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Veenbergen S, Jugooa R, Te Marvelde J, de Vries ACH, van der Velden VHJ. Normal and malignant cells are homogeneously distributed in the bone marrow of children. Leuk Lymphoma 2024; 65:1186-1189. [PMID: 38587123 DOI: 10.1080/10428194.2024.2337782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Sharon Veenbergen
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Romana Jugooa
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen Te Marvelde
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrica C H de Vries
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent H J van der Velden
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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2
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Oh BL, Vinanica N, Wong DM, Campana D. Chimeric antigen receptor T-cell therapy for T-cell acute lymphoblastic leukemia. Haematologica 2024; 109:1677-1688. [PMID: 38832423 PMCID: PMC11141683 DOI: 10.3324/haematol.2023.283848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 01/11/2024] [Indexed: 06/05/2024] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a new and effective treatment for patients with hematologic malignancies. Clinical responses to CAR T cells in leukemia, lymphoma, and multiple myeloma have provided strong evidence of the antitumor activity of these cells. In patients with refractory or relapsed B-cell acute lymphoblastic leukemia (ALL), the infusion of autologous anti-CD19 CAR T cells is rapidly gaining standard-of-care status and might eventually be incorporated into frontline treatment. In T-ALL, however, leukemic cells generally lack surface molecules recognized by established CAR, such as CD19 and CD22. Such deficiency is particularly important, as outcome is dismal for patients with T-ALL that is refractory to standard chemotherapy and/or hematopoietic stem cell transplant. Recently, CAR T-cell technologies directed against T-cell malignancies have been developed and are beginning to be tested clinically. The main technical obstacles stem from the fact that malignant and normal T cells share most surface antigens. Therefore, CAR T cells directed against T-ALL targets might be susceptible to self-elimination during manufacturing and/or have suboptimal activity after infusion. Moreover, removing leukemic cells that might be present in the cell source used for CAR T-cell manufacturing might be problematic. Finally, reconstitution of T cells and natural killer cells after CAR T-cell infusion might be impaired. In this article, we discuss potential targets for CAR T-cell therapy of T-ALL with an emphasis on CD7, and review CAR configurations as well as early clinical results.
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Affiliation(s)
- Bernice L.Z. Oh
- Viva-University Children’s Cancer Center, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore
| | - Natasha Vinanica
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore
| | - Desmond M.H. Wong
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore
| | - Dario Campana
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore
- Cancer Science Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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3
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Hayashi RJ, Hermiston ML, Wood BL, Teachey DT, Devidas M, Chen Z, Annett RD, Asselin BL, August K, Cho S, Dunsmore KP, Freedman JL, Galardy PJ, Harker-Murray P, Horton TM, Jaju A, Lam A, Messinger YH, Miles RR, Okada M, Patel S, Schafer ES, Schechter T, Shimano KA, Singh N, Steele A, Sulis ML, Vargas SL, Winter SS, Wood C, Zweidler-McKay PA, Loh ML, Hunger SP, Raetz EA, Bollard CM, Allen CE. MRD at the end of induction and EFS in T-cell lymphoblastic lymphoma: Children's Oncology Group trial AALL1231. Blood 2024; 143:2053-2058. [PMID: 38457359 PMCID: PMC11143515 DOI: 10.1182/blood.2023021184] [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: 09/14/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
ABSTRACT Defining prognostic variables in T-lymphoblastic lymphoma (T-LL) remains a challenge. AALL1231 was a Children's Oncology Group phase 3 clinical trial for newly diagnosed patients with T acute lymphoblastic leukemia or T-LL, randomizing children and young adults to a modified augmented Berlin-Frankfurt-Münster backbone to receive standard therapy (arm A) or with addition of bortezomib (arm B). Optional bone marrow samples to assess minimal residual disease (MRD) at the end of induction (EOI) were collected in T-LL analyzed to assess the correlation of MRD at the EOI to event-free survival (EFS). Eighty-six (41%) of the 209 patients with T-LL accrued to this trial submitted samples for MRD assessment. Patients with MRD <0.1% (n = 75) at EOI had a superior 4-year EFS vs those with MRD ≥0.1% (n = 11) (89.0% ± 4.4% vs 63.6% ± 17.2%; P = .025). Overall survival did not significantly differ between the 2 groups. Cox regression for EFS using arm A as a reference demonstrated that MRD EOI ≥0.1% was associated with a greater risk of inferior outcome (hazard ratio, 3.73; 95% confidence interval, 1.12-12.40; P = .032), which was independent of treatment arm assignment. Consideration to incorporate MRD at EOI into future trials will help establish its value in defining risk groups. CT# NCT02112916.
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Affiliation(s)
- Robert J. Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Michelle L. Hermiston
- Pediatric Hematology Oncology, University of California, San Francisco, San Francisco, CA
| | - Brent L. Wood
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - David T. Teachey
- Division of Pediatric Oncology, Department of Pediatrics, Center for Childhood Cancer Research, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Zhiguo Chen
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Robert D. Annett
- Department of Pediatrics, University of New Mexico, Albuquerque, NM
| | - Barbara L. Asselin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, NY
| | - Keith August
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Steve Cho
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Wisconsin Institute for Medical Research, Madison, WI
| | - Kimberly P. Dunsmore
- Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Jason Lawrence Freedman
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Paul J. Galardy
- Department of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN
| | - Paul Harker-Murray
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Midwest Children's Cancer Center, Milwaukee, WI
| | - Terzah M. Horton
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Alok Jaju
- Division of Pediatric Radiology, Department of Radiology, Lurie Children's Hospital, Chicago, IL
| | - Allison Lam
- Miller Children's and Women’s Hospital, Long Beach, CA
| | - Yoav H. Messinger
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Rodney R. Miles
- Division of Hematopathology, Department of Pathology, ARUP Institute for Clinical and Experimental Pathology, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Maki Okada
- Division of Radiation Oncology, Department of Oncology, University of Alberta–Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta–Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Eric S. Schafer
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Tal Schechter
- Division of Hematology/Oncology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kristin A. Shimano
- Department of Pediatrics, University of California Benioff Children’s Hospital, San Francisco, CA
| | - Neelam Singh
- Michigan State University Clinical Center, Lansing, MI
| | - Amii Steele
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Carolinas Medical Center/Levine Cancer Institute, Charlotte, NC
| | - Maria L. Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sarah L. Vargas
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Oncology Group, Monrovia, CA
| | - Stuart S. Winter
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Research Institute and Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN
| | - Charlotte Wood
- Department of Biostatistics, Children's Oncology Group Data Center, Gainesville, FL
| | | | - Mignon L. Loh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Stephen P. Hunger
- Division of Pediatric Oncology, Department of Pediatrics, Center for Childhood Cancer Research, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth A. Raetz
- Division of Pediatric Hematology and Oncology, Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, NYU Langone Health, New York, NY
| | - Catherine M. Bollard
- Division of Blood and Bone Marrow Transplantation, Department of Pediatrics, Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC
| | - Carl E. Allen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Huang Z, Fu Y, Yang H, Zhou Y, Shi M, Li Q, Liu W, Liang J, Zhu L, Qin S, Hong H, Liu Y. Liquid biopsy in T-cell lymphoma: biomarker detection techniques and clinical application. Mol Cancer 2024; 23:36. [PMID: 38365716 PMCID: PMC10874034 DOI: 10.1186/s12943-024-01947-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
T-cell lymphoma is a highly invasive tumor with significant heterogeneity. Invasive tissue biopsy is the gold standard for acquiring molecular data and categorizing lymphoma patients into genetic subtypes. However, surgical intervention is unfeasible for patients who are critically ill, have unresectable tumors, or demonstrate low compliance, making tissue biopsies inaccessible to these patients. A critical need for a minimally invasive approach in T-cell lymphoma is evident, particularly in the areas of early diagnosis, prognostic monitoring, treatment response, and drug resistance. Therefore, the clinical application of liquid biopsy techniques has gained significant attention in T-cell lymphoma. Moreover, liquid biopsy requires fewer samples, exhibits good reproducibility, and enables real-time monitoring at molecular levels, thereby facilitating personalized health care. In this review, we provide a comprehensive overview of the current liquid biopsy biomarkers used for T-cell lymphoma, focusing on circulating cell-free DNA (cfDNA), circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), Epstein-Barr virus (EBV) DNA, antibodies, and cytokines. Additionally, we discuss their clinical application, detection methodologies, ongoing clinical trials, and the challenges faced in the field of liquid biopsy.
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Affiliation(s)
- Zongyao Huang
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yao Fu
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Yang
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yehan Zhou
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Min Shi
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Qingyun Li
- Genecast Biotechnology Co., Ltd, Wuxi, 214104, China
| | - Weiping Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Junheng Liang
- Nanjing Geneseeq Technology Inc., Nanjing, 210032, Jiangsu, China
| | - Liuqing Zhu
- Nanjing Geneseeq Technology Inc., Nanjing, 210032, Jiangsu, China
| | - Sheng Qin
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Huangming Hong
- Department of Medical Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Yang Liu
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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El-Mallawany NK, Alexander S, Fluchel M, Hayashi RJ, Lowe EJ, Giulino-Roth L, Wistinghausen B, Hermiston M, Allen CE. Children's Oncology Group's 2023 blueprint for research: Non-Hodgkin lymphoma. Pediatr Blood Cancer 2023; 70 Suppl 6:e30565. [PMID: 37449925 PMCID: PMC10577684 DOI: 10.1002/pbc.30565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Pediatric non-Hodgkin lymphoma (NHL) includes over 30 histologies (many with subtypes), with approximately 800 cases per year in the United States. Improvements in survival in NHL over the past 5 decades align with the overall success of the cooperative trial model with dramatic improvements in outcomes. As an example, survival for advanced Burkitt lymphoma is now >95%. Major remaining challenges include survival for relapsed and refractory disease and long-term morbidity in NHL survivors. Langerhans cell histiocytosis (LCH) was added to the NHL Committee portfolio in recognition of LCH as a neoplastic disorder and the tremendous unmet need for improved outcomes. The goal of the Children' Oncology Group NHL Committee is to identify optimal cures for every child and young adult with NHL (and LCH). Further advances will require creative solutions, including engineering study groups to combine rare populations, biology-based eligibility, alternative endpoints, facilitating international collaborations, and coordinated correlative biology.
