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Niemann CU, Munir T, Moreno C, Owen C, Follows GA, Benjamini O, Janssens A, Levin MD, Robak T, Simkovic M, Voloshin S, Vorobyev V, Yagci M, Ysebaert L, Qi K, Qi Q, Sinet P, Parisi L, Srinivasan S, Schuier N, Baeten K, Howes A, Caces DB, Kater AP. Fixed-duration ibrutinib-venetoclax versus chlorambucil-obinutuzumab in previously untreated chronic lymphocytic leukaemia (GLOW): 4-year follow-up from a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24:1423-1433. [PMID: 37944541 DOI: 10.1016/s1470-2045(23)00452-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND In the GLOW study, fixed-duration ibrutinib-venetoclax showed superior progression-free survival versus chlorambucil-obinutuzumab in patients with previously untreated chronic lymphocytic leukaemia who were older or had comorbidities, or both, at a median follow up of 27·7 months. In this Article, we report updated outcomes from GLOW after a 46-month median follow-up. METHODS GLOW was a randomised, multicentre, phase 3 study done at 67 hospital centres across 14 countries. Patients aged 65 years and older or 18-64 years with previously untreated chronic lymphocytic leukaemia and a cumulative illness rating scale score of more than 6 or creatinine clearance less than 70 mL/min, or both, and an Eastern Cooperative Oncology Group performance status of 2 or less were randomly assigned (1:1) via an interactive web system with permuted blocks (block size of four) and stratified by IGHV mutational status and the presence of del11q aberration to the ibrutinib-venetoclax group (three cycles of ibrutinib lead-in [420 mg/day, orally], followed by 12 cycles of ibrutinib plus venetoclax [400 mg/day, orally, including a 5-week dose ramp-up]) or the chlorambucil-obinutuzumab group (six cycles of chlorambucil [0·5 mg/kg, orally, on days 1 and 15 of each cycle], and obinutuzumab [1000 mg, intravenously, on days 1 (or 100 mg on day 1 and 900 mg on day 2), 8, and 15 of cycle 1 and day 1 of cycles 2-6]). The primary endpoint was progression-free survival in the intention-to-treat population, assessed by an independent review committee. The safety population included all randomised patients who received at least one dose of the study treatment. This study is registered with ClinicalTrials.gov (NCT03462719) and the EU Clinical Trials Register (EudraCT 2017-004699-77). FINDINGS Between May 4, 2018, and April 5, 2019, 211 patients (122 [58%] were male and 89 [42%] were female) were randomly assigned to receive ibrutinib-venetoclax (n=106) or chlorambucil-obinutuzumab (n=105). At a median of 46 months (IQR 43-47) of follow-up, progression-free survival remained superior for the ibrutinib-venetoclax group (hazard ratio 0·214 [95% CI 0·138-0·334]; p<0·0001); 42-month progression-free survival rates were 74·6% (95% CI 65·0-82·0) for ibrutinib-venetoclax and 24·8% (16·5-34·1) for chlorambucil-obinutuzumab. Following the primary analysis, one patient in the chlorambucil-obinutuzumab group had a serious adverse event of myelodysplastic syndrome. Treatment-related deaths were reported in one patient receiving ibrutinib-venetoclax (cardiac failure, pneumonia, and sinus node dysfunction) and in one patient receiving chlorambucil-obinutuzumab (pneumonia). There were 15 deaths in the ibrutinib-venetoclax group (of which three were due to post-treatment infections) and 30 deaths in the chlorambucil-obinutuzumab group (of which 10 were due to post-treatment infections). INTERPRETATION After 4 years of follow-up, ibrutinib-venetoclax continues to significantly prolong progression-free survival (vs chemoimmunotherapy) in patients with previously untreated chronic lymphocytic leukaemia, supporting its use as a first-line option. FUNDING Janssen Research & Development and Pharmacyclics.
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Affiliation(s)
- Carsten U Niemann
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | | | | | | | | | - Tadeusz Robak
- Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Martin Simkovic
- 4th Department of Internal Medicine-Haematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Králové, Czech Republic
| | - Sergey Voloshin
- Russian Scientific and Research Institute of Hematology and Transfusiology, St Petersburg, Russia
| | | | - Munci Yagci
- Gazi Universitesi Tip Fakultesi, Ankara, Türkiye
| | - Loic Ysebaert
- Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Keqin Qi
- Janssen Research & Development, Titusville, NJ, USA
| | - Qianya Qi
- Janssen Research & Development, Raritan, NJ, USA
| | - Pierre Sinet
- Janssen Research & Development, Bridgewater, NJ, USA
| | - Lori Parisi
- Janssen Research & Development, Raritan, NJ, USA
| | - Srimathi Srinivasan
- Oncology Translational Research, Janssen Research & Development, Lower Gwynedd Township, PA, USA
| | | | - Kurt Baeten
- Janssen Research & Development, Beerse, Belgium
| | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
| | | | - Arnon P Kater
- Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
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Follows AM, Follows GA. Transverse Leukonychia (Mees' Lines). N Engl J Med 2023; 389:e48. [PMID: 38009615 DOI: 10.1056/nejmicm2304533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Annabel M Follows
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Carson L, Johnston A, Follows GA, Santarsieri A. Relapsed mantle cell lymphoma presenting with lactic acidosis and hypoglycemia: A case report. Clin Case Rep 2023; 11:e6838. [PMID: 36644610 PMCID: PMC9834148 DOI: 10.1002/ccr3.6838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Lactic acidosis and hypoglycemia are rare presentations of malignancy with a poor prognosis. We present the case of a mantle cell lymphoma patient who relapsed with lactic acidosis and hypoglycemia. Although blood glucose, pH, and lactate normalized following chemotherapy and intensive care support, the patient died from ventilator-associated pneumonia.
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Affiliation(s)
- Lucy Carson
- University of Cambridge School of Clinical MedicineCambridgeUK
| | - Andrew Johnston
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
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Bulley SJ, Santarsieri A, Lentell IC, O'Sullivan B, Hodson A, Firth O, Sadullah S, Follows AM, Karanth M, Min SY, Fowler A, Russell J, Uttenthal BJ, Hodson DJ, Follows GA. Managing relapsed refractory lymphoma with palliative oral chemotherapy: A multicentre retrospective study. EJHaem 2022; 3:1316-1320. [PMID: 36467809 PMCID: PMC9713053 DOI: 10.1002/jha2.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Abstract
PEP-C (prednisolone, etoposide, procarbazine and cyclophosphamide) is an orally administered daily chemotherapy regimen used with palliative intent in relapsed refractory lymphoma. To our knowledge, no data on PEP-C have been reported since the original group described the regimen. Here we present a multicentre retrospective cohort reporting our use of PEP-C in 92 patients over an 8-year period. We find that even heavily pretreated lymphoma can respond to PEP-C, particularly low-grade lymphoma (including mantle cell) and lymphoma that was sensitive to the previous line of systemic therapy (chemosensitive). These characteristics may help in the selection of patients likely to derive benefit. The median overall survival of patients with chemosensitive lymphoma treated with PEP-C is 217 days. Within the limitations of a retrospective cohort, we find that PEP-C is well tolerated: the most common toxicity leading to discontinuation is marrow suppression. We suggest that PEP-C should be considered for patients with relapsed refractory lymphoma in two settings: first, where there is no licensed alternative; and second, where the licensed alternative is an intravenous drug and the patient would prefer to choose an oral chemotherapy option.
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Affiliation(s)
- Simon J Bulley
- Department of Haematology and Pharmacy Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK.,Murray Edwards College, University of Cambridge Huntingdon Road Cambridge UK
| | - Anna Santarsieri
- Department of Haematology and Pharmacy Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK
| | - Isabel C Lentell
- Department of Haematology and Pharmacy Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK
| | - Brendan O'Sullivan
- Pharmacy Department Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK
| | - Andrew Hodson
- Department of Haematology Ipswich Hospital Ipswich Suffolk UK
| | - Oliver Firth
- Department of Haematology Ipswich Hospital Ipswich Suffolk UK
| | - Shalal Sadullah
- Department of Haematology James Paget University Hospitals NHS Foundation Trust Great Yarmouth Norfolk UK
| | - Annabel M Follows
- Department of Haematology and Pharmacy Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK.,Murray Edwards College, University of Cambridge Huntingdon Road Cambridge UK
| | - Mamatha Karanth
- Department of Haematology West Suffolk NHS Foundation Trust Bury St Edmunds Suffolk UK
| | - Sandra Young Min
- Department of Haematology West Suffolk NHS Foundation Trust Bury St Edmunds Suffolk UK
| | - Alexis Fowler
- Department of Haematology Hinchingbrooke Hospital North West Anglia NHS Foundation Trust Hinchingbrooke Huntingdon UK
| | - James Russell
- Department of Haematology and Pharmacy Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK
| | - Benjamin J Uttenthal
- Department of Haematology and Pharmacy Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK
| | - Daniel J Hodson
- Wellcome-MRC Cambridge Stem Cell Institute University of Cambridge Puddicombe Way Cambridge UK.,Department of Haematology University of Cambridge Cambridge UK
| | - George A Follows
- Department of Haematology and Pharmacy Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus Cambridge UK
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Santarsieri A, Rudge JF, Amin I, Gelson W, Parmar J, Pettit S, Sharkey L, Uttenthal BJ, Follows GA. Incidence and outcomes of post-transplant lymphoproliferative disease after 5365 solid-organ transplants over a 20-year period at two UK transplant centres. Br J Haematol 2022; 197:310-319. [PMID: 35235680 DOI: 10.1111/bjh.18065] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of solid-organ transplantation (SOT). We present the incidence and outcomes of PTLD in a cohort of 5365 SOT recipients over a 20-year period at two UK transplant centres. With a median follow-up of 7.7 years, 142 of 5365 patients have developed PTLD. Cumulative incidence was 18% at five years after multivisceral transplant and 1%-3% at five years following the other SOT types. Twenty-year cumulative incidence was 2%-3% following liver and heart transplantation and 10% following kidney transplantation. Median overall survival (OS) following SOT was 16 years, which is significantly reduced compared with the age-adjusted UK population. There is relatively high early mortality following diagnosis of PTLD and only patients surviving two years regained a longer-term survival approaching the non-PTLD SOT cohort. Of 90 patients with monomorphic PTLD, diffuse large B-cell lymphoma, 66 were treated with first-line rituximab monotherapy and 24 received first-line rituximab plus chemotherapy. Up-front rituximab monotherapy does not appear to compromise OS, but the number of patients dying from non-lymphoma causes before and after treatment remains high with both treatment approaches. Multivariate analysis of all 90 monomorphic PTLD patients identified an International Prognostic Index (IPI) of 3+ as the strongest pretreatment variable associating with inferior one-year OS.
