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Galas-Filipowicz D, Chavda SJ, Gong JN, Huang DCS, Khwaja A, Yong K. Co-operation of MCL-1 and BCL-X L anti-apoptotic proteins in stromal protection of MM cells from carfilzomib mediated cytotoxicity. Front Oncol 2024; 14:1394393. [PMID: 38651147 PMCID: PMC11033393 DOI: 10.3389/fonc.2024.1394393] [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: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction BCL-2 family proteins are important for tumour cell survival and drug resistance in multiple myeloma (MM). Although proteasome inhibitors are effective anti-myeloma drugs, some patients are resistant and almost all eventually relapse. We examined the function of BCL-2 family proteins in stromal-mediated resistance to carfilzomib-induced cytotoxicity in MM cells. Methods Co-cultures employing HS5 stromal cells were used to model the interaction with stroma. MM cells were exposed to CFZ in a 1-hour pulse method. The expression of BCL-2 family proteins was assessed by flow cytometry and WB. Pro-survival proteins: MCL-1, BCL-2 and BCL-XL were inhibited using S63845, ABT-199 and A-1331852 respectively. Changes in BIM binding partners were examined by immunoprecipitation and WB. Results CFZ induced dose-dependent cell death of MM cells, primarily mediated by apoptosis. Culture of MM cells on HS-5 stromal cells resulted in reduced cytotoxicity to CFZ in a cell contact-dependent manner, upregulated expression of MCL-1 and increased dependency on BCL-XL. Inhibiting BCL-XL or MCL-1 with BH-3 mimetics abrogated stromal-mediated protection only at high doses, which may not be achievable in vivo. However, combining BH-3 mimetics at sub-therapeutic doses, which alone were without effect, significantly enhanced CFZ-mediated cytotoxicity even in the presence of stroma. Furthermore, MCL-1 inhibition led to enhanced binding between BCL-XL and BIM, while blocking BCL-XL increased MCL-1/BIM complex formation, indicating the cooperative role of these proteins. Conclusion Stromal interactions alter the dependence on BCL-2 family members, providing a rationale for dual inhibition to abrogate the protective effect of stroma and restore sensitivity to CFZ.
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Affiliation(s)
| | - Selina J. Chavda
- Cancer Institute, University College London, London, United Kingdom
| | - Jia-Nan Gong
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - David C. S. Huang
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Asim Khwaja
- Cancer Institute, University College London, London, United Kingdom
| | - Kwee Yong
- Cancer Institute, University College London, London, United Kingdom
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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de Botton S, Fenaux P, Yee K, Récher C, Wei AH, Montesinos P, Taussig DC, Pigneux A, Braun T, Curti A, Grove C, Jonas BA, Khwaja A, Legrand O, Peterlin P, Arnan M, Blum W, Cilloni D, Hiwase DK, Jurcic JG, Krauter J, Thomas X, Watts JM, Yang J, Polyanskaya O, Brevard J, Sweeney J, Barrett E, Cortes J. Olutasidenib (FT-2102) induces durable complete remissions in patients with relapsed or refractory IDH1-mutated AML. Blood Adv 2023; 7:3117-3127. [PMID: 36724515 PMCID: PMC10362540 DOI: 10.1182/bloodadvances.2022009411] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [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: 11/23/2022] [Revised: 12/22/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
Olutasidenib (FT-2102) is a potent, selective, oral, small-molecule inhibitor of mutant isocitrate dehydrogenase 1 (mIDH1). Overall, 153 IDH1 inhibitor-naive patients with mIDH1R132 relapsed/refractory (R/R) acute myeloid leukemia (AML) received olutasidenib monotherapy 150 mg twice daily in the pivotal cohort of this study. The median age of participants was 71 years (range, 32-87 years) and the median number of prior regimens received by patients was 2 (1-7). The rate of complete remission (CR) plus CR with partial hematologic recovery (CRh) was 35%, and the overall response rate was 48%. Response rates were similar in patients who had, and who had not, received prior venetoclax. With 55% of patients censored at the time of data cut-off, the median duration of CR/CRh was 25.9 months. The median duration of overall response was 11.7 months, and the median overall survival was 11.6 months. Of 86 patients who were transfusion dependent at baseline, a 56-day transfusion independence was achieved in 29 (34%), which included patients in all response groups. Grade 3 or 4 treatment-emergent adverse events (≥10%) were febrile neutropenia and anemia (n = 31; 20% each), thrombocytopenia (n = 25; 16%), and neutropenia (n = 20; 13%). Differentiation syndrome adverse events of special interest occurred in 22 (14%) patients, with 14 (9%) grade ≥3 and 1 fatal case reported. Overall, olutasidenib induced durable remissions and transfusion independence with a well-characterized and manageable side effect profile. The observed efficacy represents a therapeutic advance in this molecularly defined, poor-prognostic population of patients with mIDH1 R/R AML. This trial was registered at www.clinicaltrials.gov as #NCT02719574.
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Affiliation(s)
| | - Pierre Fenaux
- Département (DMU) d’hématologie et immunologie, APHP Nord, Service d'hématologie séniors, Hôpital St Louis/université de Paris, Paris, France
| | - Karen Yee
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Christian Récher
- Service d’hématologie, CHU de Toulouse, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrew H. Wei
- The Alfred Hospital and Monash University, Peter Mac Callum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Arnaud Pigneux
- Service d’Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Thorsten Braun
- Service d'Hématologie Clinique Hôpital Avicenne-APHP-Université Paris XIII, Bobigny, France
| | - Antonio Curti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Institute of Hematology Seràgnoli, Bologna, Italy
| | - Carolyn Grove
- PathWest & Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Brian A. Jonas
- University of California Davis School of Medicine, Sacramento, CA
| | - Asim Khwaja
- University College London, London, United Kingdom
| | - Ollivier Legrand
- Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France
| | - Pierre Peterlin
- Service d'hématologie clinique, Nantes University Hospital, Nantes, France
| | - Montserrat Arnan
- Institut Català d'Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | - William Blum
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Joseph G. Jurcic
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY
| | | | | | - Justin M. Watts
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jay Yang
- Karmanos Cancer Institute, Detroit, MI
| | | | | | | | | | - Jorge Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA
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Pagliuca A, Khwaja A, Dillon R, Evans PA, Mohite U. Optimising care for UK patients with acute myeloid leukaemia. Br J Hosp Med (Lond) 2022; 83:42-50. [PMID: 36066288 DOI: 10.12968/hmed.2022.0229] [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] [Indexed: 02/11/2024]
Abstract
Acute myeloid leukaemia is a rare cancer, with about 3000 cases diagnosed each year in the UK. Diagnosis is based on patient history, blood and bone marrow tests and, in some cases, imaging. Chemotherapy is the mainstay of treatment for acute myeloid leukaemia, with eligible patients also undergoing allogeneic haematopoietic stem cell transplantation, which can be curative. However, patients must be carefully evaluated by the multidisciplinary team before they are put forward for transplant to ensure they are able to tolerate the conditioning therapy required. Improvements in transplant technology have increased donor availability and reduced transplant toxicity. At the same time, greater understanding of the cytogenetics and molecular genetics of acute myeloid leukaemia have helped to ensure that patients receive treatment that gives them the best chance of survival. A recent roundtable discussion considered how current diagnostic and treatment pathways might be adapted or enhanced to leverage good outcomes for the greatest numbers of patients.
