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Bansal R, Vergidis P, Tosh PK, Wilson J, Hathcock M, Khurana A, Bennani NN, Paludo J, Villasboas JC, Wang Y, Ansell SM, Johnston PB, Freeman C, Lin Y. Serial Evaluation of Preimmunization Antibody Titers in Lymphoma Patients Receiving Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:455.e1-455.e7. [PMID: 38346643 DOI: 10.1016/j.jtct.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/02/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
Antibody titers and the potential need for immunization have not been formally studied in recipients of chimeric antigen receptor T cell therapy (CAR-T). Prior studies have shown that CD19-targeted CAR-T can induce persistent B cell aplasia but preserve plasma cells for humoral response. Aiming to assess the immune repertoire and antibody titer status of CAR-T recipients, we conducted a retrospective study of immune cell recovery and antibody titers to vaccines in anti-CD19 CAR-T recipients at Mayo Clinic, Rochester. In our cohort of 95 CAR-T recipients, almost one-half had low CD4 T and B cell counts prior to CAR-T that remained persistently low post-CAR-T. Prior to CAR-T, the seronegative rate was lowest for tetanus and highest for pneumococcus irrespective of prior transplantation status (within 2 years of CAR-T). At 3 months post-CAR-T, overall seronegativity rates were similar to pre-CAR-T rates for the prior transplantation and no prior transplantation groups. For patients who received IVIG, loss of seropositivity was seen for hepatitis A (1 of 7; 14%). No seroconversion was noted for pneumococcus. For patients who did not receive IVIG, loss of seropositivity was seen for pneumococcus (2 of 5; 40%) and hepatitis A (1 of 4; 25%). CAR-T recipients commonly experience T cell and B cell lymphopenia and might not have adequate antibody titers against vaccine-preventable diseases despite IVIG supplementation. Loss of antibody titers post-CAR-T is possible, highlighting the need for revaccination. Additional studies with long-term follow-up are needed to inform the optimal timing of immunization post-CAR-T.
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Affiliation(s)
- Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Pritish K Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - John Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Arushi Khurana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Catherine Freeman
- Division of Asthma, Allergy and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota.
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2
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Porrata LF, Ansell SM, Micallef IN, Johnston PB, Villasboas JC, Paludo J, Durani U, Markovic SN. Day 100 Natural Killer Cell/CD14+HLA-DR DIM ratio and survival in lymphoma post-autologous peripheral blood hematopoietic stem cell transplantation. Clin Transplant 2024; 38:e15211. [PMID: 38041479 DOI: 10.1111/ctr.15211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION The infusion of autograft Natural Killer Cells (NKC)/CD14+ HLA-DRDIM ratio is a predictor of survival in lymphoma patients undergoing autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT). This study evaluated if the Day 100 NKC/CD14+ HLA-DRDIM ratio still functions as a prognostic immune-biomarker. METHODS This was a retrospective, single-institution, cohort analysis including 107 patients in this study that had clinical assessment at Day 100 post-APBHSCT from our prior phase III trial. We evaluated the prognostic ability of the Day 100 NKC/CD14+ HLA-DRDIM ratio to predict overall survival (OS) and progression-free survival (PFS) using Cox regression model for outcome analysis and survival by Kaplan-Meier method. RESULTS The median follow-up from day 100 was 94.7 months (range 4.83-158.1 months) for the entire cohort. Patients with a Day 100 NKC/CD14+ HLA-DRDIM ratio ≥1.67 experienced better OS and PFS versus those with a Day 100 NKC/CD14+ HLA-DRDIM ratio <1.67: median OS was not reached versus 49.7 months, the 5-year OS rates were 91% (95% CI, 81%-96%) versus 40% (95% CI, 27%-55%), p < .0001, respectively; and median PFS was not reached versus 23.5 months, the 5-year PFS rates were 66% (95% CI, 55%-81%) versus 21% (95% CI, 15%-40%), p < .0001, respectively. Day 100 NKC/CD14+ HLA-DRDIM ratio was an independent predictor for OS and PFS in the multivariate analysis. CONCLUSIONS Day 100 NKC/CD14+ HLA-DRDIM ratio is a prognostic immune-biomarker in lymphoma patients post- APBHSCT.
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Affiliation(s)
- Luis F Porrata
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen M Ansell
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivana N Micallef
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick B Johnston
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose C Villasboas
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonas Paludo
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Urshila Durani
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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3
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Saifi O, Breen WG, Lester SC, Rule WG, Stish BJ, Rosenthal A, Munoz J, Lin Y, Bansal R, Hathcock MA, Johnston PB, Ansell SM, Paludo J, Khurana A, Villasboas JC, Wang Y, Iqbal M, Moustafa MA, Murthy HS, Kharfan-Dabaja MA, Peterson JL, Hoppe BS. Consolidative radiotherapy for residual fluorodeoxyglucose activity on day +30 post CAR T-cell therapy in non-Hodgkin lymphoma. Haematologica 2023; 108:2982-2992. [PMID: 37317888 PMCID: PMC10620596 DOI: 10.3324/haematol.2023.283311] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/09/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
Majority of non-Hodgkin lymphoma (NHL) patients who achieve partial response (PR) or stable disease (SD) to CAR T-cell therapy (CAR T) on day +30 progress and only 30% achieve spontaneous complete response (CR). This study is the first to evaluate the role of consolidative radiotherapy (cRT) for residual fluorodeoxyglucose (FDG) activity on day +30 post- CAR T in NHL. We retrospectively reviewed 61 patients with NHL who received CAR T and achieved PR or SD on day +30. Progression-free survival (PFS), overall survival (OS), and local relapse-free survival (LRFS) were assessed from CAR T infusion. cRT was defined as comprehensive - treated all FDG-avid sites - or focal. Following day +30 positron emission tomography scan, 45 patients were observed and 16 received cRT. Fifteen (33%) observed patients achieved spontaneous CR, and 27 (60%) progressed with all relapses involving initial sites of residual FDG activity. Ten (63%) cRT patients achieved CR, and four (25%) progressed with no relapses in the irradiated sites. The 2-year LRFS was 100% in the cRT sites and 31% in the observed sites (P<0.001). The 2-year PFS was 73% and 37% (P=0.025) and the 2-year OS was 78% and 43% (P=0.12) in the cRT and observation groups, respectively. Patients receiving comprehensive cRT (n=13) had superior 2- year PFS (83% vs. 37%; P=0.008) and 2-year OS (86% vs. 43%; P=0.047) compared to observed or focal cRT patients (n=48). NHL patients with residual FDG activity following CAR T are at high risk of local progression. cRT for residual FDG activity on day +30 post-CAR T appears to alter the pattern of relapse and improve LRFS and PFS.
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Affiliation(s)
- Omran Saifi
- Department of Radiation Oncology, Mayo Clinic Jacksonville, FL
| | | | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic Rochester, MN
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Phoenix, AZ
| | | | - Allison Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic Phoenix, AZ
| | - Javier Munoz
- Division of Hematology and Medical Oncology, Mayo Clinic Phoenix, AZ
| | - Yi Lin
- Division of Hematology, Mayo Clinic Rochester, MN, USA; Division of Experimental Pathology, Mayo Clinic Rochester, MN
| | | | - Matthew A Hathcock
- Division of Hematology, Mayo Clinic Rochester, MN, USA; Department of Biostatistics, Mayo Clinic Rochester, MN
| | | | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic Rochester, MN
| | | | | | - Yucai Wang
- Division of Hematology, Mayo Clinic Rochester, MN
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic Jacksonville, FL
| | | | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic Jacksonville, FL
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Yang ZZ, Kim HJ, Wu H, Tang X, Yu Y, Krull J, Larson DP, Moore RM, Maurer MJ, Pavelko KD, Jalali S, Pritchett JC, Mudappathi R, Wang J, Villasboas JC, Mondello P, Novak AJ, Ansell SM. T-cell phenotype including CD57 + T follicular helper cells in the tumor microenvironment correlate with a poor outcome in follicular lymphoma. Blood Cancer J 2023; 13:124. [PMID: 37591873 PMCID: PMC10435479 DOI: 10.1038/s41408-023-00899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2022] [Revised: 07/19/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
T-lymphocytes are prevalent in the tumor microenvironment of follicular lymphoma (FL). However, the phenotype of T-cells may vary, and the prevalence of certain T-cell subsets may influence tumor biology and patient survival. We therefore analyzed a cohort of 82 FL patients using CyTOF to determine whether specific T-cell phenotypes were associated with distinct tumor microenvironments and patient outcome. We identified four immune subgroups with differing T-cell phenotypes and the prevalence of certain T-cell subsets was associated with patient survival. Patients with increased T cells with early differentiation stage tended to have a significantly better survival than patients with increased T-cells of late differentiation stage. Specifically, CD57+ TFH cells, with a late-stage differentiation phenotype, were significantly more abundant in FL patients who had early disease progression and therefore correlated with an inferior survival. Single cell analysis (CITE-seq) revealed that CD57+ TFH cells exhibited a substantially different transcriptome from CD57- TFH cells with upregulation of inflammatory pathways, evidence of immune exhaustion and susceptibility to apoptosis. Taken together, our results show that different tumor microenvironments among FL patients are associated with variable T-cell phenotypes and an increased prevalence of CD57+ TFH cells is associated with poor patient survival.
