 of 28-day cycles. Dose levels were 0.3 mg/m2, 0.4 mg/m2, 0.5 mg/m2, and 0.6 mg/m2. Median age was 44 years (range, 17-66 years; n = 18). Disease status at transplantation was first CR (n = 14) or second CR or beyond (n = 4). Preparative regimen was of reduced intensity in 72% of patients who received transplantation. Most common toxicity was thrombocytopenia. There were no instances of SOS; the MTD was 0.6 mg/m2. One-year nonrelapse mortality was 5.6%. With a median follow-up of 18.1 months (range, 8.6-59 months) 1-year post-allo-HCT PFS and overall survival is 89% and 94%, respectively. Low-dose INO has a favorable safety profile and was associated with high rates of 1-year PFS. This trial was registered at www.clinicaltrials.gov as #NCT03104491.
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Affiliation(s)
- Leland L. Metheny
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Ronald Sobecks
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Christina Cho
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Jiasheng Wang
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Lisa Ciarrone
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Shelby Kopp
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Robin D. Convents
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Navneet Majhail
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Paolo F. Caimi
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Brenda W. Cooper
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Molly Gallogly
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Ehsan Malek
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Benjamin Tomlinson
- Hematology and Cell Therapy Division, Seidman Cancer Center, University Hospitals, Cleveland, OH
- Case Comprehensive Cancer Center, Cleveland, OH
| | - Aaron T. Gerds
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Betty Hamilton
- Case Comprehensive Cancer Center, Cleveland, OH
- Blood and Marrow Transplant, Cleveland Clinic Foundation, Cleveland, OH
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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18
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Wang Z, Fan Z, Wu Z, Xuan L, Li X, Tang B, Liu Y, He J, Huang K, Zhou X, Gao Y, Wang Q, Li X, Lin R, Xu N, Huang F, Wang S, Liang X, Zhang J, Liu X, Sun J, Liu Q, Zhou H. PASS-ALL study of paediatric-inspired versus adult chemotherapy regimens on survival of high-risk Philadelphia-negative B-cell acute lymphoblastic leukaemia with allogeneic haematopoietic stem cell transplantation. Br J Haematol 2024; 204:628-637. [PMID: 38050437 DOI: 10.1111/bjh.19223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023]
Abstract
This PASS-ALL study was designed to explore the effect of paediatric-inspired versus adult chemotherapy regimens on survival of adolescents and young adults (AYA) with high-risk Philadelphia chromosome-negative B-cell acute lymphoblastic leukaemia (HR PH-ve B-cell ALL) eligible for allogeneic haematopoietic stem cell transplantation (allo-HSCT). The PASS-ALL study is a multicentre, observational cohort study, and 143 patients with HR B-cell PH-ve ALL were enrolled from five centres-77 patients allocated in the paediatric-inspired cohort and 66 in the adult cohort with comparable baseline characteristics. Of the 143 patients, 128 cases underwent allo-HSCT. Three-year leukaemia-free survival (LFS) in the paediatric-inspired cohort was 72.2% (95% CI 60.8%-83.6%) compared with 44.6% (95% CI 31.9%-57.3%; p = 0.001). Furthermore, time-to-positive minimal residual disease (TTP-MRD) post-HSCT was marked different, 3-year cumulative incidence of relapse was 25.9% (95% CI 15.8%-37.2%) in paediatric cohort and 45.4% (95% CI 40.0%-57.9%) in adult cohort (p = 0.026). Finally, the 3-year OS rate was 75.3% (95% CI 64.9%-85.7%) for the paediatric-inspired cohort and 64.1% (95% CI 51.8%-76.4%) for the adult cohort (p = 0.074). On a multivariate analysis, paediatric-inspired regimen is a predictive factor for LFS (HR = 2.540, 95% CI 1.327-4.862, p = 0.005). Collectively, our data suggest that paediatric-inspired chemotherapy pre-HSCT results in deeper and durable MRD response reduces relapse post-HSCT and improves survival in HR B-cell PH-ve ALL patients with allo-HSCT.
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Affiliation(s)
- Zhixiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
- Department of Hematology, People's Hospital of Ganzhou, Jiangxi, China
| | - Zhiping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Zhengwei Wu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hematology, Wuzhou Gongren Hospital, Wuzhou, Guangxi, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Xin Li
- Department of Hematology, The 3rd Xiangya Hospital of Central South University, Changsha, China
| | - Bingqing Tang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yiqian Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiabao He
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Kangyu Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuan Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Ya Gao
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Xiaofang Li
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Ren Lin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Feng Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Shunqing Wang
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Xingquan Liang
- Department of Hematology, The 1st People's Hospital of Chenzhou, Hunan, China
| | - Jingdong Zhang
- Department of Hematology, People's Hospital of Ganzhou, Jiangxi, China
| | - Xiaoli Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
| | - Hongsheng Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Clinical Medical Research, Center of Hematology Diseases of Guangdong Province, Guangzhou, China
- Department of Hematology, People's Hospital of Ganzhou, Jiangxi, China
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19
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Battipaglia G, Labopin M, Mielke S, Ruggeri A, Nur Ozkurt Z, Bourhis JH, Rabitsch W, Yakoub-Agha I, Grillo G, Sanz J, Arcese W, Novis Y, Fegueux N, Spyridonidis A, Giebel S, Nagler A, Ciceri F, Mohty M. Thiotepa-Based Regimens Are Valid Alternatives to Total Body Irradiation-Based Reduced-Intensity Conditioning Regimens in Patients with Acute Lymphoblastic Leukemia: A Retrospective Study on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:95.e1-95.e10. [PMID: 37816471 DOI: 10.1016/j.jtct.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023]
Abstract
Total body irradiation (TBI) at myeloablative doses is superior to chemotherapy-based regimens in young patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, in elderly and unfit patients, in whom reduced-intensity conditioning (RIC) regimens are preferred, whether a TBI-based or a chemotherapy-based approach is better is unexplored. Thiotepa can be used as part of ALL conditioning regimens. The current study aimed to compare transplantation outcomes after RIC with TBI-based or thiotepa-based regimens in patients with ALL. The study cohort comprised patients aged ≥40 years undergoing allo-HSCT for ALL in first complete remission between 2000 and 2020 who received an RIC regimen containing either TBI (4 to 6 Gy) or thiotepa. We identified a total of 265 patients, including 117 who received a TBI-based RIC regimen and 148 who received a thiotepa-based RIC regimen. Univariate analysis revealed no significant differences in the following transplantation outcomes for TBI versus thiotepa: relapse, 23% versus 28% (P = .24); nonrelapse mortality, 20% versus 26% (P = .61); leukemia-free survival, 57% versus 46% (P = .12); overall survival, 67% versus 56% (P = .18); graft-versus-host disease (GVHD]/relapse-free survival, 45% versus 38% (P = .21); grade II-IV acute GVHD, 30% in both groups (P = .84); grade III-IV acute GVHD, 9% versus 10% (P = .89). The sole exception was the incidence of chronic GVHD, which was higher in the recipients of TBI-based regimens (43% versus 29%; P = .03). However, multivariate analysis revealed no differences in transplantation outcomes between the 2 groups. In patients aged ≥40 years receiving RIC, use of a thiotepa-based regimen may represent a valid alternative to TBI-based regimens, as no differences were observed in the main transplantation outcomes.
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Affiliation(s)
| | - Myriam Labopin
- Statistical Unit, European Society for Blood and Marrow Transplantation, Paris, France; Hematology and Cellular Therapy Service, Hematology Department, Hôpital Saint Antoine, Paris, France; UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine, Sorbonne Universités, Paris, France
| | - Stephan Mielke
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Zubeyde Nur Ozkurt
- Hematology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey
| | - Jean Henri Bourhis
- BMT Service, Department of Hematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Werner Rabitsch
- Internal Medicine I, BMT Unit, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Giovanni Grillo
- Hematology Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jaime Sanz
- Hematology Department, University Hospital La Fe, Valencia, Spain
| | - William Arcese
- Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Yana Novis
- Hematology & Bone Marrow Transplant Unit, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Nathalie Fegueux
- Department of Clinical Hematology, CHU Lapeyronie, Montpellier, France
| | - Alexandros Spyridonidis
- Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece
| | - Sebastian Giebel
- Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Arnon Nagler
- Statistical Unit, European Society for Blood and Marrow Transplantation, Paris, France; Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Fabio Ciceri
- Hematology and BMT, Ospedale San Raffaele srl, Milano, Italy
| | - Mohamad Mohty
- Statistical Unit, European Society for Blood and Marrow Transplantation, Paris, France; Hematology and Cellular Therapy Service, Hematology Department, Hôpital Saint Antoine, Paris, France; UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine, Sorbonne Universités, Paris, France
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20
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Molina JC. Leveraging health care technology to improve health outcomes and reduce outcome disparities in AYA leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:573-580. [PMID: 38066875 PMCID: PMC10727055 DOI: 10.1182/hematology.2023000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Significant improvements have occurred for adolescent and young adult (AYA) B-cell acute lymphoblastic leukemia (B-ALL) patients following the widespread adoption of "pediatric-inspired" treatment regimens for AYA patients cared for in adult oncology settings. However, for AYA patients, aged 15 to 39, an outcomes gap remains in B-ALL, necessitating the incorporation of novel therapies into up-front treatment regimens. As a result, clinical trial enrollment remains the current standard of care for AYA B-ALL across disease subtypes when available and accessible. Currently, several up-front trials are looking to incorporate the use of inotuzumab, blinatumomab, and chimeric antigen receptor T-cell therapy into existing chemotherapy backbones for AYA patients, as well as tyrosine kinase inhibitors for both Philadelphia-positive (Ph+) and Ph-like B-ALL. In addition to ongoing attempts to improve up-front treatments by incorporating immunotherapy and targeted approaches, the increased use of next generation sequencing for measurable residual disease evaluation has led to superior risk-stratification and a decreased need to pursue consolidative hematopoietic stem cell transplantation during the first complete remission for many patients.