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Affiliation(s)
- Anna Santarsieri
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.,Anglia Ruskin University, Cambridge, UK
| | - John F Rudge
- Bullard Laboratories, University of Cambridge, Cambridge, UK
| | - Irum Amin
- Department of General Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Will Gelson
- Department of Hepatology, Addenbrooke's Hospital, Cambridge, UK
| | - Jasvir Parmar
- Cardio-Thoracic Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephen Pettit
- Cardio-Thoracic Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Lisa Sharkey
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
| | | | - George A Follows
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.,Anglia Ruskin University, Cambridge, UK
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Follows GA, Barrington SF, Bhuller KS, Culligan DJ, Cutter DJ, Gallop-Evans E, Kassam S, Osborne W, Sadullah S, Townsend W, Uttenthal BJ, Collins GP. Guideline for the first-line management of Classical Hodgkin Lymphoma - A British Society for Haematology guideline. Br J Haematol 2022; 197:558-572. [PMID: 35191541 DOI: 10.1111/bjh.18083] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/21/2022]
Abstract
This guideline was compiled according to the British Society for Haematology (BSH) process at https://b-s-h.org.uk/media/16732/bsh-guidance-development-process-dec-5-18.pdf. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. Recommendations are based on a review of the literature using Medline, PubMed/Medline and Cochrane searches beginning from 2013 up to January 2021. The following search terms were used: [Hodgkin lymphoma OR Hodgkin disease] NOT non-Hodgkin; AND [chemotherapy OR radiotherapy]; AND [elderly]; AND [teenage OR adolescent OR young adult]; AND [pregnancy]. Filters were applied to include only publications written in English, studies carried out in humans, clinical conferences, congresses, clinical trials, clinical studies, meta-analyses, multicentre studies and randomised controlled trials. References pre-2013 were taken from the previous version of this guideline.1 Review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Haematology Oncology Taskforce, the BSH Guidelines Committee and the Haematology Oncology sounding board of BSH.
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Affiliation(s)
- George A Follows
- Department of Haematology, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Kaljit S Bhuller
- Paediatric, Teenage & Young Adult (TYA) Haematology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - David J Cutter
- Department of Oncology, Oxford Cancer and Haematology Centre, University of Oxford, Oxford, UK
| | | | - Shireen Kassam
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Wendy Osborne
- Department of Haematology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Shalal Sadullah
- Department of Haematology, James Paget University Hospital, Great Yarmouth, UK
| | - William Townsend
- Department of Haematology, University College Hospital London Hospitals NHS Trust, London, UK
| | - Benjamin J Uttenthal
- Department of Haematology, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, University of Oxford, Oxford, UK
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7
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Dobson R, Du PY, Rásó-Barnett L, Yao WQ, Chen Z, Casa C, Ei-Daly H, Farkas L, Soilleux E, Wright P, Grant JW, Rodriguez-Justo M, Follows GA, Rashed H, Fabre M, Baxter EJ, Vassiliou G, Wotherspoon A, Attygalle AD, Liu H, Du MQ. Early detection of T-cell lymphoma with T follicular helper phenotype by RHOA mutation analysis. Haematologica 2022; 107:489-499. [PMID: 33567811 PMCID: PMC8804563 DOI: 10.3324/haematol.2020.265991] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/22/2021] [Indexed: 02/05/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma with T follicular helper phenotype (PTCL-TFH) are a group of complex clinicopathological entities that originate from T follicular helper cells and share a similar mutation profile. Their diagnosis is often a challenge, particularly at an early stage, because of a lack of specific histological and immunophenotypic features, paucity of neoplastic T cells and prominent polymorphous infiltrate. We investigated whether the lymphoma-associated RHOA Gly17Val (c.50G>T) mutation, occurring in 60% of cases, is present in the early "reactive" lesions, and whether mutation analysis could help to advance the early diagnosis of lymphoma. The RHOA mutation was detected by quantitative polymerase chain reaction with a locked nucleic acid probe specific to the mutation, and a further peptide nucleic acid clamp oligonucleotide to suppress the amplification of the wild-type allele. The quantitative polymerase chain reaction assay was highly sensitive and specific, detecting RHOA Gly17Val at an allele frequency of 0.03%, but not other changes in Gly17, nor in 61 controls. Among the 37 cases of AITL and PTCL-TFH investigated, RHOA Gly17Val was detected in 62.2% (23/37) of which 19 had multiple biopsies including preceding biopsies in ten and follow-up biopsies in 11 cases. RHOA Gly17Val was present in each of these preceding or follow-up biopsies including 18 specimens that showed no evidence of lymphoma by combined histological, immunophenotypic and clonality analyses. The mutation was seen in biopsies 0-26.5 months (mean 7.87 months) prior to the lymphoma diagnosis. Our results show that RHOA Gly17Val mutation analysis is valuable in the early detection of AITL and PTCL-TFH.
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MESH Headings
- Early Diagnosis
- Humans
- Immunoblastic Lymphadenopathy/diagnosis
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/pathology
- Mutation
- Phenotype
- T-Lymphocytes, Helper-Inducer/pathology
- rhoA GTP-Binding Protein/genetics
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Affiliation(s)
- Rachel Dobson
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge
| | - Peter Y Du
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge
| | - Lívia Rásó-Barnett
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Wen-Qing Yao
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge
| | - Zi Chen
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge
| | - Calogero Casa
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Hesham Ei-Daly
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Lorant Farkas
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Pathology, Akershus University Hospital, Lorenskog
| | - Elizabeth Soilleux
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Penny Wright
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - John W Grant
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | | | - George A Follows
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Hala Rashed
- Department of Cellular Pathology, University Hospitals of Leicester, East Midlands Pathology Services, Leicester
| | - Margarete Fabre
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Department of Haematology, University of Cambridge, Cambridge
| | - E Joanna Baxter
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - George Vassiliou
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Department of Haematology, University of Cambridge, Cambridge
| | | | | | - Hongxiang Liu
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Ming-Qing Du
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge.
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Abstract
Dysregulation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B/mammalian target of rapamycin signaling is common in both indolent and aggressive forms of malignant lymphoma, for which several targeted therapies have been developed. Copanlisib is a highly selective and potent intravenous pan-class I PI3K inhibitor that has demonstrated durable objective responses and a manageable safety profile in heavily pre-treated patients with indolent lymphomas. As a result, copanlisib monotherapy received accelerated approval from the US Food and Drug Administration for the treatment of adults with relapsed follicular lymphoma who have received at least two systemic therapies, and breakthrough designation for patients with pre-treated relapsed or refractory marginal zone lymphoma. Hyperglycemia and hypertension are among the most frequently reported adverse events with copanlisib monotherapy, and are infusion-related, transient, and manageable with standard therapies. Mild diarrhea is also a common adverse event with copanlisib monotherapy; there is no evidence of worsening severity of diarrhea, or serious gastrointestinal toxicities such as colitis or severe liver enzyme elevations, which have been reported with orally administered PI3K inhibitors. The intravenous route of administration and intermittent dosing schedule of copanlisib may support a favorable tolerability profile over continually administered oral alternatives. Ongoing studies of copanlisib in combination with rituximab and standard-of-care chemotherapy in patients with relapsed indolent lymphoma have the potential to support the use of copanlisib in the second-line setting, providing a much-needed additional therapeutic option in this underserved patient population.
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Affiliation(s)
- Javier Munoz
- Mayo Clinic, 5881 E. Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - George A Follows
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Russell J, Collins A, Fowler A, Karanth M, Saha C, Docherty S, Padayatty J, Maw K, Lentell I, Cooke L, Hodson A, Shah N, Sadullah S, Grigoropoulos N, Qian W, Kirkwood AA, Uttenthal BJ, Johnson P, Follows GA. Advanced Hodgkin lymphoma in the East of England: a 10-year comparative analysis of outcomes for real-world patients treated with ABVD or escalated-BEACOPP, aged less than 60 years, compared with 5-year extended follow-up from the RATHL trial. Ann Hematol 2021; 100:1049-1058. [PMID: 33641019 PMCID: PMC7960595 DOI: 10.1007/s00277-021-04460-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/10/2021] [Indexed: 10/31/2022]
Abstract
Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated(e)-BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) remains the international standard of care for advanced-stage classical Hodgkin lymphoma (HL). We performed a retrospective, multicentre analysis of 221 non-trial ("real-world") patients, aged 16-59 years, diagnosed with advanced-stage HL in the Anglia Cancer Network between 2004 and 2014, treated with ABVD or eBEACOPP, and compared outcomes with 1088 patients in the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma (RATHL) trial, aged 18-59 years, with median follow-up of 87.0 and 69.5 months, respectively. Real-world ABVD patients (n=177) had highly similar 5-year progression-free survival (PFS) and overall survival (OS) compared with RATHL (PFS 79.2% vs 81.4%; OS 92.9% vs 95.2%), despite interim positron-emission tomography-computed tomography (PET/CT)-guided dose-escalation being predominantly restricted to trial patients. Real-world eBEACOPP patients (n=44) had superior PFS (95.5%) compared with real-world ABVD (HR 0.20, p=0.027) and RATHL (HR 0.21, p=0.015), and superior OS for higher-risk (international prognostic score ≥3 [IPS 3+]) patients compared with real-world IPS 3+ ABVD (100% vs 84.5%, p=0.045), but not IPS 3+ RATHL patients. Our data support a PFS, but not OS, advantage for patients with advanced-stage HL treated with eBEACOPP compared with ABVD and suggest higher-risk patients may benefit disproportionately from more intensive therapy. However, increased access to effective salvage therapies might minimise any OS benefit from reduced relapse rates after frontline therapy.
