1
|
Stamatopoulos K, Pavlova S, Al‐Sawaf O, Chatzikonstantinou T, Karamanidou C, Gaidano G, Cymbalista F, Kater AP, Rawstron A, Scarfò L, Ghia P, Rosenquist R. Realizing precision medicine in chronic lymphocytic leukemia: Remaining challenges and potential opportunities. Hemasphere 2024; 8:e113. [PMID: 39035106 PMCID: PMC11260284 DOI: 10.1002/hem3.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/23/2024] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) exhibit diverse clinical outcomes. An expanding array of genetic tests is now employed to facilitate the identification of patients with high-risk disease and inform treatment decisions. These tests encompass molecular cytogenetic analysis, focusing on recurrent chromosomal alterations, particularly del(17p). Additionally, sequencing is utilized to identify TP53 mutations and to determine the somatic hypermutation status of the immunoglobulin heavy variable gene. Concurrently, a swift advancement of targeted treatment has led to the implementation of novel strategies for patients with CLL, including kinase and BCL2 inhibitors. This review explores both current and emerging diagnostic tests aimed at identifying high-risk patients who should benefit from targeted therapies. We outline existing treatment paradigms, emphasizing the importance of matching the right treatment to the right patient beyond genetic stratification, considering the crucial balance between safety and efficacy. We also take into consideration the practical and logistical issues when choosing a management strategy for each individual patient. Furthermore, we delve into the mechanisms underlying therapy resistance and stress the relevance of monitoring measurable residual disease to guide treatment decisions. Finally, we underscore the necessity of aggregating real-world data, adopting a global perspective, and ensuring patient engagement. Taken together, we argue that precision medicine is not the mere application of precision diagnostics and accessibility of precision therapies in CLL but encompasses various aspects of the patient journey (e.g., lifestyle exposures and comorbidities) and their preferences toward achieving true personalized medicine for patients with CLL.
Collapse
Affiliation(s)
- Kostas Stamatopoulos
- Centre for Research and Technology HellasInstitute of Applied BiosciencesThessalonikiGreece
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Sarka Pavlova
- Department of Internal Medicine, Hematology and Oncology, and Institute of Medical Genetics and GenomicsUniversity Hospital Brno and Medical Faculty, Masaryk UniversityBrnoCzech Republic
- Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | - Othman Al‐Sawaf
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD)University of Cologne, Faculty of Medicine and University Hospital of CologneCologneGermany
- Francis Crick Institute LondonLondonUK
- Cancer Institute, University College LondonLondonUK
| | | | - Christina Karamanidou
- Centre for Research and Technology HellasInstitute of Applied BiosciencesThessalonikiGreece
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational MedicineUniversity of Eastern PiedmontNovaraItaly
| | | | - Arnon P. Kater
- Department of Hematology, Cancer Center AmsterdamAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Andy Rawstron
- Haematological Malignancy Diagnostic ServiceLeeds Teaching Hospitals TrustLeedsUK
| | - Lydia Scarfò
- Medical SchoolUniversità Vita Salute San RaffaeleMilanoItaly
- Strategic Research Program on CLLIRCCS Ospedale San RaffaeleMilanoItaly
| | - Paolo Ghia
- Medical SchoolUniversità Vita Salute San RaffaeleMilanoItaly
- Strategic Research Program on CLLIRCCS Ospedale San RaffaeleMilanoItaly
| | - Richard Rosenquist
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Clinical GeneticsKarolinska University HospitalStockholmSweden
| |
Collapse
|
2
|
Serafin A, Cellini A, Cavarretta CA, Ruocco V, Angotzi F, Zatta I, Frezzato F, Bonaldi L, Martines A, Pravato S, Piazza F, Trentin L, Visentin A. Exploring the prognostic role of complex karyotype in chronic lymphocytic leukaemia patients treated with venetoclax-based regimens. Br J Haematol 2024; 205:189-193. [PMID: 38710589 DOI: 10.1111/bjh.19517] [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: 03/17/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Although the unfavourable prognostic role of complex karyotype (CK) in chronic lymphocytic leukaemia (CLL) patients treated with chemoimmunotherapy has been clarified, its impact on the outcome of patients being treated with novel targeted agents, and especially with venetoclax-based regimens, remains to be resolved. In fact, only few studies, utilizing data derived from clinical trials (e.g. MURANO, CLL14, GAIA-CLL13), specifically focus on this topic while real-word evidence is missing. In our real-life retrospective study conducted on 61 patients with CLL and treated with venetoclax-based regimens in any therapeutic line, we documented a remarkable lower progression-free survival in patients harbouring both CK and high CK, while overall response rate (including complete remissions and partial remissions) and overall survival are not affected by CK in our population.
Collapse
MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Sulfonamides/therapeutic use
- Sulfonamides/administration & dosage
- Female
- Male
- Aged
- Middle Aged
- Prognosis
- Retrospective Studies
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Aged, 80 and over
- Karyotype
- Adult
Collapse
Affiliation(s)
- Andrea Serafin
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Alessandro Cellini
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Valeria Ruocco
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Francesco Angotzi
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Ivan Zatta
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federica Frezzato
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Annalisa Martines
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Stefano Pravato
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Francesco Piazza
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Livio Trentin
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Visentin
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Bomben R, Zucchetto A, Laureana R, Chiarenza A, Olivieri J, Tissino E, Rossi FM, Vit F, Bittolo T, Papotti R, Pozzo F, Gaglio A, Degan M, Polesel J, Marasca R, Visentin A, Moia R, Innocenti I, Vitale C, Murru R, Varettoni M, Tafuri A, Zaja F, Postorino M, Martino EA, Condoluci A, Rossi D, Cuneo A, Di Raimondo F, Sportoletti P, Del Giudice I, Foà R, Mauro FR, Coscia M, Laurenti L, Gaidano G, Trentin L, Principe MID, Gentile M, Gattei V. CD49d expression is included in a revised 4-factor model predicting outcome in patients with chronic lymphocytic leukemia treated with ibrutinib: A multicenter real-world experience. Hemasphere 2024; 8:e128. [PMID: 39011128 PMCID: PMC11247362 DOI: 10.1002/hem3.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/09/2024] [Indexed: 07/17/2024] Open
Affiliation(s)
- Riccardo Bomben
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | | | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical SpecialtiesUniversity of CataniaCataniaItaly
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi” DISMAzienda Ospedaliera Universitaria S. Maria MisericordiaUdineItaly
| | - Erika Tissino
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Francesca M. Rossi
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Filippo Vit
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Tamara Bittolo
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Robel Papotti
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Federico Pozzo
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Annalisa Gaglio
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Massimo Degan
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Jerry Polesel
- Unit of Cancer EpidemiologyCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Roberto Marasca
- Hematology Unit, Department of Oncology and HematologyAzienda‐Ospedaliero Universitaria (AOU) of Modena, PoliclinicoModenaItaly
- Department of Medical and Surgical SciencesUniversity of Modena e Reggio EmiliaEmilia‐RomagnaItaly
| | - Andrea Visentin
- Hematology unit, Department of MedicineUniversity of PadovaPadovaItaly
| | - Riccardo Moia
- Division of Hematology, Department of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | | | - Candida Vitale
- A.O.U. Città della Salute e della Scienza di TorinoTorinoItaly
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS G. BrotzuCagliariItaly
| | - Marzia Varettoni
- Division of HematologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine and Hematology, Sant'Andrea ‐ University Hospital ‐ SapienzaUniversity of RomeRomeItaly
| | - Francesco Zaja
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | | | | | - Adalgisa Condoluci
- Oncology Institute of Southern Switzerland and Institute of Oncology ResearchBellinzonaSwitzerland
| | - Davide Rossi
- Oncology Institute of Southern Switzerland and Institute of Oncology ResearchBellinzonaSwitzerland
| | - Antonio Cuneo
- Hematology Section, Department of Medical SciencesUniversity of FerraraFerraraItaly
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical SpecialtiesUniversity of CataniaCataniaItaly
| | - Paolo Sportoletti
- Centro di Ricerca Emato‐Oncologica (CREO), Dipartimento di Medicina e ChirurgiaUniversità di PerugiaPerugiaItaly
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine‘Sapienza’ UniversityRomeItaly
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine‘Sapienza’ UniversityRomeItaly
| | - Francesca R. Mauro
- Hematology, Department of Translational and Precision Medicine‘Sapienza’ UniversityRomeItaly
| | - Marta Coscia
- A.O.U. Città della Salute e della Scienza di TorinoTorinoItaly
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di RomaRomaItaly
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | - Livio Trentin
- Hematology unit, Department of MedicineUniversity of PadovaPadovaItaly
| | | | - Massimo Gentile
- Hematology UnitAzienda Ospedaliera AnnunziataCosenzaItaly
- Department of Pharmacy, Health and Nutritional ScienceUniversity of CalabriaRendeItaly
| | - Valter Gattei
- Clinical and Experimental Onco‐Haematology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| |
Collapse
|
4
|
Goergen E, Al-Sawaf O. The prognostic significance of genomic complexity in patients with CLL. Leuk Lymphoma 2024; 65:873-881. [PMID: 38593054 DOI: 10.1080/10428194.2024.2333448] [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: 11/27/2023] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
Chromosomal aberrations are a common feature of cancer and can fuel cancer progression and treatment resistance. In chronic lymphocytic leukemia (CLL), the presence of multiple chromosomal aberrations is commonly referred to as "genomic complexity" or "complex karyotype"- (CKT). In the context of chemo- and chemoimmunotherapy, genomic complexity is associated with poor response to treatment and short survival, while some targeted therapies are able to mitigate its adverse prognostic impact. This article reviews currently available data and literature on the role of genomic complexity in CLL. The currently established tools to measure genomic complexity in patients with CLL are summarized and their strengths and weaknesses for routine diagnostics are evaluated. Moreover, possible definitions of CKT as an indicator for genomic complexity are discussed. Finally, data on the impact of CKT on clinical outcomes of patients with CLL are reviewed and the implications for patient stratification are presented.
