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Zhao Y, Zhang X, Ding X, Wang Y, Li Z, Zhao R, Cheng HE, Sun Y. Efficacy and safety of FLT3 inhibitors in monotherapy of hematological and solid malignancies: a systemic analysis of clinical trials. Front Pharmacol 2024; 15:1294668. [PMID: 38828446 PMCID: PMC11140126 DOI: 10.3389/fphar.2024.1294668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction: FLT3 mutations are closely associated with the occurrence of hematological and solid malignancies, especially with acute myeloid leukemia. Currently, several FLT3 inhibitors are in clinical trials, and some have been applied in clinic. However, the safety, efficacy and pharmacodynamics of these FLT3 inhibitors have not been systemically analyzed before. Methods: We searched and reviewed clinical trial reports on the monotherapy of 13 FLT3 inhibitors, including sorafenib, lestaurtinib, midostaurin, gilteritinib, quizartinib, sunitinib, crenolanib, tandutinib, cabozantinib, pexidartinib, pacritinib, famitinib, and TAK-659 in patients with hematological and solid malignancies before May 31, 2023. Results: Our results showed the most common adverse events (AEs) were gastrointestinal adverse reactions, including diarrhea, hand-foot syndrome and nausea, while the most common hematological AEs were febrile neutropenia, anemia, and thrombocytopenia. Based on the published data, the mean overall survival (OS) and the mean progression-free survival (PFS) were 9.639 and 5.905 months, respectively. The incidence of overall response rate (ORR), complete remission (CR), partial response (PR), and stable disease (SD) for all these FLT3 inhibitors was 29.0%, 8.7%, 16.0%, and 42.3%, respectively. The ORRs of FLT3 inhibitors in hematologic malignancies and solid tumors were 40.8% and 18.8%, respectively, indicating FLT3 inhibitors were more effective for hematologic malignancies than for solid tumors. In addition, time to maximum plasma concentration (Tmax) in these FLT3 inhibitors ranged from 0.7-12.0 hours, but the elimination half-life (T1/2) range was highly variable, from 6.8 to 151.8 h. Discussion: FLT3 inhibitors monotherapy has shown significant anti-tumor effect in clinic, and the effectiveness may be further improved through combination medication.
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Affiliation(s)
| | | | | | | | | | | | - Hai-En Cheng
- School of Medical Laboratory, Shandong Second Medical University, Weifang, China
| | - Yanli Sun
- School of Medical Laboratory, Shandong Second Medical University, Weifang, China
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2
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Nair PC, Piehler J, Tvorogov D, Ross DM, Lopez AF, Gotlib J, Thomas D. Next-Generation JAK2 Inhibitors for the Treatment of Myeloproliferative Neoplasms: Lessons from Structure-Based Drug Discovery Approaches. Blood Cancer Discov 2023; 4:352-364. [PMID: 37498362 PMCID: PMC10472187 DOI: 10.1158/2643-3230.bcd-22-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/20/2023] [Accepted: 06/07/2023] [Indexed: 07/28/2023] Open
Abstract
Selective inhibitors of Janus kinase (JAK) 2 have been in demand since the discovery of the JAK2 V617F mutation present in patients with myeloproliferative neoplasms (MPN); however, the structural basis of V617F oncogenicity has only recently been elucidated. New structural studies reveal a role for other JAK2 domains, beyond the kinase domain, that contribute to pathogenic signaling. Here we evaluate the structure-based approaches that led to recently-approved type I JAK2 inhibitors (fedratinib and pacritinib), as well as type II (BBT594 and CHZ868) and pseudokinase inhibitors under development (JNJ7706621). With full-length JAK homodimeric structures now available, superior selective and mutation-specific JAK2 inhibitors are foreseeable. SIGNIFICANCE The JAK inhibitors currently used for the treatment of MPNs are effective for symptom management but not for disease eradication, primarily because they are not strongly selective for the mutant clone. The rise of computational and structure-based drug discovery approaches together with the knowledge of full-length JAK dimer complexes provides a unique opportunity to develop better targeted therapies for a range of conditions driven by pathologic JAK2 signaling.
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Affiliation(s)
- Pramod C. Nair
- Cancer Program, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, Australia
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Discipline of Clinical Pharmacology, Flinders Health and Medical Research Institute (FHMRI) Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jacob Piehler
- Department of Biology and Center of Cellular Nanoanalytics, University of Osnabrück, Osnabrück, Germany
| | - Denis Tvorogov
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia
| | - David M. Ross
- Cancer Program, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, Australia
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia
- Department of Hematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Angel F. Lopez
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia
| | - Jason Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Daniel Thomas
- Cancer Program, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, Australia
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Hematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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3
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Pemmaraju N, Bose P, Rampal R, Gerds AT, Fleischman A, Verstovsek S. Ten years after ruxolitinib approval for myelofibrosis: a review of clinical efficacy. Leuk Lymphoma 2023:1-19. [PMID: 37081809 DOI: 10.1080/10428194.2023.2196593] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Myelofibrosis (MF) is a chronic myeloproliferative neoplasm characterized by splenomegaly, abnormal cytokine expression, cytopenias, and progressive bone marrow fibrosis. The disease often manifests with burdensome symptoms and is associated with reduced survival. Ruxolitinib, an oral Janus kinase (JAK) 1 and JAK2 inhibitor, was the first agent approved for MF. As a first-in-class targeted treatment, ruxolitinib approval transformed the MF treatment approach and remains standard of care. In addition, targeted inhibition of JAK1/JAK2 signaling, a key molecular pathway underlying MF pathogenesis, and the large volume of literature evaluating ruxolitinib, have led to a better understanding of the disease and improved management in general. Here we review ruxolitinib efficacy in patients with MF in the 10 years following approval, including demonstration of clinical benefit in the phase 3 COMFORT-I/II trials, real-world evidence, translational studies, and expanded access data. Lastly, future directions for MF treatment are discussed, including ruxolitinib-based combination therapies.
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Affiliation(s)
- Naveen Pemmaraju
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prithviraj Bose
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raajit Rampal
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aaron T Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Angela Fleischman
- Division of Hematology/Oncology, Medicine, University of California, Irvine, CA, USA
| | - Srdan Verstovsek
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Wang Y, Jia S, Cao X, Ge S, Yu K, Chen Y. Application of next-generation sequencing in diffuse large B-cell lymphoma. Pharmacogenomics 2023; 24:59-68. [PMID: 36661028 DOI: 10.2217/pgs-2022-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of invasive non-Hodgkin lymphoma. There is great heterogeneity in its molecular biological characteristics, clinical manifestations and prognosis. The use of rituximab has greatly improved the cure rate of DLBCL, but there are still 30% of patients with poor prognosis. In the era of precision medicine, the significance of molecular biology and genetic factors on the diagnosis, treatment and prognosis of patients has been found. Among these, next-generation sequencing technology plays an important role. This paper reviews the research progress of next-generation sequencing technology in the classification, diagnosis, prognosis and molecular targeted therapy of DLBCL.
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Affiliation(s)
- Yudi Wang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Suzhen Jia
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiubo Cao
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shengchen Ge
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yi Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
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Elbadawy HA, Wahdan SA, El-Demerdash E. Effect of atorvastatin on single oral pharmacokinetics and safety of daclatasvir in rats: Emphasis on P-glycoprotein and cytochrome P450. Curr Drug Metab 2022; 23:484-495. [PMID: 35379125 DOI: 10.2174/1389200223666220404134524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was aimed to investigate the effect of atorvastatin on daclatasvir oral pharmacokinetics and safety and assess the possible underlining mechanisms through targeting P-glycoprotein (P-gp) and cytochrome P450 (CYP3A4). METHODS The transport of daclatasvir, as well as the standard rhodamine 123 by P-gp across the rat intestine, was studied in vitro using the non-everted sac method. To assess the pharmacokinetic profile of daclatasvir in vivo, rats were divided into three groups receiving either saline, a standard P-gp inhibitor verapamil (25 mg/kg), or atorvastatin (10 mg/kg), 2hrs prior to a single dose of daclatasvir (7 mg/kg). In addition, the markers of liver and kidney functions and muscle rhabdomyolysis were assessed. Further, histopathological examination of liver and kidney tissue and assessment of CYP3A4 level were done. RESULTS The inhibitory effect of atorvastatin on Pgp activity and expression was manifested by increased serosal transport of the standard rhodamine 123, as well as daclatasvir. In vivo, Cmax (peak plasma concentration) and Area under the curve (AUC (0-t)) of daclatasvir after atorvastatin treatment increased compared to vehicle group but not in a significant manner. On the other hand, atorvastatin caused a significant increase in the clearance of daclatasvir. Concomitant administration of atorvastatin with daclatasvir significantly decreased CYP3A4 content compared to the control group. The combination also showed increased liver enzymes and some pathological alterations in the liver. CONCLUSION Atorvastatin has a significant effect on P-gp mediated intestinal transport of daclatasvir, however, it did not affect the systemic bioavailability of a single oral dose of daclatasvir.
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Affiliation(s)
- Heba A Elbadawy
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Sara A Wahdan
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Ebtehal El-Demerdash
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Loscocco GG, Vannucchi AM. Role of JAK inhibitors in myeloproliferative neoplasms: current point of view and perspectives. Int J Hematol 2022; 115:626-644. [PMID: 35352288 DOI: 10.1007/s12185-022-03335-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 12/29/2022]
Abstract
Classic Philadelphia-negative myeloproliferative neoplasms (MPN) include polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF), classified as primary (PMF), or secondary to PV or ET. All MPN, regardless of the underlying driver mutation in JAK2/CALR/MPL, are invariably associated with dysregulation of JAK/STAT pathway. The discovery of JAK2V617F point mutation prompted the development of small molecules inhibitors of JAK tyrosine kinases (JAK inhibitors-JAKi). To date, among JAKi, ruxolitinib (RUX) and fedratinib (FEDR) are approved for intermediate and high-risk MF, and RUX is also an option for high-risk PV patients inadequately controlled by or intolerant to hydroxyurea. While not yet registered, pacritinib (PAC) and momelotinib (MMB), proved to be effective particularly in thrombocytopenic and anemic MF patients, respectively. In most cases, JAKi are effective in reducing splenomegaly and alleviating disease-related symptoms. However, almost 50% lose response by three years and dose-dependent toxicities may lead to suboptimal dosing or treatment discontinuation. To date, although not being disease-modifying agents, JAKi represent the therapeutic backbone particularly in MF patient. To optimize therapeutic strategies, many trials with drug combinations of JAKi with novel molecules are ongoing. This review critically discusses the role of JAKi in the modern management of patients with MPN.