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Affiliation(s)
- Antonio Pagliuca
- Professor of Stem Cell Transplantation, King's College London & King's College Hospital NHS Foundation Trust, London, UK - Chair
| | - Asim Khwaja
- Professor of Haematology, UCL Cancer Institute, and Consultant Haematologist UCL Hospitals, London, UK
| | - Richard Dillon
- Clinical Senior Lecturer in Cancer Genetics, Kings College, London, UK
| | - Paul As Evans
- Principal Clinical Scientist, Haematological Malignancy Diagnostic Service, Leeds, UK
| | - Unmesh Mohite
- Consultant Haematologist, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
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Chan WY, Zhu C, Sanchez E, Gupta R, Fielding AK, Khwaja A, Payne EM, O'Nions J. Antibody responses to SARS-CoV-2 vaccination in patients with acute myeloid leukaemia and high risk MDS on active anti-cancer therapies. Br J Haematol 2022; 198:478-481. [PMID: 35536283 PMCID: PMC9347660 DOI: 10.1111/bjh.18248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Wei Yee Chan
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
| | - Catherine Zhu
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Emilie Sanchez
- Department of VirologyUniversity College London NHS Foundation TrustLondonUK
| | - Rajeev Gupta
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Adele K. Fielding
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Asim Khwaja
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Elspeth M. Payne
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Jenny O'Nions
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
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Schini M, Peel N, Toronjo-Urquiza L, Thomas E, Salam S, Khwaja A, Eastell R, Walsh JS. Evaluation of estimated glomerular function (eGFR) versus creatinine clearance (CrCl) to predict acute kidney injury when using zoledronate for the treatment of osteoporosis. Osteoporos Int 2022; 33:737-744. [PMID: 34654939 DOI: 10.1007/s00198-021-06160-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Zoledronate could be contributing to the development of acute kidney injury in a small number of patients. Since estimated glomerular function (eGFR) is simpler to obtain and at least as good a predictor as creatinine clearance (CrCl), it should be used in everyday practice. INTRODUCTION Zoledronate is widely used for the treatment of osteoporosis. A potential side effect is acute kidney injury (AKI). Advice from the UK Medicines and Healthcare products Regulatory Agency (MHRA) in 2019 stated that CrCl and not estimated glomerular filtration rate (eGFR) should be used and that treatment should not be given if CrCl < 35 ml/min. The objective of this study was to compare our current method of assessing renal function (eGFR) with the method proposed by the MHRA (CrCl) for predicting AKI after zoledronate infusions. METHODS The evaluation was performed at the Metabolic Bone Centre in Sheffield Teaching Hospitals, UK. Data on all the patients who had zoledronate from 1/09/2015 to 1/10/2020 were included. RESULTS Data on 4405 patients were retrieved (total number of infusions 7660). Creatinine in the 14 days post-infusion was available for a total of 969 infusions and AKI was observed within 14 days following 45 infusions (4.6%). One patient died due to pneumonia. One patient needed continued haemodialysis. Severe AKI (threefold in creatinine and/or eGFR < 15 ml/min/173 m2) was observed within 1 year following 24 infusions. If the MHRA recommendations had been followed, 996 infusions with baseline CrCl < 35 ml/min would not have been given. Of these, follow-up data on serum creatinine within 14 days were available for 142 infusions, showing AKI in only four (2.8%). Logistic regression showed that both CrCl and eGFR were significant factors in predicting AKI within 14 days, but that the current recommended cut-off of CrCl 35 ml/min had poor sensitivity. CONCLUSION Since eGFR is at least as good a predictor of AKI as CrCl, and permits the treatment of more patients at high fracture risk, we recommend that eGFR is used to determine renal function for zoledronate treatment. We suggest that the infusion is given over 30 min in patients with eGFR < 50 ml/min/1.73 m2.
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Affiliation(s)
- M Schini
- Academic Unit of Bone Metabolism, The University of Sheffield, Sheffield, UK.
- Metabolic Bone Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - N Peel
- Metabolic Bone Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - L Toronjo-Urquiza
- Chemical Engineering Department, The University of Sheffield, Sheffield, UK
| | - E Thomas
- Pharmacy, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Salam
- Academic Unit of Bone Metabolism, The University of Sheffield, Sheffield, UK
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Khwaja
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Eastell
- Academic Unit of Bone Metabolism, The University of Sheffield, Sheffield, UK
| | - J S Walsh
- Academic Unit of Bone Metabolism, The University of Sheffield, Sheffield, UK
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Coats T, Bean D, Basset A, Sirkis T, Brammeld J, Johnson S, Thomas I, Gilkes A, Raj K, Dennis M, Knapper S, Mehta P, Khwaja A, Hunter H, Tauro S, Bowen D, Jones G, Dobson R, Russell N, Dillon R. A novel algorithmic approach to generate consensus treatment guidelines in adult acute myeloid leukaemia. Br J Haematol 2022; 196:1337-1343. [PMID: 34957541 DOI: 10.1111/bjh.18013] [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: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
Induction therapy for acute myeloid leukaemia (AML) has changed with the approval of a number of new agents. Clinical guidelines can struggle to keep pace with an evolving treatment and evidence landscape and therefore identifying the most appropriate front-line treatment is challenging for clinicians. Here, we combined drug eligibility criteria and genetic risk stratification into a digital format, allowing the full range of possible treatment eligibility scenarios to be defined. Using exemplar cases representing each of the 22 identified scenarios, we sought to generate consensus on treatment choice from a panel of nine aUK AML experts. We then analysed >2500 real-world cases using the same algorithm, confirming the existence of 21/22 of these scenarios and demonstrating that our novel approach could generate a consensus AML induction treatment in 98% of cases. Our approach, driven by the use of decision trees, is an efficient way to develop consensus guidance rapidly and could be applied to other disease areas. It has the potential to be updated frequently to capture changes in eligibility criteria, novel therapies and emerging trial data. An interactive digital version of the consensus guideline is available.
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Affiliation(s)
- Thomas Coats
- Haematology Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Biostatistics and Health Informatics, King's College London, UK
| | - Daniel Bean
- Biostatistics and Health Informatics, King's College London, UK
- Health Data Research UK London, University College London, UK
| | - Aymeric Basset
- Biostatistics and Health Informatics, King's College London, UK
| | | | | | - Sean Johnson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Amanda Gilkes
- Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Kavita Raj
- Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Mike Dennis
- Haematology, The Christie NHS Foundation Trust, Manchester, UK
| | - Steve Knapper
- Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - Priyanka Mehta
- Haematology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Asim Khwaja
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Hannah Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sudhir Tauro
- Haematology, Ninewells Hospital & School of Medicine, University of Dundee, Dundee, UK
| | - David Bowen
- Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gail Jones
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Richard Dobson
- Biostatistics and Health Informatics, King's College London, UK
- Health Data Research UK London, University College London, UK
| | - Nigel Russell
- Guys' and St Thomas' NHS Foundation Trust, London, UK
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Gopal AK, Popat R, Mattison RJ, Menne T, Bloor A, Gaymes T, Khwaja A, Juckett M, Chen Y, Cotter MJ, Mufti GJ. A Phase I trial of talazoparib in patients with advanced hematologic malignancies. Int J Hematol Oncol 2021; 10:IJH35. [PMID: 34840720 PMCID: PMC8609999 DOI: 10.2217/ijh-2021-0004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Aim: The objective of this study was to establish the maximum tolerated dose (MTD), safety, pharmacokinetics, and anti-leukemic activity of talazoparib. Patients & methods: This Phase I, two-cohort, dose-escalation trial evaluated talazoparib monotherapy in advanced hematologic malignancies (cohort 1: acute myeloid leukemia/myelodysplastic syndrome; cohort 2: chronic lymphocytic leukemia/mantle cell lymphoma). Results: Thirty-three (cohort 1: n = 25; cohort 2: n = 8) patients received talazoparib (0.1–2.0 mg once daily). The MTD was exceeded at 2.0 mg/day in cohort 1 and at 0.9 mg/day in cohort 2. Grade ≥3 adverse events were primarily hematologic. Eighteen (54.5%) patients reported stable disease. Conclusion: Talazoparib is relatively well tolerated in hematologic malignancies, with a similar MTD as in solid tumors, and shows preliminary anti leukemic activity. Clinical trial registration: NCT01399840 (ClinicalTrials.gov) The objective of this study was to define the highest dose of talazoparib that people with various types of leukemia (mainly various blood cancers) could tolerate. People were assigned into two cohorts based on their type of leukemia: cohort 1 included 25 people with acute myeloid leukemia or myelodysplastic syndrome; cohort 2 included 8 people with chronic lymphocytic leukemia or mantle cell lymphoma. Similar to what researchers observed for people with solid tumors, the highest tolerated dose was 1.35 mg per day in cohort 1, and it was estimated to be ∼0.9 mg per day in cohort 2. Side effects that occurred during the study were expected, given the types of leukemia being treated. Talazoparib also showed promising anti leukemic effects in some patients. In this Phase I talazoparib trial in hematologic malignancies (cohort 1: AML/MDS, n = 25; cohort 2: CLL/MCL, n = 8), the maximum tolerated dose was exceeded at 2.0 and 0.9 mg/day in cohorts 1 and 2, respectively. Stable disease and transfusion independence were also observed.
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Affiliation(s)
- Ajay K Gopal
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Rakesh Popat
- National Institute for Health Research University College London Hospitals Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ryan J Mattison
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Tobias Menne
- Department of Hematology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Adrian Bloor
- The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Terry Gaymes
- Department of Biomolecular Science, Kingston University, London, UK
| | - Asim Khwaja
- University College London Cancer Institute & University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Juckett
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | | | | | - Ghulam J Mufti
- Department of Hematology, King's College London, King's College Hospital NHS Foundation Trust, London, UK
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10
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Grandage VL, Gale RE, Linch DC, Khwaja A. Correction: PI3-kinase/Akt is constitutively active in primary acute myeloid leukaemia cells and regulates survival and chemoresistance via NF-kB, MAPkinase and p53 pathways. Leukemia 2021; 36:296. [PMID: 34654886 DOI: 10.1038/s41375-021-01440-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- V L Grandage
- Department of Haematology, Royal Free and University College London Medical School, 98 Chenies Mews, London, UK.