Collapse
MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Prognosis
- Chromosome Aberrations
- Genomics/methods
- Biomarkers, Tumor/genetics
Collapse
Affiliation(s)
- Ellinor Goergen
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| |
Collapse
|
5
|
Langerbeins P, Giza A, Robrecht S, Cramer P, von Tresckow J, Al-Sawaf O, Fink AM, Fürstenau M, Kutsch N, Simon F, Goede V, Hoechstetter M, Niemann CU, da Cunha-Bang C, Kater A, Dubois J, Gregor M, Staber PB, Tausch E, Schneider C, Stilgenbauer S, Eichhorst B, Fischer K, Hallek M. Reassessing the chronic lymphocytic leukemia International Prognostic Index in the era of targeted therapies. Blood 2024; 143:2588-2598. [PMID: 38620092 DOI: 10.1182/blood.2023022564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
ABSTRACT We evaluated the chronic lymphocytic leukemia International Prognostic Index (CLL-IPI) in patients with CLL treated first line with targeted drugs (n = 991) or chemoimmunotherapy (n = 1256). With a median observation time of 40.5 months, the 3-year progression-free survival (PFS) rates for targeted drug-treated patients varied by CLL-IPI risk group: 96.5% (low), 87.6% (intermediate), 82.4% (high), and 78.7% (very high). Differences between consecutive CLL-IPI risk groups were observed for intermediate vs low and high vs intermediate, but not very high vs high. CLL-IPI factors β2-microglobulin, immunoglobulin heavy variable (IGHV) status, and TP53 status each retained prognostic value for PFS. The 3-year overall survival (OS) rates by CLL-IPI risk groups were 100%, 96%, 93.9%, and 89.4%, respectively, with no differences between consecutive risk groups. Age, Binet stage, β2-microglobulin, and TP53 status each retained prognostic value for OS. In chemoimmunotherapy patients (median observation time, 66.9 months), 3-year PFS rates for CLL-IPI risk groups were 78.1%, 51.4%, 40.1%, and 16.5%, respectively; corresponding 3-year OS rates were 97.4%, 93.1%, 81.8%, and 57.3%. In a matched-pair analysis, PFS differences in targeted therapies (n = 812) vs chemoimmunotherapy (n = 812) across all risk groups and OS differences in all but patients at low risk were demonstrated. The CLL-IPI maintains its prognostic value in predicting PFS outcomes with targeted drugs, but its impact in predicting survival appears diminished. Targeted therapies showed enhanced outcomes over chemoimmunotherapy, highlighting their effectiveness across various risk groups. Our findings support ongoing assessment of prognostic tools in CLL treatment evolution. These trials were registered at www.ClinicalTrials.gov as #NCT02345863, #NCT02401503, #NCT02689141, #NCT02445131, #NCT02758665, #NCT02950051, #NCT02242942, #NCT00262782, #NCT00281918, and #NCT01010061.
Collapse
MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Female
- Male
- Aged
- Middle Aged
- Prognosis
- Aged, 80 and over
- Molecular Targeted Therapy
- Adult
- beta 2-Microglobulin
- Survival Rate
Collapse
Affiliation(s)
- Petra Langerbeins
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Maria Fink
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nadine Kutsch
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Florian Simon
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Valentin Goede
- Division of Oncogeriatrics, St. Marien Hospital, Cologne, Germany
| | - Manuela Hoechstetter
- Interdisciplinary Oncology Center Munich, Outpatient Clinic, Day Hospital, Center for Clinical Trials, Hematology and Oncology, Munich, Germany
| | | | | | - Arnon Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Julie Dubois
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Gregor
- Division of Hematology, Luzerner Kantonspital, Lucerne, Switzerland
| | - Philipp Bernhard Staber
- Division of Hematology and Hemostaseology, Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Department of Internal Medicine I, Vienna, Austria
| | - Eugen Tausch
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Christof Schneider
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cologne Cluster of Excellence for Stress Responses in Aging-Associated Diseases, Clinical Research Unit, University of Cologne, Cologne, Germany
| |
Collapse
|
6
|
Kamaso J, Puiggros A, Salido M, Melero C, Rodríguez-Rivera M, Gimeno E, Martínez L, Arenillas L, Calvo X, Román D, Abella E, Ramos-Campoy S, Lorenzo M, Ferrer A, Collado R, Moro-García MA, Espinet B. Complex Karyotype Detection in Chronic Lymphocytic Leukemia: A Comparison of Parallel Cytogenetic Cultures Using TPA and IL2+DSP30 from a Single Center. Cancers (Basel) 2024; 16:2258. [PMID: 38927962 PMCID: PMC11202013 DOI: 10.3390/cancers16122258] [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: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Current CLL guidelines recommend a two parallel cultures assessment using TPA and IL2+DSP30 mitogens for complex karyotype (CK) detection. Studies comparing both mitogens for CK identification in the same cohort are lacking. We analyzed the global performance, CK detection, and concordance in the complexity assessment of two cytogenetic cultures from 255 CLL patients. IL2+DSP30 identified more altered karyotypes than TPA (50 vs. 39%, p = 0.031). Moreover, in 71% of those abnormal by both, IL2+DSP30 identified more abnormalities and/or abnormal metaphases. CK detection was similar for TPA and IL2+DSP30 (10% vs. 11%). However, 11/33 CKs (33%) were discordant, mainly due to the detection of a normal karyotype or no metaphases in the other culture. Patients requiring treatment within 12 months after sampling (active CLL) displayed significantly more CKs than those showing a stable disease (55% vs. 12%, p < 0.001). Disease status did not impact cultures' concordance (κ index: 0.735 and 0.754 for stable and active). Although CK was associated with shorter time to first treatment (TTFT) using both methods, IL2+DSP30 displayed better accuracy than TPA for predicting TTFT (C-index: 0.605 vs. 0.580, respectively). In summary, the analysis of two parallel cultures is the best option to detect CKs in CLL. Nonetheless, IL2+DSP30 could be prioritized above TPA to optimize cytogenetic assessment in clinical practice.
Collapse
Affiliation(s)
- Joanna Kamaso
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Anna Puiggros
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Marta Salido
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Carme Melero
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - María Rodríguez-Rivera
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, 08003 Barcelona, Spain; (E.G.); (E.A.)
- Applied Clinical Research in Hematological Malignances Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Laia Martínez
- Hematology Service, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain;
| | - Leonor Arenillas
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Xavier Calvo
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - David Román
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Eugènia Abella
- Department of Hematology, Hospital del Mar, 08003 Barcelona, Spain; (E.G.); (E.A.)
