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Galitzia A, Maccaferri M, Mauro FR, Murru R, Marasca R. Chronic Lymphocytic Leukemia: Management of Adverse Events in the Era of Targeted Agents. Cancers (Basel) 2024; 16:1996. [PMID: 38893115 PMCID: PMC11171383 DOI: 10.3390/cancers16111996] [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: 04/14/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment landscape for CLL has undergone a profound transformation with the advent of targeted agents (TAs) like Bruton's Tyrosine Kinase inhibitors (BTKis) and BCL-2 inhibitors (BCL-2is). These agents target crucial cellular pathways in CLL, offering superior efficacy over traditional chemo-immunotherapy, which has led to improved progression-free and overall survival rates. This advancement promises enhanced disease control and potentially normal life expectancy for many patients. However, the journey is not without challenges, as these TAs are associated with a range of adverse events (AEs) that can impact treatment efficacy and patient quality of life. This review focuses on detailing the various AEs related to TA management in CLL, evaluating their frequency and clinical impact. The aim is to present a comprehensive guide to the effective management of these AEs, ensuring optimal tolerability and efficacy of TAs. By reviewing the existing literature and consolidating findings, we provide insights into AE management, which is crucial for maximizing patient outcomes in CLL therapy.
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Affiliation(s)
- Andrea Galitzia
- Hematology and Stem Cell Transplantation Unit, Ospedale San Francesco, 08100 Nuoro, Italy;
| | - Monica Maccaferri
- Hematology Unit, Department of Oncology and Hematology, A.O.U of Modena, Policlinico, 41125 Modena, Italy; (M.M.); (R.M.)
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy;
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, 09134 Cagliari, Italy
| | - Roberto Marasca
- Hematology Unit, Department of Oncology and Hematology, A.O.U of Modena, Policlinico, 41125 Modena, Italy; (M.M.); (R.M.)
- Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, 41121 Modena, Italy
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2
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Lee BJ, Vittayawacharin P, Griffin SP, Doh J, Nam HH, Jeyakumar D, Blodget E, Kongtim P, Ciurea SO. Persistent Impairment in Immune Reconstitution and Worse Survival Outcomes in Allogeneic Stem Cell Transplantation Patients with Early Coronavirus Disease 2019 Infection. Transplant Cell Ther 2024:S2666-6367(24)00374-9. [PMID: 38710303 DOI: 10.1016/j.jtct.2024.04.021] [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: 02/19/2024] [Revised: 04/12/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
Patients undergoing allogenic hematopoietic stem cell transplantation (HSCT) are at an increased risk of mortality due to transplantation-related complications in the first year post-transplantation, owing in part to the profound immune dysregulation with T cell and B cell lymphopenia and functional impairment. Although several large studies have reported higher mortality rates from Coronavirus disease 2019 (COVID-19) in HSCT recipients, to date no study has focused on the impact of early COVID-19 infection on immune reconstitution post-transplantation and the correlation with transplantation outcomes. We retrospectively analyzed 61 consecutive adult patients who underwent their first allogeneic HSCT at our institution. Thirteen patients (21.3%) experienced early COVID-19 infection, with a median time to diagnosis of 100 days post-transplantation. In multivariable analysis, patients with early COVID-19 infection had significantly worse overall survival (adjusted hazard ratio [aHR], 4.06; 95% confidence interval [CI], 1.26 to 13.05; P = .019) and progression-free survival (aHR, 6.68; 95% CI, 2.11 to 21.11; P = .001). This was attributed mainly to higher nonrelapse mortality (NRM) among early COVID-19 patients (P = .042). Allogeneic HSCT recipients with early COVID-19 infection had significant delays in absolute lymphocyte count (95% CI, -703.69 to -56.79; P = .021), CD3+CD4+ cell (95% CI, -105.35 to -11.59; P = .042), CD3+CD8+ cell (95% CI, -324.55 to -57.13; P = .038), and CD3-CD56+ cell (95% CI, -193.51 to -47.31; P = .014) recovery compared to those without early COVID-19 infection. Our findings suggest that patients with early COVID-19 infection after allogeneic HSCT have higher NRM and worse survival, at least in part due to impaired immune reconstitution post-transplantation.
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Affiliation(s)
- Benjamin J Lee
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA; Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, California
| | - Pongthep Vittayawacharin
- Division of Hematology-Oncology, Department of Medicine, Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California; Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shawn P Griffin
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA; Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, California
| | - Jean Doh
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA; Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, California
| | - Hannah H Nam
- Division of Infectious Diseases, Department of Medicine, University of California Irvine Health, Orange, California
| | - Deepa Jeyakumar
- Division of Hematology-Oncology, Department of Medicine, Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California
| | - Emily Blodget
- Division of Infectious Diseases, Department of Medicine, University of California Irvine Health, Orange, California
| | - Piyanuch Kongtim
- Division of Hematology-Oncology, Department of Medicine, Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California
| | - Stefan O Ciurea
- Division of Hematology-Oncology, Department of Medicine, Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California.
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Bernstein JA, Maurer M, Saini SS. BTK signaling-a crucial link in the pathophysiology of chronic spontaneous urticaria. J Allergy Clin Immunol 2024; 153:1229-1240. [PMID: 38141832 DOI: 10.1016/j.jaci.2023.12.008] [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: 08/02/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
Chronic spontaneous urticaria (CSU) is an inflammatory skin disorder that manifests with itchy wheals, angioedema, or both for more than 6 weeks. Mast cells and basophils are the key pathogenic drivers of CSU; their activation results in histamine and cytokine release with subsequent dermal inflammation. Two overlapping mechanisms of mast cell and basophil activation have been proposed in CSU: type I autoimmunity, also called autoallergy, which is mediated via IgE against various autoallergens, and type IIb autoimmunity, which is mediated predominantly via IgG directed against the IgE receptor FcεRI or FcεRI-bound IgE. Both mechanisms involve cross-linking of FcεRI and activation of downstream signaling pathways, and they may co-occur in the same patient. In addition, B-cell receptor signaling has been postulated to play a key role in CSU by generating autoreactive B cells and autoantibody production. A cornerstone of FcεRI and B-cell receptor signaling is Bruton tyrosine kinase (BTK), making BTK inhibition a clear therapeutic target in CSU. The potential application of early-generation BTK inhibitors, including ibrutinib, in allergic and autoimmune diseases is limited owing to their unfavorable benefit-risk profile. However, novel BTK inhibitors with improved selectivity and safety profiles have been developed and are under clinical investigation in autoimmune diseases, including CSU. In phase 2 trials, the BTK inhibitors remibrutinib and fenebrutinib have demonstrated rapid and sustained improvements in CSU disease activity. With phase 3 studies of remibrutinib ongoing, it is hoped that BTK inhibitors will present an effective, well-tolerated option for patients with antihistamine-refractory CSU, a phenotype that presents a considerable clinical challenge.
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Affiliation(s)
- Jonathan A Bernstein
- Department of Internal Medicine, Allergy and Immunology Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sarbjit S Saini
- Johns Hopkins Asthma and Allergy Center, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Baltimore, Md.
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Murru R, Galitzia A, Barabino L, Presicci R, La Nasa G, Caocci G. Prediction of severe infections in chronic lymphocytic leukemia: a simple risk score to stratify patients at diagnosis. Ann Hematol 2024; 103:1655-1664. [PMID: 38236391 PMCID: PMC11009768 DOI: 10.1007/s00277-024-05625-y] [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: 09/12/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
Chronic Lymphocytic Leukemia (CLL) is well-known for increasing susceptibility to infections. Factors such as immune dysregulation, IGHV status, hypogammaglobulinemia, and patient comorbidity and treatment, contribute to higher infection rates and mortality. However, the impact of hypogammaglobulinemia on infection rates is controversial. We aimed to identify clinical and biological parameters linked to the risk of severe infectious events. Additionally, we set up a straightforward risk infection score to stratify CLL patients at diagnosis, thereby enabling the development of suitable infection prevention strategies. We retrospectively evaluated 210 unselected CLL patients diagnosed between 1988 and 2018. This evaluation encompassed demographics, Binet stage, immunoglobulin (Ig) levels, treatment history, comorbidities, and IGHV mutational status at diagnosis. The frequency and severity of infectious events were recorded. Analysis revealed that age, IGHV mutational status, Binet stage, and hypogammaglobulinemia were statistically associated with the Time to First Infection (TTFI) in univariate and multivariate analyses. Using hazard ratios from the multivariate analysis, we finally devised a risk scoring system that integrated age, IGHV mutational status, immunoglobulin levels, and Binet stage to stratify patients at diagnosis based on their specific infection risk. In our cohort, disease progression and infections were the leading cause of death. These findings pointed out the clinical need for a screening process strategic for defining infectious risk at the time of CLL diagnosis, with a significant enhancement in the clinical management of these patients.
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Affiliation(s)
- Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy
| | - Andrea Galitzia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Barabino
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Presicci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy.
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Zhu H, Lu X, Zhang X, Hua H, Zhang J, Miao Y, Gu W, Xu M, Lu X, Li B, Wang C, Ni H, Qian J, Shi J, Xu M, Wu G, Zhang Y, Shen Q, Wang Z, Zhu J, Cheng Z, Zhuang W, Lin G, Hu Y, Shan Q, Chen Y, Qiu H, Li J, Shi W. Multi-center study of COVID-19 infection in elderly patients with lymphoma: on behalf of Jiangsu Cooperative Lymphoma Group (JCLG). Ann Hematol 2024:10.1007/s00277-024-05744-6. [PMID: 38649594 DOI: 10.1007/s00277-024-05744-6] [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: 12/13/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Elderly patients with lymphoproliferative diseases (LPD) are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we retrospectively described the clinical features and outcomes of the first time infection of Omicron SARS-CoV-2 in 364 elderly patients with lymphoma enrolled in Jiangsu Cooperative Lymphoma Group (JCLG) between November 2022 and April 2023 in China. Median age was 69 years (range 60-92). 54.4% (198/364) of patients were confirmed as severe and critical COVID-19 infection. In univariable analysis, Age > 70 years (OR 1.88, p = 0.003), with multiple comorbidities (OR 1.41, p = 0.005), aggressive lymphoma (OR 2.33, p < 0.001), active disease (progressive or relapsed/refractory, OR 2.02, p < 0.001), and active anti-lymphoma therapy (OR 1.90, p < 0.001) were associated with severe COVID-19. Multiple (three or more) lines of previous anti-lymphoma therapy (OR 3.84, p = 0.021) remained an adverse factor for severe COVID-19 in multivariable analysis. Moreover, CD20 antibody (Rituximab or Obinutuzumab)-based treatments within the last 6 months was associated with severe COVID-19 in the entire cohort (OR 3.42, p < 0.001). Continuous BTK inhibitors might be protective effect on the outcome of COVID-19 infection (OR 0.44, p = 0.043) in the indolent lymphoma cohort. Overall, 7.7% (28/364) of the patients ceased, multiple lines of previous anti-lymphoma therapy (OR 3.46, p = 0.016) remained an adverse factor for mortality.
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Affiliation(s)
- Huayuan Zhu
- Department of Hematology, Lymphoma Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China.
| | - Xiao Lu
- Department of Hematology, Lymphoma Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Xiaoping Zhang
- Department of Hematology, The Affiliated Zhongda Hospital of Southeast University Medical College, Nanjing, 210044, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Haiying Hua
- Department of Hematology, Wuxi Third People's Hospital, Wuxi, 214045, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jie Zhang
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, 226001, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yuqing Miao
- Department of Hematology, Yancheng First People's Hospital, Yancheng, 224006, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Weiying Gu
- Department of Hematology, The First People's Hospital of Changzhou and The Third Affiliated Hospital of Soochow University, Changzhou, 213004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Min Xu
- Department of Hematology, Zhangjiagang First Affiliated Hospital of Soochow University, Zhangjiagang, 215699, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Xuzhang Lu
- Department of Hematology, Affiliated Changzhou Second Hospital of Nanjing Medical University, Changzhou, 213004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Bingzong Li
- Department of Hematology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Chunling Wang
- Department of Hematology, The First People's Hospital of Huai'an, Huai'an, 223399, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Haiwen Ni
- Department of Hematology, The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jun Qian
- Department of Hematology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jinning Shi
- Department of Hematology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, 211199, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Maozhong Xu
- Department of Hematology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, 214433, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Guangqi Wu
- Department of Hematology, The First People's Hospital of Suqian, Suqian, 223812, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yunping Zhang
- Department of Hematology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214206, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Qiudan Shen
- Department of Hematology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215008, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Zhi Wang
- Department of Hematology, Wuxi Second People's Hospital, Wuxi, 214001, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jianfeng Zhu
- Department of Hematology, The People's Hospital of Taizhou, Taizhou, 225399, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Zhen Cheng
- Department of Hematology, Taicang Hospital Affiliated to Soochow University, Taicang, 215488, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Wanchuan Zhuang
- Department of Hematology, The Second People's Hospital of Lianyungang, Lianyungang, 222002, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Guoqiang Lin
- Department of Hematology, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223022, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yongjun Hu
- Department of Hematology, Huaiyin Hospital of Huai'an, Huai'an, 223399, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Qiurong Shan
- Department of Hematology, Shuyang Traditional Chinese Medicine Hospital, Shuyang, 223614, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yifei Chen
- Department of Hematology, Jiangdu People's Hospital of Yangzhou, Yangzhou, 225202, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Hongchun Qiu
- Department of Hematology, The Third People's Hospital of Kunshan, Kunshan, 215316, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jianyong Li
- Department of Hematology, Lymphoma Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China.
| | - Wenyu Shi
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, 226001, China.
- Department of Hematology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, Jiangsu, China.
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China.
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Fallin T, Thacker E, Sahra S, Siegrist EA, White BP, Summers K, Shibib D, Sassine J. CNS Aspergillosis and Cryptococcosis with Cytomegalovirus Pneumonia in a Patient with Chronic Lymphocytic Leukemia Treated with Acalabrutinib. J Pharm Pract 2024:8971900241247660. [PMID: 38621678 DOI: 10.1177/08971900241247660] [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: 04/17/2024]
Abstract
Bruton's tyrosine kinase inhibitors (BTKis) are the preferred treatment for chronic lymphocytic leukemia (CLL). Despite their therapeutic benefits, these targeted agents have been associated with an increased risk of invasive infections. We describe a 68-year-old male who developed multiple bacterial, fungal and viral infections while on treatment with acalabrutinib. To our knowledge, this is the first reported case of concomitant CNS infections with Cryptococcus neoformans and Aspergillus fumigatus, along with cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV-1) pneumonia while on acalabrutinib. This case adds to the scarce literature of fungal and bacterial infections associated with acalabrutinib, raising the suspicion that infection risk is a medication class effect for BTKis.