| | - R E Gale
- Department of Haematology, Royal Free and University College London Medical School, 98 Chenies Mews, London, UK
| | - D C Linch
- Department of Haematology, Royal Free and University College London Medical School, 98 Chenies Mews, London, UK
| | - A Khwaja
- Department of Haematology, Royal Free and University College London Medical School, 98 Chenies Mews, London, UK
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11
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De Botton S, Yee KWL, Recher C, Wei A, Montesinos P, Taussig D, Pigneux A, Braun T, Curti A, Esteve J, Grove C, Jonas BA, Khwaja A, Legrand O, Peterlin P, Polyanskaya O, Sweeney J, Mohamed H, Cortes JE, Fenaux P. Effect of olutasidenib (FT-2102) on complete remissions in patients with relapsed/refractory (R/R) m IDH1 acute myeloid leukemia (AML): Results from a planned interim analysis of a phase 2 clinical trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7006 Background: Olutasidenib, a potent, selective, oral, small molecule inhibitor of mutant IDH1 (m IDH1), has exhibited favorable tolerability and clinical activity in high-risk AML patients (pts) in a phase 1 trial (Watts, Blood 2019). Here, we present interim analysis results of a phase 2 trial (NCT02719574) in R/R m IDH1 AML pts receiving olutasidenib monotherapy 150 mg twice daily. Methods: The efficacy evaluable (EE) set comprised m IDH1R132X pts whose first dose was ≥180 days before the data cut-off (18-JUN-20). The primary endpoint was CR+CRh (complete remission [CR] or CR with partial hematologic recovery [CRh] according to modified IWG 2003 criteria) rate. CRh was defined as bone marrow blasts <5%, absolute neutrophil count >0.5×109/L, and platelet count >50×109/L. Overall response rate (ORR) comprised CR+CRh+CR with incomplete recovery (CRi) + morphologic leukemia-free state (MLFS) + partial response (PR). Duration of treatment (DOT), duration of response (DOR), and overall survival (OS) were estimated using Kaplan-Meier methodology. Results: This clinical trial met its pre-specified early enrollment-stopping criteria for efficacy. A total of 153 pts with R/R AML received olutasidenib; median DOT, 5.5 mo (95% CI: 4.4, 8.7). 43 pts (28%) remain on treatment and 110 (72%) discontinued, most commonly due to: disease progression, 31%; AEs, 14%; death, 10%; and transplant, 8%. For the EE set (123 pts), the median age was 71 y (range: 32‒87) with a median number of prior therapies of 2 (1‒7). The CR+CRh rate was 33% including 30% of pts in CR (Table). Median duration of CR+CRh was not reached (NR) and 13.8 mo in a sensitivity analysis when HSCT or relapse was deemed end of response. ORR was 46% and median duration of ORR was 11.7 mo. Of responders who were transfusion-dependent at baseline, 56-day platelet transfusion independence (TI) and RBC TI were gained by 100% and 83%, respectively, of pts who achieved CR+CRh, and by 56% and 50% who did not. Median OS was 10.5 mo (EE set). In CR+CRh responders, median OS was NR and the estimated 18-mo OS was 87%. TEAEs in ≥25% of pts were nausea, 38%; constipation, 25%; leukocytosis, 25%. Grade 3/4 all-causality TEAEs in >10% of pts were febrile neutropenia, 20%; anemia, 19%; thrombocytopenia, 16%; neutropenia, 13%. Investigator-assessed IDH1 differentiation syndrome (any grade) was observed in 21 pts (14%); most cases resolved with treatment management; one case was fatal; 19 pts had concomitant leukocytosis. Conclusions: Olutasidenib was well tolerated and induced durable CR in a subset of high-risk R/R m IDH1 AML pts. TI was achieved in all response groups. Clinical benefit, per DOR and OS, extended beyond CR+CRh responders. Clinical trial information: NCT02719574. [Table: see text]
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Affiliation(s)
| | | | | | - Andrew Wei
- The Alfred Hospital and Monash University, Melbourne, Australia
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Thorsten Braun
- Avicenne Hospital Paris XIII University, Bobigny, France
| | - Antonio Curti
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Carolyn Grove
- PathWest & Sir Charles Gairdner Hospital, Nedlands, Australia
| | | | - Asim Khwaja
- University College London, London, United Kingdom
| | - Ollivier Legrand
- Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France
| | | | | | | | | | | | - Pierre Fenaux
- Service d’Hématologie Séniors, Hôpital Saint-Louis, Université Paris 7, Paris, France
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12
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Barrett T, Khwaja A, Carmona C, Martinez Y, Nicholas H, Rogers G, Wierzbicki AS, Lewington AJP. Acute kidney injury: prevention, detection, and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media. Clin Radiol 2020; 76:193-199. [PMID: 33390251 DOI: 10.1016/j.crad.2020.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
The National Institute for Health and Care Excellence (NICE) has recently updated the guideline for Acute kidney injury: prevention, detection and management (NG148), providing new recommendations on preventing acute kidney injury (AKI) in adults receiving intravenous iodine-based contrast media. The association between intravenous iodinated contrast media and AKI is controversial, particularly with widespread use of iso-osmolar agents. Associations between contrast media administration and AKI are largely based on observational studies, with inherent heterogeneity in patient populations, definitions applied, and timing of laboratory investigations. In an attempt to mitigate risk, kidney protection has typically been employed using intravenous volume expansion and/or oral acetylcysteine. Such interventions are in widespread use, despite lacking high-quality evidence of benefit. In the non-emergency setting, glomerular filtration rate (GFR) measurements should be obtained within the preceding 3 months before offering intravenous iodine-based contrast media. In the acute setting, adults should also have their risk of AKI assessed before offering intravenous iodine-based contrast media; however, this should not delay emergency imaging. Based on the evidence available from randomised controlled trials, the NICE committee recommends that oral hydration should be encouraged in adults at increased risk of AKI and that volume expansion with intravenous V fluids should only be considered for inpatients at particularly high risk.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge CB2 0QQ, UK.
| | - A Khwaja
- Renal Department, Sheffield Kidney Institute, Northern General Hospital, Sheffield S5 7AU, UK
| | - C Carmona
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - Y Martinez
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - H Nicholas
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - G Rogers
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - A S Wierzbicki
- Department of Chemical Pathology, Guy's & St. Thomas' Hospitals, London, UK
| | - A J P Lewington
- Renal Department, St. James's University Hospital, Beckett Street Leeds, LS9 7TF, UK
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13
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Fox TA, Carpenter B, Taj M, Perisoglou M, Nicholson E, Castleton A, Elliot J, Uttenthal B, Wright C, Halsey R, Khwaja A, Grandage V, Mansour MR, Fielding AK, Hough R. Utility of 18F-FDG-PET/CT in lymphoblastic lymphoma. Leuk Lymphoma 2020; 62:1010-1012. [PMID: 33275056 DOI: 10.1080/10428194.2020.1855346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas A Fox
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ben Carpenter
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary Taj
- Department of Clinical Haematology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Martha Perisoglou
- Department of Clinical Haematology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Emma Nicholson
- Department of Clinical Haematology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Anna Castleton
- Department of Clinical Haematology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Johnathon Elliot
- Department of Clinical Haematology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Ben Uttenthal
- Department of Clinical Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Callum Wright
- Department of Clinical Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard Halsey
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Asim Khwaja
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Victoria Grandage
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marc R Mansour
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Adele K Fielding
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Rachael Hough
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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14
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Fox TA, Troy-Barnes E, Kirkwood AA, Chan WY, Day JW, Chavda SJ, Kumar EA, David K, Tomkins O, Sanchez E, Scully M, Khwaja A, Lambert J, Singer M, Roddie C, Morris EC, Yong KL, Thomson KJ, Ardeshna KM. Response to 'Impact of immunosuppression on mortality in critically ill COVID-19 patients'. Br J Haematol 2020; 191:505-506. [PMID: 33103782 DOI: 10.1111/bjh.17110] [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: 11/28/2022]
Affiliation(s)
- Thomas A Fox
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Ethan Troy-Barnes
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- CR UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - Wei Y Chan
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - James W Day
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Selina J Chavda
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Emil A Kumar
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kate David
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Oliver Tomkins
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Emilie Sanchez
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Marie Scully
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Jonathan Lambert
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Mervyn Singer
- UCLH NIHR Biomedical Research Centre, London, UK.,Bloomsbury Institute of Intensive Care Medicine, UCL, London, UK
| | - Claire Roddie
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Emma C Morris
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK.,Department Immunology, Royal Free London Hospitals NHS Foundation Trust, London, UK
| | - Kwee L Yong
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirsty J Thomson
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirit M Ardeshna
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
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15
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Leong S, Inglott S, Papaleonidopoulou F, Orfinada K, Ancliff P, Bartram J, Carpenter B, Fielding AK, Ghorashian S, Grandage V, Gupta R, Hough R, Khwaja A, Pavasovic V, Rao A, Samarasinghe S, Vora A, Mansour MR, O'Connor D. CD1a is rarely expressed in pediatric or adult relapsed/refractory T-ALL: implications for immunotherapy. Blood Adv 2020; 4:4665-4668. [PMID: 33002130 PMCID: PMC7556151 DOI: 10.1182/bloodadvances.2020002502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/29/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sarah Leong
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Sarah Inglott
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Karen Orfinada
- Manual Blood Sciences, Health Services Laboratories, London, United Kingdom
| | - Philip Ancliff
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Jack Bartram
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ben Carpenter
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Adele K Fielding
- Department of Haematology, University College London Hospital, London, United Kingdom
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
| | - Sara Ghorashian
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Victoria Grandage
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Rajeev Gupta
- Department of Haematology, University College London Hospital, London, United Kingdom
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
| | - Rachael Hough
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College London Hospital, London, United Kingdom
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
| | - Vesna Pavasovic
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Anupama Rao
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sujith Samarasinghe
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ajay Vora
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Marc R Mansour
- Department of Haematology, University College London Hospital, London, United Kingdom
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
| | - David O'Connor
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
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16
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Fox TA, Troy-Barnes E, Kirkwood AA, Chan WY, Day JW, Chavda SJ, Kumar EA, David K, Tomkins O, Sanchez E, Scully M, Khwaja A, Lambert J, Singer M, Roddie C, Morris EC, Yong KL, Thomson KJ, Ardeshna KM. Clinical outcomes and risk factors for severe COVID-19 in patients with haematological disorders receiving chemo- or immunotherapy. Br J Haematol 2020; 191:194-206. [PMID: 32678948 PMCID: PMC7405103 DOI: 10.1111/bjh.17027] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
Haematology patients receiving chemo- or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.
