1
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Hoelzer D, Bassan R, Boissel N, Roddie C, Ribera JM, Jerkeman M. ESMO Clinical Practice Guideline interim update on the use of targeted therapy in acute lymphoblastic leukaemia. Ann Oncol 2024; 35:15-28. [PMID: 37832649 DOI: 10.1016/j.annonc.2023.09.3112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- D Hoelzer
- ONKOLOGIKUM Frankfurt am Museumsufer, Frankfurt, Germany
| | - R Bassan
- Hematology Unit, Ospedale dell'Angelo e Ospedale SS, Giovanni e Paolo, Mestre-Venezia, Italy
| | - N Boissel
- Hematology Department, Saint-Louis Hospital, APHP, Institut de Recherche Saint-Louis, Université de Paris Cité, Paris, France
| | - C Roddie
- Research Department of Haematology, UCL Cancer Institute, London, UK
| | - J M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
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2
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Kim D, Orr MJ, Kwong AJ, Deibler KK, Munshi HH, Bridges CS, Chen TJ, Zhang X, Lacorazza HD, Scheidt KA. Rational Design of Highly Potent and Selective Covalent MAP2K7 Inhibitors. ACS Med Chem Lett 2023; 14:606-613. [PMID: 37197477 PMCID: PMC10184151 DOI: 10.1021/acsmedchemlett.3c00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
The mitogen-activated protein kinase signaling cascade is conserved across eukaryotes, where it plays a critical role in the regulation of activities including proliferation, differentiation, and stress responses. This pathway propagates external stimuli through a series of phosphorylation events, which allows external signals to influence metabolic and transcriptional activities. Within the cascade, MEK, or MAP2K, enzymes occupy a molecular crossroads immediately upstream to significant signal divergence and cross-talk. One such kinase, MAP2K7, also known as MEK7 and MKK7, is a protein of great interest in the molecular pathophysiology underlying pediatric T cell acute lymphoblastic leukemia (T-ALL). Herein, we describe the rational design, synthesis, evaluation, and optimization of a novel class of irreversible MAP2K7 inhibitors. With a streamlined one-pot synthesis, favorable in vitro potency and selectivity, and promising cellular activity, this novel class of compounds wields promise as a powerful tool in the study of pediatric T-ALL.
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Affiliation(s)
- Dalton
R. Kim
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Meghan J. Orr
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Ada J. Kwong
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Kristine K. Deibler
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Hasan H. Munshi
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Cory Seth Bridges
- Department
of Pathology & Immunology, Baylor College
of Medicine, Houston, Texas 77030, United States
| | - Taylor Jie Chen
- Department
of Pathology & Immunology, Baylor College
of Medicine, Houston, Texas 77030, United States
| | - Xiaoyu Zhang
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
- Chemistry
of Life Processes Institute, Northwestern
University, Evanston, Illinois 60208, United
States
| | - H. Daniel Lacorazza
- Department
of Pathology & Immunology, Baylor College
of Medicine, Houston, Texas 77030, United States
| | - Karl A. Scheidt
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
- Chemistry
of Life Processes Institute, Northwestern
University, Evanston, Illinois 60208, United
States
- Department
of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, United States
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3
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Jung S, Jiang L, Zhao J, Shultz LD, Greiner DL, Bae M, Li X, Ordikhani F, Kuai R, Joseph J, Kasinath V, Elmaleh DR, Abdi R. Clathrin light chain-conjugated drug delivery for cancer. Bioeng Transl Med 2023; 8:e10273. [PMID: 36684105 PMCID: PMC9842032 DOI: 10.1002/btm2.10273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/25/2023] Open
Abstract
Targeted drug delivery systems hold the remarkable potential to improve the therapeutic index of anticancer medications markedly. Here, we report a targeted delivery platform for cancer treatment using clathrin light chain (CLC)-conjugated drugs. We conjugated CLC to paclitaxel (PTX) through a glutaric anhydride at high efficiency. Labeled CLCs localized to 4T1 tumors implanted in mice, and conjugation of PTX to CLC enhanced its delivery to these tumors. Treatment of three different mouse models of cancer-melanoma, breast cancer, and lung cancer-with CLC-PTX resulted in significant growth inhibition of both the primary tumor and metastatic lesions, as compared to treatment with free PTX. CLC-PTX treatment caused a marked increase in apoptosis of tumor cells and reduction of tumor angiogenesis. Our data suggested HSP70 as a binding partner for CLC. Our study demonstrates that CLC-based drug-conjugates constitute a novel drug delivery platform that can augment the effects of chemotherapeutics in treating a variety of cancers. Moreover, conjugation of therapeutics with CLC may be used as means by which drugs are delivered specifically to primary tumors and metastatic lesions, thereby prolonging the survival of cancer patients.
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Affiliation(s)
- Sungwook Jung
- Transplantation Research Center, Renal DivisionBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Liwei Jiang
- Transplantation Research Center, Renal DivisionBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Institute of Health and Medical TechnologyHefei Institutes of Physical Science, Chinese Academy of SciencesBostonHefeiChina
| | - Jing Zhao
- Transplantation Research Center, Renal DivisionBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Dale L. Greiner
- Department of Molecular MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Munhyung Bae
- Department of Biological Chemistry and Molecular PharmacologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Xiaofei Li
- Transplantation Research Center, Renal DivisionBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Farideh Ordikhani
- Transplantation Research Center, Renal DivisionBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rui Kuai
- Center for Nanomedicine and Division of Engineering in Medicine, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - John Joseph
- Center for Nanomedicine and Division of Engineering in Medicine, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Vivek Kasinath
- Transplantation Research Center, Renal DivisionBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - David R. Elmaleh
- Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Reza Abdi
- Transplantation Research Center, Renal DivisionBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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4
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Kantarjian HM, Jain N, Garcia-Manero G, Welch MA, Ravandi F, Wierda WG, Jabbour EJ. The cure of leukemia through the optimist's prism. Cancer 2022; 128:240-259. [PMID: 34614211 PMCID: PMC8738114 DOI: 10.1002/cncr.33933] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023]
Abstract
Progress is occurring at a dizzying rate across all leukemias. Since the authors' review of the topic in Cancer in 2018, numerous discoveries have been made that have improved the therapy and outcomes of several leukemia subsets. Hairy cell leukemia is potentially curable with a single course of cladribine followed by rituximab (10-year survival, ≥90%). Acute promyelocytic leukemia is curable at a rate of 80% to 90% with a nonchemotherapy regimen of all-trans retinoic acid and arsenic trioxide. The cure rate for core-binding factor acute myeloid leukemia (AML) is ≥75% with fludarabine, high-dose cytarabine, and gemtuzumab ozogamicin. Survival for patients with chronic myeloid leukemia is close to that for an age-matched normal population with BCR-ABL1 tyrosine kinase inhibitors (TKIs). Chronic lymphocytic leukemia, a previously incurable disease, may now be potentially curable with a finite duration of therapy with Bruton tyrosine kinase inhibitors and venetoclax. The estimated 5-year survival rate for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) exceeds 70% with intensive chemotherapy and ponatinib, a third-generation BCR-ABL1 TKI, and more recent nonchemotherapy regimens using dasatinib or ponatinib with blinatumomab are producing outstanding results. Survival in both younger and older patients with ALL has improved with the addition of antibodies targeting CD20, CD19 (blinatumomab), and CD22 (inotuzumab) to chemotherapy. Several recent drug discoveries (venetoclax, FLT3 and IDH inhibitors, and oral hypomethylating agents) are also improving outcomes for younger and older patients with AML and for those with higher risk myelodysplastic syndrome.
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Affiliation(s)
- Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Mary Alma Welch
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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5
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Li X, Zhou M, Qi J, Han Y. Efficacy and Safety of Inotuzumab Ozogamicin (CMC-544) for the Treatment of Relapsed/Refractory Acute Lymphoblastic Leukemia and Non-Hodgkin Lymphoma: A Systematic Review and Meta-Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e227-e247. [PMID: 33461955 DOI: 10.1016/j.clml.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of inotuzumab ozogamicin (INO) in patients with relapsed/refractory acute lymphocytic leukemia (ALL) and non-Hodgkin lymphoma (NHL). MATERIALS AND METHODS Databases (PubMed, EMBASE, and Cochrane databases) were searched through April 4, 2020. Outcome measures of efficacy covered complete remission (CR) rates and minimal residual disease response rates. Safety was evaluated by hepatic venous obstructive disease/sinus obstructive syndrome and grade ≥ 3 hematologic adverse events. We also evaluated the quality of enrolled studies by the Newcastle-Ottawa Quality Assessment Scale. RESULTS A total of 12 studies involving 644 patients were included. The summary estimates of the CR and minimal residual disease response rates for patients with ALL were 67% (95% confidence interval [CI], 61%-73%) and 45% (95% CI, 37%-53%) of patients with NHL. The pooled CR rate was 28% (95% CI, 15%-47%). Thrombocytopenia and neutropenia were the most common adverse events. In patients receiving INO, venous obstructive disease/sinus obstructive syndrome, grade ≥ 3 thrombocytopenic events, grade ≥ 3 neutropenic events of the pooled estimated incidence were 8% (95% CI, 5%-14%), 29% (95% CI, 20%-39%), and 48% (95% CI, 38%-57%). CONCLUSIONS According to our study, INO was effective in the treatment of relapsed/refractory ALL and NHL with limited adverse effects. High-quality randomized controlled trials and extensive follow-up are pending to confirm and update the results of this analysis in the future.
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Affiliation(s)
- Xueqian Li
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China; State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Meng Zhou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China; State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Jiaqian Qi
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China; State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Yue Han
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China; State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.