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Affiliation(s)
- Zhi-Zhang Yang
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Hyo Jin Kim
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hongyan Wu
- Department of Immunology, Medical College, China Three Gorges University, Yichang, Hubei, China
| | - Xinyi Tang
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yue Yu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jordan Krull
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Raymond M Moore
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Maurer
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Shahrzad Jalali
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua C Pritchett
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rekha Mudappathi
- Department of Quantitative Health Sciences and center for Individual Medicine, Mayo Clinic, Scottsdale, AZ, USA
- College of Health Solutions, Arizona State University, Scottsdale, AZ, USA
| | - Junwen Wang
- Department of Quantitative Health Sciences and center for Individual Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Jose C Villasboas
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Patrizia Mondello
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne J Novak
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Ansell
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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5
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Rosenthal AC, Munoz JL, Villasboas JC. Clinical advances in epigenetic therapies for lymphoma. Clin Epigenetics 2023; 15:39. [PMID: 36871057 PMCID: PMC9985856 DOI: 10.1186/s13148-023-01452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 02/19/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Advances in understanding of cancer biology, genomics, epigenomics, and immunology have resulted in development of several therapeutic options that expand cancer care beyond traditional chemotherapy or radiotherapy, including individualized treatment strategies, novel treatments based on monotherapies or combination therapy to reduce toxicities, and implementation of strategies for overcoming resistance to anticancer therapy. RESULTS This review covers the latest applications of epigenetic therapies for treatment of B cell, T cell, and Hodgkin lymphomas, highlighting key clinical trial results with monotherapies and combination therapies from the main classes of epigenetic therapies, including inhibitors of DNA methyltransferases, protein arginine methyltransferases, enhancer of zeste homolog 2, histone deacetylases, and the bromodomain and extraterminal domain. CONCLUSION Epigenetic therapies are emerging as an attractive add-on to traditional chemotherapy and immunotherapy regimens. New classes of epigenetic therapies promise low toxicity and may work synergistically with other cancer treatments to overcome drug resistance mechanisms.
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Affiliation(s)
- Allison C Rosenthal
- Division of Hematology, Medical Oncology, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Javier L Munoz
- Division of Hematology, Medical Oncology, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - J C Villasboas
- Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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6
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Wudhikarn K, Johnson BM, Inwards DJ, Porrata LF, Micallef IN, Ansell SM, Hogan WJ, Paludo J, Villasboas JC, Johnston PB. Outcomes of Older Adults with Non-Hodgkin Lymphoma Undergoing Autologous Stem Cell Transplantation: A Mayo Clinic Cohort Analysis. Transplant Cell Ther 2023; 29:176.e1-176.e8. [PMID: 36563788 DOI: 10.1016/j.jtct.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/26/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
Autologous stem cell transplantation (ASCT) is an important treatment that can offer a cure for patients with lymphoma. However, advanced age is an important factor that determines eligibility and outcomes after ASCT. Over the past decade, attributed to improved supportive care, ASCT for older patients has become more feasible. In this study, we report the single-center outcomes of older patients with lymphoma undergoing ASCT at Mayo Clinic Rochester to highlight its interval improvement over time and to help redefine the implications of ASCT in the chimeric antigen receptor T cell therapy era. This single-center retrospective study evaluated the characteristics and outcomes of older patients with lymphoma who underwent ASCT between 2000 and 2021. We report various relevant transplantation-related outcomes, including progression-free survival, overall survival (OS), relapse incidence, and nonrelapse mortality (NRM) in older patients with various lymphoma histologic subtypes. The main outcome was NRM, defined as the time from ASCT to non-lymphoma-related death, with relapse as a competing event. Of 492 patients age ≥65 years were analyzed. The median age at ASCT was 68.8 years. The most common indication for ASCT was diffuse large B cell lymphoma, accounting for 59.3% of cases. In multivariate analyses, patients undergoing ASCT in 2009 to 2021, an Eastern Cooperative Oncology Group Performance Status of 0, and low Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) (0 to 3) had a significantly lower NRM. Factors associated with OS included age, lactate dehydrogenase level, and HCT-CI. The 1-year NRM in older patients was low at 6.0%, in concordance with previous reports. Age should not be the sole factor determining a patient's ASCT eligibility. With the proper patient selection, ASCT remains a reasonable option for older patients with lymphoma.
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Affiliation(s)
- Kitsada Wudhikarn
- Division of Hematology, Mayo Clinic, Rochester, Minnesota; Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bradley M Johnson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | - Luis F Porrata
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Willam J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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7
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Farooqui N, Zaidi M, Vaughan L, McKee TD, Ahsan E, Pavelko KD, Villasboas JC, Markovic S, Taner T, Leung N, Dong H, Alexander MP, Herrmann SM. Cytokines and Immune Cell Phenotype in Acute Kidney Injury Associated With Immune Checkpoint Inhibitors. Kidney Int Rep 2023; 8:628-641. [PMID: 36938084 PMCID: PMC10014345 DOI: 10.1016/j.ekir.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/28/2022] [Revised: 10/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Immune checkpoint inhibitors (ICIs) induce impressive antitumor responses but may lead to acute kidney injury (AKI) associated with ICI therapy (AKI-ICI). Biomarkers distinguishing AKI-ICI from AKI because of other causes (AKI-other) are currently lacking. Because ICIs block immunoregulatory pathways, we hypothesized that biomarkers related to immune cell dysregulation, including tumor necrosis factor alpha (TNF-α) and other markers of B and T cell activation in the systemic circulation and kidney tissue, may aid with the diagnosis of AKI-ICI. Methods This is a prospective study consisting of 24 participants who presented with AKI during ICI therapy, adjudicated to either have AKI-ICI (n = 14) or AKI-other (n = 10). We compared markers of kidney inflammation and injury (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1) as well as plasma and urine levels of T cell-associated cytokines (TNF-α, interferon-γ, interleukin (IL)-2, IL-4, IL-6, IL-8, IL-9, and IL-10) between groups. We also compared T-cell responses in the systemic circulation and in kidney tissue across groups, using mass cytometry systems. Results We observed increase in several specific immune cells, including CD4 memory, T helper cells, and dendritic cells in the kidney tissue, as well as in the urine cytokines IL-2, IL-10, and TNF-α, in patients who developed AKI-ICI compared to patients with AKI-other (P < 0.05 for all). The discriminatory ability of TNF-α on AKI cause was strong (area under the curve = 0.814, 95% confidence interval: 0.623-1.00. The CD4+ T cells with memory phenotype formed the dominant subset. Conclusion These results suggest that specific T-cell responses and their respective cytokines may be indicative of AKI associated with ICI therapy and may help to differentiate AKI-ICI from AKI-other. Urine TNF-α is a promising biomarker for AKI-ICI, which is most often caused by acute interstitial nephritis (AIN), and TNF-α pathway may serve as a potential target for therapeutic intervention.
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Affiliation(s)
- Naba Farooqui
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Zaidi
- Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Lisa Vaughan
- Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Trevor D. McKee
- Department of Medical Biophysics, University of Toronto, Ontario, Canada
- Deciphex Inc., Chicago, Illinois, USA
| | - Eram Ahsan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin D. Pavelko
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | | | - Timucin Taner
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Haidong Dong
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Mariam P. Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sandra M. Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Correspondence: Sandra M. Herrmann, Nephrology and Hypertension Division, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
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8
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Wiedmeier-Nutor JE, Iqbal M, Rosenthal AC, Bezerra ED, Garcia-Robledo JE, Bansal R, Johnston PB, Hathcock M, Larsen JT, Bergsagel PL, Wang Y, Reeder CB, Leis JF, Fonseca R, Palmer JM, Gysbers BJ, Mwangi R, Warsame RM, Kourelis T, Hayman SR, Dingli D, Kapoor P, Kumar SK, Durani U, Villasboas JC, Paludo J, Bennani NN, Nowakowski G, Ansell SM, Castro JE, Kharfan-Dabaja MA, Lin Y, Vergidis P, Murthy HS, Munoz J. Response to COVID-19 vaccination post CAR T therapy in patients with non-Hodgkin lymphoma and multiple myeloma. Clinical Lymphoma Myeloma and Leukemia 2023; 23:456-462. [PMID: 37003846 PMCID: PMC9990888 DOI: 10.1016/j.clml.2023.03.002] [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: 01/10/2023] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
COVID-19 adversely affects individuals with cancer. Several studies have found that seroconversion rates among patients with hematologic malignancies are suboptimal when compared to patients without cancer. Patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are immunocompromised due to impaired humoral and cellular immunity in addition to prescribed immunosuppressive therapy. Chimeric antigen receptor T-cell (CAR T) therapy is now widely used for NHL and MM, but little is known about seroconversion rates after COVID-19 vaccination among these populations. We evaluated SARS-CoV-2 spike-binding IgG antibody levels following COVID-19 vaccination among NHL and MM CAR T therapy recipients. Out of 104 CAR T infusions, 19 patients developed known COVID-19 infection post-CAR T. We tested 17 patients that received CAR T for antibody spike titers post COVID-19 vaccination, only 29 % (n = 5) were able to mount a clinically relevant antibody response (>250 IU/mL).