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Affiliation(s)
- Thomas A Fox
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Ethan Troy-Barnes
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- CR UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - Wei Yee Chan
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - James W Day
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Selina J Chavda
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Emil A Kumar
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kate David
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Oliver Tomkins
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Emilie Sanchez
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Marie Scully
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Jonathan Lambert
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Mervyn Singer
- UCLH NIHR Biomedical Research Centre, London, UK.,Bloomsbury Institute of Intensive Care Medicine, UCL, London, UK
| | - Claire Roddie
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Emma C Morris
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK.,Department Immunology, Royal Free London Hospitals NHS Foundation Trust, London, UK
| | - Kwee L Yong
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirsty J Thomson
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirit M Ardeshna
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
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17
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Wilson AJ, Troy‐Barnes E, Subhan M, Clark F, Gupta R, Fielding AK, Kottaridis P, Mansour MR, O'Nions J, Payne E, Chavda N, Baker R, Thomson K, Khwaja A. Successful remission induction therapy with gilteritinib in a patient with de novo FLT3-mutated acute myeloid leukaemia and severe COVID-19. Br J Haematol 2020; 190:e189-e191. [PMID: 32584418 PMCID: PMC7362128 DOI: 10.1111/bjh.16962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/19/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Andrew J. Wilson
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Ethan Troy‐Barnes
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Maryam Subhan
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Fiona Clark
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Rajeev Gupta
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Adele K. Fielding
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | | | - Marc R. Mansour
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | - Jenny O'Nions
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Elspeth Payne
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | - Naina Chavda
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Robert Baker
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Kirsty Thomson
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Asim Khwaja
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
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18
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Dillon R, Hills R, Freeman S, Potter N, Jovanovic J, Ivey A, Kanda AS, Runglall M, Foot N, Valganon M, Khwaja A, Cavenagh J, Smith M, Ommen HB, Overgaard UM, Dennis M, Knapper S, Kaur H, Taussig D, Mehta P, Raj K, Novitzky-Basso I, Nikolousis E, Danby R, Krishnamurthy P, Hill K, Finnegan D, Alimam S, Hurst E, Johnson P, Khan A, Salim R, Craddock C, Spearing R, Gilkes A, Gale R, Burnett A, Russell NH, Grimwade D. Molecular MRD status and outcome after transplantation in NPM1-mutated AML. Blood 2020; 135:680-688. [PMID: 31932839 PMCID: PMC7059484 DOI: 10.1182/blood.2019002959] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [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: 08/29/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Relapse remains the most common cause of treatment failure for patients with acute myeloid leukemia (AML) who undergo allogeneic stem cell transplantation (alloSCT), and carries a grave prognosis. Multiple studies have identified the presence of measurable residual disease (MRD) assessed by flow cytometry before alloSCT as a strong predictor of relapse, but it is not clear how these findings apply to patients who test positive in molecular MRD assays, which have far greater sensitivity. We analyzed pretransplant blood and bone marrow samples by reverse-transcription polymerase chain reaction in 107 patients with NPM1-mutant AML enrolled in the UK National Cancer Research Institute AML17 study. After a median follow-up of 4.9 years, patients with negative, low (<200 copies per 105ABL in the peripheral blood and <1000 copies in the bone marrow aspirate), and high levels of MRD had an estimated 2-year overall survival (2y-OS) of 83%, 63%, and 13%, respectively (P < .0001). Focusing on patients with low-level MRD before alloSCT, those with FLT3 internal tandem duplications(ITDs) had significantly poorer outcome (hazard ratio [HR], 6.14; P = .01). Combining these variables was highly prognostic, dividing patients into 2 groups with 2y-OS of 17% and 82% (HR, 13.2; P < .0001). T-depletion was associated with significantly reduced survival both in the entire cohort (2y-OS, 56% vs 96%; HR, 3.24; P = .0005) and in MRD-positive patients (2y-OS, 34% vs 100%; HR, 3.78; P = .003), but there was no significant effect of either conditioning regimen or donor source on outcome. Registered at ISRCTN (http://www.isrctn.com/ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Nuclear Proteins/genetics
- Nucleophosmin
- Recurrence
- Young Adult
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Affiliation(s)
- Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicola Potter
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Jelena Jovanovic
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Anju Shankar Kanda
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Manohursingh Runglall
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Nicola Foot
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Mikel Valganon
- Cancer Genetics Service, Viapath, Guy's Hospital, London, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College, London, United Kingdom
| | | | | | | | | | - Mike Dennis
- Christie Hospital, Manchester, United Kingdom
| | - Steven Knapper
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Harpreet Kaur
- Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Priyanka Mehta
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Kavita Raj
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | | | | | | | | | - Kate Hill
- University Hospital, Southampton, United Kingdom
| | | | - Samah Alimam
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Erin Hurst
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | | | - Anjum Khan
- St James' Hospital, Leeds, United Kingdom
| | - Rahuman Salim
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Rosemary Gale
- Department of Haematology, University College, London, United Kingdom
| | - Alan Burnett
- Blackwaterfoot, Isle of Arran, United Kingdom; and
| | - Nigel H Russell
- Department of Haematology, Guy's Hospital, London, United Kingdom
- Nottingham University Hospital, Nottingham, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
- Department of Haematology, Guy's Hospital, London, United Kingdom
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19
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Fox TA, Halsey R, Pomplun S, Gant V, Grandage V, Mansour MR, Hough R, Khwaja A. Rapid clinical response to adjuvant corticosteroids in chronic disseminated candidiasis complicated by granulomas and persistent fever in acute leukemia patients. Leuk Lymphoma 2019; 61:944-949. [PMID: 31755343 DOI: 10.1080/10428194.2019.1691198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas A Fox
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Richard Halsey
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sabine Pomplun
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Vanya Gant
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Victoria Grandage
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Marc R Mansour
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Rachael Hough
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Asim Khwaja
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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20
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Lecat CSY, Besley C, Hough RE, Khwaja A, Furness C, Marks DI, Fielding AK. Inotuzumab ozogamicin versus FLAG-Ida in the treatment of relapsed or refractory B-cell acute lymphoblastic leukemia - real-world resource use data. Leuk Lymphoma 2019; 61:491-493. [PMID: 31580171 DOI: 10.1080/10428194.2019.1672057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Caroline Besley
- Bristol Haematology & Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - Rachael E Hough
- Department of Haematology, University College London Hospitals, London, UK
| | | | - Caroline Furness
- Bristol Haematology & Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - David I Marks
- Bristol Haematology & Oncology Centre, University Hospitals Bristol, Bristol, UK
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21
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Sellar RS, Mehra V, Fox TA, Grigg A, Kulasekararaj A, Sarma A, de Lavallade H, McLornan D, Raj K, Mufti GJ, Pagliuca A, Mackinnon S, Chakraverty R, Fielding AK, Carpenter B, Kottaridis PD, Khwaja A, Peggs KS, Thomson KJ, Morris EC, Potter VT. Comparative analysis of melphalan versus busulphan T-cell deplete conditioning using alemtuzumab in unrelated donor stem cell transplantation for acute myeloid leukaemia. Br J Haematol 2019; 187:e20-e24. [PMID: 31396948 DOI: 10.1111/bjh.16136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rob S Sellar
- Department of Haematology, UCL Cancer Institute, London, UK.,Department of Haematology, University College London Hospitals, London, UK
| | - Varun Mehra
- Department of Haematology, King's College Hospital, London, UK
| | - Thomas A Fox
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Andrew Grigg
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | | | - Anita Sarma
- Department of Haematology, King's College Hospital, London, UK
| | | | - Donal McLornan
- Department of Haematology, King's College Hospital, London, UK.,Department of Haematology, Guys and St Thomas' Hospital, London, UK
| | - Kavita Raj
- Department of Haematology, King's College Hospital, London, UK.,Department of Immunology, Royal Free Hospital, London, UK
| | - Ghulam J Mufti
- Department of Haematology, King's College Hospital, London, UK
| | | | - Stephen Mackinnon
- Department of Haematology, University College London Hospitals, London, UK
| | - Ronjon Chakraverty
- Department of Haematology, UCL Cancer Institute, London, UK.,Department of Haematology, University College London Hospitals, London, UK.,Institute of Immunity and Transplantation, University College London, London, UK
| | - Adele K Fielding
- Department of Haematology, UCL Cancer Institute, London, UK.,Department of Haematology, University College London Hospitals, London, UK
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals, London, UK
| | | | - Asim Khwaja
- Department of Haematology, UCL Cancer Institute, London, UK.,Department of Haematology, University College London Hospitals, London, UK
| | - Karl S Peggs
- Department of Haematology, UCL Cancer Institute, London, UK.,Department of Haematology, University College London Hospitals, London, UK
| | - Kirsty J Thomson
- Department of Haematology, University College London Hospitals, London, UK