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Affiliation(s)
- John C. Molina
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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21
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Al‐Kali A, Aldoss I, Atherton PJ, Strand CA, Shah B, Webster J, Bhatnagar B, Flatten KS, Peterson KL, Schneider PA, Buhrow SA, Kong J, Reid JM, Adjei AA, Kaufmann SH. A phase 2 and pharmacological study of sapanisertib in patients with relapsed and/or refractory acute lymphoblastic leukemia. Cancer Med 2023; 12:21229-21239. [PMID: 37960985 PMCID: PMC10726920 DOI: 10.1002/cam4.6701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Despite recent approval of several new agents, relapsed acute lymphoblastic leukemia (ALL) remains challenging to treat. Sapanisertib (MLN0128/TAK-228) is an oral TORC1/2 inhibitor that exhibited preclinical activity against ALL. METHODS We conducted a single-arm multi-center Phase II study of sapanisertib monotherapy (3 mg orally daily of the milled formulation for 21 days every 28 days) in patients with ALL through the Experimental Therapeutics Clinical Trials Network (NCI-9775). RESULTS Sixteen patients, 15 of whom were previously treated (median 3 prior lines of therapy), were enrolled. Major grade 3-4 non-hematologic toxicities included mucositis (3 patients) and hyperglycemia (2 patients) as well as hepatic failure, seizures, confusion, pneumonitis, and anorexia (1 patient each). Grade >2 hematological toxicity included leukopenia (3), lymphopenia (2), thrombocytopenia, and neutropenia (1). The best response was stable disease in 2 patients (12.5%), while only 3 patients (19%) were able to proceed to Cycle 2. Pharmacokinetic analysis demonstrated drug exposures similar to those observed in solid tumor patients. Immunoblotting in serially collected samples indicated limited impact of treatment on phosphorylation of mTOR pathway substrates such as 4EBP1, S6, and AKT. CONCLUSION In summary, single-agent sapanisertib had a good safety profile but limited target inhibition or efficacy in ALL as a single agent. This trial was registered at ClinicalTrials.gov as NCT02484430.
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Affiliation(s)
- Aref Al‐Kali
- Division of HematologyMayo ClinicRochesterMinnesotaUSA
| | - Ibrahim Aldoss
- Division of Hematology and Hematopoietic Cell TransplantationCity of Hope National Medical CenterDuarteCaliforniaUSA
| | | | | | - Bijal Shah
- Division of HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Jonathan Webster
- Division of Hematological MalignanciesJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Bhavana Bhatnagar
- Section of Hematology and Medical OncologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | | | | | | | - Sarah A. Buhrow
- Division of Oncology ResearchMayo ClinicRochesterMinnesotaUSA
| | - Jianping Kong
- Division of Oncology ResearchMayo ClinicRochesterMinnesotaUSA
| | - Joel M. Reid
- Division of Oncology ResearchMayo ClinicRochesterMinnesotaUSA
| | - Alex A. Adjei
- Division of Medical OncologyMayo ClinicRochesterMinnesotaUSA
- Present address:
Tausig Cancer Institute, Cleveland ClinicClevelandOhioUSA
| | - Scott H. Kaufmann
- Division of HematologyMayo ClinicRochesterMinnesotaUSA
- Division of Oncology ResearchMayo ClinicRochesterMinnesotaUSA
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22
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Sijs-Szabo A, Dinmohamed AG, Versluis J, van der Holt B, Bellido M, Hazenberg MD, van Gelder M, Schaap NPM, Meijer E, van der Wagen LE, Halkes CJM, Rijneveld AW, Cornelissen JJ. Allogeneic Stem Cell Transplantation in Patients >40 Years of Age With Acute Lymphoblastic Leukemia: Reduced Intensity Versus Myeloablative Conditioning. Transplantation 2023; 107:2561-2567. [PMID: 37389645 DOI: 10.1097/tp.0000000000004706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND The outcome in older patients with acute lymphoblastic leukemia (ALL) remains unsatisfactory due to high relapse and nonrelapse mortality (NRM) rates. Allogeneic stem cell transplantation (alloHSCT) as postremission therapy has an important role in reducing relapse rate, albeit its application is limited in older adult patients due to alloHSCT-related morbidity and mortality. Reduced-intensity conditioning (RIC) alloHSCT has been developed as a less toxic conditioning regimen, but comparative studies with myeloablative conditioning (MAC) are limited in patients with ALL. METHODS In this retrospective study, RIC-alloHSCT (n = 111) was compared with MAC-alloHSCT (n = 77) in patients aged 41 to 65 y with ALL in first complete remission. MAC was predominantly applied by combining high-dose total body irradiation and cyclophosphamide, whereas RIC mainly consisted of fludarabine and 2 Gy total body irradiation. RESULTS Unadjusted overall survival was 54% (95% confidence interval [CI], 42%-65%) at 5 y in MAC recipients compared with 39% (95% CI, 29%-49%) in RIC recipients. Overall survival and relapse-free survival were not significantly associated with type of conditioning after adjusted for the covariates age, leukemia risk status at diagnosis, donor type, and donor and recipient gender combination. NRM was significantly lower after RIC (subdistribution hazard ratio: 0.41, 95% CI, 0.22-0.78; P = 0.006), whereas relapse was significantly higher (subdistribution hazard ratio: 3.04, 95% CI, 1.71-5.40; P < 0.001). CONCLUSIONS Collectively, RIC-alloHSCT has resulted in less NRM, but it was also found to be associated with a significantly higher relapse rate. These results suggest that MAC-alloHSCT may provide a more effective type of consolidation therapy for the reduction of relapse and that RIC-alloHSCT may be restricted to patients at higher risk for NRM.
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Affiliation(s)
- Aniko Sijs-Szabo
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jurjen Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Bronno van der Holt
- Department of Hematology, HOVON Data Center, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Mar Bellido
- Department of Hematology, Rijksuniversity Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mette D Hazenberg
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michel van Gelder
- Department of Hematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nicolaas P M Schaap
- Department of Hematology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Ellen Meijer
- Department of Hematology, Amsterdam University Medical Center, Free University, Amsterdam, the Netherlands
| | | | | | - Anita W Rijneveld
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
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23
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Kanaan SB, Urselli F, Radich JP, Nelson JL. Ultrasensitive chimerism enhances measurable residual disease testing after allogeneic hematopoietic cell transplantation. Blood Adv 2023; 7:6066-6079. [PMID: 37467017 PMCID: PMC10582300 DOI: 10.1182/bloodadvances.2023010332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/15/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
Increasing mixed chimerism (reemerging recipient cells) after allogeneic hematopoietic cell transplant (allo-HCT) can indicate relapse, the leading factor determining mortality in blood malignancies. Most clinical chimerism tests have limited sensitivity and are primarily designed to monitor engraftment. We developed a panel of quantitative polymerase chain reaction assays using TaqMan chemistry capable of quantifying chimerism in the order of 1 in a million. At such analytic sensitivity, we hypothesized that it could inform on relapse risk. As a proof-of-concept, we applied our panel to a retrospective cohort of patients with acute leukemia who underwent allo-HCT with known outcomes. Recipient cells in bone marrow aspirates (BMAs) remained detectable in 97.8% of tested samples. Absolute recipient chimerism proportions and rates at which these proportions increased in BMAs in the first 540 days after allo-HCT were associated with relapse. Detectable measurable residual disease (MRD) via flow cytometry in BMAs after allo-HCT showed limited correlation with relapse. This correlation noticeably strengthened when combined with increased recipient chimerism in BMAs, demonstrating the ability of our ultrasensitive chimerism assay to augment MRD data. Our technology reveals an underappreciated usefulness of clinical chimerism. Used side by side with MRD assays, it promises to improve identification of patients with the highest risk of disease reoccurrence for a chance of early intervention.
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Affiliation(s)
- Sami B. Kanaan
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
- Research and Development, Chimerocyte Inc, Seattle, WA
| | - Francesca Urselli
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Jerald P. Radich
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - J. Lee Nelson
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
- Research and Development, Chimerocyte Inc, Seattle, WA
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA
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24
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Ali N, Iftikhar R, Ayaz Mir M, Bokhari SW, Rehman JU, Zaidi U, Nasir S, Adil SN, Satti T, Nisa Chaudhry QU, Farhan M, Farzana T, Ghafoor T, Ahsan B, Khan AS, Khan FA, Fatima SI, Samad SA, Batool A, Nadeem HM, Abbas Bukhari SN, Ansari SH, Ahmed P. Haematopoietic Stem Cell Transplant Trends in Pakistan: Activity Survey from Pakistan Bone Marrow Transplant Group. J Transplant 2023; 2023:8865364. [PMID: 37810405 PMCID: PMC10555501 DOI: 10.1155/2023/8865364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Pakistan is the fifth most populous country with a population of 225 million and has health expenditure accounting for only 2.8 percent of gross domestic product (GDP). Accordingly, there are a limited number of haematology-oncology and transplant centers in the country. The Pakistan Blood and Marrow Transplant (PBMT) group was established in 2020, and this report is the first activity survey from January 2021 to December 2022 focusing on the trends of matched-related donor, haploidentical, and autologous transplants in a developing country. A total of 12 transplant centers contributed data on the modified PBMT survey form retrospectively and 806 haematopoietic stem cell transplants (HSCTs) were carried out during the study duration. Allogeneic HSCT constituted 595 (73.8%) of all the transplants; this is in stark contrast to Western data, where autologous HSCT accounts for the majority of transplants. ß-thalassemia major and aplastic anemia were the commonest indications for allogeneic HSCT, in contrast to Western data, where acute leukemia is the leading transplant indication. Autologous transplants were more frequently performed for Hodgkin's lymphoma as compared to non-Hodgkin's lymphoma and multiple myeloma. The use of peripheral and bone marrow stem cells was comparable. A myeloablative conditioning regimen was routinely used in patients with acute leukemia. This report provides an insight of HSCT trends in Pakistan which are different from those of Western centers contributing to transplant data from South Asia.