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Affiliation(s)
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Jeremy T Larsen
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - P Leif Bergsagel
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Craig B Reeder
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Rafael Fonseca
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jeanne M Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Brianna J Gysbers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Urshila Durani
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Januario E Castro
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Javier Munoz
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
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9
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Acosta-Medina AA, Johnson IM, Bansal R, Hathcock M, Kenderian SJ, Durani U, Khurana A, Wang Y, Paludo J, Villasboas JC, Bennani NN, Johnston PB, Ansell SM, Lin Y, Alkhateeb HB. Pre-lymphodepletion & infusion endothelial activation and stress index as predictors of clinical outcomes in CAR-T therapy for B-cell lymphoma. Blood Cancer J 2023; 13:7. [PMID: 36599834 DOI: 10.1038/s41408-022-00777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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10
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Saifi O, Breen WG, Lester SC, Rule WG, Stish BJ, Rosenthal A, Munoz J, Lin Y, Bansal R, Hathcock MA, Bennani NN, Paludo J, Khurana A, Villasboas JC, Johnston PB, Ansell SM, Iqbal M, Moustafa MA, Murthy HS, Kharfan-Dabaja MA, Hoppe BS, Peterson JL. Don't Put the CART Before the Horse: The Role of Radiation Therapy in Peri-CAR T-cell Therapy for Aggressive B-cell Non-Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2022:S0360-3016(22)03637-9. [PMID: 36563910 DOI: 10.1016/j.ijrobp.2022.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE The optimal approach to incorporate radiation therapy (RT) in conjunction with chimeric antigen receptor (CAR) T-cell therapy (CART) for relapsed/refractory (r/r) B-cell non-Hodgkin lymphoma (bNHL) remains unclear. This study documented the RT local control rate among patients who received bridging radiation therapy (BRT) before CART and compares it with those who received salvage radiation therapy (SRT) after CART. This article further reports on a promising way to use SRT for post-CART disease and identifies predictors for RT in-field recurrence. METHODS AND MATERIALS We retrospectively reviewed 83 patients with r/r bNHL who received CART and RT, either as BRT pre-CART infusion (n = 35) or as SRT post-CART infusion (n = 48), between 2018 and 2021. RT was defined as comprehensive (compRT; ie, treated all sites of active disease) or focal (focRT). Limited disease was defined as disease amenable to compRT, involving <5 active disease sites. RESULTS At time of RT, patients who received BRT before CART had bulkier disease sites (median diameter, 8.7 vs 5.5 cm; P = .01) and were treated to significantly lower doses (median equivalent 2-Gy dose, 23.3 vs 34.5 Gy; P = .002), compared with SRT post-CART. Among 124 total irradiated sites identified, 8 of 59 (13%) bridged sites and 21 of 65 (32%) salvaged sites experienced in-field recurrence, translating to 1-year local control rates (LC) of 84% and 62%, respectively (P = .009). Patients with limited post-CART disease (n = 37) who received compSRT (n = 26) had better overall survival (51% vs 12%; P = .028), freedom from subsequent progression (31% vs 0%; P < .001), and freedom from subsequent event (19% vs 0%; P = .011) compared with patients with limited disease who received focSRT (n = 11). CONCLUSIONS BRT followed by CART appears to be associated with improved LC compared with SRT in r/r bNHL. Nonetheless, SRT offers a promising salvage intervention for limited (<5 sites) relapsed post-CART disease if given comprehensively.
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Affiliation(s)
- Omran Saifi
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Javier Munoz
- Division of Hematology, Mayo Clinic, Phoenix, Arizona
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota; Division of Experimental Pathology, Mayo Clinic, Rochester, Minnesota
| | - Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Arushi Khurana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Madiha Iqbal
- Division of Hematology, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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11
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O'Donoghue DF, Truong HL, Finnes HD, McDonald JS, May HP, Ansell SM, Bennani NN, Habermann TM, Inwards DJ, Johnston PB, Khurana A, Lin Y, Micallef IN, Nowakowski GS, Paludo J, Porrata LF, Thanarajasingam G, Thompson CA, Villasboas JC, Wang Y, Witzig TE, Leung N. High-Dose Methotrexate in Patients With Lymphoma: Predictors of a Complicated Course. JCO Oncol Pract 2022; 18:e1908-e1917. [PMID: 36240468 DOI: 10.1200/op.22.00182] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE High-dose methotrexate (HDMTX; > 500 mg/m2) is an important component of lymphoma therapy. Serum MTX monitoring at 48 hours is the standard approach to identify those at increased risk of developing MTX toxicity. Our aim was to characterize the incidence of complications and their association with MTX levels. METHODS A retrospective review of our institutional electronic medical record was conducted to identify patients with lymphoma who received HDMTX between January 1, 2002, and December 31, 2018. We characterized the incidence of acute kidney injury (AKI), intensive care unit (ICU) admission, length of hospital stay (LOS), and 30-day mortality across 48-hour MTX levels. To establish an association between 48-hour MTX levels and the complications listed, we performed chi-square analysis for dichotomous variables and Kruskal-Wallis for nonparametric data. Receiver operator characteristic curve analysis was performed to identify the MTX level where AKI grade ≥ 2 was more likely. Multivariate logistic regression analysis was performed to identify risk factors for this MTX level. RESULTS We identified 642 patients with 2,804 cycles of HDMTX. The incidence of AKI was 19.1% with AKI grade ≥ 2 making up 21% of cases. Rates of AKI, ICU admission, and 30-day mortality are associated with elevated 48-hour MTX levels. There was a significant increase in median LOS with elevated MTX levels (P < .001). Receiver operator characteristic curve analysis for AKI grade ≥ 2 demonstrated a 48-hour MTX level threshold of 1.28 μmol/L. Multivariate logistic regression analysis revealed age, male sex, elevated body surface area, higher MTX dose, monotherapy, and first cycle as independent factors. CONCLUSION Elevated MTX levels are associated with a significant increased rate of AKI, ICU admission, prolonged LOS, and 30-day mortality. Elevated 48-hour MTX levels, particularly > 1.28 μmol/L, should alert clinicians for complications and to initiate measures to reduce MTX levels.
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Affiliation(s)
| | | | | | | | - Heather P May
- Department of Pharmacy, Mayo Clinic, Rochester, MN.,Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN.,Department of Nephrology, Mayo Clinic, Rochester, MN
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12
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Bansal R, Novo M, Al Saleh AS, Guerrico AG, Zhang H, Shao Z, Babadi E, Martinez KE, McCoy GA, Hathcock MA, Khurana A, Bennani NN, Paludo J, Wang Y, Ansell SM, Johnston PB, Villasboas JC, Lin Y. Peak absolute lymphocyte count after CAR-T infusion predicts clinical response in aggressive lymphoma. Am J Hematol 2022; 97:E241-E244. [PMID: 35385152 DOI: 10.1002/ajh.26561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Radhika Bansal
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Mattia Novo
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | - Henan Zhang
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Zuoyi Shao
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Elham Babadi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | | | - Arushi Khurana
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Jonas Paludo
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Yucai Wang
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | | | - Yi Lin
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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13
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Farooqui N, Sy-Go JPT, Miao J, Mehta R, Vaughan LE, Bennani NN, Wang Y, Bansal R, Hathcock MA, Hayman SR, Johnston PB, Villasboas JC, Paludo J, Ansell SM, Leung N, Lin Y, Herrmann SM. Incidence and Risk Factors for Acute Kidney Injury After Chimeric Antigen Receptor T-Cell Therapy. Mayo Clin Proc 2022; 97:1294-1304. [PMID: 35787856 PMCID: PMC9703303 DOI: 10.1016/j.mayocp.2022.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the association of baseline and postinfusion patient characteristics with acute kidney injury (AKI) in the month after chimeric antigen receptor T-cell (CAR-T) therapy. METHODS We retrospectively reviewed records of 83 patients with non-Hodgkin lymphoma undergoing CAR-T therapy (axicabtagene ciloleucel) between June 2016 and November 2020. Patients were followed up to 1 month after treatment. Post-CAR-T AKI was defined as a more than 1.5-fold increase in serum creatinine concentration from baseline (on the day of CAR-T infusion) at any time up to 1 month after CAR-T therapy. RESULTS Of 83 patients, 14 (17%) developed AKI during follow-up. At 1 month after CAR-T infusion, 10 of 14 (71%) AKI events had resolved. Lower baseline estimated glomerular filtration rate, use of intravenous contrast material, tumor lysis prophylaxis, higher peak uric acid and creatine kinase levels during follow-up, and change in lactate dehydrogenase from baseline to peak level within 1 month after initiation of CAR-T therapy were significantly associated with AKI incidence during follow-up. Incidence of AKI was also higher in patients who received higher doses of corticosteroids and tocilizumab. CONCLUSION Acute kidney injury occurred in approximately 1 in 6 patients who received axicabtagene ciloleucel for non-Hodgkin lymphoma. Patients with high tumor burden receiving higher total doses of corticosteroids or tocilizumab should be closely monitored for development of AKI. Lower baseline kidney function at CAR-T initiation, exposure to contrast material, and progressive increase in levels of tumor lysis markers (uric acid, lactate dehydrogenase, creatine kinase) after CAR-T infusion may predict risk of AKI during the 1 month after infusion.
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Affiliation(s)
- Naba Farooqui
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Jing Miao
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Ramila Mehta
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Lisa E Vaughan
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Radhika Bansal
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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14
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Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Villasboas JC, Paludo J, Markovic SN. Long-term outcome of immunologic autograft engineering. EJHaem 2022; 3:488-491. [PMID: 35846064 PMCID: PMC9176079 DOI: 10.1002/jha2.404] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/11/2022]
Abstract
Our phase III trial reported that autograft-absolute lymphocyte count (A-ALC) improved survival post-autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT) for a short-term follow-up of 2 years. We evaluated retrospectively in our phase III trial patients that the A-ALC still confers survival benefit with a longer follow-up. With a median follow-up of 127.6 months, patients infused with an A-ALC ≥ 0.5 × 109 cells/kg experienced better overall survival (HR = 0.392, 95% confidence of interval [CI]: 0.224-0.687, p < 0.001) and progression-free survival (HR = 0.413, 95% CI: 0.253-0.677), p < 0.0004). This study supports that A-ALC provides long-term survival benefit post APBHSCT.