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Affiliation(s)
- Taylor Fallin
- Department of Pharmacy, Clinical and Administrative Sciences, OU Health, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Erica Thacker
- Department of Pharmacy, Clinical and Administrative Sciences, OU Health, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Syeda Sahra
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily A Siegrist
- Department of Pharmacy, Clinical Infectious Diseases, OU Health, Oklahoma City, OK, USA
| | - Bryan P White
- Department of Pharmacy, Clinical Infectious Diseases, OU Health, Oklahoma City, OK, USA
| | - Katherine Summers
- Department of Pharmacy, Critical Care, OU Health, Oklahoma City, OK, USA
| | - Dena Shibib
- Department of Pathology, Microbiology and Virology Laboratories, OU Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joseph Sassine
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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7
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Francis ER, Vu J, Perez CO, Sun C. Vaccinations in patients with chronic lymphocytic leukemia. Semin Hematol 2024; 61:131-138. [PMID: 38302313 PMCID: PMC11162341 DOI: 10.1053/j.seminhematol.2024.01.003] [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: 11/17/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by immune dysfunction resulting in heightened susceptibility to infections and elevated rates of morbidity and mortality. A key strategy to mitigate infection-related complications has been immunization against common pathogens. However, the immunocompromised status of CLL patients poses challenges in eliciting an adequate humoral and cellular immune response to vaccination. Most CLL-directed therapy disproportionately impairs humoral immunity. Vaccine responsiveness also depends on the phase and type of immune response triggered by immunization. In this review, we discuss the immune dysfunction, vaccine responsiveness, and considerations for optimizing vaccine response in patients with CLL.
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Affiliation(s)
| | - Jennifer Vu
- Rosalind Franklin University of Medicine and Science, Chicago Medical School
| | | | - Clare Sun
- National Institutes of Health, National Heart, Lung, and Blood Institute.
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Tsilingiris D, Vallianou NG, Spyrou N, Kounatidis D, Christodoulatos GS, Karampela I, Dalamaga M. Obesity and Leukemia: Biological Mechanisms, Perspectives, and Challenges. Curr Obes Rep 2024; 13:1-34. [PMID: 38159164 PMCID: PMC10933194 DOI: 10.1007/s13679-023-00542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW To examine the epidemiological data on obesity and leukemia; evaluate the effect of obesity on leukemia outcomes in childhood acute lymphoblastic leukemia (ALL) survivors; assess the potential mechanisms through which obesity may increase the risk of leukemia; and provide the effects of obesity management on leukemia. Preventive (diet, physical exercise, obesity pharmacotherapy, bariatric surgery) measures, repurposing drugs, candidate therapeutic agents targeting oncogenic pathways of obesity and insulin resistance in leukemia as well as challenges of the COVID-19 pandemic are also discussed. RECENT FINDINGS Obesity has been implicated in the development of 13 cancers, such as breast, endometrial, colon, renal, esophageal cancers, and multiple myeloma. Leukemia is estimated to account for approximately 2.5% and 3.1% of all new cancer incidence and mortality, respectively, while it represents the most frequent cancer in children younger than 5 years. Current evidence indicates that obesity may have an impact on the risk of leukemia. Increased birthweight may be associated with the development of childhood leukemia. Obesity is also associated with worse outcomes and increased mortality in leukemic patients. However, there are several limitations and challenges in meta-analyses and epidemiological studies. In addition, weight gain may occur in a substantial number of childhood ALL survivors while the majority of studies have documented an increased risk of relapse and mortality among patients with childhood ALL and obesity. The main pathophysiological pathways linking obesity to leukemia include bone marrow adipose tissue; hormones such as insulin and the insulin-like growth factor system as well as sex hormones; pro-inflammatory cytokines, such as IL-6 and TNF-α; adipocytokines, such as adiponectin, leptin, resistin, and visfatin; dyslipidemia and lipid signaling; chronic low-grade inflammation and oxidative stress; and other emerging mechanisms. Obesity represents a risk factor for leukemia, being among the only known risk factors that could be prevented or modified through weight loss, healthy diet, and physical exercise. Pharmacological interventions, repurposing drugs used for cardiometabolic comorbidities, and bariatric surgery may be recommended for leukemia and obesity-related cancer prevention.
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Affiliation(s)
- Dimitrios Tsilingiris
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Natalia G Vallianou
- Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece
| | - Nikolaos Spyrou
- Tisch Cancer Institute Icahn School of Medicine at Mount Sinai, 1190 One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Dimitris Kounatidis
- Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece
| | | | - Irene Karampela
- 2nd Department of Critical Care, Medical School, University of Athens, Attikon General University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str, 11527, Athens, Greece.
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Ntsethe A, Mkhwanazi ZA, Dludla PV, Nkambule BB. B Cell Subsets and Immune Checkpoint Expression in Patients with Chronic Lymphocytic Leukemia. Curr Issues Mol Biol 2024; 46:1731-1740. [PMID: 38534728 DOI: 10.3390/cimb46030112] [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: 01/10/2024] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024] Open
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by dysfunctional B cells. Immune checkpoint molecules such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed death-1 (PD-1) are upregulated in patients with CLL and may correlate with prognostic markers such as beta-2 microglobulin (B2M). The aim of this study was to evaluate the levels of immune checkpoints on B cell subsets and to further correlate them with B2M levels in patients with CLL. We recruited 21 patients with CLL and 12 controls. B cell subsets and the levels of immune checkpoint expression were determined using conventional multi-color flow cytometry. Basal levels of B2M in patients with CLL were measured using an enzyme-linked immunosorbent assay. Patients with CLL had increased levels of activated B cells when compared to the control group, p < 0.001. The expression of PD-1 and CTLA-4 were increased on activated B cells and memory B cells, p < 0.05. There were no associations between B2M levels and the measured immune checkpoints on B cell subsets, after adjusting for sex and age. In our cohort, the patients with CLL expressed elevated levels of PD-1 and CTLA-4 immune checkpoints on activated and memory B cell subsets. However, there was no correlation between these immune checkpoint expressions and B2M levels.
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Affiliation(s)
- Aviwe Ntsethe
- School of Laboratory Medicine and Medical Sciences (SLMMS), University of KwaZulu-Natal, Durban 4000, South Africa
| | - Zekhethelo Alondwe Mkhwanazi
- School of Laboratory Medicine and Medical Sciences (SLMMS), University of KwaZulu-Natal, Durban 4000, South Africa
| | - Phiwayinkosi Vusi Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Bongani Brian Nkambule
- School of Laboratory Medicine and Medical Sciences (SLMMS), University of KwaZulu-Natal, Durban 4000, South Africa
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10
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Boncompagni G, Tatangelo V, Lopresti L, Ulivieri C, Capitani N, Tangredi C, Finetti F, Marotta G, Frezzato F, Visentin A, Ciofini S, Gozzetti A, Bocchia M, Calzada-Fraile D, Martin Cofreces NB, Trentin L, Patrussi L, Baldari CT. Leukemic cell-secreted interleukin-9 suppresses cytotoxic T cell-mediated killing in chronic lymphocytic leukemia. Cell Death Dis 2024; 15:144. [PMID: 38360867 PMCID: PMC10869739 DOI: 10.1038/s41419-024-06528-6] [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: 05/16/2023] [Revised: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
The tumor microenvironment (TME) plays a central role in the pathogenesis of chronic lymphocytic leukemia (CLL), contributing to disease progression and chemoresistance. Leukemic cells shape the TME into a pro-survival and immunosuppressive niche through contact-dependent and contact-independent interactions with the cellular components of the TME. Immune synapse (IS) formation is defective in CLL. Here we asked whether soluble factors released by CLL cells contribute to their protection from cytotoxic T cell (CTL)-mediated killing by interfering with this process. We found that healthy CTLs cultured in media conditioned by leukemic cells from CLL patients or Eμ-TCL1 mice upregulate the exhaustion marker PD-1 and become unable to form functional ISs and kill target cells. These defects were more pronounced when media were conditioned by leukemic cells lacking p66Shc, a proapoptotic adapter whose deficiency has been implicated in disease aggressiveness both in CLL and in the Eμ-TCL1 mouse model. Multiplex ELISA assays showed that leukemic cells from Eμ-TCL1 mice secrete abnormally elevated amounts of CCL22, CCL24, IL-9 and IL-10, which are further upregulated in the absence of p66Shc. Among these, IL-9 and IL-10 were also overexpressed in leukemic cells from CLL patients, where they inversely correlated with residual p66Shc. Using neutralizing antibodies or the recombinant cytokines we show that IL-9, but not IL-10, mediates both the enhancement in PD-1 expression and the suppression of effector functions in healthy CTLs. Our results demonstrate that IL-9 secreted by leukemic cells negatively modulates the anti-tumor immune abilities of CTLs, highlighting a new suppressive mechanism and a novel potential therapeutical target in CLL.
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Affiliation(s)
| | | | | | | | - Nagaja Capitani
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | - Giuseppe Marotta
- Stem Cell Transplant and Cellular Therapy Unit, University Hospital, Siena, Italy
| | - Federica Frezzato
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
- Venetian Institute of Molecular Medicine, Padua, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
- Venetian Institute of Molecular Medicine, Padua, Italy
| | - Sara Ciofini
- Department of Medical Science, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro Gozzetti
- Department of Medical Science, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Monica Bocchia
- Department of Medical Science, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Diego Calzada-Fraile
- Immunology Unit from Hospital Universitario de la Princesa, Universidad Autónoma de Madrid and Instituto de investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029, Madrid, Spain
| | - Noa B Martin Cofreces
- Immunology Unit from Hospital Universitario de la Princesa, Universidad Autónoma de Madrid and Instituto de investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
- Venetian Institute of Molecular Medicine, Padua, Italy
| | - Laura Patrussi
- Department of Life Sciences, University of Siena, Siena, Italy.
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11
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Moss P. Ibrutinib reversal of immune exhaustion in CLL. Blood 2024; 143:5-7. [PMID: 38175677 DOI: 10.1182/blood.2023022243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
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12
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Andreescu M, Andreescu B. Immune Evasion Through Human Leukocyte Antigen Implications and Its Impact on Targeted Therapy. Cureus 2024; 16:e52737. [PMID: 38384647 PMCID: PMC10880808 DOI: 10.7759/cureus.52737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
The malfunctioning of human leukocyte antigen (HLA) class I antigens has a substantial negative impact on the effectiveness of leukemia treatment, particularly in the development of immunotherapies that rely on T-cell activation. HLA-G, a molecule that suppresses the immune response, plays a role in repressing the activation and proliferation of T cells, natural killer cells, and antigen-presenting cells. The expression of HLA-G is associated with various pathological conditions. Tumor cells exploit the immune evasion capabilities of HLA, allowing them to evade detection and elimination by the immune system. Understanding and modifying the HLA molecules is crucial for the advancement of innovative immunotherapies targeting chronic lymphocytic leukemia. Numerous mechanisms have been investigated to elucidate how HLA facilitates tumor evasion in patients with chronic lymphocytic leukemia and other malignancies. These mechanisms include inhibiting immune cell cytolysis, altering cytokine production levels, promoting immune cell programmed cell death, and impairing chemotaxis. This review provides a comprehensive overview of immune evasion mediated by HLA and its implications for targeted therapy.
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Affiliation(s)
- Mihaela Andreescu
- Faculty of Medicine, Titu Maiorescu University, Bucharest, ROU
- Hematology, Colentina Clinical Hospital, Bucharest, ROU
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13
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Crassini K, Gibson J. Pathogenesis and management of immune dysfunction secondary to B cell haematological malignancies. Intern Med J 2024; 54:16-25. [PMID: 38066723 DOI: 10.1111/imj.16279] [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: 02/18/2023] [Accepted: 10/15/2023] [Indexed: 01/26/2024]
Abstract
Malignancies of the B-lymphocyte lineage are among the most diagnosed haematological malignancies in clinical practice. In our community, multiple myeloma (MM) and its precursor condition monoclonal gammopathy of undetermined significance are the commonest, accounting for ~12% of diagnoses, followed by chronic lymphocytic leukaemia (CLL) and its precursor condition monoclonal B lymphocytosis, ~9%. Along with diffuse large B cell lymphoma, follicular lymphoma and marginal zone lymphoma, these conditions comprise around a third of all haematological malignancies diagnosed. Infection remains an important cause of mortality and morbidity in the management of patients with these conditions. This is in part treatment-related but also reflective of disease-related immune dysfunction. Infectious complications account for up to 50% of early mortality in patients with myeloma and up to 50% of all mortality in patients with CLL. A variety of strategies are available to decrease the morbidity and mortality of infectious complications; however, practices vary between countries and often between treating physicians. Treatment options have evolved significantly over the last decade, with the introduction of monoclonal antibodies, small molecule inhibitors, second- and third-generation immunomodulatory agents and CAR-T cell therapy. Much of the data that inform clinical practice in infection management predates current therapeutic approaches. This is in part because of the rapid development of new therapies but also reflective of the long natural history of many of these diseases and the need for prolonged periods of observation. In this article, we review the aspects of disease and treatment that contribute to immune dysfunction in MM, CLL and B-cell non-Hodgkin lymphoma and review the current strategies used to manage immune dysfunction and infection.
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Affiliation(s)
- Kyle Crassini
- MNCCI, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - John Gibson
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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14
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Welch BM, Manso BA, Gwin KA, Lothert PK, Parikh SA, Kay NE, Medina KL. Comparison of the blood immune repertoire with clinical features in chronic lymphocytic leukemia patients treated with chemoimmunotherapy or ibrutinib. Front Oncol 2023; 13:1302038. [PMID: 38111528 PMCID: PMC10725910 DOI: 10.3389/fonc.2023.1302038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of CD19+ CD5+ clonal B lymphocytes in the blood, bone marrow, and peripheral lymphoid organs. Treatment options for patients range from historical chemoimmunotherapy (CIT) to small molecule inhibitors targeting pro-survival pathways in leukemic B cells, such as the Bruton's tyrosine kinase inhibitor ibrutinib (IBR). Using biobanked blood samples obtained pre-therapy and at standard response evaluation timepoints, we performed an in-depth evaluation of the blood innate and adaptive immune compartments between pentostatin-based CIT and IBR and looked for correlations with clinical sequelae. CD4+ conventional T cells and CD8+ cytotoxic T cells responded similarly to CIT and IBR, although exhaustion status differed. Both treatments dramatically increased the prevalence and functional status of monocyte, dendritic cell, and natural killer cell subsets. As expected, both regimens reduced clonal B cell levels however, we observed no substantial recovery of normal B cells. Although improvements in most immune subsets were observed with CIT and IBR at response evaluation, both patient groups remained susceptible to infections and secondary malignancies during the study.