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Affiliation(s)
- Giuseppe G Loscocco
- Department of Experimental and Clinical Medicine, University of Florence, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3 pad 27B, 50134, Florence, Italy
- Doctorate School GenOMec, University of Siena, Siena, Italy
| | - Alessandro M Vannucchi
- Department of Experimental and Clinical Medicine, University of Florence, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3 pad 27B, 50134, Florence, Italy.
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7
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Li B, Wan Q, Li Z, Chng WJ. Janus Kinase Signaling: Oncogenic Criminal of Lymphoid Cancers. Cancers (Basel) 2021; 13:cancers13205147. [PMID: 34680295 PMCID: PMC8533975 DOI: 10.3390/cancers13205147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Janus kinases (JAKs) are transmembrane receptors that pass signals from extracellular ligands to downstream. Increasing evidence has suggested that JAK family aberrations promote lymphoid cancer pathogenesis and progression through mediating gene expression via the JAK/STAT pathway or noncanonical JAK signaling. We are here to review how canonical JAK/STAT and noncanonical JAK signalings are represented and deregulated in lymphoid malignancies and how to target JAK for therapeutic purposes. Abstract The Janus kinase (JAK) family are known to respond to extracellular cytokine stimuli and to phosphorylate and activate signal transducers and activators of transcription (STAT), thereby modulating gene expression profiles. Recent studies have highlighted JAK abnormality in inducing over-activation of the JAK/STAT pathway, and that the cytoplasmic JAK tyrosine kinases may also have a nuclear role. A couple of anti-JAK therapeutics have been developed, which effectively harness lymphoid cancer cells. Here we discuss mutations and fusions leading to JAK deregulations, how upstream nodes drive JAK expression, how classical JAK/STAT pathways are represented in lymphoid malignancies and the noncanonical and nuclear role of JAKs. We also summarize JAK inhibition therapeutics applied alone or synergized with other drugs in treating lymphoid malignancies.
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Affiliation(s)
- Boheng Li
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China; or (Q.W.)
| | - Qin Wan
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China; or (Q.W.)
| | - Zhubo Li
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China; or (Q.W.)
- Correspondence: or (Z.L.); (W.-J.C.)
| | - Wee-Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore 119074, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Correspondence: or (Z.L.); (W.-J.C.)
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8
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Papageorgiou SG, Thomopoulos TP, Katagas I, Bouchla A, Pappa V. Prognostic molecular biomarkers in diffuse large B-cell lymphoma in the rituximab era and their therapeutic implications. Ther Adv Hematol 2021; 12:20406207211013987. [PMID: 34104369 PMCID: PMC8150462 DOI: 10.1177/20406207211013987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) represents a group of tumors characterized by substantial heterogeneity in terms of their pathological and biological features, a causal factor of their varied clinical outcome. This variation has persisted despite the implementation of rituximab in treatment regimens over the last 20 years. In this context, prognostic biomarkers are of great importance in order to identify high-risk patients that might benefit from treatment intensification or the introduction of novel therapeutic agents. Herein, we review current knowledge on specific immunohistochemical or genetic biomarkers that might be useful in clinical practice. Gene-expression profiling is a tool of special consideration in this effort, as it has enriched our understanding of DLBCL biology and has allowed for the classification of DLBCL by cell-of-origin as well as by more elaborate molecular signatures based on distinct gene-expression profiles. These subgroups might outperform individual biomarkers in terms of prognostication; however, their use in clinical practice is still limited. Moreover, the underappreciated role of the tumor microenvironment in DLBCL prognosis is discussed in terms of prognostic gene-expression signatures, as well as in terms of individual biomarkers of prognostic significance. Finally, the efficacy of novel therapeutic agents for the treatment of DLBCL patients are discussed and an evidence-based therapeutic approach by specific genetic subgroup is suggested.
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Affiliation(s)
- Sotirios G. Papageorgiou
- Second Department of Internal Medicine and Research Unit, University General Hospital ‘Attikon’, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - Thomas P. Thomopoulos
- Second Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital, ‘Attikon’, Haidari, Athens, Greece
| | - Ioannis Katagas
- Second Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital, ‘Attikon’, Haidari, Athens, Greece
| | - Anthi Bouchla
- Second Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital, ‘Attikon’, Haidari, Athens, Greece
| | - Vassiliki Pappa
- Second Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital, ‘Attikon’, Haidari, Athens, Greece
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Abstract
Diffuse large B-cell lymphomas (DLBCL)s, the most common type of Non-Hodgkin’s Lymphoma, constitute a heterogeneous group of disorders including different disease sites, strikingly diverse molecular features and a profound variability in the clinical behavior. Molecular studies and clinical trials have partially revealed the underlying causes for this variability and have made possible the recognition of some molecular variants susceptible of specific therapeutic approaches. The main histogenetic groups include the germinal center, activated B cells, thymic B cells and terminally differentiated B cells, a basic scheme where the large majority of DLBCL cases can be ascribed. The nodal/extranodal origin, specific mutational changes and microenvironment peculiarities provide additional layers of complexity. Here, we summarize the status of the knowledge and make some specific proposals for addressing the future development of targeted therapy for DLBC cases.
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10
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Ross DM, Babon JJ, Tvorogov D, Thomas D. Persistence of myelofibrosis treated with ruxolitinib: biology and clinical implications. Haematologica 2021; 106:1244-1253. [PMID: 33472356 PMCID: PMC8094080 DOI: 10.3324/haematol.2020.262691] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Activation of JAK-STAT signaling is one of the hallmarks of myelofibrosis, a myeloproliferative neoplasm that leads to inflammation, progressive bone marrow failure, and a risk of leukemic transformation. Around 90% of patients with myelofibrosis have a mutation in JAK2, MPL, or CALR: so-called 'driver' mutations that lead to activation of JAK2. Ruxolitinib, and other JAK2 inhibitors in clinical use, provide clinical benefit but do not have a major impact on the abnormal hematopoietic clone. This phenomenon is termed 'persistence', in contrast to usual patterns of resistance. Multiple groups have shown that type 1 inhibitors of JAK2, which bind the active conformation of the enzyme, lead to JAK2 becoming resistant to degradation with consequent accumulation of phospho-JAK2. In turn, this can lead to exacerbation of inflammatory manifestations when the JAK inhibitor is discontinued, and it may also contribute to disease persistence. The ways in which JAK2 V617F and CALR mutations lead to activation of JAK-STAT signaling are incompletely understood. We summarize what is known about pathological JAK-STAT activation in myelofibrosis and how this might lead to future novel therapies for myelofibrosis with greater disease-modifying potential.
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Affiliation(s)
- David M Ross
- Department of Hematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide; Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide; Precision Medicine Theme, South Australian Health and Medical Research Institute, and Adelaide Medical School, University of Adelaide.
| | - Jeffrey J Babon
- The Walter and Eliza Hall Institute of Medical Research and Department of Medical Biology, University of Melbourne, Parkville
| | - Denis Tvorogov
- Centre for Cancer Biology, University of South Australia and SA Pathology
| | - Daniel Thomas
- Precision Medicine Theme, South Australian Health and Medical Research Institute, and Adelaide Medical School, University of Adelaide
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11
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Chen H, Pan T, He Y, Zeng R, Li Y, Yi L, Zang H, Chen S, Duan Q, Xiao L, Zhou H. Primary Mediastinal B-Cell Lymphoma: Novel Precision Therapies and Future Directions. Front Oncol 2021; 11:654854. [PMID: 33869061 PMCID: PMC8044947 DOI: 10.3389/fonc.2021.654854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is a distinct clinicopathologic disease from other types of diffuse large B-cell lymphoma (DLBCL) with unique prognostic features and limited availability of clinical data. The current standard treatment for newly diagnosed PMBCL has long been dependent on a dose-intensive, dose-adjusted multi-agent chemotherapy regimen of rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH). Recent randomized trials have provided evidence that R-CHOP followed by consolidation radiotherapy (RT) is a valuable alternative option to first-line treatment. For recurrent/refractory PMBCL (rrPMBCL), new drugs such as pembrolizumab and CAR-T cell therapy have proven to be effective in a few studies. Positron emission tomography-computed tomography (PET-CT) is the preferred imaging modality of choice for the initial phase of lymphoma treatment and to assess response to treatment. In the future, baseline quantitative PET-CT can be used to predict prognosis in PMBCL. This review focuses on the pathology of PMBCL, underlying molecular basis, treatment options, radiotherapy, targeted therapies, and the potential role of PET-CT to guide treatment choices in this disease.
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Affiliation(s)
- Huan Chen
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Tao Pan
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yizi He
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ruolan Zeng
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yajun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Liming Yi
- Department of Human Anatomy, Hunan University of Medicine, Huaihua, China
| | - Hui Zang
- Department of Basic Medicine, Yiyang Medical College, Yiyang, China
| | - Siwei Chen
- Department of Histology and Embryology of School of Basic Medical Science, Central South University, Changsha, China
| | - Qintong Duan
- Department of Histology and Embryology of School of Basic Medical Science, Central South University, Changsha, China
| | - Ling Xiao
- Department of Histology and Embryology of School of Basic Medical Science, Central South University, Changsha, China
| | - Hui Zhou
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Pidala J, Walton K, Elmariah H, Kim J, Mishra A, Bejanyan N, Nishihori T, Khimani F, Perez L, Faramand RG, Davila ML, Nieder ML, Sagatys EM, Holtan SG, Lawrence NJ, Lawrence HR, Blazar BR, Anasetti C, Sebti SM, Betts BC. Pacritinib Combined with Sirolimus and Low-Dose Tacrolimus for GVHD Prevention after Allogeneic Hematopoietic Cell Transplantation: Preclinical and Phase I Trial Results. Clin Cancer Res 2021; 27:2712-2722. [PMID: 33753457 DOI: 10.1158/1078-0432.ccr-20-4725] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/22/2021] [Accepted: 03/10/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE In this first-in-human, phase I, GVHD prevention trial (NCT02891603), we combine pacritinib (PAC), a JAK2 inhibitor, with sirolimus to concurrently reduce T-cell costimulation via mTOR and IL6 activity. We evaluate the safety of pacritinib when administered with sirolimus plus low-dose tacrolimus (PAC/SIR/TAC) after allogeneic hematopoietic cell transplantation. PATIENTS AND METHODS The preclinical efficacy and immune modulation of PAC/SIR were investigated in xenogeneic GVHD. Our phase I trial followed a 3+3 dose-escalation design, including dose level 1 (pacritinib 100 mg daily), level 2 (pacritinib 100 mg twice daily), and level 3 (pacritinib 200 mg twice daily). The primary endpoint was to identify the lowest biologically active and safe dose of pacritinib with SIR/TAC (n = 12). Acute GVHD was scored through day +100. Allografts included 8/8 HLA-matched related or unrelated donor peripheral blood stem cells. RESULTS In mice, we show that dual JAK2/mTOR inhibition significantly reduces xenogeneic GVHD and increases peripheral regulatory T cell (Treg) potency as well as Treg induction from conventional CD4+ T cells. Pacritinib 100 mg twice a day was identified as the minimum biologically active and safe dose for further study. JAK2/mTOR inhibition suppresses pathogenic Th1 and Th17 cells, spares Tregs and antileukemia effector cells, and exhibits preliminary activity in preventing GVHD. PAC/SIR/TAC preserves donor cytomegalovirus (CMV) immunity and permits timely engraftment without cytopenias. CONCLUSIONS We demonstrate that PAC/SIR/TAC is safe and preliminarily limits acute GVHD, preserves donor CMV immunity, and permits timely engraftment. The efficacy of PAC/SIR/TAC will be tested in our ongoing phase II GVHD prevention trial.