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Affiliation(s)
- Luis F Porrata
- Division of Hematology Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - David J Inwards
- Division of Hematology Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Stephen M Ansell
- Division of Hematology Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Ivana N Micallef
- Division of Hematology Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Patrick B Johnston
- Division of Hematology Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Jose C Villasboas
- Division of Hematology Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Jonas Paludo
- Division of Hematology Department of Medicine Mayo Clinic Rochester Minnesota USA
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15
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Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Villasboas JC, Paludo J, Markovic SN. Impact of autograft-absolute lymphocyte count on survival in double/triple hit lymphomas post-autologous stem cell transplantation. Leuk Lymphoma 2022; 63:2436-2443. [DOI: 10.1080/10428194.2022.2064988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Luis F. Porrata
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David J. Inwards
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Stephen M. Ansell
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ivana N. Micallef
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Patrick B. Johnston
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jose C. Villasboas
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jonas Paludo
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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16
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Bezerra ED, Muñoz J, Murthy H, Khurana A, Bansal R, Iqbal M, Maurer MJ, Hathcock M, Johnston PB, Bennani NN, Paludo J, Wang Y, Villasboas JC, Rosenthal A, Ansell S, Witzig TE, Castro JE, Kharfan-Dabaja MA, Nowakowski GS, Lin Y. Barriers to Enrollment in Clinical Trials in Patients with Aggressive B-Cell Non-Hodgkin Lymphoma That Progressed after Anti-CD19 CART Cell Therapy. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Wiedmeier-Nutor JE, Iqbal M, Muñoz J, Bezerra ED, Garcia Robledo JE, Bansal R, Johnston PB, Hathcock M, Larsen JT, Bergsagel PL, Wang Y, Reeder C, Leis JF, Fonseca R, Palmer J, Warsame R, Kourelis T, Hayman SR, Dingli D, Kapoor P, Villasboas JC, Paludo J, Bennani NN, Ansell S, Castro JE, Kharfan-Dabaja MA, Lin Y, Vergidis P, Murthy H, Rosenthal A. Response to COVID-19 Vaccination Post-CAR T Therapy in Patients with Non-Hodgkin Lymphoma and Multiple Myeloma. Transplant Cell Ther 2022. [PMCID: PMC8930047 DOI: 10.1016/s2666-6367(22)00400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Wudhikarn K, Bansal R, Khurana A, Hathcock MA, Braksick SA, Bennani NN, Paludo J, Villasboas JC, Wang Y, Johnston PB, Ansell SM, Lin Y. Age defining immune effector cell associated neurotoxicity syndromes in aggressive large B cell lymphoma patients treated with axicabtagene ciloleucel. Am J Hematol 2021; 96:E427-E430. [PMID: 34424554 DOI: 10.1002/ajh.26330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Kitsada Wudhikarn
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
- Division of Hematology and Research Unit in Translational Hematology, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Radhika Bansal
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Arushi Khurana
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Matthew A. Hathcock
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | | | - N. Nora Bennani
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Jonas Paludo
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Jose C. Villasboas
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Yucai Wang
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Patrick B. Johnston
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Stephen M. Ansell
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
| | - Yi Lin
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota USA
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19
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Khurana A, Hathcock M, Habermann TM, Al Saleh AS, Gandhi S, Truong T, Bennani NN, Paludo J, Villasboas JC, Ansell SM, Inwards DJ, Porrata LF, Johnston PB, Micallef I, Lin Y. Lines of therapy before autologous stem cell transplant and CAR-T affect outcomes in aggressive Non-Hodgkin's lymphoma. Am J Hematol 2021; 96:E386-E389. [PMID: 34260759 DOI: 10.1002/ajh.26293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Arushi Khurana
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | - Abdullah S. Al Saleh
- College of Medicine King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia
| | | | - Tuan Truong
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Jonas Paludo
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | | | | | | | - Ivana Micallef
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Yi Lin
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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20
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Barreto JN, Bansal R, Hathcock MA, Doleski CJ, Hayne JR, Truong TA, Nedved AN, Ansell SM, Bennani NN, Paludo J, Villasboas JC, Lin Y, Johnston PB. The impact of granulocyte colony stimulating factor on patients receiving chimeric antigen receptor T-cell therapy. Am J Hematol 2021; 96:E399-E402. [PMID: 34350612 DOI: 10.1002/ajh.26313] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023]
Affiliation(s)
| | - Radhika Bansal
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Matthew A. Hathcock
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Justin R. Hayne
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Tuan A. Truong
- Department of Nursing Mayo Clinic Rochester Minnesota USA
| | | | - Stephen M. Ansell
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - N. Nora Bennani
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Jonas Paludo
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Jose C. Villasboas
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Patrick B. Johnston
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
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21
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Kraft RM, Ansell SM, Villasboas JC, Bennani NN, Wang Y, Habermann TM, Thanarajasingam G, Lester SC, Macon W, Inwards DJ, Porrata LF, Micallef IN, Witzig TE, Thompson CA, Johnston PB, Nowakowski GS, Lin Y, Paludo J. Outcomes in primary cutaneous diffuse large B-cell lymphoma, leg type. Hematol Oncol 2021; 39:658-663. [PMID: 34453851 DOI: 10.1002/hon.2919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/22/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is a rare, aggressive lymphoma characterized by skin involvement predominantly in the lower extremities. Immunochemotherapy with or without involved-site radiation therapy (ISRT) is considered standard front-line therapy. Over-expression of PD-L1/PD-L2 is seen in a high proportion of PCDLBCL, LT cases, but efficacy of immune checkpoint inhibitors (ICI) in relapsed/refractory, PCDLBCL, LT has not been thoroughly studied. We conducted a retrospective cohort study of patients diagnosed with PCDLBCL, LT seen at Mayo Clinic from 1 January 2000 to 31 December 2020. Using the Kaplan-Meier method, we calculated progression-free survival, duration of response, and overall survival in patients who received front-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with and without ISRT, and salvage ICI therapy for relapsed/refractory disease. A total of 28 patients with PCDLBCL, LT were identified. The median PFS in patients treated with R-CHOP plus ISRT was 58 months (95% CI: 18-112) compared to 14 months (95% CI: 5-not reached; p = 0.04) in those treated with R-CHOP without ISRT. The median PFS from salvage ICI therapy was 10 months (95% CI: 4-not reached), and median DOR from salvage ICI therapy was 23 months [95% CI: 4-26]. R-CHOP with ISRT had a significantly longer median PFS compared to R-CHOP without ISRT as front-line therapy for PCDLBCL, LT. ICIs may have a role in treating relapsed/refractory disease as reasonable activity in heavily pre-treated patients was observed in this study.
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Affiliation(s)
- Robert M Kraft
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Macon
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - David J Inwards
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis F Porrata
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Thomas E Witzig
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Arushi Khurana, Mwangi R, Ansell SM, Habermann TM, Cerhan JR, Strouse C, Link BK, Wang Y, King RL, Macon WR, Villasboas JC, Witzig TE, Maurer MJ, Nowakowski GS. Patterns of therapy initiation during the first decade for patients with follicular lymphoma who were observed at diagnosis in the rituximab era. Blood Cancer J 2021; 11:133. [PMID: 34274939 PMCID: PMC8286048 DOI: 10.1038/s41408-021-00525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/11/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022] Open
Abstract
Immediate treatment for asymptomatic, low-tumor burden follicular lymphoma (FL) has not shown an overall survival benefit over "watch and wait" (W/W) strategy. We estimated incidence of treatment initiation at specific time points and assessed its association with the presence of any criteria such as GELF, BNLI, GITMO at diagnosis. FL patients managed by W/W strategy were identified from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma SPORE between 2002 and 2015. Cumulative incidence estimates of treatment initiation were calculated using transformation (as the first event) and death as competing risks. 401 FL patients were identified on W/W strategy. At a median follow-up of 8 years, 256 (64%) initiated treatment. For patients on the W/W strategy for 5 years, the likelihood of treatment initiation in the next 5 years was 12% compared to 43% at diagnosis unlike transformation rates which remained steady. Patients with any of popular treatment criteria at diagnosis did not have increased therapy initiation rates (44% vs. 42%) during the first 5 years or lymphoma-related death rates at 10 years (6% vs. 7%). Identifying biological differences in patients with early vs. late or no progression is a critical next step in understanding outcomes in W/W patients.
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Affiliation(s)
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Brian K Link
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew J Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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23
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Fonkoua LAK, Chakrabarti S, Sonbol MB, Kasi PM, Starr JS, Liu AJ, Nevala WK, Maus RL, Bois MC, Pitot HC, Chandrasekharan C, Ross HJ, Wu TT, Graham RP, Villasboas JC, Weiss M, Foster NR, Markovic SN, Dong H, Yoon HH. Outcomes on anti-VEGFR-2/paclitaxel treatment after progression on immune checkpoint inhibition in patients with metastatic gastroesophageal adenocarcinoma. Int J Cancer 2021; 149:378-386. [PMID: 33739449 PMCID: PMC8488901 DOI: 10.1002/ijc.33559] [Citation(s) in RCA: 8] [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: 11/15/2020] [Revised: 01/25/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
Through our involvement in KEYNOTE-059, we unexpectedly observed durable responses in two patients with metastatic gastroesophageal adenocarcinoma (mGEA) who received ramucirumab (anti-VEGFR-2)/paclitaxel after immune checkpoint inhibition (ICI). To assess the reproducibility of this observation, we piloted an approach to administer ramucirumab/paclitaxel after ICI in more patients, and explored changes in the immune microenvironment. Nineteen consecutive patients with mGEA received ICI followed by ramucirumab/paclitaxel. Most (95%) did not respond to ICI, yet after irRECIST-defined progression on ICI, all patients experienced tumor size reduction on ramucirumab/paclitaxel. The objective response rate (ORR) and progression-free survival (PFS) on ramucirumab/paclitaxel after ICI were higher than on the last chemotherapy before ICI in the same group of patients (ORR, 58.8% vs 11.8%; PFS 12.2 vs 3.0 months; respectively). Paired tumor biopsies examined by imaging mass cytometry showed a median 5.5-fold (range 4-121) lower frequency of immunosuppressive forkhead box P3+ regulatory T cells with relatively preserved CD8+ T cells, post-treatment versus pre-treatment (n = 5 pairs). We then compared the outcomes of these 19 patients with a separate group who received ramucirumab/paclitaxel without preceding ICI (n = 68). Median overall survival on ramucirumab/paclitaxel was longer with (vs without) immediately preceding ICI (14.8 vs 7.4 months) including after multivariate analysis, as was PFS. In our small clinical series, outcomes appeared improved on anti-VEGFR-2/paclitaxel treatment when preceded by ICI, in association with alterations in the immune microenvironment. However, further investigation is needed to determine the generalizability of these data. Prospective clinical trials to evaluate sequential treatment with ICI followed by anti-VEGF(R)/taxane are underway.