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Affiliation(s)
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan
| | | | | | | | - Uzma Zaidi
- National Institute of Blood Diseases, Karachi, Pakistan
| | - Shahzad Nasir
- Quaid-e-Azam International Hospital, Islamabad, Pakistan
| | | | - Tariq Satti
- Shifa International Hospital, Islamabad, Pakistan
| | | | | | | | - Tariq Ghafoor
- Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan
| | - Bushra Ahsan
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | | | | | | | | | - Aliya Batool
- Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | | | | | | | - Parvez Ahmed
- Quaid-e-Azam International Hospital, Islamabad, Pakistan
- Gambat Institute of Medical Sciences, Gambat, Pakistan
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25
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Prockop S, Wachter F. The current landscape: Allogeneic hematopoietic stem cell transplant for acute lymphoblastic leukemia. Best Pract Res Clin Haematol 2023; 36:101485. [PMID: 37611999 DOI: 10.1016/j.beha.2023.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 08/25/2023]
Abstract
One of the consistent features in development of hematopoietic stem cell transplant (HCT) for Acute Lymphoblastic Leukemia (ALL) is the rapidity with which discoveries in the laboratory are translated into innovations in clinical care. Just a few years after murine studies demonstrated that rescue from radiation induced marrow failure is mediated by cellular not humoral factors, E. Donnall Thomas reported on the transfer of bone marrow cells into irradiated leukemia patients. This was followed quickly by the first descriptions of Graft versus Leukemia (GvL) effect and Graft versus Host Disease (GvHD). Despite the pivotal nature of these findings, early human transplants were uniformly unsuccessful and identified the challenges that continue to thwart transplanters today - leukemic relapse, regimen related toxicity, and GvHD. While originally only an option for young, fit patients with a matched family donor, expansion of the donor pool to include unrelated donors, umbilical cord blood units, and more recently the growing use of haploidentical donors have all made transplant a more accessible therapy for patients with ALL. Novel agents for conditioning, prevention and treatment of GvHD have improved outcomes and investigators continue to develop novel treatment strategies that balance regimen related toxicity with disease control. Our evolving understanding of how to prevent and treat GvHD and how to prevent relapse are incorporated into novel clinical trials that are expected to further improve outcomes. Here we review current considerations and future directions for both adult and pediatric patients undergoing HCT for ALL, including indication for transplant, donor selection, cytoreductive regimens, and outcomes.
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Affiliation(s)
- Susan Prockop
- Pediatric Stem Cell Transplant Program, DFCI/BCH Center for Cancer and Blood Disorders, Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Franziska Wachter
- Pediatric Stem Cell Transplant Program, DFCI/BCH Center for Cancer and Blood Disorders, Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States.
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26
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Sun X, Liu X, Li Y, Shi X, Li Y, Tan R, Jiang Y, Sui X, Ge X, Xu H, Wang X, Fang X. Characteristics of Molecular Genetic Mutations and Their Correlation with Prognosis in Adolescent and Adult Patients with Acute Lymphoblastic Leukemia. Oncology 2023; 102:85-98. [PMID: 37437551 DOI: 10.1159/000531522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/23/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION The prognosis of acute lymphoblastic leukemia (ALL) in adolescents and adults is poor, and recurrence is an important cause of their death. Changes of genetic information play a vital role in the pathogenesis and recurrence of ALL; however, the impact of molecular genetic mutations on disease diagnosis and prognosis remains unexplored. This study aimed to explore the frequency spectrum of gene mutations and their prognostic significance, along with the minimal residual disease (MRD) level and hematopoietic stem cell transplantation (HSCT), in adolescent and adult patients aged ≥15 years with ALL. METHODS The basic characteristics, cytogenetics, molecular genetics, MRD level, treatment regimen, and survival outcome of patients with untreated ALL (≥15 years) were collected, and the correlation and survival analysis were performed using the SPSS 25.0 and R software. RESULTS This study included 404 patients, of which 147 were selected for next-generation sequencing (NGS). NGS results revealed that 91.2% of the patients had at least one mutation, and 67.35% had multiple (≥2) mutations. NOTCH1, PHF6, RUNX1, PTEN, JAK3, TET2, and JAK1 were the most common mutations in T-ALL, whereas FAT1, TET2, NARS, KMT2D, FLT3, and RELN were the most common mutations in B-ALL. Correlation analysis revealed the mutation patterns, which were significantly different between T-ALL and B-ALL. In the prognostic analysis of 107 patients with B-ALL, multivariate analysis showed that the number of mutations ≥5 was an independent risk factor for overall survival and the RELN mutation was an independent poor prognostic factor for event-free survival. DISCUSSION The distribution of gene mutations and the co-occurrence and repulsion of mutant genes in patients with ALL were closely related to the immunophenotype of the patients. The number of mutations ≥5 and the RELN mutation were significantly associated with poor prognosis in adolescent and adult patients with ALL.
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Affiliation(s)
- Xue Sun
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, China,
| | - Xiaoqian Liu
- Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ying Li
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue Shi
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yahan Li
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ran Tan
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yujie Jiang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaohui Sui
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xueling Ge
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongzhi Xu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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27
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Modi D, Alkassis S, Kim S, Kin A, Deol A, Ayash L, Ratanatharathorn V, Uberti JP. Allogeneic stem cell transplant outcomes between TBI-containing reduced intensity and myeloablative conditioning regimens for ALL in complete remission. Leuk Lymphoma 2023; 64:1285-1294. [PMID: 37154379 DOI: 10.1080/10428194.2023.2206181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
Total-body irradiation (TBI)-based conditioning regimen is preferred in acute lymphoblastic leukemia (ALL). We retrospectively evaluated allogeneic stem cell transplant (alloSCT) outcomes of 86 adult ALL patients in complete remission (CR) who received TBI-containing reduced intensity (RIC) (Flu/Mel/TBI = 31) and myeloablative conditioning (MAC) (VP16/TBI = 47; CY/TBI = 8) between January 2005 and December 2019. All patients received peripheral blood allografts. Patients in the RIC group were older than the MAC group (61 years old versus 36 years, p < .001). Donor was 8/8 HLA-matched in 83% and unrelated in 65% of patients. Three-year survival was 56.04% for RIC and 69.9% for MAC (HR 0.64; p = .19). Propensity score-based multivariable Cox analyses (PSCA) did not demonstrate any difference in grade III-IV acute graft versus host disease (GVHD) (SHR 1.23, p = .91), chronic GVHD (SHR 0.92, p = .88), survival (HR 0.94, p = .92), and relapse-free survival (HR 0.66, p = .47) between both groups, while relapse rate was lower (SHR 0.21, p = .02) for MAC compared to RIC. Our study did not demonstrate any difference in survival for TBI-containing RIC and MAC alloSCT for adult ALL in CR.
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Affiliation(s)
- Dipenkumar Modi
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Samer Alkassis
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Seongho Kim
- Biostatistics Core, Barbara Ann Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Andrew Kin
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Abhinav Deol
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Lois Ayash
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Voravit Ratanatharathorn
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Joseph P Uberti
- Department of Oncology, Blood & Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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28
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Aureli A, Marziani B, Venditti A, Sconocchia T, Sconocchia G. Acute Lymphoblastic Leukemia Immunotherapy Treatment: Now, Next, and Beyond. Cancers (Basel) 2023; 15:3346. [PMID: 37444456 DOI: 10.3390/cancers15133346] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a blood cancer that primarily affects children but also adults. It is due to the malignant proliferation of lymphoid precursor cells that invade the bone marrow and can spread to extramedullary sites. ALL is divided into B cell (85%) and T cell lineages (10 to 15%); rare cases are associated with the natural killer (NK) cell lineage (<1%). To date, the survival rate in children with ALL is excellent while in adults continues to be poor. Despite the therapeutic progress, there are subsets of patients that still have high relapse rates after chemotherapy or hematopoietic stem cell transplantation (HSCT) and an unsatisfactory cure rate. Hence, the identification of more effective and safer therapy choices represents a primary issue. In this review, we will discuss novel therapeutic options including bispecific antibodies, antibody-drug conjugates, chimeric antigen receptor (CAR)-based therapies, and other promising treatments for both pediatric and adult patients.