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Affiliation(s)
- Nader Kim El-Mallawany
- Baylor College of Medicine, Texas Children’s Hospital, Texas Children’s Cancer Center, Houston, TX
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Mark Fluchel
- Division of Pediatric Hematology/Oncology, Seattle Children’s, Hospital, and University of Washington School of Medicine, Seattle, WA
| | - Robert J. Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, Siteman Cancer Center, St. Louis, MO
| | - Eric J. Lowe
- Children’s Hospital of The Kings Daughters, Division of Pediatric Hematology-Oncology, Norfolk, VA
| | | | - Birte Wistinghausen
- Center for Cancer and Blood Disorders and Center for Cancer and Immunology Research, Children’s National Research Institute, Children’s National Hospital; The George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Carl E. Allen
- Baylor College of Medicine, Texas Children’s Hospital, Texas Children’s Cancer Center, Houston, TX
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6
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Makde MM, Kodate PM, Kamal MM, Shroff V, Tijare JR, Kumbhalkar DT. Study of Extramedullary Lymphoblastic Lymphoma (LBL) Diagnosed by Flowcytometric Immunophenotyping (FCI) on Fine Needle Aspirate (FNA) Sample-A Case Series of 18 Cases. J Cytol 2023; 40:119-125. [PMID: 37745809 PMCID: PMC10516155 DOI: 10.4103/joc.joc_141_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/10/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023] Open
Abstract
Background Lymphoblastic lymphoma (LBL) accounts for about 2% of all lymphomas. Recognition of T/B-LBL albeit of their rareness is very important as they present as localized diseases with low tumor burden. They can present both at nodal and extranodal sites. Limitation of diagnosis and classification of lymphoma on fine needle aspirate (FNA) can be minimized by clubbing it with flowcytometric immunophenotyping (FCI) to ensure diagnostic accuracy rapidly. Aim Study of a series of 18 cases of LBL to assess the utility of FCI on FNA and effusion samples in extramedullary LBL. Methods and Material FCI was done on FNA and effusion samples from 130 morphologically diagnosed/suspicious cases of lymphoreticular malignancy, followed by peripheral blood and bone marrow (BM) examination. The patients diagnosed to have B/T LBL, based on WHO 2017 classification, were selected for further analyses. Results FCI of 130 cases showed 91 mature and 18 precursor lymphoid neoplasms. These 18 cases were from lymph nodes (11), pleural fluid (03), and soft tissue masses (04). Peripheral blood and BM of 15/18 cases were normal of which FCI revealed T-LBL (11) and B-LBL (04). Two cases (both T LBL) showed BM involvement (<25%), while one case of B-LBL which was misdiagnosed as mature lymphoma by immunohistochemistry (IHC) evolved as B ALL. Conclusions Diagnosis of extramedullary B/T-LBL needs comprehensive evaluation of clinical presentation, cytomorphology, and immunophenotyping. Rapid and accurate diagnosis by FCI on FNA and effusion samples allows early therapeutic decisions, thereby avoiding leukemic dissemination.
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Affiliation(s)
- Manjiri M. Makde
- Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Purnima M. Kodate
- Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Meherbano M. Kamal
- Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Vrushali Shroff
- Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Jayashree R. Tijare
- Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Dinkar T. Kumbhalkar
- Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India
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7
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Temple WC, Mueller S, Hermiston ML, Burkhardt B. Diagnosis and management of lymphoblastic lymphoma in children, adolescents and young adults. Best Pract Res Clin Haematol 2023; 36:101449. [PMID: 36907639 DOI: 10.1016/j.beha.2023.101449] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
Lymphoblastic lymphoma (LBL) is the second most common type of non-Hodgkin Lymphoma (NHL) in children, adolescents, and young adults (CAYA), accounting for 25-35% of all cases. T-lymphoblastic lymphoma (T-LBL) comprises 70-80% of cases, while precursor B-lymphoblastic lymphoma (pB-LBL) makes up the remaining 20-25% of cases. Event-free and overall survival (EFS and OS) for paediatric LBL patients both exceed 80% with current therapies. Treatment regimens, especially in T-LBL with large mediastinal tumours, are complex with significant toxicity and long-term complications. Though prognosis overall is good for T-LBL and pB-LBL with upfront therapy, outcomes for patients with relapsed or refractory (r/r) disease remain dismal. Here, we review new understanding about the pathogenesis and biology of LBL, recent clinical results and future directions for therapy, and remaining obstacles to improve outcomes while reducing toxicity.
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Affiliation(s)
- William C Temple
- Paediatric Haematology and Oncology, University of California, San Francisco, USA; Paediatric Allergy, Immunology, and Bone Marrow Transplantation, University of California, San Francisco, USA
| | - Stephanie Mueller
- Paediatric Haematology and Oncology, University Hospital Muenster, Germany; NHL-BFM Study Center, University Hospital Muenster, Germany
| | - Michelle L Hermiston
- Paediatric Haematology and Oncology, University of California, San Francisco, USA; Paediatric Allergy, Immunology, and Bone Marrow Transplantation, University of California, San Francisco, USA.
| | - Birgit Burkhardt
- Paediatric Haematology and Oncology, University Hospital Muenster, Germany; NHL-BFM Study Center, University Hospital Muenster, Germany
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8
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Newman H, Teachey DT. A Bright Horizon: Immunotherapy for Pediatric T-Cell Malignancies. Int J Mol Sci 2022; 23:8600. [PMID: 35955734 PMCID: PMC9369002 DOI: 10.3390/ijms23158600] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023] Open
Abstract
Immunotherapy has transformed the treatment of hematologic malignancies in the past two decades. The treatment of acute lymphoblastic leukemia (ALL), in particular, has been highly impacted by multiple novel immunotherapies. For pediatric patients with T-cell malignancies, translating immunotherapies has proved more challenging due to the complexities of fratricide, risk of product contamination with malignant cells, and concerns over T-cell aplasia. Despite these hurdles, many creative and promising strategies are on the horizon. We review challenges in the development of immunotherapy for T-cell malignancies, strategies to overcome these challenges, as well as therapies currently being investigated and starting to reach the clinic. Immunotherapy will hopefully successfully treat patients with relapsed and refractory T-cell malignancies and may someday be incorporated in up-front protocols in order to prevent relapses.
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Affiliation(s)
- Haley Newman
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David T. Teachey
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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9
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Intermesoli T, Weber A, Leoncin M, Frison L, Skert C, Bassan R. Lymphoblastic Lymphoma: a Concise Review. Curr Oncol Rep 2022; 24:1-12. [DOI: 10.1007/s11912-021-01168-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 12/19/2022]
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10
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Toward Pediatric T Lymphoblastic Lymphoma Stratification Based on Minimal Disseminated Disease and NOTCH1/FBXW7 Status. Hemasphere 2021; 5:e641. [PMID: 34514345 PMCID: PMC8423389 DOI: 10.1097/hs9.0000000000000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
While outcome for pediatric T lymphoblastic lymphoma (T-LL) has improved with acute leukemia-type therapy, survival after relapse remains rare. Few prognostic markers have been identified: NOTCH1 and/or FBXW7 (N/F) mutations identify good prognosis T-LL and high-level minimal disseminated disease (MDD) is reported to be of poor prognosis. We evaluated MDD and/or MRD status by 8-color flow cytometry and/or digital droplet PCR in 82 pediatric T-LL treated according to the EURO-LB02 prednisone reference arm. Both techniques gave identical results for values ≥0.1%, allowing compilation. Unlike historical studies, an MDD threshold of 1% had no prognostic significance. The 54% (42/78) of patients with MDD ≥0.1% had a relatively favorable outcome (5-y overall survival [OS] 97.6% versus 80.6%, P = 0.015, 5-y event-free-survival [EFS] 95.2% versus 80.6%, P = 0.049). MDD lower than 0.1% had no impact in N/F mutated T-LL, but identified the N/F germline patient with a high risk of relapse. Combining oncogenetic and MDD status identified 86% of patients (n = 49) with an excellent outcome and 14% of N/F germline/MDD <0.1% patients (n = 8) with poor prognosis (5y-OS 95.9% versus 37.5%, P < 0.001; 5y-EFS 93.9% versus 37.5%, P < 0.001). If confirmed by prospective studies, MDD and N/F mutational status would allow identification of a subset of patients who merit consideration for alternative front-line treatment.
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11
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Prognostic Role of Minimal Disseminated Disease and NOTCH1/FBXW7 Mutational Status in Children with Lymphoblastic Lymphoma: The AIEOP Experience. Diagnostics (Basel) 2021; 11:diagnostics11091594. [PMID: 34573936 PMCID: PMC8468850 DOI: 10.3390/diagnostics11091594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
NOTCH1/FBXW7 (N/F) mutational status at diagnosis is employed for T-cell lymphoblastic lymphoma (T-LBL) patients’ stratification in the international protocol LBL 2018. Our aim was to validate the prognostic role of Minimal Disseminated Disease (MDD) alone and in combination with N/F mutational status in a large retrospective series of LBL pediatric patients. MDD was analyzed in 132 bone marrow and/or peripheral blood samples by flow cytometry. Mutations in N/F genes were analyzed on 58 T-LBL tumor biopsies. Using the previously established cut-off of 3%, the four-year progression-free survival (PFS) was 57% for stage I–III patients with MDD ≥ 3% versus 80% for patients with MDD inferior to cut-off (p = 0.068). We found a significant worsening in the four-year PFS for nonmutated (51 ± 12%) compared to mutated patients (100%, p = 0.0013). Combining MDD and N/F mutational status in a subgroup of available cases, we found a statistically significant difference in the four-year PFS for different risk groups (p = 0.0012). Overall, our results demonstrate that N/F mutational status has a more relevant prognostic value than MDD at diagnosis. However, the combination of N/F mutations with MDD analysis could identify patients with very aggressive disease, which might benefit from a more intensive treatment.