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Affiliation(s)
- Lionel A. Kankeu Fonkoua
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Sakti Chakrabarti
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Oncology, Medical College of Wisconsin, Wauwatosa, Wisconsin
| | | | - Pashtoon M. Kasi
- Department of Oncology, Mayo Clinic, Jacksonville, Florida
- Department of Oncology, University of Iowa, Iowa City, Iowa
| | - Jason S. Starr
- Department of Oncology, Mayo Clinic, Jacksonville, Florida
| | - Alex J. Liu
- Department of Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Rachel L. Maus
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Melanie C. Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Henry C. Pitot
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Helen J. Ross
- Department of Oncology, Mayo Clinic, Phoenix, Arizona
| | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rondell P. Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jose C. Villasboas
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
- Department of Immune Monitoring Core, Mayo Clinic, Rochester, Minnesota
| | | | - Nathan R. Foster
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Svetomir N. Markovic
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Haidong Dong
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Harry H. Yoon
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
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24
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Mondello P, Fama A, Larson MC, Feldman AL, Villasboas JC, Yang ZZ, Galkin I, Svelolkin V, Postovalova E, Bagaev A, Ovcharov P, Varlamova A, Huet S, Tesson B, McGrath KR, Slager S, Link BK, Syrbu S, Novak AJ, Habermann TM, Witzig TE, Nowakowski GS, Salles G, Cerhan JR, Ansell SM. Lack of intrafollicular memory CD4 + T cells is predictive of early clinical failure in newly diagnosed follicular lymphoma. Blood Cancer J 2021; 11:130. [PMID: 34267181 PMCID: PMC8282842 DOI: 10.1038/s41408-021-00521-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/27/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 02/07/2023] Open
Abstract
Despite a characteristic indolent course, a substantial subset of follicular lymphoma (FL) patients has an early relapse with a poor outcome. Cells in the microenvironment may be a key contributor to treatment failure. We used a discovery and validation study design to identify microenvironmental determinants of early failure and then integrated these results into the FLIPI. In total, 496 newly diagnosed FL grade 1-3 A patients who were prospectively enrolled into the MER cohort from 2002 to 2012 were evaluated. Tissue microarrays were stained for CD4, CD8, FOXP3, CD32b, CD14, CD68, CD70, SIRP-α, TIM3, PD-1, and PD-L1. Early failure was defined as failing to achieve event-free survival at 24 months (EFS24) in immunochemotherapy-treated patients and EFS12 in all others. CyTOF and CODEX analysis were performed to characterize intratumoral immunophenotypes. Lack of intrafollicular CD4 expression was the only predictor of early failure that replicated with a pooled OR 2.37 (95%CI 1.48-3.79). We next developed a bio-clinical risk model (BioFLIPI), where lack of CD4 intrafollicular expression moved patients up one FLIPI risk group, adding a new fourth high-risk group. Compared with BioFLIPI score of 1, patients with a score of 2 (OR 2.17; 95% CI 1.08-4.69), 3 (OR 3.53; 95% CI 1.78-7.54), and 4 (OR 8.92; 95% CI 4.00-21.1) had increasing risk of early failure. The favorable intrafollicular CD4 T cells were identified as activated central memory T cells, whose prognostic value was independent from genetic features. In conclusion, lack of intrafollicular CD4 expression predicts early failure in FL and combined with FLIPI improves identification of high-risk patients; however, independent validation is warranted.
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Affiliation(s)
- Patrizia Mondello
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Angelo Fama
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Hematology Unit, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale- IRCCS, Reggio Emilia, Italy
| | - Melissa C Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Jose C Villasboas
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zhi-Zhang Yang
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | - Sarah Huet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, laboratoire d'hématologie, Pierre-Bénite, France
- Université Claude Bernard Lyon I, Lyon, France
| | | | - Kaitlyn R McGrath
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Sergei Syrbu
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - Anne J Novak
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas M Habermann
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas E Witzig
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Gilles Salles
- Université Claude Bernard Lyon I, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, service d'Hématologie, Pierre-Bénite, France
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Ansell
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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25
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Pritchett JC, Yang ZZ, Kim HJ, Villasboas JC, Tang X, Jalali S, Cerhan JR, Feldman AL, Ansell SM. High-dimensional and single-cell transcriptome analysis of the tumor microenvironment in angioimmunoblastic T cell lymphoma (AITL). Leukemia 2021; 36:165-176. [PMID: 34230608 DOI: 10.1038/s41375-021-01321-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 02/08/2023]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive lymphoid malignancy associated with a poor clinical prognosis. The AITL tumor microenvironment (TME) is unique, featuring a minority population of malignant CD4+ T follicular helper (TFH) cells inter-mixed with a diverse infiltrate of multi-lineage immune cells. While much of the understanding of AITL biology to date has focused on characteristics of the malignant clone, less is known about the many non-malignant populations that comprise the TME. Recently, mutational consistencies have been identified between malignant cells and non-malignant B cells within the AITL TME. As a result, a significant role for non-malignant populations in AITL biology has been increasingly hypothesized. In this study, we have utilized mass cytometry and single-cell transcriptome analysis to identify several expanded populations within the AITL TME. Notably, we find that B cells within the AITL TME feature decreased expression of key markers including CD73 and CXCR5. Furthermore, we describe the expansion of distinct CD8+ T cell populations that feature an exhausted phenotype and an underlying expression profile indicative of dysfunction, impaired cytotoxicity, and upregulation of the chemokines XCL2 and XCL1.
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Affiliation(s)
| | - Zhi-Zhang Yang
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Hyo Jin Kim
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Xinyi Tang
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - James R Cerhan
- Department of Health Sciences Research and Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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26
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Wu H, Tang X, Kim HJ, Jalali S, Pritchett JC, Villasboas JC, Novak AJ, Yang ZZ, Ansell SM. Expression of KLRG1 and CD127 defines distinct CD8 + subsets that differentially impact patient outcome in follicular lymphoma. J Immunother Cancer 2021; 9:jitc-2021-002662. [PMID: 34226281 PMCID: PMC8258669 DOI: 10.1136/jitc-2021-002662] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Accepted: 06/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background CD8+ T-lymphocyte subsets defined by killer lectin-like receptor G1 (KLRG1) and CD127 expression have been reported to have an important role in infection, but their role in the setting of lymphoid malignancies, specifically follicular lymphoma (FL), has not been studied. Methods To characterize the phenotype of KLRG1/CD127-defined CD8+ subsets, surface and intracellular markers were measured by flow cytometry and Cytometry by time of flight (CyTOF), and the transcriptional profile of these cells was determined by CITE-Seq (Cellular Indexing of Transcriptomes and Epitopes by Sequencing). The functional capacity of each subset was determined, as was their impact on overall survival (OS) and event-free survival (EFS) of patients with FL. Results We found that intratumoral CD8+ cells in FL are skewed toward effector cell subsets, particularly KLRG+CD127- and KLRG1-CD127- cells over memory cell subsets, such as KLRG1-CD127+ and KLRG1+CD127+ cells. While effector subsets exhibited increased capacity to produce cytokines/granules when compared with memory subsets, their proliferative capacity and viability were found to be substantially inferior. Clinically, a skewed distribution of intratumoral CD8+ T cells favoring effector subtypes was associated with an inferior outcome in patients with FL. Increased numbers of CD127+KLRG1- and CD127+KLRG1+ were significantly associated with a favorable OS and EFS, while CD127-KLRG1- correlated with a poor EFS and OS in patients with FL. Furthermore, we demonstrated that interleukin (IL)-15 promotes CD127-KLRG1+ cell development in the presence of dendritic cells via a phosphoinositide 3-kinase (PI3K)-dependent mechanism, and treatment of CD8+ T cells with a PI3K inhibitor downregulated the transcription factors responsible for CD127-KLRG1+ differentiation. Conclusions Taken together, these results reveal not only a biological and prognostic role for KLRG1/CD127-defined CD8+ subsets in FL but also a potential role for PI3K inhibitors to manipulate the differentiation of CD8+ T cells, thereby promoting a more effective antitumor immune response.
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Affiliation(s)
- Hongyan Wu
- Department of Immunology, Medical College, China Three Gorges University, Yichang, Hubei, People's Republic of China
| | - Xinyi Tang
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hyo Jin Kim
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahrzad Jalali
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua C Pritchett
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jose C Villasboas
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne J Novak
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zhi-Zhang Yang
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Ansell
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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27
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Carter JM, Chumsri S, Hillman DW, Zahrieh DM, Ma Y, Wang X, Kachergus JM, Boughey JC, Liu MC, Kalari KR, Villasboas JC, Ferre RAL, Couch FJ, Goetz MP, Thompson EA. Abstract PS16-01: Intra-epithelial tumor immune landscapes are associated with clinical outcomes in early-stage triple-negative breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps16-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: Stromal tumor-infiltrating lymphocytes (sTILs) have established prognostic and predictive significance in triple-negative breast cancer (TNBC). However, the roles of other immune cells in TNBC are less well-established. We performed high-plex quantitative spatial profiling in a cohort of early-stage TNBC to 1) apply spatial context to tumoral immune landscapes and 2) identify immune proteins associated with clinical outcomes, independently of TILs and other established prognostic clinicopathologic variables, in patients (pts) treated with or without adjuvant chemotherapy (CTX). Methods: The Mayo TNBC cohort comprises pts with centrally-verified, CTX-naive tumors resected from 1985-2012. Using a cohort-based TMA, with Nanostring GeoMX DSP, we quantitated 58 proteins within spatially-distinct intra-epithelial, cytokeratin-positive tumor segments and adjacent cytokeratin-negative/nuclei-positive stromal segments. Differentially-expressed (DE) proteins were identified using a negative binomial generalized linear model (SNR>2, p< 0.05) and a target DE protein set was dichotomized (80th percentile). After adjusting for prognostic clinicopathologic variables, proteins associated with recurrence-free survival (RFS, defined as time from surgery to either local, regional, and distant recurrence, or death by any cause) were identified by performing variable selection using the Akaike Information Criterion (AIC) obtained from fitting all possible Cox proportional hazards regression models (performed separately for intra-epithelial/stromal segments, and in groups +/- adjuvant CTX. Results: From the TNBC TMA, DSP data (N=250 tumors) included 169 pts who received adjuvant CTX+ and 81 who did not (CTX-). Overall, 85/250 developed recurrent disease. In the CTX+ group, intra-epithelial tumor segments from pts without recurrent disease were enriched in 10 immune proteins, including CD8, markers involved in antigen presentation/dendritic cells (CD11c, CD40, HLA-DR) or NK cells (CD56) (FC: 1.4-2.1, p<0.05); CD14 was increased in stroma (FC: 1.5, p<0.05). In contrast, in the CTX- group, both the intra-epithelial tumor and stromal segments from pts without recurrences were enriched in immune proteins (N= 12 and 15 respectively; FC 1.6-5.5, p< 0.05) most markedly CD40, IDO1 and HLA-DR (FC: 3.2-5.5, p< 0.05). Overall, CD3, CD4, CD27, CD44, and ICOS among others were enriched only in the CTX- group; CD14 and CD56 were enriched only in the CTX+ group. Based on these spatial data, biologic function and DSP data from another set of TNBC (FinXX trial), CD11c, CD14, CD27, CD40, CD56, and IDO1 were selected for RFS analysis. After applying our model selection criterion and adjusting for pt age at surgery, tumor size, lymph node status, and sTILs, intra-epithelial CD56 was independently associated with improved RFS in the CTX+ group (HR: 0.31[0.12, 0.81]). In the CTX- group, intra-epithelial CD11c was independently associated with improved RFS (0.10 [0.01, 0.81]). Conclusion: In this early-stage TNBC cohort, spatially-distinct tumor immune landscapes were associated with RFS but differed according to receipt of CTX after surgical resection. In the patients who received CTX, the intra-epithelial compartment, rather than stromal compartment, was immune-enriched in pts without recurrences. Among a targeted protein set, intra-epithelial CD56 remained associated with improved outcomes, independent of sTILs and other clinicopathologic features. In the CTX- group, spatial landscapes were more balanced, and intra-epithelial CD11c was independently associated with improved outcomes. These data provide insight into the spatial context of intrinsic immune landscapes in TNBC, and identify candidate prognostic immune biomarkers which may inform therapeutic strategies.
