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Dong S, Premnath N, Sadeghi N, Kainthla R, Chung SS, Collins RH, Li HC, Madanat YF. Racial and ethnic disparities in Acute Myeloid Leukemia: 15-year experience at a safety net hospital system. Leuk Res 2024; 141:107503. [PMID: 38676993 DOI: 10.1016/j.leukres.2024.107503] [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: 11/28/2023] [Revised: 02/23/2024] [Accepted: 04/13/2024] [Indexed: 04/29/2024]
Abstract
Despite recent therapeutic advances, ethnic minorities in the U.S. continue to have disproportionately poor outcomes in many hematologic malignancies including AML. We identified 162 adult AML patients treated at a non-transplant safety net hospital from 2007 to 2022 and evaluated differences in disease characteristics, treatment and clinical outcomes based on race and ethnicity. Our cohort consisted of 82 (50.6%) Hispanic, 36 (22.2%) non-Hispanic black and 44 (27.2%) non-Hispanic white and Asian patients. Median age at diagnosis was 42.5, 49.0 and 52.5 years respectively (p=0.025). Hispanics had higher rates of intermediate and high-risk disease (p=0.699) and received high intensity induction and consolidation chemotherapy at lower rates (p=0.962), although differences did not reach statistical significance. Despite this, similar remission rates were achieved. Hispanics with high-risk disease had longer overall survival (OS) than the combined non-Hispanic cohort (mOS 14 m vs 7 m, p=0.030). Multivariate regression analysis showed that OS was negatively associated with age (HR 1.023, p=0.006), intermediate (HR 3.431, p=0.0003) and high-risk disease (HR 4.689, p<0.0001) and positively associated with Hispanic ethnicity (HR 0.614, p=0.026). This report suggests that contrary to other studies, Hispanics, particularly those with high-risk AML, may have improved OS compared to other ethnic groups. These results are unique to our safety net hospital setting where common barriers to medical care and healthcare disparities are largely mitigated.
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Affiliation(s)
- Sharlene Dong
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Naveen Premnath
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Stephen S Chung
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Robert H Collins
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Yazan F Madanat
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
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2
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Shah NP, Bhatia R, Altman JK, Amaya M, Begna KH, Berman E, Chan O, Clements J, Collins RH, Curtin PT, DeAngelo DJ, Drazer M, Maness L, Metheny L, Mohan S, Moore JO, Oehler V, Pratz K, Pusic I, Rose MG, Shomali W, Smith BD, Styler M, Talpaz M, Tanaka TN, Tantravahi S, Thompson J, Tsai S, Vaughn J, Welborn J, Yang DT, Sundar H, Gregory K. Chronic Myeloid Leukemia, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2024; 22:43-69. [PMID: 38394770 DOI: 10.6004/jnccn.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/25/2024]
Abstract
Chronic myeloid leukemia (CML) is defined by the presence of Philadelphia chromosome resulting from a reciprocal translocation between chromosomes 9 and 22 [t9;22] that gives rise to a BCR::ABL1 fusion gene. CML occurs in 3 different phases (chronic, accelerated, and blast phase) and is usually diagnosed in the chronic phase in developed countries. Tyrosine kinase inhibitor (TKI) therapy is a highly effective treatment option for patients with chronic phase-CML. The primary goal of TKI therapy in patients with chronic phase-CML is to prevent disease progression to accelerated phase-CML or blast phase-CML. Discontinuation of TKI therapy with careful monitoring is feasible in selected patients. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with chronic phase-CML.
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MESH Headings
- Humans
- Blast Crisis/chemically induced
- Blast Crisis/drug therapy
- Blast Crisis/genetics
- Protein Kinase Inhibitors/adverse effects
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Philadelphia Chromosome
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Fusion Proteins, bcr-abl/genetics
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Affiliation(s)
- Neil P Shah
- 1UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Jessica K Altman
- 3Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Leland Metheny
- 14Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Keith Pratz
- 18Abramson Cancer Center at the University of Pennsylvania
| | - Iskra Pusic
- 19Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - B Douglas Smith
- 22The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | - Jennifer Vaughn
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Cai SF, Huang Y, Lance JR, Mao HC, Dunbar AJ, McNulty SN, Druley T, Li Y, Baer MR, Stock W, Kovacsovics T, Blum WG, Schiller GJ, Olin RL, Foran JM, Litzow M, Lin T, Patel P, Foster MC, Boyiadzis M, Collins RH, Chervin J, Shoben A, Vergilio JA, Heerema NA, Rosenberg L, Chen TL, Yocum AO, Druggan F, Marcus S, Stefanos M, Druker BJ, Mims AS, Borate U, Burd A, Byrd JC, Levine RL, Stein EM. A study to assess the efficacy of enasidenib and risk-adapted addition of azacitidine in newly diagnosed IDH2-mutant AML. Blood Adv 2024; 8:429-440. [PMID: 37871309 PMCID: PMC10827405 DOI: 10.1182/bloodadvances.2023010563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 10/25/2023] Open
Abstract
ABSTRACT Enasidenib (ENA) is an inhibitor of isocitrate dehydrogenase 2 (IDH2) approved for the treatment of patients with IDH2-mutant relapsed/refractory acute myeloid leukemia (AML). In this phase 2/1b Beat AML substudy, we applied a risk-adapted approach to assess the efficacy of ENA monotherapy for patients aged ≥60 years with newly diagnosed IDH2-mutant AML in whom genomic profiling demonstrated that mutant IDH2 was in the dominant leukemic clone. Patients for whom ENA monotherapy did not induce a complete remission (CR) or CR with incomplete blood count recovery (CRi) enrolled in a phase 1b cohort with the addition of azacitidine. The phase 2 portion assessing the overall response to ENA alone demonstrated efficacy, with a composite complete response (cCR) rate (CR/CRi) of 46% in 60 evaluable patients. Seventeen patients subsequently transitioned to phase 1b combination therapy, with a cCR rate of 41% and 1 dose-limiting toxicity. Correlative studies highlight mechanisms of clonal elimination with differentiation therapy as well as therapeutic resistance. This study demonstrates both efficacy of ENA monotherapy in the upfront setting and feasibility and applicability of a risk-adapted approach to the upfront treatment of IDH2-mutant AML. This trial is registered at www.clinicaltrials.gov as #NCT03013998.
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Affiliation(s)
- Sheng F. Cai
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying Huang
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jennie R. Lance
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Hsiaoyin Charlene Mao
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Andrew J. Dunbar
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Yan Li
- Bristol Myers Squibb, New York, NY
| | - Maria R. Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Wendy Stock
- Department of Hematology and Oncology, University of Chicago Medical Center, Chicago, IL
| | | | - William G. Blum
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Gary J. Schiller
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Rebecca L. Olin
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | - Mark Litzow
- Department of Hematology, Mayo Clinic, Rochester, MN
| | - Tara Lin
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS
| | - Prapti Patel
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Michael Boyiadzis
- Division of Hematolog/Oncology, Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Robert H. Collins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jordan Chervin
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abigail Shoben
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Nyla A. Heerema
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Timothy L. Chen
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Franchesca Druggan
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Mona Stefanos
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Alice S. Mims
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Uma Borate
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Amy Burd
- Leukemia and Lymphoma Society, Rye Brook, NY
| | - John C. Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Ross L. Levine
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eytan M. Stein
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Zahid MF, Moriarty K, Dryden C, Weinberg O, Asif M, Ikpefan R, Anderson JM, Collins RH, Chung SS, Chen W, Patel PA, Madanat YF. Identifying patients at risk for hereditary myeloid malignancy syndromes incorporating a novel, self-administered questionnaire to an initial screening platform. Eur J Haematol 2023; 111:844-850. [PMID: 37587783 DOI: 10.1111/ejh.14084] [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: 05/23/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Four to 10% of cases of myeloid malignancies are inherited. We report our experience on hereditary myeloid malignancy syndromes (HMMS) incorporating a novel questionnaire in the screening platform for patients with myeloid malignancies and aplastic anemia. METHODS The questionnaire was sent via electronic patient portal prior to clinic visits. Patients screened positive based on responses to questionnaire items, presence of suspicion disease characteristics (young age, family history, monosomy 7 etc.) and/or presence of signs of HMMS. Those deemed at-risk based on questionnaire responses, clinical features and/or somatic mutation profile were offered germline testing. RESULTS A total of 408 patients were screened, 141 (35%) were deemed at-risk. Fifty-four (38%) of at-risk patients were seen in the genetics clinic. Forty-one (76%) of the patients seen agreed to germline testing and 13 declined due to cost or personal decision. Twenty pathogenic (P)/likely-pathogenic (LP) germline mutations were identified in 16 (39%) of the tested patients. Five patients also had a variant of uncertain significance (VUS) and an additional 13 had at least 1 VUS without P/LP mutations (total 29 VUS's were found in 18 (44%) of tested patients). The median age of diagnosis for patients with P/LP mutations was 56 years versus 66 years in the entire cohort. CONCLUSION Incorporating an electronic questionnaire is an effective screening method for HMMS. Many patients declined testing due to cost. These results highlight the importance of germline testing in patients with myeloid malignancies, further research in HMMS, and coverage by healthcare plans.
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Affiliation(s)
- Mohammad Faizan Zahid
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kelsey Moriarty
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Courtney Dryden
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Olga Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Misha Asif
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ruth Ikpefan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Julia M Anderson
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert H Collins
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen S Chung
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prapti A Patel
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yazan F Madanat
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
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5
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Hoff FW, Rolwes J, Hardeman PA, Perkins M, Major EO, Douek D, Collins RH, Greenberg BM. Long-term outcome of progressive multifocal leukoencephalopathy with recombinant interleukin-2 treatment and an associated increase in the number of HPyV-2-specific T-cells: a case report. Ther Adv Hematol 2023; 14:20406207231201721. [PMID: 37822572 PMCID: PMC10563476 DOI: 10.1177/20406207231201721] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by reactivation of the human polyomavirus 2 (HPyV-2). PML is associated with a high morbidity and mortality rate and there is currently no standard curative therapy. We report short-term immunologic response and long-term clinical outcomes in a patient diagnosed with follicular lymphoma (FL) who developed PML. Diagnosis of PML was established conclusively based on findings from a brain biopsy. The patient was treated with recombinant interleukin 2 (IL-2) and showed rapid clinical improvement. HPyV-2-specific T-cells were tracked longitudinally and correlation with clinical status, viral load, and radiographic imaging was documented. After the progression of the patient's FL, which required an allogeneic bone marrow transplant, the patient prophylactically received human leukocyte antigen-matched donor-derived HPyV-2 T-cells to prevent the recurrence of the PML as part of a clinical trial. Twelve years after the initial diagnosis of PML, he did not develop a relapse of his PML, supporting data that therapies that increase HPyV-2-specific T-cells, including IL-2, may be effective in the management of PML.
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Affiliation(s)
- Fieke W Hoff
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - John Rolwes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Paula A Hardeman
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Molly Perkins
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Eugene O Major
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Daniel Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert H Collins
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8806, USA
| | - Benjamin M Greenberg
- Department of Neurology, O'Donnell Brain Institute, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8806, USA
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Shahan JL, Collins RH, Patel P, Madanat YF, Vusirikala M. Anti-Spike Antibody Responses in Allogeneic Stem Cell Transplant Recipients to Two Doses of COVID-19 mRNA Vaccination: A Retrospective, Single-Center Analysis. J Adv Pract Oncol 2023; 14:367-371. [PMID: 37576365 PMCID: PMC10414532 DOI: 10.6004/jadpro.2023.14.5.2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients were excluded from the initial SARS-CoV-2 mRNA vaccination efficacy trials. Suboptimal vaccine responses have been reported in immunocompromised cohorts such as patients with solid tumors or hematologic malignancies, suggesting the need for additional research. Widespread data on the antibody responses and vaccine efficacy in allo-HSCT recipients is limited. In our single-center, retrospective study, we analyzed the anti-spike IgG antibody responses in 75 allo-HSCT recipients who received a series of two doses of mRNA vaccination. We collected data on previous COVID-19 infection, B and T lymphocyte recovery, donor types, graft-vs.-host disease (GVHD), and immunosuppressive medications at the time of vaccination. With the original variant, a cutoff of 4,160 arbitrary units (AU)/mL has been correlated with a 0.95 probability of a viral neutralization. We also examined the number of allo-HSCT recipients who achieved this conservative threshold. To our knowledge, no correlate exists for the currently prevalent Omicron variant and viral neutralization. Despite 29.3% (22/75) of patients being on systemic immunosuppressive medications due to chronic GVHD, positive antibody responses > 50 AU/mL were seen in 96% of patients. However, only 48% (36/75) of patients were above the neutralizing antibody threshold. Those with previous COVID-19 infection had significantly higher antibody responses. Although encouraging, the variability of the responses underscores the concept of ongoing antibody monitoring as well as consideration of additional doses of the COVID-19 vaccine in this cohort.