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Affiliation(s)
- Anna Aureli
- CNR Institute of Translational Pharmacology, Via Carducci 32, 67100 L'Aquila, Italy
| | - Beatrice Marziani
- Emergency Medicine Department, Sant'Anna University Hospital, Via A. Moro, 8, Cona, 44124 Ferrara, Italy
| | - Adriano Venditti
- Department of Biomedicine and Prevention, The University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Tommaso Sconocchia
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Giuseppe Sconocchia
- CNR Institute of Translational Pharmacology, Via Carducci 32, 67100 L'Aquila, Italy
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29
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Basquiera AL, Seiwald MC, Best Aguilera CR, Enciso L, Fernandez I, Jansen AM, Nunes E, Sanchez del Villar M, Urbalejo Ceniceros VI, Rocha V. Expert Recommendations for the Diagnosis, Treatment, and Management of Adult B-Cell Acute Lymphoblastic Leukemia in Latin America. JCO Glob Oncol 2023; 9:e2200292. [PMID: 37167576 PMCID: PMC10497277 DOI: 10.1200/go.22.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/19/2023] [Accepted: 03/13/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE Despite strong induction chemotherapy response rates, only 30%-40% of patients with adult B-cell acute lymphoblastic leukemia (ALL) attain long-term remission. This study analyzes ALL in Latin America (LA) and recommends diagnosis, treatment, and management protocols. METHODS The Americas Health Foundation organized a panel of hematologists from Argentina, Brazil, Chile, Colombia, and Mexico to examine ALL diagnosis and therapy and produce recommendations. RESULTS Lack of regional data, unequal access to diagnosis and therapy, inadequate treatment response, and uneven health care distribution complicate adult ALL management. The panel recommended diagnosis, first-line and refractory treatment, and post-transplantation maintenance. Targeted treatments, including rituximab, blinatumomab, and inotuzumab ozogamicin, are becoming available in LA and must be equitably accessed. CONCLUSION This review adapts global information on treating ALL to LA. Governments, the medical community, society, academia, industry, and patient advocates must work together to improve policies.
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Affiliation(s)
- Ana Lisa Basquiera
- Hematology and Oncology Service, Bone Marrow Transplant Program, Hospital Privado Universitario de Cordoba, Instituto Universitario de Ciencias Biomédicas de Cordoba (IUCBC), Cordoba, Argentina
| | - Maria Cristina Seiwald
- Department of Clinical Medicine, Hematology and Hemotherapy, University of Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Carlos Roberto Best Aguilera
- Conacyt National Quality Postgraduate Program, University of Guadalajara & Western General Hospital, Guadalajara, Mexico
| | | | | | | | - Elenaide Nunes
- Hospital de Clínicas—Federal University of Parana, Parana, Brazil
| | - Matias Sanchez del Villar
- Chief Bone Marrow Transplant Service, Department of Hematology, Clinica Alemana de Santiago, Santiago, Chile
| | | | - Vanderson Rocha
- Department of Clinical Medicine, Hematology and Hemotherapy, University of Sao Paulo (FMUSP), Sao Paulo, Brazil
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30
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Grain A, Rialland-Battisti F, Chevallier P, Blin N, Dalle JH, Michel G, Dhédin N, Peffault de Latour R, Pochon C, Yakoub-Agha I, Bertrand Y, Sirvent A, Jubert C, Forcade E, Berceanu A, Gandemer V, Schneider P, Bay JO, Rohrlich PS, Brissot E, Paillard C, Plantaz D, Nguyen Quoc S, Gonzales F, Maillard N, Planche L, Baruchel A. Hematopoietic stem cell transplantation for acute lymphoblastic leukemia: why do adolescents and young adults outcomes differ from those of children? A retrospective study on behalf of the Francophone Society of Stem Cell Transplantation and Cellular Therapy (SFGM-TC). J Cancer Res Clin Oncol 2023; 149:1473-1483. [PMID: 35507103 DOI: 10.1007/s00432-022-04021-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/09/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE In the acute lymphoblastic leukemia (ALL) landscape, adolescents and young adults (AYA) often present high-risk diseases and increased chemotherapy-related toxicity. Studies analyzing the outcomes of AYA after hematopoietic stem cell transplantation (HSCT) are scarce. Our study aimed to compare the outcomes of children and AYA with ALL after HSCT and to determine the factors influencing potential differences. METHOD 891 patients, from the SFGM-TC registry, aged between 1 and 25 years who received HSCT between 2005 and 2012 were included. The outcomes of AYA were compared to the ones of their younger counterparts. RESULTS Five-year OS and GRFS were lower in AYA: 53.1% versus 64% and 36% versus 47% (p = 0.0012 and p = 0.007, respectively). WhileCIR was similar in both groups, 5 year-treatment related mortality was higher in AYA: 19% versus 13% (p = 0.04). The lower GRFS in AYA was mainly explained by a higher chronic graft versus host disease (cGvHD) incidence: 32% versus 19% (p < 0.001). Use of peripheral blood stem cells and use of anti-thymoglobulin appeared to be the main factors impacting cGvHD occurrence in AYA. CONCLUSION AYA have worse outcomes than children after HSCT for ALL because of a greater risk of TRM due to cGvHD. HSCT practices should be questioned in this population.
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Affiliation(s)
- Audrey Grain
- Pediatric Hematology-Oncology Department, CHU Hopital Mère-Enfant, Nantes, France.
| | | | | | - Nicolas Blin
- Hematology Department, CHU Hotel Dieu, Nantes, France
| | - Jean-Hugues Dalle
- Robert Debré University Hospital (APHP), Université de Paris, Paris, France
| | - Gérard Michel
- Department of Paediatric Haematology and Oncology and EA3279, Timone Children Hospital and Aix-Marseille University, Marseille, France
| | - Nathalie Dhédin
- AYA Unit, Clinical Hematology Departments, Saint-Louis Hospital, Paris, France
| | | | - Cécile Pochon
- Allogeneic Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Oncohematology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | | | - Yves Bertrand
- Institut of Hematology and Pediatric Oncology, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Anne Sirvent
- Department of Clinical Haematology, CHU Montpellier, Montpellier, France
| | - Charlotte Jubert
- Department of Pediatric Hematology, Bordeaux Hospital, Bordeaux, France
| | - Edouard Forcade
- Department of Hematology and Cellular Therapy, CHU Bordeaux, Bordeaux, France
| | - Ana Berceanu
- Department of Hematology, CHU Besançon, Besançon, France
| | - Virginie Gandemer
- Department of Pediatric Oncology and Haematology, University Hospital of Rennes, Rennes, France
| | - Pascale Schneider
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Jacques-Olivier Bay
- Department of Hematology and Cellular Therapy CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Eolia Brissot
- Department of Haematology, Hôpital Saint-Antoine, Paris, France
| | - Catherine Paillard
- Pediatric Oncohematology and Bone Marrow Transplantation Unit, Hôpital de Hautepierre, CHRU, Strasbourg, France
| | - Dominique Plantaz
- Department of Pediatric Hematology-Oncology, University Hospital Grenoble, Grenoble, France
| | | | - Fanny Gonzales
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000, Lille, France
| | | | - Lucie Planche
- Clinical Research Unit, CHD Vendée, La Roche sur Yon, France
| | - André Baruchel
- Robert Debré University Hospital (APHP), Université de Paris, Paris, France
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31
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Pan Z, Wang L, Fu W, Jiang C, Zhang Z, Chen Q, Wang L, Hu X. Pediatric chemotherapy versus allo-HSCT for adolescent and adult Philadelphia chromosome-negative ALL in first complete remission: a meta-analysis. Ann Hematol 2023; 102:1131-1140. [PMID: 36947212 DOI: 10.1007/s00277-023-05160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/04/2023] [Indexed: 03/23/2023]
Abstract
Pediatric-inspired chemotherapy significantly improves survival for adolescent and adult patients with acute lymphoblastic leukemia (ALL). However, the benefits over allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain unclear. To compare clinical outcomes between pediatric-inspired chemotherapy and allo-HSCT in consolidation therapy of adolescent and adult Philadelphia chromosome-negative (Ph-neg) ALL in first complete remission (CR1), related studies from MEDLINE, Embase, and Cochrane Controlled Register of Trials updated to July 2022 were searched. A total of 13 relevant trials including 3161 patients were included in the meta-analysis. Compared with allo-HSCT, pediatric-inspired chemotherapy achieved better OS (hazard risk (HR), 0.53; 95% confidence interval (CI), 0.41 to 0.68) and DFS (HR, 0.64; 95% CI, 0.48 to 0.86), with a significant reduction in NRM (risk ratio (RR), 0.30; 95% CI, 0.18 to 0.51), but no difference in the relapse rate (RR, 1.13; 95% CI, 0.93 to 1.39). When only studies based on intention-to-treat analysis were included, pediatric-inspired chemotherapy consistently conferred a survival advantage. In subgroup analyses, patients with baseline high-risk features demonstrated similar OS and DFS between pediatric-style chemotherapy and allo-HSCT, while pediatric-style chemotherapy had an OS and DFS advantage in standard-risk subgroup. Particularly, patients with positive minimal residual disease (MRD) achieved better OS and DFS if proceeded to allo-HSCT.
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Affiliation(s)
- Zengkai Pan
- State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Road 197, Shanghai, 200025, China
| | - Luxiang Wang
- State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Road 197, Shanghai, 200025, China
| | - Weijia Fu
- Department of Hematology, Institute of Hematology, Changhai Hospital, Changhai Road 168, Shanghai, 200433, China
| | - Chuanhe Jiang
- State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Road 197, Shanghai, 200025, China
| | - Zilu Zhang
- State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Road 197, Shanghai, 200025, China
| | - Qi Chen
- Department of Health Statistics, Naval Medical University, Xiangyin Road 800, Shanghai, 200433, China.
| | - Libing Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Changhai Road 168, Shanghai, 200433, China.
| | - Xiaoxia Hu
- State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Road 197, Shanghai, 200025, China.
