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Corbacioglu S, Lode H, Ellinger S, Zeman F, Suttorp M, Escherich G, Bochennek K, Gruhn B, Lang P, Rohde M, Debatin KM, Steinbach D, Beilken A, Ladenstein R, Spachtholz R, Heiss P, Hellwig D, Tröger A, Koller M, Menhart K, Riemenschneider MJ, Zoubaa S, Kietz S, Jakob M, Sommer G, Heise T, Hundsdörfer P, Kühnle I, Dilloo D, Schönberger S, Schwabe G, von Luettichau I, Graf N, Schlegel PG, Frühwald M, Jorch N, Paulussen M, Schneider DT, Metzler M, Leipold A, Nathrath M, Imschweiler T, Christiansen H, Schmid I, Crazzolara R, Niktoreh N, Cario G, Faber J, Demmert M, Babor F, Fröhlich B, Bielack S, Bernig T, Greil J, Eggert A, Simon T, Foell J. Irinotecan and temozolomide in combination with dasatinib and rapamycin versus irinotecan and temozolomide for patients with relapsed or refractory neuroblastoma (RIST-rNB-2011): a multicentre, open-label, randomised, controlled, phase 2 trial. Lancet Oncol 2024; 25:922-932. [PMID: 38936379 DOI: 10.1016/s1470-2045(24)00202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Neuroblastoma is the most common extracranial solid tumour in children. Relapsed or refractory neuroblastoma is associated with a poor outcome. We assessed the combination of irinotecan-temozolomide and dasatinib-rapamycin (RIST) in patients with relapsed or refractory neuroblastoma. METHODS The multicentre, open-label, randomised, controlled, phase 2, RIST-rNB-2011 trial recruited from 40 paediatric oncology centres in Germany and Austria. Patients aged 1-25 years with high-risk relapsed (defined as recurrence of all stage IV and MYCN amplification stages, after response to treatment) or refractory (progressive disease during primary treatment) neuroblastoma, with Lansky and Karnofsky performance status at least 50%, were assigned (1:1) to RIST (RIST group) or irinotecan-temozolomide (control group) by block randomisation, stratified by MYCN status. We compared RIST (oral rapamycin [loading 3 mg/m2 on day 1, maintenance 1 mg/m2 on days 2-4] and oral dasatinib [2 mg/kg per day] for 4 days with 3 days off, followed by intravenous irinotecan [50 mg/m2 per day] and oral temozolomide [150 mg/m2 per day] for 5 days with 2 days off; one course each of rapamycin-dasatinib and irinotecan-temozolomide for four cycles over 8 weeks, then two courses of rapamycin-dasatinib followed by one course of irinotecan-temozolomide for 12 weeks) with irinotecan-temozolomide alone (with identical dosing as experimental group). The primary endpoint of progression-free survival was analysed in all eligible patients who received at least one course of therapy. The safety population consisted of all patients who received at least one course of therapy and had at least one post-baseline safety assessment. This trial is registered at ClinicalTrials.gov, NCT01467986, and is closed to accrual. FINDINGS Between Aug 26, 2013, and Sept 21, 2020, 129 patients were randomly assigned to the RIST group (n=63) or control group (n=66). Median age was 5·4 years (IQR 3·7-8·1). 124 patients (78 [63%] male and 46 [37%] female) were included in the efficacy analysis. At a median follow-up of 72 months (IQR 31-88), the median progression-free survival was 11 months (95% CI 7-17) in the RIST group and 5 months (2-8) in the control group (hazard ratio 0·62, one-sided 90% CI 0·81; p=0·019). Median progression-free survival in patients with amplified MYCN (n=48) was 6 months (95% CI 4-24) in the RIST group versus 2 months (2-5) in the control group (HR 0·45 [95% CI 0·24-0·84], p=0·012); median progression-free survival in patients without amplified MYCN (n=76) was 14 months (95% CI 9-7) in the RIST group versus 8 months (4-15) in the control group (HR 0·84 [95% CI 0·51-1·38], p=0·49). The most common grade 3 or worse adverse events were neutropenia (54 [81%] of 67 patients given RIST vs 49 [82%] of 60 patients given control), thrombocytopenia (45 [67%] vs 41 [68%]), and anaemia (39 [58%] vs 38 [63%]). Nine serious treatment-related adverse events were reported (five patients given control and four patients given RIST). There were no treatment-related deaths in the control group and one in the RIST group (multiorgan failure). INTERPRETATION RIST-rNB-2011 demonstrated that targeting of MYCN-amplified relapsed or refractory neuroblastoma with a pathway-directed metronomic combination of a multkinase inhibitor and an mTOR inhibitor can improve progression-free survival and overall survival. This exclusive efficacy in MYCN-amplified, relapsed neuroblastoma warrants further investigation in the first-line setting. FUNDING Deutsche Krebshilfe.
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Affiliation(s)
- Selim Corbacioglu
- University Medical Center Regensburg, Regensburg, Germany; Department of Pediatric Hematology, Oncology, and Stem Cell Transplantation,University Medical Center Regensburg, Regensburg, Germany.
| | - Holger Lode
- University Medicine Greifswald, Greifswald, Germany
| | | | - Florian Zeman
- University Medical Center Regensburg, Regensburg, Germany
| | - Meinolf Suttorp
- Medical Faculty, Technical University Dresden, Dresden, Germany
| | | | | | - Bernd Gruhn
- University Medical Center Jena, Jena, Germany
| | - Peter Lang
- University Medical Center Tuebingen, Tuebingen, Germany
| | - Marius Rohde
- University Medical Center Giessen, Giessen, Germany
| | | | | | | | - Ruth Ladenstein
- St Anna Children's Cancer Research Institute, University Medical Center, Vienna, Austria
| | | | - Peter Heiss
- University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Hellwig
- University Medical Center Regensburg, Regensburg, Germany
| | - Anja Tröger
- University Medical Center Regensburg, Regensburg, Germany
| | - Michael Koller
- University Medical Center Regensburg, Regensburg, Germany
| | - Karin Menhart
- University Medical Center Regensburg, Regensburg, Germany
| | | | - Saida Zoubaa
- University Medical Center Regensburg, Regensburg, Germany
| | - Silke Kietz
- University Medical Center Regensburg, Regensburg, Germany
| | - Marcus Jakob
- University Medical Center Regensburg, Regensburg, Germany
| | - Gunhild Sommer
- University Medical Center Regensburg, Regensburg, Germany
| | - Tilman Heise
- University Medical Center Regensburg, Regensburg, Germany
| | | | - Ingrid Kühnle
- University Medical Center Göttingen, Göttingen, Germany
| | | | | | | | | | | | | | | | - Norbert Jorch
- University Medical Center Bielefeld, Bielefeld, Germany
| | | | | | | | | | | | | | | | - Irene Schmid
- Ludwig Maximilians University Munich, Munich, Germany
| | | | | | | | - Joerg Faber
- University Medical Center Mainz, Mainz, Germany
| | | | - Florian Babor
- University Medical Center Düsseldorf, Düsseldorf, Germany
| | | | | | | | - Johann Greil
- University Medical Center Heidelberg, Heidelberg, Germany
| | | | | | - Juergen Foell
- University Medical Center Regensburg, Regensburg, Germany
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de Faria LL, Ponich Clementino C, Véras FASE, Khalil DDC, Otto DY, Oranges Filho M, Suzuki L, Bedoya MA. Staging and Restaging Pediatric Abdominal and Pelvic Tumors: A Practical Guide. Radiographics 2024; 44:e230175. [PMID: 38722785 DOI: 10.1148/rg.230175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The most common abdominal malignancies diagnosed in the pediatric population include neuroblastoma, Wilms tumor, hepatoblastoma, lymphoma, germ cell tumor, and rhabdomyosarcoma. There are distinctive imaging findings and patterns of spread for each of these tumors that radiologists must know for diagnosis and staging and for monitoring the patient's response to treatment. The multidisciplinary treatment group that includes oncologists, surgeons, and radiation oncologists relies heavily on imaging evaluation to identify the best treatment course and prognostication of imaging findings, such as the image-defined risk factors for neuroblastomas, the PRETreatment EXtent of Disease staging system for hepatoblastoma, and the Ann Arbor staging system for lymphomas. It is imperative for radiologists to be able to correctly indicate the best imaging methods for diagnosis, staging, and restaging of each of these most prevalent tumors to avoid inconclusive or unnecessary examinations. The authors review in a practical manner the most updated key points in diagnosing and staging disease and assessing response to treatment of the most common pediatric abdominal tumors. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Luisa Leitão de Faria
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Carolina Ponich Clementino
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Felippe Augusto Silvestre E Véras
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Douglas da Cunha Khalil
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Deborah Yukiko Otto
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Marcelo Oranges Filho
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Lisa Suzuki
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - M Alejandra Bedoya
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
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Zhao JD, Lu XY, Chen TP, Duan XL, Zuo W, Sai K, Zhu LR, Gao Q. Development and validation of a novel nomogram for predicting overall survival patients with neuroblastoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108321. [PMID: 38598875 DOI: 10.1016/j.ejso.2024.108321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The aim of this study was to develop a nomogram specially for predicting overall survival (OS) for Chinese patients with neuroblastoma (NB). METHODS Patients with pathologically confirmed NB who were newly diagnosed and received treatments at our hospital from October 2013 to October 2021 were retrospectively reviewed. The nomogram for OS were built based on Cox regression analysis. The validation of the prognostic model was evaluated by concordance index (C-index), calibration curves, and decision curve analyses (DCAs). RESULTS A total of 254 patients with NB were included in this study. They were randomly divided into a training cohort (n = 178) and a validation cohort (n = 76) at a ratio of 7:3. Multivariate analyses revealed that prognostic variables significantly related to the OS were age at diagnosis, bone metastasis, hepatic metastasis, INSS stage, MYCN status and DNA ploidy. The nomogram was constructed based on above 6 factors. The C-index values of the nomogram for predicting 3-year and 5-year OS were 0.926 and 0.964, respectively. The calibration curves of the nomogram showed good consistency between nomogram prediction and actual survival. The DCAs showed great clinical usefulness of the nomograms. Furthermore, patients with low-risk identified by our nomogram had much higher OS than those with high-risk (p < 0.001). CONCLUSION The nomogram we constructed exhibited good predictive performance and could be used to assist clinicians in their decision-making process.
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Affiliation(s)
- Jin-du Zhao
- Department of Oncology Surgery, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China
| | - Xian-Ying Lu
- Department of Oncology Surgery, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China
| | - Tian-Ping Chen
- Department of Hematology and Oncology, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China
| | - Xian-Lun Duan
- Department of Thoracic Surgery, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China
| | - Wei Zuo
- Department of Neonatal Surgery, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China
| | - Kai Sai
- Department of Oncology Surgery, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China
| | - Li-Ran Zhu
- Anhui Institute of Pediatric Research, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China
| | - Qun Gao
- Department of Oncology Surgery, Anhui Medical University Children's Medical Center, Anhui Provincial Children's Hospital, Hefei, 230051, Anhui, China.
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Cheung IY, Mauguen A, Modak S, Basu EM, Feng Y, Kushner BH, Cheung NK. Long Prime-Boost Interval and Heightened Anti-GD2 Antibody Response to Carbohydrate Cancer Vaccine. Vaccines (Basel) 2024; 12:587. [PMID: 38932316 PMCID: PMC11209353 DOI: 10.3390/vaccines12060587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
The carbohydrate ganglioside GD2/GD3 cancer vaccine adjuvanted by β-glucan stimulates anti-GD2 IgG1 antibodies that strongly correlate with improved progression-free survival (PFS) and overall survival (OS) among patients with high-risk neuroblastoma. Thirty-two patients who relapsed on the vaccine (first enrollment) were re-treated on the same vaccine protocol (re-enrollment). Titers during the first enrollment peaked by week 32 at 751 ± 270 ng/mL, which plateaued despite vaccine boosts at 1.2-4.5 month intervals. After a median wash-out interval of 16.1 months from the last vaccine dose during the first enrollment to the first vaccine dose during re-enrollment, the anti-GD2 IgG1 antibody rose to a peak of 4066 ± 813 ng/mL by week 3 following re-enrollment (p < 0.0001 by the Wilcoxon matched-pairs signed-rank test). Yet, these peaks dropped sharply and continually despite repeated boosts at 1.2-4.5 month intervals, before leveling off by week 20 to the first enrollment peak levels. Despite higher antibody titers, patients experienced no pain or neuropathic side effects, which were typically associated with immunotherapy using monoclonal anti-GD2 antibodies. By the Kaplan-Meier method, PFS was estimated to be 51%, and OS was 81%. The association between IgG1 titer during re-enrollment and β-glucan receptor dectin-1 SNP rs3901533 was significant (p = 0.01). A longer prime-boost interval could significantly improve antibody responses in patients treated with ganglioside conjugate cancer vaccines.
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Affiliation(s)
- Irene Y. Cheung
- Departments of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (S.M.); (E.M.B.); (Y.F.); (B.H.K.); (N.K.C.)
| | - Audrey Mauguen
- Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;
| | - Shakeel Modak
- Departments of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (S.M.); (E.M.B.); (Y.F.); (B.H.K.); (N.K.C.)
| | - Ellen M. Basu
- Departments of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (S.M.); (E.M.B.); (Y.F.); (B.H.K.); (N.K.C.)
| | - Yi Feng
- Departments of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (S.M.); (E.M.B.); (Y.F.); (B.H.K.); (N.K.C.)
| | - Brian H. Kushner
- Departments of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (S.M.); (E.M.B.); (Y.F.); (B.H.K.); (N.K.C.)
| | - Nai Kong Cheung
- Departments of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (S.M.); (E.M.B.); (Y.F.); (B.H.K.); (N.K.C.)
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Lu X, Li C, Wang S, Yin Y, Fu H, Wang H, Cheng W, Chen S. The prognostic role of 18F-FDG PET/CT-based response evaluation in children with stage 4 neuroblastoma. Eur Radiol 2024:10.1007/s00330-024-10781-w. [PMID: 38758254 DOI: 10.1007/s00330-024-10781-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES To evaluate the association between metabolic response on 18F-FDG PET/CT and long-term survival in children with neuroblastoma (NB). METHODS A total of 39 consecutive children with newly diagnosed stage 4 NB undergoing both 18F-FDG PET/CT imaging at baseline and after chemotherapy were retrospectively analyzed. The associations between metabolic parameters, including SUVmax of the lesion with the most intense 18F-FDG uptake at baseline (SUVb), after chemotherapy (SUVe), and the percentage change between SUVb and SUVe, and long-term survival were evaluated. RESULTS With a median follow-up of 56 months, 22 patients who had achieved complete resolution on PET (no residual 18F-FDG uptake higher than the surrounding backgrounds) after chemotherapy had superior 5-year overall survival (OS) (73.6% vs. 39.0%, p = 0.044). SUVb > 6.9 indicated significantly poorer 5-year event-free survival (EFS) (12.5% vs. 59.3%, p = 0.005), as did SUVe > 1.2 (18.8% vs. 41.7%, p = 0.041). Children with SUVe > 1.2 had shorter 5-year OS (33.9% vs. 75.0%, p = 0.018). Multivariate analysis identified SUVe > 1.2 as an independent predictor for both EFS [hazard ratio (HR), 3.479, 95% CI, 1.381-8.761, p = 0.008] and OS (HR, 6.948, 95% CI, 1.663-29.025, p = 0.008), while SUVb > 6.9 was a predictor for EFS (HR, 2.889, 95% CI, 1.064-7.842, p = 0.037). Among 11 children with both SUVb > 6.9 and SUVe > 1.2, all experienced disease progression or relapse within 2 years since diagnosis. CONCLUSION 18F-FDG PET/CT could be of useful to evaluate treatment response in children with stage 4 NB. CLINICAL RELEVANCE STATEMENT 18F-FDG PET/CT after chemotherapy exhibits prognostic significance in neuroblastoma and holds potential as an alternative imaging modality for response evaluation, especially in cases with metaiodobenzylguanidine-nonavid or persistent avid disease. KEY POINTS The prognostic value of chemotherapy response on 18F-FDG PET/CT in advanced neuroblastoma is unknown. Higher 18F-FDG uptake after chemotherapy was associated with worse long-term event-free survival and overall survival. 18F-FDG PET/CT after chemotherapy holds prognostic significance in children with stage 4 neuroblastoma.
