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Durer S, Durer C, Shafqat M, Comba IY, Malik S, Faridi W, Aslam S, Ijaz A, Tariq MJ, Fraz MA, Usman M, Khan AY, McBride A, Anwer F. Concomitant use of blinatumomab and donor lymphocyte infusion for mixed-phenotype acute leukemia: a case report with literature review. Immunotherapy 2020; 11:373-378. [PMID: 30786841 DOI: 10.2217/imt-2018-0104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Blinatumomab and donor lymphocyte infusion (DLI) combination is a promising cancer therapy, whereby blinatumomab might achieve an initial reduction in leukemic-cell burden using T cells, and after tumor clearance, DLI can potentially stimulate the donor immune system to achieve longer lasting remission. Here, we present a 51-year-old female with mixed phenotype acute leukemia who had a hematologic relapse 3 months after she received total body irradiation-based myeloablative allogeneic hematopoietic stem cell transplantation from an unrelated human leukocyte antigen matched (10/10) donor and achieved complete remission with minimal residual disease negativity by multi-parameter flow cytometry using the combination of blinatumomab and DLI. To the best of our knowledge, this is the first report to describe the use of blinatumomab and DLI combination therapy in the treatment of B/myeloid mixed phenotype acute leukemia.
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Affiliation(s)
- Seren Durer
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Ceren Durer
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Madeeha Shafqat
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Isin Yagmur Comba
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL 32827, USA
| | - Saad Malik
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Warda Faridi
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Shehroz Aslam
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Awais Ijaz
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Muhammad Junaid Tariq
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Muhammad Asad Fraz
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Muhammad Usman
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Ali Y Khan
- Department of Medicine, Division of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Tucson, AZ 85724, USA
| | - Ali McBride
- Department of Pharmacy, University of Arizona Cancer Center, Tucson, AZ 85721, USA
| | - Faiz Anwer
- Department of Hematology, Taussig Cancer Center, Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
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Liu D, Mamorska-Dyga A. Syk inhibitors in clinical development for hematological malignancies. J Hematol Oncol 2017; 10:145. [PMID: 28754125 PMCID: PMC5534090 DOI: 10.1186/s13045-017-0512-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/20/2017] [Indexed: 01/03/2023] Open
Abstract
Spleen tyrosine kinase (Syk) is a cytosolic non-receptor protein tyrosine kinase (PTK) and is mainly expressed in hematopoietic cells. Syk was recognized as a critical element in the B-cell receptor signaling pathway. Syk is also a key component in signal transduction from other immune receptors like Fc receptors and adhesion receptors. Several oral Syk inhibitors including fostamatinib (R788), entospletinib (GS-9973), cerdulatinib (PRT062070), and TAK-659 are being assessed in clinical trials. The second generation compound, entospletinib, showed promising results in clinical trials against B-cell malignancies, mainly chronic lymphoid leukemia. Syk inhibitors are being evaluated in combination regimens in multiple malignancies.
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Affiliation(s)
- Delong Liu
- Department of Oncology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Aleksandra Mamorska-Dyga
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY, 10595, USA
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Nägele V, Kratzer A, Zugmaier G, Holland C, Hijazi Y, Topp MS, Gökbuget N, Baeuerle PA, Kufer P, Wolf A, Klinger M. Changes in clinical laboratory parameters and pharmacodynamic markers in response to blinatumomab treatment of patients with relapsed/refractory ALL. Exp Hematol Oncol 2017; 6:14. [PMID: 28533941 PMCID: PMC5437652 DOI: 10.1186/s40164-017-0074-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/02/2017] [Indexed: 12/24/2022] Open
Abstract
Background Blinatumomab has shown a remission rate of 69% in an exploratory single-arm, phase II dose-escalation study in adult patients with relapsed/refractory B-precursor acute lymphoblastic leukemia (ALL). We evaluated changes in laboratory parameters and immunopharmacodynamic markers in patients who received blinatumomab in the exploratory phase II study. Methods Data from 36 adults with relapsed/refractory ALL receiving blinatumomab as 4-week continuous IV infusions in various dose cohorts were analyzed for changes in liver enzymes, first-dose parameters, peripheral blood cell subpopulations, and cytokine/granzyme B release. Associations with clinical response were evaluated. Results Liver enzymes and inflammatory parameters transiently increased primarily during the first treatment week without clinical symptoms and reversed to baseline levels thereafter. B and T cells showed expected depletion