| | - Silvia Ramos-Campoy
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Marta Lorenzo
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Ana Ferrer
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| | - Rosa Collado
- Department of Hematology, Consorcio Hospital General Universitario Valencia, 46014 Valencia, Spain;
| | | | - Blanca Espinet
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (J.K.); (M.S.); (C.M.); (M.R.-R.); (L.A.); (X.C.); (D.R.); (S.R.-C.); (M.L.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Hospital del Mar Research Institute (HMRI), 08003 Barcelona, Spain
| |
Collapse
|
7
|
Tsushima T, Sato N, Guo Y, Nakamura H, Kunisada K, Chi S, Akie K, Takahashi Y, Nakamura S, Shimada K, Ishii G, Minami Y, Yuda J. Richter transformation acquiring PLCG2 mutation during Bruton tyrosine kinase inhibitors treatment. EJHAEM 2024; 5:642-645. [PMID: 38895067 PMCID: PMC11182410 DOI: 10.1002/jha2.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Takafumi Tsushima
- Department of Hematology and OncologyNational Cancer Center Hospital EastKashiwaJapan
- Department of Hematology and OncologyJapanese Red Cross Narita HospitalNaritaJapan
| | - Nobue Sato
- Pharmaceutical DepartmentNational Cancer Center Hospital EastKashiwaJapan
| | - Yong‐Mei Guo
- Department of Hematology and OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Hirotaka Nakamura
- Department of Hematology and OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Kodai Kunisada
- Department of Hematology and OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Song‐Gi Chi
- Department of Hematology and OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Kenta Akie
- Department of Clinical LaboratoriesNational Cancer Center Hospital EastKashiwaJapan
| | - Yuki Takahashi
- Department of Clinical LaboratoriesNational Cancer Center Hospital EastKashiwaJapan
| | - Saki Nakamura
- Department of Clinical LaboratoriesNational Cancer Center Hospital EastKashiwaJapan
| | - Kaoru Shimada
- Department of RadiologyNational Cancer Center Hospital EastKashiwaJapan
| | - Genichiro Ishii
- Department of PathologyNational Cancer Center Hospital EastKashiwaJapan
| | - Yosuke Minami
- Department of Hematology and OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Junichiro Yuda
- Department of Hematology and OncologyNational Cancer Center Hospital EastKashiwaJapan
| |
Collapse
|
8
|
Coombs CC. Frontline Therapy of CLL-Changing Treatment Paradigms. Curr Hematol Malig Rep 2024; 19:65-74. [PMID: 38337108 DOI: 10.1007/s11899-024-00726-x] [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] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW The therapeutic landscape for chronic lymphocytic leukemia (CLL) has undergone a complete makeover following the introduction of highly effective targeted therapies, beginning with ibrutinib which first attained regulatory approval for CLL in 2014. RECENT FINDINGS In recent years, we have seen further refinement of therapeutic options with the development of newer-generation Bruton's tyrosine kinase inhibitors (BTKi) including acalabrutinib and zanubrutinib that improve upon the safety of ibrutinib. Additionally, venetoclax-based approaches, combined with anti-CD20 antibodies, have allowed for time-limited targeted therapeutic strategies which are particularly attractive for certain subsets of patients though have demonstrated efficacy across all subgroups. Lastly, there is an ongoing movement toward the development of time-limited strategies inclusive of both a BTKi and venetoclax that may further widen potential options. CLL patients requiring frontline therapy have a unique burden of choice between highly effective therapies that differ substantially with respect to side effect profiles and schedules. This review will focus on the frontline management of CLL in the setting of these rapidly changing options.
Collapse
Affiliation(s)
- Catherine C Coombs
- University of California Irvine, 200 S. Manchester Avenue, Suite 400, Room 428, ZOT 4061, Orange, Irvine, CA, 92868, USA.
| |
Collapse
|
9
|
Kittai AS, Hang Y, Bhat SA, Clark A, Grever M, Rhodes JM, Roberts M, Rogers KA, Teschemaker A, Munoz-Sagastibelza M, Woyach JA, Barrientos JC. Racial disparities in chronic lymphocytic leukemia/small lymphocytic lymphoma accounting for small molecule inhibitors: A real-world cohort analysis. Am J Hematol 2024; 99:780-784. [PMID: 38357757 DOI: 10.1002/ajh.27241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
Kaplan-Meier curve depicting overall survival from CLL treatment start by race. For patients with CLL, no overall survival difference was observed between races in this real-world US database.
Collapse
Affiliation(s)
- Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Ying Hang
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Abi Clark
- US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland, USA
| | - Michael Grever
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Joanna M Rhodes
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Melyssa Roberts
- US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Anna Teschemaker
- Global Evidence Generation, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland, USA
| | | | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
| | - Jacqueline C Barrientos
- Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
- Mount Sinai Comprehensive Cancer Center, Miami, Florida, USA
| |
Collapse
|
10
|
Avenarius MR, Huang Y, Kittai AS, Bhat SA, Rogers KA, Grever MR, Woyach JA, Miller CR. Comparison of karyotype scoring guidelines for evaluating karyotype complexity in chronic lymphocytic leukemia. Leukemia 2024; 38:676-678. [PMID: 38374409 DOI: 10.1038/s41375-024-02177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Affiliation(s)
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Cecelia R Miller
- Department of Pathology, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
11
|
Ong SY, Wang L. Leveraging genomics, transcriptomics and epigenomics to understand chemoimmunotherapy resistance in chronic lymphocytic leukemia. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2024; 7:7. [PMID: 38434768 PMCID: PMC10905154 DOI: 10.20517/cdr.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Patients with chronic lymphocytic leukemia (CLL) have differing clinical outcomes. Recent advances integrating multi-omic data have uncovered molecular subtypes in CLL with different prognostic implications and may allow better prediction of therapy response. While finite-duration chemoimmunotherapy (CIT) has enabled deep responses and prolonged duration of responses in the past, the advent of novel targeted therapy for the treatment of CLL has dramatically changed the therapeutic landscape. In this review, we discuss the latest genomic, transcriptomic, and epigenetic alterations regarded as major drivers of resistance to CIT in CLL. Further advances in genomic medicine will allow for better prediction of response to therapy and provide the basis for rational selection of therapy for long-term remissions with minimal toxicity.
Collapse
Affiliation(s)
- Shin Yeu Ong
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
- Department of Hematology, Singapore General Hospital, Singapore 169608, Singapore
| | - Lili Wang
- Department of Systems Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA
| |
Collapse
|
12
|
Brown J, Mashima K, Fernandes S, Naeem A, Shupe S, Fardoun R, Davids M. Mutations Detected in Real World Clinical Sequencing during BTK Inhibitor Treatment in CLL. RESEARCH SQUARE 2024:rs.3.rs-3837426. [PMID: 38313250 PMCID: PMC10836097 DOI: 10.21203/rs.3.rs-3837426/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
We retrospectively analyzed 609 chronic lymphocytic leukemia (CLL) patients treated with BTK inhibitors (BTKis) at Dana-Farber Cancer Institute from 2014 to 2022. Among them, 85 underwent next-generation sequencing (NGS) during or after BTKi therapy (ibrutinib, 64; acalabrutinib, 13; pirtobrutinib, 7; vecabrutinib, 1). Patients with NGS at progression (N=36, PD group) showed more 17p deletion, complex karyotype, and previous treatments including BTKi, compared to ongoing responders (N=49, NP group). 216 variants were found in 57 genes across both groups, with more variants in the PD group (158 variants, 70.3% pathogenic, P<0.001). The PD group had a higher incidence of pathogenic variants (70.3%, P<0.001), including 32 BTK(BTK C481S/F/R/Y, L528W, and T474I/L) and 4 PLCG2mutations. Notably, a high VAF L528W mutation was found in a first line ibrutinib-resistant patient. TP53, SF3B1, and NOTCH2mutations were also significantly more prevalent in the PD group (P<0.01, P<0.05, P<0.05). Additionally, MAPK pathway gene mutations trended more common and had higher VAFs in the PD group (P=0.041). T474 mutations were found in 4 of 6 patients progressing on pirtobrutinib, and BTK L528W mutation can arise with both covalent and non-covalent BTKi therapy. These results also suggest that RAS/RAF/MAPK pathway mutations may contribute to BTKi resistance.
Collapse
|
13
|
Teierle SM, Huang Y, Kittai AS, Bhat SA, Grever M, Rogers KA, Zhao W, Jones D, Byrd JC, Avenarius MR, Heerema NA, Woyach JA, Miller CR. Characteristics and outcomes of patients with CLL and CDKN2A/B deletion by fluorescence in situ hybridization. Blood Adv 2023; 7:7239-7242. [PMID: 37851900 PMCID: PMC10698542 DOI: 10.1182/bloodadvances.2023010753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/14/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Samantha M. Teierle
- Division of Hematology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Adam S. Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Seema A. Bhat
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Michael Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Kerry A. Rogers
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Weiqiang Zhao
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Daniel Jones
- Department of Pathology, The Ohio State University, Columbus, OH
| | - John C. Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH
| | | | - Nyla A. Heerema
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Jennifer A. Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | | |
Collapse
|
14
|
Nguyen-Khac F, Balogh Z, Chauzeix J, Veronese L, Chapiro E. Cytogenetics in the management of chronic lymphocytic leukemia: Guidelines from the Groupe Francophone de Cytogénétique Hématologique (GFCH). Curr Res Transl Med 2023; 71:103410. [PMID: 38039634 DOI: 10.1016/j.retram.2023.103410] [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: 07/05/2023] [Accepted: 09/14/2023] [Indexed: 12/03/2023]
Abstract
Chromosomal abnormalities are frequent in chronic lymphocytic leukemia (CLL), and most have prognostic value. In addition to the four well-known abnormalities (13q, 11q and 17p deletions, and trisomy 12), other recurrent aberrations have been linked to the disease outcome and/or drug resistance. Moreover, the complex karyotype has recently emerged as a prognostic marker for patients undergoing immunochemotherapy or targeted therapies. Here, we describe the main chromosomal abnormalities identified in CLL and related disorders (small lymphocytic lymphoma and monoclonal B-cell lymphocytosis) by reviewing the most recent literature and discussing their detection and clinical impact. Lastly, we provide technical guidelines and a strategy for the cytogenetic assessment of CLL.