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6
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Camuset M, Huault A, Grain A, Clémenceau B, Rialland F, Thomas C, Chevallier P, Béné MC, Eveillard M. Therapeutic targets in childhood B-acute lymphoblastic leukemia: what about HER2/neu? Hematol Oncol 2020; 39:270-272. [PMID: 32894593 DOI: 10.1002/hon.2799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Margaux Camuset
- Pediatric Oncology Department, Nantes University Hospital, Nantes, France
| | - Alice Huault
- Pediatric Oncology Department, Nantes University Hospital, Nantes, France
| | - Audrey Grain
- Pediatric Oncology Department, Nantes University Hospital, Nantes, France.,CRCINA, Inserm, Team 1, Nantes, France
| | | | - Fanny Rialland
- Pediatric Oncology Department, Nantes University Hospital, Nantes, France
| | - Caroline Thomas
- Pediatric Oncology Department, Nantes University Hospital, Nantes, France
| | - Patrice Chevallier
- CRCINA, Inserm, Team 1, Nantes, France.,Clinical Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie C Béné
- CRCINA, Inserm, Team 1, Nantes, France.,Hematology Laboratory, Nantes University Hospital, Nantes, France
| | - Marion Eveillard
- CRCINA, Inserm, Team 1, Nantes, France.,Hematology Laboratory, Nantes University Hospital, Nantes, France
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7
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Sachs K, Sarver AL, Noble-Orcutt KE, LaRue RS, Antony ML, Chang D, Lee Y, Navis CM, Hillesheim AL, Nykaza IR, Ha NA, Hansen CJ, Karadag FK, Bergerson RJ, Verneris MR, Meredith MM, Schomaker ML, Linden MA, Myers CL, Largaespada DA, Sachs Z. Single-Cell Gene Expression Analyses Reveal Distinct Self-Renewing and Proliferating Subsets in the Leukemia Stem Cell Compartment in Acute Myeloid Leukemia. Cancer Res 2019; 80:458-470. [PMID: 31784425 DOI: 10.1158/0008-5472.can-18-2932] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 05/30/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Standard chemotherapy for acute myeloid leukemia (AML) targets proliferative cells and efficiently induces complete remission; however, many patients relapse and die of their disease. Relapse is caused by leukemia stem cells (LSC), the cells with self-renewal capacity. Self-renewal and proliferation are separate functions in normal hematopoietic stem cells (HSC) in steady-state conditions. If these functions are also separate functions in LSCs, then antiproliferative therapies may fail to target self-renewal, allowing for relapse. We investigated whether proliferation and self-renewal are separate functions in LSCs as they often are in HSCs. Distinct transcriptional profiles within LSCs of Mll-AF9/NRASG12V murine AML were identified using single-cell RNA sequencing. Single-cell qPCR revealed that these genes were also differentially expressed in primary human LSCs and normal human HSPCs. A smaller subset of these genes was upregulated in LSCs relative to HSPCs; this subset of genes constitutes "LSC-specific" genes in human AML. To assess the differences between these profiles, we identified cell surface markers, CD69 and CD36, whose genes were differentially expressed between these profiles. In vivo mouse reconstitution assays resealed that only CD69High LSCs were capable of self-renewal and were poorly proliferative. In contrast, CD36High LSCs were unable to transplant leukemia but were highly proliferative. These data demonstrate that the transcriptional foundations of self-renewal and proliferation are distinct in LSCs as they often are in normal stem cells and suggest that therapeutic strategies that target self-renewal, in addition to proliferation, are critical to prevent relapse and improve survival in AML. SIGNIFICANCE: These findings define and functionally validate a self-renewal gene profile of leukemia stem cells at the single-cell level and demonstrate that self-renewal and proliferation are distinct in AML. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/3/458/F1.large.jpg.
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Affiliation(s)
- Karen Sachs
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Next Generation Analytics, Palo Alto, California
| | - Aaron L Sarver
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Klara E Noble-Orcutt
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca S LaRue
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Marie Lue Antony
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Chang
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Yoonkyu Lee
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Connor M Navis
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Alexandria L Hillesheim
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Ian R Nykaza
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Ngoc A Ha
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Conner J Hansen
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Fatma K Karadag
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Rachel J Bergerson
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Michael R Verneris
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Matthew M Meredith
- Molecular Lab, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew L Schomaker
- Molecular Lab, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Michael A Linden
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Chad L Myers
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota
| | - David A Largaespada
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Zohar Sachs
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. .,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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8
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Jain P, Korula A, Deshpande P, Pn N, Abu Alex A, Abraham A, Srivastava A, Janet NB, Lakshmi KM, Balasubramanian P, George B, Mathews V. Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country. J Glob Oncol 2019; 4:1-12. [PMID: 30222028 PMCID: PMC6371642 DOI: 10.1200/jgo.17.00014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Limited data exist on intensifying chemotherapy regimens in the treatment of adult acute lymphoblastic leukemia (ALL) outside the setting of a clinical trial. Materials and Methods Retrospectively, data from 507 consecutive adults (age ≥ 15 years) with a diagnosis of ALL treated at our center were analyzed. Standard-risk (SR) patients were offered treatment with a modified German Multicenter ALL (GMALL) regimen, whereas high-risk (HR) patients were offered intensification of therapy with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (HCVAD). Because of resource constraints, a proportion of HR patients opted to receive the same treatment regimen as used for SR patients. Results There were 344 SR patients (67.8%) and 163 HR patients (32.2%) at diagnosis. Among the HR patients, 53 (32.5%) opted to receive intensification with the HCVAD regimen. The SR cohort showed a superior 5-year event-free survival rate compared with the HR cohort (47.3% v 23.6%, respectively; P < .001). Within the HR subgroup, there was no statistically significant difference in overall survival or event-free survival between patients who received the modified GMALL regimen (n = 59) and patients who received HCVAD (n = 53). Conclusion Intensified therapy in the HR subset was associated with a significant increase in early treatment-related mortality and cost of treatment. A modified GMALL regimen was found to be cost-effective with clinical outcomes comparable to those achieved with more intensive regimens.
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Affiliation(s)
- Punit Jain
- All authors: Christian Medical College, Vellore, India
| | - Anu Korula
- All authors: Christian Medical College, Vellore, India
| | | | - Nisham Pn
- All authors: Christian Medical College, Vellore, India
| | - Ansu Abu Alex
- All authors: Christian Medical College, Vellore, India
| | - Aby Abraham
- All authors: Christian Medical College, Vellore, India
| | | | | | | | | | - Biju George
- All authors: Christian Medical College, Vellore, India
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9
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Shang Y, Zhou F. Current Advances in Immunotherapy for Acute Leukemia: An Overview of Antibody, Chimeric Antigen Receptor, Immune Checkpoint, and Natural Killer. Front Oncol 2019; 9:917. [PMID: 31616632 PMCID: PMC6763689 DOI: 10.3389/fonc.2019.00917] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
Recently, due to the application of hematopoietic stem cell transplantation and small molecule inhibitor, the survival of acute leukemia is prolonged. However, the 5 year survival rate remains low due to a high incidence of relapse. Immunotherapy is expected to improve the prognosis of patients with relapsed or refractory hematological malignancies because it does not rely on the cytotoxic mechanisms of conventional therapy. In this paper, the advances of immunotherapy in acute leukemia are reviewed from the aspects of Antibody including Unconjugated antibodies, Antibody-drug conjugate and Bispecific antibody, Chimeric Antigen Receptor (CARs), Immune checkpoint, Natural killer cells. The immunological features, mechanisms and limitation in clinic will be described.
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Affiliation(s)
- Yufeng Shang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
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10
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Therapeutic Modulation of Autophagy in Leukaemia and Lymphoma. Cells 2019; 8:cells8020103. [PMID: 30704144 PMCID: PMC6406467 DOI: 10.3390/cells8020103] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 02/07/2023] Open
Abstract
Haematopoiesis is a tightly orchestrated process where a pool of hematopoietic stem and progenitor cells (HSPCs) with high self-renewal potential can give rise to both lymphoid and myeloid lineages. The HSPCs pool is reduced with ageing resulting in few HSPC clones maintaining haematopoiesis thereby reducing blood cell diversity, a phenomenon called clonal haematopoiesis. Clonal expansion of HSPCs carrying specific genetic mutations leads to increased risk for haematological malignancies. Therefore, it comes as no surprise that hematopoietic tumours develop in higher frequency in elderly people. Unfortunately, elderly patients with leukaemia or lymphoma still have an unsatisfactory prognosis compared to younger ones highlighting the need to develop more efficient therapies for this group of patients. Growing evidence indicates that macroautophagy (hereafter referred to as autophagy) is essential for health and longevity. This review is focusing on the role of autophagy in normal haematopoiesis as well as in leukaemia and lymphoma development. Attenuated autophagy may support early hematopoietic neoplasia whereas activation of autophagy in later stages of tumour development and in response to a variety of therapies rather triggers a pro-tumoral response. Novel insights into the role of autophagy in haematopoiesis will be discussed in light of designing new autophagy modulating therapies in hematopoietic cancers.