| | - Emma C Morris
- Department of Haematology, University College London Hospitals, London, UK.,Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free Hospital, London, UK
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22
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O'Reilly MA, Govender D, Kirkwood AA, Vora A, Samarasinghe S, Khwaja A, Grandage V, Rao A, Ancliff P, Pavasovic V, Cheng D, Carpenter B, Daw S, Hough R, O'Connor D. The incidence of invasive fungal infections in children, adolescents and young adults with acute lymphoblastic leukaemia/lymphoma treated with the UKALL2011 protocol: a multicentre retrospective study. Br J Haematol 2019; 186:327-329. [PMID: 30768682 DOI: 10.1111/bjh.15798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maeve A O'Reilly
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Dinisha Govender
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Ajay Vora
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Sujith Samarasinghe
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Asim Khwaja
- Department of Young Adult Haematology, University College London Hospital (UCLH), London, UK
| | - Victoria Grandage
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Anupama Rao
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Philip Ancliff
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Vesna Pavasovic
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Danny Cheng
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
| | - Ben Carpenter
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Stephen Daw
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - Rachael Hough
- Department of Adolescent Haematology, University College London Hospital (UCLH), London, UK
| | - David O'Connor
- Department of Paediatric Haematology, Great Ormond Street Hospital, London, UK
- Department of Haematology, University College London Cancer Institute, London, UK
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23
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Ghori MA, Al Zubaidi A, Khwaja A. Thyrocervical trunk perforation: A rare vascular complication during cardiac intervention through right radial approach: A case report and literature review. J Saudi Heart Assoc 2019; 31:121-124. [PMID: 31031551 PMCID: PMC6479075 DOI: 10.1016/j.jsha.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/17/2019] [Accepted: 03/24/2019] [Indexed: 11/25/2022] Open
Abstract
Trans radial artery access (TRA) is considered a relatively safe approach for percutaneous coronary intervention (PCI), by virtue of its fewer access related peripheral vascular complications. Central arterial complications are rare. We are presenting a case report wherein thyrocervical trunk (TT), a branch of first part of right subclavian artery (RSA) was perforated during intervention through right radial approach, resulting in deep neck hematoma, compressing the trachea and surrounding structure. To our knowledge, this is the first reported case of TT perforation by a hydrophilic wire during a staged cardiac catheterization after primary PCI through right radial approach. Knowledge of such a rare complication, its early recognition, and endovascular treatment might spare a patient with recent acute coronary syndrome on double antiplatelet medications, from surgical intervention and fatal outcome.
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Affiliation(s)
- Masood Ayyub Ghori
- Cardiac Science Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab EmiratesUnited Arab Emirates
| | - Abdulmajeed Al Zubaidi
- Cardiac Science Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab EmiratesUnited Arab Emirates
| | - Asim Khwaja
- Radiology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab EmiratesUnited Arab Emirates
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24
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Richardson SE, Brian D, Grandage V, Hough R, Kottaridis P, Mansour MR, Payne EM, Khwaja A. Intensive Chemotherapy Is Associated With Poor Overall Survival in Autoimmune Disease-associated Myeloid Malignancies. Hemasphere 2019; 3:e164. [PMID: 31723803 PMCID: PMC6745931 DOI: 10.1097/hs9.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Simon E. Richardson
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Duncan Brian
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Victoria Grandage
- Teenage and Young Adult Unit, Department of Hematology, University College London Hospital, London, UK
| | - Rachael Hough
- Teenage and Young Adult Unit, Department of Hematology, University College London Hospital, London, UK
| | | | - Marc R. Mansour
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Elspeth M. Payne
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Asim Khwaja
- University College London Cancer Institute, London, UK
- Department of Hematology, University College London Hospital, London, UK
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25
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Burnett AK, Das Gupta E, Knapper S, Khwaja A, Sweeney M, Kjeldsen L, Hawkins T, Betteridge SE, Cahalin P, Clark RE, Hills RK, Russell NH. Addition of the mammalian target of rapamycin inhibitor, everolimus, to consolidation therapy in acute myeloid leukemia: experience from the UK NCRI AML17 trial. Haematologica 2018; 103:1654-1661. [PMID: 29976746 PMCID: PMC6165825 DOI: 10.3324/haematol.2018.189514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/24/2018] [Accepted: 07/04/2018] [Indexed: 01/14/2023] Open
Abstract
As part of the UK NCRI AML17 trial, adult patients with acute myeloid leukemia in remission could be randomized to receive the mammalian target of rapamycin inhibitor everolimus, sequentially with post-induction chemotherapy. Three hundred and thirty-nine patients were randomised (2:1) to receive everolimus or not for a maximum of 84 days between chemotherapy courses. The primary endpoint was relapse-free survival. At 5 years there was no difference in relapse-free survival [29% versus 40%; odds ratio 1.19 (0.9-1.59) P=0.2], cumulative incidence of relapse [60% versus 54%: odds ratio 1.12 (0.82-1.52): P=0.5] or overall survival [45% versus 58%: odds ratio 1.3 (0.94-1.81): P=0.11]. The independent Data Monitoring Committee advised study termination after randomization of 339 of the intended 600 patients because of excess mortality in the everolimus arm without any evidence of beneficial disease control. The delivery of the everolimus dose was variable, but there was no evidence of clinical benefit in patients with adequate dose delivery compared with no treatment. This study suggests that the addition of mammalian target of rapamycin inhibition to chemotherapy provides no benefit.
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Affiliation(s)
- Alan K Burnett
- Formerly Department of Haematology, Cardiff University School of Medicine, UK
| | - Emma Das Gupta
- Department of Haematology, Nottingham University Hospital NHS Trust, UK
| | - Steve Knapper
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Asim Khwaja
- University College, London Cancer Institute, UK
| | - Marion Sweeney
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Lars Kjeldsen
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Timothy Hawkins
- Department of Haematology, Auckland City Hospital, New Zealand
| | | | - Paul Cahalin
- Department of Haematology, Blackpool Victoria Hospital, UK
| | - Richard E Clark
- Department of Haematology, Royal Liverpool University Hospital, UK
| | - Robert K Hills
- Department of Haematology, Royal Liverpool University Hospital, UK
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, UK
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26
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El-Sharkawi D, Ng CH, Payne EM, Yong KL, Ardeshna KM, Khwaja A, Townsend W, Popat R. Clinical outcomes and survival of patients with myeloma and lymphoma enrolled into phase I clinical trials. Br J Haematol 2018; 185:344-347. [PMID: 29978458 DOI: 10.1111/bjh.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dima El-Sharkawi
- NIHR/UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chin-Hin Ng
- NIHR/UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elspeth M Payne
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kwee L Yong
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kirit M Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - William Townsend
- NIHR/UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rakesh Popat
- NIHR/UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
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27
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Freeman SD, Hills RK, Virgo P, Khan N, Couzens S, Dillon R, Gilkes A, Upton L, Nielsen OJ, Cavenagh JD, Jones G, Khwaja A, Cahalin P, Thomas I, Grimwade D, Burnett AK, Russell NH. Measurable Residual Disease at Induction Redefines Partial Response in Acute Myeloid Leukemia and Stratifies Outcomes in Patients at Standard Risk Without NPM1 Mutations. J Clin Oncol 2018; 36:1486-1497. [PMID: 29601212 PMCID: PMC5959196 DOI: 10.1200/jco.2017.76.3425] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [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] [Indexed: 12/13/2022] Open
Abstract
Purpose We investigated the effect on outcome of measurable or minimal residual disease (MRD) status after each induction course to evaluate the extent of its predictive value for acute myeloid leukemia (AML) risk groups, including NPM1 wild-type (wt) standard risk, when incorporated with other induction response criteria. Methods As part of the NCRI AML17 trial, 2,450 younger adult patients with AML or high-risk myelodysplastic syndrome had prospective multiparameter flow cytometric MRD (MFC-MRD) assessment. After course 1 (C1), responses were categorized as resistant disease (RD), partial remission (PR), and complete remission (CR) or complete remission with absolute neutrophil count < 1,000/µL or thrombocytopenia < 100,000/μL (CRi) by clinicians, with CR/CRi subdivided by MFC-MRD assay into MRD+ and MRD-. Patients without high-risk factors, including Flt3 internal tandem duplication wt/- NPM1-wt subgroup, received a second daunorubicin/cytosine arabinoside induction; course 2 (C2) was intensified for patients with high-risk factors. Results Survival outcomes from PR and MRD+ responses after C1 were similar, particularly for good- to standard-risk subgroups (5-year overall survival [OS], 27% RD v 46% PR v 51% MRD+ v 70% MRD-; P < .001). Adjusted analyses confirmed significant OS differences between C1 RD versus PR/MRD+ but not PR versus MRD+. CRi after C1 reduced OS in MRD+ (19% CRi v 45% CR; P = .001) patients, with a smaller effect after C2. The prognostic effect of C2 MFC-MRD status (relapse: hazard ratio [HR], 1.88 [95% CI, 1.50 to 2.36], P < .001; survival: HR, 1.77 [95% CI, 1.41 to 2.22], P < .001) remained significant when adjusting for C1 response. MRD positivity appeared less discriminatory in poor-risk patients by stratified analyses. For the NPM1-wt standard-risk subgroup, C2 MRD+ was significantly associated with poorer outcomes (OS, 33% v 63% MRD-, P = .003; relapse incidence, 89% when MRD+ ≥ 0.1%); transplant benefit was more apparent in patients with MRD+ (HR, 0.72; 95% CI, 0.31 to 1.69) than those with MRD- (HR, 1.68 [95% CI, 0.75 to 3.85]; P = .16 for interaction). Conclusion MFC-MRD can improve outcome stratification by extending the definition of partial response after first induction and may help predict NPM1-wt standard-risk patients with poor outcome who benefit from transplant in the first CR.