Collapse
Affiliation(s)
- Florence Nguyen-Khac
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm UMRS 1138, Drug Resistance in Hematological Malignancies Team, F-75006 Paris, France; Sorbonne Université, Paris, France; Service d'Hématologie Biologique, Bâtiment Pharmacie, 3e étage, Pitié-Salpêtrière/Charles Foix University Hospital, AP-HP, 83 Bd de l'Hôpital, Paris F-75013, France.
| | - Zsofia Balogh
- Département d'Innovation Thérapeutique et des Essais Précoces, Gustave Roussy, Villejuif, France
| | - Jasmine Chauzeix
- Service d'Hématologie biologique, CHU de Limoges - CRIBL, UMR CNRS 7276/INSERM 1262, Limoges, France
| | - Lauren Veronese
- Service de Cytogénétique Médicale, CHU Estaing, 1 place Lucie et Raymond Aubrac, Clermont-Ferrand 63003, France
| | - Elise Chapiro
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm UMRS 1138, Drug Resistance in Hematological Malignancies Team, F-75006 Paris, France; Sorbonne Université, Paris, France; Service d'Hématologie Biologique, Bâtiment Pharmacie, 3e étage, Pitié-Salpêtrière/Charles Foix University Hospital, AP-HP, 83 Bd de l'Hôpital, Paris F-75013, France
| |
Collapse
|
15
|
Avenarius MR, Huang Y, Hyak J, Byrd JC, Bhat SA, Grever M, Kittai AS, Rogers KA, Jones D, Zhao W, Heerema NA, Abruzzo LV, Woyach J, Miller CR. Refining prognosis in chronic lymphocytic leukemia with normal Fluorescence in situ hybridization results. Hematol Oncol 2023; 41:771-775. [PMID: 37010242 DOI: 10.1002/hon.3134] [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] [Indexed: 04/04/2023]
Abstract
Fluorescence in situ hybridization (FISH) to detect the recurrent cytogenetics abnormalities deletion 13q, trisomy 12, deletion 11q, and deletion 17p is important for prognostication in chronic lymphocytic leukemia (CLL). A subset of patients are negative for each of these abnormalities (normal 12/13/11/17 FISH), and outcomes are heterogenous within this group. To elucidate variables important for prognostication in this subgroup we conducted a retrospective analysis of 280 treatment-naïve CLL patients with normal standard CLL FISH results. In a multivariable model, advanced Rai stage (p = 0.04, hazard ratio [HR] 1.24 (95% confidence interval [CI] 1.01-1.53)), unmutated immunoglobulin heavy chain gene (IGHV) (p < 0.0001, HR 5.59 (95% CI 3.63-8.62)) and IGH rearrangement by FISH (p = 0.02, HR 2.56 (95% CI 1.20-5.48)) were significantly associated with shorter time to first treatment. In a multivariable model for overall survival, increasing age at 5-year increments (p < 0.0001, HR 1.55 (95% CI 1.25-1.93)), unmutated IGHV (p = 0.01, HR 5.28 (95% CI 1.52-18.35)) and gain of REL (p = 0.01, HR 4.08 (5% CI 1.45-11.49)) were significantly associated with shorter survival. Our study identifies variables important for refining prognosis for CLL patients with normal standard CLL FISH results.
Collapse
Affiliation(s)
- Matthew R Avenarius
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Hyak
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - John C Byrd
- Department of Internal Medicine, The University of Cincinnati, Cincinnati, Ohio, USA
| | - Seema A Bhat
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Grever
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Kerry A Rogers
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Dan Jones
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Weiqiang Zhao
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Nyla A Heerema
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lynne V Abruzzo
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Woyach
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cecelia R Miller
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
16
|
Rosenquist R, Bernard E, Erkers T, Scott DW, Itzykson R, Rousselot P, Soulier J, Hutchings M, Östling P, Cavelier L, Fioretos T, Smedby KE. Novel precision medicine approaches and treatment strategies in hematological malignancies. J Intern Med 2023; 294:413-436. [PMID: 37424223 DOI: 10.1111/joim.13697] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Genetic testing has been applied for decades in clinical routine diagnostics of hematological malignancies to improve disease (sub)classification, prognostication, patient management, and survival. In recent classifications of hematological malignancies, disease subtypes are defined by key recurrent genetic alterations detected by conventional methods (i.e., cytogenetics, fluorescence in situ hybridization, and targeted sequencing). Hematological malignancies were also one of the first disease areas in which targeted therapies were introduced, the prime example being BCR::ABL1 inhibitors, followed by an increasing number of targeted inhibitors hitting the Achilles' heel of each disease, resulting in a clear patient benefit. Owing to the technical advances in high-throughput sequencing, we can now apply broad genomic tests, including comprehensive gene panels or whole-genome and whole-transcriptome sequencing, to identify clinically important diagnostic, prognostic, and predictive markers. In this review, we give examples of how precision diagnostics has been implemented to guide treatment selection and improve survival in myeloid (myelodysplastic syndromes and acute myeloid leukemia) and lymphoid malignancies (acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and chronic lymphocytic leukemia). We discuss the relevance and potential of monitoring measurable residual disease using ultra-sensitive techniques to assess therapy response and detect early relapses. Finally, we bring up the promising avenue of functional precision medicine, combining ex vivo drug screening with various omics technologies, to provide novel treatment options for patients with advanced disease. Although we are only in the beginning of the field of precision hematology, we foresee rapid development with new types of diagnostics and treatment strategies becoming available to the benefit of our patients.
Collapse
Affiliation(s)
- Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Elsa Bernard
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- PRISM Center for Personalized Medicine, Gustave Roussy, Villejuif, France
| | - Tom Erkers
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- SciLifeLab, Stockholm, Sweden
| | - David W Scott
- BC Cancer's Centre for Lymphoid Cancer, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Raphael Itzykson
- Université Paris Cité, Génomes, biologie cellulaire et thérapeutique U944, INSERM, CNRS, Paris, France
- Département Hématologie et Immunologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Rousselot
- Department of Hematology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jean Soulier
- Université Paris Cité, Génomes, biologie cellulaire et thérapeutique U944, INSERM, CNRS, Paris, France
- Hématologie Biologique, APHP, Hôpital Saint-Louis, Paris, France
| | - Martin Hutchings
- Department of Haematology and Phase 1 Unit, Rigshospitalet, Copenhagen, Denmark
| | - Päivi Östling
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- SciLifeLab, Stockholm, Sweden
| | - Lucia Cavelier
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Thoas Fioretos
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Genomics Lund, Science for Life Laboratory, Lund University, Lund, Sweden
| | - Karin E Smedby
- Department of Hematology, Karolinska University Hospital, Solna, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
17
|
Kang S, Ahn IE. Prognostic Markers in the Era of Targeted Therapies. Acta Haematol 2023; 147:33-46. [PMID: 37703841 DOI: 10.1159/000533704] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Small molecules targeting Bruton's tyrosine kinase (BTK) and B-cell lymphoma-2 have become the standard of care for the treatment of chronic lymphocytic leukemia (CLL), replacing chemoimmunotherapy (CIT) in most clinical settings. Ongoing trials explore targeted combinations and minimal residual disease-driven treatment cessation. These dramatic shifts in the current and upcoming treatment landscape of CLL raise the need to reevaluate existing prognostic markers and develop novel ones. SUMMARY This review examines prognostic markers in CLL patients treated with standard and investigational targeted therapies. Specifically, initial treatment of TP53 aberrant patients with a BTK inhibitor can achieve 70% progression-free survival (PFS) at 5 years, outperforming the 15% 5-year PFS with a CIT regimen containing fludarabine, cyclophosphamide, and rituximab (FCR). The prognostic implications of the immunoglobulin heavy chain variable gene (IGHV) mutation status have also changed. Unmutated IGHV is associated with inferior PFS and overall survival after FCR and inferior PFS with fixed-duration therapy with venetoclax and anti-CD20 monoclonal antibody but not with continuous BTK inhibitor treatment. KEY MESSAGES (1) Genetic variables (e.g., TP53 aberration, IGHV mutation, complex karyotype) have a prognostic significance in CLL patients treated with targeted therapy. (2) Understanding the prognostic and predictive values of these markers is critical for the development of a risk-adapted treatment strategy in CLL.