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11
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Liu Y, Bewersdorf JP, Stahl M, Zeidan AM. Immunotherapy in acute myeloid leukemia and myelodysplastic syndromes: The dawn of a new era? Blood Rev 2018; 34:67-83. [PMID: 30553527 DOI: 10.1016/j.blre.2018.12.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/27/2022]
Abstract
Immunotherapy has revolutionized therapy in both solid and liquid malignancies. The ability to cure acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) with an allogeneic hematopoietic stem cell transplant (HSCT) is proof of concept for the application of immunotherapy in AML and MDS. However, outside of HSCT, only the anti-CD33 antibody drug conjugate gemtuzumab ozogamicin is currently approved as an antibody-targeted therapy for AML. Several avenues of immunotherapeutic drugs are currently in different stages of clinical development. Here, we review recent advances in antibody-based therapy, immune checkpoint inhibitors, vaccines and adoptive cell-based therapy for patients with AML and MDS. First, we discuss different antibody constructs. Immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein-1 (PD-1) and CD47 as well as peptide, dendritic cell and dendritic/AML cell-based vaccines are reviewed next. Lastly, adoptive cell-based therapy including chimeric antigen receptor (CAR)-T cell and NK cell therapy is discussed.
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Affiliation(s)
- Yuxin Liu
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Jan Philipp Bewersdorf
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Maximilian Stahl
- Department of Medicine, Section of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA.
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12
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Kantarjian HM, Keating MJ, Freireich EJ. Toward the potential cure of leukemias in the next decade. Cancer 2018; 124:4301-4313. [DOI: 10.1002/cncr.31669] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/22/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michael J. Keating
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Emil J Freireich
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
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Abstract
INTRODUCTION The anti-CD20 chimeric monoclonal antibody rituximab has revolutionized the treatment of B-cell malignancies, significantly improving patient clinical outcome. Recently, some single-group studies have suggested that adding rituximab to chemotherapy can improve the outcome of CD20-positive B-cell acute lymphoblastic leukemia (ALL) patients. Areas covered: An overview of the current insights of rituximab in adult ALL patients is presented here. In particular, we focused on results of multicenter randomized phase III trial (GRAALL-2005 - Group for Research on Adult Acute Lymphoblastic Leukemia) that evaluated the benefit of associating rituximab to chemotherapy in Ph-negative, B-lineage ALL expressing the CD20 antigen. Expert opinion: Data from clinical trials confirm that rituximab enhances the efficacy of chemotherapy without additive toxicity in ALL. However, results of GRAAL 2005 study represent only a modest incremental improvement in the treatment of ALL. Other promising compounds as single agent or in combination with chemotherapy are currently in different stages of clinical development. The GRAALL 2005 study sets the stage for other prospective studies which will further elucidate the role of monoclonal antibodies in the management of ALL.
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Affiliation(s)
- Luciano Levato
- a Department Hematology-Oncology , Azienda Ospedaliera Pugliese-Ciaccio , Catanzaro , Italy
| | - Stefano Molica
- a Department Hematology-Oncology , Azienda Ospedaliera Pugliese-Ciaccio , Catanzaro , Italy
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Williams S, Kim M. Inotuzumab Ozogamicin in Relapsed or Refractory B-Cell Acute Lymphoblastic Leukemia. J Adv Pract Oncol 2018; 9:670-676. [PMID: 31186988 PMCID: PMC6505665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Despite initial complete remission rates of up to 90%, long-term, disease-free survival remains poor in patients with newly diagnosed acute lymphoblastic leukemia (ALL). Response to salvage chemotherapy is suboptimal; therefore, novel therapeutic agents are being investigated in order to improve outcomes in these patients. Inotuzumab ozogamicin is a CD22-directed antibody-drug conjugate recently approved by the US Food and Drug Administration for the treatment of adults with relapsed or refractory B-cell precursor ALL. Inotuzumab ozogamicin improves response rate, minimal residual disease negativity, and survival compared to standard chemotherapy in this population. In addition, it offers more opportunities to proceed to an allogeneic stem cell transplant in patients who otherwise may not be candidates.
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Pradhan P, Leleux J, Liu J, Roy K. A simple, clinically relevant therapeutic vaccine shows long-term protection in an aggressive, delayed-treatment B lymphoma model. JCI Insight 2017; 2:92522. [PMID: 29202455 DOI: 10.1172/jci.insight.92522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 10/17/2017] [Indexed: 12/16/2022] Open
Abstract
Despite initial remission after successful treatments, B lymphoma patients often encounter relapses and resistance causing high mortality. Thus, there is a need to develop therapies that prevent relapse by providing long-term protection and, ultimately, lead to functional cure. In this study, our goal was to develop a simple, clinically relevant, and easily translatable therapeutic vaccine that provides durable immune protection against aggressive B cell lymphoma and identify critical immune biomarkers that are predictive of long-term survival. In a delayed-treatment, aggressive, murine model of A20 B lymphoma that mimics human diffuse large B cell lymphoma, we show that therapeutic A20 lysate vaccine adjuvanted with an NKT cell agonist, α-galactosylceramide (α-GalCer), provides long-term immune protection against lethal tumor challenges and the antitumor immunity is primarily CD8 T cell dependent. Using experimental and computational methods, we demonstrate that the initial strength of germinal center reaction and the magnitude of class-switching into a Th1 type humoral response are the best predictors for the long-term immunity of B lymphoma lysate vaccine. Our results not only provide fundamentally insights for successful immunotherapy and long-term protection against B lymphomas, but also present a simple, therapeutic vaccine that can be translated easily due to the facile and inexpensive method of preparation.
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Wayne AS, Shah NN, Bhojwani D, Silverman LB, Whitlock JA, Stetler-Stevenson M, Sun W, Liang M, Yang J, Kreitman RJ, Lanasa MC, Pastan I. Phase 1 study of the anti-CD22 immunotoxin moxetumomab pasudotox for childhood acute lymphoblastic leukemia. Blood 2017; 130:1620-1627. [PMID: 28983018 PMCID: PMC5630009 DOI: 10.1182/blood-2017-02-749101] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
Novel therapies are needed to overcome chemotherapy resistance for children with relapsed/refractory acute lymphoblastic leukemia (ALL). Moxetumomab pasudotox is a recombinant anti-CD22 immunotoxin. A multicenter phase 1 study was conducted to determine the maximum-tolerated cumulative dose (MTCD) and evaluate safety, activity, pharmacokinetics, and immunogenicity of moxetumomab pasudotox in children, adolescents, and young adults with ALL (N = 55). Moxetumomab pasudotox was administered as a 30-minute IV infusion at doses of 5 to 50 µg/kg every other day for 6 (cohorts A and B) or 10 (cohort C) doses in 21-day cycles. Cohorts B and C received dexamethasone prophylaxis against capillary leak syndrome (CLS). The most common treatment-related adverse events were reversible weight gain, hepatic transaminase elevation, and hypoalbuminemia. Dose-limiting CLS occurred in 2 of 4 patients receiving 30 µg/kg of moxetumomab pasudotox every other day for 6 doses. Incorporation of dexamethasone prevented further dose-limiting CLS. Six of 14 patients receiving 50 µg/kg of moxetumomab pasudotox for 10 doses developed hemolytic uremic syndrome (HUS), thrombotic microangiopathy (TMA), or HUS-like events, exceeding the MTCD. Treatment expansion at 40 µg/kg for 10 doses (n = 11) exceeded the MTCD because of 2 HUS/TMA/HUS-like events. Dose level 6B (ie, 50 µg/kg × 6 doses) was the MTCD, selected as the recommended phase 2 dose. Among 47 evaluable patients, an objective response rate of 32% was observed, including 11 (23%) composite complete responses, 5 of which were minimal residual disease negative by flow cytometry. Moxetumomab pasudotox showed a manageable safety profile and evidence of activity in relapsed or refractory childhood ALL. This trial was registered at www.clinicaltrials.gov as #NCT00659425.
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Affiliation(s)
- Alan S Wayne
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
- Laboratory of Molecular Biology, CCR, NCI, NIH, Bethesda, MD
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Deepa Bhojwani
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
- St Jude Children's Research Hospital, Memphis, TN
| | - Lewis B Silverman
- Pediatric Hematologic Malignancies Center, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | - James A Whitlock
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Weili Sun
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | | | | | - Ira Pastan
- Laboratory of Molecular Biology, CCR, NCI, NIH, Bethesda, MD
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18
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Kantarjian H, Stein A, Gökbuget N, Fielding AK, Schuh AC, Ribera JM, Wei A, Dombret H, Foà R, Bassan R, Arslan Ö, Sanz MA, Bergeron J, Demirkan F, Lech-Maranda E, Rambaldi A, Thomas X, Horst HA, Brüggemann M, Klapper W, Wood BL, Fleishman A, Nagorsen D, Holland C, Zimmerman Z, Topp MS. Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia. N Engl J Med 2017; 376:836-847. [PMID: 28249141 PMCID: PMC5881572 DOI: 10.1056/nejmoa1609783] [Citation(s) in RCA: 1299] [Impact Index Per Article: 185.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Blinatumomab, a bispecific monoclonal antibody construct that enables CD3-positive T cells to recognize and eliminate CD19-positive acute lymphoblastic leukemia (ALL) blasts, was approved for use in patients with relapsed or refractory B-cell precursor ALL on the basis of single-group trials that showed efficacy and manageable toxic effects. METHODS In this multi-institutional phase 3 trial, we randomly assigned adults with heavily pretreated B-cell precursor ALL, in a 2:1 ratio, to receive either blinatumomab or standard-of-care chemotherapy. The primary end point was overall survival. RESULTS Of the 405 patients who were randomly assigned to receive blinatumomab (271 patients) or chemotherapy (134 patients), 376 patients received at least one dose. Overall survival was significantly longer in the blinatumomab group than in the chemotherapy group. The median overall survival was 7.7 months in the blinatumomab group and 4.0 months in the chemotherapy group (hazard ratio for death with blinatumomab vs. chemotherapy, 0.71; 95% confidence interval [CI], 0.55 to 0.93; P=0.01). Remission rates within 12 weeks after treatment initiation were significantly higher in the blinatumomab group than in the chemotherapy group, both with respect to complete remission with full hematologic recovery (34% vs. 16%, P<0.001) and with respect to complete remission with full, partial, or incomplete hematologic recovery (44% vs. 25%, P<0.001). Treatment with blinatumomab resulted in a higher rate of event-free survival than that with chemotherapy (6-month estimates, 31% vs. 12%; hazard ratio for an event of relapse after achieving a complete remission with full, partial, or incomplete hematologic recovery, or death, 0.55; 95% CI, 0.43 to 0.71; P<0.001), as well as a longer median duration of remission (7.3 vs. 4.6 months). A total of 24% of the patients in each treatment group underwent allogeneic stem-cell transplantation. Adverse events of grade 3 or higher were reported in 87% of the patients in the blinatumomab group and in 92% of the patients in the chemotherapy group. CONCLUSIONS Treatment with blinatumomab resulted in significantly longer overall survival than chemotherapy among adult patients with relapsed or refractory B-cell precursor ALL. (Funded by Amgen; TOWER ClinicalTrials.gov number, NCT02013167 .).