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Affiliation(s)
- Jaime L Shahan
- From University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert H Collins
- From University of Texas Southwestern Medical Center, Dallas, Texas
| | - Prapti Patel
- From University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yazan F Madanat
- From University of Texas Southwestern Medical Center, Dallas, Texas
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7
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Saliba AN, Kaufmann SH, Stein EM, Patel PA, Baer MR, Stock W, Deininger M, Blum W, Schiller GJ, Olin RL, Litzow MR, Lin TL, Ball BJ, Boyiadzis MM, Traer E, Odenike O, Arellano ML, Walker A, Duong VH, Kovacsovics T, Collins RH, Shoben AB, Heerema NA, Foster MC, Peterson KL, Schneider PA, Martycz M, Gana TJ, Rosenberg L, Marcus S, Yocum AO, Chen T, Stefanos M, Mims AS, Borate U, Burd A, Druker BJ, Levine RL, Byrd JC, Foran JM. Pevonedistat with azacitidine in older patients with TP53-mutated AML: a phase 2 study with laboratory correlates. Blood Adv 2023; 7:2360-2363. [PMID: 36315007 PMCID: PMC10230164 DOI: 10.1182/bloodadvances.2022008625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Antoine N. Saliba
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Scott H. Kaufmann
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Eytan M. Stein
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prapti A. Patel
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Maria R. Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Wendy Stock
- Department of Medicine, Section of Hematology Oncology, University of Chicago, Chicago, IL
| | - Michael Deininger
- Division of Hematology and Oncology, Department of Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - William Blum
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Gary J. Schiller
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | - Mark R. Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Tara L. Lin
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Brian J. Ball
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | | | - Elie Traer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Olatoyosi Odenike
- Department of Medicine, Section of Hematology Oncology, University of Chicago, Chicago, IL
| | | | | | - Vu H. Duong
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Tibor Kovacsovics
- Division of Hematology and Oncology, Department of Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Robert H. Collins
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Matthew C. Foster
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Kevin L. Peterson
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN
| | - Paula A. Schneider
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | - Amy Burd
- Leukemia and Lymphoma Society, White Plains, NY
| | - Brian J. Druker
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Ross L. Levine
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John C. Byrd
- Department of Medicine, University of Cincinnati, Cincinnati, OH
| | - James M. Foran
- Division of Hematology-Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL
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8
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Duong VH, Ruppert AS, Mims AS, Borate U, Stein EM, Baer MR, Stock W, Kovacsovics T, Blum W, Arellano ML, Schiller GJ, Olin RL, Foran JM, Litzow MR, Lin TL, Patel PA, Foster MC, Redner RL, Al-Mansour Z, Cogle CR, Swords RT, Collins RH, Vergilio JA, Heerema NA, Rosenberg L, Yocum AO, Marcus S, Chen T, Druggan F, Stefanos M, Gana TJ, Shoben AB, Druker BJ, Burd A, Byrd JC, Levine RL, Boyiadzis MM. Entospletinib with decitabine in acute myeloid leukemia with mutant TP53 or complex karyotype: A phase 2 substudy of the Beat AML Master Trial. Cancer 2023. [PMID: 37078412 DOI: 10.1002/cncr.34780] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/24/2022] [Accepted: 01/13/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) who have tumor protein p53 (TP53) mutations or a complex karyotype have a poor prognosis, and hypomethylating agents are often used. The authors evaluated the efficacy of entospletinib, an oral inhibitor of spleen tyrosine kinase, combined with decitabine in this patient population. METHODS This was a multicenter, open-label, phase 2 substudy of the Beat AML Master Trial (ClinicalTrials.gov identifier NCT03013998) using a Simon two-stage design. Eligible patients aged 60 years or older who had newly diagnosed AML with mutations in TP53 with or without a complex karyotype (cohort A; n = 45) or had a complex karyotype without TP53 mutation (cohort B; n = 13) received entospletinib 400 mg twice daily with decitabine 20 mg/m2 on days 1-10 every 28 days for up to three induction cycles, followed by up to 11 consolidation cycles, in which decitabine was reduced to days 1-5. Entospletinib maintenance was given for up to 2 years. The primary end point was complete remission (CR) and CR with hematologic improvement by up to six cycles of therapy. RESULTS The composite CR rates for cohorts A and B were 13.3% (95% confidence interval, 5.1%-26.8%) and 30.8% (95% confidence interval, 9.1%-61.4%), respectively. The median duration of response was 7.6 and 8.2 months, respectively, and the median overall survival was 6.5 and 11.5 months, respectively. The study was stopped because the futility boundary was crossed in both cohorts. CONCLUSIONS The combination of entospletinib and decitabine demonstrated activity and was acceptably tolerated in this patient population; however, the CR rates were low, and overall survival was short. Novel treatment strategies for older patients with TP53 mutations and complex karyotype remain an urgent need.
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Affiliation(s)
- Vu H Duong
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Amy S Ruppert
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Alice S Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Uma Borate
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Eytan M Stein
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Wendy Stock
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
| | - Tibor Kovacsovics
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah, USA
| | - William Blum
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Gary J Schiller
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Rebecca L Olin
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California, USA
| | - James M Foran
- Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark R Litzow
- Departments of Medical Oncology, Hematology, and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tara L Lin
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Prapti A Patel
- University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert L Redner
- Hillman Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zeina Al-Mansour
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Ronan T Swords
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Robert H Collins
- University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | | | - Nyla A Heerema
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Ashley O Yocum
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Sonja Marcus
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Timothy Chen
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Franchesca Druggan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mona Stefanos
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Abigail B Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Brian J Druker
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Amy Burd
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - John C Byrd
- Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ross L Levine
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael M Boyiadzis
- Hillman Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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9
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Hoff FW, Goksu SY, Premnath N, Patel PA, Ikpefan R, Kaur G, Vusirikala M, Bat T, Chen W, Geethakumari PR, Anderson LD, Awan FT, Collins RH, Weinberg OK, Muthukumar A, Chung SS, Madanat YF. SARS-CoV-2 Vaccination IgG Antibody Responses in Patients with Hematologic Malignancies in a Myeloid Enriched Cohort: A Single Center Observation. Acta Med Acad 2023; 52:30-36. [PMID: 37326395 DOI: 10.5644/ama2006-124.399] [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: 02/04/2023] [Accepted: 04/13/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE Patients diagnosed with hematologic malignancies are at increased risk for severe SARS-CoV-2 infection. We evaluated the serological IgG response following two doses of the SARS-CoV-2 vaccine in patients with hematologic malignancies. METHODS Patients treated at UT Southwestern Medical Center with a diagnosis of a myeloid or lymphoid neoplasm were included. SARS-CoV-2 vaccination response was defined as a positive quantifiable spike IgG antibody titer. RESULTS Sixty patients were included in the study and 60% were diagnosed with a myeloid neoplasm. The majority (85%) of the patients with a myeloid malignancy and 50% of the patients with a lymphoid malignancy mounted a serological response after receiving two doses of the vaccine. CONCLUSION Vaccination should be offered irrespective of ongoing treatment or active disease. Findings require validation in a larger cohort of patients.
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Affiliation(s)
- Fieke W Hoff
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Suleyman Y Goksu
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Naveen Premnath
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Prapti A Patel
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Ruth Ikpefan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Gurbakhash Kaur
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Madhuri Vusirikala
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Taha Bat
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Larry D Anderson
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Farrukh T Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Robert H Collins
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alagarraju Muthukumar
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Stephen S Chung
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA
| | - Yazan F Madanat
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA.
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10
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Hoff FW, Chung SS, Patel PA, Premnath N, Khatib J, Tadic-Ovcina M, AhmedRabie A, Helton D, Yohannes S, Shahan J, Patel H, Geethakumari PR, Vusirikala M, Collins RH, Madanat YF. Post-transplant cyclophosphamide and early mixed donor Chimerism in myeloid malignancies; a single-center experience. Transpl Immunol 2023; 77:101808. [PMID: 36842566 DOI: 10.1016/j.trim.2023.101808] [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: 12/22/2022] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative option for high-risk myeloid malignancies. Post-transplant cyclophosphamide (PT-Cy) has proven to be effective for graft versus host disease (GVHD) prophylaxis. Given that graft-versus-tumor (GVT) effect plays a major role in reducing the risk of disease relapse, the application of PT-Cy must balance the risk of relapse. Mixed chimerism (MC) refers to a state of concurrent presence of recipient and donor cells post allo-HSCT which may precede relapse disease. OBJECTIVE We investigated the impact of PT-Cy on early MC (EMC) and disease relapse in patients with a myeloid malignancy post allo-HSCT. STUDY DESIGN This retrospective single-center study included patients that underwent allo-HSCT between 2015 and 2021. Patient and disease characteristics were collected from the electronic health records. EMC was defined as <95% donor cells at day 90-120 post allo-HSCT. RESULTS A total of 144 patient that received an allo-HSCT were included in the study. One hundred and eight (75%) patients received PT-Cy as part of the GVHD prophylaxis regimen. The majority underwent allo-HSCT for acute myeloid leukemia (62%) or myelodysplastic syndrome (31%). Sixty-five percent received allo-HSCT from a matched unrelated donor transplant and 65% received a myeloablative conditioning regimen. A lower rate of chronic GVHD (p = 0.03) and a higher rate of EMC (p = 0.04) were observed in patients that received PT-Cy. PT-Cy was not associated with overall survival (OS) and relapse-free survival (RFS). Multivariable analysis identified measurable residual disease status (p = 0.003), hematopoietic cell transplantation-specific comorbidity index (p = 0.012) and chronic GVHD (p = 0.006) as independent prognostic variables for OS. AML-adverse risk (p = 0.004) and EMC (p = 0.018) were independently prognostic for RFS. While EMC overall was not significantly associated with higher risk of relapse, EMC was associated with shorter RFS within adverse-risk AML patients. CONCLUSION Our study shows that PT-Cy was associated with an increased risk of EMC. The predictive value of EMC for relapse remains unclear and may depend on the underlying disease, which should be validated in a larger cohort.
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Affiliation(s)
- Fieke W Hoff
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Stephen S Chung
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Prapti A Patel
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Naveen Premnath
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Jude Khatib
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Mirjana Tadic-Ovcina
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Abeer AhmedRabie
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Debra Helton
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Selamawit Yohannes
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Jaime Shahan
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Hetalkumari Patel
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | | | - Madhuri Vusirikala
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Robert H Collins
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Yazan F Madanat
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States of America.