Collapse
Affiliation(s)
- Sorang Kang
- College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Inhye E Ahn
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Rigolin GM, Traversa A, Caputo V, Del Giudice I, Bardi A, Saccenti E, Raponi S, Ilari C, Cafforio L, Giovannetti A, Pizzuti A, Guarini A, Foà R, Cuneo A. Additional lesions identified by genomic microarrays are associated with an inferior outcome in low-risk chronic lymphocytic leukaemia patients. Br J Haematol 2023; 202:953-959. [PMID: 37357817 DOI: 10.1111/bjh.18946] [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: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
We explored the relevance of genomic microarrays (GM) in the refinement of prognosis in newly diagnosed low-risk chronic lymphocytic leukaemia (CLL) patients as defined by isolated del(13q) or no lesions by a standard 4 probe fluorescence in situ hybridization (FISH) analysis. Compared to FISH, additional lesions were detected by GM in 27 of the 119 patients (22.7%). The concordance rate between FISH and GM was 87.4%. Discordant results between cytogenetic banding analysis (CBA) and GM were observed in 45/119 cases (37.8%) and were mainly due to the intrinsic characteristics of each technique. The presence of additional lesions by GM was associated with age > 65 years (p = 0.047), advanced Binet stage (p = 0.001), CLL-IPI score (p < 0.001), a complex karyotype (p = 0.004) and a worse time-to-first treatment in multivariate analysis (p = 0.009). Additional lesions by GM were also significantly associated with a worse time-to-first treatment in the subset of patients with wild-type TP53 and mutated IGHV (p = 0.025). In CLL patients with low-risk features, the presence of additional lesions identified by GM helps to identify a subset of patients with a worse outcome that could be proposed for a risk-adapted follow-up and for early treatment including targeted agents within clinical trials.
Collapse
Affiliation(s)
| | - Alice Traversa
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Viviana Caputo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonella Bardi
- Hematology Section, St. Anna University Hospital, Ferrara, Italy
| | - Elena Saccenti
- Hematology Section, St. Anna University Hospital, Ferrara, Italy
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Caterina Ilari
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luciana Cafforio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
- GenomeUp S.r.l., Rome, Italy
| | - Agnese Giovannetti
- Clinical Genomics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Cuneo
- Hematology Section, St. Anna University Hospital, Ferrara, Italy
| |
Collapse
|
19
|
Rhodes J. FISH-ing for answers: Can genomic arrays add to our understanding of disease biology in low-risk chronic lymphocytic leukaemia? Br J Haematol 2023; 202:922-924. [PMID: 37519004 DOI: 10.1111/bjh.18992] [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: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
Patients with chronic lymphocytic leukaemia can have an indolent or aggressive clinical course. Current guidelines recommend performing immunoglobin heavy chain testing, four-colour probe fluorescence in situ hybridization testing and mutational analysis for TP53 mutations as part of routine prognostic testing to determine if high-risk genomic features are present. Rigolin et al. demonstrate that genomic microarray testing can identify high-risk genomic features in patients deemed low risk by current testing standards and is independently associated with shorter time to first treatment in their cohort. Commentary on: Rigolin et al. Additional lesions identified by genomic microarrays are associated with an inferior outcome in low-risk chronic lymphocytic leukaemia patients. Br J Haematol 2023;202:953-959.
Collapse
MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- In Situ Hybridization, Fluorescence
- Mutation
- Prognosis
- Genomics
Collapse
Affiliation(s)
- Joanna Rhodes
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson, New Brunswick, New York, USA
| |
Collapse
|
20
|
Woyach JA, Ghia P, Byrd JC, Ahn IE, Moreno C, O'Brien SM, Jones D, Cheung LW, Chong E, Kwei K, Dean JP, James DF, Wiestner A. B-cell Receptor Pathway Mutations Are Infrequent in Patients with Chronic Lymphocytic Leukemia on Continuous Ibrutinib Therapy. Clin Cancer Res 2023; 29:3065-3073. [PMID: 37314786 PMCID: PMC10425728 DOI: 10.1158/1078-0432.ccr-22-3887] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Acquired mutations in Bruton's tyrosine kinase (BTK) or phospholipase C-γ2 (PLCG2) genes are associated with clinical progressive disease (PD) in patients with chronic lymphocytic leukemia (CLL) treated with BTK inhibitors. Data on mutation rates in patients without PD on ibrutinib treatment are limited. EXPERIMENTAL DESIGN We evaluated frequency and time to detection of BTK and PLCG2 mutations in peripheral blood samples from 388 patients with previously untreated (n = 238) or relapsed/refractory (n = 150) CLL across five clinical trials. RESULTS With median follow-up of 35 months (range, 0-72) without PD at last sampling, mutations in BTK (3%), PLCG2 (2%), or both genes (1%) were rare in previously untreated patients. With median follow-up of 35 months (range, 1-70) without PD at last sample, mutations in BTK (30%), PLCG2 (7%), or both genes (5%) were more common in patients with relapsed/refractory CLL. Median time to first detection of BTK C481S mutation was not reached in previously untreated patients and was >5 years in patients with relapsed/refractory CLL. Among patients evaluable at PD, previously untreated patients (n = 12) had lower rates than those with relapsed/refractory disease (n = 45) of BTK (25% vs. 49%) and PLCG2 mutations (8% vs. 13%). Time from first detection of BTK C481S mutation to PD was 11.3 months in 1 previously untreated patient and median 8.5 months (range, 0-35.7) among 23 patients with relapsed/refractory CLL. CONCLUSIONS This systematic investigation describes development of mutations over time in patients without PD and informs the potential clinical opportunity to optimize ongoing benefits for such patients.
Collapse
MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Mutation
- Agammaglobulinaemia Tyrosine Kinase
- Receptors, Antigen, B-Cell/metabolism
Collapse
Affiliation(s)
| | - Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - John C. Byrd
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Inhye E. Ahn
- Laboratory of Lymphoid Malignancies, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Carol Moreno
- Department of Hematology, Hospital Santa Creu and Sant Pau, and The Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Susan M. O'Brien
- UC Irvine, Chao Family Comprehensive Cancer Center, Irvine, California
| | - Daniel Jones
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Leo W.K. Cheung
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Elizabeth Chong
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Kevin Kwei
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - James P. Dean
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Danelle F. James
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, California
| | - Adrian Wiestner
- Laboratory of Lymphoid Malignancies, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| |
Collapse
|
21
|
Fürstenau M, Thus YJ, Robrecht S, Mellink CHM, van der Kevie-Kersemaekers AM, Dubois J, von Tresckow J, Patz M, Gregor M, Thornton P, Staber PB, Tadmor T, Levin MD, da Cunha-Bang C, Schneider C, Poulsen CB, Illmer T, Schöttker B, Janssens A, Christiansen I, Nösslinger T, Baumann M, Hebart H, Gaska T, Regelink JC, Dompeling EC, Lindström V, Juliusson G, Widmer A, Goede J, Goldschmidt N, Simon F, De Silva N, Fink AM, Fischer K, Wendtner CM, Ritgen M, Brüggemann M, Tausch E, Spaargaren M, Eldering E, Stilgenbauer S, Niemann CU, Hallek M, Eichhorst B, Kreuzer KA, Kater AP. High karyotypic complexity is an independent prognostic factor in patients with CLL treated with venetoclax combinations. Blood 2023; 142:446-459. [PMID: 37172204 DOI: 10.1182/blood.2023019634] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/20/2023] [Accepted: 04/05/2023] [Indexed: 05/14/2023] Open
Abstract
Complex karyotypes have been associated with inferior outcomes in chronic lymphocytic leukemia (CLL) treated with chemoimmunotherapy (CIT), whereas their prognostic impact in the context of venetoclax-based treatments is still debated. In this prospective analysis on karyotype complexity in CLL, we evaluated the impact of complex (≥3 chromosomal aberrations [CAs], CKTs) and highly complex karyotypes (≥5 CAs; hCKTs) as well as specific aberrations in previously untreated patients without TP53 aberrations undergoing either CIT or time-limited venetoclax-based therapies in the phase 3 GAIA/CLL13 trial. Karyotype analyses were available for 895 of 926 patients (96.7%), of whom 153 (17%) had a CKT and 43 (5%) hCKT. In the CIT arm, CKT was associated with shorter progression-free survival (PFS) (hazard ratio [HR] 2.58; 95% confidence interval [95% CI], 1.54-4.32; P < .001) and overall survival (HR, 3.25; 95% CI, 1.03-10.26; P = .044). In the pooled venetoclax arms, a multivariable analysis identified hCKTs (HR, 1.96; 95% CI, 1.03-3.72; P = .041), but not CKTs, as independent adverse prognosticators for PFS. The presence of translocations (unbalanced and/or balanced) was also independently associated with shorter PFSs in the venetoclax arms. CIT led to the acquisition of additional CAs (mean CAs, 2.0-3.4; from baseline to CLL progression), whereas karyotype complexity remained stable after venetoclax-based treatments (2.0, both time points). This analysis establishes highly complex karyotypes and translocations as adverse prognostic factors in the context of venetoclax-based combination treatments. The findings of this study support the incorporation of karyotyping into the standard diagnostic workup of CLL, because it identifies patients at high risk of poor treatment outcomes and thereby improves prognostication. This trial was registered at www.clinicaltrials.gov as #NCT02950051.