Citation Format: Jodi M Carter, Saranya Chumsri, David W Hillman, David M Zahrieh, Yaohua Ma, Xue Wang, Jennifer M Kachergus, Judy C Boughey, Minetta C Liu, Krishna R Kalari, JC Villasboas, Roberto A Leon Ferre, Fergus J Couch, Matthew P Goetz, E. Aubrey Thompson. Intra-epithelial tumor immune landscapes are associated with clinical outcomes in early-stage triple-negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS16-01.
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28
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Durani U, Asante D, Heien HC, Thompson CA, Halfdanarson T, Sangaralingham L, Peethambaram P, Quevedo FJ, Villasboas JC, Go RS. Changes in Frequency of Surveillance Imaging of Survivors of Diffuse Large B-Cell Lymphoma After the American Society of Hematology Choosing Wisely Recommendations. JCO Oncol Pract 2020; 17:e490-e496. [PMID: 33095693 DOI: 10.1200/op.20.00362] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2013, the American Society of Hematology (ASH) published recommendations with Choosing Wisely to limit surveillance imaging in aggressive lymphoma. We studied surveillance imaging practice patterns for diffuse large B-cell lymphoma (DLBCL) before and after the ASH Choosing Wisely campaign. We used OptumLabs Data Warehouse, a national insurance claims database, to retrospectively study imaging frequency in survivors of DLBCL from 2008 to 2016. Three time periods were defined: Period 1 (2008 to 2010), Period 2 (2011 to 2013), and Period 3 (2014 to 2016). One thousand four hundred seventy-two patients were included. Median follow up was approximately 2 years. During the first and second years of surveillance, imaging remained stable between Period 1 (years 1 and 2: 199 [91%] and 137 [83%], respectively) and Period 2 (years 1 and 2: 257 [88%] and 172 [77%], respectively; P = .38), but decreased in Period 3 (years 1 and 2: 315 [78%] and 83 [61%], respectively; P < .01). In a multivariable logistic regression, year after 2012 was a significant predictor of decreased overuse (more than two scans per year in the first year of surveillance; [odds ratio, 0.49 for 2013 v 2008; P = .02]). Our study demonstrated the rate of surveillance scans-both computed tomography and positron emission tomography imaging-in DLBCL decreased after the ASH Choosing Wisely campaign. Multiple factors, such as changes in recommendations, reimbursement, and provider knowledge base, may have all contributed and should be studied further.
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Affiliation(s)
| | - Dennis Asante
- Department of Health Sciences Research, Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.,UnitedHealth Group, Minneapolis, MN
| | - Herbert C Heien
- Department of Health Sciences Research, Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.,OptumLabs, Cambridge, MA
| | | | | | - Lindsey Sangaralingham
- Department of Health Sciences Research, Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.,OptumLabs, Cambridge, MA
| | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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29
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Yang ZZ, Kim HJ, Villasboas JC, Price-Troska T, Jalali S, Wu H, Luchtel RA, Polley MYC, Novak AJ, Ansell SM. Mass Cytometry Analysis Reveals that Specific Intratumoral CD4 + T Cell Subsets Correlate with Patient Survival in Follicular Lymphoma. Cell Rep 2020; 26:2178-2193.e3. [PMID: 30784598 PMCID: PMC6402596 DOI: 10.1016/j.celrep.2019.01.085] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 04/30/2018] [Revised: 09/24/2018] [Accepted: 01/24/2019] [Indexed: 12/30/2022] Open
Abstract
Follicular lymphoma (FL) is an indolent B cell malignancy characterized by an extensive but poorly functional T cell infiltrate in the tumor microenvironment. Using mass cytometry, we identified at least 12 subsets of intratumoral CD4+ T cells, 3 of which were unique to FL biopsies versus control tissues. Of these subsets, the frequency of naive T cells correlated with improved patient survival. Although total PD-1+ T cell numbers were not associated with patient outcome, specific PD-1+ T cell subpopulations were associated with poor survival. Intratumoral T cells lacking CD27 and CD28 co-stimulatory receptor expression were enriched in FL and correlated with inferior patient outcomes. In vitro models revealed that CD70+ lymphoma cells played an important role in expanding this population. Taken together, our mass cytometry results identified CD4+ memory T cell populations that are poorly functional due to loss of co-stimulatory receptor expression and are associated with an inferior survival in FL. Yang et al. utilize mass cytometry (CyTOF) to characterize intratumoral T cells and explore the clinical relevance of T cell subsets in follicular lymphoma (FL). Clustering analysis reveals an immune signature with reduced expression of co-stimulatory molecules on intratumoral T cells that correlated with a poor prognosis in FL.
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Affiliation(s)
- Zhi-Zhang Yang
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Hyo Jin Kim
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jose C Villasboas
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tammy Price-Troska
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahrzad Jalali
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hongyan Wu
- Department of Immunology, Medical College, China Three Gorges University, Yichang, Hubei, China
| | - Rebecca A Luchtel
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mei-Yin C Polley
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne J Novak
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Ansell
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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30
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Kourelis TV, Jevremovic D, Jessen E, Dasari S, Villasboas JC, Dispenzieri A, Kumar S. Mass cytometry identifies expansion of double positive and exhausted T cell subsets in the tumour microenvironment of patients with POEMS syndrome. Br J Haematol 2020; 190:79-83. [PMID: 32080834 DOI: 10.1111/bjh.16522] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/15/2019] [Accepted: 01/13/2020] [Indexed: 11/28/2022]
Abstract
We sought to dissect the tumour microenvironment in a small cohort (N = 10) of patients with POEMS at diagnosis and after therapy using mass cytometry. We included 10 MGUS patients as controls. We identified 29 immune cell subsets in the CD45+ and CD3+ compartments. Double positive T cells and PD-1 positive CD4 T cells were expanded and naïve CD4 T cells were decreased in the bone marrow of patients with newly diagnosed/progressing POEMS. These findings provide evidence for possible antigenic-driven selection as a driver of disease pathogenesis in POEMS.
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Affiliation(s)
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Erik Jessen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jose C Villasboas
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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31
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Leon-Ferre RA, McGrath K, Carter JM, Kalari KR, Suman VJ, Weinshilboum R, Wang L, Knutson KL, Ansell SM, Boughey JC, Villasboas JC, Goetz MP. Abstract P5-04-09: Deep phenotyping using CyTOF identifies peripheral blood immune signatures associated with clinical outcomes and molecular subtypes in patients with early-stage triple negative breast cancer (TNBC). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-04-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
Background: Local antitumor immunity—as assessed by quantifying tumor-infiltrating immune cells—is increasingly recognized as a critical factor influencing prognosis and therapy response in TNBC. However, an understanding of systemic antitumor immune responses occurring in peripheral blood, and their influence on prognosis and chemotherapy response has not been rigorously studied.
Methods: Cytometry by time-of-flight (CyTOFTM, Fluidigm) was used to examine viably cryopreserved peripheral blood mononuclear cell (PBMC) suspensions prospectively collected from patients with early-stage TNBC prior to initiation of standard neoadjuvant paclitaxel followed by doxorubicin and cyclophosphamide (NACT) as part of the BEAUTY study [1]. Samples were stained using a panel of metal-tagged antibodies, recognizing 30 surface proteins optimized for immune monitoring of human peripheral blood. Differential abundance analysis of immune cell subsets was carried out to evaluate differences between patients who achieved pCR versus those with residual disease after NACT, and between patients with known luminal androgen receptor (LAR) versus basal TNBC subtypes defined by bulk tumor RNA sequencing.