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Affiliation(s)
- James Russell
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Angela Collins
- Department of Haematology, Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Alexis Fowler
- Department of Haematology, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9G UK
| | - Mamatha Karanth
- Department of Haematology, West Suffolk Hospital, West Suffolk NHS Trust, Hardwick Lane, Bury St Edmunds, IP33 2QZ UK
| | - Chandan Saha
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Suzanne Docherty
- Department of Haematology, Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Joseph Padayatty
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Kyaw Maw
- Department of Haematology, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, NR31 6LA UK
| | - Isabel Lentell
- Department of Haematology, West Suffolk Hospital, West Suffolk NHS Trust, Hardwick Lane, Bury St Edmunds, IP33 2QZ UK
| | - Lisa Cooke
- Department of Haematology, The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, Gayton Rd, King’s Lynn, PE30 4ET UK
| | - Andrew Hodson
- Department of Haematology, Ipswich Hospital, Ipswich Hospital NHS Trust, Heath Rd, Ipswich, IP4 5PD UK
| | - Nimish Shah
- Department of Haematology, Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Shalal Sadullah
- Department of Haematology, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, NR31 6LA UK
| | - Nicholas Grigoropoulos
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Wendi Qian
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Amy A. Kirkwood
- Cancer Research UK and University College London Cancer Trials Centre, University College London, 90 Tottenham Court Road, London, W1T 4TJ UK
| | - Benjamin J. Uttenthal
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - George A. Follows
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
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10
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Yao WQ, Wu F, Zhang W, Chuang SS, Thompson JS, Chen Z, Zhang SW, Clipson A, Wang M, Liu H, Bibawi H, Huang Y, Campos L, Grant JW, Wright P, Ei-Daly H, Rásó-Barnett L, Farkas L, Follows GA, Gao Z, Attygalle AD, Ashton-Key M, Liu W, Du MQ. Angioimmunoblastic T-cell lymphoma contains multiple clonal T-cell populations derived from a common TET2 mutant progenitor cell. J Pathol 2020; 250:346-357. [PMID: 31859368 PMCID: PMC7064999 DOI: 10.1002/path.5376] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 02/05/2023]
Abstract
Angioimmunoblastic T‐cell lymphoma (AITL) is a neoplastic proliferation of T follicular helper cells with clinical and histological presentations suggesting a role of antigenic drive in its development. Genetically, it is characterized by a stepwise acquisition of somatic mutations, with early mutations involving epigenetic regulators (TET2, DNMT3A) and occurring in haematopoietic stem cells, with subsequent changes involving signaling molecules (RHOA, VAV1, PLCG1, CD28) critical for T‐cell biology. To search for evidence of potential oncogenic cooperation between genetic changes and intrinsic T cell receptor (TCR) signaling, we investigated somatic mutations and T‐cell receptor β (TRB) rearrangement in 119 AITL, 11 peripheral T‐cell lymphomas with T follicular helper phenotype (PTCL‐TFH), and 25 PTCL‐NOS using Fluidigm polymerase chain reaction (PCR) and Illumina MiSeq sequencing. We confirmed frequent TET2, DNMT3A, and RHOA mutations in AITL (72%, 34%, 61%) and PTCL‐TFH (73%, 36%, 45%) and showed multiple TET2 mutations (2 or 3) in 57% of the involved AITL and PTCL‐TFH. Clonal TRB rearrangement was seen in 76 cases with multiple functional rearrangements (2–4) in 18 cases (24%). In selected cases, we confirmed bi‐clonal T‐cell populations and further demonstrated that these independent T‐cell populations harboured identical TET2 mutations by using BaseScope in situ hybridization, suggesting their derivation from a common TET2 mutant progenitor cell population. Furthermore, both T‐cell populations expressed CD4. Finally, in comparison with tonsillar TFH cells, both AITL and PTCL‐TFH showed a significant overrepresentation of several TRB variable family members, particularly TRBV19*01. Our findings suggest the presence of parallel neoplastic evolutions from a common TET2 mutant haematopoietic progenitor pool in AITL and PTCL‐TFH, albeit to be confirmed in a large series of cases. The biased TRBV usage in these lymphomas suggests that antigenic stimulation may play an important role in predilection of T cells to clonal expansion and malignant transformation. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Wen-Qing Yao
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Pathology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Fangtian Wu
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Haematology, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, PR China
| | - Wenyan Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, PR China
| | | | - Joe S Thompson
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Zi Chen
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Shao-Wei Zhang
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Alexandra Clipson
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Ming Wang
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Hongxiang Liu
- Molecular Malignancy Laboratory, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hani Bibawi
- Molecular Malignancy Laboratory, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Yuanxue Huang
- Molecular Malignancy Laboratory, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luis Campos
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John W Grant
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Penny Wright
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hesham Ei-Daly
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lívia Rásó-Barnett
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lorant Farkas
- The Haematopathology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - George A Follows
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zifen Gao
- Department of Pathology, Health Science Centre, Peking University, Beijing, PR China
| | | | - Margaret Ashton-Key
- Department of Cellular Pathology, Southampton University Hospitals National Health Service Foundation Trust, Southampton, UK
| | - Weiping Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Ming-Qing Du
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK.,Molecular Malignancy Laboratory, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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11
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Caeser R, Collord G, Yao WQ, Chen Z, Vassiliou GS, Beer PA, Du MQ, Scott MA, Follows GA, Hodson DJ. Targeting MEK in vemurafenib-resistant hairy cell leukemia. Leukemia 2019; 33:541-545. [PMID: 30341394 PMCID: PMC6365378 DOI: 10.1038/s41375-018-0270-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Rebecca Caeser
- Department of Haematology, University of Cambridge, Cambridge, UK
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK
| | - Grace Collord
- Wellcome Sanger Institute, Hinxton, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Wen-Qing Yao
- Division of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - Zi Chen
- Division of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - George S Vassiliou
- Department of Haematology, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Hinxton, UK
| | | | - Ming-Qing Du
- Division of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - Mike A Scott
- Haematopathology & Oncology Diagnostic Service, Cambridge University Hospitals, Cambridge, UK
| | - George A Follows
- Department of Haematology, Cambridge University Hospitals, Cambridge, UK
| | - Daniel J Hodson
- Department of Haematology, University of Cambridge, Cambridge, UK.
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, UK.
- Department of Haematology, Cambridge University Hospitals, Cambridge, UK.
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12
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Dreyling M, Santoro A, Mollica L, Leppä S, Follows GA, Lenz G, Kim WS, Nagler A, Panayiotidis P, Demeter J, Özcan M, Kosinova M, Bouabdallah K, Morschhauser F, Stevens DA, Trevarthen D, Giurescu M, Cupit L, Liu L, Köchert K, Seidel H, Peña C, Yin S, Hiemeyer F, Garcia-Vargas J, Childs BH, Zinzani PL. Phosphatidylinositol 3-Kinase Inhibition by Copanlisib in Relapsed or Refractory Indolent Lymphoma. J Clin Oncol 2017; 35:3898-3905. [DOI: 10.1200/jco.2017.75.4648] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Phosphatidylinositol 3-kinase (PI3K) signaling is critical for the proliferation and survival of malignant B cells. Copanlisib, a pan-class I PI3K inhibitor with predominant activity against PI3K-α and -δ isoforms, has demonstrated efficacy and a manageable safety profile in patients with indolent lymphoma. Patients and Methods In this phase II study, 142 patients with relapsed or refractory indolent lymphoma after two or more lines of therapy were enrolled to receive copanlisib 60 mg intravenously on days 1, 8, and 15 of a 28-day cycle. The primary end point was objective response rate; secondary end points included duration of response, progression-free survival, and overall survival. In addition, safety and gene expression were evaluated. Results Median age was 63 years (range, 25 to 82 years), and patients had received a median of three (range, two to nine) prior regimens. The objective response rate was 59% (84 of 142 patients); 12% of patients achieved a complete response. Median time to response was 53 days. Median duration of response was 22.6 months, median progression-free survival was 11.2 months, and median overall survival had not yet been reached. The most frequent treatment-emergent adverse events were transient hyperglycemia (all grades, 50%; grade 3 or 4, 41%) and transient hypertension (all grades, 30%; grade 3, 24%). Other grade ≥3 events included decreased neutrophil count (24%) and lung infection (15%). High response rates to copanlisib were associated with high expression of PI3K/B-cell receptor signaling pathway genes. Conclusion PI3K-α and -δ inhibition by copanlisib demonstrated significant efficacy and a manageable safety profile in heavily pretreated patients with relapsed or refractory indolent lymphoma.
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Affiliation(s)
- Martin Dreyling
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Armando Santoro
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Luigina Mollica
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Sirpa Leppä
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - George A. Follows
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Georg Lenz
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Won Seog Kim
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Arnon Nagler
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Panayiotis Panayiotidis
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Judit Demeter
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Muhit Özcan
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Marina Kosinova
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Krimo Bouabdallah
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Franck Morschhauser
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Don A. Stevens
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - David Trevarthen
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Marius Giurescu
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Lisa Cupit
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Li Liu
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Karl Köchert
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Henrik Seidel
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Carol Peña
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Shuxin Yin
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Florian Hiemeyer
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Jose Garcia-Vargas
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Barrett H. Childs
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
| | - Pier Luigi Zinzani
- Martin Dreyling, Ludwig Maximilians University of Munich, Munich; Georg Lenz, University Hospital Münster, Münster; Marius Giurescu, Karl Köchert, Henrik Seidel, and Florian Hiemeyer, Bayer AG, Berlin, Germany; Armando Santoro, Humanitas Clinical and Research Center, Rozzano; Pier Luigi Zinzani, University of Bologna, Bologna, Italy; Luigina Mollica, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Sirpa Leppä, Helsinki University Central Hospital Cancer Center, Helsinki, Finland; George A
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Dreyling M, Santoro A, Mollica L, Leppä S, Follows GA, Lenz G, Kim WS, Nagler A, Panayiotidis P, Demeter J, Özcan M, Kosinova M, Bouabdallah K, Morschhauser F, Stevens DA, Trevarthen D, Giurescu M, Kupit L, Yin S, Hiemeyer F, Garcia-Vargas J, Childs BH, Zinzani PL. Abstract CT149: Copanlisib in patients with relapsed or refractory indolent B-cell lymphoma: Primary results of the pivotal Chronos-1 study. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: There are limited treatment options for patients with indolent B-cell lymphoma who have relapsed or are refractory to standard therapies. Copanlisib is an intravenously administered pan-Class I phosphatidylinositol 3-kinase (PI3K) inhibitor with predominant activity against PI3K-α and PI3K-δ isoforms. We report here the primary results from a pivotal phase II study (NCT01660451, part B).
Methods: Patients with indolent B-cell non-Hodgkin lymphoma (4 subtypes: follicular [FL], marginal zone [MZL], small lymphocytic [SLL] and lymphoplasmacytoid/Waldenström macroglobulinemia [LPL-WM]) and relapsed after, or refractory to, ≥2 prior lines of treatment were eligible. Previous treatment had to include rituximab and an alkylating agent. Copanlisib (60 mg, I.V.) was intermittently administered on days 1, 8 and 15 of a 28-day cycle. The primary efficacy endpoint was objective tumor response rate (ORR) as assessed per independent radiologic review (Cheson et al., JCO 20:579, 2007).
Results: The full analysis set comprised 142 patients, of which 141 patients had indolent lymphoma (FL/MZL/SLL/LPL-WM: 104/23/8/6). At the time of primary analysis, median duration of treatment was 22 weeks (range 1-105); 46 patients remained on treatment. The most common treatment-related AEs (all grade/grade 3+) were transient hyperglycemia (49%/40%) and hypertension (29%/23%). Other AEs of interest included neutropenia (25%/19%), diarrhea (18%/4%), lung infection (14%/11%), pneumonitis (7%/1.4%), and colitis (0.7%/0.7%). No colonic perforations occurred. There were two non-fatal opportunistic infections. Laboratory toxicities of interest were principally grade-1, including alanine aminotransferase (23% all-grade/19% grade-1) and aspartate aminotransferase (28%/25%). There were 6 deaths, 3 of which were attributed to copanlisib: lung infection, respiratory failure, and a thromboembolic event. The ORR was 59.2%, including 12.0% complete response (CR) and 47.2% partial response (PR), with stable disease in 29.6% of patients and progressive disease in 2.1% of patients. In the FL subset, the ORR was 58.7%, including 14.4% CR and 44.2% PR. In the MZL subset, the ORR was 69.6%, including 8.7% CR and 60.9% PR. The estimated Kaplan-Meier (KM) median duration of response in the full analysis set was 687 days (range 0-687) and 370 days (range 0-687) in the FL subset. The KM-estimate of median PFS was 340 days (range 0-736). Median overall survival had not yet been reached.
Conclusions: Treatment of patients with relapsed or refractory indolent B-cell lymphoma with copanlisib resulted in durable tumor responses. Administration of copanlisib had a manageable safety profile, with low rates of severe hepatic enzymopathy, diarrhea or inflammatory events, as well as low rates of opportunistic infections, fatal infections or other fatal serious adverse events.