Collapse
Affiliation(s)
- Moritz Fürstenau
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Yvonne J Thus
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandra Robrecht
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Clemens H M Mellink
- Genome Diagnostics Laboratory, Section Cytogenetics, Department of Human Genetics, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne-Marie van der Kevie-Kersemaekers
- Genome Diagnostics Laboratory, Section Cytogenetics, Department of Human Genetics, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Julie Dubois
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia von Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michaela Patz
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Michael Gregor
- Division of Hematology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Patrick Thornton
- Department of Haematology, Beaumont Hospital, RCSI University of Medicine and Health Sciences, Cancer Trials Ireland, Dublin, Ireland
| | - Philipp B Staber
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Tamar Tadmor
- Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Caspar da Cunha-Bang
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christof Schneider
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Thomas Illmer
- BAG Freiberg-Richter, Jacobasch, Wolf, Illmer, Dresden, Germany
| | - Björn Schöttker
- Hämatologisch-onkologische Schwerpunktpraxis Würzburg, Würzburg, Germany
| | - Ann Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Ilse Christiansen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Nösslinger
- Department of Internal Medicine III, Hanusch Hospital, Vienna, Austria
| | - Michael Baumann
- Swiss Group for Clinical Cancer Research, Berne, Switzerland
- Department of Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Holger Hebart
- Department of Oncology, Stauferklinikum, Mutlangen, Germany
| | - Tobias Gaska
- Hematology and Oncology, Brüderkrankenhaus, Paderborn, Germany
| | - Josien C Regelink
- Department of Haematology, Meander Medisch Centrum, Amersfoort, The Netherlands
| | | | - Vesa Lindström
- Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Anouk Widmer
- Swiss Group for Clinical Cancer Research, Berne, Switzerland
- Department of Medical Oncology and Haematology, Universitätsspital Zürich, Zürich, Switzerland
| | - Jeroen Goede
- Swiss Group for Clinical Cancer Research, Berne, Switzerland
- Clinic for Medical Oncology and Hematology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Florian Simon
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Nisha De Silva
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Munich Clinic Schwabing, Munich, Germany
| | - Matthias Ritgen
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Monika Brüggemann
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Marcel Spaargaren
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Eldering
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Carsten U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Hallek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
22
|
Urso A, Cavazzini F, Ballardini MP, Gambara S, Consolo S, Rigolin GM, Cuneo A. First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era. Cancers (Basel) 2023; 15:3859. [PMID: 37568676 PMCID: PMC10417156 DOI: 10.3390/cancers15153859] [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: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Antonio Cuneo
- Hematology Unit, University of Ferrara, 44121 Ferrara, Italy (F.C.); (M.P.B.); (S.C.)
| |
Collapse
|
23
|
Seymour JF. Approach to relapsed CLL including Richter Transformation. Hematol Oncol 2023; 41 Suppl 1:136-143. [PMID: 37294971 DOI: 10.1002/hon.3146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Affiliation(s)
- John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Al Mugairi A, Alzarea E, Almosa A, Alsomali F, Alqahtani A, Alhamied F, Albogami F, Al Zajdali L, AlBalwi M, Masaudi E, Alzahrani M, Al Hijazi A, Damlaj M, Alaskar A. Clinical and Cytogenetic Characterization, and Outcome of Chronic Lymphocytic Leukemia Patients in a Single Tertiary Center in Saudi Arabia. Clin Hematol Int 2023:10.1007/s44228-023-00035-9. [PMID: 37081205 DOI: 10.1007/s44228-023-00035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/01/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Areej Al Mugairi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, KAIMRC, Riyadh, Saudi Arabia
- Saudi Society of Blood and Marrow Transplantation, Riyadh, Saudi Arabia
| | - Ekremah Alzarea
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Abdulaziz Almosa
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Feisal Alsomali
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Abdulmajeed Alqahtani
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Fawaz Alhamied
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Faris Albogami
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Lubna Al Zajdali
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Mohammed AlBalwi
- King Abdullah International Medical Research Center, KAIMRC, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Emad Masaudi
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- King Abdullah International Medical Research Center, KAIMRC, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Divisions of Adult Hematology and Stem Cell Transplant, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426, Saudi Arabia
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ayman Al Hijazi
- King Abdullah International Medical Research Center, KAIMRC, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Divisions of Adult Hematology and Stem Cell Transplant, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426, Saudi Arabia
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Moussab Damlaj
- King Abdullah International Medical Research Center, KAIMRC, Riyadh, Saudi Arabia.
- Divisions of Adult Hematology and Stem Cell Transplant, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426, Saudi Arabia.
- Saudi Society of Blood and Marrow Transplantation, Riyadh, Saudi Arabia.
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
- Khalifa University, Abu Dhabi, United Arab Emirates.
| | - Ahmed Alaskar
- King Abdullah International Medical Research Center, KAIMRC, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Divisions of Adult Hematology and Stem Cell Transplant, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426, Saudi Arabia
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
25
|
Bomben R, Rossi FM, Vit F, Bittolo T, Zucchetto A, Papotti R, Tissino E, Pozzo F, Degan M, Polesel J, Bulian P, Marasca R, Reda G, Laurenti L, Olivieri J, Chiarenza A, Laureana R, Postorino M, Del Principe MI, Cuneo A, Gentile M, Morabito F, Fronza G, Tafuri A, Zaja F, Foà R, Di Raimondo F, Del Poeta G, Gattei V. Clinical impact of TP53 disruption in chronic lymphocytic leukemia patients treated with ibrutinib: a campus CLL study. Leukemia 2023; 37:914-918. [PMID: 36807650 PMCID: PMC10079531 DOI: 10.1038/s41375-023-01845-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Riccardo Bomben
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
| | - Francesca Maria Rossi
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Filippo Vit
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Tamara Bittolo
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Robel Papotti
- International PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Erika Tissino
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Federico Pozzo
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Massimo Degan
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Pietro Bulian
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Roberto Marasca
- Hematology Unit, Department of Oncology and Hematology, Azienda-Ospedaliero Universitaria (AOU) of Modena, Policlinico, Modena, Italy.,Department of Medical and Surgical Sciences, University of Modena e Reggio Emilia, Modena, Italy
| | - Gianluigi Reda
- Division of Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi" DISM, Azienda Ospedaliera Universitaria S. Maria Misericordia, Udine, Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | | | | | | | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimo Gentile
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Fortunato Morabito
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Hematology Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine and Hematology, Sant'Andrea - University Hospital - Sapienza, University of Rome, Rome, Italy
| | - Francesco Zaja
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | | | - Valter Gattei
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
| |
Collapse
|
26
|
Edelmann J, Malcikova J, Riches JC. Opinion: What defines high-risk CLL in the post-chemoimmunotherapy era? Front Oncol 2023; 13:1106579. [PMID: 36845738 PMCID: PMC9948015 DOI: 10.3389/fonc.2023.1106579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Affiliation(s)
- Jennifer Edelmann
- ClinSciNet - The Clinician Scientist Network, Münsingen, Germany,*Correspondence: Jennifer Edelmann,
| | - Jitka Malcikova
- Department of Internal Medicine – Hematology and Oncology, University Hospital Brno, Masaryk University, Brno, Czechia,Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - John C. Riches
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Department of Haemato-Oncology, Barts Health NHS Trust, St. Bartholomew’s Hospital, London, United Kingdom
| |
Collapse
|
27
|
Woyach JA. Management of relapsed/refractory Chronic Lymphocytic Leukemia. Am J Hematol 2022; 97 Suppl 2:S11-S18. [PMID: 36125037 PMCID: PMC9826056 DOI: 10.1002/ajh.26683] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
The therapeutic landscape for chronic lymphocytic leukemia (CLL) has changed dramatically over the past decade as our understanding of the biology of CLL has advanced, allowing the development of oral therapies targeting key drivers of CLL. Currently, inhibitors of Bruton's Tyrosine Kinase and the BH3 mimetic venetoclax are standards of care for both frontline and relapsed/refractory CLL. Sequencing of available therapies, therefore, has become a major challenge of therapy. In this review, we will focus on the current landscape for the treatment of relapsed/refractory CLL. We will also discuss important considerations when sequencing these available treatments. The recent advances in this disease are significant steps forward, and raise new questions of how these available drugs should be given as well as how we can continue to improve the treatment of CLL.
Collapse
Affiliation(s)
- Jennifer A. Woyach
- Division of Hematology, Department of Internal MedicineThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
28
|
Hampel PJ, Rabe KG, Call TG, Ding W, Leis JF, Chanan-Khan AA, Kenderian SS, Muchtar E, Wang Y, Ailawadhi S, Koehler AB, Parrondo R, Schwager SM, Sher T, Hanson CA, Shi M, Van Dyke DL, Braggio E, Slager SL, Kay NE, Parikh SA. Clinical outcomes in patients with chronic lymphocytic leukemia with disease progression on ibrutinib. Blood Cancer J 2022; 12:124. [PMID: 36050317 PMCID: PMC9437078 DOI: 10.1038/s41408-022-00721-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) with disease progression on ibrutinib have worse outcomes compared to patients stopping ibrutinib due to toxicity. A better understanding of expected outcomes in these patients is necessary to establish a benchmark for evaluating novel agents currently available and in development. We evaluated outcomes of 144 patients with CLL treated at Mayo Clinic with 2018 iwCLL disease progression on ibrutinib. The median overall survival (OS) for the entire cohort was 25.5 months; it was 29.8 months and 8.3 months among patients with CLL progression (n = 104) and Richter transformation (n = 38), respectively. Longer OS was observed among patients with CLL progression who had received ibrutinib in the frontline compared to relapsed/refractory setting (not reached versus 28.5 months; p = 0.04), but was similar amongst patients treated with 1, 2, or ≥3 prior lines (18.5, 30.9, and 26.0 months, respectively, p = 0.24). Among patients with CLL disease progression on ibrutinib, OS was significantly longer when next-line treatment was chimeric antigen receptor T-cell therapy (median not reached) or venetoclax-based treatment (median 29.8 months) compared to other approved treatments, such as chemoimmunotherapy, phosphoinositide 3'-kinase inhibitors, and anti-CD20 monoclonal antibodies (9.1 months; p = 0.03). These findings suggest an unmet need for this growing patient population.