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Affiliation(s)
- Xueyuan Lu
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Li
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoyan Wang
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yafu Yin
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongliang Fu
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Cheng
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Suyun Chen
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Deyell RJ, Shen Y, Titmuss E, Dixon K, Williamson LM, Pleasance E, Nelson JMT, Abbasi S, Krzywinski M, Armstrong L, Bonakdar M, Ch'ng C, Chuah E, Dunham C, Fok A, Jones M, Lee AF, Ma Y, Moore RA, Mungall AJ, Mungall KL, Rogers PC, Schrader KA, Virani A, Wee K, Young SS, Zhao Y, Jones SJM, Laskin J, Marra MA, Rassekh SR. Whole genome and transcriptome integrated analyses guide clinical care of pediatric poor prognosis cancers. Nat Commun 2024; 15:4165. [PMID: 38755180 PMCID: PMC11099106 DOI: 10.1038/s41467-024-48363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
The role for routine whole genome and transcriptome analysis (WGTA) for poor prognosis pediatric cancers remains undetermined. Here, we characterize somatic mutations, structural rearrangements, copy number variants, gene expression, immuno-profiles and germline cancer predisposition variants in children and adolescents with relapsed, refractory or poor prognosis malignancies who underwent somatic WGTA and matched germline sequencing. Seventy-nine participants with a median age at enrollment of 8.8 y (range 6 months to 21.2 y) are included. Germline pathogenic/likely pathogenic variants are identified in 12% of participants, of which 60% were not known prior. Therapeutically actionable variants are identified by targeted gene report and whole genome in 32% and 62% of participants, respectively, and increase to 96% after integrating transcriptome analyses. Thirty-two molecularly informed therapies are pursued in 28 participants with 54% achieving a clinical benefit rate; objective response or stable disease ≥6 months. Integrated WGTA identifies therapeutically actionable variants in almost all tumors and are directly translatable to clinical care of children with poor prognosis cancers.
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Affiliation(s)
- Rebecca J Deyell
- Department of Pediatrics, BC Children's Hospital and Research Institute, Vancouver, BC, Canada.
| | - Yaoqing Shen
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Emma Titmuss
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Katherine Dixon
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Laura M Williamson
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Erin Pleasance
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Jessica M T Nelson
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Sanna Abbasi
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Martin Krzywinski
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Linlea Armstrong
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Melika Bonakdar
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Carolyn Ch'ng
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Eric Chuah
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Chris Dunham
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra Fok
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Martin Jones
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Anna F Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Karen L Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Paul C Rogers
- Department of Pediatrics, BC Children's Hospital and Research Institute, Vancouver, BC, Canada
| | - Kasmintan A Schrader
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen Wee
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Sean S Young
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Cancer Genetics and Genomics Laboratory, Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, Canada
| | - Yongjun Zhao
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Janessa Laskin
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Shahrad R Rassekh
- Department of Pediatrics, BC Children's Hospital and Research Institute, Vancouver, BC, Canada.
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7
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Raiser P, Schleiermacher G, Gambart M, Dumont B, Defachelles AS, Thebaud E, Tandonnet J, Pasqualini C, Proust S, Entz-Werle N, Aerts I, Ndounga-Diakou LA, Petit A, Puiseux C, Khanfar C, Rouger J, Mansuy L, Benadiba J, Millot F, Pluchart C, Laghouati S, Geoerger B, Vassal G, Valteau-Couanet D, Berlanga P. Chemo-immunotherapy with dinutuximab beta in patients with relapsed/progressive high-risk neuroblastoma: does chemotherapy backbone matter? Eur J Cancer 2024; 202:114001. [PMID: 38489858 DOI: 10.1016/j.ejca.2024.114001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Addition of anti-GD2 antibodies to temozolomide-based chemotherapy has demonstrated increased antitumor activity and progression-free survival in patients with relapsed/progressive high-risk neuroblastoma. However, chemo-immunotherapy is not yet approved for this indication. This study presents the chemo-immunotherapy experience in patients with relapsed/progressive high-risk neuroblastoma treated within the off-label use program of the Neuroblastoma Committee of the French Society of Pediatric Oncology (SFCE). METHODS Dinutuximab beta (dB) was administered alongside temozolomide-topotecan (TOTEM) or temozolomide-irinotecan (TEMIRI) at first disease relapse/progression or topotecan-cyclophosphamide (TopoCyclo) at further relapse/progression. Real-world data on demographics, treatment, antitumor activity and safety was collected from all patients after inclusion in SACHA-France (NCT04477681), a prospective national registry, which documents safety and efficacy data on innovative anticancer therapies prescribed to patients ≤ 25 years old as compassionate or off-label use. RESULTS Between February 2021 and July 2023, 39 patients with confirmed relapsed/progressive high-risk neuroblastoma (median age 6 years, range 1-24) were treated with dB+TopoCyclo (n = 24) or dB+TOTEM/TEMIRI (n = 15) across 17 centers. In total, 163 chemo-immunotherapy cycles were administered, main toxicities were mild or moderate, with higher incidence of hematological adverse drug reactions with dB+TopoCyclo than dB+TOTEM/TEMIRI. Objective response rate was 42% for dB+TopoCyclo (CI95% 22-63%) and 40% for dB+TOTEM/TEMIRI (CI95% 16-68%). CONCLUSION Similar objective response rates for dB+TopoCyclo and dB+TOTEM/TEMIRI in patients with relapsed/progressive high-risk neuroblastoma emphasize the importance of chemo-immunotherapy, irrespective of the chemotherapy backbone.
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Affiliation(s)
- Patricia Raiser
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Gudrun Schleiermacher
- RTOP (Recherche Translationelle en Oncologie Pediatrique), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France; SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France
| | - Marion Gambart
- Department of Pediatric Oncology, Toulouse University Hospital, 31300 Toulouse, France
| | - Benoit Dumont
- Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique/Centre Léon Bérard, 69008 Lyon, France
| | | | - Estelle Thebaud
- Pediatric Immuno-Hemato-Oncology Unit, CHU Nantes, 44000 Nantes, France
| | - Julie Tandonnet
- Pediatric Hematology-Oncology Department, Centre Hospitalier Universitaire (CHU), 33000 Bordeaux, France
| | - Claudia Pasqualini
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Stéphanie Proust
- Department of Pediatric Oncology, University Hospital, 49100 Angers, France
| | - Natacha Entz-Werle
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 67200 Strasbourg, France
| | - Isabelle Aerts
- RTOP (Recherche Translationelle en Oncologie Pediatrique), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France; SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France
| | - Lee A Ndounga-Diakou
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Arnaud Petit
- Department of Pediatric Hematology and Oncology, Hôpital Armand Trousseau, 75012 Paris, France
| | - Chloe Puiseux
- Department of Pediatric Hemato-Oncology, University Hospital of Rennes, 35200 Rennes, France
| | - Camille Khanfar
- Department of Pediatric Oncology, CHU Amiens Picardie, 80054 Amiens, France
| | - Jeremie Rouger
- Department of Pediatric Hematology and Oncology, University Hospital of Caen, 14000 Caen, France
| | - Ludovic Mansuy
- Department of Pediatric Hematology-Oncology, Children's Hospital of Brabois, 54500 Vandoeuvre Les Nancy, France
| | - Joy Benadiba
- Department of Hemato-Oncology Pediatric, Nice University Hospital, 06000 Nice, France
| | - Frédéric Millot
- Department of Paediatric Haematology and Oncology, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
| | - Claire Pluchart
- Department of Paediatric Haematology and Oncology, Centre Hospitalo-Universitaire de Reims, 51100 Reims, France
| | - Salim Laghouati
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France; INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Gilles Vassal
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Dominique Valteau-Couanet
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France.
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8
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Gorostegui M, Muñoz JP, Perez-Jaume S, Simao-Rafael M, Larrosa C, Garraus M, Salvador N, Lavarino C, Krauel L, Mañe S, Castañeda A, Mora J. Management of High-Risk Neuroblastoma with Soft-Tissue-Only Disease in the Era of Anti-GD2 Immunotherapy. Cancers (Basel) 2024; 16:1735. [PMID: 38730688 PMCID: PMC11083939 DOI: 10.3390/cancers16091735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Neuroblastoma presents with two patterns of disease: locoregional or systemic. The poor prognostic risk factors of locoregional neuroblastoma (LR-NB) include age, MYCN or MDM2-CDK4 amplification, 11q, histology, diploidy with ALK or TERT mutations, and ATRX aberrations. Anti-GD2 immunotherapy has significantly improved the outcome of high-risk (HR) NB and is mostly effective against osteomedullary minimal residual disease (MRD), but less so against soft tissue disease. The question is whether adding anti-GD2 monoclonal antibodies (mAbs) benefits patients with HR-NB compounded by only soft tissue. We reviewed 31 patients treated at SJD for HR-NB with no osteomedullary involvement at diagnosis. All tumors had molecular genetic features of HR-NB. The outcome after first-line treatment showed 25 (80.6%) patients achieving CR. Thirteen patients remain in continued CR, median follow-up 3.9 years. We analyzed whether adding anti-GD2 immunotherapy to first-line treatment had any prognostic significance. The EFS analysis using Cox models showed a HR of 0.20, p = 0.0054, and an 80% decrease in the risk of relapse in patients treated with anti-GD2 immunotherapy in the first line. Neither EFS nor OS were significantly different by CR status after first-line treatment. In conclusion, adding treatment with anti-GD2 mAbs at the stage of MRD helps prevent relapse that unequivocally portends poor survival.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jaume Mora
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (M.G.); (J.P.M.); (M.S.-R.); (C.L.); (M.G.); (N.S.); (C.L.); (L.K.); (S.M.); (A.C.)
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9
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Mora J, Modak S, Kinsey J, Ragsdale CE, Lazarus HM. GM-CSF, G-CSF or no cytokine therapy with anti-GD2 immunotherapy for high-risk neuroblastoma. Int J Cancer 2024; 154:1340-1364. [PMID: 38108214 DOI: 10.1002/ijc.34815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
Colony-stimulating factors have been shown to improve anti-disialoganglioside 2 (anti-GD2) monoclonal antibody response in high-risk neuroblastoma by enhancing antibody-dependent cell-mediated cytotoxicity (ADCC). A substantial amount of research has focused on recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjuvant to anti-GD2 monoclonal antibodies. There may be a disparity in care among patients as access to GM-CSF therapy and anti-GD2 monoclonal antibodies is not uniform. Only select countries have approved these agents for use, and even with regulatory approvals, access to these agents can be complex and cost prohibitive. This comprehensive review summarizes clinical data regarding efficacy and safety of GM-CSF, recombinant human granulocyte colony-stimulating factor (G-CSF) or no cytokine in combination with anti-GD2 monoclonal antibodies (ie, dinutuximab, dinutuximab beta or naxitamab) for immunotherapy of patients with high-risk neuroblastoma. A substantial body of clinical data support the immunotherapy combination of anti-GD2 monoclonal antibodies and GM-CSF. In contrast, clinical data supporting the use of G-CSF are limited. No formal comparison between GM-CSF, G-CSF and no cytokine has been identified. The treatment of high-risk neuroblastoma with anti-GD2 therapy plus GM-CSF is well established. Suboptimal efficacy outcomes with G-CSF raise concerns about its suitability as an alternative to GM-CSF as an adjuvant in immunotherapy for patients with high-risk neuroblastoma. While programs exist to facilitate obtaining GM-CSF and anti-GD2 monoclonal antibodies in regions where they are not commercially available, continued work is needed to ensure equitable therapeutic options are available globally.
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Affiliation(s)
- Jaume Mora
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Shakeel Modak
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joyce Kinsey
- Partner Therapeutics, Inc, Lexington, Massachusetts, USA
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10
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Fawzy M, Ahmed G, Youssef Y, Elkinaai N, Refaat A, Elahmadawy MA, Said F, Elmenawi S. Bilateral adrenal neuroblastoma: peculiar pattern of a rare pediatric presentation. Discov Oncol 2024; 15:115. [PMID: 38607453 PMCID: PMC11014822 DOI: 10.1007/s12672-024-00966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Bilateral suprarenal neuroblastoma (BSN) is a rare presentation. Few previously published literature showed BSN patients to have favorable pattern and prognosis. This study aim was to evaluate clinical and biological features in relation to outcome of Egyptian patients with BSN. METHODS Included patients were diagnosed from 2007 to 2017, retrospectively. Tissue biopsy, imaging and bone marrow were evaluated at presentation. Clinical, demographic, biological variables and risk group were determined and analyzed in relation to overall (OS) and event-free-survival (EFS). RESULTS BSN patients (n = 33) represented 2% of hospital patients with neuroblastoma during the 10-year study period, 17 were males and 16 were females. Twenty-four patients (72.7%) were infants, and 9 patients (27.3%) were above 1 year of age (range: 1 month to 3 years). Metachronous disease was present in only one patient. Amplified MYCN was found in 10 patients. Initially, most patients (n = 25) had distant metastasis, 6 had stage 3 versus 2 stage 2. Fifteen were high risk (HR), 15 intermediate (IR), 1 low risk (LR) and 2 were undetermined due to inadequate tissue biopsy. Three-year OS for HR and IR patients were 40.5% and 83.9% versus 23.2% and 56.6% EFS; respectively. CONCLUSION BSN treatment is similar to unilateral disease. A more conservative surgical approach with adrenal tissue preservation on less extensive side should be considered. Biological variables and extent of disease are amongst the most important prognostic determinants. Future studies are warranted to further address the biologic profiling of BSN and highlight prognostic significance of size difference between both adrenal sides.
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Affiliation(s)
- Mohamed Fawzy
- Pediatric Oncology Department, Children's Cancer Hospital Egypt-57357, Cairo, Egypt
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - Gehad Ahmed
- Faculty of Medicine, Department of General Surgery, Helwan University, Cairo, Egypt
- Surgical Oncology Department, Children's Cancer Hospital Egypt-57357, Cairo, Egypt
| | - Yasser Youssef
- Pediatric Oncology Department, Children's Cancer Hospital Egypt-57357, Cairo, Egypt
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - Naglaa Elkinaai
- National Cancer Institute, Cairo University, Cairo, Egypt
- Pathology Department, Children's Cancer Hospital Egypt-57357, Cairo, Egypt
| | - Amal Refaat
- National Cancer Institute, Cairo University, Cairo, Egypt
- Radiodiagnosis Department, Children's Cancer Hospital Egypt-57357, Cairo, Egypt
| | - Mai Amr Elahmadawy
- National Cancer Institute, Cairo University, Cairo, Egypt
- Nuclear Medicine Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Fadwa Said
- Department of Clinical Pathology, Cairo University, Cairo, Egypt
| | - Salma Elmenawi
- Clinical Research Department, Children's Cancer Hospital Egypt-57357, 1 Seket Al-Emam Street, El-Madbah El-Kadeem Yard, El-Saida Zenab, Cairo, Egypt.
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11
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Yankelevich M, Thakur A, Modak S, Chu R, Taub J, Martin A, Schalk D, Schienshang A, Whitaker S, Rea K, Lee DW, Liu Q, Shields AF, Cheung NKV, Lum LG. Targeting refractory/recurrent neuroblastoma and osteosarcoma with anti-CD3×anti-GD2 bispecific antibody armed T cells. J Immunother Cancer 2024; 12:e008744. [PMID: 38519053 PMCID: PMC10961524 DOI: 10.1136/jitc-2023-008744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND The survival benefit observed in children with neuroblastoma (NB) and minimal residual disease who received treatment with anti-GD2 monoclonal antibodies prompted our investigation into the safety and potential clinical benefits of anti-CD3×anti-GD2 bispecific antibody (GD2Bi) armed T cells (GD2BATs). Preclinical studies demonstrated the high cytotoxicity of GD2BATs against GD2+cell lines, leading to the initiation of a phase I/II study in recurrent/refractory patients. METHODS The 3+3 dose escalation phase I study (NCT02173093) encompassed nine evaluable patients with NB (n=5), osteosarcoma (n=3), and desmoplastic small round cell tumors (n=1). Patients received twice-weekly infusions of GD2BATs at 40, 80, or 160×106 GD2BATs/kg/infusion complemented by daily interleukin-2 (300,000 IU/m2) and twice-weekly granulocyte macrophage colony-stimulating factor (250 µg/m2). The phase II segment focused on patients with NB at the dose 3 level of 160×106 GD2BATs/kg/infusion. RESULTS Of the 12 patients enrolled, 9 completed therapy in phase I with no dose-limiting toxicities. Mild and manageable cytokine release syndrome occurred in all patients, presenting as grade 2-3 fevers/chills, headaches, and occasional hypotension up to 72 hours after GD2BAT infusions. GD2-antibody-associated pain was minimal. Median overall survival (OS) for phase I and the limited phase II was 18.0 and 31.2 months, respectively, with a combined OS of 21.1 months. A phase I NB patient had a complete bone marrow response with overall stable disease. In phase II, 10 of 12 patients were evaluable: 1 achieved partial response, and 3 showed clinical benefit with prolonged stable disease. Over 50% of evaluable patients exhibited augmented immune responses to GD2+targets post-GD2BATs, as indicated by interferon-gamma (IFN-γ) EliSpots, Th1 cytokines, and/or chemokines. CONCLUSIONS This study demonstrated the safety of GD2BATs up to 160×106 cells/kg/infusion. Coupled with evidence of post-treatment endogenous immune responses, our findings support further investigation of GD2BATs in larger phase II clinical trials.