Results: Viably cryopreserved PBMC samples from 40 treatment-naive TNBC patients were available for analysis. The median age was 52 years (range 32 - 73), with 6 (15%) patients having tumors classified as LAR TNBC, and the remaining 34 (85%) as basal TNBC. Overall, 21 (53%) patients achieved pCR after NACT. After acquisition on the mass cytometer, the median yield per sample was 626,815 single-cell events (range 42,786 - 1,035,575), with a median percent debris of 13.7% (range 14 - 58). Across the 40 PBMC samples, the total yield was 23,507,094 single-cell events. The median frequencies of major circulating immune cell subsets across the 40 TNBC patients were: T cells 53.9% (range 25.4 - 71.3), with 33.4% CD4+ T cells (range 11.4 - 46.7) and 10.3% CD8+ T cells (range 5.8 - 19.9); B cells 10.8% (3.3 - 32.6), NK cells 8.6% (1.7 - 17.0) and monocytes 10.6% (2.7 - 29.8). Examining pre-treatment blood samples, patients with residual disease after NACT exhibited a higher median frequency of baseline CD14+CD16- classical monocytes (7.5% vs. 4.1%, p=0.025) and a lower frequency of terminally-differentiated effector memory cytotoxic (CD8+) T cells (0.6% vs. 1.7%, p=0.038) compared to patients who achieved pCR. Patients with LAR TNBC also exhibited a higher frequency of CD14+CD16- classical monocytes (11.5% vs 4.3%, p=0.058), and in addition exhibited a lower frequency of central memory CD4+ T cells (10.4% vs 15.2%, p=0.048). No difference in CD8+ T cells was seen by LAR status. Additional associations of peripheral blood immune cell subsets and classic tumor pathological features will be presented at the meeting.
Conclusion: To our knowledge, this is the first study focused on TNBC to demonstrate variation in peripheral blood immune cell populations by molecular TNBC subtype (LAR vs. basal), and by chemotherapy response. A higher frequency of circulating classical monocytes—which can infiltrate into tissues and give rise to macrophages—appears to be detrimental; whereas a higher frequency of circulating antigen-experienced memory CD8+ T cells seems to be protective, suggesting a putative role of this cell subset in TNBC anti-tumoral immunity.
Reference: [1] Goetz MP et al. JNCI 2017, PMID:28376176
Citation Format: Roberto A Leon-Ferre, Kaitlyn McGrath, Jodi M Carter, Krishna R Kalari, Vera J Suman, Richard Weinshilboum, Liewei Wang, Keith L Knutson, Stephen M Ansell, Judy C Boughey, J C Villasboas, Matthew P Goetz. Deep phenotyping using CyTOF identifies peripheral blood immune signatures associated with clinical outcomes and molecular subtypes in patients with early-stage triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-04-09.
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Bagwell CB, Hunsberger B, Hill B, Herbert D, Bray C, Selvanantham T, Li S, Villasboas JC, Pavelko K, Strausbauch M, Rahman A, Kelly G, Asgharzadeh S, Gomez-Cabrero A, Behbehani G, Chang H, Lyberger J, Montgomery R, Zhao Y, Inokuma M, Goldberger O, Stelzer G. Multi-site reproducibility of a human immunophenotyping assay in whole blood and peripheral blood mononuclear cells preparations using CyTOF technology coupled with Maxpar Pathsetter, an automated data analysis system. Cytometry B Clin Cytom 2019; 98:146-160. [PMID: 31758746 DOI: 10.1002/cyto.b.21858] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/31/2022]
Abstract
High-dimensional mass cytometry data potentially enable a comprehensive characterization of immune cells. In order to positively affect clinical trials and translational clinical research, this advanced technology needs to demonstrate a high reproducibility of results across multiple sites for both peripheral blood mononuclear cells (PBMC) and whole blood preparations. A dry 30-marker broad immunophenotyping panel and customized automated analysis software were recently engineered and are commercially available as the Fluidigm® Maxpar® Direct™ Immune Profiling Assay™. In this study, seven sites received whole blood and six sites received PBMC samples from single donors over a 2-week interval. Each site labeled replicate samples and acquired data on Helios™ instruments using an assay-specific acquisition template. All acquired sample files were then automatically analyzed by Maxpar Pathsetter™ software. A cleanup step eliminated debris, dead cells, aggregates, and normalization beads. The second step automatically enumerated 37 immune cell populations and performed label intensity assessments on all 30 markers. The inter-site reproducibility of the 37 quantified cell populations had consistent population frequencies, with an average %CV of 14.4% for whole blood and 17.7% for PBMC. The dry reagent coupled with automated data analysis is not only convenient but also provides a high degree of reproducibility within and among multiple test sites resulting in a comprehensive yet practical solution for deep immune phenotyping.
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Affiliation(s)
| | | | - Beth Hill
- Verity Software House, Topsham, Maine
| | | | | | | | - Stephen Li
- Fluidigm Canada Inc., Markham, Ontario, Canada
| | | | | | | | - Adeeb Rahman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gregory Kelly
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | | | | | - Yujiao Zhao
- Yale School of Medicine, New Haven, Connecticut
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Tracy SI, Larson MC, Feldman AL, Maurer MJ, Novak AJ, Slager SL, Villasboas JC, Allmer C, Habermann TM, Farooq U, Syrbu S, Cerhan JR, Link BK. The utility of prognostic indices, early events, and histological subtypes on predicting outcomes in non-follicular indolent B-cell lymphomas. Am J Hematol 2019; 94:658-666. [PMID: 30916801 DOI: 10.1002/ajh.25473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
Indolent B-cell lymphomas other than follicular lymphoma account for up to 10% of all B-cell neoplasms. While they typically follow a slowly progressive course, some patients experience rapid progression and early mortality. Prognostic scoring systems have not been adopted, hindering the ability of clinicians or researchers to predict outcomes, or risk-stratify patients during clinical trials. To address this, we evaluated the utility of existing prognostic indices and novel, early disease-related outcomes, to predict subsequent long term survival. Baseline characteristics and outcomes data were generated from a longitudinal cohort study that prospectively enrolled 632 patients newly diagnosed with marginal zone lymphoma, lymphoplasmacytic lymphomas, or B-cell lymphomas not otherwise specified, beginning in 2002. The International Prognostic Index (IPI), Follicular Lymphoma International Prognostic Index (FLIPI), and MALT International prognostic index (MALT-IPI) demonstrated c-statistics that ranged from 0.593-0.612 for event-free survival (EFS), and 0.683-0.714 for overall survival (OS). Patients who attained event-free survival at 12 months (EFS12) experienced similar mortality to the US general population (standardized mortality ratio [SMR] 1.19; 95% CI 0.95-1.46). Patients who did not attain EFS12 had subsequent worse morality (SMR 3.14 (95% CI 2.05-4.59). The MALT-IPI demonstrated utility in predicting subsequent long-term outcomes among patients with non-follicular indolent B-cell lymphomas. This index should be used by clinicians giving guidance to patients at the time of initial diagnosis, and risk stratification during clinical studies. The divergent long-term outcomes experienced by patients who do or do not attain EFS12 suggest there exists a subset of patients who harbor high-risk disease. Future research efforts should focus on methods to identify these patients at the time of diagnosis, in order to enable risk-tailored therapy.
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Affiliation(s)
- Sean I. Tracy
- Division of Hematology, Oncology, and Bone Marrow TransplantationUniversity of Minnesota Minneapolis Minnesota
| | | | | | | | - Anne J. Novak
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Susan L. Slager
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Cristine Allmer
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Umar Farooq
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - Sergei Syrbu
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - James R. Cerhan
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Brian K. Link
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
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Yang ZZ, Kim HJ, Villasboas JC, Chen YP, Price-Troska T, Jalali S, Wilson M, Novak AJ, Ansell SM. Expression of LAG-3 defines exhaustion of intratumoral PD-1 + T cells and correlates with poor outcome in follicular lymphoma. Oncotarget 2017; 8:61425-61439. [PMID: 28977875 PMCID: PMC5617435 DOI: 10.18632/oncotarget.18251] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [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: 03/21/2017] [Accepted: 04/26/2017] [Indexed: 11/25/2022] Open
Abstract
Exhausted T-cells in follicular lymphoma (FL) typically express PD-1, but expression of PD-1 is not limited to exhausted cells. Although expected to be functionally suppressed, we found that the population of intratumoral PD-1+ T cells were predominantly responsible for production of cytokines and granules. This surprising finding prompted us to explore the involvement of LAG-3 to specifically identify functionally exhausted T cells. We found that LAG-3 was expressed on a subset of intratumoral T cells from FL and LAG-3+ T cells almost exclusively came from PD-1+ population. CyTOF analysis revealed that intratumoral LAG-3+ T cells were phenotypically heterogeneous as LAG-3 was expressed on a variety of T cell subsets. In contrast to PD-1+LAG-3- cells, intratumoral PD-1+LAG-3+ T cells exhibited reduced capacity to produce cytokines and granules. LAG-3 expression could be substantially upregulated on CD4+ or CD8+ T cells by IL-12, a cytokine that has been shown to induce T-cell exhaustion and be increased in the serum of lymphoma patients. Furthermore, we found that blockade of both PD-1 and LAG-3 signaling enhanced the function of intratumoral CD8+ T cells resulting in increased IFN-γ and IL-2 production. Clinically, LAG-3 expression on intratumoral T cells correlated with a poor outcome in FL patients. Taken together, we find that LAG-3 expression is necessary to identify the population of intratumoral PD-1+ T cells that are functionally exhausted and, in contrast, find that PD-1+LAG-3- T cells are simply activated cells that are immunologically functional. These findings may have important implications for immune checkpoint therapy in FL.