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Affiliation(s)
- Joseph Pidala
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Immunology, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Kelly Walton
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Hany Elmariah
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Asmita Mishra
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Farhad Khimani
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Lia Perez
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Rawan G Faramand
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Marco L Davila
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Immunology, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Michael L Nieder
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Elizabeth M Sagatys
- Department of Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, Florida
| | - Shernan G Holtan
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Claudio Anasetti
- Department of Blood and Marrow Transplantation - Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.,Department of Immunology, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Said M Sebti
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia
| | - Brian C Betts
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
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13
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Abstract
Hodgkin lymphoma (HL) is a B cell lymphoma characterized by few malignant cells and numerous immune effector cells in the tumour microenvironment. The incidence of HL is highest in adolescents and young adults, although HL can affect elderly individuals. Diagnosis is based on histological and immunohistochemical analyses of tissue from a lymph node biopsy; the tissue morphology and antigen expression profile enable classification into one of the four types of classic HL (nodular sclerosis, mixed cellularity, lymphocyte-depleted or lymphocyte-rich HL), which account for the majority of cases, or nodular lymphocyte-predominant HL. Although uncommon, HL remains a crucial test case for progress in cancer treatment. HL was among the first systemic neoplasms shown to be curable with radiation therapy and multiagent chemotherapy. The goal of multimodality therapy is to minimize lifelong residual treatment-associated toxicity while maintaining high levels of effectiveness. Recurrent or refractory disease can be effectively treated or cured with high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation, and prospective trials have demonstrated the potency of immunotherapeutic approaches with antibody-drug conjugates and immune checkpoint inhibitors. This Primer explores the wealth of information that has been assembled to understand HL; these updated observations verify that HL investigation and treatment remain at the leading edge of oncological research.
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14
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Makita S, Maruyama D, Tobinai K. Safety and Efficacy of Brentuximab Vedotin in the Treatment of Classic Hodgkin Lymphoma. Onco Targets Ther 2020; 13:5993-6009. [PMID: 32606807 PMCID: PMC7320890 DOI: 10.2147/ott.s193951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/11/2020] [Indexed: 01/01/2023] Open
Abstract
Classical Hodgkin lymphoma (cHL) is a B-cell-derived lymphoid malignancy with the most favorable prognosis among various adult malignancies. However, once it becomes refractory disease to chemotherapy or relapses after high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT), it is difficult to manage with conventional cytotoxic chemotherapy. The introduction of brentuximab vedotin (BV) has changed the treatment landscape of cHL in the past decade. Several studies demonstrated high efficacy of BV monotherapy in heavily treated patients with cHL relapsed or refractory after HDC/ASCT. Recent studies also reported high efficacy of concurrent or sequential combination of BV and chemotherapy in patients with transplant-eligible relapsed/refractory cHL at the second-line setting. In addition, a randomized phase III trial ECHELON-1 reported a positive result of BV in combination with AVD (doxorubicin, vinblastine, and dacarbazine) in patients with newly diagnosed advanced-stage cHL. In this review, we summarize available data of BV for cHL and discuss the current and future role of BV in the management of cHL.
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Affiliation(s)
- Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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15
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Mei Q, Zhang W, Liu Y, Yang Q, Rasko JEJ, Nie J, Liu J, Li X, Dong L, Chen M, Zhang Y, Shi L, Wu H, Han W. Camrelizumab Plus Gemcitabine, Vinorelbine, and Pegylated Liposomal Doxorubicin in Relapsed/Refractory Primary Mediastinal B-Cell Lymphoma: A Single-Arm, Open-Label, Phase II Trial. Clin Cancer Res 2020; 26:4521-4530. [PMID: 32499235 DOI: 10.1158/1078-0432.ccr-20-0514] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/23/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients with relapsed/refractory primary mediastinal B-cell lymphoma (rrPMBCL) represent a particularly challenging population to treat, with few life-saving treatment options in the context of a dismal prognosis. PATIENTS AND METHODS In this open-label, single-arm, phase II study, the safety and efficacy of combined regimen of chemotherapy consisting of gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD) plus anti-PD-1 antibody camrelizumab was assessed in rrPMBCL. Patients received chemo-immunotherapy every 3 weeks until the second confirmed complete response (CR) or up to 12 cycles, followed by camrelizumab monotherapy for up to 1 year. The primary endpoints were objective response rate (ORR) and safety. RESULTS Twenty-seven response evaluable patients were enrolled, who received a median of three first-line therapies, 59% with bulky disease. The ORR was 74%, including 56% with a CR. A median time of 1.7 months to response was observed, with 78% exhibiting tumor shrinkage at the first evaluation. After 24.8 months median follow-up, the median duration of response was not reached, with a 65% 2-year estimated response rate. Thirteen responders remained in sustained complete remission. Estimated 24-month progression-free survival and overall survival rates were 48.2% and 81.5%, respectively. Any grade and grade 3 treatment-related adverse events (AE) occurred in 93% and 33% of patients, respectively; with no grade 4 or 5 AEs. Baseline levels of IL10, IFNγ, and soluble Fas were associated with objective response. CONCLUSIONS Camrelizumab plus GVD chemotherapy offers a potent option as life-saving chemo-immunotherapy with promising efficacy and a manageable safety profile for patients with rrPMBCL, especially with bulky aggressive disease.
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Affiliation(s)
- Qian Mei
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wenying Zhang
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yang Liu
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qingming Yang
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - John E J Rasko
- Department of Cell & Molecular Therapies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Centenary Institute, Camperdown, New South Wales, Australia.,University of Sydney, Sydney Medical School, Camperdown, New South Wales, Australia
| | - Jing Nie
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jiejie Liu
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiang Li
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Liang Dong
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Meixia Chen
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lu Shi
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huitao Wu
- National Engineering Laboratory for Medical Big Data Application Technology, Chinese PLA General Hospital, Beijing, China
| | - Weidong Han
- Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
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16
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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17
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Sun F, Fang X, Wang X. Signal Pathways and Therapeutic Prospects of Diffuse Large B Cell Lymphoma. Anticancer Agents Med Chem 2020; 19:2047-2059. [PMID: 32009599 DOI: 10.2174/1871520619666190925143216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/18/2019] [Accepted: 07/18/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma which is heterogeneous both clinically and morphologically. Over the past decades, significant advances have been made in the understanding of the molecular genesis, leading to the identification of multiple pathways and molecules that can be targeted for clinical benefit. OBJECTIVE The current review aims to present a brief overview of signal pathways of DLBCL, which mainly focus on B-cell antigen Receptor (BCR), Nuclear Factor-κB (NF-κB), Phosphatidylinositol-3-Kinase (PI3K) - protein kinase B (Akt) - mammalian Target of Rapamycin (mTOR), Janus Kinase (JAK) - Signal Transducer and Activator (STAT), Wnt/β-catenin, and P53 pathways. METHODS Activation of signal pathways may contribute to the generation, development, chemotherapy sensitivity of DLBCL, and expression of pathway molecules is associated with the prognosis of DLBCL. Some agents targeting these pathways have been proved effective and relevant clinical trials are in progress. These agents used single or combined with chemotherapy/each other might raise the possibility of improving clinical outcomes in DLBCL. CONCLUSION This review presents several signal pathways of DLBCL and targeted agents had a tendency to improve the curative effect, especially in high-risk or relapsed/refractory DLBCL.
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Affiliation(s)
- Feifei Sun
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong 250021, China
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong 250021, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong 250021, China.,Shandong University School of Medicine, Jinan, Shandong 250012, China
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18
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Brachet-Botineau M, Polomski M, Neubauer HA, Juen L, Hédou D, Viaud-Massuard MC, Prié G, Gouilleux F. Pharmacological Inhibition of Oncogenic STAT3 and STAT5 Signaling in Hematopoietic Cancers. Cancers (Basel) 2020; 12:E240. [PMID: 31963765 PMCID: PMC7016966 DOI: 10.3390/cancers12010240] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
Signal Transducer and Activator of Transcription (STAT) 3 and 5 are important effectors of cellular transformation, and aberrant STAT3 and STAT5 signaling have been demonstrated in hematopoietic cancers. STAT3 and STAT5 are common targets for different tyrosine kinase oncogenes (TKOs). In addition, STAT3 and STAT5 proteins were shown to contain activating mutations in some rare but aggressive leukemias/lymphomas. Both proteins also contribute to drug resistance in hematopoietic malignancies and are now well recognized as major targets in cancer treatment. The development of inhibitors targeting STAT3 and STAT5 has been the subject of intense investigations during the last decade. This review summarizes the current knowledge of oncogenic STAT3 and STAT5 functions in hematopoietic cancers as well as advances in preclinical and clinical development of pharmacological inhibitors.
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Affiliation(s)
- Marie Brachet-Botineau
- Leukemic Niche and Oxidative metabolism (LNOx), CNRS ERL 7001, University of Tours, 37000 Tours, France;
| | - Marion Polomski
- Innovation Moléculaire et Thérapeutique (IMT), EA 7501, University of Tours, 37000 Tours, France; (M.P.); (L.J.); (D.H.); (M.-C.V.-M.); (G.P.)
| | - Heidi A. Neubauer
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, A-1210 Vienna, Austria;
| | - Ludovic Juen
- Innovation Moléculaire et Thérapeutique (IMT), EA 7501, University of Tours, 37000 Tours, France; (M.P.); (L.J.); (D.H.); (M.-C.V.-M.); (G.P.)
| | - Damien Hédou
- Innovation Moléculaire et Thérapeutique (IMT), EA 7501, University of Tours, 37000 Tours, France; (M.P.); (L.J.); (D.H.); (M.-C.V.-M.); (G.P.)
| | - Marie-Claude Viaud-Massuard
- Innovation Moléculaire et Thérapeutique (IMT), EA 7501, University of Tours, 37000 Tours, France; (M.P.); (L.J.); (D.H.); (M.-C.V.-M.); (G.P.)
| | - Gildas Prié
- Innovation Moléculaire et Thérapeutique (IMT), EA 7501, University of Tours, 37000 Tours, France; (M.P.); (L.J.); (D.H.); (M.-C.V.-M.); (G.P.)
| | - Fabrice Gouilleux
- Leukemic Niche and Oxidative metabolism (LNOx), CNRS ERL 7001, University of Tours, 37000 Tours, France;
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19
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Merryman RW, LaCasce A. Novel agents and immune invasion in Hodgkin lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:243-248. [PMID: 31808827 PMCID: PMC6913426 DOI: 10.1182/hematology.2019000029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The approval of brentuximab vedotin (BV) and the PD-1 inhibitors nivolumab and pembrolizumab has dramatically improved outcomes for patients with relapsed or refractory (R/R) classic Hodgkin lymphoma (HL). With the goal of increasing long-term disease control rates and decreasing late toxicities, these agents are currently being tested in earlier phases of treatment in combination with chemotherapy agents. In the R/R setting, our expanding understanding of HL's various mechanisms of immune evasion and treatment resistance has spurred a growing number of rationally designed combination trials. Beyond BV and PD-1 blockade, other novel therapies have demonstrated encouraging preliminary results, including targeted agents, like the CD25 antibody-drug conjugate ADCT-301, and cellular therapies, including CD30 chimeric antigen receptor T cells and Epstein-Barr virus (EBV)-directed cytotoxic T cells. These trials, coupled with the rapid development of prognostic and predictive biomarkers, should drive additional breakthroughs that promise safer and more effective therapies for patients with HL in the future.