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Affiliation(s)
- Hagop Kantarjian
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Anthony Stein
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Nicola Gökbuget
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Adele K Fielding
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Andre C Schuh
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Josep-Maria Ribera
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Andrew Wei
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Hervé Dombret
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Robin Foà
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Renato Bassan
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Önder Arslan
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Miguel A Sanz
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Julie Bergeron
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Fatih Demirkan
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Ewa Lech-Maranda
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Alessandro Rambaldi
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Xavier Thomas
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Heinz-August Horst
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Monika Brüggemann
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Wolfram Klapper
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Brent L Wood
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Alex Fleishman
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Dirk Nagorsen
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Christopher Holland
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Zachary Zimmerman
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
| | - Max S Topp
- From the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (H.K.); City of Hope National Medical Center, Duarte (A.S.), and Amgen, Thousand Oaks (A.F., D.N., Z.Z.) - both in California; Goethe University, University Hospital, Department of Medicine II, Frankfurt am Main (N.G.), Medical Department II (H.-A.H., M.B.) and Hematopathology Section and Lymph Node Registry (W.K.), University Hospital Schleswig Holstein, Campus Kiel, Kiel, and Medizinische Klinik und Poliklinik II, Universitätsklinikums Würzburg, Würzburg (M.S.T.) - all in Germany; Royal Free Hospital and University College London Cancer Institute, London (A.K.F.); Princess Margaret Cancer Centre, Toronto (A.C.S.), and Centre Intégré Universitaire de Santé et de Services Sociaux de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, Montreal (J.B.) - all in Canada; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona (J.-M.R.), the Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, and Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid (M.A.S.) - all in Spain; Alfred Hospital and Monash University, Melbourne, VIC, Australia (A.W.); Institut Universitaire d'Hématologie, Hôpital Saint-Louis (Assistance Publique - Hôpitaux de Paris), Paris (H.D.), and Centre Hospitalier Lyon Sud, Pierre-Benite (X.T.) - both in France; Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Azienda Ospedaliera Policlinico Umberto I, Università Sapienza di Roma, Rome (R.F.), Azienda Unità Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice (R.B.), and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Università Statale di Milano, Milan (A.R.) - all in Italy; Ankara Universitesi, Tip Fakültesi, Cebeci Arastirma ve Uygulama Hastanesi, Ankara (Ö.A.), and Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir (F.D.) - both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland (E.L.-M.); University of Washington Medical Center, Seattle (B.L.W.); and Amgen, Washington, DC (C.H.)
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Shah NN. Antibody Based Therapies in Acute Leukemia. Curr Drug Targets 2017; 18:257-270. [PMID: 27593687 PMCID: PMC8335750 DOI: 10.2174/1389450117666160905091459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/24/2015] [Accepted: 11/09/2015] [Indexed: 01/05/2023]
Abstract
Despite great progress in the curative treatment of acute leukemia, outcomes for those with relapsed and/or chemotherapy-refractory disease remain poor. Current intensive cytotoxic therapies can be associated with significant morbidity and novel therapies are needed to improve outcomes. Immunotherapy based approaches provide an alternative mechanism of action in the treatment of acute leukemia. Due to cell surface antigen expression, leukemia in particular is amenable to targeted therapies, such as antibody-based therapy. Based on the potential for non-overlapping toxicity, the possibility of synergistic action with standard chemotherapy, and by providing a novel method to overcome chemotherapy resistance, antibody-based therapies have shown potential for benefit. Modifications to standard monoclonal antibodies, including drug conjugation and linkage to T-cells, may further enhance efficacy of antibody-based therapies. Identifying the ideal timing for incorporation of antibody-based therapies, within standard regimens, may lead to improvement in overall outcomes. This article will provide an overview of antibody-based therapies in clinical development for the treatment of acute leukemia in children and adults, with a particular focus on the current strategies and future developments.
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Affiliation(s)
- Nirali N. Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD, USA
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Boyiadzis M, Bishop MR, Abonour R, Anderson KC, Ansell SM, Avigan D, Barbarotta L, Barrett AJ, Van Besien K, Bergsagel PL, Borrello I, Brody J, Brufsky J, Cairo M, Chari A, Cohen A, Cortes J, Forman SJ, Friedberg JW, Fuchs EJ, Gore SD, Jagannath S, Kahl BS, Kline J, Kochenderfer JN, Kwak LW, Levy R, de Lima M, Litzow MR, Mahindra A, Miller J, Munshi NC, Orlowski RZ, Pagel JM, Porter DL, Russell SJ, Schwartz K, Shipp MA, Siegel D, Stone RM, Tallman MS, Timmerman JM, Van Rhee F, Waller EK, Welsh A, Werner M, Wiernik PH, Dhodapkar MV. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of hematologic malignancies: multiple myeloma, lymphoma, and acute leukemia. J Immunother Cancer 2016; 4:90. [PMID: 28018601 PMCID: PMC5168808 DOI: 10.1186/s40425-016-0188-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/07/2016] [Indexed: 12/24/2022] Open
Abstract
Increasing knowledge concerning the biology of hematologic malignancies as well as the role of the immune system in the control of these diseases has led to the development and approval of immunotherapies that are resulting in impressive clinical responses. Therefore, the Society for Immunotherapy of Cancer (SITC) convened a hematologic malignancy Cancer Immunotherapy Guidelines panel consisting of physicians, nurses, patient advocates, and patients to develop consensus recommendations for the clinical application of immunotherapy for patients with multiple myeloma, lymphoma, and acute leukemia. These recommendations were developed following the previously established process based on the Institute of Medicine's clinical practice guidelines. In doing so, a systematic literature search was performed for high-impact studies from 2004 to 2014 and was supplemented with further literature as identified by the panel. The consensus panel met in December of 2014 with the goal to generate consensus recommendations for the clinical use of immunotherapy in patients with hematologic malignancies. During this meeting, consensus panel voting along with discussion were used to rate and review the strength of the supporting evidence from the literature search. These consensus recommendations focus on issues related to patient selection, toxicity management, clinical endpoints, and the sequencing or combination of therapies. Overall, immunotherapy is rapidly emerging as an effective therapeutic strategy for the management of hematologic malignances. Evidence-based consensus recommendations for its clinical application are provided and will be updated as the field evolves.