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12
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Ruxolitinib as a Novel Therapeutic Option for Poor Prognosis T-LBL Pediatric Patients. Cancers (Basel) 2021; 13:cancers13153724. [PMID: 34359628 PMCID: PMC8345121 DOI: 10.3390/cancers13153724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 01/05/2023] Open
Abstract
Simple Summary Current treatment protocols for pediatric patients with T-Lymphoblastic lymphoma (T-LBL) allow the achievement of a complete remission in around 85% of T-LBL pediatric patients; however the overall survival rate of second-line treatments for patients with progressive disease or relapse is around 14%. Thus, the major issues to be addressed are the identification of a valuable predictor marker to foresee the disease risk and new therapeutic targets to improve relapsed/resistant patients’ outcome. We identified JAK2 Y1007-1008 as a potential prognosis marker as well as a therapeutic target for patients with progressive disease or relapse and suggest that its inhibition by ruxolitinib, a JAK1/2 FDA approved inhibitor, could represent a novel therapeutic approach to overcome therapy resistance and meliorate the outcome of pediatric T-LBL patients. Abstract Lymphoblastic lymphoma (LBL) is the second most common type of non-Hodgkin lymphoma in childhood, mainly of T cell origin (T-LBL). Although current treatment protocols allow a complete remission in 85% of cases, the second-line treatment overall survival for patients with progressive or relapsed disease is around 14%, making this the major issue to be confronted. Thus, we performed a Reverse Phase Protein Array study in a cohort of 22 T-LBL patients to find reliable disease risk marker(s) and new therapeutic targets to improve pediatric T-LBL patients’ outcome. Interestingly, we pinpointed JAK2 Y1007-1008 as a potential prognosis marker as well as a therapeutic target in poor prognosis patients. Hence, the hyperactivation of the JAK1/2-STAT6 pathway characterizes these latter patients. Moreover, we functionally demonstrated that STAT6 hyperactivation contributes to therapy resistance by binding the glucocorticoid receptor, thus inhibiting its transcriptional activity. This was further confirmed by specific STAT6 gene silencing followed by dexamethasone treatment. Finally, JAK1/2-STAT6 pathway inhibition by ruxolitinib, an FDA approved drug, in cell line models and in one T-LBL primary sample led to cell proliferation reduction and increased apoptosis. Globally, our results identify a new potential prognostic marker and suggest a novel therapeutic approach to overcome therapy resistance in pediatric T-LBL patients.
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Integrated omics approaches to predict T-LBL relapse risk. Blood 2021; 137:2280-2282. [PMID: 33914078 DOI: 10.1182/blood.2020009599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Minimal Disease Monitoring in Pediatric Non-Hodgkin's Lymphoma: Current Clinical Application and Future Challenges. Cancers (Basel) 2021; 13:cancers13081907. [PMID: 33921029 PMCID: PMC8071445 DOI: 10.3390/cancers13081907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022] Open
Abstract
Minimal residual disease (MRD) detection is established routine practice for treatment stratification in leukemia and used for treatment optimization in adult lymphomas. Minimal disease studies in childhood non-Hodgkin lymphomas are challenged by stratified treatment in different subtypes, high cure rates, low patient numbers, limited initial tumor material, and early progression. Current clinical applications differ between the subtypes. A prognostic value of minimal disseminated disease (MDD) could not yet be clearly established for lymphoblastic lymphoma using flow cytometry and PCR-based methods for T-cell receptor (TCR) or immunoglobulin (IG) rearrangements. MYC-IGH fusion sequences or IG rearrangements enable minimal disease detection in Burkitt lymphoma and -leukemia. An additional prognostic value of MDD in Burkitt lymphoma and early MRD in Burkitt leukemia is implicated by single studies with risk-adapted therapy. MDD and MRD determined by PCR for ALK-fusion transcripts are independent prognostic parameters for patients with ALK-positive anaplastic large cell lymphoma (ALCL). They are introduced in routine clinical practice and used for patient stratification in clinical studies. Early MRD might serve as an endpoint for clinical trials and for guiding individual therapy. Validation of MDD and MRD as prognostic parameters is required for all subtypes but ALCL. Next-generation sequencing-based methods may provide new options and applications for minimal disease evaluation in childhood lymphomas.
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Choi HJ, Shin J, Kang S, Suh JK, Kim H, Koh KN, Im HJ. Long-term treatment outcomes of children and adolescents with lymphoblastic lymphoma treated with various regimens: a single-center analysis. Blood Res 2020; 55:262-274. [PMID: 33380561 PMCID: PMC7784128 DOI: 10.5045/br.2020.2020220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/03/2022] Open
Abstract
Background Lymphoblastic lymphoma (LBL) is the second most common subtype of pediatric non-Hodgkin lymphoma. Modified treatments derived from the LSA2-L2 regimen resulted in encouraging survival, but toxicities and long-term sequelae have been problematic. At present, the acute lymphoblastic leukemia (ALL)-type protocol has demonstrated efficacy in LBL. We analyzed the outcomes of children and adolescents with LBL treated with various regimens. Methods From 1991‒2018, this study enrolled 63 patients diagnosed with LBL at Asan Medical Center. Medical records were retrospectively analyzed. Results Among 63 patients, most patients (38.1%) presented with stage IV at diagnosis, and two had central nervous system (CNS) involvement. At a median follow-up of 160 months, the 5-year event free survival (EFS), overall survival (OS), and relapse free survival (RFS) were 68.8%, 79.3%, and 71.3%, respectively. Among 61 patients who received chemotherapy, 27 patients (44.3%) received the NY protocol, and 14 (23.0%) received the ALL-type protocol. There was no significant difference in 5-yr OS (85.2%/78.6%), EFS (73.5%/78.6%), and RFS (73.5%/78.6%) between the NY and ALL protocol groups, regardless of immunophenotype. Thirteen patients (21.3%) received prophylactic cranial radiotherapy with no difference in the incidence of CNS relapse based on irradiation. Conclusion This study showed no difference in outcome between the NY and ALL-type protocols, regardless of stage or immunophenotype. In addition to improving the effectiveness of treatment, it is necessary to continuously appraise the appropriate chemotherapy regimen, considering toxicities and long-term prognosis, for pediatric LBL.
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Affiliation(s)
- Ho Jung Choi
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Juhee Shin
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sunghan Kang
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Kyung Suh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyery Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung-Nam Koh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Hayashi RJ, Winter SS, Dunsmore KP, Devidas M, Chen Z, Wood BL, Hermiston ML, Teachey DT, Perkins SL, Miles RR, Raetz EA, Loh ML, Winick NJ, Carroll WL, Hunger SP, Lim MS, Gross TG, Bollard CM. Successful Outcomes of Newly Diagnosed T Lymphoblastic Lymphoma: Results From Children's Oncology Group AALL0434. J Clin Oncol 2020; 38:3062-3070. [PMID: 32552472 PMCID: PMC7479761 DOI: 10.1200/jco.20.00531] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The Children's Oncology Group (COG) protocol AALL0434 evaluated the safety and efficacy of multi-agent chemotherapy with Capizzi-based methotrexate/pegaspargase (C-MTX) in patients with newly diagnosed pediatric T-cell lymphoblastic lymphoma (T-LL) and gained preliminary data using nelarabine in high-risk patients. PATIENTS AND METHODS The trial enrolled 299 patients, age 1-31 years. High-risk (HR) patients had ≥ 1% minimal detectable disease (MDD) in the bone marrow at diagnosis or received prior steroid treatment. Induction failure was defined as failure to achieve a partial response (PR) by the end of the 4-week induction. All patients received the augmented Berlin-Frankfurt-Muenster (ABFM) C-MTX regimen. HR patients were randomly assigned to receive or not receive 6 5-day courses of nelarabine incorporated into ABFM. Patients with induction failure were nonrandomly assigned to ABFM C-MTX plus nelarabine. No patients received prophylactic cranial radiation; however, patients with CNS3 disease (CSF WBC ≥ 5/μL with blasts or cranial nerve palsies, brain/eye involvement, or hypothalamic syndrome) were ineligible. RESULTS At end-induction, 98.8% of evaluable participants had at least a PR. The 4-year event-free survival (EFS) and overall survival (OS) were 84.7% ± 2.3% and 89.0% ± 2.0%. The 4-year disease-free survival (DFS) from end-induction was 85.9% ± 2.6%. There was no difference in DFS observed between the HR and standard-risk groups (P = .29) or by treatment regimen (P = .55). Disease stage, tumor response, and MDD at diagnosis did not demonstrate thresholds that resulted in differences in EFS. Nelarabine did not show an advantage for HR patients. CNS relapse occurred in only 4 patients. CONCLUSION COG AALL0434 produced excellent outcomes in one of the largest trials ever conducted for patients with newly diagnosed T-LL. The COG ABFM regimen with C-MTX provided excellent EFS and OS without cranial radiation.
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Affiliation(s)
- Robert J. Hayashi
- Pediatric Hematology/Oncology, Washington School of Medicine, St Louis Children’s Hospital, St Louis, MO
| | - Stuart S. Winter
- Children’s Minnesota Cancer and Blood Disorders Program, Minneapolis, MN
| | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN
| | - Zhiguo Chen
- Department of Biostatistics, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Brent L. Wood
- Laboratory Medicine, Seattle Children’s Hospital, Seattle, WA
| | - Michelle L. Hermiston
- Department of Pediatrics, UCSF Benioff Children’s Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - David T. Teachey
- Division of Oncology, Department of Pediatrics, Center for Childhood Cancer Research, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sherrie L. Perkins
- Department of Pathology, University of Utah Health Sciences Center, ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Rodney R. Miles
- Department of Pathology, University of Utah Health Sciences Center, ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Elizabeth A. Raetz
- Department of Pediatrics and Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Mignon L. Loh
- Department of Pediatrics, UCSF Benioff Children’s Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Naomi J. Winick
- Pediatric Hematology/Oncology, University of Texas Southwestern/Simmons Cancer Center, Dallas, TX
| | - William L. Carroll
- Department of Pediatrics and Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Stephen P. Hunger
- Division of Oncology, Department of Pediatrics, Center for Childhood Cancer Research, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Megan S. Lim
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, and The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas G. Gross
- National Cancer Institute Center for Global Health, Rockville, MD
| | - Catherine M. Bollard
- Division of Blood and Marrow Transplantation, Children’s National Health System, Washington, DC
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17
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Abstract
Pediatric T-cell hematologic malignancies are a diverse group of rare cancers. The most common pediatric T-cell malignancies include T-cell acute lymphoblastic leukemia (T-ALL) and anaplastic large cell lymphoma (ALCL). Although the overall survival rates have improved markedly in recent years, children with relapsed T-ALL and ALCL have very low rates of cure and few salvage therapies exist. Current treatment regimens rely on toxic chemotherapies with significant short- and long-term morbidity. Immunotherapies, including antibodies and adoptive cellular therapies, have revolutionized the treatment of B-cell malignancies in pediatrics. The adaptation of these therapies to T-cell malignancies has been slower because of challenges implicit in the design and implementation of immunotherapies for T-cell malignancies, including the potential risks of fratricide, immunosuppression, and graft versus host disease (GVHD). We present a review of current challenges in the development of immunotherapies for T-cell hematologic malignancies, potential solutions and therapies under investigation. We include a particular focus on T-ALL and ALCL. Immunotherapies offer promising strategies to improve outcomes in children with T-cell malignancies, particularly in the setting of relapse. Optimizing efficacy, mitigating toxicity, and safely integrating with conventional therapies are key considerations as immunotherapies are translated into the clinic.