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Affiliation(s)
- Maxim Yankelevich
- St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Archana Thakur
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roland Chu
- Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Jeffrey Taub
- Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Alissa Martin
- Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Dana Schalk
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Amy Schienshang
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Sarah Whitaker
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Katie Rea
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Daniel W Lee
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Qin Liu
- Wistar Institute, Philadelphia, Pennsylvania, USA
| | | | - Nai-Kong V Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lawrence G Lum
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
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12
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Gatz SA, Harttrampf AC, Brard C, Bautista F, André N, Abbou S, Rubino J, Rondof W, Deloger M, Rübsam M, Marshall LV, Hübschmann D, Nebchi S, Aerts I, Thebaud E, De Carli E, Defachelles AS, Paoletti X, Godin R, Miah K, Mortimer PGS, Vassal G, Geoerger B. Phase I/II Study of the WEE1 Inhibitor Adavosertib (AZD1775) in Combination with Carboplatin in Children with Advanced Malignancies: Arm C of the AcSé-ESMART Trial. Clin Cancer Res 2024; 30:741-753. [PMID: 38051741 DOI: 10.1158/1078-0432.ccr-23-2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE AcSé-ESMART Arm C aimed to define the recommended dose and activity of the WEE1 inhibitor adavosertib in combination with carboplatin in children and young adults with molecularly enriched recurrent/refractory malignancies. PATIENTS AND METHODS Adavosertib was administered orally, twice every day on Days 1 to 3 and carboplatin intravenously on Day 1 of a 21-day cycle, starting at 100 mg/m2/dose and AUC 5, respectively. Patients were enriched for molecular alterations in cell cycle and/or homologous recombination (HR). RESULTS Twenty patients (median age: 14.0 years; range: 3.4-23.5) were included; 18 received 69 treatment cycles. Dose-limiting toxicities were prolonged grade 4 neutropenia and grade 3/4 thrombocytopenia requiring transfusions, leading to two de-escalations to adavosertib 75 mg/m2/dose and carboplatin AUC 4; no recommended phase II dose was defined. Main treatment-related toxicities were hematologic and gastrointestinal. Adavosertib exposure in children was equivalent to that in adults; both doses achieved the cell kill target. Overall response rate was 11% (95% confidence interval, 0.0-25.6) with partial responses in 2 patients with neuroblastoma. One patient with medulloblastoma experienced unconfirmed partial response and 5 patients had stable disease beyond four cycles. Seven of these eight patients with clinical benefit had alterations in HR, replication stress, and/or RAS pathway genes with or without TP53 alterations, whereas TP53 pathway alterations alone (8/10) or no relevant alterations (2/10) were present in the 10 patients without benefit. CONCLUSIONS Adavosertib-carboplatin combination exhibited significant hematologic toxicity. Activity signals and identified potential biomarkers suggest further studies with less hematotoxic DNA-damaging therapy in molecularly enriched pediatric cancers.
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Affiliation(s)
- Susanne A Gatz
- Institute of Cancer and Genomic Sciences, University of Birmingham; Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Anne C Harttrampf
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Villejuif, France
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Caroline Brard
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Francisco Bautista
- Hospital Niño Jesús, Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Madrid, Spain
| | - Nicolas André
- Hôpital de la Timone, AP-HM, Department of Pediatric Oncology, Marseille, France
- UMR INSERM 1068, CNRS UMR 7258, Aix Marseille Université U105, Marseille, Cancer Research Center (CRCM), Marseille, France
| | - Samuel Abbou
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Villejuif, France
| | - Jonathan Rubino
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Windy Rondof
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
- Gustave Roussy Cancer Campus, Bioinformatics platform, Université Paris-Saclay, Villejuif, France
| | - Marc Deloger
- Gustave Roussy Cancer Campus, Bioinformatics platform, Université Paris-Saclay, Villejuif, France
| | - Marc Rübsam
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center
| | - Lynley V Marshall
- Royal Marsden Hospital & The Institute of Cancer Research, Paediatric and Adolescent Oncology Drug Development Unit, London, United Kingdom
| | - Daniel Hübschmann
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center
- Pattern Recognition and Digital Medicine Group, Heidelberg Institute for Stem cell Technology and Experimental Medicine (HI-STEM); German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Souad Nebchi
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Isabelle Aerts
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), PSL Research University, Paris, France
| | - Estelle Thebaud
- Centre Hospitalier Universitaire, Department of Pediatric Oncology, Nantes, France
| | - Emilie De Carli
- Centre Hospitalier Universitaire, Department of Pediatric Oncology, Angers, France
| | | | - Xavier Paoletti
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Robert Godin
- AstraZeneca Oncology External R&D, Waltham, Massachusetts
| | - Kowser Miah
- Clinical Pharmacology and Quantitative Pharmacology, AstraZeneca, Waltham, Massachusetts
| | | | - Gilles Vassal
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Villejuif, France
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
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13
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Fenwick N, Weston R, Wheatley K, Hodgson J, Marshall L, Elliott M, Makin G, Ng A, Brennan B, Lowis S, Adamski J, Kilday JP, Cox R, Gattens M, Moore A, Trahair T, Ronghe M, Campbell M, Campbell H, Williams MW, Kirby M, Van Eijkelenburg N, Keely J, Scarpa U, Stavrou V, Fultang L, Booth S, Cheng P, De Santo C, Mussai F. PARC: a phase I/II study evaluating the safety and activity of pegylated recombinant human arginase BCT-100 in relapsed/refractory cancers of children and young adults. Front Oncol 2024; 14:1296576. [PMID: 38357205 PMCID: PMC10864630 DOI: 10.3389/fonc.2024.1296576] [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: 09/18/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background The survival for many children with relapsed/refractory cancers remains poor despite advances in therapies. Arginine metabolism plays a key role in the pathophysiology of a number of pediatric cancers. We report the first in child study of a recombinant human arginase, BCT-100, in children with relapsed/refractory hematological, solid or CNS cancers. Procedure PARC was a single arm, Phase I/II, international, open label study. BCT-100 was given intravenously over one hour at weekly intervals. The Phase I section utilized a modified 3 + 3 design where escalation/de-escalation was based on both the safety profile and the complete depletion of arginine (defined as adequate arginine depletion; AAD <8μM arginine in the blood after 4 doses of BCT-100). The Phase II section was designed to further evaluate the clinical activity of BCT-100 at the pediatric RP2D determined in the Phase I section, by recruitment of patients with pediatric cancers into 4 individual groups. A primary evaluation of response was conducted at eight weeks with patients continuing to receive treatment until disease progression or unacceptable toxicity. Results 49 children were recruited globally. The Phase I cohort of the trial established the Recommended Phase II Dose of 1600U/kg iv weekly in children, matching that of adults. BCT-100 was very well tolerated. No responses defined as a CR, CRi or PR were seen in any cohort within the defined 8 week primary evaluation period. However a number of these relapsed/refractory patients experienced prolonged radiological SD. Conclusion Arginine depletion is a clinically safe and achievable strategy in children with cancer. The RP2D of BCT-100 in children with relapsed/refractory cancers is established at 1600U/kg intravenously weekly and can lead to sustained disease stability in this hard to treat population. Clinical trial registration EudraCT, 2017-002762-44; ISRCTN, 21727048; and ClinicalTrials.gov, NCT03455140.
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Affiliation(s)
- Nicola Fenwick
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Rebekah Weston
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Keith Wheatley
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Jodie Hodgson
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | | | - Martin Elliott
- Leeds Teaching Hospital, St James University Hospital, Leeds, United Kingdom
| | - Guy Makin
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Antony Ng
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - Stephen Lowis
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Jenny Adamski
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - John Paul Kilday
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Rachel Cox
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Mike Gattens
- Addenbrookes Hospital, Cambridge, United Kingdom
| | - Andrew Moore
- Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Toby Trahair
- Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Milind Ronghe
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Helen Campbell
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | | | - Maria Kirby
- Michael Rice Cancer Centre, Women’s and Children’s Hospital, North Adelaide, SA, Australia
| | | | - Jennifer Keely
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Ugo Scarpa
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Victoria Stavrou
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Livingstone Fultang
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sarah Booth
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Cheng
- Bio-Cancer Treatment International, Hong Kong Science Park, Hong Kong, Hong Kong SAR, China
| | - Carmela De Santo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Francis Mussai
- Birmingham Children’s Hospital, Birmingham, United Kingdom
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14
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Ouvrard E, Kaseb A, Poterszman N, Porot C, Somme F, Imperiale A. Nuclear medicine imaging for bone metastases assessment: what else besides bone scintigraphy in the era of personalized medicine? Front Med (Lausanne) 2024; 10:1320574. [PMID: 38288299 PMCID: PMC10823373 DOI: 10.3389/fmed.2023.1320574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Accurate detection and reliable assessment of therapeutic responses in bone metastases are imperative for guiding treatment decisions, preserving quality of life, and ultimately enhancing overall survival. Nuclear imaging has historically played a pivotal role in this realm, offering a diverse range of radiotracers and imaging modalities. While the conventional bone scan using 99mTc marked bisphosphonates has remained widely utilized, its diagnostic performance is hindered by certain limitations. Positron emission tomography, particularly when coupled with computed tomography, provides improved spatial resolution and diagnostic performance with various pathology-specific radiotracers. This review aims to evaluate the performance of different nuclear imaging modalities in clinical practice for detecting and monitoring the therapeutic responses in bone metastases of diverse origins, addressing their limitations and implications for image interpretation.
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Affiliation(s)
- Eric Ouvrard
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Ashjan Kaseb
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
- Radiology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Nathan Poterszman
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Clémence Porot
- Radiopharmacy, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Francois Somme
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
- IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
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15
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Moreno L, Weston R, Owens C, Valteau-Couanet D, Gambart M, Castel V, Zwaan CM, Nysom K, Gerber N, Castellano A, Laureys G, Ladenstein R, Rössler J, Makin G, Murphy D, Morland B, Vaidya S, Thebaud E, van Eijkelenburg N, Tweddle DA, Barone G, Tandonnet J, Corradini N, Chastagner P, Paillard C, Bautista FJ, Gallego Melcon S, De Wilde B, Marshall L, Gray J, Burchill SA, Schleiermacher G, Chesler L, Peet A, Leach MO, McHugh K, Hayes R, Jerome N, Caron H, Laidler J, Fenwick N, Holt G, Moroz V, Kearns P, Gates S, Pearson ADJ, Wheatley K. Bevacizumab, Irinotecan, or Topotecan Added to Temozolomide for Children With Relapsed and Refractory Neuroblastoma: Results of the ITCC-SIOPEN BEACON-Neuroblastoma Trial. J Clin Oncol 2024:JCO2300458. [PMID: 38190578 DOI: 10.1200/jco.23.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/25/2023] [Accepted: 10/05/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE Outcomes for children with relapsed and refractory high-risk neuroblastoma (RR-HRNB) remain dismal. The BEACON Neuroblastoma trial (EudraCT 2012-000072-42) evaluated three backbone chemotherapy regimens and the addition of the antiangiogenic agent bevacizumab (B). MATERIALS AND METHODS Patients age 1-21 years with RR-HRNB with adequate organ function and performance status were randomly assigned in a 3 × 2 factorial design to temozolomide (T), irinotecan-temozolomide (IT), or topotecan-temozolomide (TTo) with or without B. The primary end point was best overall response (complete or partial) rate (ORR) during the first six courses, by RECIST or International Neuroblastoma Response Criteria for patients with measurable or evaluable disease, respectively. Safety, progression-free survival (PFS), and overall survival (OS) time were secondary end points. RESULTS One hundred sixty patients with RR-HRNB were included. For B random assignment (n = 160), the ORR was 26% (95% CI, 17 to 37) with B and 18% (95% CI, 10 to 28) without B (risk ratio [RR], 1.52 [95% CI, 0.83 to 2.77]; P = .17). Adjusted hazard ratio for PFS and OS were 0.89 (95% CI, 0.63 to 1.27) and 1.01 (95% CI, 0.70 to 1.45), respectively. For irinotecan ([I]; n = 121) and topotecan (n = 60) random assignments, RRs for ORR were 0.94 and 1.22, respectively. A potential interaction between I and B was identified. For patients in the bevacizumab-irinotecan-temozolomide (BIT) arm, the ORR was 23% (95% CI, 10 to 42), and the 1-year PFS estimate was 0.67 (95% CI, 0.47 to 0.80). CONCLUSION The addition of B met protocol-defined success criteria for ORR and appeared to improve PFS. Within this phase II trial, BIT showed signals of antitumor activity with acceptable tolerability. Future trials will confirm these results in the chemoimmunotherapy era.
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Affiliation(s)
- Lucas Moreno
- Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Guy Makin
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom
| | - Dermot Murphy
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Bruce Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Sucheta Vaidya
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | | | | | - Deborah A Tweddle
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | | | | | | | | | | | | | | | | | - Lynley Marshall
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Juliet Gray
- University Hospital Southampton, Southampton, United Kingdom
| | | | | | - Louis Chesler
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Andrew Peet
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin O Leach
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Kieran McHugh
- Great Ormond Street Hospital, London, United Kingdom
| | | | - Neil Jerome
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | | | | | | | - Grace Holt
- University of Birmingham, Birmingham, United Kingdom
| | | | - Pamela Kearns
- University of Birmingham, Birmingham, United Kingdom
| | - Simon Gates
- University of Birmingham, Birmingham, United Kingdom
| | - Andrew D J Pearson
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
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16
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Park HJ, Choi JY, Kim BK, Hong KT, Kim HY, Kim IH, Cheon GJ, Cheon JE, Park SH, Kang HJ. The Impact of 131I-Metaiodobenzylguanidine as a Conditioning Regimen of Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for High-Risk Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1936. [PMID: 38136138 PMCID: PMC10742322 DOI: 10.3390/children10121936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The optimal conditioning regimen of tandem high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) for high-risk neuroblastoma (HR-NBL) has not been established. The efficacy of 131I-MIBG therapy is under exploration in newly diagnosed HR-NBL patients. Here, we compared the outcomes of tandem HDC/ASCT between the 131I-MIBG combination and non-MIBG groups. METHODS We retrospectively analyzed the clinical data of 33 HR-NBL patients who underwent tandem HDC/ASCT between 2007 and 2021 at the Seoul National University Children's Hospital. RESULTS The median age at diagnosis was 3.6 years. 131I-MIBG was administered to 13 (39.4%) of the patients. Thirty patients (90.9%) received maintenance therapy after tandem HDC/ASCT, twenty-two were treated with isotretinoin ± interleukin-2, and eight received salvage chemotherapy. The five-year overall survival (OS) and event-free survival (EFS) rates of all patients were 80.4% and 69.4%, respectively. Comparing the 131I-MIBG combined group and other groups, the five-year OS rates were 82.1% and 79.7% (p = 0.655), and the five-year EFS rates were 69.2% and 69.6% (p = 0.922), respectively. Among the adverse effects of grade 3 or 4, the incidence of liver enzyme elevation was significantly higher in the non-131I-MIBG group. CONCLUSIONS Although tandem HDC/ASCT showed promising outcomes, the 131I-MIBG combination did not improve survival rates.
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Affiliation(s)
- Hyun Jin Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; (H.J.P.); (K.T.H.)
- Seoul National University Cancer Research Institute, Seoul 03080, Republic of Korea (G.J.C.)
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; (H.J.P.); (K.T.H.)
- Seoul National University Cancer Research Institute, Seoul 03080, Republic of Korea (G.J.C.)
| | - Bo Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; (H.J.P.); (K.T.H.)
- Seoul National University Cancer Research Institute, Seoul 03080, Republic of Korea (G.J.C.)
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; (H.J.P.); (K.T.H.)
- Seoul National University Cancer Research Institute, Seoul 03080, Republic of Korea (G.J.C.)
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Il Han Kim
- Seoul National University Cancer Research Institute, Seoul 03080, Republic of Korea (G.J.C.)
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Gi Jeong Cheon
- Seoul National University Cancer Research Institute, Seoul 03080, Republic of Korea (G.J.C.)
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; (H.J.P.); (K.T.H.)
- Seoul National University Cancer Research Institute, Seoul 03080, Republic of Korea (G.J.C.)