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Affiliation(s)
- Michael Boyiadzis
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 564, Pittsburg, PA 15232 USA
| | - Michael R. Bishop
- Hematopoietic Cellular Therapy Program, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Rafat Abonour
- Indiana University School of Medicine, 980 W. Walnut St., Walther Hall-R3, C400, Indianapolis, IN 46202 USA
| | | | | | - David Avigan
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Lisa Barbarotta
- Smilow Cancer Hospital at Yale New Haven, 35 Park Street, New Haven, CT 06519 USA
| | - Austin John Barrett
- National Institutes of Health, Building 10-CRC Room 3-5330, Bethesda, MD 20814 USA
| | - Koen Van Besien
- Weill Cornell Medical College, 407 E 71st St, New York, NY 10065 USA
| | | | - Ivan Borrello
- Johns Hopkins School of Medicine, 1650 Orleans St, Baltimore, MD 21231 USA
| | - Joshua Brody
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Jill Brufsky
- University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA 15232 USA
| | - Mitchell Cairo
- New York Medical College at Maria Fareri Children’s Hospital, 100 Woods Road, Valhalla, New York 10595 USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Adam Cohen
- Abramson Cancer Center at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Jorge Cortes
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Stephen J. Forman
- City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010 USA
| | - Jonathan W. Friedberg
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Ephraim J. Fuchs
- Johns Hopkins University School of Medicine, 401 N. Broadway, Baltimore, MD 21231 USA
| | - Steven D. Gore
- Yale Cancer Center, 333 Cedar Street, New Haven, CT 06511 USA
| | - Sundar Jagannath
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Brad S. Kahl
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110 USA
| | - Justin Kline
- The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - James N. Kochenderfer
- National Institutes of Health, National Cancer Institute, 8500 Roseweood Drive, Bethesda, MD 20814 USA
| | - Larry W. Kwak
- City of Hope National Medical Center, 1500 E. Duarte Road, Beckman Bldg., Room 4117, Duarte, CA 91010 USA
| | - Ronald Levy
- Division of Medical Oncology, Stanford University School of Medicine, 269 Campus Drive, Stanford, CA 94305 USA
| | - Marcos de Lima
- Department of Medicine-Hematology and Oncology, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106 USA
| | - Mark R. Litzow
- Department of Hematology, Mayo Clinic Cancer Center, 200 First Street SW, Rochester, MN 55905 USA
| | - Anuj Mahindra
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, Box 0324, San Francisco, CA 94143 USA
| | - Jeffrey Miller
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455 USA
| | - Nikhil C. Munshi
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Dana B106, Boston, MA 02215 USA
| | - Robert Z. Orlowski
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 429, Houston, TX 77030 USA
| | - John M. Pagel
- Swedish Cancer Institute, 1221 Madison Street, Suite 1020, Seattle, WA 98104 USA
| | - David L. Porter
- University of Pennsylvania, 3400 Civic Center Blvd, PCAM 12 South Pavilion, Philadelphia, PA 19104 USA
| | | | - Karl Schwartz
- Patients Against Lymphoma, 3774 Buckwampum Road, Riegelsville, PA 18077 USA
| | - Margaret A. Shipp
- Dana-Farber Cancer Institute, 450 Brookline Ave, Mayer 513, Boston, MA 02215 USA
| | - David Siegel
- Hackensack University Medical Center, 92 2nd St., Hackensack, NJ 07601 USA
| | - Richard M. Stone
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Martin S. Tallman
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - John M. Timmerman
- University of California, Los Angeles, 10833 LeConte Ave., Los Angeles, CA 90095 USA
| | - Frits Van Rhee
- University of Arkansas for Medical Sciences, Myeloma Institute, 4301 W Markham #816, Little Rock, AR 72205 USA
| | - Edmund K. Waller
- Winship Cancer Institute, Emory University, 1365B Clifton Road NE, Atlanta, GA 30322 USA
| | - Ann Welsh
- University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Michael Werner
- Patient Advocate, 33 East Bellevue Place, Chicago, IL 60611 USA
| | - Peter H. Wiernik
- Cancer Research Foundation of New York, 43 Longview Lane, Chappaqua, NY 10514 USA
| | - Madhav V. Dhodapkar
- Department of Hematology & Immunobiology, Yale University, 333 Cedar Street, Box 208021, New Haven, CT 06510 USA
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Gökbuget N. Treatment of older patients with acute lymphoblastic leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:573-579. [PMID: 27913531 PMCID: PMC6142461 DOI: 10.1182/asheducation-2016.1.573] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The treatment of older patients with acute lymphoblastic leukemia (ALL) is an unmet medical need. With increasing age, ALL patients have a significantly lower clinical remission rate, higher early mortality, higher relapse rate, and poorer survival compared with younger patients. This is only partly explained by a higher incidence of poor prognostic factors in the older age group. Most importantly, intensive chemotherapy with or without stem cell transplantation (SCT) is less well tolerated in older patients. Some progress has been made with delivering age-adapted, moderately intensive chemotherapy protocols for Ph/BCR-ABL-negative ALL and combinations of tyrosine kinase inhibitors with chemotherapy in Ph/BCR-ABL-positive ALL. For the future, optimizing supportive care, introducing targeted therapies, novel immunotherapies, moderately intensified consolidation strategies, and reduced intensity SCT are promising approaches. Prospective clinical trials for older patients are urgently needed to test these approaches.
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Affiliation(s)
- Nicola Gökbuget
- Department of Medicine II, Goethe University Hospital, Frankfurt am Main, Germany
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DePadova S, Howlett C, Rivera K. A Multidisciplinary Approach to Standardizing Processes for Blinatumomab Administration. Clin J Oncol Nurs 2016; 20:466-9. [DOI: 10.1188/16.cjon.466-469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Abstract
Through years of evolutionary selection pressures, organisms have developed potent toxins that coincidentally have marked antineoplastic activity. These natural products have been vital for the development of multiagent treatment regimens currently employed in cancer chemotherapy, and are used in the treatment of a variety of malignancies. Therefore, this review catalogs recent advances in natural product-based drug discovery via the examination of mechanisms of action and available clinical data to highlight the utility of these novel compounds in the burgeoning age of precision medicine. The review also highlights the recent development of antibody-drug conjugates and other immunotoxins, which are capable of delivering highly cytotoxic agents previously deemed too toxic to elicit therapeutic benefit preferentially to neoplastic cells. Finally, the review examines natural products not currently used in the clinic that have novel mechanisms of action, and may serve to supplement current chemotherapeutic protocols.
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24
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Litzow MR. Monoclonal antibody-based therapies in the treatment of acute lymphoblastic leukemia. Am Soc Clin Oncol Educ Book 2016:294-9. [PMID: 23714527 DOI: 10.14694/edbook_am.2013.33.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Recent studies have suggested that pediatric-intensive chemotherapy regimens can improve outcomes in adults with acute lymphoblastic leukemia (ALL) up to the age of 45. Above this age, toxicities increase. Monoclonal antibody-based therapies bring the promise of increased response rates without excessive toxicity. The addition of rituximab to combination chemotherapy has shown encouraging results. Newer monoclonal antibody-based therapies linked to cytotoxic agents show promise. These include inotuzumab ozogamicin, an anti-CD22 antibody linked to calicheamicin that has produced significant single-agent responses in relapsed and refractory ALL. Other monoclonal antibodies linked to plant or bacterial toxins are in earlier stages of development. Blinatumomab is a novel bispecific T-cell engaging antibody that combines single chain antibodies to CD19 and CD3 and brings a T cell in close proximity to a leukemic lymphoblast with resulting redirected lysis. This agent has demonstrated encouraging results in both the minimal residual disease setting and the relapsed/refractory setting. Autologous chimeric antigen receptor cells have shown promising responses in indolent B-cell lymphoid malignancies and are being tested in ALL. Many of these agents have the potential to increase response rates in older adults. Trials of many of these monoclonal antibody-based therapies are in various stages of development in the treatment of newly diagnosed ALL.
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Affiliation(s)
- Mark R Litzow
- From the Division of Hematology, Mayo Clinic, Rochester, MN
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25
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Le Jeune C, Thomas X. Potential for bispecific T-cell engagers: role of blinatumomab in acute lymphoblastic leukemia. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:757-65. [PMID: 26937176 PMCID: PMC4762579 DOI: 10.2147/dddt.s83848] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patients with relapsed/refractory (R/R) B-precursor acute lymphoblastic leukemia (ALL) and patients whose minimal residual disease persists during treatment have a poor leukemia-free survival. Despite improvements in front-line therapy, the outcome in these patients remains poor, especially after relapse. As there are no standard chemotherapeutic regimens for the treatment of patients with R/R B-precursor ALL, T-cell-based therapeutic approaches have recently come to the forefront in ALL therapy. Recently, monoclonal antibodies have been developed to target specific antigens expressed in B-lineage blast cells. In this setting, CD19 is of great interest as this antigen is expressed in B-lineage cells. Therefore, it has been selected as the target antigen for blinatumomab, a new bi-specific T-cell engager antibody. This sophisticated antibody binds sites for both CD19 and CD3, leading to T-cell proliferation and activation and B-cell apoptosis. Owing to its short serum half-life, blinatumomab has been administrated by continuous intravenous infusion with a favorable safety profile. The most significant toxicities were central nervous system events and the cytokine release syndrome. This new therapeutic approach using blinatumomab has been shown to be effective in patients with positive minimal residual disease and in patients with R/R B-precursor ALL leading to a recent approval by the US Food and Drug Administration after an accelerated review process. This review focuses on the profile of blinatumomab and its efficacy and safety.
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Affiliation(s)
- Caroline Le Jeune
- Hospices Civils de Lyon, Hematology Department, Lyon-Sud Hospital, Pierre Bénite, France
| | - Xavier Thomas
- Hospices Civils de Lyon, Hematology Department, Lyon-Sud Hospital, Pierre Bénite, France
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26
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Bassan R, Spinelli O. Minimal Residual Disease Monitoring in Adult ALL to Determine Therapy. Curr Hematol Malig Rep 2016; 10:86-95. [PMID: 25929769 DOI: 10.1007/s11899-015-0252-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Almost 90 % of children and 50 % of adults with acute lymphoblastic leukemia (ALL) are cured by modern treatment regimens, with significant variations due to several disease- and host-related characteristics. The attainment of an early remission and the avoidance of relapse and treatment-related mortality are the fundamental therapeutic steps. In remission patients, the assessment of the disease response to early intensive therapy through the detection and monitoring of minimal residual disease (MRD) can accurately refine the individual prognosis and is increasingly used to support a risk-oriented treatment strategy. In this way, only the patients with an unfavorable MRD response are preferably selected for allogeneic stem cell transplantation, irrespective of their clinical risk class. This choice spares transplant-related toxicities to MRD responsive cases. Further advancement is expected by integrating the MRD analysis with improved pediatric-type regimens and novel targeting agents for ALL subsets at higher risk of relapse.
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Affiliation(s)
- Renato Bassan
- UOC Ematologia, Ospedale dell'Angelo, Via Paccagnella 11, 30174, Mestre-Venezia, Italy,
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27
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Affiliation(s)
- Dieter Hoelzer
- Onkologikum Frankfurt am Museumsufer, Frankfurt, Germany
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28
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George B, Kantarjian H, Jabbour E, Jain N. Role of inotuzumab ozogamicin in the treatment of relapsed/refractory acute lymphoblastic leukemia. Immunotherapy 2016; 8:135-43. [PMID: 26780449 PMCID: PMC5618942 DOI: 10.2217/imt.15.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/03/2015] [Indexed: 02/07/2023] Open
Abstract
Inotuzumab ozogamicin is a humanized anti-CD22 monoclonal antibody bound to a toxic natural calicheamicin, which is under investigation for the treatment of relapsed/refractory acute lymphoblastic leukemia. CD22 is commonly expressed in 90-100% of malignant mature B-lymphocyte lineage. The first Phase II study with inotuzumab ozogamicin conducted by Kantarjian et al. gave the opportunity for heavily pretreated patients with acute lymphoblastic leukemia to go for allogeneic stem cell transplant. Inotuzumab is well-tolerated with the exception of veno-occlusive disease. Overall inotuzumab ozogamicin is potentially an encouraging and promising therapy for patients.