- Collaborative Innovation Center of Hematology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zhao R, Liu YY, Wu SS, Liu XC, Tian XX, Zhou KS. [Long-term results of modified POG 9404 protocol for 4 adolescents with T-cell lymphoblastic leukemia/lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:255-257. [PMID: 37356990 PMCID: PMC10119719 DOI: 10.3760/cma.j.issn.0253-2727.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 06/27/2023]
Affiliation(s)
- R Zhao
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - Y Y Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - S S Wu
- Department of Hematology, Zhumadian Central Hospital, Zhumadian 463000, China
| | - X C Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - X X Tian
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - K S Zhou
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
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Aleshina OA, Galtseva IV, Kotova ES, Isinova GI, Obukhova TN, Dvirnik VN, Sudarikov AB, Grishunina ME, Samoilova OS, Kaplanov KD, Lapin VA, Bondarenko SN, Fokina ES, Minaeva NV, Konstantinova TS, Sveshnikova YV, Zinina EE, Antipova AS, Baranova OY, Borisenkova EA, Davydova YO, Kapranov NM, Kulikov SM, Chabaeva YA, Troitskaya VV, Parovichnikova EN. Treatment outcomes for acute T-lymphoblastic leukemias/lymphomas: data from the ALL-2016 multicenter prospective randomized trial. ONCOHEMATOLOGY 2023. [DOI: 10.17650/1818-8346-2023-18-1-20-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- O. A. Aleshina
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - I. V. Galtseva
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - E. S. Kotova
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - G. I. Isinova
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - T. N. Obukhova
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - V. N. Dvirnik
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - A. B. Sudarikov
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | | | | | - K. D. Kaplanov
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | | | - S. N. Bondarenko
- I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - E. S. Fokina
- Kirov Research Institute of Hematology and Blood Transfusion, Federal Medical and Biological Agency
| | - N. V. Minaeva
- Kirov Research Institute of Hematology and Blood Transfusion, Federal Medical and Biological Agency
| | | | | | | | - A. S. Antipova
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - O. Yu. Baranova
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | | | - Yu. O. Davydova
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - N. M. Kapranov
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - S. M. Kulikov
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - Yu. A. Chabaeva
- National Medical Research Center for Hematology, Ministry of Health of Russia
| | - V. V. Troitskaya
- National Medical Research Center for Hematology, Ministry of Health of Russia
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Webster JA, Reed M, Tsai HL, Ambinder A, Jain T, Dezern AE, Levis MJ, Showel MM, Prince GT, Hourigan CS, Gladstone DE, Bolanos-Meade J, Gondek LP, Ghiaur G, Dalton WB, Paul S, Fuchs EJ, Gocke CB, Ali SA, Huff CA, Borrello IM, Swinnen L, Wagner-Johnston N, Ambinder RF, Luznik L, Gojo I, Smith BD, Varadhan R, Jones RJ, Imus PH. Allogeneic Blood or Marrow Transplantation with High-Dose Post-Transplantation Cyclophosphamide for Acute Lymphoblastic Leukemia in Patients Age ≥55 Years. Transplant Cell Ther 2023; 29:182.e1-182.e8. [PMID: 36587740 PMCID: PMC9992271 DOI: 10.1016/j.jtct.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
Patients age ≥55 years with acute lymphoblastic leukemia (ALL) fare poorly with conventional chemotherapy, with a 5-year overall survival (OS) of ∼20%. Tyrosine kinase inhibitors and novel B cell-targeted therapies can improve outcomes, but rates of relapse and death in remission remain high. Allogeneic blood or marrow transplantation (alloBMT) provides an alternative consolidation strategy, and post-transplantation cyclophosphamide (PTCy) facilitates HLA-mismatched transplantations with low rates of nonrelapse mortality (NRM) and graft-versus-host disease (GVHD). The transplantation database at Johns Hopkins was queried for patients age ≥55 years who underwent alloBMT for ALL using PTCy. The database included 77 such patients. Most received reduced-intensity conditioning (RIC) (88.3%), were in first complete remission (CR1) (85.7%), and had B-lineage disease (90.9%). For the entire cohort, 5-year relapse-free survival (RFS) and overall survival (OS) were 46% (95% confidence interval [CI], 34% to 57%) and 49% (95% CI, 37% to 60%), respectively. Grade III-IV acute GVHD occurred in only 3% of patients, and chronic GVHD occurred in 13%. In multivariable analysis, myeloablative conditioning led to worse RFS (hazard ratio [HR], 4.65; P = .001), whereas transplantation in CR1 (HR, .30; P = .004) and transplantation for Philadelphia chromosome-positive (Ph+) ALL versus T-ALL (HR, .29; P = .03) were associated with improved RFS. Of the 54 patients who underwent RIC alloBMT in CR1 for B-ALL, the 5-year RFS and OS were 62% (95% CI, 47% to 74%) and 65% (95% CI, 51% to 77%), respectively, with a 5-year relapse incidence of 16% (95% CI, 7% to 27%) and an NRM of 24% (95% CI, 13% to 36%). RIC alloBMT with PTCy in CR1 represents a promising consolidation strategy for B-ALL patients age ≥55 years.
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Affiliation(s)
- Jonathan A Webster
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland.
| | - Madison Reed
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Hua-Ling Tsai
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Alexander Ambinder
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Tania Jain
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Amy E Dezern
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Mark J Levis
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Margaret M Showel
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Gabrielle T Prince
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Christopher S Hourigan
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Douglas E Gladstone
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Javier Bolanos-Meade
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Lukasz P Gondek
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Gabriel Ghiaur
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - W Brian Dalton
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Suman Paul
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Christian B Gocke
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Syed Abbas Ali
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Ivan M Borrello
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Lode Swinnen
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Nina Wagner-Johnston
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Ivana Gojo
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - B Douglas Smith
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Ravi Varadhan
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
| | - Philip H Imus
- National Heart Lung and Blood Institute, University School of Medicine, Baltimore, Maryland
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Autologous versus allogeneic hematopoietic cell transplantation for older patients with acute lymphoblastic leukemia. An analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2023; 58:393-400. [PMID: 36611097 DOI: 10.1038/s41409-022-01904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) with reduced intensity conditioning (RIC) is an option for elderly patients with acute lymphoblastic leukemia (ALL). We retrospectively compared results of RIC-allo-HCT from either a matched sibling donor (MSD, n = 209) or matched unrelated donor (MUD, n = 209) with autologous (auto, n = 142) HCT for patients aged 55 years or more treated in first complete remission (CR1) between 2000 and 2018. The probabilities of leukemia-free survival (LFS) at 5 years were 34% for RIC-allo-HCT versus 39% for auto-HCT (p = 0.11) while overall survival (OS) rates were 42% versus 45% (p = 0.23), respectively. The incidence of relapse (RI) and non-relapse mortality (NRM) was 41% versus 51% (p = 0.22) and 25% versus 10% (p = 0.001), respectively. In a multivariate model, using auto-HCT as reference, the risk of NRM was increased for MSD-HCT (Hazard ratio [HR] = 2.1, p = 0.02) and MUD-HCT (HR = 3.08, p < 0.001), which for MUD-HCT translated into a decreased chance of LFS (HR = 1.55, p = 0.01) and OS (HR = 1.62, p = 0.008). No significant associations were found with respect to the risk of relapse. We conclude that for patients with ALL in CR1, aged above 55 years, auto-HCT may be considered a transplant option alternative to RIC-allo-HCT, although its value requires verification in prospective trials.
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36
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Thiotepa, busulfan and fludarabine conditioning-regimen is a promising approach for older adult patients with acute lymphoblastic leukemia treated with allogeneic stem cell transplantation. Bone Marrow Transplant 2023; 58:61-67. [PMID: 36224494 DOI: 10.1038/s41409-022-01841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 01/07/2023]
Abstract
For acute lymphoblastic leukemia (ALL) patients, total body irradiation (TBI)- based conditioning regimens are the first choice specially in young population. However, several studies have shown an equivalence in clinical outcomes with thiotepa-based conditioning regimen. We performed a retrospective study to evaluate the outcome of adult ALL patients who received allogeneic hematopoietic stem cell transplantation (allo-HCT) with a thiotepa-busulfan-fludarabine (TBF) myeloablative conditioning regimen with reduced toxicity. Fifty-five patients received a TBF regimen. The median age of the patients was 51 years (range, 17 to 72.4). Most patients had a diagnosis of B-ALL (93%) with 7% having T-ALL. Two - and 5-year overall survival was 73.2% and 64%, respectively. At 2 years, leukemia-free survival and GVHD-free, relapse-free survival were 59.5% and 57.6%, and at 5 years, 53.4% and 51.8%, respectively. The 5-year non-relapse mortality was 15%. The day 180 cumulative incidence (CI) of grade II-IV acute GVHD and grade III-IV acute GVHD were 38.2% and 5.5%, respectively. At 2 years, the CI of chronic GVHD and extensive chronic GVHD was 16.9% and 1.9%, respectively. Our study results do suggest that using TBF as the conditioning regimen in adult ALL patients is a promising option with acceptable toxicity.