- Wide River Institute of Immunology, Hongcheon 25159, Republic of Korea
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17
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Kushner BH, LaQuaglia MP, Cardenas FI, Basu EM, Gerstle JT, Kramer K, Roberts SS, Wolden SL, Cheung NKV, Modak S. Stage 4N neuroblastoma before and during the era of anti-G D2 immunotherapy. Int J Cancer 2023; 153:2019-2031. [PMID: 37602920 DOI: 10.1002/ijc.34693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
Patients with stage 4N neuroblastoma (distant metastases limited to lymph nodes) stand out as virtually the only survivors of high-risk neuroblastoma (HR-NB) before myeloablative therapy (MAT) and immunotherapy with anti-GD2 monoclonal antibodies (mAbs) became standard. Because no report presents more recent results with 4N, we analyzed our large 4N experience. All 51 pediatric 4N patients (<18 years old) diagnosed 1985 to 2021 were reviewed. HR-NB included MYCN-nonamplified 4N diagnosed at age ≥18 months and MYCN-amplified 4N. Among 34 MYCN-nonamplified high-risk patients, 20 are relapse-free 1.5+ to 37.5+ (median 12.5+) years post-diagnosis, including 13 without prior MAT and 5 treated with little (1 cycle; n = 2) or no mAb (n = 3), while 14 patients (7 post-MAT, 8 post-mAbs) relapsed (all soft tissue). Of 15 MYCN-amplified 4N patients, 7 are relapse-free 2.1+ to 26.4+ (median 11.6+) years from the start of chemotherapy (all received mAbs; 3 underwent MAT) and 4 are in second remission 4.2+ to 21.8+ years postrelapse (all soft tissue). Statistical analyses showed no significant association of survival with either MAT or mAbs for MYCN-nonamplified HR-NB; small numbers prevented these analyses for MYCN-amplified patients. The two patients with intermediate-risk 4N (14-months-old) are relapse-free 7+ years postresection of primary tumors; distant disease spontaneously regressed. The natural history of 4N is marked by NB confined to soft tissue without early relapse in bones or bone marrow, where mAbs have proven efficacy. These findings plus curability without MAT, as seen elsewhere and at our center, support consideration of treatment reduction for MYCN-nonamplified 4N.
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Affiliation(s)
- Brian H Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael P LaQuaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Ellen M Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justin T Gerstle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen S Roberts
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nai-Kong V Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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18
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Das A, Tabori U, Sambira Nahum LC, Collins NB, Deyell R, Dvir R, Faure-Conter C, Hassall TE, Minturn JE, Edwards M, Brookes E, Bianchi V, Levine A, Stone SC, Sudhaman S, Sanchez Ramirez S, Ercan AB, Stengs L, Chung J, Negm L, Getz G, Maruvka YE, Ertl-Wagner B, Ohashi PS, Pugh T, Hawkins C, Bouffet E, Morgenstern DA. Efficacy of Nivolumab in Pediatric Cancers with High Mutation Burden and Mismatch Repair Deficiency. Clin Cancer Res 2023; 29:4770-4783. [PMID: 37126021 PMCID: PMC10690097 DOI: 10.1158/1078-0432.ccr-23-0411] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Checkpoint inhibitors have limited efficacy for children with unselected solid and brain tumors. We report the first prospective pediatric trial (NCT02992964) using nivolumab exclusively for refractory nonhematologic cancers harboring tumor mutation burden (TMB) ≥5 mutations/megabase (mut/Mb) and/or mismatch repair deficiency (MMRD). PATIENTS AND METHODS Twenty patients were screened, and 10 were ultimately included in the response cohort of whom nine had TMB >10 mut/Mb (three initially eligible based on MMRD) and one patient had TMB between 5 and 10 mut/Mb. RESULTS Delayed immune responses contributed to best overall response of 50%, improving on initial objective responses (20%) and leading to 2-year overall survival (OS) of 50% [95% confidence interval (CI), 27-93]. Four children, including three with refractory malignant gliomas are in complete remission at a median follow-up of 37 months (range, 32.4-60), culminating in 2-year OS of 43% (95% CI, 18.2-100). Biomarker analyses confirmed benefit in children with germline MMRD, microsatellite instability, higher activated and lower regulatory circulating T cells. Stochastic mutation accumulation driven by underlying germline MMRD impacted the tumor microenvironment, contributing to delayed responses. No benefit was observed in the single patient with an MMR-proficient tumor and TMB 7.4 mut/Mb. CONCLUSIONS Nivolumab resulted in durable responses and prolonged survival for the first time in a pediatric trial of refractory hypermutated cancers including malignant gliomas. Novel biomarkers identified here need to be translated rapidly to clinical care to identify children who can benefit from checkpoint inhibitors, including upfront management of cancer. See related commentary by Mardis, p. 4701.
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Affiliation(s)
- Anirban Das
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Uri Tabori
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Lauren C. Sambira Nahum
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Natalie B. Collins
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | - Rina Dvir
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Jane E. Minturn
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Edwards
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Elissa Brookes
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Vanessa Bianchi
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Adrian Levine
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Simone C. Stone
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario
| | - Sumedha Sudhaman
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Santiago Sanchez Ramirez
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Ayse B. Ercan
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Lucie Stengs
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Jill Chung
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Logine Negm
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Gad Getz
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | | | - Birgit Ertl-Wagner
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Pamela S. Ohashi
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario
| | - Trevor Pugh
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario
| | - Cynthia Hawkins
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Eric Bouffet
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Daniel A. Morgenstern
- Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
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Yankelevich M, Thakur A, Modak S, Chu R, Taub J, Martin A, Schalk DL, Schienshang A, Whitaker S, Rea K, Lee DW, Liu Q, Shields A, Cheung NK, Lum LG. Targeting GD2-positive Refractory/Resistant Neuroblastoma and Osteosarcoma with Anti- CD3 x Anti-GD2 Bispecific Antibody Armed T cells. RESEARCH SQUARE 2023:rs.3.rs-3570311. [PMID: 37986911 PMCID: PMC10659559 DOI: 10.21203/rs.3.rs-3570311/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Since treatment of neuroblastoma (NB) with anti-GD2 monoclonal antibodies provides a survival benefit in children with minimal residual disease and our preclinical study shows that anti-CD3 x anti-GD2 bispecific antibody (GD2Bi) armed T cells (GD2BATs) were highly cytotoxic to GD2+ cell lines, we conducted a phase I/II study in recurrent/refractory patients to establish safety and explore the clinical benefit of GD2BATs. Methods The 3+3 dose escalation study (NCT02173093) phase I involved 9 evaluable patients with NB (n=5), osteosarcoma (OST) (n=3), and desmoplastic small round cell tumors (DSRCT) (n=1) with twice weekly infusions of GD2BATs at 40, 80, or 160 x 106 GD2BATs/kg/infusion with daily interleukin 2 (300,000 IU/m2) and twice weekly granulocyte-macrophage colony stimulating factor (250 μg/m2). Phase II portion of the trial was conducted in patients with NB at the dose 3 level of 160 x 106 GD2BATs/kg/infusion but failed to enroll the planned number of patients. Results Nine of 12 patients in the phase I completed therapy. There were no dose limiting toxicities (DLTs). All patients developed mild and manageable cytokine release syndrome (CRS) with grade 2-3 fevers/chills, headaches, and occasional hypotension up to 72 hours after GD2BAT infusions. GD2-antibody associated pain was not significant in this study. The median OS for patients in the Phase I and limited Phase II was 18.0 and 31.2 months, respectively, whereas the combined OS was 21.1 months. There was a complete bone marrow response with overall stable disease in one of the phase I patients with NB. Ten of 12 phase II patients were evaluable for response: 1 had partial response. Three additional patients were deemed to have clinical benefit with prolonged stable disease. More than 50% of evaluable patients showed augmented immune responses to GD2+ targets after GD2BATs as measured by interferon-gamma (IFN-γ) EliSpots, Th1 cytokines, and/or chemokines. Conclusions Our study demonstrated safety of up to 160 x 106 cells/kg/infusion of GD2BATs. Combined with evidence for the development of post treatment endogenous immune responses, this data supports further investigation of GD2 BATs in larger Phase II clinical trials.
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Affiliation(s)
| | | | | | - Roland Chu
- Children's Hospital of Michigan (CHM), Wayne State University
| | - Jeffrey Taub
- Children's Hospital of Michigan (CHM), Wayne State University
| | - Alissa Martin
- Children's Hospital of Michigan (CHM), Wayne State University
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20
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De Ioris MA, Fabozzi F, Del Bufalo F, Del Baldo G, Villani MF, Cefalo MG, Garganese MC, Stracuzzi A, Tangari F, Greco AM, Giovannoni I, Carta R, D'Andrea ML, Mastronuzzi A, Locatelli F. Venetoclax plus cyclophosphamide and topotecan in heavily pre-treated relapsed metastatic neuroblastoma: a single center case series. Sci Rep 2023; 13:19295. [PMID: 37935707 PMCID: PMC10630499 DOI: 10.1038/s41598-023-44993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023] Open
Abstract
The prognosis of relapsed/refractory (R/R) neuroblastoma (NB) is dismal, calling for new therapeutic strategies. Venetoclax (VEN) is a highly selective, potent, orally bioavailable, BCL-2 inhibitor small-molecule that showed a synergistic effect with cyclophosphamide and topotecan (Cy-Topo) in murine NB models. Our aim was to evaluate the feasibility of VEN plus Cy-Topo in children with R/R NB. Four patients, who had previously failed > 3 lines of treatment, were treated with VEN plus Cy-Topo based on a 28-day schedule in an outpatient setting. BCL-2 expression in immunochemistry on tumor samples at relapse and the BCL2 gene status was evaluated in all patients. The main toxicity was hematological, with grade 4 neutropenia and thrombocytopenia occurring in all courses and leading to transient VEN discontinuation. Grade 3 oral mucositis was observed in 1/8 courses. No other grade 2-4 toxicities were observed. BCL-2 was expressed in all tumors, while no molecular abnormalities in the BCL-2 genes were detected. A stable disease was observed in all patients, without any progression during the study period. VEN plus Cy-Topo is well tolerated, with encouraging results that may be improved by testing the schedule in less advanced patients.
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Affiliation(s)
- Maria Antonietta De Ioris
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Francesco Fabozzi
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Del Bufalo
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giada Del Baldo
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Maria Giuseppina Cefalo
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Federica Tangari
- Unit of Clinical Pharmacy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Arturo Maria Greco
- Unit of Clinical Pharmacy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Roberto Carta
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Angela Mastronuzzi
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Milan, Italy
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Lode HN, Ehlert K, Huber S, Troschke-Meurer S, Siebert N, Zumpe M, Loibner H, Ladenstein R. Long-term, continuous infusion of single-agent dinutuximab beta for relapsed/refractory neuroblastoma: an open-label, single-arm, Phase 2 study. Br J Cancer 2023; 129:1780-1786. [PMID: 37813959 PMCID: PMC10667538 DOI: 10.1038/s41416-023-02457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Short-term infusions of dinutuximab beta plus isotretinoin and cytokines administered in previous immunotherapy studies in neuroblastoma were associated with severe pain. Here, long-term, continuous infusion of single-agent dinutuximab beta was evaluated in patients with relapsed/refractory neuroblastoma. METHODS In this open-label, single-arm, Phase 2 study, patients with either refractory or relapsed high-risk neuroblastoma received dinutuximab beta by continuous infusion over 10 days of each cycle, for up to five cycles. The primary endpoint was objective response rate 24 weeks after the end of cycle 5. Secondary endpoints included adverse events, intravenous morphine use, best response, duration of response, and three-year progression-free and overall survival. RESULTS Of the 40 patients included, 38 had evaluable response. Objective response rate was 26% and best response rate 37%. Median duration of response was 238 days (IQR 108-290). Three-year progression-free and overall survival rates were 31% (95% CI 17-47) and 66% (95% CI 47-79), respectively. Prophylactic intravenous morphine use and duration of use decreased with increasing cycles. The most common grade 3 treatment-related adverse events were pain, diarrhea, and hypokalemia. CONCLUSION Long-term continuous infusion of single-agent dinutuximab beta is tolerable and associated with clinically meaningful responses in patients with relapsed/refractory high-risk neuroblastoma. CLINICAL TRIAL REGISTRATION The study is registered with ClinicalTrials.gov (NCT02743429) and EudraCT (2014-000588-42).
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Grants
- This research was funded by the University Medicine Greifswald, H.W. & J. Hector Stiftungen, Germany, under Grant M2116, Apeiron Biologics, Vienna, Austria under Grant APN, and Apeiron (Vienna, Austria) providing dinutuximab beta (ch14.18/CHO), and the St. Anna Kinderkrebsforschung (Vienna, Austria). Further funding was provided by EUSA Pharma (Hemel Hempstead, UK), which has marketing authorization for dinutuximab beta in Europe. Editorial assistance for the development of the manuscript was funded by EUSA Pharma
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Affiliation(s)
- Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany.
| | - Karoline Ehlert
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Stephanie Huber
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Sascha Troschke-Meurer
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Nikolai Siebert
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Maxi Zumpe
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | | | - Ruth Ladenstein
- Department of Studies and Statistics for Integrated Research and Projects, Children's Cancer Research Institute, Vienna, Austria
- Department of Paediatrics, St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
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22
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Sevrin F, Kolesnikov-Gauthier H, Cougnenc O, Bogart E, Schleiermacher G, Courbon F, Gambart M, Giraudet AL, Corradini N, Badel JN, Rault E, Oudoux A, Deley MCL, Valteau-Couanet D, Defachelles AS. Phase II study of 131 I-metaiodobenzylguanidine with 5 days of topotecan for refractory or relapsed neuroblastoma: Results of the French study MIITOP. Pediatr Blood Cancer 2023; 70:e30615. [PMID: 37574821 DOI: 10.1002/pbc.30615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE We report the results of the French multicentric phase II study MIITOP (NCT00960739), which evaluated tandem infusions of 131 I-metaiodobenzylguanidine (mIBG) and topotecan in children with relapsed/refractory metastatic neuroblastoma (NBL). METHODS Patients received 131 I-mIBG on day 1, with intravenous topotecan daily on days 1-5. A second activity of 131 I-mIBG was given on day 21 to deliver a whole-body radiation dose of 4 Gy, combined with a second course of topotecan on days 21-25. Peripheral blood stem cells were infused on day 31. RESULTS Thirty patients were enrolled from November 2008 to June 2015. Median age at diagnosis was 5.5 years (2-20). Twenty-one had very high-risk NBL (VHR-NBL), that is, stage 4 NBL at diagnosis or at relapse, with insufficient response (i.e., less than a partial response of metastases and more than three mIBG spots) after induction chemotherapy; nine had progressive metastatic relapse. Median Curie score at inclusion was 6 (1-26). Median number of prior lines of treatment was 3 (1-7). Objective response rate was 13% (95% confidence interval [CI]: 4-31) for the whole population, 19% for VHR-NBL, and 0% for progressive relapses. Immediate tolerance was good, with nonhematologic toxicity limited to grade-2 nausea/vomiting in eight patients. Two-year event-free survival was 17% (95% CI: 6-32). Among the 16 patients with VHR-NBL who had not received prior myeloablative busulfan-melphalan consolidation, 13 had at least stable disease after MIITOP; 11 subsequently received busulfan-melphalan; four of them were alive (median follow-up: 7 years). CONCLUSION MIITOP showed acceptable tolerability in this heavily pretreated population and encouraging survival rates in VHR-NBL when followed by busulfan-melphalan.