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Affiliation(s)
- Sylvie D. Freeman
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Robert K. Hills
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Paul Virgo
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Naeem Khan
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Steve Couzens
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Richard Dillon
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Gilkes
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Laura Upton
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Ove Juul Nielsen
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - James D. Cavenagh
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Gail Jones
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Asim Khwaja
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Paul Cahalin
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Ian Thomas
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - David Grimwade
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Alan K. Burnett
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
| | - Nigel H. Russell
- Sylvie D. Freeman and Naeem Khan, University of Birmingham, Birmingham; Robert K. Hills, Amanda Gilkes, Laura Upton, Ian Thomas, and Alan K. Burnett, Cardiff University; Steve Couzens University Hospital of Wales, Cardiff; Paul Virgo, North Bristol NHS Trust, Bristol; Richard Dillon and David Grimwade, King's College London School of Medicine; James D. Cavenagh, Queen Mary University of London; Asim Khwaja, University College London, London; Gail Jones, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle; Paul Cahalin, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool; Nigel H. Russell, Nottingham University Hospital, Nottingham, United Kingdom; Ove Juul Nielsen, Rigshospitalet, Copenhagen, Denmark
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28
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Sellar RS, Gale RE, Khwaja A, Garbowski M, Loddo M, Stoeber K, Williams GH, Linch DC. Immunophenotypic analysis of cell cycle status in acute myeloid leukaemia: relationship to cytogenetics, genotype and clinical outcome. Br J Haematol 2018; 181:486-494. [PMID: 29676467 DOI: 10.1111/bjh.15211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/17/2017] [Accepted: 02/01/2018] [Indexed: 11/30/2022]
Abstract
Cell cycle status may play an important role in directing patient therapy. We therefore determined the cell cycle status of leukaemic cells by immunophenotypic analysis of bone marrow trephine biopsies from 181 patients with acute myeloid leukaemia (AML) and correlated the results with biological features and clinical outcome. There was considerable heterogeneity between patients. The presenting white cell count significantly correlated with the proportion of non-quiescent cells (P < 0·0001), of cycling cells beyond G1 (P < 0·0001) and the speed of cycling (P < 0·0001). Profiles in acute promyelocytic leukaemia (APL) differed from non-APL and were consistent with more differentiated cells with reduced proliferative potential, but no significant differences were observed between non-APL cytogenetic risk groups. NPM1 mutations but not FLT3 internal tandem duplication (FLT3ITD ) were significantly associated with a higher proportion of cells beyond G1 (P = 0·002) and faster speed of cycling (P = 0·003). Resistance to standard cytosine arabinoside and daunorubicin induction chemotherapy was significantly related to a slower speed of cycling (P = 0·0002), as was a higher relapse rate (P = 0·05), but not with the proportion of non-quiescent cells or actively cycling cells. These results show a link between the cycling speed of AML cells and the response to chemotherapy, and help to identify a group with a very poor prognosis.
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Affiliation(s)
- Rob S Sellar
- Department of Haematology, UCL Cancer Institute, London, UK
| | | | - Asim Khwaja
- Department of Haematology, UCL Cancer Institute, London, UK
| | | | - Marco Loddo
- Department of Pathology, UCL Cancer Institute, London, UK
| | - Kai Stoeber
- Department of Pathology, UCL Cancer Institute, London, UK.,Shinogi Ltd, London, UK
| | - Gareth H Williams
- Department of Pathology, UCL Cancer Institute, London, UK.,Oncologica Ltd, Cambridge, UK
| | - David C Linch
- Department of Haematology, UCL Cancer Institute, London, UK
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29
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Abstract
Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) and is part of the CKD-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of fracture and mortality; thus, SHPT control is recommended as kidney function declines. Effective SHPT management becomes more difficult once skeletal and cardiovascular adverse effects associated with severe SHPT have become established. However, interventional studies to lower parathyroid hormone (PTH) have so far shown inconsistent results in improving patient-centred outcomes such as mortality, cardiovascular events and fracture. Pharmacological treatment effect on PTH level is also inconsistent between pre-dialysis CKD and dialysis patients, which adds to the complexity of SHPT management. This review aims to give an overview on the pathophysiology, pharmacological and non-pharmacological treatment for SHPT in CKD including some of the limitations of current therapeutic options.
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Affiliation(s)
- S N Salam
- Sheffield Kidney Institute, Sheffield, UK
| | - A Khwaja
- Sheffield Kidney Institute, Sheffield, UK
| | - M E Wilkie
- Sheffield Kidney Institute, Sheffield, UK.
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30
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Mlcochova P, Sutherland KA, Watters SA, Bertoli C, de Bruin RA, Rehwinkel J, Neil SJ, Lenzi GM, Kim B, Khwaja A, Gage MC, Georgiou C, Chittka A, Yona S, Noursadeghi M, Towers GJ, Gupta RK. A G1-like state allows HIV-1 to bypass SAMHD1 restriction in macrophages. EMBO J 2017; 36:604-616. [PMID: 28122869 PMCID: PMC5331754 DOI: 10.15252/embj.201696025] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/16/2016] [Accepted: 12/21/2016] [Indexed: 01/09/2023] Open
Abstract
An unresolved question is how HIV-1 achieves efficient replication in terminally differentiated macrophages despite the restriction factor SAMHD1. We reveal inducible changes in expression of cell cycle-associated proteins including MCM2 and cyclins A, E, D1/D3 in macrophages, without evidence for DNA synthesis or mitosis. These changes are induced by activation of the Raf/MEK/ERK kinase cascade, culminating in upregulation of CDK1 with subsequent SAMHD1 T592 phosphorylation and deactivation of its antiviral activity. HIV infection is limited to these G1-like phase macrophages at the single-cell level. Depletion of SAMHD1 in macrophages decouples the association between infection and expression of cell cycle-associated proteins, with terminally differentiated macrophages becoming highly susceptible to HIV-1. We observe both embryo-derived and monocyte-derived tissue-resident macrophages in a G1-like phase at frequencies approaching 20%, suggesting how macrophages sustain HIV-1 replication in vivo Finally, we reveal a SAMHD1-dependent antiretroviral activity of histone deacetylase inhibitors acting via p53 activation. These data provide a basis for host-directed therapeutic approaches aimed at limiting HIV-1 burden in macrophages that may contribute to curative interventions.