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11
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Lue BKH, Patel AM, Reves H, Afrough A, Anderson LD, Chung S, Collins RH, Kaur G, Kumar K, Madanat YF, Vusirikala M, Awan FT, Tessier JM, Geethakumari PR. Infectious Complications Post-CAR T-Cell Therapy for Lymphomas: Impact of Bridging Therapy. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00339-1] [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: 02/07/2023]
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12
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Sannareddy A, Reves H, Narasimhan M, Jaleta K, Anderson JM, Patel H, Anderson LD, Afrough A, Chung S, Collins RH, Kaur G, Kumar KA, Madanat YF, Vusirikala M, Awan FT, Muthukumar AR, Geethakumari PR. ‘Real-World’ Impact of Tixagevimab/Cilgavimab (Evusheld) on COVID-19 Outcomes in Patients Undergoing Cellular Therapies. Transplant Cell Ther 2023. [PMCID: PMC9899534 DOI: 10.1016/s2666-6367(23)00505-5] [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: 02/07/2023]
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13
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Premnath N, Chung SS, Weinberg OK, Ikpefan R, Pandey M, Kaur G, Geethakumari PR, Afrough A, Awan FT, Anderson LD, Vusirikala M, Collins RH, Chen W, Agathocleous M, Madanat YF. Clinical and molecular characteristics associated with Vitamin C deficiency in myeloid malignancies; real world data from a prospective cohort. Leuk Res 2023; 125:107001. [PMID: 36566538 DOI: 10.1016/j.leukres.2022.107001] [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: 10/18/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Vitamin C is an essential vitamin that acts as a co-factor for many enzymes involved in epigenetic regulation in humans. Low vitamin C levels in hematopoietic stem cells (HSC) promote self-renewal and vitamin C supplementation retards leukaemogenesis in vitamin C-deficient mouse models. Studies on vitamin C levels in patients with myeloid malignancies are limited. We thus conducted a retrospective analysis on a prospective cohort of patients with myeloid malignancies on whom plasma vitamin C levels were measured serially at diagnosis and during treatment. Baseline characteristics including hematological indices, cytogenetics, and molecular mutations are described in this cohort. Among 64 patients included in our study, 11 patients (17%) had low vitamin C levels. We noted a younger age at diagnosis for patients with myeloid malignancies who had low plasma vitamin C levels. Patients with low plasma vitamin C levels were more likely to have acute myeloid leukemia compared to other myeloid malignancies. Low vitamin C levels were associated with ASXL1 mutations. Our study calls for further multi-institutional studies to understand the relevance of low plasma vitamin C level in myeloid neoplasms, the role of vitamin C deficiency in leukemogenesis, and the potential benefit of vitamin C supplementation.
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Affiliation(s)
- Naveen Premnath
- Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Stephen S Chung
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States; Children's Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Olga K Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ruth Ikpefan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mohak Pandey
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gurbakhash Kaur
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | - Aimaz Afrough
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Farrukh T Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Larry D Anderson
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Madhuri Vusirikala
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Robert H Collins
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michalis Agathocleous
- Children's Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Yazan F Madanat
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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14
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Lyu J, Liu Y, Gong L, Chen M, Madanat YF, Zhang Y, Cai F, Gu Z, Cao H, Kaphle P, Kim YJ, Kalkan FN, Stephens H, Dickerson KE, Ni M, Chen W, Patel P, Mims AS, Borate U, Burd A, Cai SF, Yin CC, You MJ, Chung SS, Collins RH, DeBerardinis RJ, Liu X, Xu J. Disabling Uncompetitive Inhibition of Oncogenic IDH Mutations Drives Acquired Resistance. Cancer Discov 2023; 13:170-193. [PMID: 36222845 PMCID: PMC9827114 DOI: 10.1158/2159-8290.cd-21-1661] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 01/16/2023]
Abstract
Mutations in IDH genes occur frequently in acute myeloid leukemia (AML) and other human cancers to generate the oncometabolite R-2HG. Allosteric inhibition of mutant IDH suppresses R-2HG production in a subset of patients with AML; however, acquired resistance emerges as a new challenge, and the underlying mechanisms remain incompletely understood. Here we establish isogenic leukemia cells containing common IDH oncogenic mutations by CRISPR base editing. By mutational scanning of IDH single amino acid variants in base-edited cells, we describe a repertoire of IDH second-site mutations responsible for therapy resistance through disabling uncompetitive enzyme inhibition. Recurrent mutations at NADPH binding sites within IDH heterodimers act in cis or trans to prevent the formation of stable enzyme-inhibitor complexes, restore R-2HG production in the presence of inhibitors, and drive therapy resistance in IDH-mutant AML cells and patients. We therefore uncover a new class of pathogenic mutations and mechanisms for acquired resistance to targeted cancer therapies. SIGNIFICANCE Comprehensive scanning of IDH single amino acid variants in base-edited leukemia cells uncovers recurrent mutations conferring resistance to IDH inhibition through disabling NADPH-dependent uncompetitive inhibition. Together with targeted sequencing, structural, and functional studies, we identify a new class of pathogenic mutations and mechanisms for acquired resistance to IDH-targeting cancer therapies. This article is highlighted in the In This Issue feature, p. 1.
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Affiliation(s)
- Junhua Lyu
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yuxuan Liu
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lihu Gong
- Cecil H. and Ida Green Center for Reproductive Biology Sciences, Department of Obstetrics and Gynecology, and Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mingyi Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yazan F. Madanat
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yuannyu Zhang
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Feng Cai
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zhimin Gu
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hui Cao
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Pranita Kaphle
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yoon Jung Kim
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fatma N. Kalkan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Helen Stephens
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathryn E. Dickerson
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Min Ni
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Prapti Patel
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alice S. Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Uma Borate
- Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Amy Burd
- The Leukemia & Lymphoma Society, Rye Brook, New York
| | - Sheng F. Cai
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C. Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - M. James You
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen S. Chung
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert H. Collins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ralph J. DeBerardinis
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xin Liu
- Cecil H. and Ida Green Center for Reproductive Biology Sciences, Department of Obstetrics and Gynecology, and Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jian Xu
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Harold C. Simmons Comprehensive Cancer Center, and Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Corresponding Author: Jian Xu, Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, 6000 Harry Hines Boulevard, Dallas, TX 75235. Phone: 214-648-6125; E-mail:
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15
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Bottomly D, Long N, Schultz AR, Kurtz SE, Tognon CE, Johnson K, Abel M, Agarwal A, Avaylon S, Benton E, Blucher A, Borate U, Braun TP, Brown J, Bryant J, Burke R, Carlos A, Chang BH, Cho HJ, Christy S, Coblentz C, Cohen AM, d'Almeida A, Cook R, Danilov A, Dao KHT, Degnin M, Dibb J, Eide CA, English I, Hagler S, Harrelson H, Henson R, Ho H, Joshi SK, Junio B, Kaempf A, Kosaka Y, Laderas T, Lawhead M, Lee H, Leonard JT, Lin C, Lind EF, Liu SQ, Lo P, Loriaux MM, Luty S, Maxson JE, Macey T, Martinez J, Minnier J, Monteblanco A, Mori M, Morrow Q, Nelson D, Ramsdill J, Rofelty A, Rogers A, Romine KA, Ryabinin P, Saultz JN, Sampson DA, Savage SL, Schuff R, Searles R, Smith RL, Spurgeon SE, Sweeney T, Swords RT, Thapa A, Thiel-Klare K, Traer E, Wagner J, Wilmot B, Wolf J, Wu G, Yates A, Zhang H, Cogle CR, Collins RH, Deininger MW, Hourigan CS, Jordan CT, Lin TL, Martinez ME, Pallapati RR, Pollyea DA, Pomicter AD, Watts JM, Weir SJ, Druker BJ, McWeeney SK, Tyner JW. Integrative analysis of drug response and clinical outcome in acute myeloid leukemia. Cancer Cell 2022; 40:850-864.e9. [PMID: 35868306 PMCID: PMC9378589 DOI: 10.1016/j.ccell.2022.07.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/30/2022] [Accepted: 06/30/2022] [Indexed: 12/17/2022]
Abstract
Acute myeloid leukemia (AML) is a cancer of myeloid-lineage cells with limited therapeutic options. We previously combined ex vivo drug sensitivity with genomic, transcriptomic, and clinical annotations for a large cohort of AML patients, which facilitated discovery of functional genomic correlates. Here, we present a dataset that has been harmonized with our initial report to yield a cumulative cohort of 805 patients (942 specimens). We show strong cross-cohort concordance and identify features of drug response. Further, deconvoluting transcriptomic data shows that drug sensitivity is governed broadly by AML cell differentiation state, sometimes conditionally affecting other correlates of response. Finally, modeling of clinical outcome reveals a single gene, PEAR1, to be among the strongest predictors of patient survival, especially for young patients. Collectively, this report expands a large functional genomic resource, offers avenues for mechanistic exploration and drug development, and reveals tools for predicting outcome in AML.
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Affiliation(s)
- Daniel Bottomly
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Nicola Long
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Anna Reister Schultz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Stephen E Kurtz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Cristina E Tognon
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Kara Johnson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Melissa Abel
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Anupriya Agarwal
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA; Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR 97239, USA; Division of Oncologic Sciences, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Sammantha Avaylon
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Erik Benton
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Aurora Blucher
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Uma Borate
- Division of Hematology, Department of Internal Medicine, James Cancer Center, Ohio State University, Columbus, OH 43210, USA
| | - Theodore P Braun
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jordana Brown
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jade Bryant
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Russell Burke
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Amy Carlos
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Integrated Genomics Laboratory, Oregon Health & Science University, Portland, OR 97239, USA
| | - Bill H Chang
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Hyun Jun Cho
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Stephen Christy
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Cody Coblentz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Aaron M Cohen
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Amanda d'Almeida
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rachel Cook
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Alexey Danilov
- Department of Hematology and Hematopoietic Stem Cell Transplant, City of Hope National Medical Center, Duarte, CA 91010, USA
| | | | - Michie Degnin
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - James Dibb
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Christopher A Eide
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Isabel English
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Stuart Hagler
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Heath Harrelson
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rachel Henson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Integrated Genomics Laboratory, Oregon Health & Science University, Portland, OR 97239, USA
| | - Hibery Ho
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Sunil K Joshi
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Brian Junio
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andy Kaempf
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yoko Kosaka
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR 97239, USA
| | | | - Matt Lawhead
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Hyunjung Lee
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jessica T Leonard
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Chenwei Lin
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Integrated Genomics Laboratory, Oregon Health & Science University, Portland, OR 97239, USA
| | - Evan F Lind
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Selina Qiuying Liu
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Pierrette Lo
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Marc M Loriaux
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Pathology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Samuel Luty
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Julia E Maxson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Oncologic Sciences, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Tara Macey
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jacqueline Martinez
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jessica Minnier
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR 97239, USA; OHSU-PSU School of Public Health, VA Portland Health Care System, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrea Monteblanco
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Motomi Mori
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Quinlan Morrow
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Dylan Nelson
- High-Throughput Screening Services Laboratory, Oregon State University, Corvallis, OR 97331, USA
| | - Justin Ramsdill
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Angela Rofelty
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Alexandra Rogers
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Kyle A Romine
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Peter Ryabinin
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jennifer N Saultz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - David A Sampson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Samantha L Savage
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | | | - Robert Searles
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Integrated Genomics Laboratory, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rebecca L Smith
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Stephen E Spurgeon
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Tyler Sweeney
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ronan T Swords
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Aashis Thapa
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Karina Thiel-Klare
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Elie Traer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jake Wagner
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Beth Wilmot
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Joelle Wolf
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Guanming Wu
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Amy Yates
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Haijiao Zhang
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Oncologic Sciences, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Christopher R Cogle
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Robert H Collins
- Department of Internal Medicine/ Hematology Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390-8565, USA
| | - Michael W Deininger
- Division of Hematology & Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Christopher S Hourigan
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20814-1476, USA
| | - Craig T Jordan
- Division of Hematology, University of Colorado, Denver, CO 80045, USA
| | - Tara L Lin
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas, Kansas City, KS 66205, USA
| | - Micaela E Martinez
- Clinical Research Services, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Rachel R Pallapati
- Clinical Research Services, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Daniel A Pollyea
- Division of Hematology, University of Colorado, Denver, CO 80045, USA
| | - Anthony D Pomicter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Justin M Watts
- Division of Hematology, Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Scott J Weir
- Department of Cancer Biology, Division of Medical Oncology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Brian J Druker
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Shannon K McWeeney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Jeffrey W Tyner
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA.