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Affiliation(s)
- Baustin M. Welch
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Bryce A. Manso
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
- Department of Biomolecular Engineering, University of California, Santa Cruz, Santa Cruz, CA, United States
| | - Kimberly A. Gwin
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Petra K. Lothert
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Sameer A. Parikh
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Neil E. Kay
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Kay L. Medina
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
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15
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Visentin A, Chatzikonstantinou T, Scarfò L, Kapetanakis A, Demosthenous C, Karakatsoulis G, Minga E, Chamou D, Allsup D, Cabrero AA, Andres M, Antic D, Baile M, Baliakas P, Besikli-Dimou S, Bron D, Chatzileontiadou S, Cordoba R, Correa JG, Cuéllar-García C, De Paoli L, De Paolis MR, Delgado J, Dimou M, Donaldson D, Catherwood M, Doubek M, Efstathopoulou M, Eichhorst B, Elashwah S, Enrico A, Espinet B, Farina L, Ferrari A, Foglietta M, Frederiksen H, Fürstenau M, García-Marco JA, García-Serra R, Collado R, Gentile M, Gimeno E, Glenthøj A, da Silva MG, Hakobyan YK, Herishanu Y, Hernández-Rivas JÁ, Herold T, Innocenti I, Itchaki G, Jaksic O, Janssens A, Kalashnikova ОB, Kalicińska E, Kater AP, Kersting S, Labrador J, Lad D, Laurenti L, Levin MD, Lista E, Lopez-Garcia A, Malerba L, Marasca R, Marchetti M, Marquet J, Mattsson M, Mauro FR, Morawska M, Motta M, Munir T, Murru R, Niemann CU, Rodrigues RN, Olivieri J, Orsucci L, Papaioannou M, Pavlovsky MA, Piskunova I, Popov VM, Quaglia FM, Quaresmini G, Qvist K, Rigolin GM, Ruchlemer R, Šimkovič M, Špaček M, Sportoletti P, Stanca O, Tadmor T, Capasso A, Del Poeta G, Gutwein O, Karlsson LK, Milosevic I, Mirás F, Reda G, Saghumyan G, Shrestha A, Te Raa D, Tonino SH, Van Der Spek E, van Gelder M, van Kampen R, Wasik-Szczepanek E, Wróbel T, Segundo LYS, Yassin M, Pocali B, Vandenberghe E, Iyengar S, Varettoni M, Vitale C, Coscia M, Rambaldi A, Montserrat E, Cuneo A, Stavroyianni N, Trentin L, Stamatopoulos K, Ghia P. The evolving landscape of COVID-19 and post-COVID condition in patients with chronic lymphocytic leukemia: A study by ERIC, the European research initiative on CLL. Am J Hematol 2023; 98:1856-1868. [PMID: 37772428 DOI: 10.1002/ajh.27093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria. Patients infected during the most recent phases of the pandemic, though carrying a higher comorbidity burden, were less often hospitalized, rarely needed intensive care unit admission, or died compared to patients infected during the initial phases. The 4-month overall survival (OS) improved through the phases, from 68% to 83%, p = .0015. Age, comorbidity, CLL-directed treatment, but not vaccination status, emerged as risk factors for mortality. Among survivors, 6.65% patients had a reinfection, usually milder than the initial one, and 16.5% developed post-COVID condition. The latter was characterized by fatigue, dyspnea, lasting cough, and impaired concentration. Infection severity was the only risk factor for developing post-COVID. The median time to resolution of the post-COVID condition was 4.7 months. OS in patients with CLL improved during the different phases of the pandemic, likely due to the improvement of prophylactic and therapeutic measures against SARS-CoV-2 as well as the emergence of milder variants. However, mortality remained relevant and a significant number of patients developed post-COVID conditions, warranting further investigations.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
| | - Anargyros Kapetanakis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Georgios Karakatsoulis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Eva Minga
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitra Chamou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - David Allsup
- Centre for Biomedicine, Hull York Medical School, Hull, UK
| | - Alejandro Alonso Cabrero
- Spanish Society of Hematology and Hemotherapy (SEHH: Sociedad Española de Hematología y hemoterapia), Madrid, Spain
- Hematology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Martin Andres
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Darko Antic
- University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mónica Baile
- Hospital Clinico Universitario de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Clinical Genetics, Uppsala University Hospital, Uppsala, Sweden
| | | | | | - Sofia Chatzileontiadou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Raul Cordoba
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Azienda Ospedaliero-Universitaria Maggiore della Carità Novara, Novara, Italy
| | | | | | - Maria Dimou
- 1st Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Michael Doubek
- Department of Internal Medicine-Hematology and Oncology, University Hospital, Brno, Czech Republic
- Faculty of Medicine, Department of Medical Genetics and Genomics, Masaryk University, Brno, Czech Republic
| | - Maria Efstathopoulou
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Salma Elashwah
- Medical Oncology Unit, Faculty of Medicine, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | | | | | - Lucia Farina
- Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | | | - Moritz Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - José A García-Marco
- Hematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Rocío García-Serra
- Department of Hematology, Hospital General Universitario, Valencia, Spain
- Fundaci_on de Investigaci_on del Hospital General Universitario, Valencia, Spain
| | - Rosa Collado
- Department of Hematology, Hospital General Universitario, Valencia, Spain
| | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Andreas Glenthøj
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tobias Herold
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, Munich, Germany
| | - Idanna Innocenti
- Hematology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gilad Itchaki
- Meir Medical Center, Kfar-Saba, Israel
- The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Ann Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Оlga B Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Sabina Kersting
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jorge Labrador
- Hematology Department, Unit Research, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Luca Laurenti
- Hematology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Enrico Lista
- Department of Hematology, Santa Chiara Hospital, Trento, Italy
| | - Alberto Lopez-Garcia
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Lara Malerba
- Hematology and Stem Cell Transplant Center, Marche Nord Hospital, Pesaro, Italy
| | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio E., Modena, Italy
| | - Monia Marchetti
- Hematology Unit and BM Transplant Center, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Juan Marquet
- Hematology Department, Ram_on y Cajal University Hospital, Madrid, Spain
| | - Mattias Mattsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Francesca R Mauro
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland
- Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Marina Motta
- S.C. Ematologia, ASST Spedali Civili Brescia, Brescia, Italy
| | - Talha Munir
- Consultant Haematologist, St James's Hospital, Leeds, UK
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Carsten U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jacopo Olivieri
- Hematology Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Lorella Orsucci
- S.C. Ematologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | | | - Inga Piskunova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia
| | - Viola Maria Popov
- HematologyDepartment, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Giulia Quaresmini
- Department of Oncology and Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | - Kristian Qvist
- Hematologic Section, Department of Internal Medicine, Hospital Union West, Herning, Denmark
| | | | - Rosa Ruchlemer
- Department of Hematology, Shaare-Zedek Medical Center, Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - Martin Šimkovič
- Faculty of Medicine in Hradec Králové, 4th Department of Internal Medicine-Haematology, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic
| | - Martin Špaček
- First Faculty of Medicine, 1st Department of Medicine-Hematology, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, University of Perugia, Perugia, Italy
| | - Oana Stanca
- Hematology Department, Coltea Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Tamar Tadmor
- Division of Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Giovanni Del Poeta
- Department of Biomedicine and Prevention Hematology, University Tor Vergata, Rome, Italy
| | - Odit Gutwein
- Department of Hematology, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ivana Milosevic
- Faculty of Medicine, Clinical Centre of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Mirás
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Amit Shrestha
- Hematology Unit, Nepal Cancer Hospital & Research Centre, Lalitpur, Nepal
| | - Doreen Te Raa
- Department of Hematology, Gelderse Vallei Ede, Ede, the Netherlands
| | - Sanne H Tonino
- Department of Hematology, Lymmcare, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen Van Der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel van Gelder
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Ewa Wasik-Szczepanek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Tomasz Wróbel
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Lucrecia Yáñez San Segundo
- Hematology Department, University Hospital and Research Institute of Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | | | | | - Sunil Iyengar
- Haemato-oncology Unit, The Royal Marsden Hospital, UK
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Candida Vitale
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marta Coscia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rambaldi
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, University of Perugia, Perugia, Italy
| | | | | | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
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Vitale C, Griggio V, Perutelli F, Coscia M. CAR-modified Cellular Therapies in Chronic Lymphocytic Leukemia: Is the Uphill Road Getting Less Steep? Hemasphere 2023; 7:e988. [PMID: 38044959 PMCID: PMC10691795 DOI: 10.1097/hs9.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
The clinical development of chimeric antigen receptor (CAR) T-cell therapy has been more challenging for chronic lymphocytic leukemia (CLL) compared to other settings. One of the main reasons is the CLL-associated state of immune dysfunction that specifically involves patient-derived T cells. Here, we provide an overview of the clinical results obtained with CAR T-cell therapy in CLL, describing the identified immunologic reasons for the inferior efficacy. Novel CAR T-cell formulations, such as lisocabtagene maraleucel, administered alone or in combination with the Bruton tyrosine kinase inhibitor ibrutinib, are currently under investigation. These approaches are based on the rationale that improving the quality of the T-cell source and of the CAR T-cell product may deliver a more functional therapeutic weapon. Further strategies to boost the efficacy of CAR T cells should rely not only on the production of CAR T cells with an improved cellular composition but also on additional changes. Such alterations could include (1) the coadministration of immunomodulatory agents capable of counteracting CLL-related immunological alterations, (2) the design of improved CAR constructs (such as third- and fourth-generation CARs), (3) the incorporation into the manufacturing process of immunomodulatory compounds overcoming the T-cell defects, and (4) the use of allogeneic CAR T cells or alternative CAR-modified cellular vectors. These strategies may allow to develop more effective CAR-modified cellular therapies capable of counteracting the more aggressive and still incurable forms of CLL.
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Affiliation(s)
- Candida Vitale
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
| | - Valentina Griggio
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
| | - Francesca Perutelli
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
| | - Marta Coscia
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
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Chatzikonstantinou T, Scarfò L, Karakatsoulis G, Minga E, Chamou D, Iacoboni G, Kotaskova J, Demosthenous C, Smolej L, Mulligan S, Alcoceba M, Al-Shemari S, Aurran-Schleinitz T, Bacchiarri F, Bellido M, Bijou F, Calleja A, Medina A, Khan MA, Cassin R, Chatzileontiadou S, Collado R, Christian A, Davis Z, Dimou M, Donaldson D, Santos GD, Dreta B, Efstathopoulou M, El-Ashwah S, Enrico A, Fresa A, Galimberti S, Galitzia A, García-Serra R, Gimeno E, González-Gascón-y-Marín I, Gozzetti A, Guarente V, Guieze R, Gogia A, Gupta R, Harrop S, Hatzimichael E, Herishanu Y, Hernández-Rivas JÁ, Inchiappa L, Jaksic O, Janssen S, Kalicińska E, Kamel L, Karakus V, Kater AP, Kho B, Kislova M, Konstantinou E, Koren-Michowitz M, Kotsianidis I, Kreitman RJ, Labrador J, Lad D, Levin MD, Levy I, Longval T, Lopez-Garcia A, Marquet J, Martin-Rodríguez L, Maynadié M, Maslejova S, Mayor-Bastida C, Mihaljevic B, Milosevic I, Miras F, Moia R, Morawska M, Murru R, Nath UK, Navarro-Bailón A, Oliveira AC, Olivieri J, Oscier D, Panovska-Stavridis I, Papaioannou M, Papajík T, Kubova Z, Phumphukhieo P, Pierie C, Puiggros A, Rani L, Reda G, Rigolin GM, Ruchlemer R, Daniel de Deus Santos M, Schipani M, Schiwitza A, Shen Y, Simkovic M, Smirnova S, Abdelrahman Soliman DS, Spacek M, Tadmor T, Tomic K, Tse E, Vassilakopoulos T, Visentin A, Vitale C, von Tresckow J, Vrachiolias G, Vukovic V, Walewska R, Wasik-Szczepanek E, Xu Z, Yagci M, Yañez L, Yassin M, Zuchnicka J, Angelopoulou M, Antic D, Biderman B, Catherwood M, Claus R, Coscia M, Cuneo A, Demirkan F, Espinet B, Gaidano G, Kalashnikova OB, Laurenti L, Nikitin E, Pangalis GA, Panagiotidis P, Popov VM, Pospisilova S, Sportoletti P, Stavroyianni N, Tam C, Trentin L, Chatzidimitriou A, Bosch F, Doubek M, Ghia P, Stamatopoulos K. Other malignancies in the history of CLL: an international multicenter study conducted by ERIC, the European Research Initiative on CLL, in HARMONY. EClinicalMedicine 2023; 65:102307. [PMID: 38033506 PMCID: PMC10685149 DOI: 10.1016/j.eclinm.2023.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Patients with chronic lymphocytic leukemia (CLL) have a higher risk of developing other malignancies (OMs) compared to the general population. However, the impact of CLL-related risk factors and CLL-directed treatment is still unclear and represents the focus of this work. Methods We conducted a retrospective international multicenter study to assess the incidence of OMs and detect potential risk factors in 19,705 patients with CLL, small lymphocytic lymphoma, or high-count CLL-like monoclonal B-cell lymphocytosis, diagnosed between 2000 and 2016. Data collection took place between October 2020 and March 2022. Findings In 129,254 years of follow-up after CLL diagnosis, 3513 OMs were diagnosed (27.2 OMs/1000 person-years). The most common hematological OMs were Richter transformation, myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Non-melanoma skin (NMSC) and prostate cancers were the most common solid tumors (STs).The only predictor for MDS and AML development was treatment with fludarabine and cyclophosphamide with/without rituximab (FC ± R) (OR = 3.7; 95% CI = 2.79-4.91; p < 0.001). STs were more frequent in males and patients with unmutated immunoglobulin heavy variable genes (OR = 1.77; 95% CI = 1.49-2.11; p < 0.001/OR = 1.89; 95% CI = 1.6-2.24; p < 0.001).CLL-directed treatment was associated with non-melanoma skin and prostate cancers (OR = 1.8; 95% CI = 1.36-2.41; p < 0.001/OR = 2.11; 95% CI = 1.12-3.97; p = 0.021). In contrast, breast cancers were more frequent in untreated patients (OR = 0.17; 95% CI = 0.08-0.33; p < 0.001).Patients with CLL and an OM had inferior overall survival (OS) than those without. AML and MDS conferred the worst OS (p < 0.001). Interpretation OMs in CLL impact on OS. Treatment for CLL increased the risk for AML/MDS, prostate cancer, and NMSC. FCR was associated with increased risk for AML/MDS. Funding AbbVie, and EU/EFPIAInnovative Medicines Initiative Joint Undertaking HARMONY grant n° 116026.