Citation Format: Martin Dreyling, Armando Santoro, Luigina Mollica, Sirpa Leppä, George A. Follows, Georg Lenz, Won Seog Kim, Arnon Nagler, Panayiotis Panayiotidis, Judit Demeter, Muhit Özcan, Marina Kosinova, Krimo Bouabdallah, Franck Morschhauser, Don A. Stevens, David Trevarthen, Marius Giurescu, Lisa Kupit, Shuxin Yin, Florian Hiemeyer, Jose Garcia-Vargas, Barrett H. Childs, Pier Luigi Zinzani. Copanlisib in patients with relapsed or refractory indolent B-cell lymphoma: Primary results of the pivotal Chronos-1 study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT149. doi:10.1158/1538-7445.AM2017-CT149
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Affiliation(s)
- Martin Dreyling
- 1Klinikum der Universität München-Grosshadern, Munich, Germany
| | - Armando Santoro
- 2Humanitas Cancer Center- Humanitas Clinical and Research Center, Department of Oncology and Hematology, Rozzano, Italy
| | - Luigina Mollica
- 3Hôpital Maisonneuve-Rosemont - Montreal, Department of Hematology, Montreal, Quebec, Canada
| | - Sirpa Leppä
- 4Helsinki University Central Hospital Cancer Center, Department of Oncology, Helsinki, Finland
| | - George A. Follows
- 5Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Georg Lenz
- 6University Hospital Münster, Translational Oncology, Münster, Germany
| | - Won Seog Kim
- 7Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Arnon Nagler
- 8Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | | | - Judit Demeter
- 10Semmelweis University, First Department of Internal Medicine, Budapest, Hungary
| | - Muhit Özcan
- 11Ankara University School of Medicine, Department of Hematology, Ankara, Turkey
| | - Marina Kosinova
- 12Kemerovo Regional Clinical Hospital, Department of Hematology, Kemerovo, Russian Federation
| | - Krimo Bouabdallah
- 13University Hospital of Bordeaux, Service d'Hématologie et de Thérapie Cellulaire, Pessac, France
| | | | | | - David Trevarthen
- 16Comprehensive Cancer Care and Research Institute of Colorado, Englewood, CO
| | | | - Lisa Kupit
- 18Bayer HealthCare Pharmaceuticals, Whippany, NJ
| | - Shuxin Yin
- 18Bayer HealthCare Pharmaceuticals, Whippany, NJ
| | | | | | | | - Pier Luigi Zinzani
- 19Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
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Bashford-Rogers RJM, Palser AL, Hodkinson C, Baxter J, Follows GA, Vassiliou GS, Kellam P. Dynamic variation of CD5 surface expression levels within individual chronic lymphocytic leukemia clones. Exp Hematol 2016; 46:31-37.e10. [PMID: 27693386 PMCID: PMC5261558 DOI: 10.1016/j.exphem.2016.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/23/2016] [Accepted: 09/17/2016] [Indexed: 01/09/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of clonally derived mature CD5high B cells; however, the cellular origin of CLL is still unknown. Patients with CLL also harbor variable numbers of CD5low B cells, but the clonal relationship of these cells to the bulk disease is unknown and can have important implications for monitoring, treating, and understanding the biology of CLL. Here, we use B-cell receptors (BCRs) as molecular barcodes to first show by single-cell BCR sequencing that the great majority of CD5low B cells in the blood of CLL patients are clonally related to CD5high CLL B cells. We investigate whether CD5 state switching was likely to occur continuously as a common event or as a rare event in CLL by tracking somatic BCR mutations in bulk CLL B cells and using them to reconstruct the phylogenetic relationships and evolutionary history of the CLL in four patients. Using statistical methods, we show that there is no parsimonious route from a single or low number of CD5low switch events to the CD5high population, but rather, large-scale and/or dynamic switching between these CD5 states is the most likely explanation. The overlapping BCR repertoires between CD5high and CD5low cells from CLL patient peripheral blood reveal that CLL exists in a continuum of CD5 expression. The major proportion of CD5low B cells in patients are leukemic, thus identifying CD5low B cells as an important component of CLL, with implications for CLL pathogenesis, clinical monitoring, and the development of anti-CD5-directed therapies.
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MESH Headings
- Antigens, CD/genetics
- Antigens, CD/metabolism
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Biomarkers
- CD5 Antigens/genetics
- CD5 Antigens/metabolism
- Cell Membrane/metabolism
- Gene Expression
- Humans
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Receptors, Antigen, B-Cell/metabolism
- Sequence Analysis, DNA
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Affiliation(s)
| | - Anne L Palser
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Clare Hodkinson
- Cambridge Blood and Stem Cell Biobank, University of Cambridge, Department of Haematology, National Health Service Blood and Transplant Cambridge Centre, Cambridge, UK
| | - Joanna Baxter
- Cambridge Blood and Stem Cell Biobank, University of Cambridge, Department of Haematology, National Health Service Blood and Transplant Cambridge Centre, Cambridge, UK
| | - George A Follows
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - George S Vassiliou
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Paul Kellam
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK; Research Department of Infection, Division of Infection and Immunity, University College London, London, UK.
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15
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Wagner M, Oelsner M, Moore A, Götte F, Kuhn PH, Haferlach T, Fiegl M, Bogner C, Baxter EJ, Peschel C, Follows GA, Ringshausen I. Integration of innate into adaptive immune responses in ZAP-70-positive chronic lymphocytic leukemia. Blood 2016; 127:436-48. [PMID: 26508782 DOI: 10.1182/blood-2015-05-646935] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/10/2015] [Indexed: 12/30/2022] Open
Abstract
The crucial dependence of chronic lymphocytic leukemia (CLL) cells on signals derived from the B cell receptor (BCR) has encouraged the development of new inhibitors, which interfere with BCR signaling and demonstrate clinical benefits in nearly all patients. In addition, signaling through Toll-like receptor (TLR) 9 of the innate immune system has been shown to further contribute to the activation of CLL cells. However, responses to TLR9 engagement are not uniform, but diametrically opposed with cell death in some patients and cell proliferation in others. We now provide evidence that heterogeneous responses to TLR agonists are related to differences in the ability of CLL cells to activate the BCR-associated kinase Syk. Notably, expression of ZAP-70 appears to be of crucial importance for TLR9-mediated activation of Syk. We show that the activation of Syk provides an antiapoptotic signal, which is independent of Mcl-1, Bcl-2, and Bcl-XL, but related to the degradation of the proapoptotic Bim. Mechanistically, TLR9-mediated antiapoptotic signals in ZAP-70-positive CLL trigger secretion of immunoglobulin M, which then serves as (auto-) antigen for a prosurvival BCR signal. Thus, our data show that single activation of the innate immune receptor TLR9 is sufficient to fully engage BCR signaling in ZAP-70-positive CLL, protecting malignant cells from apoptosis. We conclude that the integration of TLR signaling into an adaptive immune response can further promote survival of CLL cells and may contribute to the unfavorable prognosis of ZAP-70-positive CLL.
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Affiliation(s)
- Michaela Wagner
- 3rd Department of Medicine, Technical University Munich, Munich, Germany
| | - Madlen Oelsner
- 3rd Department of Medicine, Technical University Munich, Munich, Germany
| | - Andrew Moore
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Frederik Götte
- 3rd Department of Medicine, Technical University Munich, Munich, Germany
| | - Peer-Hendrik Kuhn
- Institute for Pathology and Anatomy, Institute for Advanced Study, Technical University Munich, Munich, Germany
| | | | - Michael Fiegl
- 3rd Department of Medicine, Ludwig Maximilian University, Munich, Germany
| | - Christian Bogner
- 3rd Department of Medicine, Technical University Munich, Munich, Germany
| | - E Joanna Baxter
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Christian Peschel
- 3rd Department of Medicine, Technical University Munich, Munich, Germany
| | - George A Follows
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Ingo Ringshausen
- 3rd Department of Medicine, Technical University Munich, Munich, Germany; Department of Haematology, University of Cambridge, Cambridge, United Kingdom
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16
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Mifsud B, Tavares-Cadete F, Young AN, Sugar R, Schoenfelder S, Ferreira L, Wingett SW, Andrews S, Grey W, Ewels PA, Herman B, Happe S, Higgs A, LeProust E, Follows GA, Fraser P, Luscombe NM, Osborne CS. Mapping long-range promoter contacts in human cells with high-resolution capture Hi-C. Nat Genet 2015; 47:598-606. [PMID: 25938943 DOI: 10.1038/ng.3286] [Citation(s) in RCA: 653] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/02/2015] [Indexed: 12/14/2022]
Abstract
Transcriptional control in large genomes often requires looping interactions between distal DNA elements, such as enhancers and target promoters. Current chromosome conformation capture techniques do not offer sufficiently high resolution to interrogate these regulatory interactions on a genomic scale. Here we use Capture Hi-C (CHi-C), an adapted genome conformation assay, to examine the long-range interactions of almost 22,000 promoters in 2 human blood cell types. We identify over 1.6 million shared and cell type-restricted interactions spanning hundreds of kilobases between promoters and distal loci. Transcriptionally active genes contact enhancer-like elements, whereas transcriptionally inactive genes interact with previously uncharacterized elements marked by repressive features that may act as long-range silencers. Finally, we show that interacting loci are enriched for disease-associated SNPs, suggesting how distal mutations may disrupt the regulation of relevant genes. This study provides new insights and accessible tools to dissect the regulatory interactions that underlie normal and aberrant gene regulation.
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Affiliation(s)
- Borbala Mifsud
- 1] The Francis Crick Institute, London, UK. [2] UCL Genetics Institute, University College London, London, UK
| | | | - Alice N Young
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | | | | | - Lauren Ferreira
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | | | - Simon Andrews
- Bioinformatics Group, Babraham Institute, Cambridge, UK
| | - William Grey
- Department of Medical and Molecular Genetics, King's College London School of Medicine, London, UK
| | - Philip A Ewels
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | - Bram Herman
- Diagnostics and Genomics Division, Agilent Technologies, Santa Clara, California, USA
| | - Scott Happe
- Diagnostics and Genomics Division, Agilent Technologies, Santa Clara, California, USA
| | - Andy Higgs
- Diagnostics and Genomics Division, Agilent Technologies, Santa Clara, California, USA
| | - Emily LeProust
- Diagnostics and Genomics Division, Agilent Technologies, Santa Clara, California, USA
| | - George A Follows
- Department of Haematology, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, UK
| | - Peter Fraser
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | - Nicholas M Luscombe
- 1] The Francis Crick Institute, London, UK. [2] UCL Genetics Institute, University College London, London, UK. [3] Okinawa Institute of Science and Technology, Okinawa, Japan
| | - Cameron S Osborne
- 1] Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK. [2] Department of Medical and Molecular Genetics, King's College London School of Medicine, London, UK
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17
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Clipson A, Barrans S, Zeng N, Crouch S, Grigoropoulos NF, Liu H, Kocialkowski S, Wang M, Huang Y, Worrillow L, Goodlad J, Buxton J, Neat M, Fields P, Wilkins B, Grant JW, Wright P, Ei-Daly H, Follows GA, Roman E, Watkins AJ, Johnson PWM, Jack A, Du MQ. The prognosis of MYC translocation positive diffuse large B-cell lymphoma depends on the second hit. J Pathol Clin Res 2015; 1:125-133. [PMID: 27347428 PMCID: PMC4915334 DOI: 10.1002/cjp2.10] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/23/2014] [Indexed: 12/14/2022]
Abstract
A proportion of MYC translocation positive diffuse large B‐cell lymphomas (DLBCL) harbour a BCL2 and/or BCL6 translocation, known as double‐hit DLBCL, and are clinically aggressive. It is unknown whether there are other genetic abnormalities that cooperate with MYC translocation and form double‐hit DLBCL, and whether there is a difference in clinical outcome between the double‐hit DLBCL and those with an isolated MYC translocation. We investigated TP53 gene mutations along with BCL2 and BCL6 translocations in a total of 234 cases of DLBCL, including 81 with MYC translocation. TP53 mutations were investigated by PCR and sequencing, while BCL2 and BCL6 translocation was studied by interphase fluorescence in situ hybridization. The majority of MYC translocation positive DLBCLs (60/81 = 74%) had at least one additional genetic hit. In MYC translocation positive DLBCL treated by R‐CHOP (n = 67), TP53 mutation and BCL2, but not BCL6 translocation had an adverse effect on patient overall survival. In comparison with DLBCL with an isolated MYC translocation, cases with MYC/TP53 double‐hits had the worst overall survival, followed by those with MYC/BCL2 double‐hits. In MYC translocation negative DLBCL treated by R‐CHOP (n = 101), TP53 mutation, BCL2 and BCL6 translocation had no impact on patient survival. The prognosis of MYC translocation positive DLBCL critically depends on the second hit, with TP53 mutations and BCL2 translocation contributing to an adverse prognosis. It is pivotal to investigate both TP53 mutations and BCL2 translocations in MYC translocation positive DLBCL, and to distinguish double‐hit DLBCLs from those with an isolated MYC translocation.