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Affiliation(s)
- François Sevrin
- Department of Pediatric Oncology, Oscar Lambret Center, Lille, France
| | | | - Olivier Cougnenc
- Department of Clinical Pharmacy, Oscar Lambret Center, Lille, France
| | - Emilie Bogart
- Department of Methodology and Biostatistics, Oscar Lambret Center, Lille, France
| | | | - Frederic Courbon
- Service de Médecine Nucléaire, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Marion Gambart
- Hematology and Oncology Unit, Children's Hospital, CHU Toulouse, Toulouse, France
| | | | - Nadège Corradini
- Institute of Pediatric Hematology and Oncology, Léon Bérard Center, Lyon, France
| | - Jean-Noël Badel
- Department of Nuclear Medicine, Léon Bérard Center, Lyon, France
| | - Erwann Rault
- Department of Medical Physics, Oscar Lambret Center, Lille, France
| | - Aurore Oudoux
- Department of Nuclear Medicine, Oscar Lambret Center, Lille, France
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23
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Casanova M, Bautista F, Campbell-Hewson Q, Makin G, Marshall LV, Verschuur AC, Cañete Nieto A, Corradini N, Ploeger BA, Brennan BJ, Mueller U, Zebger-Gong H, Chung JW, Geoerger B. Regorafenib plus Vincristine and Irinotecan in Pediatric Patients with Recurrent/Refractory Solid Tumors: An Innovative Therapy for Children with Cancer Study. Clin Cancer Res 2023; 29:4341-4351. [PMID: 37606641 PMCID: PMC10618645 DOI: 10.1158/1078-0432.ccr-23-0257] [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: 02/06/2023] [Revised: 05/17/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE This phase Ib study defined the safety, MTD, and recommended phase II dose (RP2D) of regorafenib combined with vincristine and irinotecan (VI). Secondary objectives were evaluation of antitumor activity and pharmacokinetics (PK) of regorafenib and irinotecan. PATIENTS AND METHODS Patients aged 6 months to <18 years with relapsed/refractory solid malignancies [≥50% with rhabdomyosarcoma (RMS)] received regorafenib (starting dose 72 mg/m2/day) concomitantly or sequentially with vincristine 1.5 mg/m2 on days 1 and 8, and irinotecan 50 mg/m2 on days 1-5 (21-day cycle). Adverse events (AE) and tumor response were assessed. PK (regorafenib and irinotecan) were evaluated using a population PK model. RESULTS We enrolled 21 patients [median age, 10 years; 12, RMS; 5, Ewing sarcoma (EWS)]. The MTD/RP2D of regorafenib in the sequential schedule was 82 mg/m2. The concomitant dosing schedule was discontinued because of dose-limiting toxicities in 2 of 2 patients treated. Most common grade 3/4 (>30% of patients) AEs were neutropenia, anemia, thrombocytopenia, and leukopenia. The overall response rate was 48% and disease control rate [complete response (CR)/partial response/stable disease/non-CR/non-progressive disease] was 86%. Median progression-free survival was 7.0 months [95% confidence interval (CI), 2.9-14.8] and median overall survival was 8.7 months (95% CI, 5.5-16.3). When combined with VI, regorafenib PK was similar to single-agent PK in children and adults (treated with regorafenib 160 mg/day). CONCLUSIONS Regorafenib can be combined sequentially with standard dose VI in pediatric patients with relapsed/refractory solid tumors with appropriate dose modifications. Clinical activity was observed in patients with RMS and EWS (ClinicalTrials.gov NCT02085148).
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Affiliation(s)
- Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francisco Bautista
- Department of Paediatric Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Guy Makin
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester and Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Lynley V. Marshall
- Paediatric and Adolescent Oncology Drug Development Team, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Arnauld C. Verschuur
- Department of Pediatric Haematology-Oncology, La Timone Children's Hospital, AP-HM, Marseille, France
| | - Adela Cañete Nieto
- Unidad de Oncología Pediátrica, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - Nadège Corradini
- Hematology and Oncology Pediatric Institute, Léon Bérard Center, Lyon, France
| | - Bart A. Ploeger
- Pharmacometrics/Modelling and Simulation, Bayer AG, Berlin, Germany
| | | | - Udo Mueller
- Department of Statistics, ClinStat GmbH, Cologne, Germany
| | - Hong Zebger-Gong
- Medical Affairs and Pharmacovigilance, Bayer AG, Berlin, Germany
| | - John W. Chung
- Clinical Development Oncology, Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, INSERM U1015, Université Paris-Saclay, Villejuif, France
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24
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Izurieta-Pacheco AC, Sangrós-Gimenez A, Martínez-Garcia E, Perez-Jaume S, Mora J, Gorostegui-Obanos M. Vitamin D Status in Children With High-risk Neuroblastoma. J Pediatr Hematol Oncol 2023; 45:e953-e958. [PMID: 37779236 DOI: 10.1097/mph.0000000000002762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Vitamin D deficiency has become a matter of concern in pediatric cancer patients. A relationship between neuroblastoma and Vitamin D signaling pathways has been revealed with interest in the antiproliferative and antiinvasive properties of vitamin D. Our aim is to describe the prevalence of Vitamin D deficiency among children with high-risk neuroblastoma (HR-NB) and to explore its association with disease status. MATERIALS AND METHODS In all, 182 patients with HR-NB were managed at our center from 2017 to 2021. Serum 25(OH)D levels were tested at the first blood analysis performed and correlated with clinical data and disease status. RESULTS One hundred forty-eight (81.4%) had low 25(OH)D levels (48.4% categorized as deficiency (25(OH)D below 20 ng/mL) and 33.0% as insufficiency (25(OH)D 20 to 30 ng/mL). Median Vitamin D level was 20.2 ng/mL. Vitamin D levels were not associated with race or sex. Although malnourished patients had lower median 25(OH)D levels(11.1 ng/mL), no statistical association was observed with Vitamin D deficiency. There was no association between Vitamin D levels and disease status. An inverse correlation was found between age and vitamin D levels ( P =0.0040). CONCLUSION A concerning high prevalence of low Vitamin D levels affects more than two-thirds of patients with HR-NB in our cohort, regardless of the disease status at the time of evaluation. Older children are at a higher risk for deficient levels of vitamin D.
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25
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Muñoz JP, Larrosa C, Chamorro S, Perez-Jaume S, Simao M, Sanchez-Sierra N, Varo A, Gorostegui M, Castañeda A, Garraus M, Lopez-Miralles S, Mora J. Early Salvage Chemo-Immunotherapy with Irinotecan, Temozolomide and Naxitamab Plus GM-CSF (HITS) for Patients with Primary Refractory High-Risk Neuroblastoma Provide the Best Chance for Long-Term Outcomes. Cancers (Basel) 2023; 15:4837. [PMID: 37835531 PMCID: PMC10571514 DOI: 10.3390/cancers15194837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
Patients with high-risk neuroblastoma (HR-NB) who are unable to achieve a complete response (CR) to induction therapy have worse outcomes. We investigated the combination of humanized anti-GD2 mAb naxitamab (Hu3F8), irinotecan (I), temozolomide (T), and sargramostim (GM-CSF)-HITS-against primary resistant HR-NB. Eligibility criteria included having a measurable chemo-resistant disease at the end of induction (EOI) treatment. Patients were excluded if they had progressive disease (PD) during induction. Prior anti-GD2 mAb and/or I/T therapy was permitted. Each cycle, administered four weeks apart, comprised Irinotecan 50 mg/m2/day intravenously (IV) plus Temozolomide 150 mg/m2/day orally (days 1-5); naxitamab 2.25 mg/kg/day IV on days 2, 4, 8 and 10, (total 9 mg/kg or 270 mg/m2 per cycle), and GM-CSF 250 mg/m2/day subcutaneously was used (days 6-10). Toxicity was measured using CTCAE v4.0 and responses through the modified International Neuroblastoma Response Criteria (INRC). Thirty-four patients (median age at treatment initiation, 4.9 years) received 164 (median 4; 1-12) HITS cycles. Toxicities included myelosuppression and diarrhea, which was expected with I/T, and pain and hypertension, expected with naxitamab. Grade ≥3-related toxicities occurred in 29 (85%) of the 34 patients; treatment was outpatient. The best responses were CR = 29% (n = 10); PR = 3% (n = 1); SD = 53% (n = 18); PD = 5% (n = 5). For cohort 1 (early treatment), the best responses were CR = 47% (n = 8) and SD = 53% (n = 9). In cohort 2 (late treatment), the best responses were CR = 12% (n = 2); PR = 6% (n = 1); SD = 53% (n = 9); and PD = 29% (n = 5). Cohort 1 had a 3-year OS of 84.8% and EFS 54.4%, which are statistically significant improvements (EFS p = 0.0041 and OS p = 0.0037) compared to cohort 2. In conclusion, naxitamab-based chemo-immunotherapy is effective against primary chemo-resistant HR-NB, increasing long-term outcomes when administered early during the course of treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jaume Mora
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (J.P.M.); (C.L.); (S.C.); (S.P.-J.); (M.S.); (N.S.-S.); (A.V.); (M.G.); (A.C.); (M.G.); (S.L.-M.)
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26
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Murphy PS, Galette P, van der Aart J, Janiczek RL, Patel N, Brown AP. The role of clinical imaging in oncology drug development: progress and new challenges. Br J Radiol 2023; 96:20211126. [PMID: 37393537 PMCID: PMC10546429 DOI: 10.1259/bjr.20211126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023] Open
Abstract
In 2008, the role of clinical imaging in oncology drug development was reviewed. The review outlined where imaging was being applied and considered the diverse demands across the phases of drug development. A limited set of imaging techniques was being used, largely based on structural measures of disease evaluated using established response criteria such as response evaluation criteria in solid tumours. Beyond structure, functional tissue imaging such as dynamic contrast-enhanced MRI and metabolic measures using [18F]flourodeoxyglucose positron emission tomography were being increasingly incorporated. Specific challenges related to the implementation of imaging were outlined including standardisation of scanning across study centres and consistency of analysis and reporting. More than a decade on the needs of modern drug development are reviewed, how imaging has evolved to support new drug development demands, the potential to translate state-of-the-art methods into routine tools and what is needed to enable the effective use of this broadening clinical trial toolset. In this review, we challenge the clinical and scientific imaging community to help refine existing clinical trial methods and innovate to deliver the next generation of techniques. Strong industry-academic partnerships and pre-competitive opportunities to co-ordinate efforts will ensure imaging technologies maintain a crucial role delivering innovative medicines to treat cancer.
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Affiliation(s)
| | - Paul Galette
- Telix Pharmaceuticals (US) Inc, Fishers, United States
| | | | | | | | - Andrew P. Brown
- Vale Imaging Consultancy Solutions, Harston, Cambridge, United Kingdom
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27
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Cupit-Link M, Federico SM. Treatment of High-Risk Neuroblastoma with Dinutuximab and Chemotherapy Administered in all Cycles of Induction. Cancers (Basel) 2023; 15:4609. [PMID: 37760578 PMCID: PMC10527563 DOI: 10.3390/cancers15184609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Administration of chemoimmunotherapy using concurrent chemotherapy and an anti-GD2 monoclonal antibody (mAb), dinutuximab (DIN), demonstrated efficacy for the treatment of relapsed and refractory neuroblastoma. Chemoimmunotherapy, using a humanized anti-GD2 mAb, demonstrated a signal of activity in a phase 2 study for the treatment of patients with newly diagnosed high-risk neuroblastoma (HRNBL). In this single-institution retrospective study, patients with HRNBL received an Induction chemotherapy regimen plus DIN in all Induction cycles. Toxicity and response data were abstracted from the electronic medical record. Toxicities were graded by CTCAE v.5.0. The end of Induction (EOI) objective response rate was determined using the Revised International Neuroblastoma Response Criteria. Twenty-seven patients with HRNBL (23 newly diagnosed, 16 females, median age 3.9 years) started Induction chemoimmunotherapy from 27 January 2017 to 28 December 2022. All patients received DIN with all cycles of Induction therapy, and all but one patient completed Induction therapy. The most common non-hematologic grade ≥ 3 toxicities included fever (44%), hypoxemia (20%), and hypoalbuminemia (11%). End of Induction responses included eighteen with a complete response (CR), seven with a partial response (PR), one with progressive disease (PD), and zero with a minor response or stable disease. Twenty-six of twenty-seven patients (96%) completed all Induction cycles and were evaluable for a response. The EOI response of PR or better in the evaluable cohort was 96%. Dinutuximab was well tolerated with all Induction cycles, demonstrated an encouraging EOI response rate, and should be evaluated in a randomized study.
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28
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Bagatell R, DuBois SG, Naranjo A, Belle J, Goldsmith KC, Park JR, Irwin MS. Children's Oncology Group's 2023 blueprint for research: Neuroblastoma. Pediatr Blood Cancer 2023; 70 Suppl 6:e30572. [PMID: 37458162 PMCID: PMC10587593 DOI: 10.1002/pbc.30572] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Neuroblastoma is the most common extra-cranial solid tumor in children and is known for its clinical heterogeneity. A greater understanding of the biology of this disease has led to both improved risk stratification and new approaches to therapy. Outcomes for children with low and intermediate risk disease are excellent overall, and efforts to decrease therapy for such patients have been largely successful. Although survival has improved over time for patients with high-risk disease and treatments evaluated in the relapse setting are now being moved into earlier phases of treatment, much work remains to improve survival and decrease therapy-related toxicities. Studies of highly annotated biobanked samples continue to lead to important insights regarding neuroblastoma biology. Such studies, along with correlative biology studies incorporated into therapeutic trials, are expected to continue to provide insights that lead to new and more effective therapies. A focus on translational science is accompanied by an emphasis on new agent development, optimized risk stratification, and international collaboration to address questions relevant to molecularly defined subsets of patients. In addition, the COG Neuroblastoma Committee is committed to addressing the patient/family experience, mitigating late effects of therapy, and studying social determinants of health in patients with neuroblastoma.
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Affiliation(s)
- Rochelle Bagatell
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven G DuBois
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Arlene Naranjo
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Jen Belle
- Children's Oncology Group, Monrovia, California, USA
| | - Kelly C Goldsmith
- Department of Pediatrics, Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, USA
| | - Julie R Park
- Department of Oncology, St Jude Children's Research Hospital Department of Oncology, Memphis, Tennessee, USA
| | - Meredith S Irwin
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
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29
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Inoue S, Win KHN, Mon CY, Fujikawa T, Hyodo S, Uemura S, Ishida T, Mori T, Hasegawa D, Kosaka Y, Nishimura A, Nakatani N, Nino N, Tamura A, Yamamoto N, Nozu K, Nishimura N. Higher levels of minimal residual disease in peripheral blood than bone marrow before 1st and 2nd relapse/regrowth in a patient with high‑risk neuroblastoma: A case report. Oncol Lett 2023; 26:369. [PMID: 37559575 PMCID: PMC10407720 DOI: 10.3892/ol.2023.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/26/2023] [Indexed: 08/11/2023] Open
Abstract
More than half of patients with high-risk neuroblastoma (HR-NB) experience relapse/regrowth due to the activation of chemoresistant minimal residual disease (MRD). MRD in patients with HR-NB can be evaluated by quantitating neuroblastoma-associated mRNAs (NB-mRNAs) in bone marrow (BM) and peripheral blood (PB) samples. Although several sets of NB-mRNAs have been shown to possess a prognostic value for MRD in BM samples (BM-MRD), MRD in PB samples (PB-MRD) is considered to be low and difficult to evaluate. The present report describes an HR-NB case presenting higher PB-MRD than BM-MRD before 1st and 2nd relapse/regrowth. A 3-year-old female presented with an abdominal mass, was diagnosed with HR-NB, and treated according to the nationwide standard protocol for HR-NB. Following systemic induction and consolidation therapy with local therapy, the patient achieved complete remission but experienced a 1st relapse/regrowth 6 months after maintenance therapy. The patient partially responded to salvage chemotherapy and anti-GD2 immunotherapy but had a 2nd relapse/regrowth 14 months after the 1st relapse/regrowth. Consecutive PB-MRD and BM-MRD monitoring revealed that PB-MRD was lower than BM-MRD at diagnosis (100 times) and 1st and 2nd relapse/regrowth (1,000 and 3 times) but became higher than BM-MRD before 1st and 2nd relapse/regrowth. The present case highlights that PB-MRD can become higher than BM-MRD before relapse/regrowth of patients with HR-NB.
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Affiliation(s)
- Shotaro Inoue
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Kaung Htet Nay Win
- Department of Public Health, Kobe University Graduate School of Health Science, Kobe, Hyogo 654-0142, Japan
| | - Cho Yee Mon
- Department of Public Health, Kobe University Graduate School of Health Science, Kobe, Hyogo 654-0142, Japan
| | - Tomoko Fujikawa
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Sayaka Hyodo
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Suguru Uemura
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Toshiaki Ishida
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Takeshi Mori
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Akihiro Nishimura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Naoko Nakatani
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Nanako Nino
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Akihiro Tamura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Nobuyuki Yamamoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Noriyuki Nishimura
- Department of Public Health, Kobe University Graduate School of Health Science, Kobe, Hyogo 654-0142, Japan
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30
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Wang ZN, Zhang Y, Sun J, Zhao ZZ, Wang S, Yang C. The prognostic and predictive value of plasma D-dimer in children with neuroblastoma: a 7-year retrospective analysis at a single institution. Ann Surg Treat Res 2023; 105:148-156. [PMID: 37693287 PMCID: PMC10485353 DOI: 10.4174/astr.2023.105.3.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose Elevated plasma D-dimer level is a poor prognostic factor for many solid tumors. However, limited research has been conducted on D-dimer in children with neuroblastoma (NB), and its clinical significance remains unclear. The present study investigated the clinical and prognostic significance of D-dimer in pediatric NB patients. Methods A retrospective analysis of all newly admitted NB patients was conducted from January 2014 to December 2020. Baseline clinicopathological features, preoperative laboratory parameters, and follow-up information were collected. Univariate and multivariate analyses were performed to determine the relationship between D-dimer level, clinical features, and the prognostic value. Results Among 266 patients, the median value of D-dimer was 2.98 ng/mL, of which 132 patients showed elevated D-dimer levels before surgery (>2.98 ng/mL). Univariate analysis revealed that elevated D-dimer was significantly associated with age, hemoglobin, neutrophil-to-lymphocyte ratio, neuron-specific enolase, 24-hour vanillylmandelic acid, overall survival, and so on (P < 0.05). Patients with elevated D-dimer levels had shorter median overall survival time when compared with normal D-dimer levels (P = 0.01). The prognosis was better in patients with normal D-dimer levels when combined with lower age, ganglioneuroblastoma tumor type, lower stage on International Neuroblastoma Staging System, low-risk group, and without bone metastasis or bone marrow metastasis. The continuous increase of D-dimer level after treatment indicated tumor recurrence or progression. Conclusion A high D-dimer level is associated with low overall survival, and an elevated D-dimer level after treatment indicates tumor recurrence and progression. D-dimer can be used as one of the evaluation factors for NB treatment or prognosis.