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Affiliation(s)
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Georgios Karakatsoulis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Eva Minga
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitra Chamou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Gloria Iacoboni
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Jana Kotaskova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Lukas Smolej
- 4th Department of Internal Medicine-Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | | | - Miguel Alcoceba
- Department of Haematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC (CB16/12/00233) and Cancer Research Centre (CIC-IBMCC, USAL-CSIC), Salamanca, Spain
| | - Salem Al-Shemari
- Faculty of Medicine, Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | | | - Mar Bellido
- Hematology Department, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Anne Calleja
- Department of Hemato-Oncology, Institut Paoli Calmettes, Marseille, France
| | | | - Mehreen Ali Khan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Ramona Cassin
- Hematology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Sofia Chatzileontiadou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Rosa Collado
- Servicio de Hematología, Consorcio Hospital General Universitario de Valencia, Fundación de Investigación Hospital General Universitario de Valencia, Valencia, Spain
| | - Amy Christian
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Zadie Davis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Maria Dimou
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - David Donaldson
- Clinical Haematology, Belfast City Hospital, Belfast, United Kingdom
| | | | - Barbara Dreta
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maria Efstathopoulou
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | | | | | - Alberto Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Galitzia
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Rocío García-Serra
- Servicio de Hematología, Consorcio Hospital General Universitario de Valencia, Fundación de Investigación Hospital General Universitario de Valencia, Valencia, Spain
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | | | | | - Valerio Guarente
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Romain Guieze
- Department of Hematology and Cell Therapy, Estaing University Hospital, Clermont-Ferrand, France
| | - Ajay Gogia
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritu Gupta
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sean Harrop
- Peter MacCallum Cancer Centre, St Vincent's Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Eleftheria Hatzimichael
- Faculty of Medicine, Department of Haematology, School of Health Sciences, University of Ioannina, Stavros Niarchos Avenue, Ioannina 45110, Greece
| | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Luca Inchiappa
- Department of Hemato-Oncology, Institut Paoli Calmettes, Marseille, France
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Susanne Janssen
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Laribi Kamel
- Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Arnon P. Kater
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Bonnie Kho
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
| | - Maria Kislova
- Department of Hematology, Oncology, and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | | | - Maya Koren-Michowitz
- Department of Hematology, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Robert J. Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jorge Labrador
- Department of Hematology, Hospital Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ilana Levy
- Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | - Thomas Longval
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Alberto Lopez-Garcia
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Juan Marquet
- Hematology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Lucia Martin-Rodríguez
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Marc Maynadié
- Biological Haematology Department, Dijon Bourgogne University Hospital, Haematological Malignancies Registry, LNC UMR 1231, Dijon 21000, France
| | - Stanislava Maslejova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Biljana Mihaljevic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milosevic
- Faculty of Medicine, Clinical Centre of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Miras
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland
- Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Uttam Kumar Nath
- Department of Medical Oncology & Hematology, All India Institute of Medical Sciences, Rishikesh, India
| | - Almudena Navarro-Bailón
- Department of Haematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC (CB16/12/00233) and Cancer Research Centre (CIC-IBMCC, USAL-CSIC), Salamanca, Spain
| | - Ana C. Oliveira
- Department of Clinical Hematology, ICO, Hospital Duran i Reynals, IDIBELL, Barcelona, Spain
| | | | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Irina Panovska-Stavridis
- Medical Faculty, University Clinic of Hematology, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Tomas Papajík
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Zuzana Kubova
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Cheyenne Pierie
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Anna Puiggros
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar and Translational Research on Hematological Neoplasms Group, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lata Rani
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Rosa Ruchlemer
- Department of Hematology, Shaare-Zedek Medical Center, Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | | | - Mattia Schipani
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Annett Schiwitza
- Hematology and Oncology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Yandong Shen
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Martin Simkovic
- 4th Department of Internal Medicine-Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Svetlana Smirnova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Medical Research Center for Hematology, Moscow, Russia
| | | | - Martin Spacek
- First Faculty of Medicine, 1st Department of Medicine - Hematology, Charles University and General Hospital in Prague, Czech Republic
| | - Tamar Tadmor
- Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | - Kristina Tomic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Eric Tse
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Julia von Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - George Vrachiolias
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vojin Vukovic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Renata Walewska
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Ewa Wasik-Szczepanek
- Dept. Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Zhenshu Xu
- Fujian Provincial Key Laboratory of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Munci Yagci
- Gazi University Medical Faculty, Ankara, Turkey
| | - Lucrecia Yañez
- Department of Hematology, University Hospital Marqués de Valdecilla, Santander, Spain
- Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | - Jana Zuchnicka
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Maria Angelopoulou
- Haematology, University of Athens, Laikon General Hospital, Athens, Greece
| | - Darko Antic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bella Biderman
- Department of Molecular Hematology, National Medical Research Center for Hematology, Moscow, Russia
| | - Mark Catherwood
- Clinical Haematology, Belfast City Hospital, Belfast, United Kingdom
| | - Rainer Claus
- Pathology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
- Faculty of Medicine, Comprehensive Cancer Center Augsburg, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | | | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Blanca Espinet
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar and Translational Research on Hematological Neoplasms Group, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Olga B. Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eugene Nikitin
- Department of Hematology, Oncology, and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | | | - Panagiotis Panagiotidis
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Viola Maria Popov
- Hematology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Sarka Pospisilova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Sportoletti
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Constantine Tam
- Peter MacCallum Cancer Centre, St Vincent's Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Francesc Bosch
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Michael Doubek
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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18
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Doukas PG, St. Pierre F, Karmali R, Mi X, Boyer J, Nieves M, Ison MG, Winter JN, Gordon LI, Ma S. Humoral Immunity After COVID-19 Vaccination in Chronic Lymphocytic Leukemia and Other Indolent Lymphomas: A Single-Center Observational Study. Oncologist 2023; 28:e930-e941. [PMID: 37141401 PMCID: PMC10546828 DOI: 10.1093/oncolo/oyad121] [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: 11/03/2022] [Accepted: 04/06/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) and other non-Hodgkin's lymphomas (NHLs) lead to broad immunosuppression, conferring a greater risk for morbidity and mortality from SARS-CoV-2. Our study analyzed antibody (Ab) seropositivity from SARS-CoV-2 vaccination in patients with these cancers. METHODS In the final analysis, 240 patients were involved, and seropositivity was defined as a positive total or spike protein Ab. RESULTS Seropositivity was 50% in CLL, 68% in WM, and 70% in the remaining NHLs. Moderna vaccination led to higher seropositivity compared to Pfizer vaccination across all cancers (64% vs. 49%; P = .022) and specifically CLL patients (59% vs. 43%; P = .029). This difference was not explainable by differences in treatment status or prior anti-CD20 monoclonal Ab therapy. In CLL patients, current or prior cancer therapy led to lower seropositivity compared to treatment-naïve patients (36% vs. 68%; P = .000019). CLL patients treated with Bruton's tyrosine kinase (BTK) inhibitors had better seropositivity after receiving the Moderna vaccination compared to Pfizer (50% vs. 23%; P = .015). Across all cancers, anti-CD20 agents within 1 year led to a lower Ab response compared to greater than one year (13% vs. 40%; P = .022), a difference which persisted after booster vaccination. CONCLUSION Antibody response is lower in patients with indolent lymphomas compared to the general population. Lower Ab seropositivity was found in patients with a history of anti-leukemic agent therapy or those immunized with Pfizer vaccine. This data suggests that Moderna vaccination may confer a greater degree of immunity against SARS-CoV-2 in patients with indolent lymphomas.
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Affiliation(s)
- Peter G Doukas
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Frederique St. Pierre
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Xinlei Mi
- Department of Preventive Medicine and Biostatistics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Boyer
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Mariana Nieves
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Jane N Winter
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Leo I Gordon
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Shuo Ma
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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19
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Brady MT, Laniewski N, Strawderman M, Chu CC, Kanagaiah P, Sangster MY, Topham DJ, Friedberg JW, Zent CS. Long-term results of vaccination with adjuvanted recombinant varicella zoster glycoprotein E during initial Bruton tyrosine kinase inhibitors therapy for chronic lymphocytic leukemia or lymphoplasmacytic lymphoma. Am J Hematol 2023; 98:E288-E290. [PMID: 37483138 DOI: 10.1002/ajh.27038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Michael T Brady
- Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Nathan Laniewski
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - Myla Strawderman
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Charles C Chu
- Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Preshetha Kanagaiah
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - Mark Y Sangster
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - David J Topham
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jonathan W Friedberg
- Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Clive S Zent
- Wilmot Cancer Institute and Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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20
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Fisher JG, Doyle ADP, Graham LV, Sonar S, Sale B, Henderson I, Del Rio L, Johnson PWM, Landesman Y, Cragg MS, Forconi F, Walker CJ, Khakoo SI, Blunt MD. XPO1 inhibition sensitises CLL cells to NK cell mediated cytotoxicity and overcomes HLA-E expression. Leukemia 2023; 37:2036-2049. [PMID: 37528310 PMCID: PMC10539165 DOI: 10.1038/s41375-023-01984-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: 03/09/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023]
Abstract
The first-in-class inhibitor of exportin-1 (XPO1) selinexor is currently under clinical investigation in combination with the BTK inhibitor ibrutinib for patients with chronic lymphocytic leukaemia (CLL) or non-Hodgkin lymphoma. Selinexor induces apoptosis of tumour cells through nuclear retention of tumour suppressor proteins and has also recently been described to modulate natural killer (NK) cell and T cell cytotoxicity against lymphoma cells. Here, we demonstrate that XPO1 inhibition enhances NK cell effector function against primary CLL cells via downregulation of HLA-E and upregulation of TRAIL death receptors DR4 and DR5. Furthermore, selinexor potentiates NK cell activation against CLL cells in combination with several approved treatments; acalabrutinib, rituximab and obinutuzumab. We further demonstrate that lymph node associated signals (IL-4 + CD40L) inhibit NK cell activation against CLL cells via upregulation of HLA-E, and that inhibition of XPO1 can overcome this protective effect. These findings allow for the design of more efficacious combination strategies to harness NK cell effector functions against CLL.
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Affiliation(s)
- Jack G Fisher
- School of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Amber D P Doyle
- School of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Lara V Graham
- School of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Shreyanshi Sonar
- School of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Ben Sale
- School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Isla Henderson
- School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Luis Del Rio
- School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Peter W M Johnson
- School of Cancer Sciences, University of Southampton, Southampton, UK
| | | | - Mark S Cragg
- School of Cancer Sciences, University of Southampton, Southampton, UK
- Antibody and Vaccine Group, Centre for Cancer Immunology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Francesco Forconi
- School of Cancer Sciences, University of Southampton, Southampton, UK
- Haematology Department, Cancer Care Directorate, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Salim I Khakoo
- School of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Matthew D Blunt
- School of Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
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21
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Moreno C, Solman IG, Tam CS, Grigg A, Scarfò L, Kipps TJ, Srinivasan S, Mali RS, Zhou C, Dean JP, Szafer-Glusman E, Choi M. Immune restoration with ibrutinib plus venetoclax in first-line chronic lymphocytic leukemia: the phase 2 CAPTIVATE study. Blood Adv 2023; 7:5294-5303. [PMID: 37315225 PMCID: PMC10506056 DOI: 10.1182/bloodadvances.2023010236] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
We evaluated immune cell subsets in patients with chronic lymphocytic leukemia (CLL) who received first-line therapy with 3 cycles of ibrutinib then 13 cycles of ibrutinib plus venetoclax in the minimal residual disease (MRD) cohort of the CAPTIVATE study (NCT02910583). Patients with Confirmed undetectable MRD (uMRD) were randomly assigned to placebo or ibrutinib groups; patients without Confirmed uMRD were randomly assigned to ibrutinib or ibrutinib plus venetoclax groups. We compared immune cell subsets in samples collected at 7 time points with age-matched healthy donors. CLL cells decreased within 3 cycles after venetoclax initiation; from cycle 16 onward, levels were similar to healthy donor levels (HDL; ≤0.8 cells per μL) in patients with Confirmed uMRD and slightly above HDL in patients without Confirmed uMRD. By 4 months after cycle 16, normal B cells had recovered to HDL in patients randomly assigned to placebo. Regardless of randomized treatment, abnormal counts of T cells, classical monocytes, and conventional dendritic cells recovered to HDL within 6 months (median change from baseline -49%, +101%, and +91%, respectively); plasmacytoid dendritic cells recovered by cycle 20 (+598%). Infections generally decreased over time regardless of randomized treatment and were numerically lowest in patients randomly assigned to placebo within 12 months after cycle 16. Sustained elimination of CLL cells and recovery of normal B cells were confirmed in samples from patients treated with fixed-duration ibrutinib plus venetoclax in the GLOW study (NCT03462719). These results demonstrate promising evidence of restoration of normal blood immune composition with ibrutinib plus venetoclax.
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Affiliation(s)
- Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | - Constantine S. Tam
- Department of Hematology, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | | | - Lydia Scarfò
- Division of Experimental Oncology, Università Vita Salute San Raffaele and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Thomas J. Kipps
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | | | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - James P. Dean
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | | | - Michael Choi
- University of California San Diego, La Jolla, CA
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22
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Maggioni G, Fedrigo M, Visentin A, Carturan E, Ruocco V, Trentin L, Alaibac M, Angelini A. Severe Fatal Mucormycosis in a Patient with Chronic Lymphocytic Leukaemia Treated with Zanubrutinib: A Case Report and Review of the Literature. Curr Oncol 2023; 30:8255-8265. [PMID: 37754514 PMCID: PMC10529318 DOI: 10.3390/curroncol30090599] [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: 07/26/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
Severe mucormycosis is a fatal disease rarely complicating chronic lymphoproliferative disorders. We present a fulminant and fatal case of a 74-year-old Caucasian woman suffering from CLL treated with second-generation BTK inhibitor zanubrutinib. After a first septic episode a month prior, originating from the lung with later systemic involvement by an unidentified agent and treated with large-spectrum antibiotics and fluconazonle, a slow-onset enlarging tender warm and erythematous nodular swollen cutaneous lesion appeared in her lower limbs and spread subsequently to her upper limbs, progressing towards central ulceration with a necrotic core. Suspecting a mycotic dissemination from an unknown agent, a skin punch biopsy was performed, and intraconazole was started. Due to spread of the skin lesions, the patient was hospitalized and intravenous liposomal ampthotericin B was started. Histopathology showed an atypical sporangium-rich mycotic angioinvasion of the small vessels. Only the increase of BDG and GM could corroborate the hypothesis of mycotic infection. However, long-term CLL, immunosuppressive therapies, neutropenia, and prior use of azoles and other antimycotic agents were risk factors for mucormycosis; BTK inhibitor could also be added as another novel risk factor. Despite all therapeutic efforts, the patient died. Post-mortem molecular exams confirmed the diagnosis of disseminated mucormycosis.