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Affiliation(s)
- Reid W Merryman
- Department of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ann LaCasce
- Department of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA
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20
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Singer JW, Al-Fayoumi S, Taylor J, Velichko S, O'Mahony A. Comparative phenotypic profiling of the JAK2 inhibitors ruxolitinib, fedratinib, momelotinib, and pacritinib reveals distinct mechanistic signatures. PLoS One 2019; 14:e0222944. [PMID: 31560729 PMCID: PMC6764664 DOI: 10.1371/journal.pone.0222944] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
Janus kinase-signal transducers and activators of transcription (JAK-STAT) signaling is critical to multiple cellular processes, including survival, differentiation, and proliferation. JAK-STAT signaling dysregulation has been noted in inflammatory disorders, and aberrant JAK2 pathway activation has been implicated in myelofibrosis and polycythemia vera. Moreover, 4 therapeutic JAK2 inhibitors (ruxolitinib, fedratinib, momelotinib, and pacritinib) have either been approved or are in advanced clinical development for myelofibrosis. Although all inhibit JAK2, reports indicate that they also inhibit other kinases. Profiling based solely on in vitro potencies is insufficient to predict the observed clinical effects. To provide further translational insights into clinical outcomes, we compared phenotypic biomarker profiles of ruxolitinib, fedratinib, momelotinib, and pacritinib in the BioMAP® Diversity PLUS panel of 12 human primary cell systems designed to recapitulate key aspects of tissue and disease states. Biomarker activity profiles that represent mechanistic signatures for each agent were compared with each other and a database of reference benchmark profiles. At clinically relevant concentrations, these agents had distinct biomarker impacts indicating diverse mechanistic signatures, suggesting divergent clinical effects for each agent. They disparately modulated inflammatory cytokine production and immune function. At clinically relevant concentrations, ruxolitinib had the broadest scope of activities across all 12 cellular systems, whereas pacritinib was more specific for the BT system (modelling T cell-dependent B cell activation) and exhibited the strongest inhibition of sIL-17A, sIL-2, and sIL-6. All 4 agents were antiproliferative to B cells, but ruxolitinib and momelotinib were also antiproliferative to T cells. These differential activities likely reflect distinct secondary pharmacology for these agents known primarily as JAK2 inhibitors. The phenotypic analysis reported herein represents key data on distinct modes-of-action that may provide insights on clinical outcomes reported for these agents. Such translational findings may also inform the development of next-generation molecules with improved efficacy and safety.
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Affiliation(s)
- Jack W Singer
- CTI BioPharma Corp., Seattle, Washington, United States of America.,Elson Floyd College of Medicine, Washington State University, Seattle, Washington, United States of America
| | | | - Jason Taylor
- CTI BioPharma Corp., Seattle, Washington, United States of America
| | - Sharlene Velichko
- Eurofins Discovery, Phenotypic Services, Burlingame, California, United States of America
| | - Alison O'Mahony
- Eurofins Discovery, Phenotypic Services, Burlingame, California, United States of America
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21
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Abstract
Classic Hodgkin lymphoma (cHL) is one of the most common lymphomas in the Western world. Advances in the management of cHL have led to high cure rates exceeding 80%. Nevertheless, relapse or refractory disease in a subset of patients and treatment-related toxicity still represents unsolved clinical problems. The introduction of targeted treatments such as PD-1 blockade and the CD30 antibody drug conjugate, brentuximab vedotin, has broadened treatment options in cHL, emphasizing the critical need to identify biomarkers with the goal to provide rationales for treatment selection, increase effective drug utilization, and minimize toxicity. The unique biology of cHL featuring low abundant tumor cells and numerous nonmalignant immune cells in the tumor microenvironment can provide various types of promising biomarkers related to the tumor cells directly, tumor microenvironment cross-talk, and host immune response. Here, we comprehensively review novel biomarkers including circulating tumor DNA and gene expression-based prognostic models that might guide the ideal management of cHL in the future.
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22
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Tomassetti S, Chen R, Dandapani S. The role of pembrolizumab in relapsed/refractory primary mediastinal large B-cell lymphoma. Ther Adv Hematol 2019; 10:2040620719841591. [PMID: 31040936 PMCID: PMC6477766 DOI: 10.1177/2040620719841591] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/13/2019] [Indexed: 12/11/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL). PMBCL comprises approximately 10% of DLBCLs, thus making it a rare variant of DLBCL. Cure rates for PMBCL with upfront regimens like DA-REPOCH exceed 90%. However, if there is a poor response to this first-line therapy, relapsed/refractory PMBCL (rrPMBCL) has limited treatment options. The historic trend is to treat rrPMBCL with salvage regimens commonly used for DLBCL followed by high-dose therapy and autologous stem cell transplant (HDT-ASCT); however, response rates to salvage therapy remain low and few patients are able to proceed to transplant. An interesting feature of PMBCL is that even though it is classified as a subtype of DLBCL, PMBCL actually shares many clinical, pathologic, and genetic features with classical Hodgkin lymphoma (cHL). For example, both frequently express program death ligand 1 and 2 (PD-L1/2), which is not seen in other mature B-cell lymphomas. The expression of PD-L1/2 in PMBCL makes PDL1 inhibitors, such as pembrolizumab, an attractive therapeutic target. Pembrolizumab is an effective and well-tolerated therapy now approved for a number of cancer types from advanced melanoma to relapsed/refractory cHL. There are now multi-institutional trials underway assessing the role of pembrolizumab in the treatment of rrPMBCL.
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Affiliation(s)
| | - Robert Chen
- City of Hope National Medical Center, Duarte, CA, USA
| | - Savita Dandapani
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010-3012, USA
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23
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Lees C, Keane C, Gandhi MK, Gunawardana J. Biology and therapy of primary mediastinal B-cell lymphoma: current status and future directions. Br J Haematol 2019; 185:25-41. [PMID: 30740662 PMCID: PMC6594147 DOI: 10.1111/bjh.15778] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a distinct disease closely related to classical nodular sclerosing Hodgkin lymphoma. Conventional diagnostic paradigms utilising clinical, morphological and immunophenotypical features can be challenging due to overlapping features with other B-cell lymphomas. Reliable diagnostic and prognostic biomarkers that are applicable to the conventional diagnostic laboratory are largely lacking. Nuclear factor kappa B (NF-κB) and Janus kinase/signal transducers and activators of transcription (JAK-STAT) signalling pathways are characteristically dysregulated in PMBCL and implicated in several aspects of disease pathogenesis, and the latter pathway in host immune evasion. The tumour microenvironment is manipulated by PMBCL tumours to avoid T-cell mediated destruction via strategies that include loss of tumour cell antigenicity, T-cell exhaustion and activation of suppressive T-regulatory cells. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) and DA-EPOCH-R (dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, rituximab) are the most common first-line immunochemotherapy regimens. End of treatment positron emission tomography scans are the recommended imaging modality and are being evaluated to stratify patients for radiotherapy. Relapsed/refractory disease has a relatively poor outcome despite salvage immunochemotherapy and subsequent autologous stem cell transplantation. Novel therapies are therefore being developed for treatment-resistant disease, targeting aberrant cellular signalling and immune evasion.
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Affiliation(s)
- Charlotte Lees
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
- Princess Alexandra Hospital Southside Clinical UnitFaculty of MedicineUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
| | - Colm Keane
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
- Department of HaematologyPrincess Alexandra HospitalBrisbaneQLDAustralia
| | - Maher K. Gandhi
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
- Department of HaematologyPrincess Alexandra HospitalBrisbaneQLDAustralia
| | - Jay Gunawardana
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
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24
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Mina AA, Vakkalagadda C, Pro B. Novel Therapies and Approaches to Relapsed/Refractory HL Beyond Chemotherapy. Cancers (Basel) 2019; 11:cancers11030421. [PMID: 30934568 PMCID: PMC6468730 DOI: 10.3390/cancers11030421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022] Open
Abstract
Although Hodgkin lymphoma (HL) is highly curable with first-line therapy, relapses occur in approximately 10–20% of patients with early stage disease and 30–40% of patients with advanced stage disease. The standard approach for relapsed or refractory disease is salvage therapy, followed by consolidation with high dose therapy and autologous stem cell transplant (ASCT). Patients who achieve a complete response to salvage therapy prior to ASCT have better outcomes, thus recent studies have focused on incorporating newer agents in this setting. Major challenges in the management of relapsed patients remain how to choose and sequence the many salvage therapies that are currently available and how to best incorporate novel agents in the current treatment paradigms. In this article, we will summarize the most recent advances in the management of patients with recurrent HL and will mainly focus on the role of new agents approved and under investigation. Aside from brentuximab vedotin and checkpoint inhibitors, other novel agents and therapies are showing promising early results. However, at least with some of the newest targeted strategies, it is important to recognize that we are facing new challenges in terms of toxicities, which require very close monitoring and education of both the patient and treating physician.