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Affiliation(s)
- Caroline Diorio
- Division of Oncology, Department of Pediatrics, Center for Childhood Cancer Research, Children's Hospital of Philadelphia and Pereleman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David T Teachey
- Division of Oncology, Department of Pediatrics, Center for Childhood Cancer Research, Children's Hospital of Philadelphia and Pereleman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Teachey DT, O'Connor D. How I treat newly diagnosed T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma in children. Blood 2020; 135:159-166. [PMID: 31738819 PMCID: PMC6966932 DOI: 10.1182/blood.2019001557] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy that has historically been associated with a very poor prognosis. Nevertheless, despite a lack of incorporation of novel agents, the development of intensified T-ALL-focused protocols has resulted in significant improvements in outcome in children. Through the use of several representative cases, we highlight the key changes that have driven these advances including asparaginase intensification, the use of induction dexamethasone, and the safe omission of cranial radiotherapy. We discuss the results of recent trials to explore key topics including the implementation of risk stratification with minimal residual disease measurement and how to treat high-risk subtypes such as early T-cell precursor ALL. In particular, we address current discrepancies in treatment between different cooperative groups, including the use of nelarabine, and provide rationales for current treatment protocols for both T-ALL and T-lymphoblastic lymphoma.
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Affiliation(s)
- David T Teachey
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David O'Connor
- Department of Haematology, University College London (UCL) Cancer Institute, London, United Kingdom; and
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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19
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Chitikela S, Pushpam D. Commentary on Clinical Predictors and Prognostic Model for Pediatric Lymphoblastic Lymphoma Treated with Uniform BFM90 Protocol: A Single-Center Experience of 65 Patients from Asia. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_12_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Suh JK, Gao YJ, Tang JY, Jou ST, Lin DT, Takahashi Y, Kojima S, Jin L, Zhang Y, Seo JJ. Clinical Characteristics and Treatment Outcomes of Pediatric Patients with Non-Hodgkin Lymphoma in East Asia. Cancer Res Treat 2019; 52:359-368. [PMID: 31352772 PMCID: PMC7176969 DOI: 10.4143/crt.2019.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/26/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose The presentations and geographic incidence of pediatric non-Hodgkin lymphoma (NHL) differ from those of adults. This study delineated the characteristics and outcomes of pediatric NHL in East Asia. Materials and Methods Medical records of 749 pediatric patients with NHL treated at participating institutions in mainland China, Japan, Korea, and Taiwan from January 2008 to December 2013 were reviewed. Demographic and clinical features, survival outcomes, and putative prognostic factors were analyzed. Results Five hundred thirty patients (71%) were male. The most common pathologic subtypes were Burkitt lymphoma (BL) (36%). Six hundred seven patients (81%) had advanced diseases at diagnosis. The 5-year overall survival and event-free survival (EFS) rates were 89% and 84%. The 5-year EFS rates of BL, lymphoblastic lymphoma, and diffuse large B-cell lymphoma were 88%, 88%, and 89%, and those of anaplastic large cell lymphoma (ALCL) and peripheral T-cell lymphoma (PTCL) were 71% and 56% (p < 0.001). Central nervous system involvement, high lactate dehydrogenase level (> 250 IU/mL), and advanced disease at diagnosis (≥ stage III) were associated with poor outcomes (p < 0.05). ALCL and PTCL relapsed more frequently than other pathologic subtypes (p < 0.001). Conclusion In East Asia, PTCL was more frequent than in Western countries, and bone marrow involvement did not affect treatment outcome. This international study should motivate future collaborative study on NHL in East Asia.
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Affiliation(s)
- Jin Kyung Suh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Yi-Jin Gao
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai, China
| | - Jing-Yan Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai, China
| | - Shiann-Tarng Jou
- Department of Pediatrics Hematology/Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Dong-Tsamn Lin
- Department of Pediatrics Hematology/Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ling Jin
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yonghong Zhang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jong Jin Seo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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21
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Cairo MS, Beishuizen A. Childhood, adolescent and young adult non-Hodgkin lymphoma: current perspectives. Br J Haematol 2019; 185:1021-1042. [PMID: 30729513 PMCID: PMC6897376 DOI: 10.1111/bjh.15764] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The 6th International Symposium on Childhood, Adolescent and Young Adult (CAYA) Non-Hodgkin Lymphoma (NHL) was held in Rotterdam, Netherlands, 26-29 September, 2018. This summary manuscript is a perspective on the presentations from the plenary scientific sessions, including wellness and survivorship, B-cell NHL, AYA lymphoma, translational NHL biology, lymphoma immunology, bone marrow transplantation and cell therapy, T/Natural Killer cell lymphoma, anaplastic large cell lymphoma, lymphoblastic lymphoma, novel lymphoma therapeutics and Hodgkin lymphoma. The symposium was attended by over 260 registrants from 42 different countries and included young, middle and senior investigators. Finally, the Angelo Rosolen, MD, Memorial Lecture was delivered by Alfred Reiter, MD.
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Affiliation(s)
- Mitchell S. Cairo
- Departments of Pediatrics, Medicine, Pathology, Microbiology& Immunology, and Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA
| | - Auke Beishuizen
- Division of Paediatric Haemato-Oncology, Princess Maxima Centre for Paediatric Oncology, Utrecht
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
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22
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Burkhardt B, Hermiston ML. Lymphoblastic lymphoma in children and adolescents: review of current challenges and future opportunities. Br J Haematol 2019; 185:1158-1170. [PMID: 30809797 DOI: 10.1111/bjh.15793] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lymphoblastic lymphoma (LBL) is the second most common type of Non-Hodgkin Lymphoma (NHL) in childhood and adolescence, accounting for 25-35% of all cases. The majority, 70-80%, is of T-lymphoblastic origin while 20-25% arise from B lymphoblasts. With current therapy, the event-free and overall survivals for paediatric LBL patients now exceeds 80%. Therapy, especially in T-LBL with large mediastinal tumours, is challenging, with both significant morbidity and late sequela. An additional challenge is the dismal prognosis of patients with refractory or relapsed disease. This review article will focus on the growing knowledge of the pathogenesis and biology of LBL, recent advances and challenges in the therapy of LBL, and ongoing and future efforts and opportunities in optimizing therapy and developing novel targeted treatment approaches.
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Affiliation(s)
- Birgit Burkhardt
- Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Michelle L Hermiston
- Pediatric Hematology and Oncology, University of California, San Francisco, CA, USA
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23
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Galardy PJ, Bedekovics T, Macintyre E, Miles RR. Lymphoma diagnostics: getting more from less. Br J Haematol 2019; 185:1136-1141. [PMID: 30784044 DOI: 10.1111/bjh.15788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In the modern era, clinicians and pathologists increasingly make challenging diagnoses in patients with suspected lymphoma using minimal amounts of diagnostic material. The increase in utilization of minimally invasive procedures, such as fine needle aspiration or needle core biopsies, lead to challenges in our ability to make accurate histopathological assessments of disease, including the integration of new diagnostic and prognostic testing, with smaller amounts of material. The trend towards minimally invasive diagnostics is also often in conflicting interest with researchers seeking to study tissue specimens to better understand the biology and genetics of these diseases to move the field forward. Thankfully, there are emerging fields which seek to extract large amounts of diagnostic and prognostic data out of material that is circulating in the blood of patients with lymphoma. Here we will review recent exciting data regarding the use of circulating tumour cells, circulating tumour DNA, and the detection and utility of circulating exosomes and how it can assist in diagnosis, prognosis and therapeutic monitoring. These advances hold the promise to enable continued safe patient care while also advancing discovery, translational and clinical research.
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Affiliation(s)
- Paul J Galardy
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Haematology-Oncology, Mayo Clinic, Rochester, MN, USA
| | - Tibor Bedekovics
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Macintyre
- Diagnostic Haematology, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM) U1151, Paris, France
| | - Rodney R Miles
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
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Yang KB, Sun XF, Zhen ZZ, Lu SY, Zhu J, Sun FF, Wang J, Huang JT, Chen RR, Ye LT, Liu Y, You ZY. [Impact of intensified maintenance therapy on the prognosis of children and adolescents with advanced lymphoblastic lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:778-783. [PMID: 29081195 PMCID: PMC7348356 DOI: 10.3760/cma.j.issn.0253-2727.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
目的 探讨增加维持治疗强度对Ⅲ期和Ⅳ期儿童青少年淋巴母细胞淋巴瘤(Lymphoblastic lymphoma, LBL)患者预后的影响。 方法 回顾性分析接受BFM-NHL-90/-95方案治疗且未做纵隔和中枢预防性放疗的Ⅲ期和Ⅳ期儿童青少年LBL患者的治疗结果。研究分组:1998年至2005年收治的患者于维持治疗阶段,在口服巯基嘌呤和甲氨蝶呤的基础上,定期采用“足叶乙甙+阿糖胞苷”和大剂量甲氨蝶呤交替进行化疗,为强化维持治疗组;其余为非强化维持治疗组。 结果 187例LBL患者纳入研究,其中强化维持治疗组52例,非强化维持治疗组135例,两组患者的性别、年龄、免疫分型、临床分期、危险度分层、受累部位的差异均无统计学意义(P值均>0.05);中位随访48(0.5~221)个月,两组患者的5年无事件生存(EFS)率分别为(76.9±5.8)%和(77.9±4.3)%(χ2=0.249,P=0.617),5年总生存(OS)率分别为(78.8±5.7)%和(79.8±4.1)%(χ2=0.353,P=0.552),差异均无统计学意义;亚组分析结果显示,两组患者在不同临床分期(Ⅲ/Ⅳ期)、免疫分型(T/B-LBL)和危险分层(中/高危)中的EFS、OS率差异均无统计学意义(P值均>0.05)。维持治疗期间,强化维持治疗组和非强化维持治疗组患者Ⅲ、Ⅳ级骨髓抑制发生率分别为55.8%和18.5%(χ2=25.363,P<0.05)。 结论 提高维持治疗强度并未提高Ⅲ期和Ⅳ期儿童青少年LBL患者的长期生存且可增加骨髓抑制等治疗相关不良反应。
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Affiliation(s)
- K B Yang
- State Key Laboratory of Oncology in Southern China; Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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25
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Abstract
Lymphomas in adolescents and young adults represent approximately one quarter of all cancers in this age group. Historically, adolescent and young adult cancer patients represent a unique population with diverging issues surrounding psychosocial hardships/barriers, economics, and lack of standardization of therapeutic approaches.Furthermore, the biologic differences within the adolescent and young adult population seen in various lymphoma subtypes likely play a role in overall outcomes for this group. Without an organized approach to clinical and translational research for adolescent and young adult patients within specialized treatment centers, this population may continue to experience inferior results. Here we look at the current perspectives of adolescent and young adult lymphomas with respect to disease biology, clinical characteristics, treatment, and prognosis of this unique lymphoma population.