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Affiliation(s)
- Petra Mlcochova
- Division of Infection and Immunity, University College London, London, UK
| | | | - Sarah A Watters
- Division of Infection and Immunity, University College London, London, UK
| | - Cosetta Bertoli
- MRC Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Rob Am de Bruin
- MRC Laboratory for Molecular Cell Biology, University College London, London, UK
| | - Jan Rehwinkel
- Medical Research Council Human Immunology Unit, Radcliffe Department of Medicine, Medical Research Council Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Stuart J Neil
- Division of Immunology, Infection and Inflammatory Disease, King's College, London, UK
| | - Gina M Lenzi
- Department of Pediatrics, Center for Drug Discovery, Emory School of Medicine, Atlanta, GA, USA
| | - Baek Kim
- Department of Pediatrics, Center for Drug Discovery, Emory School of Medicine, Atlanta, GA, USA
| | - Asim Khwaja
- Research Department of Haematology, UCL, London, UK
| | - Matthew C Gage
- Division of Medicine, University College London, London, UK
| | | | | | - Simon Yona
- Division of Medicine, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Greg J Towers
- Division of Infection and Immunity, University College London, London, UK
| | - Ravindra K Gupta
- Division of Infection and Immunity, University College London, London, UK
- Africa Health Research Institute, KwaZulu Natal, South Africa
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31
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Burnett A, Cavenagh J, Russell N, Hills R, Kell J, Jones G, Nielsen OJ, Khwaja A, Thomas I, Clark R. Defining the dose of gemtuzumab ozogamicin in combination with induction chemotherapy in acute myeloid leukemia: a comparison of 3 mg/m2 with 6 mg/m2 in the NCRI AML17 Trial. Haematologica 2016; 101:724-31. [PMID: 26921360 PMCID: PMC5013968 DOI: 10.3324/haematol.2016.141937] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 01/05/2016] [Accepted: 02/23/2016] [Indexed: 11/09/2022] Open
Abstract
Arecent source data meta-analysis of randomized trials in adults assessing the immunoconjugate gemtuzumab ozogamicin combined with standard chemotherapy in acute myeloid leukemia showed a significant survival benefit in patients without an adverse karyotype. It is not clear whether the optimal dose should be 3 mg/m(2) or 6 mg/m(2) In this study, we randomized 788 patients to a single dose of gemtuzumab ozogamicin 3 mg/m(2) or 6 mg/m(2) with the first course of induction therapy. We found that the rate of complete remission was higher with 3 mg/m(2) [82% vs 76%; odds ratio 1.46 (1.04-2.06); P=0.03], but this was balanced by a higher rate of complete remission with incomplete peripheral blood count recovery in the 6 mg/m(2) treatment (10% vs 7%) resulting in similar overall response rate [89% vs 86%; hazard ratio 1.34 (0.88-2.04); P=0.17]. There was no overall difference in relapse or survival at four years between the arms: 46% vs 54%; hazard ratio 1.17 (0.94-1.45), P=0.5, and 50% versus 47%; hazard ratio 1.10 (0.90-1.34), P=0.3, respectively. The 30- and 60-day mortality was significantly higher in the 6 mg/m(2) recipients: 7% versus 3%; hazard ratio 2.07 (1.11-3.87), P=0.02, and 9% versus 5%; hazard ratio 1.99 (1.17-3.39), P=0.01, respectively, which in addition was associated with a higher rate of veno-occlusive disease (5.6% vs 0.5%; P<0.0001). Our conclusion from this trial is that there is no advantage in using a single dose of 6 mg/m(2) of gemtuzumab ozogamicin in combination with induction chemotherapy when compared with a 3 mg/m(2) dose, with respect to response, disease-free and overall survival, either overall, or in any disease subgroup. (AML17 was registered as ISRCTN55675535).
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MESH Headings
- Adolescent
- Adult
- Aged
- Aminoglycosides/administration & dosage
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Female
- Gemtuzumab
- Humans
- Infant
- Infant, Newborn
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Odds Ratio
- Recurrence
- Remission Induction
- Survival Analysis
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Alan Burnett
- Department of Haematology, Cardiff University School of Medicine, UK
| | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, West Smithfield, London UK
| | - Nigel Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, UK
| | - Robert Hills
- Department of Haematology, Cardiff University School of Medicine, UK
| | - Jonathan Kell
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Gail Jones
- Department of Haematology, Newcastle Teaching Hospitals NHS Trust, UK
| | | | - Asim Khwaja
- Department of Haematology, University College, London Cancer Institute, UK
| | - Ian Thomas
- Department of Haematology, Cardiff University School of Medicine, UK
| | - Richard Clark
- Department of Haematology, Royal Liverpool University Hospital, UK
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32
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Tron AE, Keeton EK, Ye M, Casas-Selves M, Chen H, Dillman KS, Gale RE, Stengel C, Zinda M, Linch DC, Lai Z, Khwaja A, Huszar D. Next-generation sequencing identifies a novel ELAVL1-TYK2 fusion gene in MOLM-16, an AML cell line highly sensitive to the PIM kinase inhibitor AZD1208. Leuk Lymphoma 2016; 57:2927-2929. [PMID: 27189703 DOI: 10.3109/10428194.2016.1171861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Erika K Keeton
- a Oncology iMed, AstraZeneca , Waltham , MA , USA.,b N-of-One, Inc , Lexington , MA , USA
| | - Minwei Ye
- a Oncology iMed, AstraZeneca , Waltham , MA , USA
| | - Matias Casas-Selves
- a Oncology iMed, AstraZeneca , Waltham , MA , USA.,c Drug Discovery Program, Ontario Institute for Cancer Research , Toronto , Canada
| | - Huawei Chen
- a Oncology iMed, AstraZeneca , Waltham , MA , USA
| | | | - Rosemary E Gale
- d Department of Haematology , University College London Cancer Institute , London , UK
| | - Chloe Stengel
- d Department of Haematology , University College London Cancer Institute , London , UK
| | | | - David C Linch
- d Department of Haematology , University College London Cancer Institute , London , UK
| | - Zhongwu Lai
- a Oncology iMed, AstraZeneca , Waltham , MA , USA
| | - Asim Khwaja
- d Department of Haematology , University College London Cancer Institute , London , UK
| | - Dennis Huszar
- a Oncology iMed, AstraZeneca , Waltham , MA , USA.,e Oncology Drug Discover Unit, Takeda Pharmaceuticals International Co , Cambridge , MA , USA
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33
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Sellar RS, Fraser L, Khwaja A, Gale RE, Marafioti T, Akarca A, Hubank M, Brooks T, Stoeber K, Williams G, Linch DC. Cell cycle status in AML blast cells from peripheral blood, bone marrow aspirates and trephines and implications for biological studies and treatment. Br J Haematol 2016; 174:275-9. [PMID: 27061724 DOI: 10.1111/bjh.14055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/16/2015] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Abstract
Using immunohistochemistry and flow cytometry to define phases of the cell cycle, this study shows that a high proportion of acute myeloid leukaemia (AML) blasts obtained from trephine biopsies are cycling, whereas >95% of peripheral blood-derived blasts are arrested in G1 . Results obtained from bone marrow aspirates are more similar to those from blood rather than from trephine biopsies. These differences were confirmed by gene expression profiling in a patient with high count AML. This has implications for cell cycle and other biological studies using aspirates rather than trephine biopsies and for the use of cell mobilising agents before chemotherapy.
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Affiliation(s)
- Rob S Sellar
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Laura Fraser
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Rosemary E Gale
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Teresa Marafioti
- Department of Histopathology, University College London Hospitals, London, UK.,Department of Cellular Pathology, University College London Hospitals, London, UK
| | - Ayse Akarca
- Department of Histopathology, University College London Hospitals, London, UK.,Department of Cellular Pathology, University College London Hospitals, London, UK
| | - Mike Hubank
- Genetics and Genomic Medicine Programme, UCL Institute of Child Health, London, UK
| | - Tony Brooks
- Genetics and Genomic Medicine Programme, UCL Institute of Child Health, London, UK
| | - Kai Stoeber
- Department of Histopathology, University College London Hospitals, London, UK
| | - Gareth Williams
- Department of Histopathology, University College London Hospitals, London, UK
| | - David C Linch
- Department of Haematology, University College London Cancer Institute, London, UK
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34
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Khwaja A, Bjorkholm M, Gale RE, Levine RL, Jordan CT, Ehninger G, Bloomfield CD, Estey E, Burnett A, Cornelissen JJ, Scheinberg DA, Bouscary D, Linch DC. Acute myeloid leukaemia. Nat Rev Dis Primers 2016; 2:16010. [PMID: 27159408 DOI: 10.1038/nrdp.2016.10] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute myeloid leukaemia (AML) is a disorder characterized by a clonal proliferation derived from primitive haematopoietic stem cells or progenitor cells. Abnormal differentiation of myeloid cells results in a high level of immature malignant cells and fewer differentiated red blood cells, platelets and white blood cells. The disease occurs at all ages, but predominantly occurs in older people (>60 years of age). AML typically presents with a rapid onset of symptoms that are attributable to bone marrow failure and may be fatal within weeks or months when left untreated. The genomic landscape of AML has been determined and genetic instability is infrequent with a relatively small number of driver mutations. Mutations in genes involved in epigenetic regulation are common and are early events in leukaemogenesis. The subclassification of AML has been dependent on the morphology and cytogenetics of blood and bone marrow cells, but specific mutational analysis is now being incorporated. Improvements in treatment in younger patients over the past 35 years has largely been due to dose escalation and better supportive care. Allogeneic haematopoietic stem cell transplantation may be used to consolidate remission in those patients who are deemed to be at high risk of relapse. A plethora of new agents - including those targeted at specific biochemical pathways and immunotherapeutic approaches - are now in trial based on improved understanding of disease pathophysiology. These advances provide good grounds for optimism, although mortality remains high especially in older patients.