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Affiliation(s)
- Alain Antoine Mina
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
| | - Chetan Vakkalagadda
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
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Keudell G, Younes A. Novel therapeutic agents for relapsed classical Hodgkin lymphoma. Br J Haematol 2018; 184:105-112. [DOI: 10.1111/bjh.15695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gottfried Keudell
- Lymphoma Service Memorial Sloan‐Kettering Cancer Center New York NY USA
| | - Anas Younes
- Lymphoma Service Memorial Sloan‐Kettering Cancer Center New York NY USA
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26
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Cirillo M, Reinke S, Klapper W, Borchmann S. The translational science of hodgkin lymphoma. Br J Haematol 2018; 184:30-44. [DOI: 10.1111/bjh.15658] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Melita Cirillo
- Department of Haematology; Royal Perth Hospital; Perth Australia
- Department I of Internal Medicine; German Hodgkin Study Group (GHSG); Cologne Germany
| | - Sarah Reinke
- Department of Pathology; Hematopathology Section; University Hospital Schleswig-Holstein, Campus Kiel; Kiel Germany
| | - Wolfram Klapper
- Department of Pathology; Hematopathology Section; University Hospital Schleswig-Holstein, Campus Kiel; Kiel Germany
| | - Sven Borchmann
- Department I of Internal Medicine; German Hodgkin Study Group (GHSG); Cologne Germany
- Else Kröner Forschungskolleg Clonal Evolution in Cancer; University Hospital of Cologne; Cologne Germany
- Centre for Molecular Medicine Cologne; University of Cologne; Cologne Germany
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27
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Singer JW, Fleischman A, Al-Fayoumi S, Mascarenhas JO, Yu Q, Agarwal A. Inhibition of interleukin-1 receptor-associated kinase 1 (IRAK1) as a therapeutic strategy. Oncotarget 2018; 9:33416-33439. [PMID: 30279971 PMCID: PMC6161786 DOI: 10.18632/oncotarget.26058] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023] Open
Abstract
Interleukin-1 receptor-associated kinases (IRAK1, IRAK2, IRAK3 [IRAK-M], and IRAK4) are serine-threonine kinases involved in toll-like receptor and interleukin-1 signaling pathways, through which they regulate innate immunity and inflammation. Evidence exists that IRAKs play key roles in the pathophysiologies of cancers, and metabolic and inflammatory diseases, and that IRAK inhibition has potential therapeutic benefits. Molecules capable of selectively interfering with IRAK function and expression have been reported, paving the way for the clinical evaluation of IRAK inhibition. Herein, we focus on IRAK1, review its structure and physiological roles, and summarize emerging data for IRAK1 inhibitors in preclinical and clinical studies.
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Affiliation(s)
| | - Angela Fleischman
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA
| | | | - John O Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qiang Yu
- Genome Institute of Singapore, Singapore, SG, Singapore
| | - Anupriya Agarwal
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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28
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Tremblay D, Mascarenhas J. Pacritinib to treat myelofibrosis patients with thrombocytopenia. Expert Rev Hematol 2018; 11:707-714. [DOI: 10.1080/17474086.2018.1500456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Douglas Tremblay
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - John Mascarenhas
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
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29
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How I treat primary mediastinal B-cell lymphoma. Blood 2018; 132:782-790. [PMID: 29976557 DOI: 10.1182/blood-2018-04-791566] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022] Open
Abstract
The World Health Organization now recognizes primary mediastinal B-cell lymphoma (PMBCL) as a unique clinical and biologic entity. PMBCL is distinct from other B-cell non-Hodgkin lymphoma subtypes and has features that overlap with classical Hodgkin lymphoma, including a peak incidence in the adolescent and young adult population, mediastinal presentation of disease, and molecular alterations in JAK2 and programmed death ligands. Because PMBCL is rare, there are few prospective clinical trials to guide therapy, resulting in no single standard of care. Given the long life expectancy of survivors of PMBCL, treatment approaches must balance maximizing cure while minimizing long-term toxicity. In this article, I review my approach to the treatment of PMBCL, incorporating data from adult and pediatric studies, as well as recent advances in our understanding of the molecular basis of PMBCL.
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30
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Shah GL, Moskowitz CH. Transplant strategies in relapsed/refractory Hodgkin lymphoma. Blood 2018; 131:1689-1697. [PMID: 29500170 PMCID: PMC5897866 DOI: 10.1182/blood-2017-09-772673] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/28/2017] [Indexed: 02/07/2023] Open
Abstract
The majority of patients with Hodgkin lymphoma (HL) are cured with initial therapy. However, high-dose therapy with autologous hematopoietic cell transplant (AHCT) allows for the cure of an additional portion of patients with relapsed or primary refractory disease. Positron emission tomography-negative complete remission before AHCT is critical for long-term disease control. Several salvage options are available with comparable response rates, and the choice can be dependent of comorbidities and logistics. Radiation therapy can also improve the remission rate and is an important therapeutic option for selected patients. Brentuximab vedotin (BV) maintenance after AHCT is beneficial in patients at high risk for relapse, especially those with more than 1 risk factor, but can have the possibility of significant side effects, primarily neuropathy. Newer agents with novel mechanisms of action are under investigation to improve response rates for patients with subsequent relapse, although are not curative alone. BV and the checkpoint inhibitors nivolumab and pembrolizumab are very effective with limited side effects and can bridge patients to curative allogeneic transplants (allo-HCT). Consideration for immune-mediated toxicities, timing of allogeneic hematopoietic cell transplant based on response, and the potential for increased graft-versus-host disease remain important. Overall, prospective investigations continue to improve outcomes and minimize toxicity for relapsed or primary refractory HL patients.
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Affiliation(s)
- Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Craig H Moskowitz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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31
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Kallam A, Armitage JO. Current and emerging treatment options for a patient with a second relapse of Hodgkin’s lymphoma. Expert Rev Hematol 2018. [DOI: 10.1080/17474086.2018.1449637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Avyakta Kallam
- Division of Oncology/Hematology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA
| | - James O. Armitage
- Division of Oncology/Hematology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA
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32
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Biology of classical Hodgkin lymphoma: implications for prognosis and novel therapies. Blood 2018; 131:1654-1665. [PMID: 29500175 DOI: 10.1182/blood-2017-09-772632] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022] Open
Abstract
Hodgkin lymphoma is considered a prime example of treatment success, with cure rates exceeding 80% using modern combined modality therapies. However, especially in adolescents and young adults, treatment-related toxicity and long-term morbidity still represent persistent challenges. Moreover, outcomes in patients with relapsed or refractory disease remain unfavorable in the era of high-dose chemotherapy and stem-cell transplantation. Hence, there is a high demand for novel and innovative alternative treatment approaches. In recent years, many new therapeutic agents have emerged from preclinical and clinical studies that target molecular hallmarks of Hodgkin lymphoma, including the aberrant phenotype of the tumor cells, deregulated oncogenic pathways, and immune escape. The antibody-drug conjugate brentuximab vedotin and immune checkpoint inhibitors have already shown great success in patients with relapsed/refractory disease, leading to US Food and Drug Administration approval and new trials testing these agents in various clinical settings. The expanding knowledge and understanding of Hodgkin lymphoma biology and disease progression, as well as the development of robust tools for biomarker-driven risk stratification and therapeutic decision making, continue to be fundamentally important for the success of these and other novel agents. We anticipate that the availability and clinical implementation of novel molecular assays will be instrumental in an era of rapid shifts in the treatment landscape of this disease. Here, we review the current knowledge of Hodgkin lymphoma pathobiology, highlighting the related development of novel treatment strategies and prognostic models that hold the promise to continually challenge and change the current standard of care in classical Hodgkin lymphoma.
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Mauz-Körholz C, Ströter N, Baumann J, Botzen A, Körholz K, Körholz D. Pharmacotherapeutic Management of Pediatric Lymphoma. Paediatr Drugs 2018; 20:43-57. [PMID: 29127674 DOI: 10.1007/s40272-017-0265-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) comprise approximately 15% of all childhood malignancies. Cure rates for both lymphoma entities have evolved tremendously during the last couple of decades, raising the 5-year survival rates to almost 100% for HL and to 85% for NHL. The mainstay therapy for both malignancies is still chemotherapy-with different regimens recommended for different types of disease. In HL, combined modality treatment, i.e., chemotherapy followed by radiotherapy, has long been the standard regimen. In order to reduce long-term side effects, such as second malignancies, most major pediatric HL consortia have studied response-based radiotherapy reduction strategies over the last 3 decades. For recurrent disease, high-dose chemotherapy followed by an autologous or an allogeneic hematopoietic stem-cell transplant is an option. No targeted agents have yet gained regulatory approval for use in pediatric patients with lymphoma. For adult lymphoma patients, the CD20 antibody rituximab and the CD30 antibody-drug conjugate brentuximab vedotin are targeted agents used regularly in first- and second-line treatment regimens. More recently, immune checkpoint inhibitors, phosphatidyl-inositol-3-kinase inhibitors, and Bruton's tyrosine kinase inhibitors appear to be very promising new treatment options in adult lymphoma. Here, we discuss the current experience with these types of agents in pediatric lymphoma patients.
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Affiliation(s)
- Christine Mauz-Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany. .,Medical Faculty of the Martin-Luther-University of Halle-Wittenberg, Halle, Germany.