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Affiliation(s)
- Binsah George
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Elias Jabbour
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Nitin Jain
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
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29
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Ravandi F, Jorgensen JL, O'Brien SM, Jabbour E, Thomas DA, Borthakur G, Garris R, Huang X, Garcia-Manero G, Burger JA, Ferrajoli A, Wierda W, Kadia T, Jain N, Wang SA, Konoplev S, Kebriaei P, Champlin RE, McCue D, Estrov Z, Cortes JE, Kantarjian HM. Minimal residual disease assessed by multi-parameter flow cytometry is highly prognostic in adult patients with acute lymphoblastic leukaemia. Br J Haematol 2015; 172:392-400. [PMID: 26492205 DOI: 10.1111/bjh.13834] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Abstract
The prognostic value of minimal residual disease (MRD) assessed by multi-parameter flow cytometry (MFC) was investigated among 340 adult patients with B-cell acute lymphoblastic leukaemia (B-ALL) treated between 2004 and 2014 using regimens including the hyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) backbone. Among them, 323 (95%) achieved complete remission (CR) and were included in this study. Median age was 52 years (range, 15-84). Median white blood cell count (WBC) was 9·35 × 10(9) /l (range, 0·4-658·1 ×1 0(9) /l). MRD by MFC was initially assessed with a sensitivity of 0·01%, using a 15-marker, 4-colour panel and subsequently a 6-colour panel on bone marrow specimens obtained at CR achievement and at approximately 3 month intervals thereafter. MRD negative status at CR was associated with improved disease-free survival (DFS) and overall survival (OS) (P = 0·004 and P = 0·03, respectively). Similarly, achieving MRD negative status at approximately 3 and 6 months was associated with improved DFS (P = 0·004 and P < 0·0001, respectively) and OS (P = 0·004 and P < 0·0001, respectively). Multivariate analysis including age, WBC at presentation, cytogenetics (standard versus high risk) and MRD status at CR, 3 and 6 months, indicated that MRD negative status at CR was an independent predictor of DFS (P < 0·05). Achievement of an MRD negative state assessed by MFC is an important predictor of DFS and OS in adult patients with ALL.
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Affiliation(s)
- Farhad Ravandi
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey L Jorgensen
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan M O'Brien
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah A Thomas
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Garris
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuelin Huang
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guillermo Garcia-Manero
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan A Burger
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Wierda
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan Kadia
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nitin Jain
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sergei Konoplev
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Departments of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Champlin
- Departments of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah McCue
- Departments of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeev Estrov
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Cortes
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop M Kantarjian
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fan D, Li W, Yang Y, Zhang X, Zhang Q, Yan Y, Yang M, Wang J, Xiong D. Redirection of CD4+ and CD8+ T lymphocytes via an anti-CD3 × anti-CD19 bi-specific antibody combined with cytosine arabinoside and the efficient lysis of patient-derived B-ALL cells. J Hematol Oncol 2015; 8:108. [PMID: 26444983 PMCID: PMC4596481 DOI: 10.1186/s13045-015-0205-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/28/2015] [Indexed: 01/07/2023] Open
Abstract
Background B-acute lymphoblastic leukemia (B-ALL) is derived from B cell progenitors. Recently, the development of appropriate combinations of chemotherapy and immunotherapy represents a promising approach for eliminating cancer. We previously constructed an anti-CD3 × anti-CD19 bi-specific antibody in a diabody configuration and its disulfide-stabilized format (ds-diabody). The combination of the diabody or ds-diabody and Ara-C was highly effective in enhancing the cytotoxicity of T cells against the CD19+ human leukemia cell-line, Nalm-6, both in vitro and in vivo. This study verified whether B-ALL patient-derived cells were sensitive to the diabody or ds-diabody and low-dosage Ara-C combination. Methods This study aimed to detect the B7 family members B7.1 (CD80) and B7.2 (CD86) that were expressed in B-ALL patient-derived cells pre-treated by Ara-C (0.25 μM) and to determine the targeted killing ability of T cell subtypes induced by the diabody or ds-diabody combination with Ara-C both in vitro and in vivo. We also determined the levels of the cytokines that were released by activated CD4+ or CD8+ T cells during therapy. Result Low-dose Ara-C enhanced CD80 and CD86 expression in nearly 50 % of specimens of B-ALL patient-derived cells. A combination of diabody or ds-diabody and Ara-C enhanced T cell against B-ALL cells in vitro and in vivo. Both CD8+ and CD4+ T cells were potently activated. Expression of CD25 and CD69 was augmented equally by CD4+ or CD8+ T cells. However, CD8+ T cells made the major contribution by redirecting target cell lysis in a granzyme B and perforin-dependent mechanism. CD4+ T cells played an important immunomodulatory role by secreting IL2. Consequently, IL3, IL6, TNFα, and IFNγ were also released by CD4+ or CD8+ T cells following diabody-mediated T cell activation. Conclusion T cell therapy induced by diabody or ds-diabody combined with low dose of Ara-C was effective against cancer cell-lines and in clinical trials. In vivo, the ds-diabody was more efficient than its parent diabody due to its enhanced stability.
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Affiliation(s)
- Dongmei Fan
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Wei Li
- Department of Maxillofacial and E.N.T. Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.
| | - Yuqi Yang
- School of Pharmacy, Tianjin Medical University, Tianjin, 300070, People's Republic of China.
| | - Xiaolong Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Qing Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Yan Yan
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Ming Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Dongsheng Xiong
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
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31
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Yilmaz M, Richard S, Jabbour E. The clinical potential of inotuzumab ozogamicin in relapsed and refractory acute lymphocytic leukemia. Ther Adv Hematol 2015; 6:253-61. [PMID: 26425338 DOI: 10.1177/2040620715596715] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Antibody-drug conjugates (ADCs) are likely to make a significant contribution in the treatment of acute lymphoblastic leukemia (ALL) by combining the cytotoxicity of chemotherapy with the specificity of monoclonal antibodies. CD22, an endocytic receptor expressed by the majority of B cells, is an excellent target for ADCs. Inotuzumab ozogamicin (INO) is an ADC that consists of a cytotoxic moiety (derivative of calicheamicin) attached to a humanized monoclonal anti-CD22 antibody. As a single agent, INO, was shown to be effective with an objective response rate of 50% in the treatment of relapsed and refractory CD22 positive ALL patients. Clinical trials investigating the combination of INO with the conventional chemotherapies are ongoing. This review summarizes the clinical potential of INO in treatment of relapsed and refractory ALL, based on currently available data in the literature.
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Affiliation(s)
- Musa Yilmaz
- Department of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Samantha Richard
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Box 428, 1515 Holcombe Blvd., Houston, TX 77030, USA
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How I treat adults with relapsed or refractory Philadelphia chromosome-negative acute lymphoblastic leukemia. Blood 2015; 126:589-96. [PMID: 25966988 DOI: 10.1182/blood-2014-09-551937] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 04/02/2015] [Indexed: 12/17/2022] Open
Abstract
The long-term prognosis of adult patients with relapsed Philadelphia chromosome-negative acute lymphoblastic lymphoma (ALL) is poor. Allogeneic stem cell transplant in second remission is the only curative approach and is the goal when feasible. There is no standard chemotherapy regimen for relapsed disease, although a few agents are approved for use in this setting. The bispecific CD19-directed CD3 T-cell engager, blinatumomab, has recently been granted accelerated approval by the US Food and Drug Administration for relapsed or refractory disease of B-cell lineage. For patients with relapsed T-cell ALL, nelarabine is available. Liposomal vincristine is also approved for relapsed disease. When selecting combination chemotherapy salvage options, evaluation of the prior treatment and timing of relapse informs treatment decisions. Monoclonal and cellular investigational therapies are quite promising and should be explored in the appropriate patient.
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How I treat T-cell acute lymphoblastic leukemia in adults. Blood 2015; 126:833-41. [PMID: 25966987 DOI: 10.1182/blood-2014-10-551895] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 04/25/2015] [Indexed: 01/13/2023] Open
Abstract
T-cell immunophenotype of acute lymphoblastic leukemia (T-ALL) is an uncommon aggressive leukemia that can present with leukemic and/or lymphomatous manifestations. Molecular studies are enhancing our understanding of the pathogenesis of T-ALL, and the discovery of activating mutations of NOTCH1 and FBXW7 in a majority of patients has been a seminal observation. The use of pediatric intensive combination chemotherapy regimens in adolescents and young adults has significantly improved the outcome of patients with T-ALL. The use of nelarabine for relapsed and refractory T-ALL results in responses in a substantial minority of patients. Allogeneic hematopoietic cell transplantation (HCT) still plays a key role in patients with high-risk or relapsed/refractory disease. γ-Secretase inhibitors hold promise for the treatment of patients with NOTCH1 mutations, and the results of clinical trials with these agents are eagerly awaited. It is recommended that younger patients receive a pediatric-intensive regimen. Older and unfit patients can receive suitable multiagent chemotherapy and be allocated to HCT based on their response, risk factors, and comorbidities. Although advances in the treatment of T-ALL have lagged behind those of B-cell ALL, it is hoped that the molecular revolution will enhance our understanding of the pathogenesis and treatment of this aggressive lymphoid malignancy.