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Wang YZ, Hao L, Chang Y, Jiang Q, Jiang H, Zhang LP, He LL, Yuan XY, Qin YZ, Huang XJ, Liu YR. A seven-color panel including CD34 and TdT could be applied in >97% patients with T cell lymphoblastic leukemia for minimal residual disease detection independent of the initial phenotype. Leuk Res 2018; 72:12-19. [DOI: 10.1016/j.leukres.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/25/2018] [Accepted: 07/12/2018] [Indexed: 12/27/2022]
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Clinical Features and Prognosis According to Immunophenotypic Subtypes Including the Early T-Cell Precursor Subtype of T-Lymphoblastic Lymphoma in the Japanese Pediatric Leukemia/Lymphoma Study Group ALB-NHL03 Study. J Pediatr Hematol Oncol 2018; 40:e34-e37. [PMID: 28538509 DOI: 10.1097/mph.0000000000000850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We reviewed the immunophenotypic subtypes of pediatric T-cell lymphoblastic lymphoma in the Japanese Pediatric Leukemia/Lymphoma Study Group ALB-NHL03 study. Of the 104 patients, 40 patients each had sufficient data to evaluate the immunophenotypes and early T-cell precursor (ETP) subtype. Pro-T, pre-T, intermediate T, and mature T cells were observed in 1, 9, 21, and 9 cases, respectively. The 3-year event-free survival (EFS) rates of those with pro-T/pre-T, intermediate T, and mature T cells were 80.0±12.6%, 71.4±9.9%, and 88.9±10.5%, respectively (P=0.546). There were 8 and 32 cases of ETP and non-ETP subtypes, with 3-year EFS rates of 75.0±15.3% and 71.9±8.0%, respectively (P=0.828), indicating that the immunophenotypic subtype was not predictive of EFS in this study.
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Landmann E, Burkhardt B, Zimmermann M, Meyer U, Woessmann W, Klapper W, Wrobel G, Rosolen A, Pillon M, Escherich G, Attarbaschi A, Beishuizen A, Mellgren K, Wynn R, Ratei R, Plesa A, Schrappe M, Reiter A, Bergeron C, Patte C, Bertrand Y. Results and conclusions of the European Intergroup EURO-LB02 trial in children and adolescents with lymphoblastic lymphoma. Haematologica 2017; 102:2086-2096. [PMID: 28983060 PMCID: PMC5709108 DOI: 10.3324/haematol.2015.139162] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 09/28/2017] [Indexed: 11/09/2022] Open
Abstract
In the European Intergroup EURO-LB02 trial, children and adolescents with lymphoblastic lymphoma underwent the non-Hodgkin lymphoma Berlin-Frankfurt-Münster protocol without prophylactic cranial radiotherapy. The primary aims of this trial were to test whether replacing prednisone with dexamethasone during induction increases event-free survival in the subgroups with T-cell lymphoblastic lymphoma and whether therapy duration could be reduced from 24 to 18 months (factorial design, randomizations). These questions could not be answered due to premature closure of the trial. Here we report on the secondary aims of the trial: whether the results of the NHL-BFM90 study could be reproduced and evaluation of disease features and prognostic factors. Three hundred and nineteen patients (66 with precursor B-cell lymphoblastic lymphoma, 233 with T-cell lymphoblastic lymphoma, 12 with mixed phenotype, 8 not classifiable) were enrolled. In induction, 215 patients received prednisone and 104 patients received dexamethasone. The median follow-up was 6.8 years (range, 3.0–10.3). The 5-year event-free survival was 82±2% [12 toxic deaths, 5 secondary malignancies, 43 non-response/relapse (central nervous system n=9; all received prednisone during induction)]. The event-free survival rate was 80±5% for patients with precursor B-cell lymphoblastic lymphoma, 82±3% for those with T-cell lymphoblastic lymphoma, and 100% for patients with a mixed phenotype. During induction, significantly more grade III/IV toxicities were observed in patients receiving dexamethasone, resulting in significant treatment delays. The number of toxic deaths did not differ significantly. The only variable associated with outcome was performance status at diagnosis. The 90% event-free survival rate for patients with T-cell lymphoblastic lymphoma shown in study NHL-BFM90 was not replicated, mainly due to more toxic deaths and central nervous system relapses. Dexamethasone in induction may prevent central nervous system relapse more effectively than prednisone but produces a higher burden of toxicity. (#NCT00275106).
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Affiliation(s)
- Eva Landmann
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Birgit Burkhardt
- Department of Pediatric Hematology and Oncology, Children's University Hospital, Münster, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Germany
| | - Ulrike Meyer
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Wolfram Klapper
- Department of Hematopathology and Lymph Node Registry, University Hospital, Kiel, Germany
| | - Grazyna Wrobel
- Department of Bone Marrow Transplantation, Children's Oncology and Hematology, Wroclaw Medical University, Poland
| | - Angelo Rosolen
- Clinica di Oncoematologia Pediatrica, Università di Padova, Italy
| | - Marta Pillon
- Clinica di Oncoematologia Pediatrica, Università di Padova, Italy
| | - Gabriele Escherich
- Clinic for Pediatric Hematology and Oncology, University Medical Center, Hamburg, Germany
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Austria
| | - Auke Beishuizen
- Department of Pediatric Hematology/Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands and the Dutch Childhood Oncology Group, the Hague, the Netherlands
| | - Karin Mellgren
- Department of Pediatric Oncology and Hematology, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Robert Wynn
- Central Manchester University Hospitals, Great Britain
| | - Richard Ratei
- Department of Hematology, Oncology and Tumor Immunology, Helios Klinikum, Berlin-Buch, Germany
| | - Adriana Plesa
- Department of Hematopathology and Flow Cytometry, CHU, Lyon-HCL, France
| | - Martin Schrappe
- Department of Pediatrics, Christian-Albrechts-University, Kiel, Germany
| | - Alfred Reiter
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Christophe Bergeron
- Institut d'Hematologie et d'Oncologie Pediatrique, Centre Léon Bérard and HCL, Claude Bernard University, Lyon, France
| | | | - Yves Bertrand
- Institut d'Hematologie et d'Oncologie Pediatrique, Centre Léon Bérard and HCL, Claude Bernard University, Lyon, France
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Adult T-type lymphoblastic lymphoma: Treatment advances and prognostic indicators. Exp Hematol 2017; 51:7-16. [DOI: 10.1016/j.exphem.2017.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
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Dayton VD, Williams SJ, McKenna RW, Linden MA. Unusual extramedullary hematopoietic neoplasms in lymph nodes. Hum Pathol 2017; 62:13-22. [DOI: 10.1016/j.humpath.2016.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 12/19/2022]
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Dozzo M, Carobolante F, Donisi PM, Scattolin A, Maino E, Sancetta R, Viero P, Bassan R. Burkitt lymphoma in adolescents and young adults: management challenges. Adolesc Health Med Ther 2017; 8:11-29. [PMID: 28096698 PMCID: PMC5207020 DOI: 10.2147/ahmt.s94170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.
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Affiliation(s)
- Massimo Dozzo
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Pietro Maria Donisi
- Simple Departmental Operative Unit of Anatomic Pathology, Ospedale Ss. Giovanni e Paolo, Venice, Italy
| | | | - Elena Maino
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Piera Viero
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | - Renato Bassan
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
- Correspondence: Renato Bassan, Complex Operative Unit of Hematology, Ospedale dell’Angelo, Via Paccagnella 11, 30174 Mestre-Venice, Italy, Tel +39 41 965 7362, Fax +39 41 965 7361, Email
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Sandlund JT, Martin MG. Non-Hodgkin lymphoma across the pediatric and adolescent and young adult age spectrum. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:589-597. [PMID: 27913533 PMCID: PMC6142492 DOI: 10.1182/asheducation-2016.1.589] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The non-Hodgkin lymphomas (NHLs) occurring in children and adolescents and young adults (AYA) are characterized by various age-related differences in tumor biology and survival. Children generally present with high-grade lymphomas, such as Burkitt lymphoma, diffuse large B-cell lymphoma, lymphoblastic lymphoma, and anaplastic large cell lymphoma, whereas low-grade histologic subtypes, such as follicular lymphoma, occur more frequently with increasing age. Treatment outcome for children with NHL is generally superior to that observed in adults. Factors contributing to this discrepancy include psychosocial factors, patient factors, and differences in tumor biology and therapy. These factors will be reviewed, with particular attention to the biological features of diffuse large B-cell lymphoma and anaplastic large cell lymphoma and corresponding therapeutic challenges. Novel targeting agents have been developed, which have been shown to be active in some patients. There is clearly a need for treatment protocols with eligibility criteria that cover the full span of the pediatric and AYA age range and that incorporate detailed molecular characterization of the tumors.
