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Alsadhan A, Chen J, Gaglione EM, Underbayev C, Tuma PL, Tian X, Freeman LA, Baskar S, Nierman P, Soto S, Itsara A, Ahn IE, Sun C, Bibikova E, Hartmann TN, Mhibik M, Wiestner A. CD49d Expression Identifies a Biologically Distinct Subtype of Chronic Lymphocytic Leukemia with Inferior Progression-Free Survival on BTK Inhibitor Therapy. Clin Cancer Res 2023; 29:3612-3621. [PMID: 37227160 PMCID: PMC10524232 DOI: 10.1158/1078-0432.ccr-22-3217] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/14/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To determine the role of CD49d for response to Bruton's tyrosine kinase inhibitors (BTKi) in patients with chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS In patients treated with acalabrutinib (n = 48), CD49d expression, VLA-4 integrin activation, and tumor transcriptomes of CLL cells were assessed. Clinical responses to BTKis were investigated in acalabrutinib- (n = 48; NCT02337829) and ibrutinib-treated (n = 73; NCT01500733) patients. RESULTS In patients treated with acalabrutinib, treatment-induced lymphocytosis was comparable for both subgroups but resolved more rapidly for CD49d+ cases. Acalabrutinib inhibited constitutive VLA-4 activation but was insufficient to block BCR and CXCR4-mediated inside-out activation. Transcriptomes of CD49d+ and CD49d- cases were compared using RNA sequencing at baseline and at 1 and 6 months on treatment. Gene set enrichment analysis revealed increased constitutive NF-κB and JAK-STAT signaling, enhanced survival, adhesion, and migratory capacity in CD49d+ over CD49d- CLL that was maintained during therapy. In the combined cohorts of 121 BTKi-treated patients, 48 (39.7%) progressed on treatment with BTK and/or PLCG2 mutations detected in 87% of CLL progressions. Consistent with a recent report, homogeneous and bimodal CD49d-positive cases (the latter having concurrent CD49d+ and CD49d- CLL subpopulations, irrespective of the traditional 30% cutoff value) had a shorter time to progression of 6.6 years, whereas 90% of cases homogenously CD49d- were estimated progression-free at 8 years (P = 0.0004). CONCLUSIONS CD49d/VLA-4 emerges as a microenvironmental factor that contributes to BTKi resistance in CLL. The prognostic value of CD49d is improved by considering bimodal CD49d expression. See related commentary by Tissino et al., p. 3560.
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Affiliation(s)
- Anfal Alsadhan
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
- Catholic University of America, DC, 20064, USA
- College of applied medical sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jonathan Chen
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Erika M. Gaglione
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Chingiz Underbayev
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | | | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lita A. Freeman
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sivasubramanian Baskar
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Pia Nierman
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Susan Soto
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Andy Itsara
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Inhye E. Ahn
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Clare Sun
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | | | - Tanja Nicole Hartmann
- Department of Medicine I, Medical Center-University, Faculty of Medicine of Freiburg, Freiburg, Germany
| | - Maissa Mhibik
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
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Abstract
Patients with chronic lymphocytic leukemia can be divided into three categories: those who are minimally affected by the problem, often never requiring therapy; those that initially follow an indolent course but subsequently progress and require therapy; and those that from the point of diagnosis exhibit an aggressive disease necessitating treatment. Likewise, such patients pass through three phases: development of the disease, diagnosis, and need for therapy. Finally, the leukemic clones of all patients appear to require continuous input from the exterior, most often through membrane receptors, to allow them to survive and grow. This review is presented according to the temporal course that the disease follows, focusing on those external influences from the tissue microenvironment (TME) that support the time lines as well as those internal influences that are inherited or develop as genetic and epigenetic changes occurring over the time line. Regarding the former, special emphasis is placed on the input provided via the B-cell receptor for antigen and the C-X-C-motif chemokine receptor-4 and the therapeutic agents that block these inputs. Regarding the latter, prominence is laid upon inherited susceptibility genes and the genetic and epigenetic abnormalities that lead to the developmental and progression of the disease.