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Affiliation(s)
- Giuseppe Maggioni
- Pathology Unit, Department of Medicine, University of Padova, Via A. Gabelli 61, 35121 Padova, Italy
| | - Marny Fedrigo
- Cardiovascular Pathology Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Andrea Visentin
- Hematology Unit, Department of Medicine, University of Padova, Via N. Giustiniani 2, 35128 Padova, Italy
| | - Elisa Carturan
- Cardiovascular Pathology Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Valeria Ruocco
- Hematology Unit, Department of Medicine, University of Padova, Via N. Giustiniani 2, 35128 Padova, Italy
| | - Livio Trentin
- Hematology Unit, Department of Medicine, University of Padova, Via N. Giustiniani 2, 35128 Padova, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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23
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Levy Yurkovski I, Tadmor T. Accelerated Chronic Lymphocytic Leukemia and Richter Transformation in the Era of Novel Agents. Acta Haematol 2023; 147:73-83. [PMID: 37666234 DOI: 10.1159/000533664] [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: 04/22/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Tremendous developments in the field of chronic lymphocytic leukemia (CLL) in recent years have led to a revolutionary change in the treatment approach, which today is based on targeted treatments with a good response and optimal prognosis. Nevertheless, CLL can present or progress to "accelerated CLL" (A-CLL) or to "Richter transformation" (RT) and these two entities have a more aggressive course and are still characterized by challenges in the fields of diagnosis and therapy. In the current review, we summarized the latest knowledge in terms of diagnostic approaches to A-CLL, available treatments and clinical trials, for both A-CLL and RT which still pose an unmet need and require additional basic and clinical investigations. SUMMARY A-CLL is a rare and underdiagnosed entity that probably stands in the "gray zone" between CLL and RT, generally holding an intermediate prognosis. Its diagnosis is mainly based on histological findings including expanded proliferation centers, increased mitotic activity, and/or high Ki-67 index. Due to its rarity, its treatment approach has still not been defined, but it seems that novel agents, especially Bruton tyrosine kinase inhibitors (BTKi), are effective. As for RT, the standard therapy still consists of chemo-immunotherapy followed by stem-cell transplantation for fit responders with a dismal prognosis. New approaches are recently adopted including B-cell inhibition via novel agents (BTKi, venetoclax), T-cell engagers (checkpoint inhibitors, bispecific antibodies [BiTe] or the chimeric antigen receptor [CAR] technology), antibody-drug conjugates, or drug combinations. Although both CAR-T and BiTe seem promising, especially when combined with BTKi, evidence is still insufficient, and patients should generally be recruited in clinical trials. KEY MESSAGES The field of CLL has been a subject of major advances in recent years, but A-CLL and RT remain topics of "unmet need" and require further studies to identify the best diagnostic approach and a more effective treatment.
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Affiliation(s)
- Ilana Levy Yurkovski
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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24
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Michelerio A, Tomasini C, Fiandrino G, De Amici M, Varettoni M, Defrancesco I, Cavalloni C, Brazzelli V, Derlino F, Paulli M, Arcaini L, Vassallo C. Eosinophilic dermatosis of hematologic malignancy in patients with chronic lymphocytic leukemia/non-Hodgkin's B lymphoma: a single center prospective clinico-pathological study. Front Med (Lausanne) 2023; 10:1231003. [PMID: 37614953 PMCID: PMC10442565 DOI: 10.3389/fmed.2023.1231003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Background The pathogenesis of eosinophilic dermatosis of hematologic malignancy (EDHM) is poorly understood. Previously thought to be a hypersensitivity reaction to insect bites, immune dysregulation and cytokine imbalance are now thought to be responsible. Its prognostic significance is unclear. Objective To describe the clinical, pathological and immunological findings in a series of oncohematological patients with EDHM. Methods An observational prospective cohort study of oncohematological patients receiving a diagnosis of EDHM between April 2017 and December 2018. Results A total of 15 patients with EDHM (10 females and 5 males) were identified among 422 oncohematological patients. Disease presentation varied from firm erythematous papules to more polymorphic presentations. The lesions were most prevalent on the exposed sites, 8/15 patients recalled an insect bite. Lesion seasonality was reported in 13/15 patients. IgE levels were elevated in six patients, circulating IL-4 and IL-5 were within a normal range. Twelve out of 15 patients developed skin manifestations after chemotherapy. The infiltrate could be eosinophil-rich or lymphocytic-rich. Interestingly, the histopathologic findings were in accordance with arthropod bites. Conclusion A role for insect bites in EDHM is supported by our findings. EDHM may be related to aggressive hematologic disease.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Tomasini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Fiandrino
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mara De Amici
- Laboratory of Immuno-Allergology of Clinical Chemistry and Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marzia Varettoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Irene Defrancesco
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cavalloni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Derlino
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Paulli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Vassallo
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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25
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Tariq B, Conto S, Cohen A, Sahasranaman S, Ou YC. A Phase 1, Open-Label, Fixed-Sequence, Drug-Drug Interaction Study of Zanubrutinib with Rifabutin in Healthy Volunteers. Clin Pharmacol Drug Dev 2023; 12:832-838. [PMID: 37145975 DOI: 10.1002/cpdd.1250] [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: 12/10/2022] [Accepted: 03/06/2023] [Indexed: 05/07/2023]
Abstract
Zanubrutinib is a second-generation Bruton tyrosine kinase inhibitor that is primarily metabolized by CYP3A enzymes. Previous drug-drug interaction (DDI) studies have demonstrated that co-administration of zanubrutinib with rifampin, a strong CYP3A inducer, reduces zanubrutinib plasma concentrations, potentially impacting activity. The impact of the co-administration of zanubrutinib with less potent CYP3A inducers is unclear. This phase 1, open-label, fixed-sequence DDI study evaluated the pharmacokinetics, safety, and tolerability of zanubrutinib when co-administered with steady-state rifabutin, a known CYP3A inducer less potent than rifampin, in 13 healthy male volunteers (NCT04470908). Co-administration of zanubrutinib with rifabutin resulted in a less than 2-fold reduction of zanubrutinib exposures. Overall, zanubrutinib was well tolerated. The results of this study provide useful information for the evaluation of the DDI between rifabutin and zanubrutinib. In conjunction with safety and efficacy data from other clinical studies, these results will be taken into consideration to determine the appropriate dose recommendation of zanubrutinib when co-administered with CYP3A inducers.
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Affiliation(s)
- Bilal Tariq
- Clinical Pharmacology, BeiGene USA, Inc., Fulton, Maryland, USA
| | - Stephanie Conto
- Clinical Operations, BeiGene USA, Inc., Cambridge, Massachusetts, USA
| | - Aileen Cohen
- BeiGene, Ltd. and BeiGene USA, Inc., San Mateo, California, USA
| | | | - Ying C Ou
- BeiGene, Ltd. and BeiGene USA, Inc., San Mateo, California, USA
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26
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Jeraiby MA. A Case of Chronic Lymphocytic Leukemia Coinciding With COVID-19. Cureus 2023; 15:e42522. [PMID: 37637550 PMCID: PMC10457498 DOI: 10.7759/cureus.42522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Comorbidities including leukemia are risk factors in coronavirus disease 2019 (COVID-19) patients for high morbidity and mortality. The severity of the disease is usually correlated with lymphopenia. On the other hand, we came across a case of marked absolute lymphocytosis in a COVID-19 patient, which further escalated five-fold during his hospital stay. Subsequently, the diagnosis of chronic lymphocytic leukemia (CLL) was made following positive cell surface markers for CD19+, CD5+, and CD20+ (dim), in the presence of restricted immunoglobulin light chain of lambda type on flow cytometry. Numerous cases are available in the literature of COVID-19 among established CLL patients. However, we are mentioning here the second case where the diagnosis of CLL was established accidentally during the work-up for lymphocytosis in COVID-19 infection.
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Affiliation(s)
- Mohammed A Jeraiby
- Department of Medical Biochemistry, Faculty of Medicine, Jazan University, Jazan, SAU
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27
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Yin X, Hu X, Tong H, You L. Trends in mortality from infection among patients with hematologic malignancies: differences according to hematologic malignancy subtype. Ther Adv Chronic Dis 2023; 14:20406223231173891. [PMID: 37360415 PMCID: PMC10288445 DOI: 10.1177/20406223231173891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background Infection is the most important cause of non-relapse mortality in hematologic malignancy patients, leading to increased costs and prolonged hospitalization times. However, comprehensive and comparable reports on infection-specific mortality (ISM) trends in hematologic malignancy patients are lacking. Objectives We aimed to provide updated ISM trends and factors associated with ISM among hematologic malignancy patients. Design This is a retrospective study. Methods Patients diagnosed with the five most common hematologic malignancies from 1983 to 2016 from the Surveillance, Epidemiology, and End Results database were included. Joinpoint regression was used to analyze mortality trends. Results ISM decreased beginning in 1983, 1988, and 1994, with yearly decreases of -2.1% for acute leukemia (AL), -1.3% for Hodgkin lymphoma (HL), and -14.3% for non-Hodgkin lymphoma (NHL). In contrast, ISM in patients with chronic leukemia (CL) and multiple myeloma (MM) increased dramatically beginning in 2000, with yearly increases of 2.8% and 3.3%, respectively. ISM rates were higher in males than in females across all hematologic malignancy subtypes. The mortality trends significantly differed according to race, age, sex, and stage, which could help in further etiological investigations. Moreover, male sex, older age at diagnosis, black race, and unmarried status were poor prognostic factors for ISM across all hematologic malignancy subtypes. Conclusion A promising downward trend in ISM in recent years occurred in patients with AL, HL, and NHL; however, ISM increased dramatically in patients with CL and MM. Our data suggest that risk assessment and careful infection monitoring are recommended for hematologic malignancy patients, particularly those with CL and MM.
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Affiliation(s)
- Xuejiao Yin
- Department of Hematology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, China
| | - Xuelian Hu
- Department of Hematology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital of Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou 310003, China
- Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, China
| | - Liangshun You
- Department of Hematology, The First Affiliated Hospital of Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou 310003, China
- Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, China
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28
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Wang J, Nakato R. Comprehensive multiomics analyses reveal pervasive involvement of aberrant cohesin binding in transcriptional and chromosomal disorder of cancer cells. iScience 2023; 26:106908. [PMID: 37283809 PMCID: PMC10239702 DOI: 10.1016/j.isci.2023.106908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/27/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
Chromatin organization, whose malfunction causes various diseases including cancer, is fundamentally controlled by cohesin. While cancer cells have been found with mutated or misexpressed cohesin genes, there is no comprehensive survey about the presence and role of abnormal cohesin binding in cancer cells. Here, we systematically identified ∼1% of cohesin-binding sites (701-2,633) as cancer-aberrant binding sites of cohesin (CASs). We integrated CASs with large-scale transcriptomics, epigenomics, 3D genomics, and clinical information. CASs represent tissue-specific epigenomic signatures enriched for cancer-dysregulated genes with functional and clinical significance. CASs exhibited alterations in chromatin compartments, loops within topologically associated domains, and cis-regulatory elements, indicating that CASs induce dysregulated genes through misguided chromatin structure. Cohesin depletion data suggested that cohesin binding at CASs actively regulates cancer-dysregulated genes. Overall, our comprehensive investigation suggests that aberrant cohesin binding is an essential epigenomic signature responsible for dysregulated chromatin structure and transcription in cancer cells.
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Affiliation(s)
- Jiankang Wang
- School of Biomedical Sciences, Hunan University, Changsha, China
- Institute for Quantitative Biosciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryuichiro Nakato
- Institute for Quantitative Biosciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Van Not OJ, van den Eertwegh AJM, Haanen JB, van Rijn RS, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Boers-Sonderen MJ, van Eijs MJM, de Groot JWB, Hospers GAP, Kapiteijn E, de Meza M, Piersma D, Stevense-den Boer M, van der Veldt AAM, Vreugdenhil G, Wouters MWJM, Suijkerbuijk KPM, Blokx WAM. Response to checkpoint inhibition and targeted therapy in melanoma patients with concurrent haematological malignancies. Eur J Cancer 2023; 186:27-37. [PMID: 37023588 DOI: 10.1016/j.ejca.2023.03.009] [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: 01/12/2023] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Patients diagnosed with haematologic malignancies (HMs) have a higher risk of developing subsequent solid tumours, such as melanoma. Patients with HM were mostly excluded from clinical trials but potentially derive less benefit from immune checkpoint inhibitors (ICIs) due to disease- or treatment-related T- or B-cell dysfunction. METHODS All advanced melanoma patients treated with anti-PD-1-based treatment or targeted therapy between 2015 and 2021 were included from the prospective nationwide Dutch Melanoma Treatment Registry. Progression-free survival (PFS) and melanoma-specific survival (MSS) were analysed for patients with HM (HM+) and without HM (HM-). A cox model was used to account for confounders associated with PFS and MSS. RESULTS In total, 4638 advanced melanoma patients received first-line anti-PD-1 monotherapy (n = 1763), ipilimumab-nivolumab (n = 800), or BRAF(/MEK) inhibitors (n = 2075). Concurrent HMs were present for 46 anti-PD1-treated patients, 11 ipilimumab-nivolumab-treated patients and 43 BRAF(/MEK)-inhibitor-treated patients. In anti-PD-1-treated patients, the median PFS was 2.8 months for HM+ and 9.9 months for HM- (p = 0.01). MSS was 41.2 months for HM+ and 58.1 months for HM- (p = 0.00086). In multivariable analysis, the presence of an HM was significantly associated with higher risk of melanoma progression (HRadj 1.62; 95% confidence interval [95% CI] 1.15-2.29; p = 0.006) and melanoma-related death (HRadj 1.74; 95% CI 1.09-2.78; p = 0.020). Median PFS and MSS for first-line BRAF(/MEK-) inhibitor-treated HM+ and HM- patients were not significantly different. CONCLUSIONS Patients with HM and advanced melanoma show significantly worse melanoma-related outcomes when treated with ICI, but not targeted therapy, compared to patients without HM. Clinicians should be aware of potentially altered effectiveness of ICI in patients with active HM.
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Affiliation(s)
- Olivier J Van Not
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden 2333AA, The Netherlands; Department of Medical Oncology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands.