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Affiliation(s)
- John T. Sandlund
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatrics, University of Tennessee College of Medicine, Memphis TN
| | - Mike G. Martin
- Department of Medicine, University of Tennessee College of Medicine, Memphis, TN; and
- The West Cancer Center, Memphis TN
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Tembhare PR, Ghogale S, Ghatwai N, Badrinath Y, Kunder N, Patkar NV, Bibi AR, Chatterjee G, Arora B, Narula G, Banawali S, Deshpande N, Amare P, Gujral S, Subramanian PG. Evaluation of new markers for minimal residual disease monitoring in B-cell precursor acute lymphoblastic leukemia: CD73 and CD86 are the most relevant new markers to increase the efficacy of MRD 2016; 00B: 000-000. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:100-111. [PMID: 27718302 DOI: 10.1002/cyto.b.21486] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/02/2016] [Accepted: 10/05/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Multiparametric flow cytometry (MFC) is a popular technique for minimal residual disease (MRD) analysis. However, its applicability is still limited to 90% of B-cell precursor acute lymphoblastic leukemia (BCPALL) due to two major issues, i.e. a proportion of cases do not express adequate leukemia associated immunophenotype (LAIPs) with currently used markers and drug-induced antigen modulation. Hence, the incorporation of additional reliable markers is required for the further improvement of MFC-based MRD evaluation. We studied the utility of new markers in improvising MFC-based MRD detection in BCPALL. METHODS Expression-patterns of six new markers, i.e. CD24, CD44, CD72, CD73, CD86, and CD200 were studied in leukemic-blasts from ninety childhood BCPALL patients and in hematogones from 20 uninvolved staging bone marrow (BM) and ten postinduction non-BCPALL BM samples using eight-color MFC. The utility of these new markers in the day 35 postinduction MRD evaluation was determined. RESULTS Frequencies of LAIPs of CD73, CD86, CD72, CD44, CD200, and CD24 in diagnostic samples were 76.7, 56.7, 55.6, 50, 28.9, and 20%, respectively. Differential expression of all new markers was highly significant (P < 0.01) between early (CD10+ CD19+ CD34+) hematogones, late (CD10+ CD19+ CD34-) hematogones and BCPALL blasts except between early hematogones and BCPALL blasts for CD200 (P = 0.1). In MRD-positive samples, CD73 showed the maximum (83%) frequency of LAIP and CD86 showed the highest (100%) stability of aberrant expression. Inclusion of CD73 and CD86 increased the applicability of MFC-MRD assay to 98.9% MRD samples. CONCLUSION CD73 and CD86 are the most relevant markers to incorporate in the routine MRD evaluation of BCPALL. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Prashant R Tembhare
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Sitaram Ghogale
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nisha Ghatwai
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Yajamanam Badrinath
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nikesh Kunder
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nikhil V Patkar
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Asma R Bibi
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Center, Main Building, Ground floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Center, Main Building, Ground floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Shripad Banawali
- Department of Pediatric Oncology, Tata Memorial Center, Main Building, Ground floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Prathibha Amare
- Department of Cancer Cytogenetics, Tata Memorial Center, Mumbaim, Room 726, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
| | - Papagudi G Subramanian
- Hematopathology Laboratory, Tata Memorial Center, Mumbai, Room 727, Hematopathology Laboratory, Annexe Building, 7th Floor, Tata Memorial Hospital, Parel, 400012, Mumbai, India
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Michaux K, Bergeron C, Gandemer V, Mechinaud F, Uyttebroeck A, Bertrand Y. Relapsed or Refractory Lymphoblastic Lymphoma in Children: Results and Analysis of 23 Patients in the EORTC 58951 and the LMT96 Protocols. Pediatr Blood Cancer 2016; 63:1214-21. [PMID: 27037853 DOI: 10.1002/pbc.25990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/25/2016] [Accepted: 03/06/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The treatment of children with T-cell lymphoblastic lymphoma (T-LBL) and precursor B-cell lymphoblastic lymphoma (pB-LBL) has improved during the last decades. However, patients with relapsed or refractory lymphomas still have a poor prognosis. METHODS We report the characteristics and evolution of T-LBL and pB-LBL relapses in two multicenter prospective studies (LMT 96, European Organization for Research and Treatment of Cancer 58951). RESULTS From 1997 to 2008, 194 patients were included in these studies (157 T-LBL; 37 pB-LBL); among them, 23 patients underwent relapse or progression (18 T-LBL and 5 pB-LBL). The median age was 7.7 years (range 1.4-16.3). The survival rate at 8 years was 8.7% (21 deaths). The median time from diagnosis to relapse was 9 months [1-69] and 11 months [1-45] for T-LBL and pB-LBL, respectively. Twenty-two patients received a second-line treatment but remission was achieved in only seven patients. In 10 patients, intensification with hematopoietic stem cell transplantation (HSCT) was performed and four of them had a second relapse. Two patients still alive had T-LBL, experienced relapses 15 and 69 months after diagnosis, and received HSCT. Relapse during the intensive phase and second-line treatment without HSCT were identified as risk factors for bad prognosis (P = 0.01). CONCLUSIONS The results of second-line treatment, including intensive chemotherapy and HSCT, show that salvage treatment is still disappointing in controlling refractory forms. Early identification of patients at high risk of relapse is mandatory, allowing earlier intensification. Valid prognostic parameters, such as biological markers, are needed. International cooperation is warranted to collect more data on these rare diagnoses.
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Affiliation(s)
- Katell Michaux
- Pediatric Hematology/Oncology Department (IHOP), Hospices Civils de Lyon and Centre Léon Bérard, Lyon, France
| | - Christophe Bergeron
- Pediatric Hematology/Oncology Department (IHOP), Hospices Civils de Lyon and Centre Léon Bérard, Lyon, France
| | - Virginie Gandemer
- Pediatric Hematology Department, University Hospital, Rennes, France
| | - Françoise Mechinaud
- Pediatric Hematology/Oncology Department, University Hospital, Nantes, France
| | - Anne Uyttebroeck
- Pediatric Hematology/Oncology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Yves Bertrand
- Pediatric Hematology/Oncology Department (IHOP), Hospices Civils de Lyon and Centre Léon Bérard, Lyon, France.,Pediatric Hematology Department, University Hospital, Rennes, France.,Pediatric Hematology/Oncology Department, University Hospital, Nantes, France.,Pediatric Hematology/Oncology Department, University Hospital Gasthuisberg, Leuven, Belgium.,Claude Bernard Lyon 1 University, Lyon, France
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Cairo MS, Pinkerton R. Childhood, adolescent and young adult non-Hodgkin lymphoma: state of the science. Br J Haematol 2016; 173:507-30. [DOI: 10.1111/bjh.14035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mitchell S. Cairo
- Department of Pediatrics, Medicine, Pathology, Microbiology & Immunology and Cell Biology & Anatomy; New York Medical College; Valhalla NY USA
| | - Ross Pinkerton
- Department of Oncology; Children's Health Queensland; Brisbane Australia
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Oliveira MCLA, Sampaio KC, Oliveira AC, Santos AD, Castro LP, Viana MB. Outcome of children and adolescents with lymphoblastic lymphoma. Rev Assoc Med Bras (1992) 2016; 61:417-22. [PMID: 26603004 DOI: 10.1590/1806-9282.61.05.417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/04/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION lymphoblastic lymphoma (LBL) is the second most common subtype of non-Hodgkin lymphoma in children. The aim of this study was to characterize the clinical course of children and adolescents with LBL treated at a tertiary center. METHODS this is a retrospective cohort study of 27 patients aged 16 years or younger with LBL admitted between January 1981 and December 2013. Patients were treated according to the therapy protocol used for acute lymphoblastic leucemia. Diagnosis was based on biopsy of tumor and/or cytological examination of pleural effusions. The overall survival was analyzed using the Kaplan-Meier method. RESULTS the median age at diagnosis was 11.6 years (interquartile range, 4.6- 13.8). LBL had T-cell origin in 16 patients (59%). The most common primary manifestation in T-cell LBL was mediastinal involvement, in 9 patients (56%). Intra-abdominal tumor was the major site of involvement in patients with precursor B-LBL. Most patients had advanced disease (18 patients - 67%) at diagnosis. Twenty-four patients (89%) achieved complete clinical remission. After a median follow-up of 43 months (interquartile range, 6.4-95), 22 patients (81%) were alive in first complete remission. Five children (18.5%) died, three of them soon after admission and two after relapsing. The probability of survival at five years for 20 patients with de novo LBL was 78% (SD 9.4). CONCLUSION our findings confirm the favorable prognosis of children with LBL with an intensive chemotherapy regimen derived from ALL therapy.
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Affiliation(s)
| | - Keyla Christy Sampaio
- Pediatrics Department, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Aieska Dantas Santos
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lúcia Porto Castro
- Pathology Department, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marcos Borato Viana
- Pediatrics Department, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Shiramizu B, Mussolin L, Woessmann W, Klapper W. Paediatric non-Hodgkin lymphoma - perspectives in translational biology. Br J Haematol 2016; 173:617-24. [PMID: 27009921 DOI: 10.1111/bjh.14009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Exciting advances have been achieved for infants, children and adolescents diagnosed with, and treated for, non-Hodgkin lymphoma (NHL). In spite of these successes, new frontiers are being paved to improve the prognosis for those who relapse or have resistant disease. This review summarizes some of the novel approaches and ideas in NHL monitoring, diagnosis and treatment as discussed at the 5th International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma on October 22nd-24th 2015 in Varese, Italy.
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Affiliation(s)
- Bruce Shiramizu
- John A. Burns School of Medicine, Department of Pediatrics, University of Hawaii, Honolulu, USA
| | - Lara Mussolin
- Department of Woman and Child Health, University of Padova, Padova, Italy.,IRP-Istituto di Ricerca Pediatrica-Cittàdella Speranza, Padova, Italy
| | - Wilhelm Woessmann
- Department of Paediatric Haematology and Oncology, Justus-Liebig-University, Giessen, Germany.,Department of Paediatric Haematology and Oncology, Non-Hodgkin Lymphoma-Berlin-Frankfurt-Münster Study Centre, Justus-Liebig University, Giessen, Germany
| | - Wolfram Klapper
- Department of Pathology, Haematopathology Section, University-Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
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Burkhardt B, Mueller S, Khanam T, Perkins SL. Current status and future directions of T-lymphoblastic lymphoma in children and adolescents. Br J Haematol 2016; 173:545-59. [DOI: 10.1111/bjh.14017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Birgit Burkhardt
- Paediatric Haematology and Oncology; University Hospital Muenster; Germany
| | - Stephanie Mueller
- Paediatric Haematology and Oncology; University Hospital Muenster; Germany
| | - Tasneem Khanam
- Paediatric Haematology and Oncology; University Hospital Muenster; Germany
| | - Sherrie L. Perkins
- Department of Pathology; University of Utah Health Sciences Center, ARUP Institute for Clinical and Experimental Pathology; Salt Lake City Utah
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Kelemen K, Holden J, Johnson LJ, Davion S, Robetorye RS. Immunophenotypic and cytogenetic findings of B-lymphoblastic leukemia/lymphoma associated with combined IGH/BCL2 and MYC rearrangement. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:310-314. [PMID: 26517296 DOI: 10.1002/cyto.b.21334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/19/2015] [Accepted: 10/28/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND B-lymphoblastic leukemias (B-LBL) with combined IGH/BCL2 and MYC rearrangement are rare and their clinical, cytogenetic and immunophenotypic features are not well characterized. Here, we describe a case of a 61-year-old woman with B-LBL associated with these cytogenetic alterations and present a review of the literature of this disease. METHODS Four-color flow cytometry (FC) was performed on a BD FACSCanto II flow cytometer. Data were analyzed with BD FACSDiva software. Cytogenetic, fluorescence in situ hybridization (FISH), and molecular studies were performed by conventional methods. A review of the literature was performed by a PubMed-assisted search. RESULTS Including our case, eight B-LBLs associated with a documented "double-hit" karyotype (IGH/BCL2 and 8q24/MYC rearrangement) were identified in the literature (male/female 2/6, age 15-65). Three occurred de-novo, and five had a history of a CD10+ B-cell lymphoma. The typical immunophenotype was CD10, CD19, TdT positive, and negative for CD34 and surface immunoglobulin (Ig), established either by FC or immunohistochemistry. Seven cases were CD20-, and one case was CD20+. Translocation partners of MYC varied, and included IGH, lambda light chain, and an unknown gene on chromosome 9. Prognosis was poor with median survival of five months. CONCLUSIONS Patients with B-LBL associated with a combined IGH/BCL2 and MYC rearrangement often have a history of a mature B-cell lymphoma. The immunophenotype of these cases is different from that of mature "double-hit" lymphomas; FC is essential to differentiate the B-LBL cases from the leukemic phase of mature B-cell lymphomas. © 2015 International Clinical Cytometry Society.