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Zahid MF, Dryden C, Ikpefan R, Moriarty K, Collins RH, Vusirikala M, Madanat YF, Patel PA. CGE22-103: Identifying Patients at Risk for Hereditary Myeloid Malignancy Syndromes Using a Self-Administered Questionnaire as an Initial Screening Tool: A Single Center Experience. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7315] [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: 11/17/2022]
Affiliation(s)
- Mohammad Faizan Zahid
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Courtney Dryden
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ruth Ikpefan
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kelsey Moriarty
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Robert H Collins
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Madhuri Vusirikala
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yazan F Madanat
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Prapti A Patel
- 1 Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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17
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Yang F, Long N, Anekpuritanang T, Bottomly D, Savage JC, Lee T, Solis-Ruiz J, Borate U, Wilmot B, Tognon C, Bock AM, Pollyea DA, Radhakrishnan S, Radhakrishnan S, Patel P, Collins RH, Tantravahi S, Deininger MW, Fan G, Druker B, Shinde U, Tyner JW, Press RD, McWeeney S, Agarwal A. Identification and prioritization of myeloid malignancy germline variants in a large cohort of adult patients with AML. Blood 2022; 139:1208-1221. [PMID: 34482403 PMCID: PMC9211447 DOI: 10.1182/blood.2021011354] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/12/2021] [Indexed: 11/20/2022] Open
Abstract
Inherited predisposition to myeloid malignancies is more common than previously appreciated. We analyzed the whole-exome sequencing data of paired leukemia and skin biopsy samples from 391 adult patients from the Beat AML 1.0 consortium. Using the 2015 American College of Medical Genetics and Genomics (ACMG) guidelines for variant interpretation, we curated 1547 unique variants from 228 genes. The pathogenic/likely pathogenic (P/LP) germline variants were identified in 53 acute myeloid leukemia (AML) patients (13.6%) in 34 genes, including 6.39% (25/391) of patients harboring P/LP variants in genes considered clinically actionable (tier 1). 41.5% of the 53 patients with P/LP variants were in genes associated with the DNA damage response. The most frequently mutated genes were CHEK2 (8 patients) and DDX41 (7 patients). Pathogenic germline variants were also found in new candidate genes (DNAH5, DNAH9, DNMT3A, and SUZ12). No strong correlation was found between the germline mutational rate and age of AML onset. Among 49 patients who have a reported history of at least one family member affected with hematological malignancies, 6 patients harbored known P/LP germline variants and the remaining patients had at least one variant of uncertain significance, suggesting a need for further functional validation studies. Using CHEK2 as an example, we show that three-dimensional protein modeling can be one of the effective methodologies to prioritize variants of unknown significance for functional studies. Further, we evaluated an in silico approach that applies ACMG curation in an automated manner using the tool for assessment and (TAPES) prioritization in exome studies, which can minimize manual curation time for variants. Overall, our findings suggest a need to comprehensively understand the predisposition potential of many germline variants in order to enable closer monitoring for disease management and treatment interventions for affected patients and families.
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Affiliation(s)
- Fei Yang
- Department of Pathology and Laboratory Medicine and
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Nicola Long
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Tauangtham Anekpuritanang
- Department of Pathology and Laboratory Medicine and
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
| | - Daniel Bottomly
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Division of Bioinformatics & Computational Biology and
| | - Jonathan C Savage
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, OR
| | - Tiffany Lee
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Jose Solis-Ruiz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Uma Borate
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Beth Wilmot
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Division of Bioinformatics & Computational Biology and
| | - Cristina Tognon
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Allison M Bock
- Department of Medicine, University of Colorado, Aurora, CO
| | | | | | | | - Prapti Patel
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Guang Fan
- Department of Pathology and Laboratory Medicine and
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Brian Druker
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Ujwal Shinde
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, OR
| | - Jeffrey W Tyner
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Department of Cell, Developmental & Cancer Biology
| | - Richard D Press
- Department of Pathology and Laboratory Medicine and
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Shannon McWeeney
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Division of Bioinformatics & Computational Biology and
| | - Anupriya Agarwal
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
- Department of Cell, Developmental & Cancer Biology
- Division of Hematology and Oncology, and
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR
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18
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Goksu SY, Ozer M, Goksu BB, Wang R, Khatib J, Patel PA, Vusirikala M, Cole S, Seyhanli A, Collins RH, Chung S, Zeidan AM, Madanat YF. The impact of race and ethnicity on outcomes of patients with myelodysplastic syndromes: a population-based analysis. Leuk Lymphoma 2022; 63:1651-1659. [PMID: 35133215 DOI: 10.1080/10428194.2022.2032034] [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] [Indexed: 10/19/2022]
Abstract
Race and ethnic backgrounds affect the disease characteristics and clinical outcomes in many cancers, including acute myeloid leukemia; however, the association of race/ethnicity on myelodysplastic syndrome (MDS) is still controversial. Therefore, we aimed to study the impact of race/ethnicity on the disease characteristics and survival outcomes in patients with MDS. Adult patients with MDS diagnosed in 2004-2016 were selected using the SEER database. Race/ethnicity was categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic. Hispanic and NHB patients had significantly lower incidence rate ratio (IRR) in age group ≥01 years (p < .001) compared to NHW; however, in the age group <50 years, NHB patients had significantly higher IRR with an increased incidence rate of 49%. NHB patients had better overall survival than Hispanic and NHW patients (p < .001), even after adjusting for confounding variables. MDS have significant differences in age at diagnosis, disease risk, and survival outcomes based on racial/ethnic backgrounds.
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Affiliation(s)
- Suleyman Yasin Goksu
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Muhammet Ozer
- Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | - Busra B Goksu
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA
| | - Rong Wang
- Department of Population and Data Sciences, Yale University, New Haven, CT, USA
| | - Jude Khatib
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Prapti A Patel
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Madhuri Vusirikala
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Suzanne Cole
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Ahmet Seyhanli
- Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Robert H Collins
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Stephen Chung
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale Cancer Center and Smilow Cancer Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Yazan F Madanat
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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19
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Madanat YF, Patel P, Chung S, Yan J, Ahn C, Khatib J, Tadic-Ovcina M, AhmedRabie A, Helton D, Shahan J, Dryden C, White A, Patel H, Ramakrishnan P, Kansagra A, Collins RH, Vusirikala M. Post-Transplant Cyclophosphamide and Early Mixed Donor Chimerism in Myeloid Malignancies; UT Southwestern Experience. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00177-9] [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: 11/24/2022]
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20
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Shahan JL, AhmedRabie A, Tadic-Ovcina M, Patel P, Ramakrishnan P, Kansagra A, Chung S, Collins RH, Madanat YF, Dryden C, Vusirikala M. Cytomegalovirus Reactivation in Allogeneic Hematopoietic Cell Transplant Recipients Receiving Letermovir Prophylaxis and Cytomegalovirus Specific T Cell Immunity, a Retrospective Single Center Experience. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00128-7] [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: 11/15/2022]
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21
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Stephens E, Mehta A, Persoon T, Baker S, David R, Nair K, Madanat YF, Rizvi S, Patel P, Chung S, Vusirkala M, Awan F, Anderson LD, Sweetenham JW, Collins RH, Ramakrishnan P, Ramasamy D, Kansagra A. Continuous Telemetry Monitoring in Chimeric Antigen Receptor (CAR) T-Cell Therapy Patients. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00260-8] [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: 11/24/2022]
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22
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Bergstrom C, Chen W, Zhang C, Anderson L, Awan F, Chung S, Rizvi S, Ramakrishnan P, Vusirkala M, Patel P, Collins RH, Kansagra AJ. The Association of Leukocyte Immunoglobulin-like Receptor B4 (LILRB-4) with Central Nervous System Involvement in Patients with Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.619] [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: 10/25/2022]
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23
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Dao KHT, Gotlib J, Deininger MMN, Oh ST, Cortes JE, Collins RH, Winton EF, Parker DR, Lee H, Reister A, Schultz, Savage S, Stevens, Brockett C, Subbiah N, Press RD, Raess PW, Cascio M, Dunlap J, Chen Y, Degnin C, Maxson JE, Tognon CE, Macey T, Druker BJ, Tyner JW. Efficacy of Ruxolitinib in Patients With Chronic Neutrophilic Leukemia and Atypical Chronic Myeloid Leukemia. J Clin Oncol 2019; 38:1006-1018. [PMID: 31880950 DOI: 10.1200/jco.19.00895] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Colony-stimulating factor-3 receptor (CSF3R)-T618I is a recurrent activating mutation in chronic neutrophilic leukemia (CNL) and to a lesser extent in atypical chronic myeloid leukemia (aCML) resulting in constitutive JAK-STAT signaling. We sought to evaluate safety and efficacy of the JAK1/2 inhibitor ruxolitinib in patients with CNL and aCML, irrespective of CSF3R mutation status. METHODS We conducted a phase II study of ruxolitinib in 44 patients (21 CNL and 23 aCML). The primary end point was overall hematologic response rate (ORR) by the end of 6 continuous 28-day cycles for the first 25 patients enrolled. We considered a response as either partial (PR) or complete response (CR). We expanded accrual to 44 patients to increase our ability to evaluate secondary end points, including grade ≥ 3 adverse events, spleen volume, symptom assessment, genetic correlates of response, and 2-year survival. RESULTS ORR was 32% for the first 25 enrolled patients (8 PR [7 CNL and 1 aCML]). In the larger cohort of 44 patients, 35% had a response (11 PR [9 CNL and 2 aCML] and 4 CR [CNL]), and 50% had oncogenic CSF3R mutations. The mean absolute allele burden reduction of CSF3R-T618I after 6 cycles was greatest in the CR group, compared with the PR and no response groups. The most common cause of death is due to disease progression. Grade ≥ 3 anemia and thrombocytopenia were observed in 34% and 14% of patients, respectively. No serious adverse events attributed to ruxolitinib were observed. CONCLUSION Ruxolitinib was well tolerated and demonstrated an estimated response rate of 32%. Patients with a diagnosis of CNL and/or harboring CSF3R-T618I were most likely to respond.
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Affiliation(s)
- Kim-Hien T Dao
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Jason Gotlib
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA
| | | | - Stephen T Oh
- Division of Hematology, Department of Medicine, Washington University in St Louis, St Louis, MO
| | - Jorge E Cortes
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert H Collins
- Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Dana R Parker
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Hyunjung Lee
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Anna Reister
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Schultz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Samantha Savage
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Stevens
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Chase Brockett
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Nan Subbiah
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Richard D Press
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Philipp W Raess
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Michael Cascio
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Jennifer Dunlap
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Yiyi Chen
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Catherine Degnin
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Julia E Maxson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Cristina E Tognon
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Tara Macey
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Brian J Druker
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR.,Howard Hughes Medical Institute, Chase, MD
| | - Jeffrey W Tyner
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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Brown TJ, Patel PA, Oliver D, Churchill H, Monaghan SA, Collins RH. Next-Generation Sequencing Directs Therapy and Delineates a Clonal Relationship in Mast Cell Sarcoma and Acute Myeloid Leukemia. JCO Precis Oncol 2019; 3:1-6. [DOI: 10.1200/po.18.00291] [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: 11/20/2022] Open
Affiliation(s)
| | - Prapti A. Patel
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Dwight Oliver
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Hywyn Churchill
- The University of Texas Southwestern Medical Center, Dallas, TX
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25
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Zhang H, Wilmot B, Bottomly D, Dao KHT, Stevens E, Eide CA, Khanna V, Rofelty A, Savage S, Reister Schultz A, Long N, White L, Carlos A, Henson R, Lin C, Searles R, Collins RH, DeAngelo DJ, Deininger MW, Dunn T, Hein T, Luskin MR, Medeiros BC, Oh ST, Pollyea DA, Steensma DP, Stone RM, Druker BJ, McWeeney SK, Maxson JE, Gotlib JR, Tyner JW. Genomic landscape of neutrophilic leukemias of ambiguous diagnosis. Blood 2019; 134:867-879. [PMID: 31366621 PMCID: PMC6742922 DOI: 10.1182/blood.2019000611] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Chronic neutrophilic leukemia (CNL), atypical chronic myeloid leukemia (aCML), and myelodysplastic/myeloproliferative neoplasms, unclassifiable (MDS/MPN-U) are a group of rare and heterogeneous myeloid disorders. There is strong morphologic resemblance among these distinct diagnostic entities as well as a lack of specific molecular markers and limited understanding of disease pathogenesis, which has made diagnosis challenging in certain cases. The treatment has remained empirical, resulting in dismal outcomes. We, therefore, performed whole-exome and RNA sequencing of these rare hematologic malignancies and present the most complete survey of the genomic landscape of these diseases to date. We observed a diversity of combinatorial mutational patterns that generally do not cluster within any one diagnosis. Gene expression analysis reveals enrichment, but not cosegregation, of clinical and genetic disease features with transcriptional clusters. In conclusion, these groups of diseases represent a continuum of related diseases rather than discrete diagnostic entities.