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1118, Amsterdam 1081HZ, The Netherlands
| | - John B Haanen
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden 8934AD, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | | | - Christian U Blank
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands; Department of Medical Oncology & Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen 6525GA, The Netherlands
| | - Mick J M van Eijs
- Department of Medical Oncology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands; Center for Translational Immunology, University Medical Centre Utrecht, Lundlaan 6, Utrecht 3584EA, The Netherlands
| | | | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, Groningen 9713GZ, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333ZA, The Netherlands
| | - Melissa de Meza
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden 2333AA, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Centre, Einthovenweg 20, Leiden 2333ZC, The Netherlands; Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Koningsplein 1, Enschede 7512KZ, The Netherlands
| | | | - Astrid A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Centre, 's-Gravendijkwal 230, Rotterdam 3015CE, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, De Run 4600, Eindhoven 5504DB, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden 2333AA, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Centre, Einthovenweg 20, Leiden 2333ZC, The Netherlands; Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands
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Qin K, Honjo K, Sherrill-Mix S, Liu W, Stoltz RM, Oman AK, Hall LA, Li R, Sterrett S, Frederick ER, Lancaster JR, Narkhede M, Mehta A, Ogunsile FJ, Patel RB, Ketas TJ, Cruz Portillo VM, Cupo A, Larimer BM, Bansal A, Goepfert PA, Hahn BH, Davis RS. Exposure of progressive immune dysfunction by SARS-CoV-2 mRNA vaccination in patients with chronic lymphocytic leukemia: A prospective cohort study. PLoS Med 2023; 20:e1004157. [PMID: 37384638 PMCID: PMC10309642 DOI: 10.1371/journal.pmed.1004157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) have reduced seroconversion rates and lower binding antibody (Ab) and neutralizing antibody (NAb) titers than healthy individuals following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccination. Here, we dissected vaccine-mediated humoral and cellular responses to understand the mechanisms underlying CLL-induced immune dysfunction. METHODS AND FINDINGS We performed a prospective observational study in SARS-CoV-2 infection-naïve CLL patients (n = 95) and healthy controls (n = 30) who were vaccinated between December 2020 and June 2021. Sixty-one CLL patients and 27 healthy controls received 2 doses of the Pfizer-BioNTech BNT162b2 vaccine, while 34 CLL patients and 3 healthy controls received 2 doses of the Moderna mRNA-1273 vaccine. The median time to analysis was 38 days (IQR, 27 to 83) for CLL patients and 36 days (IQR, 28 to 57) for healthy controls. Testing plasma samples for SARS-CoV-2 anti-spike and receptor-binding domain Abs by enzyme-linked immunosorbent assay (ELISA), we found that all healthy controls seroconverted to both antigens, while CLL patients had lower response rates (68% and 54%) as well as lower median titers (23-fold and 30-fold; both p < 0.001). Similarly, NAb responses against the then prevalent D614G and Delta SARS-CoV-2 variants were detected in 97% and 93% of controls, respectively, but in only 42% and 38% of CLL patients, who also exhibited >23-fold and >17-fold lower median NAb titers (both p < 0.001). Interestingly, 26% of CLL patients failed to develop NAbs but had high-titer binding Abs that preferentially reacted with the S2 subunit of the SARS-CoV-2 spike. Since these patients were also seropositive for endemic human coronaviruses (HCoVs), these responses likely reflect cross-reactive HCoV Abs rather than vaccine-induced de novo responses. CLL disease status, advanced Rai stage (III-IV), elevated serum beta-2 microglobulin levels (β2m >2.4 mg/L), prior therapy, anti-CD20 immunotherapy (<12 months), and intravenous immunoglobulin (IVIg) prophylaxis were all predictive of an inability to mount SARS-CoV-2 NAbs (all p ≤ 0.03). T cell response rates determined for a subset of participants were 2.8-fold lower for CLL patients compared to healthy controls (0.05, 95% CI 0.01 to 0.27, p < 0.001), with reduced intracellular IFNγ staining (p = 0.03) and effector polyfunctionality (p < 0.001) observed in CD4+ but not in CD8+ T cells. Surprisingly, in treatment-naïve CLL patients, BNT162b2 vaccination was identified as an independent negative risk factor for NAb generation (5.8, 95% CI 1.6 to 27, p = 0.006). CLL patients who received mRNA-1273 had 12-fold higher (p < 0.001) NAb titers and 1.7-fold higher (6.5, 95% CI 1.3 to 32, p = 0.02) response rates than BNT162b2 vaccinees despite similar disease characteristics. The absence of detectable NAbs in CLL patients was associated with reduced naïve CD4+ T cells (p = 0.03) and increased CD8+ effector memory T cells (p = 0.006). Limitations of the study were that not all participants were subjected to the same immune analyses and that pre-vaccination samples were not available. CONCLUSIONS CLL pathogenesis is characterized by a progressive loss of adaptive immune functions, including in most treatment-naïve patients, with preexisting memory being preserved longer than the capacity to mount responses to new antigens. In addition, higher NAb titers and response rates identify mRNA-1273 as a superior vaccine for CLL patients.
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Affiliation(s)
- Kai Qin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kazuhito Honjo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Scott Sherrill-Mix
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Weimin Liu
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Regina M. Stoltz
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Allisa K. Oman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lucinda A. Hall
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ran Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Sarah Sterrett
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ellen R. Frederick
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jeffrey R. Lancaster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mayur Narkhede
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amitkumar Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Foluso J. Ogunsile
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rima B. Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Thomas J. Ketas
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Victor M. Cruz Portillo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Albert Cupo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Benjamin M. Larimer
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Paul A. Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Beatrice H. Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Randall S. Davis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Coyne V, Mead HL, Mongini PKA, Barker BM. B Cell Chronic Lymphocytic Leukemia Development in Mice with Chronic Lung Exposure to Coccidioides Fungal Arthroconidia. Immunohorizons 2023; 7:333-352. [PMID: 37195872 PMCID: PMC10579974 DOI: 10.4049/immunohorizons.2300013] [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: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
Links between repeated microbial infections and B cell chronic lymphocytic leukemia (B-CLL) have been proposed but not tested directly. This study examines how prolonged exposure to a human fungal pathogen impacts B-CLL development in Eµ-hTCL1-transgenic mice. Monthly lung exposure to inactivated Coccidioides arthroconidia, agents of Valley fever, altered leukemia development in a species-specific manner, with Coccidioides posadasii hastening B-CLL diagnosis/progression in a fraction of mice and Coccidioides immitis delaying aggressive B-CLL development, despite fostering more rapid monoclonal B cell lymphocytosis. Overall survival did not differ significantly between control and C. posadasii-treated cohorts but was significantly extended in C. immitis-exposed mice. In vivo doubling time analyses of pooled B-CLL showed no difference in growth rates of early and late leukemias. However, within C. immitis-treated mice, B-CLL manifests longer doubling times, as compared with B-CLL in control or C. posadasii-treated mice, and/or evidence of clonal contraction over time. Through linear regression, positive relationships were noted between circulating levels of CD5+/B220low B cells and hematopoietic cells previously linked to B-CLL growth, albeit in a cohort-specific manner. Neutrophils were positively linked to accelerated growth in mice exposed to either Coccidioides species, but not in control mice. Conversely, only C. posadasii-exposed and control cohorts displayed positive links between CD5+/B220low B cell frequency and abundance of M2 anti-inflammatory monocytes and T cells. The current study provides evidence that chronic lung exposure to fungal arthroconidia affects B-CLL development in a manner dependent on fungal genotype. Correlative studies suggest that fungal species differences in the modulation of nonleukemic hematopoietic cells are involved.
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Affiliation(s)
- Vanessa Coyne
- Pathogen Microbiome Institute, Northern Arizona University, Flagstaff, AZ
| | - Heather L. Mead
- Pathogen Microbiome Institute, Northern Arizona University, Flagstaff, AZ
| | | | - Bridget M. Barker
- Pathogen Microbiome Institute, Northern Arizona University, Flagstaff, AZ
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Kättström M, Uggla B, Tina E, Kimby E, Norén T, Athlin S. Improved plasmablast response after repeated pneumococcal revaccinations following primary immunization with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia. Vaccine 2023; 41:3128-3136. [PMID: 37061372 DOI: 10.1016/j.vaccine.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) show an immune dysfunction with increased risk of infections and poor response to vaccination. Streptococcus pneumoniae is a common cause of morbidity and mortality in CLL patients. In a previous randomized clinical trial, we found a superior immune response in CLL patients receiving conjugated pneumococcal vaccine compared to non-conjugated vaccine. The response to revaccination in CLL patients is scarcely studied. In this study, early humoral response to repeated revaccinations with pneumococcal vaccines was evaluated, by determination of B cell subsets and plasmablast dynamics in peripheral blood. METHOD CLL patients (n = 14) and immunocompetent controls (n = 31) were revaccinated with a 13-valent pneumococcal conjugate vaccine (PCV13) after previous primary immunization (3-6 years ago) with PCV13 or a 23-valent pneumococcal polysaccharide vaccine (PPSV23). Eight weeks after the first revaccination, all CLL patients received a second revaccination with PCV13 or PPSV23. B cell subsets including plasmablasts were analyzed in peripheral blood by flow cytometry, before and after the first and the second revaccination. RESULTS None of the CLL patients, but all controls, had detectable plasmablasts at baseline (p < 0.001). After the first revaccination with PCV13, the plasmablast proportions did not increase in CLL patients (p = 0.13), while increases were seen in controls (p < 0.001). However, after a second revaccination with PCV13 or PPSV23, plasmablasts increased compared to baseline also in CLL patients (p < 0.01). If no response was evident after first revaccination, only a second revaccination with PCV13 increased plasmablasts in contrast to PPSV23 revaccination. Patients with hypogammaglobulinemia and ongoing/previous CLL specific treatment responded poorly, also to a second revaccination. CONCLUSION In CLL patients, pneumococcal revaccination induced minor early plasmablast response compared to controls, but the response improved using a strategy of repeated doses with of conjugated T cell dependent pneumococcal vaccine.
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Affiliation(s)
- Magdalena Kättström
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden.
| | - Bertil Uggla
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
| | - Elisabet Tina
- Department of Clinical Research Laboratory, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Kimby
- Unit of Hematology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Torbjörn Norén
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Simon Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
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Khan S, Allsup D, Molica S. An updated perspective on immunoglobulin replacement in chronic lymphocytic leukaemia in the era of targeted therapies. Front Oncol 2023; 13:1135812. [PMID: 37091176 PMCID: PMC10117948 DOI: 10.3389/fonc.2023.1135812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Chronic lymphocytic leukaemia (CLL) is a malignancy of clonally expanded antigen-switched, neoplastic, mature B cells. CLL is characterised by a variable degree of immunosuppression and secondary hypogammaglobulinemia. B-cell depleting therapies have historically been deployed with a proportion of patients becoming resistant to multiple lines of treatment with an associated worsening of immunosuppression and heightened infection risk. Advances in molecular diagnostics and the development of new therapies targeting Bruton's tyrosine kinase and B-cell lymphoma-2 have resulted in novel insights into the cellular mechanisms associated with an increased infection risk and T-cell escape from the complex tumour environment found in CLL. Generally, immunoglobulin replacement therapy with polyvalent human immunoglobulin G (IgG) is indicated in patients with recurrent severe bacterial infections and low IgG levels, but there is no consensus on the threshold IgG level for initiation of such therapy. A proportion of CLL patients have residual IgG production, with preserved quality of the immunoglobulin molecules, and therefore a definition of 'IgG quality' may allow for lower dosing or less frequent treatment with immunoglobulin therapy in such patients. Immunoglobulin therapy can restore innate immunity and in conjunction with CLL targeted therapies may allow T-cell antigen priming, restore T-cell function thereby providing an escape from tumour-associated autoimmunity and the development of an immune-mediated anti-tumour effect. This review aims to discuss the mechanisms by which CLL-targeted therapy may exert a synergistic therapeutic effect with immunoglobulin replacement therapy both in terms of reducing tumour bulk and restoration of immune function.
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Affiliation(s)
- Sujoy Khan
- Department of Immunology and Allergy, Castle Hill Hospital, Hull University Teaching Hospital National Health Service (NHS) Trust, Cottingham, United Kingdom
| | - David Allsup
- Department of Haematology, Castle Hill Hospital, Hull University Teaching Hospital NHS Trust, Cottingham, United Kingdom
- Centre for Biomedicine, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Stefano Molica
- Department of Haematology, Castle Hill Hospital, Hull University Teaching Hospital NHS Trust, Cottingham, United Kingdom
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34
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Ringelstein-Harlev S, Fanadka M, Horowitz NA, Bettman NP, Katz T. In chronic lymphocytic leukemia, activation of the thrombopoietin receptor promotes T-cell inhibitory properties, contributing to immunosuppression. Eur J Haematol 2023; 110:371-378. [PMID: 36478591 DOI: 10.1111/ejh.13912] [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: 05/15/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
In chronic lymphocytic leukemia (CLL), the immune system is skewed towards a suppressive milieu. Levels of thrombopoietin (TPO), promoting cellular immune regulatory activity in immune thrombocytopenic purpura, were shown to be elevated in CLL patients. This study explored TPO as a potential immunomodulator, supporting CLL progression. We evaluated CLL cell-induced expression of TPO receptor (TPO-R) on T-cells and effects of its activation on T-cell responses. CLL cell involvement in TPO generation was also assessed. Baseline TPO-R expression on CD4 + T-cells was found to be higher in CLL patients than in healthy controls (HC). Exposure of HC-T-cells to B-cells, especially to CLL-B-cells stimulated with B-cell activating molecules, resulted in enhanced TPO-R expression on T-cells. CLL-T-cell stimulation with TPO reduced their proliferation and expanded the regulatory T-cell (Treg) population. At baseline, phosphorylation of STAT5, known to impact the Treg phenotype, was elevated in CLL-T-cells relative to those of HC. Exposure to TPO further enhanced STAT5 phosphorylation in CLL-T-cells, possibly driving the observed Treg expansion. The CLL immune milieu is involved in promotion of inhibitory features in T-cells through increased TPO-R levels and TPO-induced intracellular signaling. TPO and its signaling pathway could potentially support immunosuppression in CLL, and may emerge as novel therapeutic targets.
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Affiliation(s)
- Shimrit Ringelstein-Harlev
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Mona Fanadka
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Netanel A Horowitz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Noam P Bettman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Tami Katz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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35
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Mékinian A, Quinquenel A, Belkacem KA, Kanoun F, Dondi E, Franck E, Boubaya M, Mhibik M, Baran-Marszak F, Letestu R, Ajchenbaum-Cymbalista F, Lévy V, Varin-Blank N, Le Roy C. Immuno-regulatory malignant B cells contribute to Chronic Lymphocytic Leukemia progression. Cancer Gene Ther 2023:10.1038/s41417-023-00602-5. [PMID: 36973425 DOI: 10.1038/s41417-023-00602-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/29/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
Chronic Lymphocytic Leukemia (CLL) is a heterogeneous B cell neoplasm ranging from indolent to rapidly progressive disease. Leukemic cell subsets with regulatory properties evade immune clearance; however, the contribution of such subsets during CLL progression is not completely elucidated. Here, we report that CLL B cells crosstalk with their immune counterparts, notably by promoting the regulatory T (Treg) cell compartment and shaping several helper T (Th) subsets. Among various constitutively- and BCR/CD40-mediated factors secreted, tumour subsets co-express two important immunoregulatory cytokines, IL10 and TGFβ1, both associated with a memory B cell phenotype. Neutralizing secreted IL10 or inhibiting the TGFβ signalling pathway demonstrated that these cytokines are mainly involved in Th- and Treg differentiation/maintenance. In line with the regulatory subsets, we also demonstrated that a CLL B cell population expresses FOXP3, a marker of regulatory T cells. Analysis of IL10, TGFβ1 and FOXP3 positive subpopulations frequencies in CLL samples discriminated 2 clusters of untreated CLL patients that were significantly different in Tregs frequency and time-to-treatment. Since this distinction was pertinent to disease progression, the regulatory profiling provides a new rationale for patient stratification and sheds light on immune dysfunction in CLL.