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Future of Therapy in Acute Lymphoblastic Leukemia (ALL)—Potential Role of Immune-Based Therapies. Curr Hematol Malig Rep 2015; 10:76-85. [DOI: 10.1007/s11899-015-0251-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The treatment of adult acute lymphoblastic leukemia (ALL) poses a tremendous challenge for hematologists. The use of pediatric-based chemotherapy regimens in young adults up to the age of 45 years has resulted in improved outcomes when compared retrospectively with historical controls treated with adult therapy. A better understanding of the molecular landscape of ALL and advances in the field of monoclonal antibody therapy have resulted in the development of several new agents that may provide for a reduction in the toxicity inherent in pediatric-like regimens. The anti-CD20 antibody, rituximab, anti CD22 antibody, epratuzumab, anti-CD22 antibody-drug conjugate, Inotuzumab ozogamicin, the bi-specific T-cell engager (BiTE) antibody, Blinatumomab, and chimeric receptor antigen (CAR) therapy are among the emerging agents that have demonstrated the potential to improve response rate and decrease toxicity when used alone or in combination with chemotherapy. Several role-defining phase II and phase III clinical trials with these agents are currently underway in the relapsed/refractory and newly diagnosed ALL settings.
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Guru Murthy GS, Venkitachalam R, Mehta P. Trends in survival outcomes of B-lineage acute lymphoblastic leukemia in elderly patients: analysis of Surveillance, Epidemiology, and End Results database. Leuk Lymphoma 2015; 56:2296-300. [DOI: 10.3109/10428194.2014.991921] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maino E, Scattolin AM, Viero P, Sancetta R, Pascarella A, Vespignani M, Bassan R. Modern immunotherapy of adult B-lineage acute lymphoblastic leukemia with monoclonal antibodies and chimeric antigen receptor modified T cells. Mediterr J Hematol Infect Dis 2015; 7:e2015001. [PMID: 25574360 PMCID: PMC4283921 DOI: 10.4084/mjhid.2015.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 11/20/2014] [Indexed: 11/08/2022] Open
Abstract
The introduction of newer cytotoxic monoclonal antibodies and chimeric antigen receptor modified T cells is opening a new age in the management of B-lineage adult acute lymphoblastic leukemia. This therapeutic change must be very positively acknowledged because of the limits of intensive chemotherapy programs and allogeneic stem cell transplantation. In fact, with these traditional therapeutic tools the cure can be achieved in only 40-50% of the patients. The failure rates are particularly high in the elderly, in patients with post-induction persistence of minimal residual disease and especially in refractory/relapsed disease. The place of the novel immunotherapeutics in improving the outcome of adult patients with B-lineage acute lymphoblastic leukemia is reviewed.
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Affiliation(s)
- Elena Maino
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Anna Maria Scattolin
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Piera Viero
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Rosaria Sancetta
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Anna Pascarella
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Michele Vespignani
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Renato Bassan
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
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Abstract
Despite the significant advances in modern chemotherapy, it remains challenging to treat adult patients with acute lymphoblastic leukaemia (ALL). The relapse rate remains high, and the outcome at the time of relapse is dismal. Antibody-based therapies have demonstrated promising results in this patient group. Variable mechanisms have been applied to target surface antigens (CD20 [also termed MS4A1], CD22, CD52 and CD19) that are commonly expressed on malignant leukaemia cells. In this review, we will focus on the clinical application of such therapies in adult ALL, including the naked antibodies: Rituximab, Ofatumumab, Epratuzumab and Alemtuzumab; the immunotoxins: BL22 and Combotox; the immunoconjugates: inotuzumab and SAR 3419; as well as the Bi-specific T cell engaging (BiTE)-specific antibody, Blinatumomab.
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Affiliation(s)
- Jing Ai
- Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Parikh SA, Litzow MR. Philadelphia chromosome-negative acute lymphoblastic leukemia: therapies under development. Future Oncol 2014; 10:2201-12. [DOI: 10.2217/fon.14.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Although the prognosis of adults with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) has steadily improved over the past decade, less than 50% of patients maintain their remission at 5 years. Several approaches have been explored in the past few years including: monoclonal antibodies – either ‘naked’ (rituximab) or in combination with an immunotoxin (calicheamicin or maytansin), plant toxin (ricin), or bacterial toxin (Pseudomonas or diphtheria), and a novel bispecific T-cell-engaging antibody (blinatumomab); chimeric antigen therapy using autologous T cells that target CD19-expressing ALL; and novel agents such as proteasome inhibitors, liposomal vincristine, hypomethylating agents, nelarabine and NOTCH1 inhibitors. This review summarizes treatment approaches currently under investigation for the treatment of adult Philadelphia chromosome-negative ALL.
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Affiliation(s)
- Sameer A Parikh
- Mayo Clinic, Division of Hematology, Department of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Mark R Litzow
- Mayo Clinic, Division of Hematology, Department of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Prognostic significance and treatment implications of minimal residual disease studies in Philadelphia-negative adult acute lymphoblastic leukemia. Mediterr J Hematol Infect Dis 2014; 6:e2014062. [PMID: 25237475 PMCID: PMC4165493 DOI: 10.4084/mjhid.2014.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/22/2014] [Indexed: 11/08/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is curable in about 40-50% of adult patients, however this is subject to ample variations owing to several host- and disease-related prognostic characteristics. Currently, the study of minimal residual disease (MRD) following induction and early consolidation therapy stands out as the most sensitive individual prognostic marker to define the risk of relapse following the achievement of remission, and ultimately that of treatment failure or success. Because substantial therapeutic advancement is now being achieved using intensified pediatric-type regimens, MRD analysis is especially useful to orientate stem cell transplantation choices. These strategic innovations are progressively leading to greater than 50% cure rates.
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Oriol A. Treatment of relapsed or refractory acute lymphoblastic leukemia in adult patients. Acta Haematol 2014; 133:89-90. [PMID: 25170866 DOI: 10.1159/000362778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Albert Oriol
- Clinical Hematology Service and Oncohematological Clinical Trial Unit, Institut Català d'Oncologia (ICO), and Institut de Recerca contra la Leucèmia Josep Carreras (IJC), Hospital Germans Trias i Pujol, Badalona, Spain
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Cytotoxicity of CD56-positive lymphocytes against autologous B-cell precursor acute lymphoblastic leukemia cells. Leukemia 2014; 29:788-97. [PMID: 25134458 PMCID: PMC4334757 DOI: 10.1038/leu.2014.246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/06/2014] [Indexed: 01/10/2023]
Abstract
Precursor B-lineage acute lymphoblastic leukemia (pre-B ALL) affects hematopoietic development and therefore is associated with immune deficiencies that can be further exacerbated by chemotherapy. It is unclear if and when monoclonal antibodies (mAbs) that stimulate antibody-mediated cellular cytotoxicity (ADCC) can be used for treatment because this depends on the presence of functional effector cells. Here, we used flow cytometry to determine that patient samples at diagnosis, post-induction and relapse contain detectable numbers of CD56+ cells. We were able to selectively expand CD56+ immune effector cells from bone marrow and peripheral blood samples at diagnosis and at various stages of treatment by co-culture with artificial antigen-presenting K562 clone 9.mbIL-21 cells. Amplified CD56+CD3- cells had spontaneous and anti-BAFF-R mAb-stimulated ADCC activity against autologous ALL cells, which could be further enhanced by IL15. Importantly, matched CD56+ effector cells also killed autologous ALL cells grown out from leukemia samples of the same patient, through both spontaneous as well as antibody-dependent cellular cytotoxicity. Since autologous cell therapy will not be complicated by graft-versus-host disease, our results show that expanded CD56+ cells could be applied for treatment of pre-B-ALL without transplantation, or for purging of bone marrow in the setting of autologous bone marrow transplants.
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Le Jeune C, Thomas X. Antibody-based therapies in B-cell lineage acute lymphoblastic leukaemia. Eur J Haematol 2014; 94:99-108. [DOI: 10.1111/ejh.12408] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Caroline Le Jeune
- Hematology Department; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre Bénite France
| | - Xavier Thomas
- Hematology Department; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre Bénite France
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Abstract
PURPOSE OF REVIEW To describe the current new targeted therapy with monoclonal and bispecific antibodies in adult acute lymphoblastic leukemia (ALL), to improve response rates and outcome. RECENT FINDINGS Blast cells in ALL express a variety of specific antigens, such as CD19, CD20, CD22, CD33 and CD52, and recently monoclonal antibodies (MoAbs) became available to target these antigens. The anti-CD20 MoAb rituximab has substantially improved the outcome in Burkitt lymphoma/leukemia, and is currently applied in de-novo B-precursor ALL. The MoAbs directed against CD22, linked to cytotoxic agents, either to calicheamicin (inotuzomab ozogamicin) or to plant or bacterial toxins (epratuzumab) are explored in refractory/relapsed childhood and adult ALL. Targeting CD19 is of great interest, as it is expressed in all B-lineage cells, including early precursors. The new bispecific antibody blinatumomab combines single chain antibodies to CD19 and CD3, and thereby T cells lyse the CD19 bearing B cells and is effective in patients with positive minimal residual disease (MRD) or refractory/relapsed ALL. SUMMARY Antibody therapy in ALL is very promising, with high rate of complete remission and MRD-negativity in advanced ALL. It is currently explored in de-novo ALL to establish the best setting in combination with chemotherapy or even as a monotherapy.