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Affiliation(s)
- Zhen-Ni Wang
- Department of Pediatric Surgical Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National International Science and Technology Cooperation Base for Critical Children’s Developmental Diseases, Chongqing, China
- Key Laboratory of Child Developmental Diseases Research of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yao Zhang
- Department of Pediatric Surgical Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National International Science and Technology Cooperation Base for Critical Children’s Developmental Diseases, Chongqing, China
- Key Laboratory of Child Developmental Diseases Research of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Sun
- Department of Pediatric Surgical Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National International Science and Technology Cooperation Base for Critical Children’s Developmental Diseases, Chongqing, China
- Key Laboratory of Child Developmental Diseases Research of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhen-Zhen Zhao
- Department of Pediatric Surgical Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National International Science and Technology Cooperation Base for Critical Children’s Developmental Diseases, Chongqing, China
- Key Laboratory of Child Developmental Diseases Research of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Shan Wang
- Department of Pediatric Surgical Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National International Science and Technology Cooperation Base for Critical Children’s Developmental Diseases, Chongqing, China
- Key Laboratory of Child Developmental Diseases Research of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chao Yang
- Department of Pediatric Surgical Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National International Science and Technology Cooperation Base for Critical Children’s Developmental Diseases, Chongqing, China
- Key Laboratory of Child Developmental Diseases Research of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Cupit-Link M, Hagiwara K, Zhang J, Federico SM. Clinical Response to a PARP Inhibitor and Chemotherapy in a Child with BARD1-Mutated Refractory Neuroblastoma: A Case Report. RESEARCH SQUARE 2023:rs.3.rs-3250117. [PMID: 37645774 PMCID: PMC10462232 DOI: 10.21203/rs.3.rs-3250117/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Despite advances in the treatment of high-risk neuroblastoma, approximately half of these patients die from the disease. Targeted therapy based on synthetic lethality associated with homologous recombination deficiency (HRD) caused by germline mutations in homologous recombination repair genes has shown great efficacy in several adult solid tumors. Here we report the first successful treatment of a pediatric patient with refractory neuroblastoma and a germline pathogenic mutation in BARD1 using a PARP inhibitor, talazoparib, in combination with cytotoxic chemotherapy and radiation therapy. Allele-specific expression in RNA-seq indicates bi-allelic loss of BARD1 in tumor; however, the HRD score was below the threshold currently used for HRD classification in adult cancers. Our study demonstrates that the use of PARP inhibition in combination with DNA-damaging agents should be considered in children with BARD1-mutated neuroblastoma and cautions against the use of HRD score alone as a biomarker for this pediatric population.
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Affiliation(s)
- Maggie Cupit-Link
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Kohei Hagiwara
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Sara M. Federico
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105
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Wieczorek A, Żebrowska U, Ussowicz M, Sokół A, Stypińska M, Dembowska-Bagińska B, Pawińska-Wąsikowska K, Balwierz W. Dinutuximab Beta Maintenance Therapy in Patients with High-Risk Neuroblastoma in First-Line and Refractory/Relapsed Settings-Real-World Data. J Clin Med 2023; 12:5252. [PMID: 37629294 PMCID: PMC10455178 DOI: 10.3390/jcm12165252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Dinutuximab beta is approved for the maintenance treatment of patients with high-risk neuroblastoma (HR-NB), including patients with relapsed/refractory (R/R) disease. However, the data on its use in real-world clinical practice is limited. We retrospectively reviewed the clinical records of 54 patients with HR-NB who received maintenance therapy with dinutuximab beta in first-line (37 patients) or R/R settings (17 patients) at three centers in Poland. Of the 37 patients who received first-line treatment, twenty-eight had a complete response, two had a partial response, three had progressive disease, and four relapsed at the end of treatment. The median overall survival (OS) was 24.37 months, and the three-year progression-free survival (PFS) and OS were 0.63 and 0.80, respectively. Of the 17 patients in the R/R group, 11 had a complete response, two had a partial response, one had stable disease, and three had progressive disease or relapsed at the end of treatment. The median OS was 33.1 months and the three-year PFS and OS were 0.75 and 0.86, respectively. Treatment was generally well tolerated, including in patients with co-morbidities and those who had experienced toxicities with previous therapies. These findings demonstrate that the use of dinutuximab beta is feasible and beneficial as a first-line or R/R treatment in routine clinical practice in Poland.
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Affiliation(s)
- Aleksandra Wieczorek
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 30-663 Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland
| | - Urszula Żebrowska
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Agnieszka Sokół
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Marzena Stypińska
- Department of Oncology, Children Memorial Health Institute, 04-730 Warsaw, Poland
| | | | - Katarzyna Pawińska-Wąsikowska
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 30-663 Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 30-663 Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland
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Stiefel J, Kushner BH, Roberts SS, Iglesias-Cardenas F, Kramer K, Modak S. Anaplastic Lymphoma Kinase Inhibitors for Therapy of Neuroblastoma in Adults. JCO Precis Oncol 2023; 7:e2300138. [PMID: 37561984 PMCID: PMC10581627 DOI: 10.1200/po.23.00138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Adult-onset neuroblastoma (AON) differs significantly in biology and clinical behavior from childhood-onset disease. AON poses therapeutic challenges since tolerance of intensive multimodality therapies that are standard of care for pediatric neuroblastoma (NB) is poor. AON is enriched for somatic mutations including anaplastic lymphoma kinase (ALK), deemed to be an oncogenic driver in NB. ALK inhibitors (ALKis), therefore, have the potential to be of therapeutic benefit. The purpose of this study is to report on their use in AON. METHODS A single-center retrospective review of adults with NB receiving ALKi (2012-2022) was performed. Response was evaluated using International Neuroblastoma Response Criteria. RESULTS Fifteen patients with ALK-mutated AON were treated with US Food and Drug Administration-approved ALKi starting at a median age of 34 (16-71) years. Initial ALKi was lorlatinib, crizotinib, and alectinib in seven, five, and three patients respectively; seven received multiple ALKis due to progressive disease/intolerability of one agent. All patients experienced ≥grade 2 adverse events (AEs): crizotinib and alectinib were associated primarily with gastrointestinal AEs, lorlatinib with neurologic AEs, weight gain, and hyperlipidemia resulting in dose reduction or discontinuation of ALKi in several patients. No responses were observed with crizotinib (n = 5 patients), ceritinib, alectinib, or brigatinib (n = 1 each). Of the 13 patients receiving lorlatinib, four, five, and four patients had a complete or partial response (major response rate 69%), and stable disease, respectively. Responses were noted in all disease compartments; complete metabolic response was seen in two L2 patients. Ten of 13 patients remain progression-free at a median of 19 (6-50) months on lorlatinib. Three (two receiving dose-reduced therapy) had progressive disease. Median survival from start of first ALKi was 43 ± 26 months. CONCLUSION ALKis, particularly lorlatinib, are effective treatment options for AON. However, AEs necessitating dose reduction are common.
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Affiliation(s)
- Jessica Stiefel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian H. Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen S. Roberts
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
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Wang P, Li T, Liu Z, Jin M, Su Y, Zhang J, Jing H, Zhuang H, Li F. [ 18F]MFBG PET/CT outperforming [ 123I]MIBG SPECT/CT in the evaluation of neuroblastoma. Eur J Nucl Med Mol Imaging 2023; 50:3097-3106. [PMID: 37160439 DOI: 10.1007/s00259-023-06221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Iodine 123 labeled meta-iodobenzylguanidine ([123I]MIBG) scan with SPECT/CT imaging is one of the most commonly used imaging modalities in the evaluation of neuroblastoma. [18F]-meta-fluorobenzylguanidine ([18F]MFBG) is a novel positron emission tomography (PET) tracer which was reported to have a similar biodistribution to [123I]MIBG. However, the experience of using [18F]MFBG PET/CT in the evaluation of patients with neuroblastoma is limited. This preliminary investigation aims to assess the efficacy of [18F]MFBG PET/CT in the evaluation of neuroblastomas in comparison to [123I]MIBG scans with SPECT/CT. MATERIALS AND METHODS In this prospective, single-center study, 40 participants (mean age 6.0 ± 3.7 years) with history of neuroblastoma were enrolled. All children underwent both [123I]MIBG SPECT/CT and [18F]MFBG PET/CT studies. The number of lesions and the Curie scores revealed by each imaging method were recorded. RESULTS Six patients had negative findings on both [123I]MIBG and [18F]MFBG studies. Four of the 34 patients (11.8%) were negative on [123I]MIBG but positive on [18F]MFBG, while 30 patients were positive on both [123I]MIBG and [18F]MFBG studies. In these 34 patients, [18F]MFBG PET/CT identified 784 lesions while [123I]MIBG SPECT/CT detected 532 lesions (p < 0.001). The Curie scores obtained from [18F]MFBG PET/CT (11.32 ± 8.18, range 1-27) were statistically higher (p < 0.001) than those from [123I]MIBG SPECT/CT (7.74 ± 7.52, range 0-26). 30 of 34 patients (88.2%) with active disease on imaging had higher Curie scores based on the [18F]MFBG study than on the [123I]MIBG imaging. CONCLUSION [18F]MFBG PET/CT shows higher lesion detection rate than [123I]MIBG SPECT/CT in the evaluation of pediatric patients with neuroblastoma. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov : NCT05069220 (Registered: 25 September 2021, retrospectively registered); Institute Review Board of Peking Union Medical College Hospital: ZS-2514.
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Affiliation(s)
- Peipei Wang
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China
| | - Tuo Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, People's Republic of China
| | - Mei Jin
- Department of Medical Oncology, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Yan Su
- Department of Medical Oncology, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.
| | - Jingjing Zhang
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hongli Jing
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China.
| | - Hongming Zhuang
- Department of Radiology, Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Fang Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China.
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35
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Streby KA, Parisi MT, Shulkin BL, LaBarre B, Bagatell R, Diller L, Grupp SA, Matthay KK, Voss SD, Yu AL, London WB, Park JR, Yanik GA, Naranjo A. Impact of diagnostic and end-of-induction Curie scores with tandem high-dose chemotherapy and autologous transplants for metastatic high-risk neuroblastoma: A report from the Children's Oncology Group. Pediatr Blood Cancer 2023; 70:e30418. [PMID: 37199022 PMCID: PMC10511015 DOI: 10.1002/pbc.30418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Diagnostic mIBG (meta-iodobenzylguanidine) scans are an integral component of response assessment in children with high-risk neuroblastoma. The role of end-of-induction (EOI) Curie scores (CS) was previously described in patients undergoing a single course of high-dose chemotherapy (HDC) and autologous hematopoietic cell transplant (AHCT) as consolidation therapy. OBJECTIVE We now examine the prognostic significance of CS in patients randomized to tandem HDC and AHCT on the Children's Oncology Group (COG) trial ANBL0532. STUDY DESIGN A retrospective analysis of mIBG scans obtained from patients enrolled in COG ANBL0532 was performed. Evaluable patients had mIBG-avid, International Neuroblastoma Staging System (INSS) stage 4 disease, did not progress during induction therapy, consented to consolidation randomization, and received either single or tandem HDC (n = 80). Optimal CS cut points maximized the outcome difference (≤CS vs. >CS cut-off) according to the Youden index. RESULTS For recipients of tandem HDC, the optimal cut point at diagnosis was CS = 12, with superior event-free survival (EFS) from study enrollment for patients with CS ≤ 12 (3-year EFS 74.2% ± 7.9%) versus CS > 12 (59.2% ± 7.1%) (p = .002). At EOI, the optimal cut point was CS = 0, with superior EOI EFS for patients with CS = 0 (72.9% ± 6.4%) versus CS > 0 (46.5% ± 9.1%) (p = .002). CONCLUSION In the setting of tandem transplantation for children with high-risk neuroblastoma, CS at diagnosis and EOI may identify a more favorable patient group. Patients treated with tandem HDC who exhibited a CS ≤ 12 at diagnosis or CS = 0 at EOI had superior EFS compared to those with CS above these cut points.
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Affiliation(s)
- Keri A. Streby
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children’s Hospital/The Ohio State University, Columbus, Ohio
| | - Marguerite T. Parisi
- Department of Radiology, Seattle Children’s Hospital/University of Washington School of Medicine, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Barry L. Shulkin
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Adjunct Professor of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brian LaBarre
- Children’s Oncology Group Statistics & Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Rochelle Bagatell
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa Diller
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Stephan A. Grupp
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine K. Matthay
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alice L. Yu
- University of California in San Diego, San Diego, California
- Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wendy B. London
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Julie R. Park
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory A. Yanik
- Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Arlene Naranjo
- Children’s Oncology Group Statistics & Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
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36
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Krystal J, Foster JH. Treatment of High-Risk Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1302. [PMID: 37628301 PMCID: PMC10453838 DOI: 10.3390/children10081302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
High-risk neuroblastoma is a highly aggressive solid tumor that most commonly presents in early childhood. Advances in treatment through decades of clinical trials and research have led to improved outcomes. This review provides an overview of the current state of treatment for high-risk neuroblastoma.
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Affiliation(s)
- Julie Krystal
- Zucker Hofstra School of Medicine, Department of Pediatrics, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA
| | - Jennifer H. Foster
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Cancer Center, Houston, TX 77030, USA;
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Mangó K, Fekete F, Kiss ÁF, Erdős R, Fekete JT, Bűdi T, Bruckner E, Garami M, Micsik T, Monostory K. Association between CYP2B6 genetic variability and cyclophosphamide therapy in pediatric patients with neuroblastoma. Sci Rep 2023; 13:11770. [PMID: 37479763 PMCID: PMC10361978 DOI: 10.1038/s41598-023-38983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/18/2023] [Indexed: 07/23/2023] Open
Abstract
Cyclophosphamide, an oxazaphosphorine prodrug is frequently used in treatment of neuroblastoma, which is one of the most prevalent solid organ malignancies in infants and young children. Cytochrome P450 2B6 (CYP2B6) is the major catalyst and CYP2C19 is the minor enzyme in bioactivation and inactivation pathways of cyclophosphamide. CYP-mediated metabolism may contribute to the variable pharmacokinetics of cyclophosphamide and its toxic byproducts leading to insufficient response to the therapy and development of clinically significant side effects. The aim of the study was to reveal the contribution of pharmacogenetic variability in CYP2B6 and CYP2C19 to the treatment efficacy and cyclophosphamide-induced side effects in pediatric neuroblastoma patients under cyclophosphamide therapy (N = 50). Cyclophosphamide-induced hematologic toxicities were pivotal in all patients, whereas only moderate hepatorenal toxicity was developed. The patients' CYP2B6 metabolizer phenotypes were associated with the occurrence of lymphopenia, thrombocytopenia, and monocytopenia as well as of liver injury, but not with kidney or urinary bladder (hemorrhagic cystitis) toxicities. Furthermore, the patients' age (< 1.5 years, P = 0.03) and female gender (P ≤ 0.02), but not CYP2B6 or CYP2C19 metabolizer phenotypes appeared as significant prognostic factors in treatment outcomes. Our results may contribute to a better understanding of the impact of CYP2B6 variability on cyclophosphamide-induced side effects.