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Affiliation(s)
- Alexandra Clipson
- Division of Molecular Histopathology Department of Pathology University of Cambridge UK
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service St. James's Institute of Oncology Leeds UK
| | - Naiyan Zeng
- Division of Molecular Histopathology Department of Pathology University of Cambridge UK
| | - Simon Crouch
- Department of Health Sciences Epidemiology and Cancer Statistics Group University of York York UK
| | - Nicholas F Grigoropoulos
- Division of Molecular HistopathologyDepartment of PathologyUniversity of CambridgeUK; Department of HaematologyAddenbrooke's Hospital, Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Hongxiang Liu
- Department of Histopathology Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Sylvia Kocialkowski
- Division of Molecular Histopathology Department of Pathology University of Cambridge UK
| | - Ming Wang
- Division of Molecular Histopathology Department of Pathology University of Cambridge UK
| | - Yuanxue Huang
- Division of Molecular Histopathology Department of Pathology University of Cambridge UK
| | - Lisa Worrillow
- Haematological Malignancy Diagnostic Service St. James's Institute of Oncology Leeds UK
| | - John Goodlad
- Department of Pathology Western General Hospital Edinburgh UK
| | - Jenny Buxton
- Department of Haematology Western General Hospital Edinburgh UK
| | - Michael Neat
- Department of Haematology and Department of Cytogenetics GSTS Pathology Guy's and St. Thomas NHS Foundation Trust London UK
| | - Paul Fields
- Department of Haematology GSST Kings Health Partners London UK
| | - Bridget Wilkins
- Histopathology Department St Thomas' Hospital and King's College London UK
| | - John W Grant
- Department of Histopathology Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Penny Wright
- Department of Histopathology Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Hesham Ei-Daly
- Department of Haematology Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - George A Follows
- Department of Haematology Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Eve Roman
- Department of Health Sciences Epidemiology and Cancer Statistics Group University of York York UK
| | - A James Watkins
- Department of Haematology Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Peter W M Johnson
- Cancer Research UK Centre University of Southampton Southampton United Kingdom
| | - Andrew Jack
- Haematological Malignancy Diagnostic Service St. James's Institute of Oncology Leeds UK
| | - Ming-Qing Du
- Division of Molecular HistopathologyDepartment of PathologyUniversity of CambridgeUK; Department of HistopathologyAddenbrooke's Hospital, Cambridge University Hospitals NHS Foundation TrustCambridgeUK
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18
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Bashford-Rogers RJM, Palser AL, Idris SF, Carter L, Epstein M, Callard RE, Douek DC, Vassiliou GS, Follows GA, Hubank M, Kellam P. Capturing needles in haystacks: a comparison of B-cell receptor sequencing methods. BMC Immunol 2014; 15:29. [PMID: 25189176 PMCID: PMC4243823 DOI: 10.1186/s12865-014-0029-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/15/2014] [Indexed: 01/20/2023] Open
Abstract
Background Deep-sequencing methods are rapidly developing in the field of B-cell receptor (BCR) and T-cell receptor (TCR) diversity. These promise to revolutionise our understanding of adaptive immune dynamics, identify novel antibodies, and allow monitoring of minimal residual disease. However, different methods for BCR and TCR enrichment and amplification have been proposed. Here we perform the first systematic comparison between different methods of enrichment, amplification and sequencing for generating BCR and TCR repertoires using large sample numbers. Results Resampling from the same RNA or cDNA pool results in highly correlated and reproducible repertoires, but resampling low frequency clones leads to stochastic variance. Repertoires generated by different sequencing methods (454 Roche and Illumina MiSeq) and amplification methods (multiplex PCR, 5’ Rapid amplification of cDNA ends (5’RACE), and RNA-capture) are highly correlated, and resulting IgHV gene frequencies between the different methods were not significantly different. Read length has an impact on captured repertoire structure, and ultimately full-length BCR sequences are most informative for repertoire analysis as diversity outside of the CDR is very useful for phylogenetic analysis. Additionally, we show RNA-based BCR repertoires are more informative than using DNA. Conclusions Repertoires generated by different sequencing and amplification methods are consistent, but we show that read lengths, depths and error profiles should be considered in experimental design, and multiple sampling approaches could be employed to minimise stochastic sampling variation. This detailed investigation of immune repertoire sequencing methods is essential for informing basic and clinical research. Electronic supplementary material The online version of this article (doi:10.1186/s12865-014-0029-0) contains supplementary material, which is available to authorized users.
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19
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Follows GA, Ardeshna KM, Barrington SF, Culligan DJ, Hoskin PJ, Linch D, Sadullah S, Williams MV, Wimperis JZ. Guidelines for the first line management of classical Hodgkin lymphoma. Br J Haematol 2014; 166:34-49. [PMID: 24712411 DOI: 10.1111/bjh.12878] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- George A Follows
- Department of Haematology, Addenbrookes Hospital, Cambridge University Teaching Hospitals, Cambridge, UK
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20
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Hillmen P, Gribben JG, Follows GA, Milligan D, Sayala HA, Moreton P, Oscier DG, Dearden CE, Kennedy DB, Pettitt AR, Nathwani A, Varghese A, Cohen D, Rawstron A, Oertel S, Pocock CFE. Rituximab plus chlorambucil as first-line treatment for chronic lymphocytic leukemia: Final analysis of an open-label phase II study. J Clin Oncol 2014; 32:1236-41. [PMID: 24638012 DOI: 10.1200/jco.2013.49.6547] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Most patients with chronic lymphocytic leukemia (CLL) are elderly and/or have comorbidities that may make them ineligible for fludarabine-based treatment. For this population, chlorambucil monotherapy is an appropriate therapeutic option; however, response rates with chlorambucil are low, and more effective treatments are needed. This trial was designed to assess how the addition of rituximab to chlorambucil (R-chlorambucil) would affect safety and efficacy in patients with CLL. PATIENTS AND METHODS Patients with first-line CLL were treated with rituximab (375 mg/m(2) on day 1, cycle one, and 500 mg/m(2) thereafter) plus chlorambucil (10 mg/m(2)/d all cycles; day 1 through 7) for six 28-day cycles. For patients not achieving complete response (CR), six additional cycles of chlorambucil alone could be administered. The primary end point of the study was safety. RESULTS A total of 100 patients were treated with R-chlorambucil, with a median follow-up of 30 months. Median age of patients was 70 years (range, 43 to 86 years), with patients having a median of seven comorbidities. Hematologic toxicities accounted for most grade 3/4 adverse events reported, with neutropenia and lymphopenia both occurring in 41% of patients and leukopenia in 23%. Overall response rates were 84%, with CR achieved in 10% of patients. Median progression-free survival was 23.5 months; median overall survival was not reached. CONCLUSION These results compare favorably with previously published results for chlorambucil monotherapy, suggesting that the addition of rituximab to chlorambucil may improve efficacy with no unexpected adverse events. R-chlorambucil may improve outcome for patients who are ineligible for fludarabine-based treatments.
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Affiliation(s)
- Peter Hillmen
- Peter Hillmen, Abraham Varghese, and Andy Rawstron, St James's Institute of Oncology; Dena Cohen, University of Leeds, Leeds; John G. Gribben, Barts and the London School of Medicine; Claire E. Dearden, Royal Marsden Hospital; Amit Nathwani, University College London, London; George A. Follows, Addenbrooke's Hospital, Cambridge; Donald Milligan, Heartlands Hospital, Birmingham; Hazem A. Sayala, Hull and East Yorkshire Hospitals, Hull; Paul Moreton, Pinderfields General Hospital, Wakefield; David G. Oscier, Royal Bournemouth Hospital, Bournemouth; Daniel B. Kennedy, Leicester Royal Infirmary, Leicester; Andrew R. Pettitt, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool; Christopher F.E. Pocock, East Kent Hospitals, Canterbury, United Kingdom; and Stephan Oertel, F. Hoffmann-La Roche, Basel, Switzerland
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21
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Abstract
Hairy cell leukemia (HCL) is an indolent low-grade B-cell lymphoproliferative disorder that is reasonably sensitive to standard first-line purine analog therapy. However, in many cases, repeat relapses occur, requiring multiple courses of purine analog therapy, promoting eventual drug resistance. This, coupled with the concerning side effects of repeated purine analog exposure, has prompted the search for alternative targets and therapies that may provide deeper remissions. Novel strategies employing immune-mediated targeting via monoclonal antibody therapies and recombinant immunotoxins appear promising in HCL and are currently under investigation. More recently, the concept of targeted kinase inhibition using small-molecule inhibitors in HCL has emerged as another potentially viable option. As a deeper understanding of the aberrant molecular pathways contributing to the pathogenesis of HCL develops, the landscape of management for HCL, particularly in the relapse setting, may change significantly in the future as a result of these promising immunotargets and therapies.