| | - Natascha Ströter
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Julia Baumann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Ante Botzen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
| | - Katharina Körholz
- Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research center (DKFZ), Heidelberg, Germany
| | - Dieter Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Feulgenstraße 12, 35392, Giessen, Germany
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34
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Van Den Neste E, André M, Gastinne T, Stamatoullas A, Haioun C, Belhabri A, Reman O, Casasnovas O, Ghesquieres H, Verhoef G, Claessen MJ, Poirel HA, Copin MC, Dubois R, Vandenberghe P, Stoian IA, Cottereau AS, Bailly S, Knoops L, Morschhauser F. A phase II study of the oral JAK1/JAK2 inhibitor ruxolitinib in advanced relapsed/refractory Hodgkin lymphoma. Haematologica 2018; 103:840-848. [PMID: 29351986 PMCID: PMC5927969 DOI: 10.3324/haematol.2017.180554] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/10/2018] [Indexed: 12/31/2022] Open
Abstract
JAK2 constitutive activation/overexpression is common in classical Hodgkin lymphoma, and several cytokines stimulate Hodgkin lymphoma cells by recognizing JAK1-/JAK2-bound receptors. JAK blockade may thus be therapeutically beneficial in Hodgkin lymphoma. In this phase II study we assessed the safety and efficacy of ruxolitinib, an oral JAK1/2 inhibitor, in patients with relapsed/refractory Hodgkin lymphoma. The primary objective was overall response rate according to the International Harmonization Project 2007 criteria. Thirty-three patients with advanced disease (median number of prior lines of treatment: 5; refractory: 82%) were included; nine (27.3%) received at least six cycles of ruxolitinib and six (18.2%) received more than six cycles. The overall response rate after six cycles was 9.4% (3/32 patients). All three responders had partial responses; another 11 patients had transient stable disease. Best overall response rate was 18.8% (6/32 patients). Rapid alleviation of B-symptoms was common. The median duration of response was 7.7 months, median progression-free survival 3.5 months (95% CI: 1.9–4.6), and the median overall survival 27.1 months (95% CI: 14.4–27.1). Forty adverse events were reported in 14/33 patients (42.4%). One event led to treatment discontinuation, while 87.5% of patients recovered without sequelae. Twenty-five adverse events were grade 3 or higher. These events were mostly anemia (n=11), all considered related to ruxolitinib. Other main causes of grade 3 or higher adverse events included lymphopenia and infections. Of note, no cases of grade 4 neutropenia or thrombocytopenia were observed. Ruxolitinib shows signs of activity, albeit short-lived, beyond a simple anti-inflammatory effect. Its limited toxicity suggests that it has the potential to be combined with other therapeutic modalities. ClinicalTrials.gov: NCT01877005
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Affiliation(s)
- Eric Van Den Neste
- Department of Hematology, Cliniques Universitaires Saint-Luc, UCL Brussels, Belgium
| | - Marc André
- Hematology Department, CHU UCL Namur, Yvoir, Belgium
| | | | | | - Corinne Haioun
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Mondor, Créteil, France
| | - Amine Belhabri
- Onco-hematology, Centre Leon Berard, University Claude Bernard Lyon 1, France
| | - Oumedaly Reman
- Hematology, Centre Hospitalier Universitaire, Caen, France
| | | | - Hervé Ghesquieres
- Hospices Civils de Lyon, Université Claude Bernard, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Gregor Verhoef
- Department of Hematology, University Hospitals Leuven, Belgium
| | | | - Hélène A Poirel
- Center for Human Genetics, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | | | | | - Sarah Bailly
- Department of Hematology, Cliniques Universitaires Saint-Luc, UCL Brussels, Belgium
| | - Laurent Knoops
- Cliniques Universitaires Saint-Luc and de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
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35
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Diaz AE, Mesa RA. Pacritinib and its use in the treatment of patients with myelofibrosis who have thrombocytopenia. Future Oncol 2017; 14:797-807. [PMID: 29235894 DOI: 10.2217/fon-2017-0494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The treatment landscape for myelofibrosis (MF) has reached the molecular era by targeting different pathways that are implied in this myeloproliferative neoplasm. A few years ago, the first-in-class JAK1/JAK2 inhibitor ruxolitinib, demonstrated reductions in both constitutional symptoms and splenomegaly, leading to the US FDA approval. The development or worsening of cytopenias in patients receiving ruxolitinib uncovered an unmet need that has been addressed by alternative approaches. Pacritinib, a dual JAK2 and FLT3 inhibitor which also inhibits IRAK1, has demonstrated the ability to favorably impact MF-associated splenomegaly and symptom burden, while having limited myelosuppression with manageable gastrointestinal toxicity. Herein, we provide an overview of pacritinib, from early preclinical studies to the latest and ongoing PAC203 trial, as an emerging therapy for MF.
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Affiliation(s)
- Adolfo Enrique Diaz
- Hematology Oncology Division, UT Health San Antonio Cancer Center, 7979 Wurzbach Road, San Antonio, TX 78229, USA
| | - Ruben A Mesa
- Hematology Oncology Division, UT Health San Antonio Cancer Center, 7979 Wurzbach Road, San Antonio, TX 78229, USA
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36
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Amin AD, Peters TL, Li L, Rajan SS, Choudhari R, Puvvada SD, Schatz JH. Diffuse large B-cell lymphoma: can genomics improve treatment options for a curable cancer? Cold Spring Harb Mol Case Stud 2017; 3:a001719. [PMID: 28487884 PMCID: PMC5411687 DOI: 10.1101/mcs.a001719] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gene-expression profiling and next-generation sequencing have defined diffuse large B-cell lymphoma (DLBCL), the most common lymphoma diagnosis, as a heterogeneous group of subentities. Despite ongoing explosions of data illuminating disparate pathogenic mechanisms, however, the five-drug chemoimmunotherapy combination R-CHOP remains the frontline standard treatment. This has not changed in 15 years, since the anti-CD20 monoclonal antibody rituximab was added to the CHOP backbone, which first entered use in the 1970s. At least a third of patients are not cured by R-CHOP, and relapsed or refractory DLBCL is fatal in ∼90%. Targeted small-molecule inhibitors against distinct molecular pathways activated in different subgroups of DLBCL have so far translated poorly into the clinic, justifying the ongoing reliance on R-CHOP and other long-established chemotherapy-driven combinations. New drugs and improved identification of biomarkers in real time, however, show potential to change the situation eventually, despite some recent setbacks. Here, we review established and putative molecular drivers of DLBCL identified through large-scale genomics, highlighting among other things the care that must be taken when differentiating drivers from passengers, which is influenced by the promiscuity of activation-induced cytidine deaminase. Furthermore, we discuss why, despite having so much genomic data available, it has been difficult to move toward personalized medicine for this umbrella disorder and some steps that may be taken to hasten the process.
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Affiliation(s)
- Amit Dipak Amin
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
| | - Tara L Peters
- Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
| | - Lingxiao Li
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
| | - Soumya Sundara Rajan
- Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
| | - Ramesh Choudhari
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
| | - Soham D Puvvada
- Department of Medicine, Division of Hematology-Oncology, University of Arizona Comprehensive Cancer Center, Tucson, Arizona 85719, USA
| | - Jonathan H Schatz
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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Wang K, Zhao X, Chen Q, Fan D, Qiao Z, Lin S, Jiang T, Dai J, Ai L. A new diagnostic marker for differentiating multicentric gliomas from multiple intracranial diffuse large B-cell lymphomas on 18F-FDG PET images. Medicine (Baltimore) 2017; 96:e7756. [PMID: 28796066 PMCID: PMC5556232 DOI: 10.1097/md.0000000000007756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intracranial gliomas and lymphomas may share similar radiological manifestations, while the treatment strategies for them are different. The aim of the study was to investigate the diagnostic value of fluorine-18-fluoro-2-deoxy-D-glucose (F-FDG) positron emission computed tomography (PET) for differentiation of multicentric gliomas and intracranial multiple diffuse large B-cell lymphomas (DLBCLs) as a study of diagnostic accuracy.A total of 32 patients with multiple intracranial tumors visualized on contrast-enhanced magnetic resonance imaging (MRI) were retrospectively evaluated. Histopathological findings confirmed multicentric gliomas and multiple DLBCLs in 17 and 15 patients, respectively. All patients underwent F-FDG PET with or without C-methionine PET. Maximum standardized uptake values (SUVmax) and tumor-to-normal tissue (T/N) ratios were compared between the 2 tumors. The diagnostic value of F-FDG PET for differentiating multicentric gliomas from multiple DLBCLs was evaluated by receiver operating characteristic (ROC) analysis.The SUVmax of multiple DLBCLs was significantly higher than that of multicentric gliomas (P = .009). However, the percentage of maximum difference-value of SUVmax (or T/N ratio) of multiple DLBCLs was significant lower than that of multicentric gliomas (P < .001). The ROC curve demonstrated that the percentage of maximum difference-value of SUVmax (or T/N ratio) on F-FDG PET images could effectively differentiate multicentric gliomas from multiple DLBCLs, with a cut-off value of 44.4%, sensitivity of 64.7%, and specificity of 100% (P < .001).Percentage of maximum difference-value of SUVmax (or T/N ratio) on F-FDG PET images might be a potential indicator for distinguishing multicentric gliomas from intracranial multiple DLBCLs, which might help determine the treatment strategy.
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Affiliation(s)
| | | | | | - Di Fan
- Department of Nuclear Medicine
| | | | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
- Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor
- Beijing Neurosurgical Institute
| | - Jianping Dai
- Department of Nuclear Medicine
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Ai
- Department of Nuclear Medicine
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38
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Drug Discovery by Molecular Imaging and Monitoring Therapy Response in Lymphoma. Int J Mol Sci 2017; 18:ijms18081639. [PMID: 28749424 PMCID: PMC5578029 DOI: 10.3390/ijms18081639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 12/12/2022] Open
Abstract
Molecular imaging allows a noninvasive assessment of biochemical and biological processes in living subjects. Treatment strategies for malignant lymphoma depend on histology and tumor stage. For the last two decades, molecular imaging has been the mainstay diagnostic test for the staging of malignant lymphoma and the assessment of response to treatment. This technology enhances our understanding of disease and drug activity during preclinical and clinical drug development. Here, we review molecular imaging applications in drug development, with an emphasis on oncology. Monitoring and assessing the efficacy of anti-cancer therapies in preclinical or clinical models are essential and the multimodal molecular imaging approach may represent a new stage for pharmacologic development in cancer. Monitoring the progress of lymphoma therapy with imaging modalities will help patients. Identifying and addressing key challenges is essential for successful integration of molecular imaging into the drug development process. In this review, we highlight the general usefulness of molecular imaging in drug development and radionuclide-based reporter genes. Further, we discuss the different molecular imaging modalities for lymphoma therapy and their preclinical and clinical applications.
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39
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Younes A, Ansell S, Fowler N, Wilson W, de Vos S, Seymour J, Advani R, Forero A, Morschhauser F, Kersten MJ, Tobinai K, Zinzani PL, Zucca E, Abramson J, Vose J. The landscape of new drugs in lymphoma. Nat Rev Clin Oncol 2017; 14:335-346. [PMID: 28031560 PMCID: PMC5611863 DOI: 10.1038/nrclinonc.2016.205] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The landscape of drugs for the treatment of lymphoma has become crowded in light of the plethora of new agents, necessitating the efficient prioritization of drugs for expedited development. The number of drugs available, and the fact that many can be given for an extended period of time, has resulted in the emergence of new challenges; these include determining the optimal duration of therapy, and the need to balance costs, benefits, and the risk of late-onset toxicities. Moreover, with the increase in the number of available investigational drugs, the number of possible combinations is becoming overwhelming, which necessitates prioritization plans for the selective development of novel combination regimens. In this Review, we describe the most-promising agents in clinical development for the treatment of lymphoma, and provide expert opinion on new strategies that might enable more streamlined drug development. We also address new approaches for patient selection and for incorporating new end points into clinical trials.