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Affiliation(s)
- Katalin Mangó
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar Tudósok 2, 1117, Budapest, Hungary
- Doctoral School of Pharmaceutical Sciences, Semmelweis University, Üllői 26, 1085, Budapest, Hungary
| | - Ferenc Fekete
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar Tudósok 2, 1117, Budapest, Hungary
| | - Ádám Ferenc Kiss
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar Tudósok 2, 1117, Budapest, Hungary
| | - Réka Erdős
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar Tudósok 2, 1117, Budapest, Hungary
| | - János Tibor Fekete
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar Tudósok 2, 1117, Budapest, Hungary
- Department of Bioinformatics, Semmelweis University, Tűzoltó 7-9, 1094, Budapest, Hungary
| | - Tamás Bűdi
- Center of Pediatrics, Semmelweis University, Tűzoltó 7-9, 1094, Budapest, Hungary
| | - Edit Bruckner
- Center of Pediatrics, Semmelweis University, Tűzoltó 7-9, 1094, Budapest, Hungary
| | - Miklós Garami
- Center of Pediatrics, Semmelweis University, Tűzoltó 7-9, 1094, Budapest, Hungary
| | - Tamás Micsik
- Fejér County Saint George University Teaching Hospital, Seregélyesi 3, 8000, Székesfehérvár, Hungary
| | - Katalin Monostory
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar Tudósok 2, 1117, Budapest, Hungary.
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Cole KA, Ijaz H, Surrey LF, Santi M, Liu X, Minard CG, Maris JM, Voss S, Reid JM, Fox E, Weigel BJ. Pediatric phase 2 trial of a WEE1 inhibitor, adavosertib (AZD1775), and irinotecan for relapsed neuroblastoma, medulloblastoma, and rhabdomyosarcoma. Cancer 2023; 129:2245-2255. [PMID: 37081608 PMCID: PMC10628947 DOI: 10.1002/cncr.34786] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 04/22/2023]
Abstract
BACKGROUND Inhibition of the WEE1 kinase by adavosertib (AZD1775) potentiates replicative stress from genomic instability or chemotherapy. This study reports the pediatric solid tumor phase 2 results of the ADVL1312 trial combining irinotecan and adavosertib. METHODS Pediatric patients with recurrent neuroblastoma (part B), medulloblastoma/central nervous system embryonal tumors (part C), or rhabdomyosarcoma (part D) were treated with irinotecan and adavosertib orally for 5 days every 21 days. The combination was considered effective if there were at least three of 20 responses in parts B and D or six of 19 responses in part C. Tumor tissue was analyzed for alternative lengthening of telomeres and ATRX. Patient's prior tumor genomic analyses were provided. RESULTS The 20 patients with neuroblastoma (part B) had a median of three prior regimens and 95% had a history of prior irinotecan. There were three objective responses (9, 11, and 18 cycles) meeting the protocol defined efficacy end point. Two of the three patients with objective responses had tumors with alternative lengthening of telomeres. One patient with pineoblastoma had a partial response (11 cycles), but parts C and D did not meet the protocol defined efficacy end point. The combination was well tolerated and there were no dose limiting toxicities at cycle 1 or beyond in any parts of ADVL1312 at the recommended phase 2 dose. CONCLUSION This is first phase 2 clinical trial of adavosertib in pediatrics and the first with irinotecan. The combination may be of sufficient activity to consider further study of adavosertib in neuroblastoma.
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Affiliation(s)
- Kristina A. Cole
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heba Ijaz
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lea F. Surrey
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mariarita Santi
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiaowei Liu
- Children’s Oncology Group, Monravia, California, USA
| | | | - John M. Maris
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephan Voss
- Dana‐Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Elizabeth Fox
- St Jude Children’s Research Hospital, Memphis, Tennessee, USA
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Chehelgerdi M, Chehelgerdi M. The use of RNA-based treatments in the field of cancer immunotherapy. Mol Cancer 2023; 22:106. [PMID: 37420174 PMCID: PMC10401791 DOI: 10.1186/s12943-023-01807-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
Over the past several decades, mRNA vaccines have evolved from a theoretical concept to a clinical reality. These vaccines offer several advantages over traditional vaccine techniques, including their high potency, rapid development, low-cost manufacturing, and safe administration. However, until recently, concerns over the instability and inefficient distribution of mRNA in vivo have limited their utility. Fortunately, recent technological advancements have mostly resolved these concerns, resulting in the development of numerous mRNA vaccination platforms for infectious diseases and various types of cancer. These platforms have shown promising outcomes in both animal models and humans. This study highlights the potential of mRNA vaccines as a promising alternative approach to conventional vaccine techniques and cancer treatment. This review article aims to provide a thorough and detailed examination of mRNA vaccines, including their mechanisms of action and potential applications in cancer immunotherapy. Additionally, the article will analyze the current state of mRNA vaccine technology and highlight future directions for the development and implementation of this promising vaccine platform as a mainstream therapeutic option. The review will also discuss potential challenges and limitations of mRNA vaccines, such as their stability and in vivo distribution, and suggest ways to overcome these issues. By providing a comprehensive overview and critical analysis of mRNA vaccines, this review aims to contribute to the advancement of this innovative approach to cancer treatment.
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Affiliation(s)
- Mohammad Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran.
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
| | - Matin Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
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40
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Geoerger B, Marshall LV, Nysom K, Makin G, Bouffet E, Defachelles AS, Amoroso L, Aerts I, Leblond P, Barahona P, Van-Vlerken K, Fu E, Solca F, Lorence RM, Ziegler DS. Afatinib in paediatric patients with recurrent/refractory ErbB-dysregulated tumours: Results of a phase I/expansion trial. Eur J Cancer 2023; 188:8-19. [PMID: 37178647 DOI: 10.1016/j.ejca.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
AIM This phase I/expansion study assessed the safety, pharmacokinetics and preliminary antitumor activity of afatinib in paediatric patients with cancer. METHODS The dose-finding part enroled patients (2-<18 years) with recurrent/refractory tumours. Patients received 18 or 23 mg/m2/d afatinib orally (tablet or solution) in 28-d cycles. In the maximum tolerated dose (MTD) expansion, eligible patients (1-<18 years) had tumours fulfilling ≥2 of the following criteria in the pre-screening: EGFR amplification; HER2 amplification; EGFR membrane staining (H-score>150); HER2 membrane staining (H-score>0). The primary end-points were dose-limiting toxicities (DLTs), afatinib exposure, and objective response. RESULTS Of 564 patients pre-screened, 536 patients had biomarker data and 63 (12%) fulfilled ≥2 EGFR/HER2 criteria required for inclusion in the expansion part. A total of 56 patients were treated (17 in the dose-finding and 39 in the expansion part). DLTs were observed in one of six MTD-evaluable patients receiving 18 mg/m²/d and in two of five MTD-evaluable patients receiving 23 mg/m²/d; 18 mg/m²/d was defined as the MTD. There were no new safety signals. Pharmacokinetics confirmed exposure consistent with the approved dose in adults. One partial response (-81% per Response Assessment in Neuro-Oncology) was observed in a patient with a glioneuronal tumour harbouring a CLIP2::EGFR fusion; unconfirmed partial responses were observed in two patients. In total, 25% of patients experienced objective response or stable disease (95% confidence interval: 14-38). CONCLUSION Targetable EGFR/HER2 drivers are rare in paediatric cancers. Treatment with afatinib led to a durable response (>3 years) in one patient with a glioneuronal tumour with CLIP2::EGFR fusion.
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Affiliation(s)
- Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, INSERM U1015, Université Paris-Saclay, Villejuif, France.
| | - Lynley V Marshall
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Guy Makin
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK; Royal Manchester Children's Hospital, Manchester, UK
| | - Eric Bouffet
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | - Isabelle Aerts
- Institut Curie, PSL Research University, Oncology Center SIREDO, Paris, France
| | - Pierre Leblond
- Institute of Pediatric Hematology and Oncology, Centre Léon Bérard, Lyon, France
| | | | | | - Eric Fu
- Boehringer Ingelheim Pharmaceuticals, Inc. Ridgefield, CT, USA
| | - Flavio Solca
- Boehringer Ingelheim RCV GmbH & Co.KG Vienna, Austria
| | | | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia; Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia
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41
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Lode HN, Ladenstein R, Troschke-Meurer S, Struppe L, Siebert N, Zumpe M, Ehlert K, Huber S, Glogova E, Hundsdoerfer P, Eggert A, Zaniewska-Tekieli A, Balwierz W, Wieczorek A. Effect and Tolerance of N5 and N6 Chemotherapy Cycles in Combination with Dinutuximab Beta in Relapsed High-Risk Neuroblastoma Patients Who Failed at Least One Second-Line Therapy. Cancers (Basel) 2023; 15:3364. [PMID: 37444475 DOI: 10.3390/cancers15133364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
The anti-disialoganglioside (GD2) monoclonal antibody dinutuximab beta is approved for the maintenance treatment of high-risk neuroblastoma. Dinutuximab beta combined with different chemotherapy regimens is being investigated in various clinical settings. We conducted a retrospective clinical chart review of 25 patients with relapsed/refractory neuroblastoma who had failed ≥1 second-line therapy and received compassionate use treatment with dinutuximab beta long-term infusion combined with the induction chemotherapy regimens N5 (cisplatin, etoposide, vindesine) and N6 (vincristine, dacarbazine, ifosfamide, doxorubicin) recommended by the German Pediatric Oncology and Hematology Group [GPOH] guidelines. The treatment did not result in any unexpected severe toxicities or in any major treatment delays. Grade 3/4 pain was reported by 4/25 patients in cycle 1, decreasing to 0/9 patients in cycles 3 and 4. The median follow-up was 0.6 years. The best response in this group was 48% (12/25 patients), which included three patients with minor responses. At 1 year, the estimated event-free survival was 27% (95% confidence interval [CI] 8-47) and overall survival was 44% (95% CI 24-65). Combining long-term infusion of dinutuximab beta with N5 and N6 chemotherapy demonstrated an acceptable safety profile and encouraging objective response rates in heavily pretreated patients with high-risk neuroblastoma, warranting further evaluation in clinical trials.
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Affiliation(s)
- Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Ruth Ladenstein
- Department of Paediatrics, St. Anna Children's Hospital, Medical University of Vienna, 1090 Vienna, Austria
- Department for Studies and Statistics and Integrated Research and Project, Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung GmbH, 1090 Vienna, Austria
| | - Sascha Troschke-Meurer
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Linda Struppe
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Nikolai Siebert
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Maxi Zumpe
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Karoline Ehlert
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Stefanie Huber
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Evgenia Glogova
- Department of Paediatrics, St. Anna Children's Hospital, Medical University of Vienna, 1090 Vienna, Austria
- Department for Studies and Statistics and Integrated Research and Project, Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung GmbH, 1090 Vienna, Austria
| | | | - Angelika Eggert
- Clinic for Pediatric Hematology and Oncology, Charité University Medicine Berlin, 13353 Berlin, Germany
| | - Anna Zaniewska-Tekieli
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Aleksandra Wieczorek
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 31-008 Krakow, Poland
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Heczey A, Xu X, Courtney AN, Tian G, Barragan GA, Guo L, Amador CM, Ghatwai N, Rathi P, Wood MS, Li Y, Zhang C, Demberg T, Di Pierro EJ, Sher AC, Zhang H, Mehta B, Thakkar SG, Grilley B, Wang T, Weiss BD, Montalbano A, Subramaniam M, Xu C, Sachar C, Wells DK, Dotti G, Metelitsa LS. Anti-GD2 CAR-NKT cells in relapsed or refractory neuroblastoma: updated phase 1 trial interim results. Nat Med 2023; 29:1379-1388. [PMID: 37188782 DOI: 10.1038/s41591-023-02363-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/24/2023] [Indexed: 05/17/2023]
Abstract
Vα24-invariant natural killer T cells (NKTs) have anti-tumor properties that can be enhanced by chimeric antigen receptors (CARs). Here we report updated interim results from the first-in-human phase 1 evaluation of autologous NKTs co-expressing a GD2-specific CAR with interleukin 15 (IL15) (GD2-CAR.15) in 12 children with neuroblastoma (NB). The primary objectives were safety and determination of maximum tolerated dose (MTD). The anti-tumor activity of GD2-CAR.15 NKTs was assessed as a secondary objective. Immune response evaluation was an additional objective. No dose-limiting toxicities occurred; one patient experienced grade 2 cytokine release syndrome that was resolved by tocilizumab. The MTD was not reached. The objective response rate was 25% (3/12), including two partial responses and one complete response. The frequency of CD62L+NKTs in products correlated with CAR-NKT expansion in patients and was higher in responders (n = 5; objective response or stable disease with reduction in tumor burden) than non-responders (n = 7). BTG1 (BTG anti-proliferation factor 1) expression was upregulated in peripheral GD2-CAR.15 NKTs and is a key driver of hyporesponsiveness in exhausted NKT and T cells. GD2-CAR.15 NKTs with BTG1 knockdown eliminated metastatic NB in a mouse model. We conclude that GD2-CAR.15 NKTs are safe and can mediate objective responses in patients with NB. Additionally, their anti-tumor activity may be enhanced by targeting BTG1. ClinicalTrials.gov registration: NCT03294954 .
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Affiliation(s)
- Andras Heczey
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA.
- Department of Medicine, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA.
| | - Xin Xu
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Amy N Courtney
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Gengwen Tian
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel A Barragan
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Linjie Guo
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Claudia Martinez Amador
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Ghatwai
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Purva Rathi
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Michael S Wood
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Yanchuan Li
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Chunchao Zhang
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Thorsten Demberg
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Erica J Di Pierro
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Andrew C Sher
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Huimin Zhang
- Department of Medicine, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Birju Mehta
- Department of Medicine, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Sachin G Thakkar
- Department of Medicine, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Bambi Grilley
- Department of Medicine, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Tao Wang
- Biostatistics and Data Management Resource, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Brian D Weiss
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | | | | | | | | | | | - Gianpietro Dotti
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leonid S Metelitsa
- Department of Pediatrics, Center for Advanced Innate Cell Therapy, Baylor College of Medicine, Houston, TX, USA.
- Department of Medicine, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA.
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Lai HA, Sharp SE, Bhatia A, Dietz KR, McCarville B, Rajderkar D, Servaes S, Shulkin BL, Singh S, Trout AT, Watal P, Parisi MT. Imaging of pediatric neuroblastoma: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29974. [PMID: 36184716 PMCID: PMC10680359 DOI: 10.1002/pbc.29974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
Neuroblastoma is the most common extracranial solid neoplasm in children. This manuscript provides consensus-based imaging recommendations for pediatric neuroblastoma patients at diagnosis and during follow-up.
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Affiliation(s)
- Hollie A. Lai
- Department of Radiology, Children’s Health Orange County, Orange, CA
| | - Susan E. Sharp
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Aashim Bhatia
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kelly R. Dietz
- Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Sabah Servaes
- Department of Radiology, West Virginia University Children’s Hospital, Morgantown, WV
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, University of TN Health Science Center, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sudha Singh
- Department of Radiology, Monroe Carrell Jr Children’s Hospital, Vanderbilt University, Nashville, TN
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Pankaj Watal
- Department of Radiology, Nemours Children’s Hospital, Florida and University of Central Florida College of Medicine, Orlando, FL
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA
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Mora J, Castañeda A, Gorostegui M, Varo A, Perez-Jaume S, Simao M, Muñoz JP, Garraus M, Larrosa C, Salvador N, Lavarino C, Krauel L, Mañe S. Naxitamab Combined with Granulocyte-Macrophage Colony-Stimulating Factor as Consolidation for High-Risk Neuroblastoma Patients in First Complete Remission under Compassionate Use-Updated Outcome Report. Cancers (Basel) 2023; 15:cancers15092535. [PMID: 37174002 PMCID: PMC10177429 DOI: 10.3390/cancers15092535] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Naxitamab is an anti-GD2 antibody approved for the treatment of relapsed/refractory HR-NB. We report the survival, safety, and relapse pattern of a unique set of HR-NB patients consolidated with naxitamab after having achieved first CR. Eighty-two patients were treated with 5 cycles of GM-CSF for 5 days at 250 μg/m2/day (-4 to 0), followed by GM-CSF for 5 days at 500 μg/m2/day (1-5) and naxitamab at 3 mg/kg/day (1, 3, 5), on an outpatient basis. All patients but one were older than 18 months at diagnosis and had stage M; 21 (25.6%) pts had MYCN-amplified (A) NB; and 12 (14.6%) detectable MRD in the BM. Eleven (13.4%) pts had received high-dose chemotherapy and ASCT and 26 (31.7%) radiotherapy before immunotherapy. With a median follow-up of 37.4 months, 31 (37.8%) pts have relapsed. The pattern of relapse was predominantly (77.4%) an isolated organ. Five-year EFS and OS were 57.9% (71.4% for MYCN A) 95% CI = (47.2, 70.9%); and 78.6% (81% for MYCN A) 95% CI = (68.7%, 89.8%), respectively. EFS showed significant differences for patients having received ASCT (p = 0.037) and pre-immunotherapy MRD (p = 0.0011). Cox models showed only MRD as a predictor of EFS. In conclusion, consolidation with naxitamab resulted in reassuring survival rates for HR-NB patients after end-induction CR.