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Cai Z, Liu Y, Tang B, Wu Z, Wang Z, Lin R, Xu X, Huang Z, Ou J, Li X, Liu X, Liu Q, Zhou H. Dynamics of minimal residual disease defines a novel risk-classification and the role of allo-HSCT in adult Ph-negative B-cell acute lymphoblastic leukemia. Leuk Lymphoma 2022; 63:3181-3190. [PMID: 36098226 DOI: 10.1080/10428194.2022.2115841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The prognosis of minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL) patients is well established. However, the implementation of dynamic MRD for risk classification and decision-making for allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains vague. In this study, we collected multiparameter flow cytometry (MFC)-MRD data of Ph-negative B-ALL patients (n = 134) from the Precision-Classification-Directed-Target-Total-Therapy-ALL-2016 (PDT-ALL-2016) cohort and stratified it into high-(HR), medium-(MR), and standard-risk (SR) groups. With a median of 3.65 years follow-up (95% CI: 3.037-4.263), 3-year OS rate was 51.8 ± 8.3% in HR, compared with MR 61.5 ± 10.8% (p = 0.472), and SR 73.3 ± 5.9% (p = 0.006). Multivariate analysis shows that integrated dynamic MRD is an independent factor for overall survival. Compared to pediatric-inspired chemotherapy, allo-HSCT significantly improves the survival of the HR cohort (p < 0.001), but not in MR and SR. Finally, our study suggests that integrated dynamic MRD defines a novel risk-classification criteria and highlights the benefits of allo-HSCT in adult patients with Ph-negative ALL.
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Affiliation(s)
- Zihong Cai
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yiqian Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bingqing Tang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhengwei Wu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhixiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ren Lin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiuli Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zicong Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiawang Ou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaofang Li
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoli Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongsheng Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Sun G, Tang B, Song K, Wu Y, Tu M, Wan X, Yao W, Geng L, Qiang P, Zhu X. Unrelated cord blood transplantation vs. HLA-matched sibling transplantation for adults with B-cell acute lymphoblastic leukemia in complete remission: superior OS for patients with long-term survival. STEM CELL RESEARCH & THERAPY 2022; 13:500. [PMID: 36210439 PMCID: PMC9549614 DOI: 10.1186/s13287-022-03186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/30/2022] [Indexed: 12/03/2022]
Abstract
Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important curative therapy for adult acute lymphoblastic leukemia (ALL). For patients who lack a human leukocyte antigen (HLA)-matched sibling donor, unrelated cord blood (UCB) is an alternative graft option. Previous studies have focused mainly on all T- and B-cell ALL (B-ALL) patients, while data related specifically to adult B-ALL patients after UCB transplantation (UCBT) are scarce. Methods We retrospectively compared the outcomes of UCBT and HLA-matched sibling transplantation (MST) in the treatment of adult B-ALL patients in complete remission (CR) at our center. From June 2006 to December 2020, 156 adult B-ALL patients who achieved CR before transplantation were enrolled. The main clinical outcomes of UCBT and MST were analyzed. Results Hematopoietic recovery was significantly faster in MST recipients than in UCBT recipients. Higher incidences of grades II-IV and III-IV acute graft-versus host disease (aGVHD) were found in UCBT recipients (P < 0.001 and = 0.03), while a lower incidence of extensive chronic GVHD (cGVHD) was found in UCBT recipients (P < 0.001). The cumulative incidences of 2-year non-relapse mortality (NRM), 2-year relapse, 5-year disease-free survival (DFS) and 5-year GVHD-free relapse-free survival (GRFS) were comparable between MST and UCBT recipients. The overall survival (OS) during the first 700 days was similar between the MST and UCBT groups, while the OS of patients with a survival time of more than 700 days in the UCBT group was better than that in the MST group according to multivariate analysis (P = 0.03). Conclusions Our study shows that when treating adult B-ALL patients in CR, UCBT can achieve comparable effects as MST, may provide superior OS for patients with long-term survival, and should be considered a good alternative. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-03186-3.
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Tracy SI, Cao Q, Bachan B, Meredith M, Oseth L, Weisdorf D, Brunstein C, Hirsch B, Bachanova V. Ph-like gene alterations and complex chromosomal abnormalities are frequent in patients with acute lymphoblastic leukemia experiencing relapse after allogeneic hematopoietic cell transplantation. Eur J Haematol 2022; 109:406-408. [PMID: 35700331 PMCID: PMC9474703 DOI: 10.1111/ejh.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
The new aspect of our work is to reveal that Ph-like alterations are common among patients with Ph-ALL experiencing relapse after hematopoietic cell transplantation (HCT), despite acquisition of MRD-negative complete responses prior to transplant. This is also the central finding of our work. Therefore, the anticipated benefits of HCT appear diminished among this patient subset; such patients may be better served with efforts to further increase MRD depth prior to HCT, or alternative therapies.
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Affiliation(s)
- Sean I. Tracy
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Qing Cao
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Ben Bachan
- University of Minnesota, Minneapolis, MN
| | - Matthew Meredith
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - LeAnn Oseth
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Daniel Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Claudio Brunstein
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Betsy Hirsch
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
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40
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Cai B, Wang Y, Lei Y, Shi Y, Sun Q, Qiao J, Hu K, Lei Y, Li B, Liu T, Liu Z, Yao B, Zhao X, Li X, Zhao W, Feng X, Xie A, Ning X, Feng M, Zhao W, Guo J, Ai H, Yu C, Guo M. Hyper-CVAD-Based Stem Cell Microtransplant as Post-Remission Therapy in Acute Lymphoblastic Leukemia. Stem Cells Transl Med 2022; 11:1113-1122. [PMID: 36181762 DOI: 10.1093/stcltm/szac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
Post-remission strategies for patients with acute lymphoblastic leukemia (ALL) are limited to the multiagent chemotherapy and allogeneic stem cell transplant (allo-SCT), and cellular therapies are seldom involved. Although chemotherapy combined with mismatched granulocyte colony-stimulating factor mobilized peripheral blood mononuclear cell infusion (microtransplant, MST) has been studied in patients with acute myeloid leukemia, its efficacy in ALL is still undetermined. We enrolled 48 patients receiving hyper-CVAD-based MST between July 1, 2009, and January 31, 2018. No acute or chronic graft-versus-host disease occurred in patients receiving MST. Four-year overall survival (OS) and leukemia-free survival (LFS) were 62% and 35%, respectively, and the 4-year relapse rate was 65%. No patient experienced non-relapse mortality. Subgroup analysis showed that OS rates were comparable between groups with different age, risk stratification, minimal residual disease status prior to MST and immunophenotype. Adult patients tended to achieve better 4-year LFS (62% vs. 26%, P = .058) and lower hematologic relapse rate (38% vs. 74%, P = .058) compared with adolescent and young adult patients. Donor chimerism/microchimerism was detectable ranging from 0.002% to 42.78% in 78% (42/54) available samples within 14 days after each infusion and at 3 months or one year after the last cell infusion. Multivariate analyses demonstrated that white blood cells <30 × 109/L at diagnosis and sufficient hyper-CVAD cycles were prognostic factors for better 4-year OS and LFS, while the B-cell phenotype and higher number of infused CD34+ cells in the first cycle were predictors for favorable 4-year LFS. The hyper-CVAD-based MST was a feasible strategy for treating ALL patients with mild toxicity.
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Affiliation(s)
- Bo Cai
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yi Wang
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yangyang Lei
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yanping Shi
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Qiyun Sun
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jianhui Qiao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Kaixun Hu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yaqing Lei
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bingxia Li
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tieqiang Liu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhiqing Liu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bo Yao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xuecong Zhao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaofei Li
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wen Zhao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiujie Feng
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Anli Xie
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Ning
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mingxing Feng
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Weiwei Zhao
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jiayue Guo
- Department of Clinical Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Huisheng Ai
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Changlin Yu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mei Guo
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
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Yang TT, Meng Y, Kong DL, Wei GQ, Zhang MM, Wu WJ, Shi JM, Luo Y, Zhao YM, Yu J, Jing RR, Zhao MY, Zhao HL, Huang H, Hu YX. Comparable outcomes in patients with B-cell acute lymphoblastic leukemia receiving haploidentical hematopoietic stem cell transplantation: Pretransplant minimal residual disease-negative complete remission following chimeric antigen receptor T-cell therapy versus chemotherapy. Front Immunol 2022; 13:934442. [PMID: 36110859 PMCID: PMC9468760 DOI: 10.3389/fimmu.2022.934442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionChimeric antigen receptor (CAR) T-cell (CAR-T) therapy followed by haploidentical hematopoietic stem cell transplantation (haplo-HSCT) markedly improves the long-term survival of patients with refractory/relapsed (R/R) B-cell acute lymphoblastic leukemia (B-ALL).MethodsWe performed a parallel comparison of transplant outcomes in 168 B-ALL patients undergoing haplo-HSCT after achieving minimal residual disease (MRD)-negative complete remission (CR) from CAR-T therapy (n = 28) or chemotherapy (n = 140) between January 2016 and August 2021. We further divided the chemotherapy group into the first CR group (chemo+CR1, n = 118) and a second or more CR group (chemo+≥CR2, n = 22).ResultsWith a median follow-up period of 31.0 months, the 2-year overall survival (OS), leukemia-free survival (LFS), non-relapse mortality (NRM), and relapse rates in the CAR-T and chemotherapy groups did not differ significantly (OS, 87.9% vs. 71.5 %; LFS, 72.0% vs. 66.8%; NRM, 3.9% vs. 13.7%; relapse, 24.1% vs. 19.4%). Multivariate analysis confirmed that ≥CR2 at transplantation following chemotherapy was an independent risk factor associated with poor OS (hazard ratio (HR) 4.22 [95% CI, 1.34–13.293], p = 0.014) and LFS (HR 2.57 [95% CI, 1.041–6.343], p = 0.041). The probabilities of OS and LFS at 2 years in the CAR-T group were comparable to those in the chemo+CR1 group but significantly higher than those in the chemo+≥CR2 group (OS, 87.9% vs. 37.8%, p = 0.007; LFS, 72.0% vs. 41.7%, p = 0.043). No significant differences in the incidences of NRM were noted among the three groups.ConclusionsOur results demonstrated that patients with R/R B-ALL receiving haplo-HSCT after CAR-T therapy achieved comparable outcomes to patients transplanted post-chemotherapy-based MRD-negative CR1, without increased risk of transplant-related mortality and toxicity.