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Affiliation(s)
- Haijiao Zhang
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Beth Wilmot
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Daniel Bottomly
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | | - Emily Stevens
- Fred Hutchinson Cancer Research Institute, Washington University School of Medicine, Seattle, WA
| | - Christopher A Eide
- Division of Hematology and Medical Oncology, and
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Vishesh Khanna
- Division of Hematology and Medical Oncology, and
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Angela Rofelty
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Samantha Savage
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Anna Reister Schultz
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Nicola Long
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
| | - Libbey White
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Amy Carlos
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Rachel Henson
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Chenwei Lin
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Robert Searles
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR
| | - Robert H Collins
- Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Tamara Dunn
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Than Hein
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Bruno C Medeiros
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Stephen T Oh
- Hematology Division, Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO; and
| | - Daniel A Pollyea
- Division of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado School of Medicine, Aurora, CO
| | - David P Steensma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Brian J Druker
- Division of Hematology and Medical Oncology, and
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Shannon K McWeeney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | | - Jason R Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey W Tyner
- Department of Cell, Developmental and Cancer Biology
- Division of Hematology and Medical Oncology, and
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26
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Tyner JW, Tognon CE, Bottomly D, Wilmot B, Kurtz SE, Savage SL, Long N, Schultz AR, Traer E, Abel M, Agarwal A, Blucher A, Borate U, Bryant J, Burke R, Carlos A, Carpenter R, Carroll J, Chang BH, Coblentz C, d'Almeida A, Cook R, Danilov A, Dao KHT, Degnin M, Devine D, Dibb J, Edwards DK, Eide CA, English I, Glover J, Henson R, Ho H, Jemal A, Johnson K, Johnson R, Junio B, Kaempf A, Leonard J, Lin C, Liu SQ, Lo P, Loriaux MM, Luty S, Macey T, MacManiman J, Martinez J, Mori M, Nelson D, Nichols C, Peters J, Ramsdill J, Rofelty A, Schuff R, Searles R, Segerdell E, Smith RL, Spurgeon SE, Sweeney T, Thapa A, Visser C, Wagner J, Watanabe-Smith K, Werth K, Wolf J, White L, Yates A, Zhang H, Cogle CR, Collins RH, Connolly DC, Deininger MW, Drusbosky L, Hourigan CS, Jordan CT, Kropf P, Lin TL, Martinez ME, Medeiros BC, Pallapati RR, Pollyea DA, Swords RT, Watts JM, Weir SJ, Wiest DL, Winters RM, McWeeney SK, Druker BJ. Functional genomic landscape of acute myeloid leukaemia. Nature 2018; 562:526-531. [PMID: 30333627 PMCID: PMC6280667 DOI: 10.1038/s41586-018-0623-z] [Citation(s) in RCA: 719] [Impact Index Per Article: 119.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/14/2018] [Indexed: 01/08/2023]
Abstract
The implementation of targeted therapies for acute myeloid leukaemia (AML) has been challenging because of the complex mutational patterns within and across patients as well as a dearth of pharmacologic agents for most mutational events. Here we report initial findings from the Beat AML programme on a cohort of 672 tumour specimens collected from 562 patients. We assessed these specimens using whole-exome sequencing, RNA sequencing and analyses of ex vivo drug sensitivity. Our data reveal mutational events that have not previously been detected in AML. We show that the response to drugs is associated with mutational status, including instances of drug sensitivity that are specific to combinatorial mutational events. Integration with RNA sequencing also revealed gene expression signatures, which predict a role for specific gene networks in the drug response. Collectively, we have generated a dataset-accessible through the Beat AML data viewer (Vizome)-that can be leveraged to address clinical, genomic, transcriptomic and functional analyses of the biology of AML.
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Affiliation(s)
- Jeffrey W Tyner
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Cristina E Tognon
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Howard Hughes Medical Institute, Portland, OR, USA
| | - Daniel Bottomly
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Beth Wilmot
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Stephen E Kurtz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Samantha L Savage
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Nicola Long
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Anna Reister Schultz
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Elie Traer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Melissa Abel
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Anupriya Agarwal
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Aurora Blucher
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Uma Borate
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jade Bryant
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Russell Burke
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amy Carlos
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR, USA
| | - Richie Carpenter
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Joseph Carroll
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Technology Transfer & Business Development, Oregon Health & Science University, Portland, OR, USA
| | - Bill H Chang
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Cody Coblentz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amanda d'Almeida
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Rachel Cook
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Alexey Danilov
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kim-Hien T Dao
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michie Degnin
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Deirdre Devine
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - James Dibb
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David K Edwards
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Christopher A Eide
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Howard Hughes Medical Institute, Portland, OR, USA
| | - Isabel English
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jason Glover
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Rachel Henson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR, USA
| | - Hibery Ho
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Abdusebur Jemal
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Kara Johnson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ryan Johnson
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brian Junio
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Andy Kaempf
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR, USA
| | - Jessica Leonard
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Chenwei Lin
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR, USA
| | - Selina Qiuying Liu
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Pierrette Lo
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Marc M Loriaux
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Dapartment of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Samuel Luty
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Tara Macey
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jason MacManiman
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jacqueline Martinez
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Motomi Mori
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR, USA
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Dylan Nelson
- High-Throughput Screening Services Laboratory, Oregon State University, Corvalis, OR, USA
| | - Ceilidh Nichols
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jill Peters
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Justin Ramsdill
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Angela Rofelty
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Robert Schuff
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Robert Searles
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Integrated Genomics Laboratories, Oregon Health & Science University, Portland, OR, USA
| | - Erik Segerdell
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Rebecca L Smith
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Stephen E Spurgeon
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Tyler Sweeney
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Aashis Thapa
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Corinne Visser
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jake Wagner
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kevin Watanabe-Smith
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kristen Werth
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Joelle Wolf
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Libbey White
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Amy Yates
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Haijiao Zhang
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Christopher R Cogle
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, FL, USA
| | - Robert H Collins
- Department of Internal Medicine/Hematology Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Denise C Connolly
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
- Fox Chase Cancer Center Biosample Repository Facility, Philadelphia, PA, USA
| | - Michael W Deininger
- Division of Hematology & Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Leylah Drusbosky
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, FL, USA
| | - Christopher S Hourigan
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Craig T Jordan
- Division of Hematology, University of Colorado, Denver, CO, USA
| | - Patricia Kropf
- Bone Marrow Transplant Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Tara L Lin
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Micaela E Martinez
- Clinical Research Services, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Bruno C Medeiros
- Department of Medicine-Hematology, Stanford University, Stanford, CA, USA
| | - Rachel R Pallapati
- Clinical Research Services, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Ronan T Swords
- Department of Hematology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Justin M Watts
- Department of Hematology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Scott J Weir
- Department of Toxicology, Pharmacology and Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - David L Wiest
- Blood Cell Development and Function Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ryan M Winters
- Fox Chase Cancer Center Biosample Repository Facility, Philadelphia, PA, USA
| | - Shannon K McWeeney
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Brian J Druker
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Howard Hughes Medical Institute, Portland, OR, USA.
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DiNardo CD, Stein EM, de Botton S, Roboz GJ, Altman JK, Mims AS, Swords R, Collins RH, Mannis GN, Pollyea DA, Donnellan W, Fathi AT, Pigneux A, Erba HP, Prince GT, Stein AS, Uy GL, Foran JM, Traer E, Stuart RK, Arellano ML, Slack JL, Sekeres MA, Willekens C, Choe S, Wang H, Zhang V, Yen KE, Kapsalis SM, Yang H, Dai D, Fan B, Goldwasser M, Liu H, Agresta S, Wu B, Attar EC, Tallman MS, Stone RM, Kantarjian HM. Durable Remissions with Ivosidenib in IDH1-Mutated Relapsed or Refractory AML. N Engl J Med 2018; 378:2386-2398. [PMID: 29860938 DOI: 10.1056/nejmoa1716984] [Citation(s) in RCA: 927] [Impact Index Per Article: 154.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mutations in the gene encoding isocitrate dehydrogenase 1 ( IDH1) occur in 6 to 10% of patients with acute myeloid leukemia (AML). Ivosidenib (AG-120) is an oral, targeted, small-molecule inhibitor of mutant IDH1. METHODS We conducted a phase 1 dose-escalation and dose-expansion study of ivosidenib monotherapy in IDH1-mutated AML. Safety and efficacy were assessed in all treated patients. The primary efficacy population included patients with relapsed or refractory AML receiving 500 mg of ivosidenib daily with at least 6 months of follow-up. RESULTS Overall, 258 patients received ivosidenib and had safety outcomes assessed. Among patients with relapsed or refractory AML (179 patients), treatment-related adverse events of grade 3 or higher that occurred in at least 3 patients were prolongation of the QT interval (in 7.8% of the patients), the IDH differentiation syndrome (in 3.9%), anemia (in 2.2%), thrombocytopenia or a decrease in the platelet count (in 3.4%), and leukocytosis (in 1.7%). In the primary efficacy population (125 patients), the rate of complete remission or complete remission with partial hematologic recovery was 30.4% (95% confidence interval [CI], 22.5 to 39.3), the rate of complete remission was 21.6% (95% CI, 14.7 to 29.8), and the overall response rate was 41.6% (95% CI, 32.9 to 50.8). The median durations of these responses were 8.2 months (95% CI, 5.5 to 12.0), 9.3 months (95% CI, 5.6 to 18.3), and 6.5 months (95% CI, 4.6 to 9.3), respectively. Transfusion independence was attained in 29 of 84 patients (35%), and patients who had a response had fewer infections and febrile neutropenia episodes than those who did not have a response. Among 34 patients who had a complete remission or complete remission with partial hematologic recovery, 7 (21%) had no residual detectable IDH1 mutations on digital polymerase-chain-reaction assay. No preexisting co-occurring single gene mutation predicted clinical response or resistance to treatment. CONCLUSIONS In patients with advanced IDH1-mutated relapsed or refractory AML, ivosidenib at a dose of 500 mg daily was associated with a low frequency of grade 3 or higher treatment-related adverse events and with transfusion independence, durable remissions, and molecular remissions in some patients with complete remission. (Funded by Agios Pharmaceuticals; ClinicalTrials.gov number, NCT02074839 .).
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MESH Headings
- Administration, Oral
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cell Count
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm
- Enzyme Inhibitors/administration & dosage
- Enzyme Inhibitors/adverse effects
- Enzyme Inhibitors/pharmacokinetics
- Female
- Follow-Up Studies
- Glycine/administration & dosage
- Glycine/adverse effects
- Glycine/analogs & derivatives
- Glycine/pharmacokinetics
- Hemoglobins/analysis
- Humans
- Isocitrate Dehydrogenase/antagonists & inhibitors
- Isocitrate Dehydrogenase/genetics
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Mutation
- Pyridines/administration & dosage
- Pyridines/adverse effects
- Pyridines/pharmacokinetics
- Recurrence
- Remission Induction
- Survival Rate
- Young Adult
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Affiliation(s)
- Courtney D DiNardo
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Eytan M Stein
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Stéphane de Botton
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Gail J Roboz
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Jessica K Altman
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Alice S Mims
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Ronan Swords
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Robert H Collins
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Gabriel N Mannis
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Daniel A Pollyea
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Will Donnellan
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Amir T Fathi
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Arnaud Pigneux
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Harry P Erba
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Gabrielle T Prince
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Anthony S Stein
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Geoffrey L Uy
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - James M Foran
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Elie Traer
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Robert K Stuart
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Martha L Arellano
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - James L Slack
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Mikkael A Sekeres
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Christophe Willekens
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Sung Choe
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hongfang Wang
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Vickie Zhang
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Katharine E Yen
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Stephanie M Kapsalis
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hua Yang
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - David Dai
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Bin Fan
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Meredith Goldwasser
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hua Liu
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Sam Agresta
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Bin Wu
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Eyal C Attar
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Martin S Tallman
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Richard M Stone
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
| | - Hagop M Kantarjian
- From the University of Texas M.D. Anderson Cancer Center, Houston (C.D.D., H.M.K.); Memorial Sloan Kettering Cancer Center (E.M.S., M.S.T.) and Weill Cornell Medical College (G.J.R.), New York; Institut Gustave Roussy, Villejuif (S.B., C.W.), and Centre Hospitalier Universitaire Bordeaux, Bordeaux (A.P.) - both in France; Northwestern University, Chicago (J.K.A.); Ohio State University Wexner Medical Center, Columbus (A.S.M.); Sylvester Comprehensive Cancer Center, University of Miami, Miami (R.S.); University of Texas Southwestern Medical Center, Dallas (R.H.C.); University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco (G.N.M.), and City of Hope Medical Center, Duarte (A.S.S.) - both in California; University of Colorado School of Medicine, Aurora (D.A.P.); Sarah Cannon Research Institute, Nashville (W.D.); Massachusetts General Hospital Cancer Center (A.T.F.) and Dana-Farber Cancer Institute (R.M.S.), Boston, and Agios Pharmaceuticals, Cambridge (S.C., H.W., V.Z., K.E.Y., S.M.K., H.Y., D.D., B.F., M.G., H.L., S.A., B.W., E.C.A.) - all in Massachusetts; University of Alabama at Birmingham, Birmingham (H.P.E.); Johns Hopkins University, Baltimore (G.T.P.); Washington University School of Medicine, St. Louis (G.L.U.); Mayo Clinic, Jacksonville, FL (J.M.F.); Oregon Health and Science University Knight Cancer Institute, Portland (E.T.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.K.S.); Winship Cancer Institute of Emory University, Atlanta (M.L.A.); Mayo Clinic, Phoenix, AZ (J.L.S.); and Cleveland Clinic, Cleveland (M.A.S.)