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Affiliation(s)
- Faisal Basheer
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - David M Bloxham
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Mike A Scott
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - George A Follows
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
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22
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Affiliation(s)
- Nicholas F Grigoropoulos
- Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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23
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Affiliation(s)
- Nicholas F Grigoropoulos
- Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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24
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Follows GA, Sims H, Bloxham DM, Zenz T, Hopper MA, Liu H, Bench A, Wright P, Van't Veer MB, Scott MA. Rapid response of biallelic BRAF V600E mutated hairy cell leukaemia to low dose vemurafenib. Br J Haematol 2012; 161:150-3. [PMID: 23278307 DOI: 10.1111/bjh.12201] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maund IF, Williams MV, Hoskin PJ, Follows GA. Is this the end of radiotherapy in early hodgkin lymphoma? Clin Oncol (R Coll Radiol) 2012; 25:46-8. [PMID: 22841148 DOI: 10.1016/j.clon.2012.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/06/2012] [Indexed: 11/30/2022]
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Pettitt AR, Jackson R, Carruthers S, Dodd J, Dodd S, Oates M, Johnson GG, Schuh A, Matutes E, Dearden CE, Catovsky D, Radford JA, Bloor A, Follows GA, Devereux S, Kruger A, Blundell J, Agrawal S, Allsup D, Proctor S, Heartin E, Oscier D, Hamblin TJ, Rawstron A, Hillmen P. Alemtuzumab in Combination With Methylprednisolone Is a Highly Effective Induction Regimen for Patients With Chronic Lymphocytic Leukemia and Deletion of TP53: Final Results of the National Cancer Research Institute CLL206 Trial. J Clin Oncol 2012; 30:1647-55. [DOI: 10.1200/jco.2011.35.9695] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In chronic lymphocytic leukemia (CLL), TP53 deletion/mutation is strongly associated with an adverse outcome and resistance to chemotherapy-based treatment. In contrast, TP53 defects are not associated with resistance to the anti-CD52 monoclonal antibody alemtuzumab or methylprednisolone. In an attempt to improve the treatment of TP53-defective CLL, a multicenter phase II study was developed to evaluate alemtuzumab and methylprednisolone in combination. Patients and Methods Thirty-nine patients with TP53-deleted CLL (17 untreated and 22 previously treated) received up to 16 weeks of treatment with alemtuzumab 30 mg three times a week and methylprednisolone 1.0 g/m2 for five consecutive days every 4 weeks. Antimicrobial prophylaxis consisted of cotrimoxazole, itraconazole, and aciclovir (or valganciclovir for asymptomatic cytomegalovirus viremia). The primary end point was response as assigned by an end-point review committee. Secondary end points were safety, progression-free survival (PFS) and overall survival (OS). Results The overall response rate, complete response rate (including with incomplete marrow recovery), median PFS, and median OS were 85%, 36%, 11.8 months, and 23.5 months, respectively, in the entire cohort and 88%, 65%, 18.3 months, and 38.9 months, respectively, in previously untreated patients. Grade 3 to 4 hematologic and glucocorticoid-associated toxicity occurred in 67% and 23% of patients, respectively. Grade 3 to 4 infection occurred in 51% of the overall cohort and in 29% of patients less than 60 years of age. Treatment-related mortality was 5%. Conclusion Alemtuzumab plus methypredisolone is the most effective induction regimen hitherto reported in TP53-deleted CLL. The risk of infection is age related and, in younger patients, seems only marginally higher than that associated with rituximab, fludarabine, and cyclophosphamide.
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Affiliation(s)
- Andrew R. Pettitt
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Richard Jackson
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Stacey Carruthers
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - James Dodd
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Susanna Dodd
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Melanie Oates
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Gillian G. Johnson
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Anna Schuh
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Estella Matutes
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Claire E. Dearden
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Daniel Catovsky
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - John A. Radford
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Adrian Bloor
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - George A. Follows
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Stephen Devereux
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Anton Kruger
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Julie Blundell
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Samir Agrawal
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - David Allsup
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Stephen Proctor
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Earnest Heartin
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - David Oscier
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Terry J. Hamblin
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Andrew Rawstron
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
| | - Peter Hillmen
- Andrew R. Pettitt, Richard Jackson, Stacey Carruthers, James Dodd, Susanna Dodd, and Melanie Oates, University of Liverpool; Andrew R. Pettitt and Gillian G Johnson, Royal Liverpool & Broadgreen University Hospitals National Health Service (NHS) Trust, Liverpool; Anna Schuh, Oxford Radcliffe Hospitals NHS Trust, Oxford; Estella Matutes, Claire E. Dearden, and Daniel Catovsky, Institute of Cancer Research and Royal Marsden Hospital NHS Trust, Surrey; John A. Radford and Adrian Bloor, The University of
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Abstract
Primary testicular non-Hodgkin lymphoma (PTL) comprises around 9% of testicular cancers and 1-2% of all non-Hodgkin lymphomas. Its incidence is increasing and it primarily affects older men, with a median age at presentation of around 67 years. By far the most common histological subtype is diffuse large B-cell lymphoma, accounting for 80-90% of PTLs. Most patients present with a unilateral testicular mass or swelling. Up to 90% of patients have stage I or II disease at diagnosis (60 and 30%, respectively) and bilateral testicular involvement is seen in around 35% of patients. PTL demonstrates a continuous pattern of relapse and propensity for extra-nodal sites such as the central nervous system and contralateral testis. Retrospective data have emphasised the importance of prophylactic radiotherapy in reducing recurrence rates within the contralateral testis. Recent outcome data from the prospective IELSG-10 trial have shown far better progression-free and overall survival than historical outcomes. This supports the use of orchidectomy followed by Rituximab- cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP), central nervous system prophylaxis and prophylactic radiotherapy to the contralateral testis with or without nodal radiotherapy in patients with limited disease. Central nervous system relapse remains a significant issue and future research should focus on identifying the best strategy to reduce its occurrence. Here we discuss the evidence supporting combination chemotherapy and radiotherapy in PTL.
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Affiliation(s)
- S S Ahmad
- The Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
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Follows GA, Ferreira R, Janes ME, Spensberger D, Cambuli F, Chaney AF, Kinston SJ, Landry JR, Green AR, Göttgens B. Mapping and functional characterisation of a CTCF-dependent insulator element at the 3' border of the murine Scl transcriptional domain. PLoS One 2012; 7:e31484. [PMID: 22396734 PMCID: PMC3291548 DOI: 10.1371/journal.pone.0031484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 01/09/2012] [Indexed: 11/18/2022] Open
Abstract
The Scl gene encodes a transcription factor essential for haematopoietic development. Scl transcription is regulated by a panel of cis-elements spread over 55 kb with the most distal 3′ element being located downstream of the neighbouring gene Map17, which is co-regulated with Scl in haematopoietic cells. The Scl/Map17 domain is flanked upstream by the ubiquitously expressed Sil gene and downstream by a cluster of Cyp genes active in liver, but the mechanisms responsible for delineating the domain boundaries remain unclear. Here we report identification of a DNaseI hypersensitive site at the 3′ end of the Scl/Map17 domain and 45 kb downstream of the Scl transcription start site. This element is located at the boundary of active and inactive chromatin, does not function as a classical tissue-specific enhancer, binds CTCF and is both necessary and sufficient for insulator function in haematopoietic cells in vitro. Moreover, in a transgenic reporter assay, tissue-specific expression of the Scl promoter in brain was increased by incorporation of 350 bp flanking fragments from the +45 element. Our data suggests that the +45 region functions as a boundary element that separates the Scl/Map17 and Cyp transcriptional domains, and raise the possibility that this element may be useful for improving tissue-specific expression of transgenic constructs.
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Affiliation(s)
- George A Follows
- Department of Haematology, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom.
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Boyd EM, Bench AJ, van ‘t Veer MB, Wright P, Bloxham DM, Follows GA, Scott MA. High resolution melting analysis for detection of BRAF exon 15 mutations in hairy cell leukaemia and other lymphoid malignancies. Br J Haematol 2011; 155:609-12. [DOI: 10.1111/j.1365-2141.2011.08868.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chowdhury O, Varghese A, Pattinson J, Carrington P, Bloor A, Follows GA, Hillmen P, Schuh A. Ofatumumab in advanced stage chronic lymphocytic leukaemia: results of the UK named patient compassionate use programme. Br J Haematol 2011; 155:519-21. [DOI: 10.1111/j.1365-2141.2011.08711.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stephens PJ, Greenman CD, Fu B, Yang F, Bignell GR, Mudie LJ, Pleasance ED, Lau KW, Beare D, Stebbings LA, McLaren S, Lin ML, McBride DJ, Varela I, Nik-Zainal S, Leroy C, Jia M, Menzies A, Butler AP, Teague JW, Quail MA, Burton J, Swerdlow H, Carter NP, Morsberger LA, Iacobuzio-Donahue C, Follows GA, Green AR, Flanagan AM, Stratton MR, Futreal PA, Campbell PJ. Massive genomic rearrangement acquired in a single catastrophic event during cancer development. Cell 2011; 144:27-40. [PMID: 21215367 PMCID: PMC3065307 DOI: 10.1016/j.cell.2010.11.055] [Citation(s) in RCA: 1668] [Impact Index Per Article: 128.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/03/2010] [Accepted: 11/24/2010] [Indexed: 12/13/2022]
Abstract
Cancer is driven by somatically acquired point mutations and chromosomal rearrangements, conventionally thought to accumulate gradually over time. Using next-generation sequencing, we characterize a phenomenon, which we term chromothripsis, whereby tens to hundreds of genomic rearrangements occur in a one-off cellular crisis. Rearrangements involving one or a few chromosomes crisscross back and forth across involved regions, generating frequent oscillations between two copy number states. These genomic hallmarks are highly improbable if rearrangements accumulate over time and instead imply that nearly all occur during a single cellular catastrophe. The stamp of chromothripsis can be seen in at least 2%–3% of all cancers, across many subtypes, and is present in ∼25% of bone cancers. We find that one, or indeed more than one, cancer-causing lesion can emerge out of the genomic crisis. This phenomenon has important implications for the origins of genomic remodeling and temporal emergence of cancer. PaperClip
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Grigoropoulos NF, Shaw AS, Hampson FA, Baglin TP, Follows GA. Incidental pulmonary emboli in lymphoma patients are associated with aggressive disease and poor prognosis. J Thromb Haemost 2010; 8:2835-6. [PMID: 20854375 DOI: 10.1111/j.1538-7836.2010.04061.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Walter K, Cockerill PN, Barlow R, Clarke D, Hoogenkamp M, Follows GA, Richards SJ, Cullen MJ, Bonifer C, Tagoh H. Aberrant expression of CD19 in AML with t(8;21) involves a poised chromatin structure and PAX5. Oncogene 2010; 29:2927-37. [DOI: 10.1038/onc.2010.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Affiliation(s)
- Joseph Padayatty
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
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Grove CS, Follows GA, Erber WN. Incidental finding of lymphocytosis in an asymptomatic patient. BMJ 2009; 338:b2119. [PMID: 19515711 DOI: 10.1136/bmj.b2119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Carolyn S Grove
- Haematology Department, Addenbrooke's Hospital, Cambridge CB2 0QQ
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Abstract
BACKGROUND The myeloproliferative disorders are clonal disorders with frequent somatic gain-of-function alterations affecting tyrosine kinases. In these diseases, there is an increase in DNA damage and a risk of progression to acute leukemia. The molecular mechanisms in myeloproliferative disorders that prevent apoptosis induced by damaged DNA are obscure. METHODS We searched for abnormalities of the proapoptotic Bcl-x(L) deamidation pathway in primary cells from patients with chronic myeloid leukemia (CML) or polycythemia vera, myeloproliferative disorders associated with the BCR-ABL fusion kinase and the Janus tyrosine kinase 2 (JAK2) V617F mutation, respectively. RESULTS The Bcl-x(L) deamidation pathway was inhibited in myeloid cells, but not T cells, in patients with CML or polycythemia vera. DNA damage did not increase levels of the amiloride-sensitive sodium-hydrogen exchanger isoform 1 (NHE-1), intracellular pH, Bcl-x(L) deamidation, and apoptosis. Inhibition of the pathway was reversed by enforced alkalinization or overexpression of NHE-1, leading to a restoration of apoptosis. In patients with CML, the pathway was blocked in CD34+ progenitor cells and mature myeloid cells. Imatinib or JAK2 inhibitors reversed inhibition of the pathway in cells from patients with CML and polycythemia vera, respectively, but not in cells from a patient with resistance to imatinib because of a mutation in the BCR-ABL kinase domain. CONCLUSIONS BCR-ABL and mutant JAK2 inhibit the Bcl-x(L) deamidation pathway and the apoptotic response to DNA damage in primary cells from patients with CML or polycythemia vera.