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Affiliation(s)
- Ting-Ting Yang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Ye Meng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - De-Lin Kong
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Guo-Qing Wei
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Ming-Ming Zhang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Wen-Jun Wu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Ji-Min Shi
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yi Luo
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yan-Min Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Jian Yu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Rui-Rui Jing
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Meng-Yu Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Hou-Li Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yong-Xian Hu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- *Correspondence: Yong-Xian Hu,
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Qi HZ, Xu J, Yang QQ, Lin R, Wang ZX, Zhao K, Wang Q, Zhou X, Fan ZP, Huang F, Xu N, Xuan L, Jin H, Sun J, Gale RP, Zhou HS, Liu QF. Effect of pediatric- versus adult-type chemotherapy regimens on outcomes of allogeneic hematopoietic stem cell transplants for adult T-cell acute lymphoblastic leukemia in first complete remission. Bone Marrow Transplant 2022; 57:1704-1711. [PMID: 36042299 DOI: 10.1038/s41409-022-01796-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022]
Abstract
The optimal chemotherapy regimen pre-transplantation for adult T-cell acute lymphoblastic leukemia (T-ALL) patients remains unknown. Here, we compared the transplant outcomes in 127 subjects receiving pediatric- (N = 57) or adult-type (N = 70) regimens pre-transplant. The corresponding 3-year cumulative incidences of relapse (CIR) was 7% (95% CI: 3-11%) and 29% (95% CI: 23-35%; P = 0.02), leukemia-free survivals (LFS) was 86% (95% CI: 81-91%) and 57% (95% CI: 51-63%; P = 0.003), overall survivals (OS) was 88% (95% CI: 84-92%) and 58% (95% CI: 52-64%; P = 0.002), the 1-year NRM was 4% (95% CI: 1-7%) and 9% (95% CI: 4-14%; P = 0.40). Multivariate analysis showed that pediatric-type regimen was associated with lower CIR (Hazard Ratio [HR] = 0.31 [95% CI: 0.09-1.00]; P = 0.05), better LFS (HR = 0.34 [95% CI: 0.15-0.78]; P = 0.01) and OS (HR = 0.30 [95% CI: 0.13-0.72]; P = 0.01). Our results suggested that adult T-ALL patients undergoing allo-HSCT might benefit from pediatric-type chemotherapy.
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Affiliation(s)
- Han-Zhou Qi
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian-Qian Yang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ren Lin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Xiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke Zhao
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuan Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Ping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hua Jin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - Hong-Sheng Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Qi-Fa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Ozdemir ZN, Kircali E, Şahin U, Seval GC, Bozdağ SC, Toprak SK, Yuksel MK, Topcuoglu P, Arslan O, Demirer T, Ilhan O, Beksac M, Gurman G, Ozcan M. Pretransplant Consolidation Therapies Improve the Outcome of Myeloablative Allogeneic Transplantation in Adults with Ph-negative Acute Lymphoblastic Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:596-600. [PMID: 35410758 DOI: 10.1016/j.clml.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
BACKROUND AND AIM The benefit of pre-transplant consolidation in patients with acute lymphoblastic leukemia (ALL) who achieved first complete remission (CR1) has not yet been clearly demonstrated. Here, we aimed to investigate the relationship between the treatments received before transplantation and transplant outcome in Ph-ALL patients who underwent myeloablative allo-HSCT in CR1. PATIENTS AND METHODS A total of 55, 32 (58.2%) men and 23 (41.8%) women, who underwent allo-HSCT with the diagnosis of Ph-ALL were evaluated retrospectively. All patients underwent to allo-HSCT with myeloablative conditioning regimen in the 1st CR from the available donor. RESULTS In patients who received >2 consolidation, the 2-year and 3-year OS was 69% and 65%, respectively, while the 2-year and 3-year OS was 39% and 26%, respectively, in those who received < 2 consolidation (P =.03). RFS was similar in both groups (P = .8). One year- NRM was found 28% in patients who received ≥ 2 consolidations, and 37% in patients who received <2 consolidation (P =.06). L-asparaginase, high dose methotrexate, and cranial treatments given before transplantation had no effect on transplant outcomes (P > .05). CONCLUSION Contrary to the belief that pre-transplant consolidation is not beneficial in ALL patients who proceed with allo-HCST in CR1, our results showed that consolidation treatments reduce NRM and improve the survival.
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Affiliation(s)
- Zehra Narli Ozdemir
- University of Health Science Izmir Bozyaka Training and Research Hospital, Department of Hematology, İzmir, Turkey.
| | - Ekin Kircali
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Uğur Şahin
- Medicana International Ankara Hospital, Department of Hematology, Ankara, Turkey
| | | | - Sinem Civriz Bozdağ
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Selami Kocak Toprak
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Meltem Kurt Yuksel
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Pervin Topcuoglu
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Onder Arslan
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Taner Demirer
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Osman Ilhan
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Meral Beksac
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Gunhan Gurman
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Muhit Ozcan
- Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
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Maciocia PM, Wawrzyniecka PA, Maciocia NC, Burley A, Karpanasamy T, Devereaux S, Hoekx M, O'Connor D, Leon T, Rapoz-D'Silva T, Pocock R, Rahman S, Gritti G, Yánez DC, Ross S, Crompton T, Williams O, Lee L, Pule MA, Mansour MR. Anti-CCR9 chimeric antigen receptor T cells for T-cell acute lymphoblastic leukemia. Blood 2022; 140:25-37. [PMID: 35507686 DOI: 10.1182/blood.2021013648] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022] Open
Abstract
T cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy of immature T lymphocytes, associated with higher rates of induction failure compared with those in B cell acute lymphoblastic leukemia. The potent immunotherapeutic approaches applied in B cell acute lymphoblastic leukemia, which have revolutionized the treatment paradigm, have proven more challenging in T-ALL, largely due to a lack of target antigens expressed on malignant but not healthy T cells. Unlike B cell depletion, T-cell aplasia is highly toxic. Here, we show that the chemokine receptor CCR9 is expressed in >70% of cases of T-ALL, including >85% of relapsed/refractory disease, and only on a small fraction (<5%) of normal T cells. Using cell line models and patient-derived xenografts, we found that chimeric antigen receptor (CAR) T-cells targeting CCR9 are resistant to fratricide and have potent antileukemic activity both in vitro and in vivo, even at low target antigen density. We propose that anti-CCR9 CAR-T cells could be a highly effective treatment strategy for T-ALL, avoiding T cell aplasia and the need for genome engineering that complicate other approaches.
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Affiliation(s)
- Paul M Maciocia
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Patrycja A Wawrzyniecka
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Nicola C Maciocia
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Amy Burley
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Thaneswari Karpanasamy
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Sam Devereaux
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Malika Hoekx
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - David O'Connor
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Theresa Leon
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Tanya Rapoz-D'Silva
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Rachael Pocock
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Sunniyat Rahman
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Giuseppe Gritti
- Department of Haematology, Ospedale Papa Giovanni XXIII, Bergamo, Italy; and
| | - Diana C Yánez
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Susan Ross
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Tessa Crompton
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Owen Williams
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Lydia Lee
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Martin A Pule
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Marc R Mansour
- Department of Haematology, Cancer Institute, University College London, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Silva WF, Cysne DN, Kerbauy MN, Colturato I, Maia ACA, Tucunduva L, Barros GM, Colturato VA, Hamerschlak N, Rocha V. Predictive Factors and Outcomes after Allogeneic Stem Cell Transplantation for Adults with Acute Lymphoblastic Leukemia in Brazil. Transplant Cell Ther 2022; 28:763.e1-763.e7. [DOI: 10.1016/j.jtct.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
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Jain H, Rajendra A, Sengar M, Goli VB, Thorat J, Muthuluri H, Tongaonkar AH, Kota KK, Gupta H, Sharma N, Eipe T, Mehta H. The current treatment approach to adolescents and young adults with acute lymphoblastic leukemia (AYA-ALL): challenges and considerations. Expert Rev Anticancer Ther 2022; 22:845-860. [PMID: 35734814 DOI: 10.1080/14737140.2022.2093718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AYA-ALL differs from pediatric ALL in terms of clinical, biological, psychosocial factors and access to care and has an inferior outcome. It is now being recognized that pediatric-inspired protocols are superior to adult protocols for this cohort, but given the lack of randomized trials, several questions remain unanswered. AREAS COVERED In this review, we discuss how AYA-ALL is different from the pediatric ALL population, compare AYA ALL with ALL in middle and older age adults, review the studies that have enrolled the AYA cohort, summarize risk-stratified and response-adapted approaches, describe the biological subtypes, and review the novel agents/approaches under evaluation. EXPERT OPINION AYA-ALL is a complex and challenging disease that needs multidisciplinary and focused care. Well-designed clinical trials that focus on this cohort are needed to further improve the outcomes.