Collapse
Affiliation(s)
- Paul J Hampel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kari G Rabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Timothy G Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Asher A Chanan-Khan
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Saad S Kenderian
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eli Muchtar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yucai Wang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Amber B Koehler
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ricardo Parrondo
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Susan M Schwager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Taimur Sher
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Curtis A Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Van Dyke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Esteban Braggio
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Susan L Slager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Neil E Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
29
|
Sigmund AM, Huang Y, Ruppert AS, Maddocks K, Rogers KA, Jaglowski S, Bhat SA, Kittai AS, Grever MR, Byrd JC, Woyach JA. Depth of response and progression-free survival in chronic lymphocytic leukemia patients treated with ibrutinib. Leukemia 2022; 36:2129-2131. [PMID: 35842461 DOI: 10.1038/s41375-022-01640-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kami Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
30
|
Puiggros A, Ramos-Campoy S, Kamaso J, de la Rosa M, Salido M, Melero C, Rodríguez-Rivera M, Bougeon S, Collado R, Gimeno E, García-Serra R, Alonso S, Moro-García MA, García-Malo MD, Calvo X, Arenillas L, Ferrer A, Mantere T, Hoischen A, Schoumans J, Espinet B. Optical Genome Mapping: A Promising New Tool to Assess Genomic Complexity in Chronic Lymphocytic Leukemia (CLL). Cancers (Basel) 2022; 14:cancers14143376. [PMID: 35884436 PMCID: PMC9317182 DOI: 10.3390/cancers14143376] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022] Open
Abstract
Novel treatments in chronic lymphocytic leukemia (CLL) have generated interest regarding the clinical impact of genomic complexity, currently assessed by chromosome banding analysis (CBA) and chromosomal microarray analysis (CMA). Optical genome mapping (OGM), a novel technique based on imaging of long DNA molecules labeled at specific sites, allows the identification of multiple cytogenetic abnormalities in a single test. We aimed to determine whether OGM is a suitable alternative to cytogenomic assessment in CLL, especially focused on genomic complexity. Cytogenomic OGM aberrations from 42 patients were compared with CBA, FISH, and CMA information. Clinical−biological characteristics and time to first treatment (TTFT) were analyzed according to the complexity detected by OGM. Globally, OGM identified 90.3% of the known alterations (279/309). Discordances were mainly found in (peri-)centromeric or telomeric regions or subclonal aberrations (<15−20%). OGM underscored additional abnormalities, providing novel structural information on known aberrations in 55% of patients. Regarding genomic complexity, the number of OGM abnormalities had better accuracy in predicting TTFT than current methods (C-index: 0.696, 0.602, 0.661 by OGM, CBA, and CMA, respectively). A cut-off of ≥10 alterations defined a complex OGM group (C-OGM, n = 12), which included 11/14 patients with ≥5 abnormalities by CBA/CMA and one patient with chromothripsis (Kappa index = 0.778; p < 0.001). Moreover, C-OGM displayed enrichment of TP53 abnormalities (58.3% vs. 3.3%, p < 0.001) and a significantly shorter TTFT (median: 2 vs. 43 months, p = 0.014). OGM is a robust technology for implementation in the routine management of CLL patients, although further studies are required to define standard genomic complexity criteria.
Collapse
Affiliation(s)
- Anna Puiggros
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
- Correspondence: (A.P.); (B.E.)
| | - Silvia Ramos-Campoy
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Joanna Kamaso
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Mireia de la Rosa
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Marta Salido
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Carme Melero
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - María Rodríguez-Rivera
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Sandrine Bougeon
- Oncogenomic Laboratory, Hematology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland; (S.B.); (J.S.)
| | - Rosa Collado
- Department of Hematology, Consorcio Hospital General Universitario, 46014 Valencia, Spain; (R.C.); (R.G.-S.)
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, 08003 Barcelona, Spain;
- Applied Clinical Research in Hematological Malignances, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Rocío García-Serra
- Department of Hematology, Consorcio Hospital General Universitario, 46014 Valencia, Spain; (R.C.); (R.G.-S.)
- Research Foundation from Hospital General Universitario, 46014 Valencia, Spain
| | - Sara Alonso
- Department of Hematology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | | | | | - Xavier Calvo
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Leonor Arenillas
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Ana Ferrer
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Tuomo Mantere
- Department of Human Genetics, Radboud University Medical Center, 6500 Nijmegen, The Netherlands; (T.M.); (A.H.)
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit and Biocenter Oulu, University of Oulu, 90570 Oulu, Finland
| | - Alexander Hoischen
- Department of Human Genetics, Radboud University Medical Center, 6500 Nijmegen, The Netherlands; (T.M.); (A.H.)
- Radboud Center for Infectious Diseases (RCI), Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6532 Nijmegen, The Netherlands
| | - Jacqueline Schoumans
- Oncogenomic Laboratory, Hematology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland; (S.B.); (J.S.)
| | - Blanca Espinet
- Molecular Cytogenetics and Hematological Cytology Laboratories, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (S.R.-C.); (J.K.); (M.d.l.R.); (M.S.); (C.M.); (M.R.-R.); (X.C.); (L.A.); (A.F.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
- Correspondence: (A.P.); (B.E.)
| |
Collapse
|
31
|
Cherng HJ, Khwaja R, Kanagal‐Shamanna R, Tang G, Burger J, Thompson P, Ferrajoli A, Estrov Z, Sasaki K, Sampath D, Wang X, Kantarjian H, Keating M, Wierda WG, Jain N. TP53-altered chronic lymphocytic leukemia treated with firstline Bruton's tyrosine kinase inhibitor-based therapy: A retrospective analysis. Am J Hematol 2022; 97:1005-1012. [PMID: 35567779 PMCID: PMC9354943 DOI: 10.1002/ajh.26595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022]
Abstract
Long-term follow up of prospective studies has shown that continuous Bruton's tyrosine kinase inhibitor (BTKi) therapy leads to durable remissions in previously untreated patients with TP53-altered chronic lymphocytic leukemia (CLL); however, it is unknown how variant allele frequency (VAF) of TP53 mutation (TP53-m) or percentage of cells with deletion of chromosome 17p [del(17p)] influences efficacy of firstline BTKi. We performed a retrospective analysis of 130 patients with CLL with baseline del(17p) and/or TP53-m treated with BTKi with or without the BCL2 inhibitor venetoclax (VEN) and with or without CD20 antibody in the firstline setting. A total of 104/130 (80%) patients had del(17p). TP53-m was noted in 89/110 (81%) patients tested; there were 101 unique TP53-m with an available VAF. The 4-year progression-free survival (PFS) and overall survival (OS) rates were 72.9% and 83.6%. No baseline characteristics including IGHV mutation status and number of TP53 alterations were associated with significant differences in PFS or OS, though a trend toward shorter PFS with increasing karyotypic complexity (hazard ratio 1.08, p = .066) was observed. Del(17p) was identified in <25% of cells in 26/104 (25%) of patients, and 28/101 (28%) of TP53-m were low-burden with a VAF of <10%; outcomes of these patients were similar to those with high-burden lesions. This study suggests that low-burden TP53 alterations should not be ignored when assessing genomic risk in CLL in the era of targeted therapy.