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Affiliation(s)
- Arsène Mékinian
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
| | - Anne Quinquenel
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
| | - Koceïla Ait Belkacem
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
| | - Feriel Kanoun
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
| | - Elisabetta Dondi
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
| | - Emilie Franck
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
| | | | - Maïssa Mhibik
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
| | - Fanny Baran-Marszak
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
- Service d'Hématologie Biologique, APHP, Hôpital Avicenne, Bobigny, France
| | - Rémi Letestu
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
- Service d'Hématologie Biologique, APHP, Hôpital Avicenne, Bobigny, France
| | - Florence Ajchenbaum-Cymbalista
- INSERM, U978, Bobigny, France
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France
- Service d'Hématologie Biologique, APHP, Hôpital Avicenne, Bobigny, France
| | - Vincent Lévy
- URC, APHP, Hôpital Avicenne, Bobigny, France
- CRC, APHP, Hôpital Avicenne, Bobigny, France
| | - Nadine Varin-Blank
- INSERM, U978, Bobigny, France.
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France.
| | - Christine Le Roy
- INSERM, U978, Bobigny, France.
- Université Paris 13 dite « Sorbonne Paris Nord », UFR SMBH, Labex INFLAMEX, Bobigny, France.
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Cliff ERS, Reynolds G, Grigg A. Disseminated Invasive Mucormycosis Infection Following Autologous Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma. Clin Hematol Int 2023:10.1007/s44228-023-00031-z. [PMID: 36750525 PMCID: PMC9905013 DOI: 10.1007/s44228-023-00031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
Invasive fungal infections (IFI) are challenging to predict, diagnose and treat, and are associated with a particularly high mortality among patients with hematological malignancies. They are relatively uncommon in patients with lymphoma, compared with those with acute leukemia or undergoing allogeneic transplantation. We present a patient, autografted for recurrent lymphoma, with fever and refractory diarrhea persisting post engraftment, eventually attributable to disseminated mucor infection. This case illustrates the challenge of timely diagnosis and initiation of treatment for IFI in lymphoma patients, who do not routinely receive antifungal prophylaxis, and the importance of aggressive investigation and symptom-directed tissue sampling for evidence of IFI in febrile immunocompromised hosts not responding to broad-spectrum antibiotics.
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Affiliation(s)
- Edward R. Scheffer Cliff
- grid.410678.c0000 0000 9374 3516Department of Clinical Haematology, Austin Health, Heidelberg, VIC Australia
| | - Gemma Reynolds
- grid.410678.c0000 0000 9374 3516Department of Infectious Diseases, Austin Health, Heidelberg, VIC Australia ,grid.1055.10000000403978434Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, Parkville, VIC Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia. .,Department of Medicine, University of Melbourne, Parkville, VIC, Australia. .,Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, VIC, Australia.
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37
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Jolles S, Giralt S, Kerre T, Lazarus HM, Mustafa SS, Ria R, Vinh DC. Agents contributing to secondary immunodeficiency development in patients with multiple myeloma, chronic lymphocytic leukemia and non-Hodgkin lymphoma: A systematic literature review. Front Oncol 2023; 13:1098326. [PMID: 36824125 PMCID: PMC9941665 DOI: 10.3389/fonc.2023.1098326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/04/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Patients with hematological malignancies (HMs), like chronic lymphocytic leukemia (CLL), multiple myeloma (MM), and non-Hodgkin lymphoma (NHL), have a high risk of secondary immunodeficiency (SID), SID-related infections, and mortality. Here, we report the results of a systematic literature review on the potential association of various cancer regimens with infection rates, neutropenia, lymphocytopenia, or hypogammaglobulinemia, indicative of SID. Methods A systematic literature search was performed in 03/2022 using PubMed to search for clinical trials that mentioned in the title and/or abstract selected cancer (CLL, MM, or NHL) treatments covering 12 classes of drugs, including B-lineage monoclonal antibodies, CAR T therapies, proteasome inhibitors, kinase inhibitors, immunomodulators, antimetabolites, anti-tumor antibiotics, alkylating agents, Bcl-2 antagonists, histone deacetylase inhibitors, vinca alkaloids, and selective inhibitors of nuclear export. To be included, a publication had to report at least one of the following: percentages of patients with any grade and/or grade ≥3 infections, any grade and/or grade ≥3 neutropenia, or hypogammaglobulinemia. From the relevant publications, the percentages of patients with lymphocytopenia and specific types of infection (fungal, viral, bacterial, respiratory [upper or lower respiratory tract], bronchitis, pneumonia, urinary tract infection, skin, gastrointestinal, and sepsis) were collected. Results Of 89 relevant studies, 17, 38, and 34 included patients with CLL, MM, and NHL, respectively. In CLL, MM, and NHL, any grade infections were seen in 51.3%, 35.9% and 31.1% of patients, and any grade neutropenia in 36.3%, 36.4%, and 35.4% of patients, respectively. The highest proportion of patients with grade ≥3 infections across classes of drugs were: 41.0% in patients with MM treated with a B-lineage monoclonal antibody combination; and 29.9% and 38.0% of patients with CLL and NHL treated with a kinase inhibitor combination, respectively. In the limited studies, the mean percentage of patients with lymphocytopenia was 1.9%, 11.9%, and 38.6% in CLL, MM, and NHL, respectively. Two studies reported the proportion of patients with hypogammaglobulinemia: 0-15.3% in CLL and 5.9% in NHL (no studies reported hypogammaglobulinemia in MM). Conclusion This review highlights cancer treatments contributing to infections and neutropenia, potentially related to SID, and shows underreporting of hypogammaglobulinemia and lymphocytopenia before and during HM therapies.
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Affiliation(s)
- Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom,*Correspondence: Stephen Jolles,
| | - Sergio Giralt
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Tessa Kerre
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Hillard M. Lazarus
- Department of Medicine, Hematology-Oncology, Case Western Reserve University, Cleveland, OH, United States
| | - S. Shahzad Mustafa
- Rochester Regional Health, Rochester, NY, United States,Department of Medicine, Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, United States
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Donald C. Vinh
- Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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38
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COVID-19 Breakthrough Infections in Vaccinated Patients With CLL in Israel. Hemasphere 2023; 7:e839. [PMID: 36751514 PMCID: PMC9894345 DOI: 10.1097/hs9.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023] Open
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39
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Hernandez SPA, Hersby DS, Munk KK, Tamhane T, Trubach D, Tagliamonte M, Buonaguro L, Gang AO, Hadrup SR, Saini SK. Three doses of BNT162b2 COVID-19 mRNA vaccine establish long-lasting CD8 + T cell immunity in CLL and MDS patients. Front Immunol 2023; 13:1035344. [PMID: 36703960 PMCID: PMC9873231 DOI: 10.3389/fimmu.2022.1035344] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Patients with hematological malignancies are prioritized for COVID-19 vaccine due to their high risk for severe SARS-CoV-2 infection-related disease and mortality. To understand T cell immunity, its long-term persistence, and its correlation with antibody response, we evaluated the BNT162b2 COVID-19 mRNA vaccine-specific immune response in chronic lymphocytic leukemia (CLL) and myeloid dysplastic syndrome (MDS) patients. Longitudinal analysis of CD8+ T cells using DNA-barcoded peptide-MHC multimers covering the full SARS-CoV-2 Spike-protein (415 peptides) showed vaccine-specific T cell activation and persistence of memory T cells up to six months post-vaccination. Surprisingly, a higher frequency of vaccine-induced antigen-specific CD8+ T cells was observed in the patient group compared to a healthy donor group. Furthermore, and importantly, immunization with the second booster dose significantly increased the frequency of antigen-specific CD8+ T cells as well as the total number of T cell specificities. Altogether 59 BNT162b2 mRNA vaccine-derived immunogenic responses were identified, of which 23 established long-term CD8+ T cell memory response with a strong immunodominance for NYNYLYRLF (HLA-A24:02) and YLQPRTFLL (HLA-A02:01) epitopes. In summary, we mapped the vaccine-induced antigen-specific CD8+ T cells and showed a booster-specific activation and enrichment of memory T cells that could be important for long-term disease protection in this patient group.
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Affiliation(s)
- Susana Patricia Amaya Hernandez
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kamilla Kjærgaard Munk
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Tripti Tamhane
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Darya Trubach
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Tagliamonte
- Innovative Immunological Models Unit, National Cancer Institute Pascale Foundation – IRCCS, Napoli, Italy
| | - Luigi Buonaguro
- Innovative Immunological Models Unit, National Cancer Institute Pascale Foundation – IRCCS, Napoli, Italy
| | - Anne Ortved Gang
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sine Reker Hadrup
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Sunil Kumar Saini
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark,*Correspondence: Sunil Kumar Saini,
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40
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Noto A, Cassin R, Mattiello V, Bortolotti M, Reda G, Barcellini W. Should treatment of hypogammaglobulinemia with immunoglobulin replacement therapy (IgRT) become standard of care in patients with chronic lymphocytic leukemia? Front Immunol 2023; 14:1062376. [PMID: 37122737 PMCID: PMC10140292 DOI: 10.3389/fimmu.2023.1062376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Hypogammaglobulinemia (HGG) is a frequent finding in patients with hematological malignancies, and is commonly described in chronic lymphocytic leukemia (CLL) before or after treatment. We reviewed published literature available online in the last thirty years through Medline search of indexed articles focusing on the main differences and advantages of the products now available on the market, namely intravenous Ig (IVIg) and subcutaneous Ig (SCIg) preparations. IgRT is effective and safe in the prophylaxis of infections in a selected group of patients with CLL and hypogammaglobulinemia and is therefore a valuable tool for clinicians in the everyday management of infectious risk. We encourage the use of SCIg formulations as they appear to have similar efficacy but better cost-effectiveness and tolerability.
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Affiliation(s)
- Alessandro Noto
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ramona Cassin
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Mattiello
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Bortolotti
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Gianluigi Reda,
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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41
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Benjamini O, Gershon R, Bar‐Haim E, Lustig Y, Cohen H, Doolman R, Kedmi M, Ribakovsky E, Kneller A, Hod T, Erez N, Levy I, Rahav G, Avigdor A. Cellular and humoral response to the fourth BNT162b2 mRNA COVID-19 vaccine dose in patients with CLL. Eur J Haematol Suppl 2023; 110:99-108. [PMID: 36208015 PMCID: PMC9874468 DOI: 10.1111/ejh.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/27/2023]
Abstract
We assessed the humoral and cellular response to the fourth BNT162b2 mRNA COVID-19 vaccine dose in patients with CLL. A total of 67 patients with CLL and 85 age matched controls tested for serologic response and pseudo-neutralization assay. We also tested the functional T-cell response by interferon gamma (IFNγ) to spike protein in 26 patients. Two weeks after the fourth vaccine antibody serologic response was evident in 37 (55.2%) patients with CLL, 20 /22 (91%) of treatment naïve, and 9/32 (28%) patients with ongoing therapy, compared with 100% serologic response in age matched controls. The antibody titer increased by 10-fold in patients with CLL, however, still 88-folds lower than age matched controls. Predictors of better chances of post fourth vaccination serologic response were previous positive serologies after second, third, and pre-fourth vaccination, neutralizing assay, and treatment naïve patients. T-cell response improved from 42.3% before the fourth vaccine to 84.6% 2 weeks afterwards. During the time period of 3 months after the fourth vaccination, 14 patients (21%) developed COVID-19 infection, all recovered uneventfully. Our data demonstrate that fourth SARS-CoV-2 vaccination improves serologic response in patients with CLL to a lesser extent than healthy controls and induces functional T-cell response.
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Affiliation(s)
- Ohad Benjamini
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael,Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Rotem Gershon
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Erez Bar‐Haim
- Department of Biochemistry and Molecular GeneticsIsrael Institute for Biological ResearchNess‐ZionaIsrael
| | - Yaniv Lustig
- Central Virology LaboratoryMinistry of Health and Chaim Sheba Medical CenterTel‐HashomerIsrael
| | - Hila Cohen
- Department of Biochemistry and Molecular GeneticsIsrael Institute for Biological ResearchNess‐ZionaIsrael
| | - Ram Doolman
- The Dworman Automated‐Mega LaboratorySheba Medical CenterTel‐HashomerIsrael
| | - Meirav Kedmi
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael,Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Mina and Everard Goodman Faculty of Life ScienceBar‐Ilan UniversityRamat‐GanIsrael
| | | | - Abraham Kneller
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael
| | - Tammy Hod
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,Nephrology DepartmentChaim Sheba Medical CentreTel‐HashomerIsrael
| | - Noam Erez
- Department of Infectious DiseasesIsrael Institute for Biological ResearchNess‐ZionaIsrael
| | - Itzhak Levy
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Infectious Disease UnitChaim Sheba Medical CenterTel‐HashomerIsrael
| | - Galia Rahav
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Infectious Disease UnitChaim Sheba Medical CenterTel‐HashomerIsrael
| | - Abraham Avigdor
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael,Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
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42
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COVID-19 Vaccination Response and Its Practical Application in Patients With Chronic Lymphocytic Leukemia. Hemasphere 2023; 7:e811. [PMID: 36570695 PMCID: PMC9771252 DOI: 10.1097/hs9.0000000000000811] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/09/2022] [Indexed: 12/27/2022] Open
Abstract
Patients with chronic lymphocyticleukemia (CLL) typically have innate/adaptive immune system dysregulation, thus the protective effect of coronavirus disease 2019 (COVID-19) vaccination remains uncertain. This prospective review evaluates vaccination response in these patients, including seropositivity rates by CLL treatment status, type of treatment received, and timing of vaccination. Antibody persistence, predictors of poor vaccine response, and severity of COVID-19 infection in vaccinated patients were also analyzed. Practical advice on the clinical management of patients with CLL is provided. Articles reporting COVID-19 vaccination in patients with CLL, published January 1, 2021-May 1, 2022, were included. Patients with CLL displayed the lowest vaccination responses among hematologic malignancies; however, seropositivity increased with each vaccination. One of the most commonly reported independent risk factors for poor vaccine response was active CLL treatment; others included hypogammaglobulinemia and age >65-70 years. Patients who were treatment-naive, off therapy, in remission, or who had a prior COVID-19 infection displayed the greatest responses. Further data are needed on breakthrough infection rates and a heterologous booster approach in patients with hematologic malignancies. Although vaccine response was poor for patients on active therapy regardless of treatment type, CLL management in the context of COVID-19 should aim to avoid delays in antileukemic treatment, especially with the advent of numerous strategies to mitigate risk of severe COVID-19 such as pre-exposure prophylaxis, and highly effective antivirals and monoclonal antibody therapy upon confirmed infection. Patients with CLL should remain vigilant in retaining standard prevention measures such as masks, social distancing, and hand hygiene.