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Affiliation(s)
- Hasmukh Jain
- Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Akhil Rajendra
- Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Manju Sengar
- Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Vasu Babu Goli
- Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | | | | | | | | | - Himanshi Gupta
- Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Neha Sharma
- Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Thomas Eipe
- Gloria, PRRA-143, Pallissery road, Palarivattom, Ernakulam, Kerala, India
| | - Hiral Mehta
- A/31, 65-D, Bafna Courts, West Ponnurangam Road, RS Puram, Coimbatore, India
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Mizuta S, Ugai T, Kato H, Doki N, Ota S, Kawakita T, Katayama Y, Kurokawa M, Nakamae H, Yano S, Nawa Y, Kanda Y, Fukuda T, Atsuta Y, Kako S. Propensity score matching/reweighting analysis comparing autologous and allogeneic stem cell transplantation for B-lineage acute lymphoblastic leukemia. Int J Hematol 2022; 116:393-400. [PMID: 35536509 DOI: 10.1007/s12185-022-03368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
We compared the outcomes of autologous stem cell transplantation (auto-SCT) with those of allogeneic stem cell transplantation (allo-SCT) from a human leukocyte antigen-matched related donor in patients with Philadelphia chromosome-negative B-lineage acute lymphoblastic leukemia (ALL). Newly diagnosed patients who underwent allo-SCT (n = 486) or auto-SCT (n = 99) after achieving first complete remission (CR) were included. Propensity score matching (PS) and an inverse probability of the treatment weighting (IPTW) analysis were applied to compensate for imbalances in baseline characteristics. The 5 years rates of overall survival (OS) among those in the PS-matched cohorts were 57% [95% confidence interval (CI) 46-67%] for those who received allo-SCT and 44% (95% CI 33-54%) for those who received auto-SCT. Multivariable, propensity score-matched, and IPTW analyses all revealed no statistically significant differences in OS between the two groups [hazard ratios (HR) 0.81, 95% CI 0.53-1.27, p = 0.36; HR 0.84, 95% CI 0.40-1.78, p = 0.65; HR 0.71, 95% CI 0.25-2.02, p = 0.53, respectively]. Prospective trials that include autologous transplantation as a treatment option are needed to examine the potential of autologous transplantation.
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Affiliation(s)
- Shuichi Mizuta
- Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan.
| | - Tomotaka Ugai
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Harumi Kato
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Mineo Kurokawa
- Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Shingo Yano
- Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichiro Nawa
- Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Shimotsuke, Japan
| | - Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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48
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Sun W, Huang X. Role of allogeneic haematopoietic stem cell transplantation in the treatment of adult acute lymphoblastic leukaemia in the era of immunotherapy. Chin Med J (Engl) 2022; 135:890-900. [PMID: 34890382 PMCID: PMC9276108 DOI: 10.1097/cm9.0000000000001898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently the standard of care for adult acute lymphoblastic leukemia (ALL) patients. In recent years, with the continuous development of immunotherapy, such as chimeric antigen receptor T cells, blinatumomab, and inotuzumab ozogamicin, a series of vital clinical studies have confirmed its high response rate and favorable outcomes for ALL. Although the emergence of immunotherapy has expanded relapsed or refractory (r/r) ALL patients' opportunities to receive allo-HSCT, allo-HSCT is associated with potential challenges. In this review, the role of allo-HSCT in the treatment of adult ALL in the era of immunotherapy will be discussed.
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Affiliation(s)
- Wei Sun
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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Curran E, Muffly L, Luskin MR. Innovative Approaches to the Management of Acute Lymphoblastic Leukemia Across the Age Spectrum. Am Soc Clin Oncol Educ Book 2022; 42:1-11. [PMID: 35503981 DOI: 10.1200/edbk_349647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Adults compose nearly half of all patients diagnosed with acute lymphoblastic leukemia (ALL) and historically have had poor survival compared with pediatric patients. Recently approved therapies, such as monoclonal antibodies, CAR T-cell constructs, and next-generation tyrosine kinase inhibitors, have improved survival in relapsed and refractory ALL, and studies are now examining incorporating these treatments and others into the upfront setting. In adolescent and young adult patients, use of pediatric-based regimens has already improved survival compared with historical controls, and the addition of monoclonal antibodies, such as inotuzumab ozogamicin and blinatumomab, may further enhance this survival benefit. In older adults, approaches have centered on minimizing conventional chemotherapy to decrease toxicity by incorporating monoclonal antibodies and other novel therapies to increase efficacy. With the addition of tyrosine kinase inhibitors to chemotherapy for patients with Philadelphia chromosome-positive ALL, survival of this once poor-prognosis ALL subtype now approaches or exceeds outcomes of other subtypes of adult ALL. Further refinements in the backbone treatment regimen and optimal consolidation approaches will likely improve survival further. Although allogeneic hematopoietic stem cell transplant was previously routinely used as consolidation for adults with ALL, incorporation of measurable residual disease and other risk stratification strategies has enabled better identification of patients who will benefit from allogeneic hematopoietic stem cell transplant. Ongoing clinical trials investigating these approaches will continue the evolution of treatment approaches for adults with ALL, with further improvement in outcomes anticipated.
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Affiliation(s)
- Emily Curran
- University of Cincinnati, Division of Hematology and Oncology, Department of Internal Medicine and Department of Pediatrics, Cincinnati, OH
| | - Lori Muffly
- Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Internal Medicine, Stanford University, Stanford, CA
| | - Marlise R Luskin
- Dana-Farber Cancer Institute, Division of Leukemia, Department of Medical Oncology, Boston, MA
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In-vivo T-cell depleted reduced-intensity conditioned allogeneic haematopoietic stem-cell transplantation for patients with acute lymphoblastic leukaemia in first remission: results from the prospective, single-arm evaluation of the UKALL14 trial. Lancet Haematol 2022; 9:e276-e288. [PMID: 35358442 PMCID: PMC8969058 DOI: 10.1016/s2352-3026(22)00036-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The outcome of chemotherapy in patients older than 40 years with acute lymphoblastic leukaemia is poor and myeloablative allogeneic haematopoietic stem-cell transplantation (HSCT) has a high transplant-related mortality (TRM) in this age cohort. The aim of this study was to assess the activity and safety of reduced-intensity conditioned allogeneic HSCT in this patient population. METHODS This was a single-arm, prospective study within the UKALL14 trial done in 46 centres in the UK, which recruited patients to the transplantation substudy. Participants in UKALL14 had B-cell or T-cell acute lymphoblastic leukaemia, were aged 25-65 years (BCR-ABL1-negative) or 18-65 years (BCR-ABL1-positive), and for this subcohort had a fit, matched sibling donor or an 8 out of 8 allelic matched unrelated donor (HLA-A, HLA-B, HLA-C, and HLA-DR). On June 20, 2014, the protocol was amended to allow 7 out of 8 matched unrelated donors if the patient had high risk cytogenetics or was minimal residual disease (MRD)-positive after the second induction course. Patients were given fludarabine, melphalan, and alemtuzumab (FMA; intravenous fludarabine 30 mg/m2 on days -6 to -2, melphalan 140 mg/m2 on day -2, and alemtuzumab 30 mg on day -1 [sibling donor] and days -2 and -1 [unrelated donor]) before allogeneic HSCT (aged ≥41 years patient pathway). Donor lymphocyte infusions were given from 6 months for mixed chimerism or MRD. The primary endpoint was event-free survival and secondary and transplantation-specific endpoints included overall survival, relapse incidence, TRM, and acute and chronic graft-versus-host disease (GVHD). This study is registered with ClinicalTrials.gov, NCT01085617. FINDINGS From Feb 22, 2011, to July 26, 2018, 249 patients (236 aged ≥41 years and 13 younger than 41 years) considered unfit for a myeloablative allograft received an FMA reduced-intensity conditioned HSCT. 138 (55%) patients were male and 111 (45%) were female. 88 (35%) participants received transplantations from a sibling donor and 160 (64%) received transplantations from unrelated donors. 211 (85%) participants had B-precursor acute lymphoblastic leukaemia. High-risk cytogenetics were present in 43 (22%) and another 63 (25%) participants were BCR-ABL1-positive. At median follow-up of 49 months (IQR 36-70), 4-year event-free survival was 46·8% (95% CI 40·1-53·2) and 4-year overall survival was 54·8% (48·0-61·2). 4-year cumulative incidence of relapse was 33·6% (27·9-40·2) and 4-year TRM was 19·6% (15·1-25·3). 27 (56%) of 48 patients with TRM had infection as the named cause of death. Seven (15%) of 48 patients had fungal infections, 13 (27%) patients had bacterial infections (six gram-negative), and 11 (23%) had viral infections (three cytomegalovirus and two Epstein-Barr virus). Acute GVHD grade 2-4 occurred in 29 (12%) of 247 patients and grade 3-4 occurred in 12 (5%) patients. Chronic GVHD incidence was 84 (37%) of 228 patients (50 [22%] had extensive chronic GVHD). 49 (30%) of 162 patients had detectable end-of-induction MRD, which portended worse outcomes with event-free survival (HR 2·40 [95% CI 1·46-3·93]) and time-to-relapse (HR 2·41 [1·29-4·48]). INTERPRETATION FMA reduced-intensity conditioned allogeneic HSCT in older patients with acute lymphoblastic leukaemia in first complete remission provided good disease control with moderate GVHD, resulting in better-than-expected event-free survival and overall survival in this high-risk population. Strategies to reduce infection-related TRM will further improve outcomes. FUNDING Cancer Research UK.
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