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MESH Headings
- Apoptosis
- Cation Transport Proteins/genetics
- Cell Line, Tumor
- DNA Damage/genetics
- Deamination
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/physiology
- Gene Transfer Techniques
- Genes, abl/genetics
- Humans
- Janus Kinase 2/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukocytes, Mononuclear
- Myeloproliferative Disorders/blood
- Myeloproliferative Disorders/genetics
- Polycythemia Vera/blood
- Polycythemia Vera/genetics
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/physiology
- Signal Transduction/genetics
- Sodium-Hydrogen Exchanger 1
- Sodium-Hydrogen Exchangers/genetics
- bcl-X Protein/genetics
- bcl-X Protein/physiology
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Affiliation(s)
- Rui Zhao
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, United Kingdom.
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Smith AM, Sanchez MJ, Follows GA, Kinston S, Donaldson IJ, Green AR, Göttgens B. A novel mode of enhancer evolution: the Tal1 stem cell enhancer recruited a MIR element to specifically boost its activity. Genome Res 2008; 18:1422-32. [PMID: 18687876 PMCID: PMC2527711 DOI: 10.1101/gr.077008.108] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Altered cis-regulation is thought to underpin much of metazoan evolution, yet the underlying mechanisms remain largely obscure. The stem cell leukemia TAL1 (also known as SCL) transcription factor is essential for the normal development of blood stem cells and we have previously shown that the Tal1 +19 enhancer directs expression to hematopoietic stem cells, hematopoietic progenitors, and to endothelium. Here we demonstrate that an adjacent region 1 kb upstream (+18 element) is in an open chromatin configuration and carries active histone marks but does not function as an enhancer in transgenic mice. Instead, it boosts activity of the +19 enhancer both in stable transfection assays and during differentiation of embryonic stem (ES) cells carrying single-copy reporter constructs targeted to the Hprt locus. The +18 element contains a mammalian interspersed repeat (MIR) which is essential for the +18 function and which was transposed to the Tal1 locus approximately 160 million years ago at the time of the mammalian/marsupial branchpoint. Our data demonstrate a previously unrecognized mechanism whereby enhancer activity is modulated by a transposon exerting a "booster" function which would go undetected by conventional transgenic approaches.
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Affiliation(s)
- Aileen M Smith
- University of Cambridge Department of Haematology, Cambridge Institute for Medical Research, Cambridge CB2 2XY, United Kingdom
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38
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Abstract
Mouse models of human cancer are a potential preclinical setting for drug testing and for development of methods for delivery of macromolecular drugs to tumors. We have assessed a mouse model of leukemia caused by Mll-Enl protein fusion as a preclinical situation in which myeloid-lineage leukemia results from de novo occurrence of chromosomal translocations between Mll and Enl genes. Here, we show that the mouse leukemias respond to cytosine arabinoside, a frontline treatment for human leukemia. The observations show that the myeloid cells are susceptible to the drug and the mice undergo a remission that comprises a reduction of the myeloid population of cells and recovery of the lymphoid population. This translocator model should therefore prove useful for future drug assessments against the recurrent mixed-lineage leukemia-associated translocations.
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Affiliation(s)
- Florencia Cano
- Leeds Institute of Molecular Medicine, Section of Experimental Therapeutics, Wellcome Trust Brenner Building, St James's University Hospital, Leeds, UK
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Zhao R, Oxley D, Smith TS, Follows GA, Green AR, Alexander DR. DNA damage-induced Bcl-xL deamidation is mediated by NHE-1 antiport regulated intracellular pH. PLoS Biol 2007; 5:e1. [PMID: 17177603 PMCID: PMC1702560 DOI: 10.1371/journal.pbio.0050001] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 10/25/2006] [Indexed: 12/30/2022] Open
Abstract
The pro-survival protein Bcl-xL is critical for the resistance of tumour cells to DNA damage. We have previously demonstrated, using a mouse cancer model, that oncogenic tyrosine kinase inhibition of DNA damage–induced Bcl-xL deamidation tightly correlates with T cell transformation in vivo, although the pathway to Bcl-xL deamidation remains unknown and its functional consequences unclear. We show here that rBcl-xL deamidation generates an iso-Asp52/iso-Asp66 species that is unable to sequester pro-apoptotic BH3-only proteins such as Bim and Puma. DNA damage in thymocytes results in increased expression of the NHE-1 Na/H antiport, an event both necessary and sufficient for subsequent intracellular alkalinisation, Bcl-xL deamidation, and apoptosis. In murine thymocytes and tumour cells expressing an oncogenic tyrosine kinase, this DNA damage–induced cascade is blocked. Enforced intracellular alkalinisation mimics the effects of DNA damage in murine tumour cells and human B-lineage chronic lymphocytic leukaemia cells, thereby causing Bcl-xL deamidation and increased apoptosis. Our results define a signalling pathway leading from DNA damage to up-regulation of the NHE-1 antiport, to intracellular alkalanisation to Bcl-xL deamidation, to apoptosis, representing the first example, to our knowledge, of how deamidation of internal asparagine residues can be regulated in a protein in vivo. Our findings also suggest novel approaches to cancer therapy. Cell survival and cell death (apoptosis) are controlled by a finely tuned ensemble of pro-survival and pro-apoptotic proteins. When the two types of protein are balanced, cells survive. But if the pro-survival proteins dominate, there is a danger that cells with damaged DNA will stay alive, leading to malignancy. One of the key pro-survival proteins, Bcl-xL, acts by blocking the actions of pro-apoptotic proteins. We show here that DNA damage results in an important modification of Bcl-xL. Specifically, when the amide groups are removed from two critical asparagine (amino acid) residues, Bcl-xL can no longer block pro-apoptotic proteins, leading to cell death. Surprisingly, Bcl-xL deamidation is catalysed not by an enzyme, but by increased pH inside the cell due to the up-regulation of an NHE-1 transporter that moves positive ions across the cell membrane. Indeed, artificially increasing pH causes Bcl-xL deamidation and apoptosis in the absence of initial DNA damage. Exploring this novel pathway may ultimately suggest approaches to cancer therapy, especially when malignant cells are resistant to chemotherapy or radiotherapy. Until now, the mechanisms and functional implications for DNA damage-induced Bcl-xL deamidation were unknown. Here the authors provide important new insights into this phenomenon and its impact on cell survival.
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Affiliation(s)
- Rui Zhao
- Laboratory of Lymphocyte Signalling and Development, The Babraham Institute, Babraham, Cambridge, United Kingdom
| | - David Oxley
- Protein Technologies Laboratory, The Babraham Institute, Babraham, Cambridge, United Kingdom
| | - Trevor S Smith
- Protein Technologies Laboratory, The Babraham Institute, Babraham, Cambridge, United Kingdom
| | - George A Follows
- Department of Haematology, University of Cambridge, Hills Road, Cambridge, United Kingdom
| | - Anthony R Green
- Department of Haematology, University of Cambridge, Hills Road, Cambridge, United Kingdom
| | - Denis R Alexander
- Laboratory of Lymphocyte Signalling and Development, The Babraham Institute, Babraham, Cambridge, United Kingdom
- * To whom correspondence should be addressed. E-mail:
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40
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Abstract
Molecular genetic techniques have become an integral part of the diagnostic assessment for many lymphomas and other chronic lymphoid neoplasms. The demonstration of a clonal immunoglobulin or T cell receptor gene rearrangement offers a useful diagnostic tool in cases where the diagnosis is equivocal. Molecular genetic detection of other genomic rearrangements may not only assist with the diagnosis but can also provide important prognostic information. Many of these rearrangements can act as molecular markers for the detection of low levels of residual disease. In this review, we discuss the applications of molecular genetic analysis to the chronic lymphoid malignancies. The review concentrates on those disorders for which molecular genetic analysis can offer diagnostic and/or prognostic information.
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MESH Headings
- Burkitt Lymphoma/genetics
- Gene Rearrangement
- Humans
- Immunoglobulin G/genetics
- Leukemia, Hairy Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Prolymphocytic/genetics
- Leukemia-Lymphoma, Adult T-Cell/genetics
- Lymphoma, B-Cell/genetics
- Lymphoma, Follicular/genetics
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, T-Cell/genetics
- Molecular Diagnostic Techniques
- Receptors, Antigen, T-Cell/genetics
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Affiliation(s)
- A J Bench
- Haemato-Oncology Diagnostic Service, Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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41
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Follows GA, Janes ME, Vallier L, Green AR, Gottgens B. Real-time PCR mapping of DNaseI-hypersensitive sites using a novel ligation-mediated amplification technique. Nucleic Acids Res 2007; 35:e56. [PMID: 17389645 PMCID: PMC1885650 DOI: 10.1093/nar/gkm108] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mapping sites within the genome that are hypersensitive to digestion with DNaseI is an important method for identifying DNA elements that regulate transcription. The standard approach to locating these DNaseI-hypersensitive sites (DHSs) has been to use Southern blotting techniques, although we, and others, have recently published alternative methods using a range of technologies including high-throughput sequencing and genomic array tiling paths. In this article, we describe a novel protocol to use real-time PCR to map DHS. Advantages of the technique reported here include the small cell numbers required for each analysis, rapid, relatively low-cost experiments with minimal need for specialist equipment. Presented examples include comparative DHS mapping of known TAL1/SCL regulatory elements between human embryonic stem cells and K562 cells.
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Affiliation(s)
- George A Follows
- Department of Haematology, Cambridge Institute for Medical Research, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 2XY, UK.