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Affiliation(s)
- Katalin Kelemen
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Jaclyn Holden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Laura J Johnson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Simone Davion
- Department of Pathology, the Billings Clinic, Billings, Montana
| | - Ryan S Robetorye
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
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Oliveira MCLA, Sampaio KC, Oliveira AC, Santos AD, Castro LP, Viana MB. Outcome of children and adolescents with lymphoblastic lymphoma. Rev Assoc Med Bras (1992) 2016; 62:59-64. [DOI: 10.1590/1806-9282.62.01.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/04/2015] [Indexed: 01/19/2023] Open
Abstract
SUMMARY Introduction: lymphoblastic lymphoma (LBL) is the second most common subtype of non-Hodgkin lymphoma in children. The aim of this study was to characterize the clinical course of children and adolescents with LBL treated at a tertiary center. Methods: this is a retrospective cohort study of 27 patients aged 16 years or less with LBL admitted between January 1981 and December 2013. Patients received intensive chemotherapy regimen derived from acute lymphoblastic leukemia (ALL) therapy. Diagnosis was based on biopsy of tumor and/or cytological examination of pleural effusions. The overall survival was analyzed using the Kaplan-Meier method. Results: the median age at diagnosis was 11.6 years (interquartile range, 4.6-13.8). LBL had T cell origin in 16 patients (59%). The most common primary manifestation in T-cell LBL was mediastinum involvement in 9 patients (56%). Intra-abdominal tumor was the major site of involvement in patients with pB-LBL. Most patients had advanced disease (18 patients - 67%) at diagnosis. Twenty-four patients (89%) achieved complete clinical remission. After a median follow-up of 43 months (interquartile range, 6.4-95), 22 patients (81%) were alive in first complete remission. Five children (18.5%) died, three of them soon after admission and two after relapsing. The probability of survival at five years for 20 patients with de novo LBL was 78% (SD 9.4). Conclusion: our findings confirm the favorable prognosis of children with LBL with an intensive chemotherapy regimen derived from ALL therapy.
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Bassan R, Maino E, Cortelazzo S. Lymphoblastic lymphoma: an updated review on biology, diagnosis, and treatment. Eur J Haematol 2016; 96:447-60. [DOI: 10.1111/ejh.12722] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Renato Bassan
- Unità Operativa Complessa di Ematologia; Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo; Mestre-Venezia Italy
| | - Elena Maino
- Unità Operativa Complessa di Ematologia; Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo; Mestre-Venezia Italy
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Mussolin L, Buldini B, Lovisa F, Carraro E, Disarò S, Lo Nigro L, d'Amore ESG, Pillon M, Basso G. Detection and role of minimal disseminated disease in children with lymphoblastic lymphoma: The AIEOP experience. Pediatr Blood Cancer 2015; 62:1906-13. [PMID: 26109265 DOI: 10.1002/pbc.25607] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/27/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The use of intensive chemotherapy regimens in children with lymphoblastic lymphoma (LBL) has significantly improved outcome, but the salvage rate for these patients is still poor. The aim of this study was to evaluate the prognostic value of minimal disseminated disease (MDD), studied by multiparametric flow cytometry (MFC), in pediatric patients with T- and B-lineage LBL. PROCEDURE We examined bone marrow (BM) and peripheral blood (PB) samples from a series of 65 children affected by T- (52) and B-lineage (13) LBL using an MFC method; 10 of them were also analyzed for clonality of T-cell receptor gene rearrangements. RESULTS MDD was detected in 49% (32/65) of BM samples, whereas only 21% (14/65) were positive at standard morphological evaluation. Findings from MFC analyses of paired BM and PB samples were highly concordant. We analyzed the prognostic significance of MDD results detected at diagnosis in morphologically negative patients, as almost all relapsed cases (10/11) did not have any morphological involvement of BM at diagnosis. Using an MDD cut-off level of 3% by FCM (75th percentile), 5-year event-free survival (EFS) was 60% (SE ± 22) for patients with MDD >3% LBL cells versus 83% (SE ± 6) for the remaining patients (P = 0.04). No statistically significant difference in EFS was observed between LBL patients considering all the other clinical characteristics. CONCLUSIONS Our data demonstrated that MDD studied at diagnosis by MFC could represent a useful prognostic tool in childhood LBL and further application for better stratification is warranted.
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Affiliation(s)
- Lara Mussolin
- Istituto di Ricerca Pediatrico-Fondazione Città della Speranza, Padua, Italy.,Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Padua, Italy
| | - Barbara Buldini
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Padua, Italy
| | - Federica Lovisa
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Padua, Italy
| | - Elisa Carraro
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Padua, Italy
| | - Silvia Disarò
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Padua, Italy
| | - Luca Lo Nigro
- Center of Pediatric Hematology Oncology, Azienda Policlinico, Catania, Italy
| | | | - Marta Pillon
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Padua, Italy
| | - Giuseppe Basso
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Padua, Italy
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Minard-Colin V, Brugières L, Reiter A, Cairo MS, Gross TG, Woessmann W, Burkhardt B, Sandlund JT, Williams D, Pillon M, Horibe K, Auperin A, Le Deley MC, Zimmerman M, Perkins SL, Raphael M, Lamant L, Klapper W, Mussolin L, Poirel HA, Macintyre E, Damm-Welk C, Rosolen A, Patte C. Non-Hodgkin Lymphoma in Children and Adolescents: Progress Through Effective Collaboration, Current Knowledge, and Challenges Ahead. J Clin Oncol 2015; 33:2963-74. [PMID: 26304908 PMCID: PMC4979194 DOI: 10.1200/jco.2014.59.5827] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Non-Hodgkin lymphoma is the fourth most common malignancy in children, has an even higher incidence in adolescents, and is primarily represented by only a few histologic subtypes. Dramatic progress has been achieved, with survival rates exceeding 80%, in large part because of a better understanding of the biology of the different subtypes and national and international collaborations. Most patients with Burkitt lymphoma and diffuse large B-cell lymphoma are cured with short intensive pulse chemotherapy containing cyclophosphamide, cytarabine, and high-dose methotrexate. The benefit of the addition of rituximab has not been established except in the case of primary mediastinal B-cell lymphoma. Lymphoblastic lymphoma is treated with intensive, semi-continuous, longer leukemia-derived protocols. Relapses in B-cell and lymphoblastic lymphomas are rare and infrequently curable, even with intensive approaches. Event-free survival rates of approximately 75% have been achieved in anaplastic large-cell lymphomas with various regimens that generally include a short intensive B-like regimen. Immunity seems to play an important role in prognosis and needs further exploration to determine its therapeutic application. ALK inhibitor therapeutic approaches are currently under investigation. For all pediatric lymphomas, the intensity of induction/consolidation therapy correlates with acute toxicities, but because of low cumulative doses of anthracyclines and alkylating agents, minimal or no long-term toxicity is expected. Challenges that remain include defining the value of prognostic factors, such as early response on positron emission tomography/computed tomography and minimal disseminated and residual disease, using new biologic technologies to improve risk stratification, and developing innovative therapies, both in the first-line setting and for relapse.
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Affiliation(s)
- Véronique Minard-Colin
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Laurence Brugières
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Alfred Reiter
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Mitchell S Cairo
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Thomas G Gross
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Wilhelm Woessmann
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Birgit Burkhardt
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - John T Sandlund
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Denise Williams
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Marta Pillon
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Keizo Horibe
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Anne Auperin
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Marie-Cécile Le Deley
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Martin Zimmerman
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Sherrie L Perkins
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Martine Raphael
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Laurence Lamant
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Wolfram Klapper
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Lara Mussolin
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Hélène A Poirel
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Elizabeth Macintyre
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Christine Damm-Welk
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Angelo Rosolen
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels
| | - Catherine Patte
- Véronique Minard-Colin, Laurence Brugières, Anne Auperin, Marie-Cécile Le Deley, and Catherine Patte, Institut Gustave Roussy, Villejuif; Martine Raphael, Centre National de la Recherche Scientifique UMR 8126, Université Paris Sud; Elizabeth Macintyre, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, and Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris; Laurence Lamant, Institut Universitaire du Cancer Toulouse Oncopole and Université Paul-Sabatier, Toulouse, France; Alfred Reiter, Wilhelm Woessmann, and Christine Damm-Welk, Justus-Liebig-University Giessen, Giessen; Birgit Burkhardt, Children University Hospital, Münster; Martin Zimmerman, Medizinische Hochschule, Hannover; Wolfram Klapper, Christian-Albrechts-University Kiel, Kiel, Germany; Mitchell S. Cairo, New York Medical College, Valhalla, NY; Thomas G. Gross, National Cancer Institute, Bethesda, MD; John T. Sandlund, St Jude Children's Research Hospital and University of Tennessee Health Science Center, College of Medicine, Memphis, TN; Sherrie L. Perkins, University of Utah Health Sciences, Salt Lake City, UT; Denise Williams, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom; Marta Pillon and Angelo Rosolen, University of Padova, Padova; Lara Mussolin, Istituto di Ricerca Pediatrico-Fondazione Cittàdella Speranza and University of Padua, Padua, Italy; Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; and Hélène A. Poirel, Center for Human Genetics, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Belgium, Brussels.