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Carey A, Edwards DK, Eide CA, Newell L, Traer E, Medeiros BC, Pollyea DA, Deininger MW, Collins RH, Tyner JW, Druker BJ, Bagby GC, McWeeney SK, Agarwal A. Identification of Interleukin-1 by Functional Screening as a Key Mediator of Cellular Expansion and Disease Progression in Acute Myeloid Leukemia. Cell Rep 2017; 18:3204-3218. [PMID: 28355571 DOI: 10.1016/j.celrep.2017.03.018] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [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: 08/08/2016] [Revised: 12/29/2016] [Accepted: 03/02/2017] [Indexed: 12/22/2022] Open
Abstract
Secreted proteins in the bone marrow microenvironment play critical roles in acute myeloid leukemia (AML). Through an ex vivo functional screen of 94 cytokines, we identified that the pro-inflammatory cytokine interleukin-1 (IL-1) elicited profound expansion of myeloid progenitors in ∼67% of AML patients while suppressing the growth of normal progenitors. Levels of IL-1β and IL-1 receptors were increased in AML patients, and silencing of the IL-1 receptor led to significant suppression of clonogenicity and in vivo disease progression. IL-1 promoted AML cell growth by enhancing p38MAPK phosphorylation and promoting secretion of various other growth factors and inflammatory cytokines. Treatment with p38MAPK inhibitors reversed these effects and recovered normal CD34+ cells from IL-1-mediated growth suppression. These results highlight the importance of ex vivo functional screening to identify common and actionable extrinsic pathways in genetically heterogeneous malignancies and provide impetus for clinical development of IL-1/IL1R1/p38MAPK pathway-targeted therapies in AML.
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Affiliation(s)
- Alyssa Carey
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - David K Edwards
- Department of Cell, Developmental and Cancer Biology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Christopher A Eide
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Howard Hughes Medical Institute, Portland, OR 97239, USA
| | - Laura Newell
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Elie Traer
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | | | - Daniel A Pollyea
- University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Robert H Collins
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jeffrey W Tyner
- Department of Cell, Developmental and Cancer Biology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Brian J Druker
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Howard Hughes Medical Institute, Portland, OR 97239, USA
| | - Grover C Bagby
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Shannon K McWeeney
- Division of Bioinformatics and Computational Biology, Department of Medical Informatics & Clinical Epidemiology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Anupriya Agarwal
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA; Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR 97239, USA.
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Khoury HJ, Collins RH, Blum W, Stiff PS, Elias L, Lebkowski JS, Reddy A, Nishimoto KP, Sen D, Wirth ED, Case CC, DiPersio JF. Immune responses and long-term disease recurrence status after telomerase-based dendritic cell immunotherapy in patients with acute myeloid leukemia. Cancer 2017; 123:3061-3072. [PMID: 28411378 DOI: 10.1002/cncr.30696] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Telomerase activity in leukemic blasts frequently is increased among patients with high-risk acute myeloid leukemia (AML). In the current study, the authors evaluated the feasibility, safety, immunogenicity, and therapeutic potential of human telomerase reverse transcriptase (hTERT)-expressing autologous dendritic cells (hTERT-DCs) in adult patients with AML. METHODS hTERT-DCs were produced from patient-specific leukapheresis, electroporated with an mRNA-encoding hTERT and a lysosomal-targeting sequence, and cryopreserved. A total of 22 patients with a median age of 58 years (range, 30-75 years) with intermediate-risk or high-risk AML in first or second complete remission (CR) were enrolled. hTERT-DCs were generated for 24 patients (73%). A median of 17 intradermal vaccinations (range, 6-32 intradermal vaccinations) containing 1×107 cells were administered as 6 weekly injections followed by 6 biweekly injections. A total of 21 patients (16 in first CR, 3 in second CR, and 2 with early disease recurrence) received hTERT-DCs. RESULTS hTERT-DCs were well tolerated with no severe toxicities reported, with the exception of 1 patient who developed idiopathic thrombocytopenic purpura. Of the 19 patients receiving hTERT-DCs in CR, 11 patients (58%) developed hTERT-specific T-cell responses that primarily were targeted toward hTERT peptides with predicted low human leukocyte antigen (HLA)-binding affinities. With a median follow-up of 52 months, 58% of patients in CR (11 of 19 patients) were free of disease recurrence at the time of their last follow-up visit; 57% of the patients who were aged ≥60 years (4 of 7 patients) also were found to be free of disease recurrence at a median follow-up of 54 months. CONCLUSIONS The generation of hTERT-DCs is feasible and vaccination with hTERT-DCs appears to be safe and may be associated with favorable recurrence-free survival. Cancer 2017;123:3061-72. © 2017 American Cancer Society.
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Affiliation(s)
- Hanna J Khoury
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert H Collins
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - William Blum
- Department of Hematology, The Ohio State University, Columbus, Ohio
| | - Patrick S Stiff
- Department of Medicine, Loyola University, Maywood, Illinois
| | | | | | | | | | - Debasish Sen
- Asterias Biotherapeutics Inc, Menlo Park, California
| | | | - Casey C Case
- Asterias Biotherapeutics Inc, Menlo Park, California
| | - John F DiPersio
- Department of Oncology, Washington University School of Medicine, St. Louis, Missouri
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Affiliation(s)
- Martin F. Dietrich
- Harold C. Simmons Cancer Center, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Robert H. Collins
- Harold C. Simmons Cancer Center, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas
| | - David E. Gerber
- Harold C. Simmons Cancer Center, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas
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McGehee E, Rakheja D, Oliver D, Chen W, Boriack R, Collins RH. The importance of plasma D-2HG measurement in screening forIDHmutations in acute myeloid leukaemia. Br J Haematol 2015. [DOI: 10.1111/bjh.13598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth McGehee
- UT Southwestern Medical School; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Dinesh Rakheja
- Department of Pathology and Laboratory Medicine; Children's Medical Center; Dallas TX USA
- Departments of Pathology and Pediatrics; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Dwight Oliver
- Department of Pathology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Weina Chen
- Department of Pathology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Richard Boriack
- Department of Pathology and Laboratory Medicine; Children's Medical Center; Dallas TX USA
| | - Robert H. Collins
- Hematology/Oncology; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
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Wang M, Popplewell LL, Collins RH, Winter JN, Goy A, Kaminski MS, Bartlett NL, Johnston PB, Lister J, Fanning SR, Tuscano JM, Beck JT, Kaya H, Robeva A, Fan J, Klimovsky J, Cheung W, Cherfi A, O'Connor OA. Everolimus for patients with mantle cell lymphoma refractory to or intolerant of bortezomib: multicentre, single-arm, phase 2 study. Br J Haematol 2014; 165:510-8. [PMID: 24579926 DOI: 10.1111/bjh.12780] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 06/27/2013] [Accepted: 12/06/2013] [Indexed: 02/03/2023]
Abstract
The multicentre, open-label, two-stage, single-arm, phase 2, PILLAR (PIvotaL Lymphoma triAls of RAD001)-1 study (NCT00702052) assessed the efficacy and safety of everolimus 10 mg/d in adults with confirmed mantle cell lymphoma (MCL) refractory to or intolerant of bortezomib who received ≥1 other antineoplastic agent, either separately or in combination with bortezomib. Primary endpoint was overall response rate (ORR) per investigator review according to the response criteria for malignant lymphoma. Secondary endpoints included progression-free survival (PFS), overall survival (OS) and safety. Fifty-eight patients were enrolled from August 2008-January 2011. Five partial responses were observed (ORR 8·6%; 90% confidence interval [CI] 3·5-17·3%); the study did not meet the prespecified objective of ≥8 objective responses among 57 patients. Median PFS and OS were 4·4 months (95% CI 3·5-6·1) and 16·9 months (95% CI 14·4-29·9), respectively. Grade 3/4 non-haematological toxicities occurred in 70·7% of patients. Based on laboratory values, grade 3/4 thrombocytopenia, neutropenia and anaemia occurred in 13·8%, 13·8% and 8·6% of patients, respectively. Everolimus demonstrated modest activity and acceptable tolerability in heavily pretreated patients with MCL refractory to or intolerant of bortezomib. Future studies evaluating everolimus in a less refractory population or in combination with other targeted therapies in refractory MCL are warranted.
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Affiliation(s)
- Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Maxson JE, Gotlib J, Pollyea DA, Fleischman AG, Agarwal A, Eide CA, Bottomly D, Wilmot B, McWeeney SK, Tognon CE, Pond JB, Collins RH, Goueli B, Oh ST, Deininger MW, Chang BH, Loriaux MM, Druker BJ, Tyner JW. Oncogenic CSF3R mutations in chronic neutrophilic leukemia and atypical CML. N Engl J Med 2013; 368:1781-90. [PMID: 23656643 PMCID: PMC3730275 DOI: 10.1056/nejmoa1214514] [Citation(s) in RCA: 404] [Impact Index Per Article: 36.7] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND The molecular causes of many hematologic cancers remain unclear. Among these cancers are chronic neutrophilic leukemia (CNL) and atypical (BCR-ABL1-negative) chronic myeloid leukemia (CML), both of which are diagnosed on the basis of neoplastic expansion of granulocytic cells and exclusion of genetic drivers that are known to occur in other myeloproliferative neoplasms and myeloproliferative-myelodysplastic overlap neoplasms. METHODS To identify potential genetic drivers in these disorders, we used an integrated approach of deep sequencing coupled with the screening of primary leukemia cells obtained from patients with CNL or atypical CML against panels of tyrosine kinase-specific small interfering RNAs or small-molecule kinase inhibitors. We validated candidate oncogenes using in vitro transformation assays, and drug sensitivities were validated with the use of assays of primary-cell colonies. RESULTS We identified activating mutations in the gene encoding the receptor for colony-stimulating factor 3 (CSF3R) in 16 of 27 patients (59%) with CNL or atypical CML. These mutations segregate within two distinct regions of CSF3R and lead to preferential downstream kinase signaling through SRC family-TNK2 or JAK kinases and differential sensitivity to kinase inhibitors. A patient with CNL carrying a JAK-activating CSF3R mutation had marked clinical improvement after the administration of the JAK1/2 inhibitor ruxolitinib. CONCLUSIONS Mutations in CSF3R are common in patients with CNL or atypical CML and represent a potentially useful criterion for diagnosing these neoplasms. (Funded by the Leukemia and Lymphoma Society and others.).