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Affiliation(s)
- Asim Khwaja
- Department of Haematology, University College London, UCL Cancer Institute, 72 Huntley Street, London WC1E 6DD, UK
| | - Magnus Bjorkholm
- Department of Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Rosemary E Gale
- Department of Haematology, University College London, UCL Cancer Institute, 72 Huntley Street, London WC1E 6DD, UK
| | - Ross L Levine
- Human Oncology and Pathogenesis Program, Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Craig T Jordan
- Division of Hematology, University of Colorado Denver, Denver, Colorado, USA
| | - Gerhard Ehninger
- Department of Internal Medicine, Technical University Dresden, Dresden, Germany
| | | | - Eli Estey
- Division of Hematology, University of Washington and Clinical Research Division Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | - David A Scheinberg
- Molecular Pharmacology Program, Experimental Therapeutics Center, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Didier Bouscary
- Institut Cochin, Département Développement Reproduction Cancer, CNRS UMR8104, INSERM U1016, Paris, France.,Service d'Hématologie, Hôpital Cochin, AP-HP, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
| | - David C Linch
- Department of Haematology, University College London, UCL Cancer Institute, 72 Huntley Street, London WC1E 6DD, UK
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35
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Burnett AK, Russell NH, Hills RK, Bowen D, Kell J, Knapper S, Morgan YG, Lok J, Grech A, Jones G, Khwaja A, Friis L, McMullin MF, Hunter A, Clark RE, Grimwade D. Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial. Lancet Oncol 2015; 16:1295-305. [PMID: 26384238 DOI: 10.1016/s1470-2045(15)00193-x] [Citation(s) in RCA: 341] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute promyelocytic leukaemia is a chemotherapy-sensitive subgroup of acute myeloid leukaemia characterised by the presence of the PML-RARA fusion transcript. The present standard of care, chemotherapy and all-trans retinoic acid (ATRA), results in a high proportion of patients being cured. In this study, we compare a chemotherapy-free ATRA and arsenic trioxide treatment regimen with the standard chemotherapy-based regimen (ATRA and idarubicin) in both high-risk and low-risk patients with acute promyelocytic leukaemia. METHODS In the randomised, controlled, multicentre, AML17 trial, eligible patients (aged ≥16 years) with acute promyelocytic leukaemia, confirmed by the presence of the PML-RARA transcript and without significant cardiac or pulmonary comorbidities or active malignancy, and who were not pregnant or breastfeeding, were enrolled from 81 UK hospitals and randomised 1:1 to receive treatment with ATRA and arsenic trioxide or ATRA and idarubicin. ATRA was given to participants in both groups in a daily divided oral dose of 45 mg/m(2) until remission, or until day 60, and then in a 2 weeks on-2 weeks off schedule. In the ATRA and idarubicin group, idarubicin was given intravenously at 12 mg/m(2) on days 2, 4, 6, and 8 of course 1, and then at 5 mg/m(2) on days 1-4 of course 2; mitoxantrone at 10 mg/m(2) on days 1-4 of course 3, and idarubicin at 12 mg/m(2) on day 1 of the final (fourth) course. In the ATRA and arsenic trioxide group, arsenic trioxide was given intravenously at 0·3 mg/kg on days 1-5 of each course, and at 0·25 mg/kg twice weekly in weeks 2-8 of course 1 and weeks 2-4 of courses 2-5. High-risk patients (those presenting with a white blood cell count >10 × 10(9) cells per L) could receive an initial dose of the immunoconjugate gemtuzumab ozogamicin (6 mg/m(2) intravenously). Neither maintenance treatment nor CNS prophylaxis was given to patients in either group. All patients were monitored by real-time quantitative PCR. Allocation was by central computer minimisation, stratified by age, performance status, and de-novo versus secondary disease. The primary endpoint was quality of life on the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health status. All analyses are by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN55675535. FINDINGS Between May 8, 2009, and Oct 3, 2013, 235 patients were enrolled and randomly assigned to ATRA and idarubicin (n=119) or ATRA and arsenic trioxide (n=116). Participants had a median age of 47 years (range 16-77; IQR 33-58) and included 57 high-risk patients. Quality of life did not differ significantly between the treatment groups (EORTC QLQ-C30 global functioning effect size 2·17 [95% CI -2·79 to 7·12; p=0·39]). Overall, 57 patients in the ATRA and idarubicin group and 40 patients in the ATRA and arsenic trioxide group reported grade 3-4 toxicities. After course 1 of treatment, grade 3-4 alopecia was reported in 23 (23%) of 98 patients in the ATRA and idarubicin group versus 5 (5%) of 95 in the ATRA and arsenic trioxide group, raised liver alanine transaminase in 11 (10%) of 108 versus 27 (25%) of 109, oral toxicity in 22 (19%) of 115 versus one (1%) of 109. After course 2 of treatment, grade 3-4 alopecia was reported in 25 (28%) of 89 patients in the ATRA and idarubicin group versus 2 (3%) of 77 in the ATRA and arsenic trioxide group; no other toxicities reached the 10% level. Patients in the ATRA and arsenic trioxide group had significantly less requirement for most aspects of supportive care than did those in the ATRA and idarubicin group. INTERPRETATION ATRA and arsenic trioxide is a feasible treatment in low-risk and high-risk patients with acute promyelocytic leukaemia, with a high cure rate and less relapse than, and survival not different to, ATRA and idarubicin, with a low incidence of liver toxicity. However, no improvement in quality of life was seen.
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Affiliation(s)
- Alan K Burnett
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK.
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Robert K Hills
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK
| | - David Bowen
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Kell
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Steve Knapper
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK
| | - Yvonne G Morgan
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Jennie Lok
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Angela Grech
- Department of Haematology Cardiff University School of Medicine, Cardiff, UK
| | - Gail Jones
- Department of Haematology, Newcastle Teaching Hospitals NHS Trust, Newcastle, UK
| | - Asim Khwaja
- Department of Haematology, University College Hospitals, London, UK
| | - Lone Friis
- Department of Haematology, Rigshospitalet, National University Hospital, Copenhagen, Denmark
| | | | - Ann Hunter
- Department of Haematology, Leicester Royal Infirmary, Leicester, UK
| | - Richard E Clark
- Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
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McEachern K, Keeton E, Dillman K, Ye M, Stengel C, Chen H, Wang S, Grosskurth S, Gale RE, Linch DC, Khwaja A, Lai Z, Huszar D. Abstract 2063: A novel ELAVL1-TYK2 fusion protein drives STAT3/5 activation and PIM-1 expression, survival and growth in the MOLM-16 acute myeloid leukemia cell line. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Pim kinases are upregulated in leukemias and lymphomas and mediate cell growth and survival. Acute myeloid leukemia cell lines sensitive to the pan-Pim kinase inhibitor AZD1208 showed elevated pSTAT5 and Pim-1 expression that correlated with known tyrosine kinase mutations. However, one of the most sensitive lines, MOLM-16, lacked a reported driver mutation. RNA transcriptome sequencing identified a novel fusion gene comprised of the TYK2 kinase domain fused to the N-terminus of the RNA binding protein ELAVL1/HuR. The genes are co-localized within ∼2 MB on the short arm of chromosome 19, at position 13.2. The fusion results in loss of the Tyk2 pseudokinase domain, which negatively regulates kinase activity, suggesting a gain of function genetic alteration. Tyk2 was highly expressed and found to be amplified in MOLM-16 cells, with a higher degree of amplification of the exons encoding the kinase domain. Knockdown experiments demonstrated that down-regulation of the fusion gene, but not of the wild type ELAVL1 or TYK2 transcripts, resulted in suppression of STAT3/5 phosphorylation, Pim1 levels, and proliferation. Conversely, expression of the ELAVL1-TYK2 fusion protein in FDCP1 cells was shown to confer IL-3 independent growth. The fusion was not identified in screening of ∼200 AML patient samples or through analysis of TCGA data suggesting that it occurs at a low frequency, but interestingly NPM1-Tyk2 fusions have recently been described in cutaneous CD30-positive lymphoproliferative disorders (Velusamy et al. Blood 2014).
Citation Format: Kristen McEachern, Erika Keeton, Keith Dillman, Minwei Ye, Chloe Stengel, Huawei Chen, Suping Wang, Shaun Grosskurth, Rosemary E. Gale, David C. Linch, Asim Khwaja, Zhongwu Lai, Dennis Huszar. A novel ELAVL1-TYK2 fusion protein drives STAT3/5 activation and PIM-1 expression, survival and growth in the MOLM-16 acute myeloid leukemia cell line. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2063. doi:10.1158/1538-7445.AM2015-2063
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Affiliation(s)
| | | | | | | | - Chloe Stengel
- 2University College London Cancer Institute, London, United Kingdom
| | | | | | | | - Rosemary E. Gale
- 2University College London Cancer Institute, London, United Kingdom
| | - David C. Linch
- 2University College London Cancer Institute, London, United Kingdom
| | - Asim Khwaja
- 2University College London Cancer Institute, London, United Kingdom
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Tinsley S, Meja K, Shepherd C, