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Telfer P, Anie KA, Kotsiopoulou S, Aiken L, Hibbs S, Burt C, Stuart-Smith S, Lugthart S. The acute pain crisis in sickle cell disease: What can be done to improve outcomes? Blood Rev 2024; 65:101194. [PMID: 38553339 DOI: 10.1016/j.blre.2024.101194] [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: 12/04/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/21/2024]
Abstract
The acute pain crisis (APC) is the commonest complication of sickle cell disease (SCD). Severe episodes may require treatment in hospital with strong opioid analgesic drugs, combined with additional supportive care measures. Guidelines for APC management have been produced over the past two decades gathering evidence from published studies, expert opinion, and patient perspective. Unfortunately, reports from multiple sources indicate that guidelines are often not followed, and that acute care in emergency departments and on acute medical wards is suboptimal. It is important to understand what leads to this breakdown in health care, and to identify evidence-based interventions which could be implemented to improve care. This review focuses on recently published articles as well as information about on-going clinical trials. Aspects of care which could potentially make a difference to patient experience include availability and accessibility of individual care plans agreed between patient and treating specialist, innovative means of delivering initial opioids to reduce time to first analgesia, and availability of a specialist unit away from the ED, where expert care can be delivered in a more compassionate environment. The current evidence of improved outcomes and health economic advantage with these interventions is inadequate, and this is hampering their implementation into health care systems.
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Affiliation(s)
- Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, UK; Department of Haematology, Royal London Hospital, Bart's Health NHS Trust, London, UK.
| | - Kofi A Anie
- Brent Sickle Cell & Thalassaemia Centre, London North West University Healthcare NHS Trust, London, UK
| | | | - Laura Aiken
- Department of Haematology, Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Stephen Hibbs
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | - Sanne Lugthart
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, UK; Department of Haematology, University Hospitals of Bristol, Bristol, UK
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2
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Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, Gonzalez Arias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG. Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK. Br J Haematol 2024. [PMID: 38594876 DOI: 10.1111/bjh.19453] [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: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - S Chaganti
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - S Lugthart
- University Hospitals Bristol and Weston, Bristol, UK
| | - W Osborne
- Freeman Hospital, Newcastle, UK
- Newcastle University, Newcastle, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | | | - A Latif
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - D Springell
- University College London Hospitals, London, UK
| | - J L Brady
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Illidge
- Cancer Sciences, University of Manchester Christie NHS Trust, Manchester NIHR BRC, Manchester, UK
| | - A Stevens
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - L Hawley
- University Hospitals Bristol and Weston, Bristol, UK
| | - N O'Rourke
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Bedi
- Western General Hospital, Edinburgh, UK
| | | | - J Frew
- Freeman Hospital, Newcastle, UK
| | - D Burns
- Queen Elizabeth Hospital, Birmingham, UK
| | - M O'Reilly
- University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | | | - N G Mikhaeel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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3
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Bourlon C, Roddie C, Menne T, Norman J, O'Reilly M, Gibb A, Besley C, Chaganti S, Arias CG, Jones C, Dikair A, Allen S, Seymour F, Osborne W, Mathew A, Townsend W, Patten PE, Thoulouli E, Abdulgawad A, Lugthart S, Sanderson R, Kirkwood AA, Kuhnl A. Outcomes after chimeric antigen receptor T-cell therapy across large B-cell lymphoma subtypes. Haematologica 2024. [PMID: 38572567 DOI: 10.3324/haematol.2024.285010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Indexed: 04/05/2024] Open
Abstract
Not available.
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Affiliation(s)
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, UK; UCL Cancer Institute, University College London, London
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle University, Newcastle
| | - Jane Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London
| | - Adam Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester
| | - Caroline Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol
| | | | | | - Ceri Jones
- Department of Haematology. University Hospital of Wales, Cardiff
| | - Abdalla Dikair
- Department of Haematology, Queen Elizabeth Hospital, Glasgow
| | - Sharon Allen
- Department of Haematology, Cambridge University Hospitals, Cambridge
| | | | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle University, Newcastle
| | - Amrith Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham
| | - William Townsend
- Department of Haematology, University College London Hospitals, London
| | - Piers Em Patten
- Department of Haematology, King's College Hospital, London, UK; Comprehensive Cancer Centre, King's College London, London
| | - Eleni Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester
| | | | - Sanne Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol
| | | | - Amy A Kirkwood
- CR UK and UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London.
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4
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Boyle S, Roddie C, O'Reilly M, Menne T, Norman J, Gibb A, Lugthart S, Chaganti S, Gonzalez Arias C, Jones C, Latif A, Uttenthal BJ, Seymour F, Osborne W, Springell D, Hardefeldt P, Yallop D, Thoulouli E, Bloor A, Besley C, Mathew A, Burns D, Cwynarski K, Sanderson R, Kuhnl A. Improved outcomes of large B-cell lymphoma patients treated with CD19 CAR T in the UK over time. Br J Haematol 2024; 204:507-513. [PMID: 37848384 DOI: 10.1111/bjh.19157] [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: 07/08/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
The success of CD19 Chimeric antigen receptor (CAR) T-cell therapy in large B-cell lymphoma (LBCL) has been partially offset by toxicity and logistical challenges, which off-the-shelf agents like CD20xCD3 bispecific antibodies might potentially overcome. However, when using CAR T outcomes as the 'standard-of-care comparator̕ for relapsed/refractory (r/r) LBCL, a potential learning curve with implementing a novel, complex therapy like CAR T needs to be considered. To address this, we analysed 726 UK patients intended to be treated with CD19 CAR T for r/r LBCL and compared outcomes between the first year of the national CAR T programme (Era 1; 2019) and the more recent treatment era (Era 2; 2020-2022). We identified significant improvements for Era 2 versus Era 1 in dropout rate (17% vs. 27%, p = 0.001), progression-free survival (1-year PFS 50% vs. 32%, p < 0.001) and overall survival (1-year OS 60% vs. 40%, p < 0.001). We also observed increased use of bridging therapy, improvement in bridging outcomes, more tocilizumab/corticosteroid use, reduced high-grade cytokine release syndrome (4% vs. 9%, p = 0.01) and intensive care unit admissions (20% vs. 32%, p = 0.001). Our results demonstrate significant improvement in CAR T outcomes over time, highlighting the importance of using up-to-date clinical data when comparing CAR T against new treatment options for r/r LBCL.
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Affiliation(s)
- S Boyle
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
| | - M O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - S Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | - B J Uttenthal
- Department of Haematology, Cambridge University Hospitals, Cambridge, UK
| | - F Seymour
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - D Springell
- Department of Haematology, University College London Hospitals, London, UK
| | - P Hardefeldt
- Department of Haematology, King's College Hospital, London, UK
| | - D Yallop
- Department of Haematology, King's College Hospital, London, UK
| | - E Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - A Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - D Burns
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - K Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
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5
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Lugthart S, Ginete C, Kuona P, Brito M, Inusa BPD. An update review of new therapies in sickle cell disease: the prospects for drug combinations. Expert Opin Pharmacother 2024; 25:157-170. [PMID: 38344818 DOI: 10.1080/14656566.2024.2317336] [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: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited disorder characterised by polymerisation of deoxygenated haemoglobin S and microvascular obstruction. The cardinal feature is generalised pain referred to as vaso-occlusive crises (VOC), multi-organ damage and premature death. SCD is the most prevalent inherited life-threatening disorders in the world and over 85% of world's 400,000 annual births occur low-and-middle-income countries. Hydroxyurea remained the only approved disease modifying therapy (1998) until the FDA approved L-glutamine (2017), Crizanlizumab and Voxelotor (2019) and gene therapies (Exa-cel and Lovo-cel, 2023). AREAS COVERED Clinical trials performed in the last 10 years (November 2013 - November 2023) were selected for the review. They were divided according to the mechanisms of drug action. The following pubmed central search terms [sickle cell disease] or [sickle cell anaemia] Hydroxycarbamide/ Hydroxyurea, L-Glutamine, Voxelotor, Crizanlizumab, Mitapivat, Etavopivat, gene therapy, haematopoietic stem cell transplantation, and combination therapy. EXPERT OPINION We recommend future trials of combination therapies for specific complications such as VOCs, chronic pain and renal impairment as well as personalised medicine approach based on phenotype and patient characteristics. Following recent approval of gene therapy for SCD, the challenge is addressing the role of shared decision-making with families, global access and affordability.
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Affiliation(s)
- Sanne Lugthart
- Haematology department, University Hospitals of Bristol and Weston Foundation Trust, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Catarina Ginete
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Patience Kuona
- Child, Adolescent and Women's Health Department, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Miguel Brito
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Baba Psalm Duniya Inusa
- Paediatric Haematology, Evelina London, Guy's and St Thomas NHS Foundation Trust, London
- Women's and Children Academic health, Life Sciences and Medicine, King's College London, London
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6
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Kuhnl A, Roddie C, Kirkwood AA, Tholouli E, Menne T, Patel A, Besley C, Chaganti S, Sanderson R, O'Reilly M, Norman J, Osborne W, Bloor A, Lugthart S, Malladi R, Patten PEM, Neill L, Martinez-Cibrian N, Kennedy H, Phillips EH, Jones C, Sharplin K, El-Sharkawi D, Latif AL, Mathew A, Uttenthal B, Stewart O, Marzolini MAV, Townsend W, Cwynarski K, Ardeshna K, Ardavan A, Robinson K, Pagliuca A, Collins GP, Johnson R, McMillan A. A national service for delivering CD19 CAR-Tin large B-cell lymphoma - The UK real-world experience. Br J Haematol 2022; 198:492-502. [PMID: 35485402 DOI: 10.1111/bjh.18209] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 01/25/2022] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 01/01/2023]
Abstract
CD19 CAR-T have emerged as a new standard treatment for relapsed/refractory (r/r) large B-cell lymphoma (LBCL). CAR-T real-world (RW) outcomes published to date suggest significant variability across countries. We provide results of a large national cohort of patients intended to be treated with CAR-T in the UK. Consecutive patients with r/r LBCL approved for CAR-T by the National CAR-T Clinical Panel between December 2018 and November 2020 across all UK CAR-T centres were included. 404/432 patients were approved [292 axicabtagene ciloleucel (axi-cel), 112 tisagenlecleucel (tisa-cel)], 300 (74%) received the cells. 110/300 (38.3%) patients achieved complete remission (CR) at 6 months (m). The overall response rate was 77% (52% CR) for axi-cel, 57% (44% CR) for tisa-cel. The 12-month progression-free survival was 41.8% (axi-cel) and 27.4% (tisa-cel). Median overall survival for the intention-to-treat population was 10.5 m, 16.2 m for infused patients. The incidence of grade ≥3 cytokine release syndrome and neurotoxicity were 7.6%/19.6% for axi-cel and 7.9%/3.9% for tisa-cel. This prospective RW population of CAR-T eligible patients offers important insights into the clinical benefit of CD19 CAR-T in LBCL in daily practice. Our results confirm long-term efficacy in patients receiving treatment similar to the pivotal trials, but highlight the significance of early CAR-T failure.
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Affiliation(s)
- Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Amit Patel
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - Caroline Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Robin Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
| | - Jane Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Adrian Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - Sanne Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - Ram Malladi
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK.,Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - Piers E M Patten
- Department of Haematology, King's College Hospital, London, UK.,Comprehensive Cancer Centre, King's College London, London, UK
| | - Lorna Neill
- Department of Haematology, University College London Hospitals, London, UK
| | | | - Hannah Kennedy
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Elizabeth H Phillips
- Department of Medical Oncology, The Christie Hospital, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ceri Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Kirsty Sharplin
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | | | | | - Amrith Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Orla Stewart
- Department of Haematology, King's College Hospital, London, UK
| | | | - William Townsend
- Department of Haematology, University College London Hospitals, London, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospitals, London, UK
| | - Arzhang Ardavan
- NCRI Consumer Forum, London, UK.,Department of Physics, University of Oxford, UK
| | | | | | - Graham P Collins
- Department of Haematology, Oxford University Hospital, Oxford, UK
| | | | - Andrew McMillan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK
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7
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Vora SM, Boyd S, Denny N, Jackson E, Roy NBA, Howard J, Lugthart S. Expanded eligibility for emerging therapies in sickle cell disease in the UK - crizanlizumab and voxelotor. Br J Haematol 2022; 197:502-504. [PMID: 35189668 DOI: 10.1111/bjh.18059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sona M Vora
- Haematology Department, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Stephen Boyd
- Department of Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Nicholas Denny
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Noemi B A Roy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jo Howard
- Department of Haematology, Guy 's and St Thomas' NHS Foundation Trust, London, UK.,Department of Haematology, King's College London, London, UK
| | - Sanne Lugthart
- Haematology Department, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK.,School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
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8
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Johansson U, Gallagher K, Burgoyne V, Maus MV, Casey KS, Brini GG, Frigault MJ, Yam JY, Chavda N, Besley C, Lugthart S. Detection of CAR-T19 cells in peripheral blood and cerebrospinal fluid: An assay applicable to routine diagnostic laboratories. Cytometry B Clin Cytom 2021; 100:622-631. [PMID: 33915021 DOI: 10.1002/cyto.b.22005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/14/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chimeric antigen receptor-modified T-cells targeting CD19 (CAR-T19) are licensed for treating relapsed/refractory diffuse large B-cell lymphoma and B-acute lymphoblastic leukemia. Predicting treatment responses and toxicity (e.g., cytokine release syndrome and neurotoxicity) remains a big challenge. CAR-T19 monitoring could increase our understanding of treatment responses and be of relevance to patient management. A robust method for accurate CAR-T19 detection is therefore extremely desirable. METHODS An assay that uses fluorochrome-conjugated human recombinant soluble CD19 was tested against two commercially available CAR-T19 therapies and a CAR-T19 cell line developed in-house. Precision, concordance, and analyte stability were tested using peripheral blood obtained from CAR-T19-treated patients and controls. RESULTS The assay showed good accuracy, and had a limit of blank for whole blood samples of 0.13%. Reproducibility and inter-operator concordance were satisfactory (CVs <15%). The assay distinguished CAR-T19 from reactive T-cells in cerebrospinal fluid (CSF) from patients with suspected immune effector cell-associated neurotoxicity syndrome (ICANS), and was adapted to study memory T-cell compartments in treated patients. CONCLUSION The assay enabled routine monitoring of CAR-T19 in blood and CSF samples. Despite profound cytopenia in many lymphoma patients, results were obtained regularly from only 4 ml of blood. The assay can be adapted easily to characterize the memory and exhaustion status of CAR-T19 and native T-cells. Importantly, it does not rely on CAR construct specificity; thus, it can be used to detect any CD19-targeted CAR cell. Finally, our validation process can serve as a blueprint for other fluorochrome proteins used to detect CAR cells.
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Affiliation(s)
- Ulrika Johansson
- SI-HMDS, University Hospitals and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Kathleen Gallagher
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Victoria Burgoyne
- SI-HMDS, University Hospitals and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Marcela V Maus
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Keagan S Casey
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Gabrielle G Brini
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Matthew J Frigault
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jennifer Y Yam
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Nikesh Chavda
- Department of Haematology, University Hospitals and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Caroline Besley
- Department of Haematology, University Hospitals and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Sanne Lugthart
- Department of Haematology, University Hospitals and Weston NHS Foundation Trust, Bristol, United Kingdom
- Department of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
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9
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Telfer P, De la Fuente J, Sohal M, Brown R, Eleftheriou P, Roy N, Piel FB, Chakravorty S, Gardner K, Velangi M, Drasar E, Shah F, Porter JB, Trompeter S, Atoyebi W, Szydlo R, Anie KA, Ryan K, Sharif J, Wright J, Astwood E, Nicolle CS, Webster A, Roberts DJ, Lugthart S, Kaya B, Awogbade M, Rees DC, Hollingsworth R, Inusa B, Howard J, Layton DM. Real-time national survey of COVID-19 in hemoglobinopathy and rare inherited anemia patients. Haematologica 2020; 105:2651-2654. [PMID: 33054122 PMCID: PMC7604629 DOI: 10.3324/haematol.2020.259440] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Josu De la Fuente
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London
| | - Mamta Sohal
- Imperial College Healthcare NHS Trust, London
| | - Ralph Brown
- Imperial College Healthcare NHS Trust, London
| | | | - Noémi Roy
- John Radcliffe Hospital, Oxford, UK; NIHR Biomedical Research Centre, Oxford
| | - Frédéric B Piel
- School of Public Health, Faculty of Medicine, Imperial College London, London
| | | | - Kate Gardner
- Guy's and St Thomas' NHS Foundation Trust, London
| | | | - Emma Drasar
- University College London Hospitals NHS Foundation Trust, London, UK; Whittington Health NHS Trust, London
| | - Farrukh Shah
- University College London Hospitals NHS Foundation Trust, London, UK; Whittington Health NHS Trust, London
| | - John B Porter
- University College London Hospitals NHS Foundation Trust, London
| | - Sara Trompeter
- University College London Hospitals NHS Foundation Trust, London, UK; NHS Blood and Transplant, London
| | | | | | - Kofi A Anie
- London North West University Healthcare NHS Trust, London
| | - Kate Ryan
- Manchester University NHS Foundation Trust, Manchester
| | - Joseph Sharif
- Manchester University NHS Foundation Trust, Manchester
| | | | | | - C Sarah Nicolle
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Amy Webster
- University Hospitals of Leicester, Leicester
| | - David J Roberts
- John Radcliffe Hospital, Oxford, UK; NIHR Biomedical Research Centre, Oxford, UK; NHS Blood and Transplant, Oxford
| | | | | | - Moji Awogbade
- King's College Hospital NHS Foundation Trust, London
| | - David C Rees
- King's College Hospital NHS Foundation Trust, London
| | | | - Baba Inusa
- Guy's and St Thomas' NHS Foundation Trust, London
| | - Jo Howard
- Guy's and St Thomas' NHS Foundation Trust, London
| | - D Mark Layton
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London.
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10
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Roy NBA, Telfer P, Eleftheriou P, de la Fuente J, Drasar E, Shah F, Roberts D, Atoyebi W, Trompeter S, Layton DM, Lugthart S, Stuart-Smith S, Chakravorty S, Wright J, Porter J, Inusa B, Howard J. Protecting vulnerable patients with inherited anaemias from unnecessary death during the COVID-19 pandemic. Br J Haematol 2020; 189:635-639. [PMID: 32330288 PMCID: PMC7264776 DOI: 10.1111/bjh.16687] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
With the developing COVID‐19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self‐isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life‐saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID‐19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID‐19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID‐19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.
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Affiliation(s)
- Noémi B A Roy
- John Radcliffe Hospital, Oxford, UK.,NIHR Biomedical Research Centre, Oxford, UK
| | | | | | - Josu de la Fuente
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Emma Drasar
- University College London Hospital, London, UK.,Whittigton Health NHS Trust, London, UK
| | - Farrukh Shah
- University College London Hospital, London, UK.,Whittigton Health NHS Trust, London, UK
| | | | | | - Sara Trompeter
- NHS Blood and Transplant, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | | | - John Porter
- University College London Hospital, London, UK
| | - Baba Inusa
- Guys and St Thomas's NHS Trust, London, UK
| | - Jo Howard
- Guys and St Thomas's NHS Trust, London, UK
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11
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Newhall DA, Oliver R, Lugthart S. Anaemia: A disease or symptom. Neth J Med 2020; 78:104-110. [PMID: 32332184] [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: 06/11/2023]
Abstract
Anaemia is a common diagnosis for clinicians. This mini-review summarises criteria for diagnosing the cause of anaemia. Within the microcytic anaemias, iron-deficient anaemia is most common. In addition, we would like to raise awareness of thalassaemia as a differential diagnosis. A normocytic anaemia, such as anaemia of chronic disease, is a diagnosis of exclusion. A macrocytic anaemia scheme is provided and differentiates based on reticulocyte count. We aim to provide the readers a clear overview of anaemia and when to refer to haematologists.
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Affiliation(s)
- D A Newhall
- Anaesthesia Department, North Bristol Trust, Bristol, United Kingdom
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12
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Lugthart S. The new Dutch antithrombotic management guideline Treating venous thrombosis with direct oral anticoagulants for a lifetime? Neth J Med 2017; 75:48-49. [PMID: 28276327] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- S Lugthart
- Department of Hematology, Erasmus MC, Rotterdam, the Netherlands
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13
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Lugthart S, Leebeek FW. Direct oral anticoagulants: to switch or not to switch? Neth J Med 2015; 73:359-361. [PMID: 26478544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Lugthart
- Department of Haematology, Erasmus MC University Hospital, Rotterdam, the Netherlands
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14
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Lugthart S. Up close and personal with low-molecular-weight heparins (LMWHs). Neth J Med 2015; 73:261-262. [PMID: 26228189] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- S Lugthart
- Department of Haematology, Erasmus MC, Rotterdam, the Netherlands
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15
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Lugthart S, Figueroa ME, Bindels E, Skrabanek L, Valk PJM, Li Y, Meyer S, Erpelinck-Verschueren C, Greally J, Löwenberg B, Melnick A, Delwel R. Aberrant DNA hypermethylation signature in acute myeloid leukemia directed by EVI1. Blood 2011; 117:234-41. [PMID: 20855866 PMCID: PMC3037746 DOI: 10.1182/blood-2010-04-281337] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [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: 04/21/2010] [Accepted: 08/31/2010] [Indexed: 12/20/2022] Open
Abstract
DNA methylation patterns are frequently dysregulated in cancer, although little is known of the mechanisms through which specific gene sets become aberrantly methylated. The ecotropic viral integration site 1 (EVI1) locus encodes a DNA binding zinc-finger transcription factor that is aberrantly expressed in a subset of acute myeloid leukemia (AML) patients with poor outcome. We find that the promoter DNA methylation signature of EVI1 AML blast cells differs from those of normal CD34(+) bone marrow cells and other AMLs. This signature contained 294 differentially methylated genes, of which 238 (81%) were coordinately hypermethylated. An unbiased motif analysis revealed an overrepresentation of EVI1 binding sites among these aberrantly hypermethylated loci. EVI1 was capable of binding to these promoters in 2 different EVI1-expressing cell lines, whereas no binding was observed in an EVI1-negative cell line. Furthermore, EVI1 was observed to interact with DNA methyl transferases 3A and 3B. Among the EVI1 AML cases, 2 subgroups were recognized, of which 1 contained AMLs with many more methylated genes, which was associated with significantly higher levels of EVI1 than in the cases of the other subgroup. Our data point to a role for EVI1 in directing aberrant promoter DNA methylation patterning in EVI1 AMLs.
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Affiliation(s)
- Sanne Lugthart
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
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16
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Lugthart S, Gröschel S, Beverloo HB, Kayser S, Valk PJM, van Zelderen-Bhola SL, Jan Ossenkoppele G, Vellenga E, van den Berg-de Ruiter E, Schanz U, Verhoef G, Vandenberghe P, Ferrant A, Köhne CH, Pfreundschuh M, Horst HA, Koller E, von Lilienfeld-Toal M, Bentz M, Ganser A, Schlegelberger B, Jotterand M, Krauter J, Pabst T, Theobald M, Schlenk RF, Delwel R, Döhner K, Löwenberg B, Döhner H. Clinical, molecular, and prognostic significance of WHO type inv(3)(q21q26.2)/t(3;3)(q21;q26.2) and various other 3q abnormalities in acute myeloid leukemia. J Clin Oncol 2010; 28:3890-8. [PMID: 20660833 DOI: 10.1200/jco.2010.29.2771] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [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 Acute myeloid leukemia (AML) with inv(3)(q21q26.2)/t(3;3)(q21;q26.2) [inv(3)/t(3;3)] is recognized as a distinctive entity in the WHO classification. Risk assignment and clinical and genetic characterization of AML with chromosome 3q abnormalities other than inv(3)/t(3;3) remain largely unresolved. PATIENTS AND METHODS Cytogenetics, molecular genetics, therapy response, and outcome analysis were performed in 6,515 newly diagnosed adult AML patients. Patients were treated on Dutch-Belgian Hemato-Oncology Cooperative Group/Swiss Group for Clinical Cancer Research (HOVON/SAKK; n = 3,501) and German-Austrian Acute Myeloid Leukemia Study Group (AMLSG; n = 3,014) protocols. EVI1 and MDS1/EVI1 expression was determined by real-time quantitative polymerase chain reaction. RESULTS 3q abnormalities were detected in 4.4% of AML patients (288 of 6,515). Four distinct groups were defined: A: inv(3)/t(3;3), 32%; B: balanced t(3q26), 18%; C: balanced t(3q21), 7%; and D: other 3q abnormalities, 43%. Monosomy 7 was the most common additional aberration in groups (A), 66%; (B), 31%; and (D), 37%. N-RAS mutations and dissociate EVI1 versus MDS1/EVI1 overexpression were associated with inv(3)/t(3;3). Patients with inv(3)/t(3;3) and balanced t(3q21) at diagnosis presented with higher WBC and platelet counts. In multivariable analysis, only inv(3)/t(3;3), but not t(3q26) and t(3q21), predicted reduced relapse-free survival (hazard ratio [HR], 1.99; P < .001) and overall survival (HR, 1.4; P = .006). This adverse prognostic impact of inv(3)/t(3;3) was enhanced by additional monosomy 7. Group D 3q aberrant AML also had a poor outcome related to the coexistence of complex and/or monosomal karyotypes and cryptic inv(3)/t(3;3). CONCLUSION Various categories of 3q abnormalities in AML can be distinguished according to their clinical, hematologic, and genetic features. AML with inv(3)/t(3;3) represents a distinctive subgroup with unfavorable prognosis.
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Affiliation(s)
- Sanne Lugthart
- Erasmus University Medical Center, Rotterdam, The Netherlands
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17
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Gröschel S, Lugthart S, Schlenk RF, Valk PJ, Eiwen K, Goudswaard C, van Putten WJ, Kayser S, Verdonck LF, Lübbert M, Ossenkoppele GJ, Germing U, Schmidt-Wolf I, Schlegelberger B, Krauter J, Ganser A, Döhner H, Löwenberg B, Döhner K, Delwel R. HighEVI1Expression Predicts Outcome in Younger Adult Patients With Acute Myeloid Leukemia and Is Associated With Distinct Cytogenetic Abnormalities. J Clin Oncol 2010; 28:2101-7. [DOI: 10.1200/jco.2009.26.0646] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PurposeThe purpose of this study was to investigate frequency and prognostic significance of high EVI1 expression in acute myeloid leukemia (AML).Patients and MethodsA diagnostic assay detecting multiple EVI1 splice variants was developed to determine the relative EVI1 expression by single real-time quantitative polymerase chain reaction in 1,382 newly diagnosed adult patients with AML younger than 60 years. Patients were treated on four Dutch-Belgian HOVON (n = 458) and two German-Austrian AML Study Group protocols (n = 924).ResultsThe EVI1 assay was tested in the HOVON cohort and validated in the AMLSG cohort. High EVI1 levels (EVI1+) were found with similar frequencies in both cohorts combined, with a 10.7% incidence (148 of 1,382). EVI1+independently predicted low complete remission (CR) rate (odds ratio, 0.54; P = .002), adverse relapse-free survival (RFS; hazard ratio [HR], 1.32; P = .05), and event-free survival (EFS; HR, 1.46; P < .001). This adverse prognostic impact was more pronounced in the intermediate cytogenetic risk group (EFS; HR, 1.64; P < .001; and RFS; HR, 1.55; P = .02), and was also apparent in cytogenetically normal AML (EFS; HR, 1.67; P = .008). Besides inv(3)/t(3;3), EVI1+was significantly associated with chromosome abnormalities monosomy 7 and t(11q23), conferring prognostic impact within these two cytogenetic subsets. EVI1+was virtually absent in favorable-risk AML and AML with NPM1 mutations. Patients with EVI1+AML (n = 28) who received allogeneic stem cell transplantation in first CR had significantly better 5-year RFS (33% ± 10% v 0%).ConclusionEVI1 expression in AML is unequally distributed in cytogenetic subtypes. It predicts poor outcome, particularly among intermediate cytogenetic risk AML. Patients with EVI1+AML may benefit from allogeneic transplantation in first CR. Pretreatment EVI1 screening should be included in risk stratification.
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Affiliation(s)
- Stefan Gröschel
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Sanne Lugthart
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Richard F. Schlenk
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Peter J.M. Valk
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Karina Eiwen
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Chantal Goudswaard
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Wim J.L. van Putten
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Sabine Kayser
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Leo F. Verdonck
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Michael Lübbert
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Gert-Jan Ossenkoppele
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Ulrich Germing
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Ingo Schmidt-Wolf
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Brigitte Schlegelberger
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Jürgen Krauter
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Arnold Ganser
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Hartmut Döhner
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Bob Löwenberg
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Konstanze Döhner
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
| | - Ruud Delwel
- From the Internal Medicine III, University of Ulm, Ulm; University of Freiburg Medical Center, Freiburg; Universitätsklinik Düsseldorf, Düsseldorf; Medizinische Klinik und Poliklinik III, University of Bonn, Bonn; Departments of Cell and Molecular Pathology and Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Departments of Hematology and Trials and Statistics, Erasmus University Medical Center, Rotterdam; Haematology, University Medical Center,
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18
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Balgobind BV, Lugthart S, Hollink IH, Arentsen-Peters STJCM, van Wering ER, de Graaf SSN, Reinhardt D, Creutzig U, Kaspers GJL, de Bont ESJM, Stary J, Trka J, Zimmermann M, Beverloo HB, Pieters R, Delwel R, Zwaan CM, van den Heuvel-Eibrink MM. EVI1 overexpression in distinct subtypes of pediatric acute myeloid leukemia. Leukemia 2010; 24:942-9. [PMID: 20357826 DOI: 10.1038/leu.2010.47] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Overexpression of the ecotropic virus integration-1 (EVI1) gene (EVI1+), localized at chromosome 3q26, is associated with adverse outcome in adult acute myeloid leukemia (AML). In pediatric AML, 3q26 abnormalities are rare, and the role of EVI1 is unknown. We studied 228 pediatric AML samples for EVI1+ using gene expression profiling and RQ-PCR. EVI1+ was found in 20/213 (9%) of children with de novo AML, and in 4/8 with secondary AML. It was predominantly found in MLL-rearranged AML (13/47), monosomy 7 (2/3), or FAB M6/7 (6/10), and mutually exclusive with core-binding factor AML, t(15;17), and NPM1 mutations. Fluorescent in situ hybridization (FISH) was performed to detect cryptic 3q26 abnormalities. However, none of the EVI1+ patients harbored structural 3q26 alterations. Although significant differences in 4 years pEFS for EVI1+ and EVI1- pediatric AML were observed (28%+/-11 vs 44%+/-4, P=0.04), multivariate analysis did not identify EVI1+ as an independent prognostic factor. We conclude that EVI1+ can be found in approximately 10% of pediatric AML. Although EVI1+ was not an independent prognostic factor, it was predominantly found in subtypes of pediatric AML that are related with an intermediate to unfavorable prognosis. Further research should explain the role of EVI1+ in disease biology in these cases. Remarkably, no 3q26 abnormalities were identified in EVI1+ pediatric AML.
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Affiliation(s)
- B V Balgobind
- Department of Pediatric Oncology/Hematology, Erasmus MC--Sophia Children's Hospital, Rotterdam, The Netherlands
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19
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Figueroa ME, Lugthart S, Li Y, Erpelinck-Verschueren C, Deng X, Christos PJ, Schifano E, Booth J, van Putten W, Skrabanek L, Campagne F, Mazumdar M, Greally JM, Valk PJ, Löwenberg B, Delwel R, Melnick A. DNA methylation signatures identify biologically distinct subtypes in acute myeloid leukemia. Cancer Cell 2010; 17:13-27. [PMID: 20060365 PMCID: PMC3008568 DOI: 10.1016/j.ccr.2009.11.020] [Citation(s) in RCA: 611] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 10/25/2009] [Accepted: 11/23/2009] [Indexed: 01/11/2023]
Abstract
We hypothesized that DNA methylation distributes into specific patterns in cancer cells, which reflect critical biological differences. We therefore examined the methylation profiles of 344 patients with acute myeloid leukemia (AML). Clustering of these patients by methylation data segregated patients into 16 groups. Five of these groups defined new AML subtypes that shared no other known feature. In addition, DNA methylation profiles segregated patients with CEBPA aberrations from other subtypes of leukemia, defined four epigenetically distinct forms of AML with NPM1 mutations, and showed that established AML1-ETO, CBFb-MYH11, and PML-RARA leukemia entities are associated with specific methylation profiles. We report a 15 gene methylation classifier predictive of overall survival in an independent patient cohort (p < 0.001, adjusted for known covariates).
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Affiliation(s)
- Maria E. Figueroa
- Department of Medicine, Hematology Oncology Division, Weill Cornell Medical College, New York, NY 10065, USA
| | - Sanne Lugthart
- Department of Hematology, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Yushan Li
- Department of Medicine, Hematology Oncology Division, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Xutao Deng
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Paul J. Christos
- Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Elizabeth Schifano
- Biological Statistics and Computational Biology, Cornell University, Ithaca, NY 14853, USA
| | - James Booth
- Biological Statistics and Computational Biology, Cornell University, Ithaca, NY 14853, USA
| | - Wim van Putten
- Department of Trials and Statistics, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Lucy Skrabanek
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Fabien Campagne
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Madhu Mazumdar
- Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - John M. Greally
- Department of Genetics, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Peter J.M. Valk
- Department of Hematology, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Ruud Delwel
- Department of Hematology, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
- Correspondence: (R.D.), (A.M.)
| | - Ari Melnick
- Department of Medicine, Hematology Oncology Division, Weill Cornell Medical College, New York, NY 10065, USA
- Correspondence: (R.D.), (A.M.)
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20
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Verhaak RGW, Wouters BJ, Erpelinck CAJ, Abbas S, Beverloo HB, Lugthart S, Löwenberg B, Delwel R, Valk PJM. Prediction of molecular subtypes in acute myeloid leukemia based on gene expression profiling. Haematologica 2008; 94:131-4. [PMID: 18838472 DOI: 10.3324/haematol.13299] [Citation(s) in RCA: 258] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We examined the gene expression profiles of two independent cohorts of patients with acute myeloid leukemia [n=247 and n=214 (younger than or equal to 60 years)] to study the applicability of gene expression profiling as a single assay in prediction of acute myeloid leukemia-specific molecular subtypes. The favorable cytogenetic acute myeloid leukemia subtypes, i.e., acute myeloid leukemia with t(8;21), t(15;17) or inv(16), were predicted with maximum accuracy (positive and negative predictive value: 100%). Mutations in NPM1 and CEBPA were predicted less accurately (positive predictive value: 66% and 100%, and negative predictive value: 99% and 97% respectively). Various other characteristic molecular acute myeloid leukemia subtypes, i.e., mutant FLT3 and RAS, abnormalities involving 11q23, -5/5q-, -7/7q-, abnormalities involving 3q (abn3q) and t(9;22), could not be correctly predicted using gene expression profiling. In conclusion, gene expression profiling allows accurate prediction of certain acute myeloid leukemia subtypes, e.g. those characterized by expression of chimeric transcription factors. However, detection of mutations affecting signaling molecules and numerical abnormalities still requires alternative molecular methods.
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Affiliation(s)
- Roel G W Verhaak
- Erasmus University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands
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21
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Wouters BJ, Sanders MA, Lugthart S, Geertsma-Kleinekoort WMC, van Drunen E, Beverloo HB, Löwenberg B, Valk PJM, Delwel R. Segmental uniparental disomy as a recurrent mechanism for homozygous CEBPA mutations in acute myeloid leukemia. Leukemia 2007; 21:2382-4. [PMID: 17554374 DOI: 10.1038/sj.leu.2404795] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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22
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Abstract
Over the past four decades, treatment of acute leukemia in children has made remarkable progress, from this disease being lethal to now achieving cure rates of 80% for acute lymphoblastic leukemia and 45% for acute myeloid leukemia. This progress is largely owed to the optimization of existing treatment modalities rather than the discovery of new agents. However, the annual number of patients with leukemia who experience relapse after initial therapy remains greater than that of new cases of most childhood cancers. The aim of pharmacogenetics is to develop strategies to personalize medications and tailor treatment regimens to individual patients, with the goal of enhancing efficacy and safety through better understanding of the person's genetic makeup. In this review, we summarize recent pharmacogenomic studies related to the treatment of pediatric acute leukemia. These include work using candidate-gene approaches, as well as genome-wide studies using haplotype mapping and gene expression profiling. These strategies illustrate the promise of pharmacogenomics to further advance the treatment of human cancers, with childhood leukemia serving as a paradigm.
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Affiliation(s)
- Meyling H Cheok
- St. Jude Children's Research Hospital, Department of Pharmaceutical Sciences, Memphis, TN 38105, USA.
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23
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Lugthart S, Cheok MH, den Boer ML, Yang W, Holleman A, Cheng C, Pui CH, Relling MV, Janka-Schaub GE, Pieters R, Evans WE. Identification of genes associated with chemotherapy crossresistance and treatment response in childhood acute lymphoblastic leukemia. Cancer Cell 2005; 7:375-86. [PMID: 15837626 DOI: 10.1016/j.ccr.2005.03.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 12/11/2004] [Accepted: 03/02/2005] [Indexed: 10/25/2022]
Abstract
Acute lymphoblastic leukemia (ALL) can be cured with combination chemotherapy in over 75% of children, but the cause of treatment failure in the remaining patients is unknown. We determined the sensitivity of ALL cells to individual antileukemic agents in 441 patients and used a genome-wide approach to identify 45 genes differentially expressed in ALL exhibiting crossresistance to prednisolone, vincristine, asparaginase, and daunorubicin. We also identified a distinct phenotype of discordant resistance to asparaginase and vincristine and 139 genes whose expression was associated with this novel phenotype. The expression of these genes discriminated treatment outcome in two independent patient populations, identifying a subset of patients with a markedly inferior outcome (37% +/- 13% 5 year DFS).
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Affiliation(s)
- Sanne Lugthart
- Hematological Malignancy Program, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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