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Visentin A, Molinari MC, Pravato S, Cellini A, Angotzi F, Cavaretta CA, Ruocco V, Imbergamo S, Piazza F, Proietti G, Mauro FR, Trentin L. A Retrospective Study on the Efficacy of Subcutaneous Immunoglobulin as Compared to Intravenous Formulation in Patients with Chronic Lymphocytic Leukemia and Secondary Antibody Deficiency. Curr Oncol 2022; 30:274-283. [PMID: 36661671 PMCID: PMC9857433 DOI: 10.3390/curroncol30010022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Secondary antibody deficiency (SAD) is a common complication in chronic lymphocytic leukemia (CLL) which favors the development of life-threatening infections. Subcutaneous immunoglobulins (IG) (SCIG) have been proven to be as effective as intravenous immunoglobulin (IVIG) in primary immunodeficiencies. Since only a few studies investigated SCIG in secondary antibody deficiency, the aim of this study was to assess the efficacy and safety of SCIG or IVIG in CLL patients with secondary antibody deficiency. One hundred and sixteen CLL patients were recruited, 63% were males, and the median age was 68 years; 44% had bronchiectasis and 76% never smoked. Forty-nine patients received IVIG and 88 SCIG, including 28 patients who shifted from IVIG to SCIG. Despite similar baseline IgG levels, patients receiving SCIG achieved higher IgG after at least +6 months (p = 0.0009). We observed that SCIG can decrease the cumulative incidence of first (HR 0.39 p < 0.0001) and second (HR 0.56 p = 0.0411) infection more than IVIG. The effect was remarkable in that patients were able to reach at least 6 g/L of IgG after 6 months of treatments (p < 0.0001). Replacement therapies were well tolerated with less adverse events and a lower discontinuation rate in patients was managed with SCIG than IVIG. In this study we describe the clinical features of a large cohort of CLL with secondary antibody deficiency receiving IG. We demonstrated that SCIG are active and well tolerated drugs that allows to reach higher IgG levels and decrease the rate of infections better than IVIG, in particular when IgG levels reach 6 g/L.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Hematology Unit, Department of Medicine of Systems (DIDAS), Azienda Ospedale Università Padova, 35128 Padova, Italy
| | - Maria Chiara Molinari
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Stefano Pravato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Alessandro Cellini
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Francesco Angotzi
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Chiara Adele Cavaretta
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Valeria Ruocco
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Silvia Imbergamo
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Giulia Proietti
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Francesca Romana Mauro
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Hematology Unit, Department of Medicine of Systems (DIDAS), Azienda Ospedale Università Padova, 35128 Padova, Italy
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44
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Multiple COVID-19 vaccine doses in CLL and MBL improve immune responses with progressive and high seroconversion. Blood 2022; 140:2709-2721. [PMID: 36206503 PMCID: PMC9550283 DOI: 10.1182/blood.2022017814] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) or monoclonal B-lymphocytosis (MBL) have impaired response to COVID-19 vaccination. A total of 258 patients (215 with CLL and 43 with MBL) had antispike antibody levels evaluable for statistical analysis. The overall seroconversion rate in patients with CLL was 94.2% (antispike antibodies ≥50 AU/mL) and 100% in patients with MBL after multiple vaccine doses. After 3 doses (post-D3) in 167 patients with CLL, 73.7% were seropositive, 17.4% had antispike antibody levels between 50 and 999 AU/mL, and 56.3% had antispike antibody levels ≥1000 AU/mL, with a median rise from 144.6 to 1800.7 AU/mL. Of patients who were seronegative post-D2, 39.7% seroconverted post-D3. For those who then remained seronegative after their previous dose, seroconversion occurred in 40.6% post-D4, 46.2% post-D5, 16.7% post-D6, and 0% after D7 or D8. After seroconversion, most had a progressive increase in antispike antibody levels. Neutralization was associated with higher antispike antibody levels, more vaccine doses, and earlier severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants; neutralizing antibody against early clade D614G was detected in 65.3%, against Delta in 52.0%, and against Omicron in 36.5%. SARS-CoV-2-specific T-cell production of interferon γ and interleukin 2 occurred in 73.9% and 60.9%, respectively, of 23 patients tested. After multiple vaccine doses, by multivariate analysis, immunoglobulin M ≥0.53 g/L, immunoglobulin subclass G3 ≥0.22 g/L and absence of current CLL therapy were independent predictors of positive serological responses. Multiple sequential COVID-19 vaccination significantly increased seroconversion and antispike antibody levels in patients with CLL or MBL.
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45
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Qin K, Honjo K, Sherrill-Mix S, Liu W, Stoltz R, Oman AK, Hall LA, Li R, Sterrett S, Frederick ER, Lancaster JR, Narkhede M, Mehta A, Ogunsile FJ, Patel RB, Ketas TJ, Cruz Portillo VM, Cupo A, Larimer BM, Bansal A, Goepfert PA, Hahn BH, Davis RS. SARS-CoV-2 mRNA vaccination exposes progressive adaptive immune dysfunction in patients with chronic lymphocytic leukemia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.12.19.22283645. [PMID: 36597532 PMCID: PMC9810225 DOI: 10.1101/2022.12.19.22283645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic lymphocytic leukemia (CLL) patients have lower seroconversion rates and antibody titers following SARS-CoV-2 vaccination, but the reasons for this diminished response are poorly understood. Here, we studied humoral and cellular responses in 95 CLL patients and 30 healthy controls after two BNT162b2 or mRNA-2173 mRNA immunizations. We found that 42% of CLL vaccinees developed SARS-CoV-2-specific binding and neutralizing antibodies (NAbs), while 32% had no response. Interestingly, 26% were seropositive, but had no detectable NAbs, suggesting the maintenance of pre-existing endemic human coronavirus-specific antibodies that cross-react with the S2 domain of the SARS-CoV-2 spike. These individuals had more advanced disease. In treatment-naïve CLL patients, mRNA-2173 induced 12-fold higher NAb titers and 1.7-fold higher response rates than BNT162b2. These data reveal a graded loss of immune function, with pre-existing memory being preserved longer than the capacity to respond to new antigens, and identify mRNA-2173 as a superior vaccine for CLL patients.
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Affiliation(s)
- Kai Qin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,These authors contributed equally
| | - Kazuhito Honjo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,These authors contributed equally
| | - Scott Sherrill-Mix
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Weimin Liu
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Regina Stoltz
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Allisa K. Oman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lucinda A. Hall
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ran Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Sterrett
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ellen R. Frederick
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jeffrey R. Lancaster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Mayur Narkhede
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Amitkumar Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Foluso J. Ogunsile
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Rima B. Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Thomas J. Ketas
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Victor M Cruz Portillo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Albert Cupo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Benjamin M. Larimer
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Paul A. Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Beatrice H. Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Randall S. Davis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Biochemistry & Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Lead Contact,Correspondence: (R.S.D.)
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46
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Yano M, Byrd JC, Muthusamy N. Natural Killer Cells in Chronic Lymphocytic Leukemia: Functional Impairment and Therapeutic Potential. Cancers (Basel) 2022; 14:cancers14235787. [PMID: 36497266 PMCID: PMC9739887 DOI: 10.3390/cancers14235787] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Immunotherapy approaches have advanced rapidly in recent years. While the greatest therapeutic advances so far have been achieved with T cell therapies such as immune checkpoint blockade and CAR-T, recent advances in NK cell therapy have highlighted the therapeutic potential of these cells. Chronic lymphocytic leukemia (CLL), the most prevalent form of leukemia in Western countries, is a very immunosuppressive disease but still shows significant potential as a target of immunotherapy, including NK-based therapies. In addition to their antileukemia potential, NK cells are important immune effectors in the response to infections, which represent a major clinical concern for CLL patients. Here, we review the interactions between NK cells and CLL, describing functional changes and mechanisms of CLL-induced NK suppression, interactions with current therapeutic options, and the potential for therapeutic benefit using NK cell therapies.
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Affiliation(s)
- Max Yano
- Medical Science Training Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - John C. Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Correspondence: (J.C.B.); (N.M.)
| | - Natarajan Muthusamy
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
- Correspondence: (J.C.B.); (N.M.)
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47
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Parikh SA, Achenbach SJ, Rabe KG, Norman AD, Boddicker NJ, Olson JE, Call TG, Cerhan JR, Vachon CM, Kay NE, Braggio E, Hanson CA, Slager SL, Shanafelt TD. The risk of coronavirus disease 2019 (COVID-19) among individuals with monoclonal B cell lymphocytosis. Blood Cancer J 2022; 12:159. [PMID: 36418344 PMCID: PMC9684458 DOI: 10.1038/s41408-022-00754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Sara J Achenbach
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Kari G Rabe
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Aaron D Norman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - Janet E Olson
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | - James R Cerhan
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Esteban Braggio
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Susan L Slager
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Stanford, CA, USA
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48
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Wang X, Sima L. Antibody response after vaccination against SARS-CoV-2 in adults with hematological malignancies: a systematic review and meta-analysis. J Infect 2022:S0163-4453(22)00674-0. [PMID: 36417984 PMCID: PMC9675635 DOI: 10.1016/j.jinf.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Vaccines against SARS-CoV-2 have shown remarkable efficacy and thus constitute an important preventive option against coronavirus disease 2019 (COVID-19), especially in fragile patients. We aimed to systematically analyze the outcomes of patients with hematological malignancies who received vaccination and to identify specific groups with differences in outcomes. The primary end point was antibody response after full vaccination (2 doses of mRNA or one dose of vector- based vaccines). We identified 49 studies comprising 11,086 individuals. Overall risk of bias was low. The pooled response for hematological malignancies was 64% (95% confidence interval [CI]: 59-69; I²=93%) versus 96% (95% CI: 92-97; I²=44%) for solid cancer and 98% (95% CI: 96-99; I²=55%) for healthy controls (P<0.001). Outcome was different across hematological malignancies (P<0.001). The pooled response was 50% (95% CI: 43-57; I²=84%) for chronic lymphocytic leukemia, 76% (95% CI: 67-83; I²=92%) for multiple myeloma, 83% (95% CI: 69-91; I²=85%) for myeloproliferative neoplasms, 91% (95% CI: 82-96; I²=12%) for Hodgkin lymphoma, and 58% (95% CI: 44-70; I²=84%) for aggressive and 61% (95% CI: 48-72; I²=85%) for indolent non-Hodgkin lymphoma. The pooled response for allogeneic and autologous hematopoietic cell transplantation was 82% and 83%, respectively. Being in remission and prior COVID-19 showed significantly higher responses. Low pooled response was identified for active treatment (35%), anti-CD20 therapy ≤1 year (15%), Bruton kinase inhibition (23%), venetoclax (26%), ruxolitinib (42%), and chimeric antigen receptor T-cell therapy (42%). Studies on timing, value of boosters, and long-term efficacy are needed. This study is registered with PROSPERO (clinicaltrials gov. Identifier: CRD42021279051).
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Laozei Sima
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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49
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Cassioli C, Patrussi L, Valitutti S, Baldari CT. Learning from TCR Signaling and Immunological Synapse Assembly to Build New Chimeric Antigen Receptors (CARs). Int J Mol Sci 2022; 23:14255. [PMID: 36430728 PMCID: PMC9694822 DOI: 10.3390/ijms232214255] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cell immunotherapy is a revolutionary pillar in cancer treatment. Clinical experience has shown remarkable successes in the treatment of certain hematological malignancies but only limited efficacy against B cell chronic lymphocytic leukemia (CLL) and other cancer types, especially solid tumors. A wide range of engineering strategies have been employed to overcome the limitations of CAR T cell therapy. However, it has become increasingly clear that CARs have unique, unexpected features; hence, a deep understanding of how CARs signal and trigger the formation of a non-conventional immunological synapse (IS), the signaling platform required for T cell activation and execution of effector functions, would lead a shift from empirical testing to the rational design of new CAR constructs. Here, we review current knowledge of CARs, focusing on their structure, signaling and role in CAR T cell IS assembly. We, moreover, discuss the molecular features accounting for poor responses in CLL patients treated with anti-CD19 CAR T cells and propose CLL as a paradigm for diseases connected to IS dysfunctions that could significantly benefit from the development of novel CARs to generate a productive anti-tumor response.
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Affiliation(s)
- Chiara Cassioli
- Department of Life Sciences, University of Siena, 53100 Siena, Italy
| | - Laura Patrussi
- Department of Life Sciences, University of Siena, 53100 Siena, Italy
| | - Salvatore Valitutti
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Université de Toulouse III-Paul Sabatier, 31037 Toulouse, France
- Department of Pathology, Institut Universitaire du Cancer-Oncopole de Toulouse, 31059 Toulouse, France
| | - Cosima T. Baldari
- Department of Life Sciences, University of Siena, 53100 Siena, Italy
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50
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Seganfredo FB, Dias AR, Santos PR, Rebelo M, João C, Mendes D, Carmo E. Successful treatment of persistent and severe SARS‐CoV‐2 infection in a high‐risk chronic lymphocytic leukemia patient using Ronapreve™ antibodies. Clin Case Rep 2022; 10:e6548. [PMID: 36408087 PMCID: PMC9666912 DOI: 10.1002/ccr3.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with lymphoproliferative diseases are at an increased risk of an incomplete immune response following vaccination or SARS‐CoV‐2 infection and might develop persistent viral infection and severe COVID‐19 disease. We present a case of successful treatment of persistent and mechanical‐ventilation‐requiring SARS‐CoV‐2 infection in a del17+ CLL patient using exogenous antibodies. Patients with chronic lymphocytic leukemia (CLL) might have an incomplete immune response following vaccination or SARS‐CoV‐2 infection. There is therapeutic potential of monoclonal antibodies in persistent and severe COVID‐19, mirrored in a CLL patient.
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Affiliation(s)
- Fernanda Braga Seganfredo
- Haematology Department Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) Lisbon Portugal
| | - Ana Raquel Dias
- Haematology Department Hospital do Divino Espírito Santo de Ponta Delgada Ponta Delgada Portugal
| | - Pedro R. Santos
- Intensive Care Unit Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
| | - Marta Rebelo
- Intensive Care Unit Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
| | - Cristina João
- Haematology Department Fundação Champalimaud Lisbon Portugal
| | - Dina Mendes
- Pharmaceutical Department Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
| | - Eduarda Carmo
- Intensive Care Unit Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
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