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Smith MA, Altekruse SF, Adamson PC, Reaman GH, Seibel NL. Declining childhood and adolescent cancer mortality. Cancer 2014; 120:2497-506. [PMID: 24853691 DOI: 10.1002/cncr.28748] [Citation(s) in RCA: 321] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/03/2013] [Accepted: 10/17/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND To evaluate whether progress continues in identifying more effective treatments for children and adolescents with cancer, the authors examined both overall and disease-specific childhood cancer mortality rates for the United States, focusing on data from 2000 to 2010. METHODS Age-adjusted US mortality trends from 1975 to 2010 were estimated using joinpoint regression analysis. Analyses of annual percentage change (APC) were performed on the same diagnostic groupings for the period restricted to 2000 through 2010 for groupings ages <20 years, <15 years, and 15 to 19 years. RESULTS After a plateau in mortality rates during 1998 to 2002 (APC, 0.3%), the annual decline in childhood cancer mortality from 2002 to 2010 (APC, -2.4%) was similar to that observed from 1975 to 1998 (APC, -2.7%). Statistically significant declines in mortality rates from 2000 to 2010 were noted for acute lymphoblastic leukemia, acute myeloid leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, neuroblastoma, central nervous system cancers, and gonadal cancers. From 2000 to 2010, the rates of decline in mortality for the group ages 15 to 19 years generally were equal to or greater than the rates of decline for the group ages birth to 14 years. Improvements in treatment since 1975 resulted >45,000 cancer deaths averted through 2010. CONCLUSIONS Cancer mortality for both children and adolescents declined from 2000 to 2010, with significant declines observed for multiple cancer types. However, greater than 1900 cancer deaths still occur each year among children and adolescents in the United States, and many survivors experience long-term effects that limit their quality of life. Continued research directed toward identifying more effective treatments that produce fewer long-term sequelae is critical to address these remaining challenges.
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Affiliation(s)
- Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
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Ribera JM, Oriol A, Morgades M, Montesinos P, Sarrà J, González-Campos J, Brunet S, Tormo M, Fernández-Abellán P, Guàrdia R, Bernal MT, Esteve J, Barba P, Moreno MJ, Bermúdez A, Cladera A, Escoda L, García-Boyero R, del Potro E, Bergua J, Amigo ML, Grande C, Rabuñal MJ, Hernández-Rivas JM, Feliu E. Treatment of High-Risk Philadelphia Chromosome–Negative Acute Lymphoblastic Leukemia in Adolescents and Adults According to Early Cytologic Response and Minimal Residual Disease After Consolidation Assessed by Flow Cytometry: Final Results of the PETHEMA ALL-AR-03 Trial. J Clin Oncol 2014; 32:1595-1604. [DOI: 10.1200/jco.2013.52.2425] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose Minimal residual disease (MRD) is an important prognostic factor in adults with acute lymphoblastic leukemia (ALL) and may be used for treatment decisions. The Programa Español de Tratamientos en Hematología (PETHEMA) ALL-AR-03 trial (Treatment of High Risk Adult Acute Lymphoblastic Leukemia [LAL-AR/2003]) assigned adolescent and adult patients (age 15 to 60 years) with high-risk ALL (HR-ALL) without the Philadelphia (Ph) chromosome to chemotherapy or to allogeneic hematopoietic stem-cell transplantation (allo-HSCT) according to early cytologic response (day 14) and flow-MRD level after consolidation. Patients and Methods Patients with good early cytologic response (< 10% blasts in bone marrow at day 14 of induction) and a flow-MRD level less than 5 × 10−4 at the end of consolidation were assigned to delayed consolidation and maintenance therapy, and allo-HSCT was scheduled in patients with poor early cytologic response or flow-MRD level ≥ 5 × 10−4. Results Complete remission was attained in 282 (87%) of 326 patients, and 179 (76%) of 236 patients who completed early consolidation were assigned by intention-to treat to receive allo-HSCT (71) or chemotherapy (108). Five-year disease-free survival (DFS) and overall survival (OS) probabilities were 37% and 35% for the whole series, 32% and 37% for patients assigned to allo-HSCT, and 55% and 59% for those assigned to chemotherapy. Multivariable analysis showed poor MRD clearance (≥ 1 × 10−3 after induction and ≥ 5 × 10−4 after early consolidation) as the only prognostic factor for DFS and OS. Conclusion Prognosis for Ph-negative HR-ALL in adolescents and adults with good early response to induction and low flow-MRD levels after consolidation is quite favorable when allo-HSCT is avoided. In this study, the pattern of MRD clearance was the only prognostic factor for DFS and OS.
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Affiliation(s)
- Josep-Maria Ribera
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Albert Oriol
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Mireia Morgades
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Pau Montesinos
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Josep Sarrà
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - José González-Campos
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Salut Brunet
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Mar Tormo
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Pascual Fernández-Abellán
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Ramon Guàrdia
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - María-Teresa Bernal
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Jordi Esteve
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Pere Barba
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - María-José Moreno
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Arancha Bermúdez
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Antonia Cladera
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Lourdes Escoda
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Raimundo García-Boyero
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Eloy del Potro
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Juan Bergua
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - María-Luz Amigo
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Carlos Grande
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - María-José Rabuñal
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Jesús-María Hernández-Rivas
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
| | - Evarist Feliu
- Josep-Maria Ribera, Albert Oriol, Mireia Morgades, and Evarist Feliu, Institut Català d'Oncologia-Hospital Germans Trias i Pujol-Jose Carreras Research Institute; Salut Brunet, Hospital de Sant Pau; Jordi Esteve, Hospital Clínic; Pere Barba, Hospital Vall d'Hebron, Barcelona; Pau Montesinos, Hospital Universitario La Fe; Mar Tormo, Hospital Clínico, Valencia; Josep Sarrà, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat; José González-Campos, Hospital Universitario Virgen
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49
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Mei Y, Gao C, Wang K, Cui L, Li W, Zhao X, Liu F, Wu M, Deng G, Ding W, Jia H, Li Z. Effect of microRNA-210 on prognosis and response to chemotherapeutic drugs in pediatric acute lymphoblastic leukemia. Cancer Sci 2014; 105:463-72. [PMID: 24720529 PMCID: PMC4317805 DOI: 10.1111/cas.12370] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/29/2014] [Accepted: 02/09/2014] [Indexed: 12/19/2022] Open
Abstract
Many studies have demonstrated that microRNA-210 (miR-210) expression is intensively upregulated in hypoxic states and differentially regulated in most types of cancer cells. However, the clinical significance of miR-210 and its effects on the response of leukemic cells to chemotherapeutic drugs in childhood acute lymphoblastic leukemia (ALL) remain unknown. In the current study, using real-time qRT-PCR to detect miR-210 expression in bone marrow samples from 114 children at initial diagnosis of ALL, we investigated the prognostic significance of miR-210 and determined its associations with common clinical characteristics and treatment outcome. We further examined its effect on the response to chemotherapeutic drugs in the Reh and RS4;11 cell lines. Results showed that miR-210 expression was significantly lower in patients suffering from relapse and induction failure than in other patients (P < 0.001). Using the receiver operating characteristic curve, 3.8243 was selected as the cut-off value of miR-210 expression in our test cohort (38 cases). A significantly poorer treatment outcome (P < 0.05) was found in the low-expression group and verified in the validation cohort (76 cases, P < 0.05). Patients with low expression of miR-210 and positive minimal residual disease at the end of induction had a much higher rate of relapse or induction failure (P = 0.001). Increasing/decreasing miR-210 expression using agomir/antagomir could enhance or reduce the response of Reh cells and RS4;11 cells to daunorubicin/dexamethasone/L-asparaginase and daunorubicin/dexamethasone/vincristine, respectively. In conclusion, miR-210 may be a good prognostic factor and a useful predictor of drug sensitivity, and is a potential therapeutic target for pediatric ALL.
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Affiliation(s)
- Yanyan Mei
- Key Laboratory of Major Diseases in Children (Capital Medical University), Ministry of Education, National Key Discipline of Pediatrics, Ministry of Education, Hematology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
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50
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Maino E, Sancetta R, Viero P, Imbergamo S, Scattolin AM, Vespignani M, Bassan R. Current and future management of Ph/BCR-ABL positive ALL. Expert Rev Anticancer Ther 2014; 14:723-40. [PMID: 24611626 DOI: 10.1586/14737140.2014.895669] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Following the introduction of targeted therapy with tyrosine kinase inhibitors (TKI) at the beginning of the past decade, the outcome of patients with Philadelphia-chromosome positive acute lymphoblastic leukemia (Ph+ ALL) has dramatically improved. Presently, the use of refined programs with first/second generation TKI's and chemotherapy together with allogeneic stem cell transplantation allow up to 50% of all patients to be cured. Further progress is expected with the new TKI ponatinib, overcoming resistance caused by T315I point mutation, other targeted therapies, autologous transplantation in molecularly negative patients, therapeutic monoclonal antibodies like inotuzumab ozogamicin and blinatumomab, and chimeric antigen receptor-modified T cells. Ph+ ALL could become curable in the near future even without allogeneic stem cell transplantation, minimizing the risk of therapy-related death and improving greatly the quality of patients' life.
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Affiliation(s)
- Elena Maino
- Hematology/Bone Marrow Transplantation Unit, Ospedale dell'Angelo and Ospedale SS. Giovanni e Paolo, Via Paccagnella 11, 30174 Venezia-Mestre, Italy
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