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Pillon M, Aricò M, Mussolin L, Carraro E, Conter V, Sala A, Buffardi S, Garaventa A, D'Angelo P, Lo Nigro L, Santoro N, Piglione M, Lombardi A, Porta F, Cesaro S, Moleti ML, Casale F, Mura R, d'Amore ESG, Basso G, Rosolen A. Long-term results of the AIEOP LNH-97 protocol for childhood lymphoblastic lymphoma. Pediatr Blood Cancer 2015; 62:1388-94. [PMID: 25755200 DOI: 10.1002/pbc.25469] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/02/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Treatment intensification was considered a suitable strategy to increase the cure rate of lymphoblastic lymphoma (LBL) in children. PROCEDURE The AIEOP LNH-97 trial was run between 1997 and 2007 for newly diagnosed LBL in patients aged less than 18 years. Treatment schedule was based on the previous, LSA2-L2 derived, AIEOP LNH-92 protocol. Modifications included: increased dose of upfront cyclophosphamide and methotrexate, use of l-Asparaginase during induction therapy, intensive block therapy for slow responders, and late intensification ("Reinduction") for patients with advanced stage disease. Total therapy duration was 12 months for stage I and II, and 24 months for stage III and IV. Central nervous system prophylaxis did not include cranial irradiation. RESULTS 114 eligible patients were enrolled, 84 males and 30 females; median age was 9 years. Complete remission was obtained in 98% of patients. After a median follow-up time of seven years, 29 patients failed due to progression of disease (n = 2), relapse (n = 25), or second malignancy (n = 2). The 7-year overall survival was 82% (standard error [SE] 4%) and the 7-year event-free survival was 74% (SE 4%). No subgroup showed significantly different event free survival. None of the patients died of front line chemotherapy-related toxicity. CONCLUSIONS Treatment intensification was associated with good outcome in children and adolescents with LBL, with limited toxicity. Prognosis after relapse was better for patients who underwent allogeneic hematopoietic stem cell transplantation. Measurements of biological markers and treatment response are necessary for achieving further improvement through more accurate identification and stratification of patients at risk of disease relapse.
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Affiliation(s)
- Marta Pillon
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Lara Mussolin
- Istituto di Ricerca Pediatrica, Fondazione Citt, à, della Speranza, Padova, Italy
| | - Elisa Carraro
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valentino Conter
- Clinica Pediatrica, Università degli Studi di Milano-Bicocca, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Alessandra Sala
- Clinica Pediatrica, Università degli Studi di Milano-Bicocca, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Salvatore Buffardi
- Pediatric Oncology Department, Santobono-Pausilipon Hospital of Napoli, Napoli, Italy
| | - Alberto Garaventa
- Department of Hematology-Oncology, Istituto Giannina Gaslini, Genova, Italy
| | - Paolo D'Angelo
- Department of Oncology, Pediatric Hematology and Oncology Unit, A.R.N.A.S. Ospedali Civico Di Cristina e Benfratelli, Palermo, Italy
| | - Luca Lo Nigro
- Pediatric Hematology-Oncology, Policlinico di Catania, Catania, Italy
| | - Nicola Santoro
- Division of Paediatric Haematology-Oncology, Department of Pediatrics, Bari, Italy
| | - Matilde Piglione
- Division of Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Torino, Italy
| | - Alessandra Lombardi
- Dipartimento di Onco-Ematologia Pediatrica, Ospedale Bambino Gesù, Roma, Italy
| | - Fulvio Porta
- Oncology-Haematology and BMT Unit, Ospedale dei Bambini, Spedali Civili, Brescia, Italy
| | - Simone Cesaro
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Maria L Moleti
- Hematology, Department of Cellular Biotechnologies and Hematology, Roma, Italy
| | - Fiorina Casale
- Pediatric Oncology Service,, Pediatric Department, Second University of Napoli, Napoli, Italy
| | - Rossella Mura
- Pediatric Hematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | | | - Giuseppe Basso
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Angelo Rosolen
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy
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Minimal residual disease diagnostics in acute lymphoblastic leukemia: need for sensitive, fast, and standardized technologies. Blood 2015; 125:3996-4009. [PMID: 25999452 DOI: 10.1182/blood-2015-03-580027] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/10/2015] [Indexed: 12/26/2022] Open
Abstract
Monitoring of minimal residual disease (MRD) has become routine clinical practice in frontline treatment of virtually all childhood acute lymphoblastic leukemia (ALL) and in many adult ALL patients. MRD diagnostics has proven to be the strongest prognostic factor, allowing for risk group assignment into different treatment arms, ranging from significant treatment reduction to mild or strong intensification. Also in relapsed ALL patients and patients undergoing stem cell transplantation, MRD diagnostics is guiding treatment decisions. This is also why the efficacy of innovative drugs, such as antibodies and small molecules, are currently being evaluated with MRD diagnostics within clinical trials. In fact, MRD measurements might well be used as a surrogate end point, thereby significantly shortening the follow-up. The MRD techniques need to be sensitive (≤10(-4)), broadly applicable, accurate, reliable, fast, and affordable. Thus far, flow cytometry and polymerase chain reaction (PCR) analysis of rearranged immunoglobulin and T-cell receptor genes (allele-specific oligonucleotide [ASO]-PCR) are claimed to meet these criteria, but classical flow cytometry does not reach a solid 10(-4), whereas classical ASO-PCR is time-consuming and labor intensive. Therefore, 2 high-throughput technologies are being explored, ie, high-throughput sequencing and next-generation (multidimensional) flow cytometry, both evaluating millions of sequences or cells, respectively. Each of them has specific advantages and disadvantages.
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Sandlund JT, Guillerman RP, Perkins SL, Pinkerton CR, Rosolen A, Patte C, Reiter A, Cairo MS. International Pediatric Non-Hodgkin Lymphoma Response Criteria. J Clin Oncol 2015; 33:2106-11. [PMID: 25940725 DOI: 10.1200/jco.2014.59.0745] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Response criteria are well established for adult patients with non-Hodgkin lymphoma (NHL). A revised set of response criteria in adults with NHL was recently published. However, NHL in children and adolescents involves different histologies, primary sites of disease, patterns of metastatic spread, approaches to therapy, and responses to treatment compared with adult NHL. However, there are no standardized response criteria specific to pediatric NHL. Therefore, we developed international standardized methods for assessing response to therapy in children and adolescents with NHL. METHODS An international multidisciplinary group of pediatric oncologists, pathologists, biologists, and radiologists convened during and after the Third and Fourth International Childhood, Adolescent and Young Adult NHL Symposia to review existing response and outcome data, develop methods for response evaluation that reflect incorporation of more sensitive technologies currently in use, and incorporate primary and metastatic sites of disease for the evaluation of therapeutic response in children and adolescents with NHL. RESULTS Using the current adult NHL response criteria as a starting point, international pediatric NHL response criteria were developed incorporating both contemporary diagnostic imaging and pathology techniques, including novel molecular and flow cytometric technologies used for the determination of minimal residual disease. CONCLUSION Use of the international pediatric NHL response criteria in children and adolescents receiving therapy for NHL incorporates data obtained from new and more sensitive technologies that are now being widely used for disease evaluation, providing a standardized means for reporting treatment response.
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Affiliation(s)
- John T Sandlund
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - R Paul Guillerman
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Sherrie L Perkins
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - C Ross Pinkerton
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Angelo Rosolen
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Catherine Patte
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Alfred Reiter
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Mitchell S Cairo
- John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; Angelo Rosolen, University of Padova, Padova, Italy; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig-University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
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Rosolen A, Perkins SL, Pinkerton CR, Guillerman RP, Sandlund JT, Patte C, Reiter A, Cairo MS. Revised International Pediatric Non-Hodgkin Lymphoma Staging System. J Clin Oncol 2015; 33:2112-8. [PMID: 25940716 DOI: 10.1200/jco.2014.59.7203] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Treatment and prognosis of pediatric non-Hodgkin lymphoma (NHL) have improved dramatically in the last 30 years. However, the St Jude NHL staging classification for pediatric NHL was developed more than 35 years ago. The most recent Lugano lymphoma staging classification focused on adult lymphoma. Furthermore, major limitations of the current pediatric NHL staging classification include lack of consideration of new distinct pediatric NHL histologic entities; absence of recognition of frequent skin, bone, kidney, ovarian, and other organ involvement; and lack of newer precise methods to detect bone marrow and CNS involvement, minimal disease quantification, and highly sensitive imaging technologies. METHODS An international multidisciplinary expert panel convened in Frankfurt, Germany, in 2009 at the Third International Childhood, Adolescent and Young Adult NHL Symposium to develop a revised international pediatric NHL staging system (IPNHLSS), addressing limitations of the current pediatric NHL staging system and creating a revised classification. Evidence-based disease distribution and behavior were reviewed from multiple pediatric cooperative group NHL studies. RESULTS A revised IPNHLSS was developed incorporating new histologic entities, extranodal dissemination, improved diagnostic methods, and advanced imaging technology. CONCLUSION This revised IPNHLSS will facilitate more precise staging for children and adolescents with NHL and facilitate comparisons of efficacy across different treatment strategies, various institutions, multicenter trials, and cooperative groups by allowing for reproducible pediatric-based staging at diagnosis and relapse.
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Affiliation(s)
- Angelo Rosolen
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Sherrie L Perkins
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - C Ross Pinkerton
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - R Paul Guillerman
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - John T Sandlund
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Catherine Patte
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Alfred Reiter
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Mitchell S Cairo
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
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Liang Y, Yang LH, Jiang H, Yuan XJ, Sun LR, Wang NL, Tang JY. Treatment outcome of young children with acute lymphoblastic leukaemia: achievements and directions implied from Shanghai Children's Medical Centre based SCMC-ALL-2005 protocol. Br J Haematol 2015; 169:267-77. [PMID: 25655921 DOI: 10.1111/bjh.13288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/24/2014] [Indexed: 11/28/2022]
Abstract
This multicenter study used the Shanghai Children's Medical Center (SCMC)-ALL-2005 protocol for treatment of young patients (<2 years old) with acute lymphoblastic leukaemia (ALL), which was designed to improve treatment outcome in Chinese paediatric patients. These aims were pursued through risk-directed stratification based on presenting clinical and genetic features, minimal residual disease (MRD) levels and treatment response. All the patients achieved completed remission with 5-year event-free survivals of 82·6 ± 9·7% (low risk), 52·6 ± 8·4% (intermediate risk), 28·6 ± 17·1% (high risk). Disease recurrence was detected in bone marrow, bone marrow plus testis, testis alone and central nervous system in 16 (24·2%), 1 (1·5%), 1 (1·5%) and 1 (1·5%) patients respectively. No deaths were reported during induction. The SCMC-ALL-2005 trial for ALL patients <2 years old indicated high remission induction and low infection and treatment-related mortality rates.
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Affiliation(s)
- Yang Liang
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, Connecticut, America
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