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Affiliation(s)
- Nicholas Chiorazzi
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Shih-Shih Chen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Kanti R. Rai
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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Bosch R, Mora A, Vicente EP, Ferrer G, Jansà S, Damle R, Gorlatov S, Rai K, Montserrat E, Nomdedeu J, Pratcorona M, Blanco L, Saavedra S, Garrido A, Esquirol A, Garcia I, Granell M, Martino R, Delgado J, Sierra J, Chiorazzi N, Moreno C. FcγRIIb expression in early stage chronic lymphocytic leukemia. Leuk Lymphoma 2017; 58:2642-2648. [PMID: 28372509 DOI: 10.1080/10428194.2017.1307981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In normal B-cells, B-cell antigen receptor (BCR) signaling can be negatively regulated by the low-affinity receptor FcγRIIb (CD32b). To better understand the role of FcγRIIb in chronic lymphocytic leukemia (CLL), we correlated its expression on 155 samples from newly-diagnosed Binet A patients with clinical characteristics and outcome. FcγRIIb expression was similar in normal B-cells and leukemic cells, this being heterogenous among patients and within CLL clones. FcγRIIb expression did not correlate with well known prognostic markers [disease stage, serum beta-2 microglobulin (B2M), IGHV mutational status, expression of ZAP-70 and CD38, and cytogenetics] except for a weak concordance with CD49d. Moreover, patients with low FcγRIIb expression (69/155, 44.5%) required therapy earlier than those with high FcγRIIb expression (86/155, 55.5%) (median 151.4 months vs. not reached; p=.071). These results encourage further investigation on the role of FcγRIIb in CLL biology and prognostic significance in larger series of patients.
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Affiliation(s)
- Rosa Bosch
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Alba Mora
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Eva Puy Vicente
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Gerardo Ferrer
- c Karches Centre for Chronic Lymphocytic Leukemia Research, The Feinstein Institute for Medical Research , Manhasset , NY , USA
| | - Sonia Jansà
- d Department of Human Anatomy and Embryology , University of Barcelona , Barcelona , Spain
| | - Rajendra Damle
- c Karches Centre for Chronic Lymphocytic Leukemia Research, The Feinstein Institute for Medical Research , Manhasset , NY , USA
| | | | - Kanti Rai
- f Haematology/Oncology, Oncology LIJ Medical Centre , Lake Success , NY , USA
| | - Emili Montserrat
- g Department of Hematology , Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS , Barcelona , Spain
| | - Josep Nomdedeu
- h Laboratory of Hematology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Marta Pratcorona
- h Laboratory of Hematology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Laura Blanco
- h Laboratory of Hematology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Silvana Saavedra
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Ana Garrido
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Albert Esquirol
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Irene Garcia
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Miquel Granell
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Rodrigo Martino
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Julio Delgado
- g Department of Hematology , Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS , Barcelona , Spain
| | - Jorge Sierra
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Nicholas Chiorazzi
- c Karches Centre for Chronic Lymphocytic Leukemia Research, The Feinstein Institute for Medical Research , Manhasset , NY , USA
| | - Carol Moreno
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
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Degheidy HA, Venzon DJ, Farooqui MZ, Abbasi F, Arthur DC, Wiestner A, Stetler-Stevenson MA, Marti GE. Improved ZAP-70 assay using two clones, multiple methods of analysis and clinical correlation. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2011; 80:309-17. [PMID: 21472850 PMCID: PMC3407415 DOI: 10.1002/cyto.b.20593] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/23/2011] [Accepted: 03/01/2011] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In a companion methodological study, we compared two anti-ZAP-70 clones (1E7.2 AF 488 and SBZAP PE) and four selected methods of analysis. Clinical correlations are required for validation. METHODS Multicolor flow-cytometric evaluation of ZAP-70, CD38, CD69, CD26, CD49d, and CD27 was tested in 45 untreated-CLL patients. Four methods of ZAP-70 expression analysis and a scoring system were designed. A correlation analysis between ZAP-70 score, immunoglobulin heavy chain variable (IGHV) mutational status, fluorescence in situ hybridization, and these biomarkers was undertaken. RESULTS There is a strong correlation between ZAP-70 expression and IGHV mutational status. The scoring system for a single reagent (P = 0.0006 or 0.0002) favors the use of multiple methods of analysis. The combined score was substantially equivalent (P = 0.0003). There was also a correlation with del 13q14 (P = 0.017) and trisomy12 (P = 0.011). A correlation for CD38 and ZAP-70 score was seen using both 1E7.2 AF488 and SBZAP PE when ≥20% or ≥7% cutoff was used. A positive correlation was seen for CD49d expression using both reagents. CD26 showed a correlation with ZAP-70 expression, but it was dependent upon the method of analysis. CD69 and CD27 showed no statistically significant correlation. CONCLUSION In our study population, ZAP-70 expression is the better predictor of the IGHV mutational status. The correlation analysis confirms that the use of four methods of analysis with a single reagent or both reagents is superior to the use of a single method of analysis. The routine use of CD38, CD49d, and CD26 will require standardization.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/blood
- Antigens, Surface/blood
- Antigens, Surface/immunology
- Biomarkers, Tumor/blood
- Female
- Flow Cytometry/methods
- Gene Expression/immunology
- Humans
- Immunoassay/standards
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Heavy Chains/immunology
- In Situ Hybridization, Fluorescence
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
- Mutation
- ZAP-70 Protein-Tyrosine Kinase/blood
- ZAP-70 Protein-Tyrosine Kinase/immunology
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Affiliation(s)
- Heba A. Degheidy
- Center for Biologics Evaluation and Research, FDA, Bethesda, MD, USA
| | | | | | - Fatima Abbasi
- Center for Biologics Evaluation and Research, FDA, Bethesda, MD, USA
| | | | | | | | - Gerald E. Marti
- Center for Biologics Evaluation and Research, FDA, Bethesda, MD, USA
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Anti-human very late antigen-α4 (CD49d) monoclonal antibody (BU49) cross-reacts with the canine B-cell leukemia cell line GL-1, resulting in the induction of homotypic cell aggregation. Cell Immunol 2010; 263:55-64. [DOI: 10.1016/j.cellimm.2010.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 02/17/2010] [Accepted: 02/22/2010] [Indexed: 12/24/2022]
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Bulian P, Del Poeta G, Gattei V. How would I manage a sample submitted for flow cytometry analysis for suspicious chronic lymphocytic leukaemia. Hematol Oncol 2009; 27:186-9. [DOI: 10.1002/hon.900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dal-Bo M, Bertoni F, Forconi F, Zucchetto A, Bomben R, Marasca R, Deaglio S, Laurenti L, Efremov DG, Gaidano G, Del Poeta G, Gattei V. Intrinsic and extrinsic factors influencing the clinical course of B-cell chronic lymphocytic leukemia: prognostic markers with pathogenetic relevance. J Transl Med 2009; 7:76. [PMID: 19715592 PMCID: PMC2747913 DOI: 10.1186/1479-5876-7-76] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 08/28/2009] [Indexed: 11/13/2022] Open
Abstract
B-cell chronic lymphocytic leukemia (CLL), the most frequent leukemia in the Western world, is characterized by extremely variable clinical courses with survivals ranging from 1 to more than 15 years. The pathogenetic factors playing a key role in defining the biological features of CLL cells, hence eventually influencing the clinical aggressiveness of the disease, are here divided into "intrinsic factors", mainly genomic alterations of CLL cells, and "extrinsic factors", responsible for direct microenvironmental interactions of CLL cells; the latter group includes interactions of CLL cells occurring via the surface B cell receptor (BCR) and dependent to specific molecular features of the BCR itself and/or to the presence of the BCR-associated molecule ZAP-70, or via other non-BCR-dependent interactions, e.g. specific receptor/ligand interactions, such as CD38/CD31 or CD49d/VCAM-1. A putative final model, discussing the pathogenesis and the clinicobiological features of CLL in relationship of these factors, is also provided.
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Affiliation(s)
- Michele Dal-Bo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy.
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