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Affiliation(s)
- Anas Younes
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA
| | - Stephen Ansell
- Division of Haematology, Mayo Clinic, 200 1st St Sw, Rochester, Minnesota 55905, USA
| | - Nathan Fowler
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
| | - Wyndham Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Sven de Vos
- Department of Medicine, Ronald Reagan UCLA Medical Center, Santa Monica, California 90404, USA
| | - John Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, A'Beckett Street, East Melbourne, Victoria 8006, Australia
| | - Ranjana Advani
- Division of Oncology, Stanford University Cancer Center, 875 Blake Wilbur Drive, Stanford, California 94305, USA
| | - Andres Forero
- Division of Haematology and Oncology, University of Alabama School of Medicine, 1720 2nd Avenue South, NP2540, Birmingham, Alabama 35294-3300, USA
| | | | - Marie Jose Kersten
- Department of Haematology, Academic Medical Center and LYMMCARE, Amsterdam, Netherlands
| | - Kensei Tobinai
- Haematology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Pier Luigi Zinzani
- Institute of Haematology "L. e A. Seràgnoli," University of Bologna, Via Massarenti, 9-40138 Bologna, Italy
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
| | - Jeremy Abramson
- Massachusetts General Hospital Cancer Center, Yawkey Center for Outpatient Care, Mailstop: Yawkey 9A, 32 Fruit Street, Boston, Massachusetts 02114, USA
| | - Julie Vose
- UNMC Oncology/Haematology Division, 987680 Nebraska Medical Center, Omaha, Nebraska 681980-7680, USA
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Staiger AM, Ziepert M, Horn H, Scott DW, Barth TFE, Bernd HW, Feller AC, Klapper W, Szczepanowski M, Hummel M, Stein H, Lenze D, Hansmann ML, Hartmann S, Möller P, Cogliatti S, Lenz G, Trümper L, Löffler M, Schmitz N, Pfreundschuh M, Rosenwald A, Ott G. Clinical Impact of the Cell-of-Origin Classification and the MYC/ BCL2 Dual Expresser Status in Diffuse Large B-Cell Lymphoma Treated Within Prospective Clinical Trials of the German High-Grade Non-Hodgkin's Lymphoma Study Group. J Clin Oncol 2017; 35:2515-2526. [PMID: 28525305 DOI: 10.1200/jco.2016.70.3660] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose To explore the prognostic impact and interdependence of the cell-of-origin (COO) classification, dual expression (DE) of MYC and BCL2 proteins, and MYC, BCL2, and BCL6 translocations in two prospectively randomized clinical trials of patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods Overall, 452 formalin-fixed paraffin-embedded samples from two prospective, randomized DLBCL trials (RICOVER-60, prospective, randomized study for patients > 60 years, all IPI groups; and R-MegaCHOEP, prospective, randomized study for patients ≤ 60 years with age-adjusted IPI 2,3) of the German High-Grade Non-Hodgkin Lymphoma Study Group were analyzed with the Lymph2Cx assay for COO classification, with immunohistochemistry for MYC and BCL2, and with fluorescent in situ hybridization for MYC, BCL2, and BCL6 rearrangements. Results COO classification was successful in 414 of 452 samples. No significant differences with respect to COO (activated B-cell [ABC]-like DLBCL v germinal center B-cell [GCB]-like DLBCL) were observed in event-free survival, progression-free survival, and overall survival in patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in the RICOVER-60 trial. Also, no differences with respect to COO were observed in multivariable analyses adjusted for International Prognostic Index factors in event-free survival (hazard ratio [HR] of ABC-like disease v GCB-like disease, 1.0; 95% CI, 0.6 to 1.6; P = .93), progression-free survival (HR, 1.1; 95% CI, 0.6 to 1.8; P = .82), and overall survival (HR, 1.0; 95% CI, 0.6 to 1.8; P = .96). Similar results were observed in the R-MegaCHOEP trial. In patients treated with R-CHOP, DE status was associated with significantly inferior survival compared with nonDE within the GCB, but not within the ABC subgroup. DE status was associated with significantly inferior outcome compared with patients with ABC-like DLBCL without DE (5-year PFS rate, 39% [95% CI,19% to 59%] v 68% [95% CI, 52% to 85%]; P = .03) and compared with patients with GCB-like DLBCL without DE. When data from patients with nonDE were analyzed separately, the outcome of patients in the ABC subgroup was inferior to that of patients in the GCB subgroup (5-year PFS rate, 68% [95% CI, 52% to 85%] v 85% [95% CI, 74% to 96%]; P = .04). Conclusion COO profiling in two prospective randomized DLBCL trials failed to identify prognostic subgroups, whereas dual expression of MYC and BCL2 was predictive of poor survival. Evaluation of prognostic or predictive biomarkers in the management of DLBCL, such as the COO, within prospective clinical trials will be important in the future.
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Affiliation(s)
- Annette M Staiger
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Marita Ziepert
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heike Horn
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - David W Scott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Thomas F E Barth
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heinz-Wolfram Bernd
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Alfred C Feller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Wolfram Klapper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Monika Szczepanowski
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Hummel
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Harald Stein
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Dido Lenze
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Martin-Leo Hansmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sylvia Hartmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Peter Möller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sergio Cogliatti
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Georg Lenz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Lorenz Trümper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Markus Löffler
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Norbert Schmitz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Pfreundschuh
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andreas Rosenwald
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - German Ott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
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Curran EK, Godfrey J, Kline J. Mechanisms of Immune Tolerance in Leukemia and Lymphoma. Trends Immunol 2017; 38:513-525. [PMID: 28511816 DOI: 10.1016/j.it.2017.04.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/05/2017] [Accepted: 04/18/2017] [Indexed: 12/18/2022]
Abstract
The mechanisms through which immune responses are generated against solid cancers are well characterized and knowledge of the immune evasion pathways exploited by these malignancies has grown considerably. However, for hematological cancers, which develop and disseminate quite differently than solid tumors, the pathways that regulate immune activation or tolerance are less clear. Growing evidence suggests that, while numerous immune escape pathways are shared between hematological and solid malignancies, several unique pathways are exploited by leukemia and lymphoma. Below we discuss immune evasion mechanisms in leukemia and lymphoma, highlighting key differences from solid tumors. A more complete characterization of the mechanisms of immune tolerance in hematological malignancies is critical to inform the development of future immunotherapeutic approaches.
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Affiliation(s)
- Emily K Curran
- Department of Medicine, Section of Hematology, University of Chicago, Chicago, IL, USA; Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - James Godfrey
- Department of Medicine, Section of Hematology, University of Chicago, Chicago, IL, USA
| | - Justin Kline
- Department of Medicine, Section of Hematology, University of Chicago, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA; Committee on Immunology, University of Chicago, Chicago, IL, USA.
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Rocha TMBDSD, Fortier SC, Fischer TRDC, Perini GF, Gaiolla RD, Fogliatto L, Delamain MT, Costa AFD, Castro NSD, Barretos WG, Souza CAD, Buccheri V, Chiattone CS. Everolimus as a single agent in refractory or relapsed Hodgkin's lymphoma: the Brazilian Named Patient Program Experience. Rev Bras Hematol Hemoter 2017; 39:216-222. [PMID: 28830600 PMCID: PMC5567422 DOI: 10.1016/j.bjhh.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/13/2017] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
Abstract
Background Despite all the scientific progress that has been made on understanding the disease, prognosis for patients with relapsed and refractory Hodgkin's lymphoma remains poor and the treatment is palliative in the majority of the cases. Thus, the aim of this study was to present the results on the compassionate use of everolimus in a group of patients who were monitored at nine different centers in Brazil. Methods A 10-mg oral dose of everolimus was given to each patient daily. Response time was evaluated from the beginning of medication use until loss of response, toxicity or medical decision to cease treatment. Results Thirty-three patients were evaluated. The median age at the beginning of medication administration was 29 years. Patients had received a median of five prior therapies. Overall response rate was 45.4%, with 13 patients achieving partial response, two achieved clinical response, 14 remained with stable disease, two had disease progression, and two were not evaluated. Patients received a median of 14 cycles. Progression-free survival was nine months, and overall survival was estimated to be 36 months. Three patients used the medication for more than four years. The most frequently reported adverse events were thrombocytopenia and hypercholesterolemia. Three patients had pulmonary toxicity. Grade III and IV adverse events occurred in 39% of the patients. Conclusion Everolimus was found to provide a response in a group of patients with refractory or relapsed Hodgkin's lymphoma who had adequate tolerability to the drug.
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Affiliation(s)
| | - Sergio Costa Fortier
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | | | | | - Rafael Dezen Gaiolla
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Laura Fogliatto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | | | | | | | - Wolney Gois Barretos
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | | | - Valéria Buccheri
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
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Karantanos T, Politikos I, Boussiotis VA. Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin's lymphoma with an emphasis on targeted therapies and transplantation strategies. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2017; 7:37-52. [PMID: 28701859 PMCID: PMC5502320 DOI: 10.2147/blctt.s105458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hodgkin’s lymphoma (HL) is highly curable with first-line therapy. However, a minority of patients present with refractory disease or experience relapse after completion of frontline treatment. These patients are treated with salvage chemotherapy followed by autologous stem cell transplantation (ASCT), which remains the standard of care with curative potential for refractory or relapsed HL. Nevertheless, a significant percentage of such patients will progress after ASCT, and allogeneic hematopoietic stem cell transplantation remains the only curative approach in that setting. Recent advances in the pathophysiology of refractory or relapsed HL have provided the rationale for the development of novel targeted therapies with potent anti-HL activity and favorable toxicity profile, in contrast to cytotoxic chemotherapy. Brentuximab vedotin and programmed cell death-1-based immunotherapy have proven efficacy in the management of refractory or relapsed HL, whereas several other agents have shown promise in early clinical trials. Several of these agents are being incorporated with transplantation strategies in order to improve the outcomes of refractory or relapsed HL. In this review we summarize the current knowledge regarding the mechanisms responsible for the development of refractory/relapsed HL and the outcomes with current treatment strategies, with an emphasis on targeted therapies and hematopoietic stem cell transplantation.
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Affiliation(s)
- Theodoros Karantanos
- General Internal Medicine Section, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vassiliki A Boussiotis
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Cancer Center, Harvard Medical School, Boston, MA, USA
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Abstract
Classical Hodgkin lymphoma (cHL) is the most common hematological malignancy in young adults and can be cured in most cases. However, relapsed and refractory Hodgkin lymphoma, certain patient groups, such as elderly patients, and toxicity of first-line treatment still pose significant challenges. Consequently, new treatment options are needed. Recently, many new treatment concepts have been evaluated in clinical trials. Targeted drug-antibody conjugates and immune checkpoint inhibitors have decisively changed treatment approaches. This review aims to give a comprehensive overview of novel agents in Hodgkin lymphoma that have been recently or are currently being evaluated in clinical trials. In addition to dedicated sections on brentuximab vedotin (BV) and immune checkpoint inhibitors, other emerging substances and concepts are discussed. In doing so, this review compares trial results regarding safety and efficacy. A special focus lies on the effect novel agents will have on the different treatment settings faced by clinicians involved in the treatment of Hodgkin lymphoma.