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Affiliation(s)
- Zhi-Zhang Yang
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hyo Jin Kim
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jose C Villasboas
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ya-Ping Chen
- Division of Oncology/Hematology and Internal Medicine, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Tammy Price-Troska
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahrzad Jalali
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mara Wilson
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne J Novak
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Ansell
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Yang ZZ, Kim HJ, Price-Troska T, Jalali S, Villasboas JC, Novak AJ, Ansell SM. Constitutive expression of TIGIT defines a population of CD4+ regulatory T cells in Bcell non-Hodgkin lymphoma. The Journal of Immunology 2017. [DOI: 10.4049/jimmunol.198.supp.155.12] [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] [Indexed: 01/03/2023]
Abstract
Abstract
T cell Ig and ITIM domain (TIGIT) is an immune checkpoint molecule and its ligation delivers an inhibitory signal to T cells that negatively regulates anti-tumor responses. However, the expression and biological relevance of TIGIT in B-cell non-Hodgkin lymphoma (NHL) is completely unknown. To phenotypically characterize TIGIT+ T cell subsets, we profiled TIGIT-expressing CD4+ and CD8+ T cells from biopsy specimens of B-cell NHL. TIGIT expression was not detectable on T cells from peripheral blood, however, TIGIT is constitutively expressed on CD4+ T cells from biopsy specimens of B-cell NHL with a median of 44.8% (range: 25.9–62.2, n=8) of CD4+ T cells expressing TIGIT. By profiling the CD4+TIGIT+ T cells, we observed that CD25 was highly expressed on intratumoral CD4+TIGIT+ T cells. Intracellular staining revealed that Foxp3 was expressed by intratumoral CD4+TIGIT+ T cells. These intratumoral CD4+TIGIT+ T cells expressed high level of chemokine receptor CCR4 and were absent of IL-7 receptor-α (CD127). Functionally, CD4+TIGIT+ T cells displayed reduced cytokine production, as the number of IFN-γ- and TNF-α-producing cells was lower in the TIGIT+ population than in TIGIT− T cells. While TIGIT expression can be induced by TCR activation, treatment of T cells with IL-2 and TGF-β inhibited TCR-mediated TIGIT induction. Furthermore, lymphoma B cells were involved in TIGIT induction as in vitro depletion of lymphoma B cells altered upregulation of TIGIT on CD4+ T cells in B-cell NHL. Taken together, these results indicated that constitutive expression of TIGIT defines a CD4+ population with similar phenotype to regulatory T cells. Inhibition of TIGIT signaling may be an additional mechanism to prevent T-cell suppression in B-cell NHL
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Affiliation(s)
- Zhi-Zhang Yang
- 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hyo Jin Kim
- 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tammy Price-Troska
- 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahrzad Jalali
- 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jose C. Villasboas
- 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne J. Novak
- 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen M. Ansell
- 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Affiliation(s)
- J C Villasboas
- a Department of Medicine, Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Stephen Ansell
- a Department of Medicine, Division of Hematology , Mayo Clinic , Rochester , MN , USA
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Jatoi A, Grudem ME, Dockter TJ, Block MS, Villasboas JC, Tan A, Deering E, Kasi PM, Mansfield AS, Botero JP, Okuno SH, Smith DR, Fields AP. A proof-of-concept trial of protein kinase C iota inhibition with auranofin for the paclitaxel-induced acute pain syndrome. Support Care Cancer 2016; 25:833-838. [PMID: 27838777 DOI: 10.1007/s00520-016-3467-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/01/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Paclitaxel causes the paclitaxel-induced acute pain (PIAP) syndrome. Based on preclinical data, we hypothesized that the protein kinase C (PKC) iota inhibitor, auranofin (a gold salt used for other pain conditions), palliates this pain. METHODS In a randomized, double-blinded manner, patients who had suffered this syndrome were assigned a one-time dose of auranofin 6 mg orally on day #2 of the chemotherapy cycle (post-paclitaxel) versus placebo. Patients completed the Brief Pain Inventory and a pain diary on days 2 through 8 and at the end of the cycle. The primary endpoint was pain scores, as calculated by area under the curve, in response to "Please rate your pain by circling the one number that best describes your pain at its worse in the last 24 hours." RESULTS Thirty patients were enrolled. For the primary endpoint, mean area under the curve of 55 units (standard deviation 19) and 61 units (standard deviation 22) were observed in auranofin-treated and placebo-exposed patients, respectively (p = 0.44). On day 8 and at the end of the cycle, pain scores in auranofin-treated patients were more favorable, although differences were not statistically significant. CONCLUSIONS In the dose schedule studied, auranofin did not palliate the PIAP syndrome, but delayed beneficial trends suggest further study for this indication.
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Affiliation(s)
- Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Megan E Grudem
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Travis J Dockter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew S Block
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jose C Villasboas
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Angelina Tan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Erin Deering
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Pashtoon M Kasi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aaron S Mansfield
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Juliana Perez Botero
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Scott H Okuno
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Deanne R Smith
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Chen YP, Yang ZZ, Villasboas JC, Price-Troska T, Novak AJ, Ansell SM. Abstract 3287: Expression of CD14 and SIRP-α defines distinct populations of intratumoral monocytes/macrophages in B-cell non-Hodgkin lymphomas. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND
Monocytes and macrophages (mo/mΦ) are part of composition of tumor microenvironment in B-cell non-Hodgkin lymphoma (B-NHL). CD14+HLA-DRlow monocytes are immunosuppressive and this phenotype is promoted by increased expression of IL-10 in lymphoma. Despite their association with poor outcome, monocytes retain phagocytic function particularly in the presence of monoclonal antibodies and can be associated with an improved outcome in patients treated with rituximab. The aim of this study was to determine the prevalence of CD14+HLA-DRlow mo/mΦ in B-NHL tissue compared to normal tissue, and to determine whether their phenotype suggests that they are capable of phagocytic function.
METHODS
Tissue mo/mΦ were isolated by negative selection from 13 diagnostic B-NHL biopsy specimens and 6 normal tissues using a monocyte enrichment kit. Morphological and immunophenotypic characteristics of isolated mo/mΦ were determined by flow cytometry, immunocytochemistry and cytometry by time-of-flight (CyTOF). The purity of isolated tissue mo/mΦ was more than 95%, being confirmed by Giemsa stain and flow cytometry.
RESULTS
Increased numbers of CD68+ cells in initial B-NHL biopsies when compared to normal tissue was confirmed by immunohistochemistry and flow cytometry. However, CD14 expression was substantially lower than CD68 expression in the tissues suggesting that many CD68+ mo/mΦ are CD14 negative. Using a monocyte enrichment kit to isolate all mo/mΦ, we found that CD14 negative mo/mΦ constituted half the tissue mo/mΦ. Furthermore, we found by flow cytometry, CyTOF and Giemsa stain that CD14- mo/mΦ constituted 2 populations: a more frequent population of larger cells and a less common population of smaller cells. While all cells expressed CD68, the larger cells had increased expression of CD32, CD64 and HLA-DR. The CD14+ cells typically also expressed CD163 and CD33 and were a subset of the larger monocyte population, while the population of small cells was positive only for CD68 and CD45. Using CD14 and SIRP-α, we could identify 3 populations of mo/mΦ: CD14+SIRP-αhigh, CD14-SIRP-αlow and CD14-SIRP-α- cells. CD14+SIRP-αhigh cells and CD14-SIRP-αlow cells typically constitute the population of larger cells, while CD14-SIRP-α- cells constituted the population of smaller cells. Interestingly, while the CD14-SIRP-α- cells lack the typical phenotypic markers of mo/mΦ, they morphologically have the appearance of monocytic cells and this population appears expanded in lymphoma tissue.
CONCLUSIONS
We have identified a unique population of small mo/mΦ that have an immature phenotype and lack expression of CD14, SIRP-α, CD163, and other FcγR markers. This subset of mo/mΦ is prevalent in lymphoma and may have limited phagocytic function. This CD68+CD14-SIRP-α- mo/mΦ subpopulation may account for prognostic differences in the outcome of lymphoma patients treated with or without monoclonal antibodies.
Citation Format: Ya-Ping Chen, Zhi-Zhang Yang, Jose C. Villasboas, Tammy Price-Troska, Anne J. Novak, Stephen M. Ansell. Expression of CD14 and SIRP-α defines distinct populations of intratumoral monocytes/macrophages in B-cell non-Hodgkin lymphomas. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3287.
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Affiliation(s)
- Ya-Ping Chen
- Division of Hematology, Mayo Clinic, Rochester, MN
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Abstract
Hodgkin lymphoma (HL) is a rare cancer of the immune system that typically affects lymph nodes and sometimes other organs. Although the majority of patients can be potentially cured with the use of multi-agent chemotherapy and radiotherapy, a proportion of them will relapse or develop resistant disease for which treatment options are limited. In recent years, new agents have been developed and tested in HL with encouraging results. Two classes of drugs stand out as highly active in advanced HL based on recent study results: antibody-drug conjugates and programmed death 1 inhibitors. Clinical trials in HL with these agents have been completed in the past several years and the results have recently become available. In this review, we discuss the recent advances in the management of HL with a focus on strategies to decrease toxicity and a review of the two drug classes that have the potential to change the landscape of treatment of this disease.
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Affiliation(s)
- Jose C Villasboas
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Ansell
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Villasboas JC, Ansell SM. Nivolumab for the treatment of classical Hodgkin lymphoma after failure of autologous stem cell transplant and brentuximab. Expert Rev Anticancer Ther 2015; 16:5-12. [PMID: 26577822 DOI: 10.1586/14737140.2016.1121812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cancer cells are able to escape surveillance from the immune system by co-opting physiologic mechanisms such as the programmed cell death-1 (PD-1) receptor pathway. Agents able to block the interaction between the PD-1 receptor and its ligands have the potential to release T cells from tumor-induced suppression and eradicate malignant cells. Nivolumab - a PD-1 inhibitor - is approved for the treatment of patients with metastatic melanoma and lung cancer. This agent has been tested in patients with advanced Hodgkin lymphoma (HL) and showed impressive results in a phase I trial. Here we review the profile of Nivolumab including its pharmacological properties, clinical efficacy and safety in patients with advanced classical HL.
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Affiliation(s)
- Jose C Villasboas
- a Department of Medicine/Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Stephen M Ansell
- a Department of Medicine/Division of Hematology , Mayo Clinic , Rochester , MN , USA
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Villasboas JC, Ansell SM. Therapeutic targets and investigated strategies for treating B-cell non-Hodgkin lymphoma. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1062753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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