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MESH Headings
- Animals
- Humans
- Janus Kinases/antagonists & inhibitors
- Leukemia, Lymphoid/genetics
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/diagnosis
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/genetics
- Leukemia, Neutrophilic, Chronic/diagnosis
- Leukemia, Neutrophilic, Chronic/genetics
- Mice
- Mutation
- Protein Kinase Inhibitors/pharmacology
- Protein-Tyrosine Kinases/antagonists & inhibitors
- RNA, Small Interfering
- Receptors, Colony-Stimulating Factor/genetics
- Signal Transduction/physiology
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Affiliation(s)
- Julia E Maxson
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97239, USA
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Naina HV, Levitt D, Vusirikala M, Anderson LD, Scaglioni PP, Kirk A, Collins RH. Successful Treatment of Relapsed and Refractory Extramedullary Acute Promyelocytic Leukemia With Tamibarotene. J Clin Oncol 2011; 29:e534-6. [DOI: 10.1200/jco.2011.34.8953] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | - Angela Kirk
- University of Texas Southwestern, Dallas, TX
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Tirado CA, Chen W, Valdez FJ, Henderson S, Doolittle J, Garcia R, Patel S, Holdridge S, Chastain C, Collins RH. Acute myeloid leukemia (M2) with a cryptic RUNX1/RUNX1T1 t(1;21;8)(p36;q22;q22) variant. ACTA ACUST UNITED AC 2009; 193:67-9. [DOI: 10.1016/j.cancergencyto.2009.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/10/2009] [Indexed: 10/20/2022]
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36
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Tirado CA, Chena W, Valdez FJ, Henderson S, Smart RL, Doolittle J, Garcia R, Patel S, Holdridge S, Chastain C, Auchus M, Collins RH. A Cryptic t(1;21;8)(p36;q22;q22) in a Case of Acute Myeloid Leukemia with Maturation. J Assoc Genet Technol 2009; 35:88-92. [PMID: 19738329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The t(8;21)/RUNX1-RUNX1T1 is found in ~5 percent of cases of acute myeloid leukemia (AML) and in 10 percent of the prior AML with maturation (M2) category of the French-American-British (FAB) classification. While AML with t(8;21) is considered a distinct entity with a favorable prognosis, the clinical consequence of variant translocations is less well defined. In this report we described a 45 year-old male patient having a diagnosis of AML-M2 with morphologic and immunophenotypic features suggestive of t(8;21). However, the initial karyotypic analysis revealed an apparently balanced translocation between 1p36 and 8q22. Further fluorescence in situ hybridization (FISH) studies using the AML1/ETO and the p58 probes from Abbott Molecular, demonstrated a three-way translocation between chromosomes 1, 21, and 8, with single fusion of RUNX1-RUNX1T1 on the derivative chromosome 8 [t(1;21;8)(p36.1;q22;q22)]. The patient was in complete remission after induction therapy followed by consolidation. This report demonstrates the importance of FISH studies for detection of cryptic specific chromosome rearrangements that may have prognostic significance.
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Affiliation(s)
- Carlos A Tirado
- Laboratory of Cytogenetics, UT Southwestern Medical Center, Dallas, TX
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37
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Shah NP, Kantarjian HM, Kim DW, Réa D, Dorlhiac-Llacer PE, Milone JH, Vela-Ojeda J, Silver RT, Khoury HJ, Charbonnier A, Khoroshko N, Paquette RL, Deininger M, Collins RH, Otero I, Hughes T, Bleickardt E, Strauss L, Francis S, Hochhaus A. Intermittent target inhibition with dasatinib 100 mg once daily preserves efficacy and improves tolerability in imatinib-resistant and -intolerant chronic-phase chronic myeloid leukemia. J Clin Oncol 2008; 26:3204-12. [PMID: 18541900 DOI: 10.1200/jco.2007.14.9260] [Citation(s) in RCA: 371] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Dasatinib is a BCR-ABL inhibitor, 325-fold more potent than imatinib against unmutated BCR-ABL in vitro. Phase II studies have demonstrated efficacy and safety with dasatinib 70 mg twice daily in chronic-phase (CP) chronic myelogenous leukemia (CML) after imatinib treatment failure. In phase I, responses occurred with once-daily administration despite only intermittent BCR-ABL inhibition. Once-daily treatment resulted in less toxicity, suggesting that toxicity results from continuous inhibition of unintended targets. Here, a dose- and schedule-optimization study is reported. PATIENTS AND METHODS In this open-label phase III trial, 670 patients with imatinib-resistant or -intolerant CP-CML were randomly assigned 1:1:1:1 between four dasatinib treatment groups: 100 mg once daily, 50 mg twice daily, 140 mg once daily, or 70 mg twice daily. RESULTS With minimum follow-up of 6 months (median treatment duration, 8 months; range, < 1 to 15 months), marked and comparable hematologic (complete, 86% to 92%) and cytogenetic (major, 54% to 59%; complete, 41% to 45%) response rates were observed across the four groups. Time to and duration of cytogenetic response were similar, as was progression-free survival (8% to 11% of patients experienced disease progression or died). Compared with the approved 70-mg twice-daily regimen, dasatinib 100 mg once daily resulted in significantly lower rates of pleural effusion (all grades, 7% v 16%; P = .024) and grade 3 to 4 thrombocytopenia (22% v 37%; P = .004), and fewer patients required dose interruption (51% v 68%), reduction (30% v 55%), or discontinuation (16% v 23%). CONCLUSION Dasatinib 100 mg once daily retains the efficacy of 70 mg twice daily with less toxicity. Intermittent target inhibition with tyrosine kinase inhibitors may preserve efficacy and reduce adverse events.
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Affiliation(s)
- Neil P Shah
- Division of Hematology/Oncology, University of California, San Francisco School of Medicine, Box 1270, 505 Parnassus Ave, San Francisco, CA 94143, USA.
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Abstract
This article describes four new cases from our clinical practices of therapy-related acute leukemia after use of mitoxantrone in the treatment of patients with multiple sclerosis (MS) and reviews the mechanisms that predispose to this serious complication of treatment. The study consisted of a retrospective case series. Four previously unreported cases of secondary leukemia arising after mitoxantrone therapy in MS patients were identified, out of a combined cohort of 152 patients treated at our institutions. Three of the patients developed the acute promyelocytic leukemia subtype, after varying doses and latencies of mitoxantrone therapy. One of the study patients died. Characteristics of these patients and 10 previously reported cases are summarized. MS patients treated with mitoxantrone remain at risk for therapy-related leukemia, particularly acute promyelocytic leukemia. Strategies for minimization and prompt identification of this adverse event are needed.
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Mundy DI, Sathe A, Ortega S, Collins RH, Karandikar NJ. In Vitro Methotrexate as a Practical Approach to Selective Allodepletion (102.7). The Journal of Immunology 2007. [DOI: 10.4049/jimmunol.178.supp.102.7] [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
Graft-versus-Host Disease (GvHD) is a major cause of transplant-related morbidity and mortality in recipients of allogeneic hematopoietic stem cell transplantation. GvHD is mediated predominantly by alloreactive donor T-cells, therefore selective depletion of the alloreactive cells from the graft may alleviate GvHD, while maintaining other advantages conferred by donor T-cells, such as graft survival, antiviral immunity and graft-versus-leukemia effect. In this study, we evaluated the ability of methotrexate, a clinically approved anti-metabolite drug, to deplete alloreactive T-cells in mixed lymphocyte reactions (MLR). We show that methotrexate potently inhibits the proliferation of alloreactive T-cells in primary in vitro MLR. In addition, re-exposure of methotrexate-treated cells to the same allostimulus, results in a selective inhibition of the alloreactive immune response while the responses to third party allostimuli and viral antigens are preserved. In conclusion, our results provide strong pre-clinical evidence that in vitro treatment with MTX, a practical FDA-approved agent, results in specific allodepletion and may have excellent potential as an effective approach for preventing or minimizing GvHD.
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Affiliation(s)
- Dorothy I. Mundy
- 1Hematology/Oncology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-8565,
| | - Atul Sathe
- 2Pathology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9072
| | - Sterling Ortega
- 2Pathology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9072
| | - Robert H. Collins
- 1Hematology/Oncology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-8565,
| | - Nitin J. Karandikar
- 2Pathology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9072
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Sathe A, Ortega SB, Mundy DI, Collins RH, Karandikar NJ. In vitro methotrexate as a practical approach to selective allodepletion. Biol Blood Marrow Transplant 2007; 13:644-54. [PMID: 17531774 DOI: 10.1016/j.bbmt.2007.01.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 01/03/2007] [Accepted: 01/21/2007] [Indexed: 01/24/2023]
Abstract
Graft-versus-host disease (GVHD) is a major cause of transplant-related morbidity and mortality in recipients of allogeneic hematopoietic stem cell transplantation. As GVHD is mediated predominantly by alloreactive donor T cells, selective allodepletion from the graft may alleviate GVHD, whereas potentially maintaining other advantages conferred by donor T cells, such as graft survival, antiviral immunity, and graft-versus-leukemia effect. In this study, we evaluated the ability of methotrexate, a clinically approved antimetabolite drug, to deplete alloreactive T cells in HLA-mismatched mixed lymphocyte reactions (MLR). We observed that methotrexate could inhibit the proliferation of alloreactive T cells in primary in vitro MLR. On reexposure of methotrexate-treated cells to the same allostimulus, a significant reduction in the alloreactive immune response was observed, whereas responses to third-party allostimuli and viral antigens were preserved. Thus, our results provide preclinical evidence that in vitro methotrexate treatment results in specific allodepletion and may be used as an effective agent for preventing GVHD.
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Affiliation(s)
- Atul Sathe
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9072, USA
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41
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Deeg HJ, O'Donnell M, Tolar J, Agarwal R, Harris RE, Feig SA, Territo MC, Collins RH, McSweeney PA, Copelan EA, Khan SP, Woolfrey A, Storer B. Optimization of conditioning for marrow transplantation from unrelated donors for patients with aplastic anemia after failure of immunosuppressive therapy. Blood 2006; 108:1485-91. [PMID: 16684959 PMCID: PMC1895515 DOI: 10.1182/blood-2006-03-005041] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 87 patients with aplastic anemia who failed to respond to immunosuppressive treatment, we determined the minimal dose of total body irradiation (TBI) required when added to antithymocyte globulin (ATG, 30 mg/kg x 3) plus cyclophosphamide (CY, 50 mg/kg x 4) to achieve engraftment of unrelated donor marrow. TBI was started at 3 x 200 cGy, to be escalated or deescalated in steps of 200 cGy depending on graft failure or toxicity. Patients were aged 1.3 to 53.5 years (median, 18.6 years). The interval from diagnosis to transplantation was 3 to 328 months (median, 14.6 months). Donors were HLA-A, -B, -C, -DR, and -DQ identical for 62 patients, and nonidentical for 1 to 3 HLA loci at the antigen or allele level for 25. The dose-limiting toxicity was diffuse pulmonary injury. The optimum TBI dose was 1 x 200 cGy. Nine patients did not tolerate ATG and were prepared with CY + TBI. Graft failure occurred in 5% of patients. With a median follow-up of 7 years, 38 (61%) of 62 HLA-identical, and 10 (40%) of 25 HLA-nonidentical transplant recipients are surviving. The highest survival rate with HLA-identical transplants was observed at 200 cGy TBI. Thus, low-dose TBI + CY + ATG conditioning resulted in excellent outcome of unrelated transplants in patients with aplastic anemia who had received multiple transfusions.
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Affiliation(s)
- H Joachim Deeg
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Mail Stop D1-100, PO Box 19024, Seattle, WA 98109-1024, USA.
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Abstract
Numerous lines of preclinical and clinical evidence support the existence of a graft-versus-leukemia effect, but less evidence supporting a comparable graft-versus-lymphoma effect exists. We review here current clinical data addressing the graft-versus-lymphoma effect, including comparisons of autologous, syngeneic, and allogeneic transplantation; responses to immunomodulation; and responses to nonmyeloablative stem cell transplantation. Despite several limitations of the data, we believe that there is sufficient evidence suggesting a significant graft-versus-lymphoma effect. In addition, we discuss approaches for clinical management of lymphoma patients, opportunities for mechanistic studies afforded by donor leukocyte infusions and nonmyeloablative transplantation, and suggestions for clinical studies to further define the magnitude and applicability of the graft-versus-lymphoma effect.
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Affiliation(s)
- B W Butcher
- Department of Internal Medicine, Hematopoietic Cell Transplantation Program, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Butcher BW, Wilson KS, Kroft SH, Collins RH, Bhushan V. Acute leukemia with B-lymphoid and myeloid differentiation associated with an inv(5)(q13q33) in an adult patient. ACTA ACUST UNITED AC 2005; 157:62-6. [PMID: 15676149 DOI: 10.1016/j.cancergencyto.2004.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 02/27/2004] [Revised: 05/03/2004] [Accepted: 05/11/2004] [Indexed: 12/21/2022]
Abstract
A paracentric inversion in the long arm of chromosome 5, inv(5)(q13q33), was found as a clonal abnormality in a patient with a treatment-resistant biphenotypic acute leukemia with B-lymphoid and myeloid differentiation. This cytogenetic aberration has not been reported previously in biphenotypic acute leukemia, although rearrangements of chromosome bands q13 and q33 have been implicated in the development of several hematologic malignancies. The presence of this aberration as the sole chromosomal abnormality suggests an important role in the pathogenesis of biphenotypic acute leukemia.
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Affiliation(s)
- Brad W Butcher
- Hematopoietic Cell Transplantation Program, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75235-7320, USA.
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Michálek J, Collins RH, Vitetta ES. Clinical-scale selective depletion of alloreactive T cells using an anti-CD25 immunotoxin. Neoplasma 2003; 50:296-9. [PMID: 12937844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation is the treatment of choice for many hematological malignancies. Its efficacy is limited by graft-versus-host disease (GVHD), the leading cause of post-transplant morbidity and mortality. GVHD is mediated by a subpopulation of T cells in the stem cell graft. Ex vivo T cell depletion of all T cells of the graft can prevent development of GVHD but can lead to a delay in immune reconstitution and an increase of potentially lethal opportunistic infections and leukemic relapses. Hypothetically, an approach that enables a selective depletion of the alloreactive donor T cells that cause GVHD while preserving third party (anti-leukemic and anti-microbial) reactivity would be optimal for recipients of HSCT. Our preliminary data demonstrated that an anti-CD25 immunotoxin, which reacts with a cell surface activation antigen, can selectively deplete alloreactive donor T cells activated by non-leukemic recipient white blood cells while preserving the beneficial third-party reactivity in vitro. In this report we describe a method for clinical-scale ex vivo selective depletion of alloreactive donor T cells using the anti-CD25 immunotoxin, RFT5-SMPT-dgRTA. Two logs of alloreactive T cells could be selectively depleted while preserving third party reactivity. This method was reproducible in 10 pre-clinical experiments with 8 HLA-mismatched healthy volunteer pairs and 2 HLA-matched sibling donor/patient pairs.
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Affiliation(s)
- J Michálek
- Cancer Immunobiology Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA.
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Affiliation(s)
- Vikas Bhushan
- Hematopoietic Cell Transplantation Program, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-8852, USA
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Abstract
Allogeneic haemopoietic stem cell transplantation can be complicated by acute graft-versus-host disease (GVHD). If the alloreactive T-cell clones responsible for this disorder could be identified before stem cell transplantation, they could be quantitatively monitored afterwards to allow initiation of immunosuppression before GVHD becomes apparent. We identified an alloreactive CD4+ T-cell clone from a donor before stem cell transplantation, and then monitored its frequency in the recipient's peripheral blood after transplantation by use of clonotypic quantitative real-time PCR. Greatly increased concentrations of this clone (nearly 100% of circulating CD4+ T cells) preceded and closely correlated with the onset of clinical GVHD, suggesting that a sole alloreactive T-cell clone was responsible for initiation of this disease in vivo. This simple identification and monitoring of potentially GVHD-causing clones can be undertaken before stem cell transplantation with no previous knowledge of the alloantigen responsible, and could allow earlier diagnosis and intervention in GVHD.
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Affiliation(s)
- Jaroslav Michálek
- Cancer Immunobiology Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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47
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Michalek J, Collins RH, Durrani HP, Vaclavkova P, Ruff LE, Douek DC, Vitetta ES. Definitive separation of graft-versus-leukemia- and graft-versus-host-specific CD4+ T cells by virtue of their receptor beta loci sequences. Proc Natl Acad Sci U S A 2003; 100:1180-4. [PMID: 12531922 PMCID: PMC298747 DOI: 10.1073/pnas.0337543100] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2002] [Indexed: 11/18/2022] Open
Abstract
Although graft-versus-host (GVH) disease (GVHD) is usually associated with graft versus leukemia (GVL), GVL can occur in the absence of clinical GVHD. There is evidence to suggest that GVL and GVH are mediated by different clones of T cells. The objective of this study was to identify the two types of T cells based on their receptor sequences. To this end we used irradiated nonleukemic cells from recipients as stimulator cells in a primary mixed leukocyte reaction (MLR). The activated CD4(+) donor T cells that expressed CD25 were purified by cell sorting. To prepare GVL-specific T cells, alloreactive T cells in the primary MLR were first depleted with an anti-CD25 immunotoxin. The remaining T cells had negligible alloreactivity in a secondary MLR. The allodepleted cells were then stimulated by using purified leukemia cells from the same individual as stimulator cells, and the CD25(+)-activated cells were purified by cell sorting. The GVL- and GVH-specific T cells were analyzed for their T cell receptor (TCR) clonality by using anchored RT-PCR of all the TCRbeta locus complementarity-determining region 3 (CDR3) sequences. By comparing TCRbeta CDR3 sequences from transformed bacterial colonies, we were able to demonstrate that T cells mediating GVH were different from those mediating GVL in each of the eight HLA-mismatched and one HLA-matched donor/recipient pairs. By using the appropriate TCRbeta CDR3-specific primers and probes, the GVH- and GVL-specific clones were monitored in a recipient undergoing an allogeneic stem cell transplant from her HLA-matched related donor.
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Affiliation(s)
- J Michalek
- Cancer Immunobiology Center and Bone Marrow Transplant Program, Department of Internal Medicine, University of Texas Southwestern Medical Center, 6000 Harry Hines Boulevard, Dallas, TX 75390, USA
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48
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Aquino VM, Douek DC, Berryman B, Johnson M, Jain VK, Collins RH. Evaluation of thymic output by measurement of T-cell-receptor gene rearrangement excisional circles (TREC) in patients who have received fludarabine. Leuk Lymphoma 2003; 44:343-8. [PMID: 12688355 DOI: 10.1080/1042819021000029696] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The role of the thymus in immune reconstitution in adults receiving chemotherapy is controversial. Detection of T-cell-receptor gene rearrangement excisional circles (TREC) in peripheral blood T cells has been shown to estimate thymic output. Therefore, we measured TREC levels to assess the contribution of the thymus to immune recovery following treatment with fludarabine. Patients who had received fludarabine alone or a fludarabine containing regimen were identified. Cryopreserved peripheral-blood mononuclear cells were obtained and analyzed by four-color flow cytometry utilizing fluorochrome-conjugated antibodies against CD4, CD8, CD45RO and CD27. Proportions of naïve T cells in each CD4+ and CD8+ subset were measured by gating on CD45RO-negative, CD27+ cells. Quantification of TREC in sorted naïve CD4+ and CD8+ T cells was performed by real-time PCR. Thirteen patients received a mean of 3.8 +/- 0.4 courses of fludarabine and samples were obtained at a average of 18.8 (range 3.6-40.3) months after completing chemotherapy. Ten (77%) had detectable TREC levels. There was a positive correlation (Spearman's rank correlation) between the degree of TREC expression and the percentage of naïve T cells (r = 0.6, p = 0.03), naïve CD4+ (r = 0.6, p = 0.03) and naïve CD8+ (r = 0.66, p = 0.01) cells. We conclude that increased thymic output as demonstrated by an increase in TREC levels correlated with, and was predictive ofincreased numbers of naive T cell following fludarabine administration. The thymus appears to play a role in immune recovery in adults after receiving chemotherapy.
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Affiliation(s)
- Victor M Aquino
- Department of Pediatrics, the University of Texas Southwestern Medical Center of Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA.
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Xu Y, McKenna RW, Hoang MP, Collins RH, Kroft SH. Composite angioimmunoblastic T-cell lymphoma and diffuse large B-cell lymphoma: a case report and review of the literature. Am J Clin Pathol 2002; 118:848-54. [PMID: 12472277 DOI: 10.1309/vd2d-98me-mb3f-wh34] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We report a rare case of composite angioimmunoblastic T-cell lymphoma (AILT) and diffuse large B-cell lymphoma occurring in a 48-year-old woman with generalized lymphadenopathy and hepatosplenomegaly. The patient initially sought care at a local hospital with a single enlarged left cervical lymph node. Histologic examination of the node was interpreted as an atypical immunoblastic proliferation. She developed generalized lymphadenopathy 10 months later and was referred to our institution for further evaluation. The recent biopsy of the cervical node showed typical features of AILT Flow cytometric immunophenotyping identified an aberrant CD4+ T-cell population that lacked surface CD3. Polymerase chain reaction analysis of the T-cell receptor gamma gene revealed a clonal rearrangement. In addition to the AILT, the lymph node showed partial involvement by a diffuse large B-cell lymphoma. The B lymphoma cells and admixed immnunoblasts and Reed-Sternberg-like B cells in the AILT were positive for Epstein-Barr virus (EBV) by in situ hybridization. Ourfindings raise the possibility that the EBV-associated large B-cell lymphoma is a secondary event in AILT via EBV infection or reactivation followed by clonal expansion of an immortalized EBV-infected B cell clone.
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MESH Headings
- Epstein-Barr Virus Infections/genetics
- Epstein-Barr Virus Infections/pathology
- Female
- Flow Cytometry
- Genes, Immunoglobulin
- Genes, T-Cell Receptor gamma
- Herpesvirus 4, Human/genetics
- Humans
- Immunophenotyping
- In Situ Hybridization
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/virology
- Middle Aged
- Polymerase Chain Reaction
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Affiliation(s)
- Yin Xu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75390-9073, USA
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Levine JE, Braun T, Penza SL, Beatty P, Cornetta K, Martino R, Drobyski WR, Barrett AJ, Porter DL, Giralt S, Leis J, Holmes HE, Johnson M, Horowitz M, Collins RH. Prospective trial of chemotherapy and donor leukocyte infusions for relapse of advanced myeloid malignancies after allogeneic stem-cell transplantation. J Clin Oncol 2002; 20:405-12. [PMID: 11786567 DOI: 10.1200/jco.2002.20.2.405] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with advanced myeloid malignancies who experience relapse after allogeneic bone marrow transplantation (BMT) have a poor prognosis. Long-term survival after chemotherapy alone, second myeloablative transplant, or donor leukocyte infusions (DLIs) alone is unusual. DLIs may have minimal effectiveness in advanced disease because adequate cellular responses are not able to develop in the presence of bulky, fast-growing disease. A chemotherapy strategy was used to debulk disease before administration of granulocyte colony-stimulating factor (G-CSF)-primed DLIs. PATIENTS AND METHODS Sixty-five patients experiencing hematologic relapse of myeloid malignancy after HLA-matched sibling BMT were prospectively treated with cytarabine-based chemotherapy, then G-CSF-primed DLIs. No prophylactic immunosuppression was provided. RESULTS Twenty-seven of 57 assessable patients experienced a complete response. Graft-versus-host disease (GVHD) was observed in 56% of the patients. Treatment-related mortality was 23%. Overall survival at 2 years for the entire cohort was 19%. Patients with a complete response were more likely to survive, with 1- and 2-year survival rates of 51% and 41%, respectively, with a median follow-up of more than 2 years. The 1-year survival for nonresponders was 5%. A posttransplant remission lasting more than 6 months before relapse was associated with a higher likelihood of response. GVHD was not required for durable remission. CONCLUSION Salvage treatment with chemotherapy before DLI can help some patients with advanced myeloid relapse and is not dependent on GVHD. Patients with short remissions after BMT are unlikely to benefit from this approach, and the approach is associated with significant treatment-related mortality. Modifications of this approach or entirely different approaches will be required for most patients with this difficult clinical problem.
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