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42
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Chan WYI, Follows GA, Lacaud G, Pimanda JE, Landry JR, Kinston S, Knezevic K, Piltz S, Donaldson IJ, Gambardella L, Sablitzky F, Green AR, Kouskoff V, Göttgens B. The paralogous hematopoietic regulators Lyl1 and Scl are coregulated by Ets and GATA factors, but Lyl1 cannot rescue the early Scl-/- phenotype. Blood 2006; 109:1908-16. [PMID: 17053063 DOI: 10.1182/blood-2006-05-023226] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transcription factors are key regulators of hematopoietic stem cells (HSCs), yet the molecular mechanisms that control their expression are largely unknown. Previously, we demonstrated that expression of Scl/Tal1, a transcription factor required for the specification of HSCs, is controlled by Ets and GATA factors. Here we characterize the molecular mechanisms controlling expression of Lyl1, a paralog of Scl also required for HSC function. Two closely spaced promoters directed expression to hematopoietic progenitor, megakaryocytic, and endothelial cells in transgenic mice. Conserved binding sites required for promoter activity were bound in vivo by GATA-2 and the Ets factors Fli1, Elf1, Erg, and PU.1. However, despite coregulation of Scl and Lyl1 by the same Ets and GATA factors, Scl expression was initiated prior to Lyl1 in embryonic stem (ES) cell differentiation assays. Moreover, ectopic expression of Scl but not Lyl1 rescued hematopoietic differentiation in Scl-/- ES cells, thus providing a molecular explanation for the vastly different phenotypes of Scl-/- and Lyl1-/- mouse embryos. Furthermore, coregulation of Scl and Lyl1 later during development may explain the mild phenotype of Scl-/- adult HSCs.
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Affiliation(s)
- Wan Y I Chan
- Department of Haematology, Cambridge Institute for Medical Research, University of Cambridge, United Kingdom
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43
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Follows GA, Dhami P, Göttgens B, Bruce AW, Campbell PJ, Dillon SC, Smith AM, Koch C, Donaldson IJ, Scott MA, Dunham I, Janes ME, Vetrie D, Green AR. Identifying gene regulatory elements by genomic microarray mapping of DNaseI hypersensitive sites. Genome Res 2006; 16:1310-9. [PMID: 16963707 PMCID: PMC1581440 DOI: 10.1101/gr.5373606] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The identification of cis-regulatory elements is central to understanding gene transcription. Hypersensitivity of cis-regulatory elements to digestion with DNaseI remains the gold-standard approach to locating such elements. Traditional methods used to identify DNaseI hypersensitive sites are cumbersome and can only be applied to short stretches of DNA at defined locations. Here we report the development of a novel genomic array-based approach to DNaseI hypersensitive site mapping (ADHM) that permits precise, large-scale identification of such sites from as few as 5 million cells. Using ADHM we identified all previously recognized hematopoietic regulatory elements across 200 kb of the mouse T-cell acute lymphocytic leukemia-1 (Tal1) locus, and, in addition, identified two novel elements within the locus, which show transcriptional regulatory activity. We further validated the ADHM protocol by mapping the DNaseI hypersensitive sites across 250 kb of the human TAL1 locus in CD34+ primary stem/progenitor cells and K562 cells and by mapping the previously known DNaseI hypersensitive sites across 240 kb of the human alpha-globin locus in K562 cells. ADHM provides a powerful approach to identifying DNaseI hypersensitive sites across large genomic regions.
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Affiliation(s)
- George A Follows
- Department of Haematology, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 2XY, United Kingdom.
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Mollica LR, Crawley JTB, Liu K, Rance JB, Cockerill PN, Follows GA, Landry JR, Wells DJ, Lane DA. Role of a 5′-enhancer in the transcriptional regulation of the human endothelial cell protein C receptor gene. Blood 2006; 108:1251-9. [PMID: 16627757 DOI: 10.1182/blood-2006-02-001461] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractThe endothelial cell protein C receptor (EPCR) is expressed by endothelial cells of large blood vessels and by hematopoietic stem cells. DNaseI hypersensitive (DH) site mapping across 38 kb of the human EPCR gene (hEPCR) locus identified 3 potential regulatory elements. By itself, the DH region spanning the proximal promoter (PP) was unable to direct cell-specific transcription in transgenic mice. A second DH element, located upstream of PP and termed –5.5HS was hypersensitive only in endothelial cells (ECs) and immature hematopoietic cell lines. Transgenes expressing LacZ under the control of –5.5HS coupled to either PP or the SV40 promoter were able to direct β-galactosidase activity to the endothelium of large vessels during embryogenesis and adulthood. The –5.5HS exhibited enhancer activity that was conferred by the interplay of transcription factors interacting with conserved Ets and composite GATA/Tal1 motifs. The third DH element, located in intron 2, was primarily hypersensitive in EPCR-negative cells, and capable of initiating antisense transcription, suggesting a role in hEPCR silencing. This study identifies critical elements required for the tissue specificity of hEPCR and suggests a mechanism for endothelial and hematopoietic stem cell–specific transcriptional regulation that reflects the common origin of these cell types.
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45
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Follows GA, Tagoh H, Lefevre P, Morgan GJ, Bonifer C. Differential transcription factor occupancy but evolutionarily conserved chromatin features at the human and mouse M-CSF (CSF-1) receptor loci. Nucleic Acids Res 2004; 31:5805-16. [PMID: 14530429 PMCID: PMC219482 DOI: 10.1093/nar/gkg804] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The c-FMS gene encodes the macrophage colony-stimulating factor receptor (M-CSFR or CSF1-R), which is a tyrosine kinase growth factor receptor essential for macrophage development. We have previously characterized the chromatin features of the mouse gene; however, very little is known about chromatin structure and function of the human c-FMS locus. Here we present a side-by-side comparison of the chromatin structure, histone modification, transcription factor occupancy and cofactor recruitment of the human and the mouse c-FMS loci. We show that, similar to the mouse gene, the human c-FMS gene possesses a promoter and an intronic enhancer element (c-fms intronic regulatory element or FIRE). Both elements are evolutionarily conserved and specifically active in macrophages. However, we demonstrate by in vivo footprinting that both murine and human c-FMS cis-regulatory elements are recognised by an overlapping, but non-identical, set of transcription factors. Despite these differences, chromatin immunoprecipitation experiments show highly similar patterns of histone H3 modification and a similar distribution of chromatin modifying and remodelling activities at individual cis-regulatory elements and across the c-FMS locus. Our experiments support the hypothesis that the same regulatory principles operate at both genes via conserved cores of transcription factor binding sites.
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Affiliation(s)
- George A Follows
- Molecular Medicine Unit, University of Leeds, St James's University Hospital, Leeds LS9 7TF, UK
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46
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Follows GA, Tagoh H, Lefevre P, Hodge D, Morgan GJ, Bonifer C. Epigenetic consequences of AML1-ETO action at the human c-FMS locus. EMBO J 2003; 22:2798-809. [PMID: 12773394 PMCID: PMC156747 DOI: 10.1093/emboj/cdg250] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2002] [Revised: 03/25/2003] [Accepted: 03/26/2003] [Indexed: 11/14/2022] Open
Abstract
Although many leukaemia-associated nuclear oncogenes are well characterized, little is known about the molecular details of how they alter gene expression. Here we examined transcription factor complexes and chromatin structure of the human c-FMS gene in normal and leukaemic cells. We demonstrate by in vivo footprinting and chromatin immunoprecipitation assays that this gene is bound by the transcription factor AML1 (RUNX1). In t(8;21) leukaemic cells expressing the aberrant fusion protein AML1-ETO, we demonstrate that this protein is part of a transcription factor complex binding to extended sequences of the c-FMS intronic regulatory region rather than the promoter. The AML1-ETO complex does not disrupt binding of other transcription factors, indicating that c-FMS is not irreversibly epigenetically silenced. However, AML1-ETO binding correlates with changes in the histone modification pattern and increased association of histone deacetylases. Our experiments provide for the first time a direct insight into the chromatin structure of an AML1-ETO-bound target gene.
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MESH Headings
- Acute Disease
- Base Sequence
- Binding Sites/genetics
- Cell Line
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 8/genetics
- Core Binding Factor Alpha 2 Subunit
- Gene Expression
- Gene Silencing
- Genes, fms
- HL-60 Cells
- HeLa Cells
- Histone Deacetylase 1
- Histone Deacetylases/metabolism
- Histones/chemistry
- Histones/metabolism
- Humans
- Introns
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/metabolism
- Molecular Sequence Data
- Oncogene Proteins, Fusion/genetics
- Promoter Regions, Genetic
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- RUNX1 Translocation Partner 1 Protein
- Transcription Factors/genetics
- Translocation, Genetic
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Affiliation(s)
- George A Follows
- Molecular Medicine Unit, University of Leeds, St James's University Hospital, Leeds LS9 7TF, UK
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47
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Rance JB, Follows GA, Cockerill PN, Bonifer C, Lane DA, Simmonds RE. Regulation of the human endothelial cell protein C receptor gene promoter by multiple Sp1 binding sites. Blood 2003; 101:4393-401. [PMID: 12560236 DOI: 10.1182/blood-2002-05-1570] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The human endothelial cell protein C receptor (hEPCR) is normally expressed by the endothelium of large blood vessels, but the molecular basis for its in vivo specificity is uncertain. In this study, DNaseI hypersensitive site mapping demonstrated the presence of a hypersensitive site in the 5' flanking region of the hEPCR gene in endothelial cells and certain transformed cells (HeLa and U937) known to express hEPCR in vitro. Conversely, this site was only weakly hypersensitive in HepG2 cells, cells which do not express hEPCR mRNA. Functional analysis of this 5' flanking region by in vivo dimethylsulfate footprinting in cultured endothelial cells identified multiple regions, containing high and low homology consensus Sp1 binding sequences, that were protected from methylation in endothelial cells. These sequences were not protected in HepG2 cells. Reporter gene analysis of this region in endothelial cells demonstrated the presence of promoter activity conferred by the proximal 572 bp but failed to identify a functional TATA-box. This promoter was inactive in HepG2 cells. Electrophoresis mobility shift assays using endothelial cell nuclear extracts identified Sp1 family proteins binding to sites that were protected during footprinting. Sp1 sites were identified in regions at -368, -232, -226, -201, -146, and -102 bp relative to the translation start site. With the exception of the site at -102 bp, each identified Sp1 binding site made a positive contribution to reporter gene expression, although no individual site was critically important. We conclude that transcription factor binding to Sp1 binding sites in the 5' flanking region is critical for normal hEPCR gene expression in endothelial cells.
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Affiliation(s)
- James B Rance
- Department of Haematology, Imperial College London-Faculty of Medicine, Hammersmith Hospital Campus, London, United Kingdom.
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48
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Follows GA, Child JA, Smith GM. Fast-track referral system for patients with haematological malignancy. Clin Lab Haematol 2001; 23:333-4. [PMID: 11703418 DOI: 10.1046/j.1365-2257.2001.00407.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Follows GA, McVerry A, Owen RG. Precursor B-lymphoblastic transformation of grade I follicle center lymphoma following rituximab therapy. Am J Clin Pathol 2000; 114:982-3. [PMID: 11338486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
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50
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Abstract
A 43 year old male presented with a marked eosinophilia and associated systemic symptoms. A diagnosis of myelodysplasia was made on the basis of bone marrow morphology and karyotype. Over a 12 month period the disease transformed into acute lymphoblastic leukaemia, confirmed by flow cytometry, cytochemistry, and immunohistochemistry. Karyotyping was abnormal with 5q- and -7 which persisted from diagnosis through to blastic transformation. He died following initial induction chemotherapy. Eosinophilic myelodysplasia is an uncommon condition in haematological practice and no previous report of lymphoblastic transformation has been found.
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Affiliation(s)
- G A Follows
- Department of Haematology, Bradford Royal Infirmary, UK
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