Collapse
Affiliation(s)
- Hua‐Jay J. Cherng
- Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Raamis Khwaja
- Department of Internal Medicine The University of Texas Health Science Center at Houston Houston Texas USA
| | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Guilin Tang
- Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jan Burger
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Philip Thompson
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Alessandra Ferrajoli
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zeev Estrov
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Deepa Sampath
- Department of Hematopoietic Biology and Malignancy The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Xuemei Wang
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Michael Keating
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - William G. Wierda
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| |
Collapse
|
32
|
Molica S, Giannarelli D, Visentin A, Reda G, Sportoletti P, Frustaci AM, Chiarenza A, Ciolli S, Vitale C, Laurenti L, De Paoli L, Murru R, Gentile M, Moia R, Rigolin GM, Levato L, Giordano A, Del Poeta G, Stelitano C, Deodato M, Ielo C, Noto A, Guarente V, Coscia M, Tedeschi A, Gaidano G, Cuneo A, Foa' R, Trentin L, Mauro FR. Prediction of outcomes in chronic lymphocytic leukemia patients treated with ibrutinib: Validation of current prognostic models and development of a simplified three-factor model. Am J Hematol 2022; 97:E176-E180. [PMID: 35170793 DOI: 10.1002/ajh.26502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Stefano Molica
- Department of Hematology‐Oncology Azienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Diana Giannarelli
- Biostatistic Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padua Italy
| | - Gianluigi Reda
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Paolo Sportoletti
- Institute of Hematology‐Centro di Ricerca Emato‐Oncologica (CREO), Department of Medicine University of Perugia Perugia Italy
| | - Anna Maria Frustaci
- Department of Hematology Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milano Milan 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
| | - Luca Laurenti
- Institute of Haematology Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit Ospedale Oncologico A. Businco AO Brotzu Cagliari Italy
| | - Massimo Gentile
- Hematology Unit Hematology and Oncology Department Cosenza Italy
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences St. Anna University Hospital Ferrara Italy
| | - Luciano Levato
- Department of Hematology‐Oncology Azienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Annamaria Giordano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section University of Bari Bari Italy
| | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention University Tor Vergata Rome Italy
| | - Caterina Stelitano
- Department Hematology Grande Ospedale Metropolitano Reggio Calabria Italy
| | - Marina Deodato
- Department of Hematology Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milano Milan Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Alessandro Noto
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Valerio Guarente
- Institute of Hematology‐Centro di Ricerca Emato‐Oncologica (CREO), Department of Medicine University of Perugia Perugia Italy
| | - 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
| | - Alessandra Tedeschi
- Department of Hematology Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milano Milan Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences St. Anna University Hospital Ferrara Italy
| | - Robin Foa'
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padua Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| |
Collapse
|
33
|
Maitre E, Cornet E, Debliquis A, Drenou B, Gravey F, Chollet D, Cheze S, Docquier M, Troussard X, Matthes T. Hairy cell leukemia: a specific 17-gene expression signature points to new targets for therapy. J Cancer Res Clin Oncol 2022; 148:2013-2022. [PMID: 35476232 PMCID: PMC9293816 DOI: 10.1007/s00432-022-04010-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/01/2022] [Indexed: 11/16/2022]
Abstract
Background Hairy cell leukemia (HCL) is a rare chronic B cell malignancy, characterized by infiltration of bone marrow, blood and spleen by typical “hairy cells” that bear the BRAFV600E mutation. However, in addition to the intrinsic activation of the MAP kinase pathway as a consequence of the BRAFV600E mutation, the potential participation of other signaling pathways to the pathophysiology of the disease remains unclear as the precise origin of the malignant hairy B cells. Materials and methods Using mRNA gene expression profiling based on the Nanostring technology and the analysis of 290 genes with crucial roles in B cell lymphomas, we defined a 17 gene expression signature specific for HCL. Results Separate analysis of samples from classical and variant forms of hairy cell leukemia showed almost similar mRNA expression profiles apart from overexpression in vHCL of the immune checkpoints CD274 and PDCD1LG2 and underexpression of FAS. Our results point to a post-germinal memory B cell origin and in some samples to the activation of the non-canonical NF-κB pathway. Conclusions This study provides a better understanding of the pathogenesis of HCL and describes new and potential targets for treatment approaches and guidance for studies in the molecular mechanisms of HCL. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-04010-4.
Collapse
Affiliation(s)
- Elsa Maitre
- Normandie University, UNIROUEN, UNICAEN, INSERM1245, MICAH, Avenue de la côte de Nacre, 14033, Caen, France.,Laboratory Hematology, University Hospital Caen, Avenue de la Côte de Nacre, 14033, Caen cedex, France
| | - Edouard Cornet
- Laboratory Hematology, University Hospital Caen, Avenue de la Côte de Nacre, 14033, Caen cedex, France
| | - Agathe Debliquis
- Department of Haematology, Groupe Hospitalier de la Région Mulhouse Sud Alsace, 20 avenue du docteur René laennec, 68100, Mulhouse, France
| | - Bernard Drenou
- Department of Haematology, Groupe Hospitalier de la Région Mulhouse Sud Alsace, 20 avenue du docteur René laennec, 68100, Mulhouse, France
| | - François Gravey
- Normandie University, UNIROUEN, UNICAEN, GRAM2.0, Avenue de la côte de Nacre, 14033, Caen, France
| | - Didier Chollet
- iGE3 Genomics Platform, University Medical Center, Geneva University, 1211, Geneva, Switzerland.,Department of Genetics and Evolution, Sciences III, Geneva University, 1205, Geneva, Switzerland
| | - Stephane Cheze
- Hematology Institute, University Hospital Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Mylène Docquier
- iGE3 Genomics Platform, University Medical Center, Geneva University, 1211, Geneva, Switzerland.,Department of Genetics and Evolution, Sciences III, Geneva University, 1205, Geneva, Switzerland
| | - Xavier Troussard
- Normandie University, UNIROUEN, UNICAEN, INSERM1245, MICAH, Avenue de la côte de Nacre, 14033, Caen, France.,Laboratory Hematology, University Hospital Caen, Avenue de la Côte de Nacre, 14033, Caen cedex, France.,Hematology Institute, University Hospital Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Thomas Matthes
- Hematology Service, Department of Oncology and Clinical Pathology Service, Department of Diagnostics, University Hospital Geneva, 1211, Geneva, Switzerland.
| |
Collapse
|
34
|
Nguyen-Khac F, Bidet A, Daudignon A, Lafage-Pochitaloff M, Ameye G, Bilhou-Nabéra C, Chapiro E, Collonge-Rame MA, Cuccuini W, Douet-Guilbert N, Eclache V, Luquet I, Michaux L, Nadal N, Penther D, Quilichini B, Terre C, Lefebvre C, Troadec MB, Véronèse L. The complex karyotype in hematological malignancies: a comprehensive overview by the Francophone Group of Hematological Cytogenetics (GFCH). Leukemia 2022; 36:1451-1466. [DOI: 10.1038/s41375-022-01561-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
|
35
|
Gauthier M. La leucémie lymphoïde chronique. Rev Med Interne 2022; 43:356-364. [DOI: 10.1016/j.revmed.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/29/2021] [Accepted: 01/29/2022] [Indexed: 12/01/2022]
|
36
|
Are we finally getting personal? Moving towards a personalized approach in chronic lymphocytic leukemia. Semin Cancer Biol 2022; 84:329-338. [DOI: 10.1016/j.semcancer.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/21/2022]
|
37
|
Chatzikonstantinou T, Demosthenous C, Baliakas P. Biology and Treatment of High-Risk CLL: Significance of Complex Karyotype. Front Oncol 2021; 11:788761. [PMID: 34912723 PMCID: PMC8667220 DOI: 10.3389/fonc.2021.788761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022] Open
Abstract
Several reports highlight the clinical significance of cytogenetic complexity, namely, complex karyotype (CK) identified though the performance of chromosome banding analysis (CBA) in chronic lymphocytic leukemia. Indeed, apart from a number of studies underscoring the prognostic and predictive value of CK in the chemo(immune)therapy era, mounting evidence suggests that CK could serve as an independent prognosticator and predictor even in patients treated with novel agents. In the present review, we provide an overview of the current knowledge regarding the clinical impact of CK in CLL, touching upon open issues related to the incorporation of CK in the clinical setting.
Collapse
Affiliation(s)
- Thomas Chatzikonstantinou
- Hematology Department-Bone Marrow Transplantation (BMT) Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Christos Demosthenous
- Hematology Department-Bone Marrow Transplantation (BMT) Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - 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
| |
Collapse
|
38
|
The more complex, the worse outcome in CLL. Blood 2021; 138:2305-2307. [PMID: 34882215 DOI: 10.1182/blood.2021013285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
|
39
|
Molica S, Seymour JF, Polliack A. A perspective on prognostic models in chronic lymphocytic leukemia in the era of targeted agents. Hematol Oncol 2021; 39:595-604. [PMID: 34596261 DOI: 10.1002/hon.2929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022]
Abstract
Despite the increase in the number of prognostic models currently available for evaluating patients with chronic lymphocytic leukemia (CLL), their current application and utilization in clinical practice in the era of targeted agents is unclear. A critical reappraisal of recently developed prognostic models is presented in this review. The underlying CLL's genetic instability and changes in the host's health and comorbidities can all contribute to the acquisition of additional risk factors for adverse outcomes during the course of the disease. Therefore, available risk models solely based on pretreatment variables only partially predict patients' clinical outcome. A dynamic prognostic model that takes into account changes in the risk profile over time could indeed be useful in routine clinical practice. The next generation of risk assessment models should incorporate post-treatment and response biomarkers such as minimal residual disease. Finally, recent advances in the field of machine learning present novel opportunities to generate models capable of providing an individualized estimation of clinical outcomes in CLL. However, in the era of improved prognostic models, it is important to remember that these indices should supplement but not replace clinical expertise and medical decision-making.
Collapse
Affiliation(s)
- Stefano Molica
- Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Aaron Polliack
- Department of Hematology, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|