and redistribution kinetics, respectively. Similarly, thrombocytes and T cells displayed an initial decline in cell counts, whereas neutrophils peaked during the first days after infusion start. T-cell redistribution coincided with upregulation of LFA-1 and CD69. Patients who responded to blinatumomab had more pronounced T-cell expansion, which was associated with proliferation of CD4+ and CD8+ T cells and memory subsets. Release of cytokines and granzyme B primarily occurred during the first week of cycle 1, except for IL-10, which was released in subsequent cycles. Blinatumomab step-dosing was associated with lower cytokine release and lower body temperature. Conclusions In this study of relapsed/refractory ALL, blinatumomab-induced changes in laboratory parameters were transient and reversible. The evaluated PD markers demonstrated blinatumomab activity, and the analysis of cytokines supported the rationale for stepwise dosing. (ClinicalTrials.gov Identifier NCT01209286.) Electronic supplementary material The online version of this article (doi:10.1186/s40164-017-0074-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginie Nägele
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Andrea Kratzer
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Gerhard Zugmaier
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | | | - Youssef Hijazi
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Nicola Gökbuget
- Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Patrick A Baeuerle
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Peter Kufer
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Andreas Wolf
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
| | - Matthias Klinger
- Amgen Research (Munich) GmbH, Staffelseestrasse 2, 81477 Munich, Germany
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Abstract
Chimeric antigen receptor (CAR)-engineered T cells (CAR-T cells) have yielded unprecedented efficacy in B cell malignancies, most remarkably in anti-CD19 CAR-T cells for B cell acute lymphoblastic leukemia (B-ALL) with up to a 90% complete remission rate. However, tumor antigen escape has emerged as a main challenge for the long-term disease control of this promising immunotherapy in B cell malignancies. In addition, this success has encountered significant hurdles in translation to solid tumors, and the safety of the on-target/off-tumor recognition of normal tissues is one of the main reasons. In this mini-review, we characterize some of the mechanisms for antigen loss relapse and new strategies to address this issue. In addition, we discuss some novel CAR designs that are being considered to enhance the safety of CAR-T cell therapy in solid tumors.
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Katchi T, Liu D. Diagnosis and treatment of CD20 negative B cell lymphomas. Biomark Res 2017; 5:5. [PMID: 28191314 PMCID: PMC5297138 DOI: 10.1186/s40364-017-0088-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023] Open
Abstract
CD20 negative B cell non-Hodgkin lymphoma (NHL) is rare and accounts for approximately 1-2% of B cell lymphomas. CD20- negative NHL is frequently associated with extranodal involvement, atypical morphology, aggressive clinical behaviour, resistance to standard chemotherapy and poor prognosis. The most common types of these include plasmablastic lymphoma, primary effusion lymphoma, large B-cell lymphoma arising from HHV8-associated multicentric Castleman’s disease, and ALK+ large B cell lymphoma. This review provides an overview of the diagnostic and treatment modalities for CD20 negative B cell NHL.
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Affiliation(s)
- Tasleem Katchi
- Division of Hematology & Oncology, New York Medical College and Westchester Medical Center, Valhalla, NY 10595 USA
| | - Delong Liu
- Division of Hematology & Oncology, New York Medical College and Westchester Medical Center, Valhalla, NY 10595 USA
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Wu J, Liu C, Tsui ST, Liu D. Second-generation inhibitors of Bruton tyrosine kinase. J Hematol Oncol 2016; 9:80. [PMID: 27590878 PMCID: PMC5010774 DOI: 10.1186/s13045-016-0313-y] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/26/2016] [Indexed: 12/14/2022] Open
Abstract
Bruton tyrosine kinase (BTK) is a critical effector molecule for B cell development and plays a major role in lymphoma genesis. Ibrutinib is the first-generation BTK inhibitor. Ibrutinib has off-target effects on EGFR, ITK, and Tec family kinases, which explains the untoward effects of ibrutinib. Resistance to ibrutinib was also reported. The C481S mutation in the BTK kinase domain was reported to be a major mechanism of resistance to ibrutinib. This review summarizes the clinical development of novel BTK inhibitors, ACP-196 (acalabrutinib), ONO/GS-4059, and BGB-3111.
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Affiliation(s)
- Jingjing Wu
- Department of Oncology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Christina Liu
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, 60208, USA
| | - Stella T Tsui
- SUNY Stony Brook University, Stony Brook, NY, 11794, USA
| | - Delong Liu
- Department of Oncology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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