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Affiliation(s)
- Sven Borchmann
- a German Hodgkin Study Group (GHSG), Department I of Internal Medicine , University Hospital Cologne , Cologne , Germany
| | - Bastian von Tresckow
- a German Hodgkin Study Group (GHSG), Department I of Internal Medicine , University Hospital Cologne , Cologne , Germany
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Moffitt AB, Dave SS. Clinical Applications of the Genomic Landscape of Aggressive Non-Hodgkin Lymphoma. J Clin Oncol 2017; 35:955-962. [PMID: 28297626 DOI: 10.1200/jco.2016.71.7603] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this review, we examine the genomic landscapes of lymphomas that arise from B, T, and natural killer cells. Lymphomas represent a striking spectrum of clinical behaviors. Although some lymphomas are curable with standard therapy, the majority of the affected patients succumb to their disease. Here, the genetic underpinnings of these heterogeneous entities are reviewed. We consider B-cell lymphomas, including Burkitt lymphoma, diffuse large B-cell lymphoma, Hodgkin lymphoma, and primary mediastinal B-cell lymphoma. We also examine T-cell lymphomas, including anaplastic large-cell lymphoma, angioimmunoblastic T-cell lymphoma, cutaneous T-cell lymphoma, adult T-cell leukemia/lymphoma, and other peripheral T-cell lymphomas. Together, these malignancies make up most lymphomas diagnosed around the world. Genomic technologies, including microarrays and next-generation sequencing, have enabled a better understanding of the molecular underpinnings of these cancers. We describe the broad genomics findings that characterize these lymphoma types and discuss new therapeutic opportunities that arise from these findings.
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Affiliation(s)
- Andrea B Moffitt
- Andrea B. Moffitt and Sandeep S. Dave, Duke University, Durham, NC
| | - Sandeep S Dave
- Andrea B. Moffitt and Sandeep S. Dave, Duke University, Durham, NC
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Senkevitch E, Durum S. The promise of Janus kinase inhibitors in the treatment of hematological malignancies. Cytokine 2016; 98:33-41. [PMID: 28277287 DOI: 10.1016/j.cyto.2016.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/20/2016] [Indexed: 01/12/2023]
Abstract
The Janus kinases (JAK) are a family of kinases that play an essential role in cytokine signaling and are implicated in the pathogenesis of autoimmune diseases and hematological malignancies. As a result, the JAKs have become attractive therapeutic targets. The discovery of a JAK2 point mutation (JAK2 V617F) as the main cause of polycythemia vera lead to the development and FDA approval of a JAK1/2 inhibitor, ruxolitinib, in 2011. This review focuses on the various JAK and associated components aberrations implicated in myeloproliferative neoplasms, leukemias, and lymphomas. In addition to ruxolitinib, other JAK inhibitors are currently being evaluated in clinical trials for treating hematological malignancies. The use of JAK inhibitors alone or in combination therapy should be considered as a way to deliver targeted therapy to patients.
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Affiliation(s)
- Emilee Senkevitch
- Cytokines and Immunity Section, Cancer and Inflammation Program, National Cancer Institute, National Institutes of Health, Frederick, MD, United States
| | - Scott Durum
- Cytokines and Immunity Section, Cancer and Inflammation Program, National Cancer Institute, National Institutes of Health, Frederick, MD, United States.
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Ma J, Xing W, Coffey G, Dresser K, Lu K, Guo A, Raca G, Pandey A, Conley P, Yu H, Wang YL. Cerdulatinib, a novel dual SYK/JAK kinase inhibitor, has broad anti-tumor activity in both ABC and GCB types of diffuse large B cell lymphoma. Oncotarget 2016; 6:43881-96. [PMID: 26575169 PMCID: PMC4791274 DOI: 10.18632/oncotarget.6316] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
B-cell receptor (BCR) and JAK/STAT pathways play critical roles in diffuse large B-cell lymphoma (DLBCL). Herein, we investigated the anti-lymphoma activity of cerdulatinib, a novel compound that dually targets SYK and JAK/STAT pathways. On a tissue microarray of 62 primary DLBCL tumors, 58% expressed either phosphorylated SYK or STAT3 or both. SYK and STAT3 are also phosphorylated in a panel of eleven DLBCL cell lines although ABC and GCB subtypes exhibited different JAK/STAT and BCR signaling profiles. In both ABC and GCB cell lines, cerdulatinib induced apoptosis that was associated with caspase-3 and PARP cleavage. The compound also blocked G1/S transition and caused cell cycle arrest, accompanied by inhibition of RB phosphorylation and down-regulation of cyclin E. Phosphorylation of BCR components and STAT3 was sensitive to cerdulatinib in both ABC and GCB cell lines under stimulated conditions. Importantly, JAK/STAT and BCR signaling can be blocked by cerdulatinib in primary GCB and non-GCB DLBCL tumor cells that were accompanied by cell death. Our work provides mechanistic insights into the actions of cerdulatinib, suggesting that the drug has a broad anti-tumor activity in both ABC and GCB DLBCL, at least in part by inhibiting SYK and JAK pathways.
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Affiliation(s)
- Jiao Ma
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Wei Xing
- Department of Pathology, University of Massachusetts Memorial Medical Center and Medical School, Worcester, MA, USA
| | - Greg Coffey
- Department of Biology, Portola Pharmaceuticals, Inc., South San Francisco, CA, USA
| | - Karen Dresser
- Department of Pathology, University of Massachusetts Memorial Medical Center and Medical School, Worcester, MA, USA
| | - Kellie Lu
- University of Chicago Laboratory School, Chicago, IL, USA
| | - Ailin Guo
- Department of Pathology, Division of Genomic and Molecular Pathology, University of Chicago, Chicago, IL, USA
| | - Gordana Raca
- Department of Medicine, University of Chicago, IL, USA
| | - Anjali Pandey
- Department of Biology, Portola Pharmaceuticals, Inc., South San Francisco, CA, USA
| | - Pamela Conley
- Department of Biology, Portola Pharmaceuticals, Inc., South San Francisco, CA, USA
| | - Hongbo Yu
- Department of Pathology, University of Massachusetts Memorial Medical Center and Medical School, Worcester, MA, USA
| | - Y Lynn Wang
- Department of Pathology, Division of Genomic and Molecular Pathology, University of Chicago, Chicago, IL, USA
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Jain T, Mesa R. The development, safety and efficacy of pacritinib for the treatment of myelofibrosis. Expert Rev Anticancer Ther 2016; 16:1101-1108. [PMID: 27598824 DOI: 10.1080/14737140.2016.1233061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dysregulation of janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway has been described in myelofibrosis (MF). Currently, there is an unmet need for agents that have the benefit of JAK inhibition, yet also are safe and effective in patients with thrombocytopenia. Areas covered: We discuss the various preclinical and clinical studies describing pacritinib, a selective JAK2/FLT3 inhibitor. So far, it has shown promising results, without significant thrombocytopenia. A PubMed search, using keywords 'pacritinib', 'SB 1518' and 'myelofibrosis' was conducted. Published abstracts from recent national and international meetings were also reviewed for unpublished data. Expert commentary: Currently, pacritinib is on hold by Food and Drugs Administration. It would be imperative to understand if there is a treatment related toxicity that would limit its use. If a safe path is found for this agent, it could have a significant benefit in various settings, based on the data so far.
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Affiliation(s)
- Tania Jain
- a Division of Hematology Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Ruben Mesa
- a Division of Hematology Oncology , Mayo Clinic , Phoenix , AZ , USA
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Witkowska M, Smolewski P, Majchrzak A, Robak T. Innovation in non-Hodgkin lymphoma drug discovery: what needs to be done? Expert Opin Drug Discov 2016; 11:1033-1045. [PMID: 27569454 DOI: 10.1080/17460441.2016.1230095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION A new generation of anticancer agents called target drugs has been recently developed for the treatment of non-Hodgkin lymphomas. Current recovery rates in these diseases are up to 70% with immunotherapy based on the anti-CD20 monoclonal antibody combined with standard chemotherapeutics. However, there are still refractory or relapsed patients. Recently, several novel anti-lymphoma agents have been developed. Choosing the most effective personalized therapy still remains a crucial challenge in hematology. Areas covered: New drugs can specifically target malignant cells and inhibit cancer cell growth, proliferation and survival by specific interactions with one or more target proteins. Recent clinical studies have illustrated promising outcomes for novel drugs used as single agents and in combination with traditional therapeutics. In this article, the authors discuss novel targeted therapies with a promising outcome in NHL patients that are becoming integrated into treatment paradigms. Expert opinion: The development of new treatment options may help to avoid cytotoxic chemotherapy entirely in some clinical settings. Multicenter studies should be continued to investigate small agents and pathways inhibitors as this will enable us to enhance not only the duration of the treatment response but also the quality of the extended survival.
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Affiliation(s)
- Magdalena Witkowska
- a Department of Experimental Hematology , Medical University of Lodz , Lodz , Poland
| | - Piotr Smolewski
- a Department of Experimental Hematology , Medical University of Lodz , Lodz , Poland
| | - Agata Majchrzak
- a Department of Experimental Hematology , Medical University of Lodz , Lodz , Poland.,b Department of Hematology , Medical University of Lodz , Lodz , Poland
| | - Tadeusz Robak
- b Department of Hematology , Medical University of Lodz , Lodz , Poland
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Singer JW, Al-Fayoumi S, Ma H, Komrokji RS, Mesa R, Verstovsek S. Comprehensive kinase profile of pacritinib, a nonmyelosuppressive Janus kinase 2 inhibitor. J Exp Pharmacol 2016; 8:11-9. [PMID: 27574472 PMCID: PMC4993559 DOI: 10.2147/jep.s110702] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Pacritinib, potent inhibitor of Janus kinase 2 (JAK2), JAK2V617F, and fms-like receptor tyrosine kinase 3, is in Phase III development in myelofibrosis. Among type 1 inhibitors, pacritinib shows a lack of myelosuppression at doses that both inhibit JAK2/signal transducer and activator of transcription 3 pathway and demonstrate clinical efficacy. To elucidate these mechanisms and identify other disease targets, a kinome analysis screened 439 recombinant kinases at 100 nM pacritinib concentration. For kinases with >50% inhibition, pacritinib was titrated from 1 to 100 nM. JAK2, JAK2V617F, FLT3, colony-stimulating factor 1 receptor, and interleukin-1 receptor-associated kinase 1 achieved half-maximal inhibitory concentrations <50 nM. Pacritinib did not inhibit JAK1 (82% control at 100 nM). Lack of myelosuppression may stem from inhibiting JAK2 without affecting JAK1 and reducing hematopoietic inhibitory cytokines by suppressing interleukin-1 receptor-associated kinase 1 or colony-stimulating factor 1 receptor. The pacritinib kinome suggests therapeutic utility in acute myeloid leukemia, myelodysplastic syndrome, chronic myelomonocytic leukemia, solid tumors, and inflammatory conditions.
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Affiliation(s)
- Jack W Singer
- Translational Medicine, CTI BioPharma Corp., Seattle, WA
| | | | - Haiching Ma
- Department of Research and Development, Reaction Biology, Malvern, PA
| | - Rami S Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ruben Mesa
- Division of Hematology and Medical Oncology, Mayo Clinic Cancer Center, Scottsdale, AZ
| | - Srdan Verstovsek
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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