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Affiliation(s)
- Jaume Mora
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Alicia Castañeda
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Maite Gorostegui
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Amalia Varo
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Sara Perez-Jaume
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Margarida Simao
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Juan Pablo Muñoz
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Moira Garraus
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Cristina Larrosa
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Noelia Salvador
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Cinzia Lavarino
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Lucas Krauel
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Salvador Mañe
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
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Del Bufalo F, De Angelis B, Caruana I, Del Baldo G, De Ioris MA, Serra A, Mastronuzzi A, Cefalo MG, Pagliara D, Amicucci M, Li Pira G, Leone G, Bertaina V, Sinibaldi M, Di Cecca S, Guercio M, Abbaszadeh Z, Iaffaldano L, Gunetti M, Iacovelli S, Bugianesi R, Macchia S, Algeri M, Merli P, Galaverna F, Abbas R, Garganese MC, Villani MF, Colafati GS, Bonetti F, Rabusin M, Perruccio K, Folsi V, Quintarelli C, Locatelli F. GD2-CART01 for Relapsed or Refractory High-Risk Neuroblastoma. N Engl J Med 2023; 388:1284-1295. [PMID: 37018492 DOI: 10.1056/nejmoa2210859] [Citation(s) in RCA: 131] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Immunotherapy with chimeric antigen receptor (CAR)-expressing T cells that target the disialoganglioside GD2 expressed on tumor cells may be a therapeutic option for patients with high-risk neuroblastoma. METHODS In an academic, phase 1-2 clinical trial, we enrolled patients (1 to 25 years of age) with relapsed or refractory, high-risk neuroblastoma in order to test autologous, third-generation GD2-CAR T cells expressing the inducible caspase 9 suicide gene (GD2-CART01). RESULTS A total of 27 children with heavily pretreated neuroblastoma (12 with refractory disease, 14 with relapsed disease, and 1 with a complete response at the end of first-line therapy) were enrolled and received GD2-CART01. No failure to generate GD2-CART01 was observed. Three dose levels were tested (3-, 6-, and 10×106 CAR-positive T cells per kilogram of body weight) in the phase 1 portion of the trial, and no dose-limiting toxic effects were recorded; the recommended dose for the phase 2 portion of the trial was 10×106 CAR-positive T cells per kilogram. Cytokine release syndrome occurred in 20 of 27 patients (74%) and was mild in 19 of 20 (95%). In 1 patient, the suicide gene was activated, with rapid elimination of GD2-CART01. GD2-targeted CAR T cells expanded in vivo and were detectable in peripheral blood in 26 of 27 patients up to 30 months after infusion (median persistence, 3 months; range, 1 to 30). Seventeen children had a response to the treatment (overall response, 63%); 9 patients had a complete response, and 8 had a partial response. Among the patients who received the recommended dose, the 3-year overall survival and event-free survival were 60% and 36%, respectively. CONCLUSIONS The use of GD2-CART01 was feasible and safe in treating high-risk neuroblastoma. Treatment-related toxic effects developed, and the activation of the suicide gene controlled side effects. GD2-CART01 may have a sustained antitumor effect. (Funded by the Italian Medicines Agency and others; ClinicalTrials.gov number, NCT03373097.).
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Affiliation(s)
- Francesca Del Bufalo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Biagio De Angelis
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Ignazio Caruana
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giada Del Baldo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria A De Ioris
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Annalisa Serra
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Angela Mastronuzzi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria G Cefalo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Daria Pagliara
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Matteo Amicucci
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giuseppina Li Pira
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giovanna Leone
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Valentina Bertaina
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Matilde Sinibaldi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefano Di Cecca
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Marika Guercio
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Zeinab Abbaszadeh
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Laura Iaffaldano
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Monica Gunetti
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefano Iacovelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Rossana Bugianesi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefania Macchia
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Mattia Algeri
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Pietro Merli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Federica Galaverna
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Rachid Abbas
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria C Garganese
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria F Villani
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giovanna S Colafati
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Federico Bonetti
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Marco Rabusin
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Katia Perruccio
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Veronica Folsi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Concetta Quintarelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Franco Locatelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
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Desai AV, Elmuti L, Cahaney C, De Guzman RM, Streby KA, Cohn SL. Multimodality treatment for recurrent neuroblastoma in the central nervous system. Pediatr Blood Cancer 2023; 70:e30227. [PMID: 36720647 DOI: 10.1002/pbc.30227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
Survival for patients with recurrent central nervous system (CNS) neuroblastoma remains poor. A single-institutional study demonstrated the potential of multimodality therapy, including compartmental intrathecal radioimmunotherapy (cRIT) with 131 I-3F8 or 131 I-8H9 to increase the survival of neuroblastoma patients with CNS relapse. However, not all patients are able to receive this therapy. We report three patients with CNS neuroblastoma who remain disease-free 3-9 years after receiving multimodality treatment without cRIT. Additional studies to identify patients most likely to benefit from cRIT are warranted.
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Affiliation(s)
- Ami V Desai
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Lena Elmuti
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Christine Cahaney
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | | | - Keri A Streby
- Department of Pediatrics, The Ohio State University/Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Susan L Cohn
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
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Ognibene M, De Marco P, Amoroso L, Cangelosi D, Zara F, Parodi S, Pezzolo A. Multiple Genes with Potential Tumor Suppressive Activity Are Present on Chromosome 10q Loss in Neuroblastoma and Are Associated with Poor Prognosis. Cancers (Basel) 2023; 15:cancers15072035. [PMID: 37046696 PMCID: PMC10093755 DOI: 10.3390/cancers15072035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Neuroblastoma (NB) is a tumor affecting the peripheral sympathetic nervous system that substantially contributes to childhood cancer mortality. Despite recent advances in understanding the complexity of NB, the mechanisms determining its progression are still largely unknown. Some recurrent segmental chromosome aberrations (SCA) have been associated with poor survival. However, the prognostic role of most SCA has not yet been investigated. We examined a cohort of 260 NB primary tumors at disease onset for the loss of chromosome 10q, by array-comparative genomic hybridization (a-CGH) and Single Nucleotide Polymorphism (SNP) array and we found that 26 showed 10q loss, while the others 234 displayed different SCA. We observed a lower event-free survival for NB patients displaying 10q loss compared to patients with tumors carrying other SCA. Furthermore, analyzing the region of 10q loss, we identified a cluster of 75 deleted genes associated with poorer outcome. Low expression of six of these genes, above all CCSER2, was significantly correlated to worse survival using in silico data from 786 NB patients. These potential tumor suppressor genes can be partly responsible for the poor prognosis of NB patients with 10q loss.
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Abele N, Langner S, Felbor U, Lode H, Hosten N. Quantitative Diffusion-Weighted MRI of Neuroblastoma. Cancers (Basel) 2023; 15:cancers15071940. [PMID: 37046600 PMCID: PMC10092990 DOI: 10.3390/cancers15071940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023] Open
Abstract
Neuroblastoma is the most common extracranial, malignant, solid tumor found in children. In more than one-third of cases, the tumor is in an advanced stage, with limited resectability. The treatment options include resection, with or without (neo-/) adjuvant therapy, and conservative therapy, the latter even with curative intent. Contrast-enhanced MRI is used for staging and therapy monitoring. Diffusion-weighted imaging (DWI) is often included. DWI allows for a calculation of the apparent diffusion coefficient (ADC) for quantitative assessment. Histological tumor characteristics can be derived from ADC maps. Monitoring the response to treatment is possible using ADC maps, with an increase in ADC values in cases of a response to therapy. Changes in the ADC value precede volume reduction. The usual criteria for determining the response to therapy can therefore be supplemented by ADC values. While these changes have been observed in neuroblastoma, early changes in the ADC value in response to therapy are less well described. In this study, we evaluated whether there is an early change in the ADC values in neuroblastoma under therapy; if this change depends on the form of therapy; and whether this change may serve as a prognostic marker. We retrospectively evaluated neuroblastoma cases treated in our institution between June 2007 and August 2014. The examinations were grouped as 'prestaging'; 'intermediate staging'; 'final staging'; and 'follow-up'. A classification of "progress", "stable disease", or "regress" was made. For the determination of ADC values, regions of interest were drawn along the borders of all tumor manifestations. To calculate ADC changes (∆ADC), the respective MRI of the prestaging was used as a reference point or, in the case of therapies that took place directly after previous therapies, the associated previous staging. In the follow-up examinations, the previous examination was used as a reference point. The ∆ADC were grouped into ∆ADCregress for regressive disease, ∆ADCstable for stable disease, and ∆ADC for progressive disease. In addition, examinations at 60 to 120 days from the baseline were grouped as er∆ADCregress, er∆ADCstable, and er∆ADCprogress. Any differences were tested for significance using the Mann-Whitney test (level of significance: p < 0.05). In total, 34 patients with 40 evaluable tumor manifestations and 121 diffusion-weighted MRI examinations were finally included. Twenty-seven patients had INSS stage IV neuroblastoma, and seven had INSS stage III neuroblastoma. A positive N-Myc expression was found in 11 tumor diseases, and 17 patients tested negative for N-Myc (with six cases having no information). 26 patients were assigned to the high-risk group according to INRG and eight patients to the intermediate-risk group. There was a significant difference in mean ADC values from the high-risk group compared to those from the intermediate-risk group, according to INRG. The differences between the mean ∆ADC values (absolute and percentage) according to the course of the disease were significant: between ∆ADCregress and ∆ADCstable, between ∆ADCprogress and ∆ADCstable, as well as between ∆ADCregress and ∆ADCprogress. The differences between the mean er∆ADC values (absolute and percentage) according to the course of the disease were significant: between er∆ADCregress and er∆ADCstable, as well as between er∆ADCregress and er∆ADCprogress. Forms of therapy, N-Myc status, and risk groups showed no further significant differences in mean ADC values and ∆ADC/er∆ADC. A clear connection between the ADC changes and the response to therapy could be demonstrated. This held true even within the first 120 days after the start of therapy: an increase in the ADC value corresponds to a probable response to therapy, while a decrease predicts progression. Minimal or no changes were seen in cases of stable disease.
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Affiliation(s)
- Niklas Abele
- Department of Radiology, Germany University of Greifswald, 17475 Greifswald, Germany
- Institute of Pathology, University of Erlangen, 91054 Erlangen, Germany
| | - Soenke Langner
- Department of Radiology, Germany University of Greifswald, 17475 Greifswald, Germany
- Department of Radiology, University of Rostock, 18057 Rostock, Germany
| | - Ute Felbor
- Department of Human Genetics, University of Greifswald, 17475 Greifswald, Germany
- Interfaculty Institute of Genetics and Functional Genetics, University of Greifswald, 17475 Greifswald, Germany
| | - Holger Lode
- Department of Pediatric Hematology and Oncology, University of Greifswald, 17475 Greifswald, Germany
| | - Norbert Hosten
- Department of Radiology, Germany University of Greifswald, 17475 Greifswald, Germany
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Veiga-Canuto D, Cerdà-Alberich L, Jiménez-Pastor A, Carot Sierra JM, Gomis-Maya A, Sangüesa-Nebot C, Fernández-Patón M, Martínez de las Heras B, Taschner-Mandl S, Düster V, Pötschger U, Simon T, Neri E, Alberich-Bayarri Á, Cañete A, Hero B, Ladenstein R, Martí-Bonmatí L. Independent Validation of a Deep Learning nnU-Net Tool for Neuroblastoma Detection and Segmentation in MR Images. Cancers (Basel) 2023; 15:cancers15051622. [PMID: 36900410 PMCID: PMC10000775 DOI: 10.3390/cancers15051622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES To externally validate and assess the accuracy of a previously trained fully automatic nnU-Net CNN algorithm to identify and segment primary neuroblastoma tumors in MR images in a large children cohort. METHODS An international multicenter, multivendor imaging repository of patients with neuroblastic tumors was used to validate the performance of a trained Machine Learning (ML) tool to identify and delineate primary neuroblastoma tumors. The dataset was heterogeneous and completely independent from the one used to train and tune the model, consisting of 300 children with neuroblastic tumors having 535 MR T2-weighted sequences (486 sequences at diagnosis and 49 after finalization of the first phase of chemotherapy). The automatic segmentation algorithm was based on a nnU-Net architecture developed within the PRIMAGE project. For comparison, the segmentation masks were manually edited by an expert radiologist, and the time for the manual editing was recorded. Different overlaps and spatial metrics were calculated to compare both masks. RESULTS The median Dice Similarity Coefficient (DSC) was high 0.997; 0.944-1.000 (median; Q1-Q3). In 18 MR sequences (6%), the net was not able neither to identify nor segment the tumor. No differences were found regarding the MR magnetic field, type of T2 sequence, or tumor location. No significant differences in the performance of the net were found in patients with an MR performed after chemotherapy. The time for visual inspection of the generated masks was 7.9 ± 7.5 (mean ± Standard Deviation (SD)) seconds. Those cases where manual editing was needed (136 masks) required 124 ± 120 s. CONCLUSIONS The automatic CNN was able to locate and segment the primary tumor on the T2-weighted images in 94% of cases. There was an extremely high agreement between the automatic tool and the manually edited masks. This is the first study to validate an automatic segmentation model for neuroblastic tumor identification and segmentation with body MR images. The semi-automatic approach with minor manual editing of the deep learning segmentation increases the radiologist's confidence in the solution with a minor workload for the radiologist.
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Affiliation(s)
- Diana Veiga-Canuto
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
- Correspondence: (D.V.-C.); (L.M.-B.)
| | - Leonor Cerdà-Alberich
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
| | - Ana Jiménez-Pastor
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, 46026 Valencia, Spain
| | - José Miguel Carot Sierra
- Departamento de Estadística e Investigación Operativa Aplicadas y Calidad, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain
| | - Armando Gomis-Maya
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
| | - Cinta Sangüesa-Nebot
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
| | - Matías Fernández-Patón
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
| | - Blanca Martínez de las Heras
- Unidad de Oncohematología Pediátrica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
| | - Sabine Taschner-Mandl
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Vanessa Düster
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Ulrike Pötschger
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Cologne, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | | | - Adela Cañete
- Unidad de Oncohematología Pediátrica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Cologne, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Ruth Ladenstein
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Luis Martí-Bonmatí
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain
- Correspondence: (D.V.-C.); (L.M.-B.)
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Wang H, Qin J, Chen X, Zhang T, Zhang L, Ding H, Pan Z, He L. Contrast-enhanced computed tomography radiomics in predicting primary site response to neoadjuvant chemotherapy in high-risk neuroblastoma. Abdom Radiol (NY) 2023; 48:976-986. [PMID: 36571609 DOI: 10.1007/s00261-022-03774-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To explore the clinical value of contrast-enhanced computed tomography (CECT) radiomics in predicting primary site response to neoadjuvant chemotherapy in high-risk neuroblastoma. MATERIALS AND METHODS Seventy patients were retrospectively included and separated into very good partial response (VGPR) group and non-VGPR group according to the changes in primary tumor volume. The clinical features with statistical difference between the two groups were used to construct the clinical models using a logistic regression (LR) algorithm. The radiomics models based on different radiomics features selected by Kruskal-Wallis (KW) test and recursive feature elimination (RFE) were established using support vector machine (SVM) and LR algorithms. The radiomics score (Radscore) and clinical features were integrated into the combined models. Leave-one-out cross-validation (LOOCV) was used to validate the predictive performance of models in the entire dataset. RESULTS The optimal clinical model achieved an area under the curve (AUC) of 0.767 [95% confidence interval (CI): 0.638, 0.896] and an accuracy of 0.771 after LOOCV. The AUCs of the best KW + SVM, KW + LR, RFE + SVM, and RFE + LR radiomics models were 0.816, 0.826, 0.853, and 0.850, respectively, and the corresponding AUCs after LOOCV were 0.780, 0.785, 0.755, and 0.772, respectively. The AUC and accuracy after LOOCV of the optimal combined model was 0.804 (95% CI: 0.694, 0.915) and 0.814, respectively. The Delong test showed a statistical difference in predictive performance between the optimal clinical and combined models after LOOCV (Z = 2.003, P = 0.045). The decision curve analysis showed that the combined model performs better than the clinical model. CONCLUSION The CECT radiomics models have a favorable predictive performance in predicting VGPR of high-risk neuroblastoma to neoadjuvant chemotherapy. When integrating radiomics features and clinical features, the predictive performance of the combined models can be further improved.
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Affiliation(s)
- Haoru Wang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China
| | - Jinjie Qin
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China
| | - Xin Chen
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China
| | - Ting Zhang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China
| | - Li Zhang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China
| | - Hao Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China.
| | - Ling He
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China.
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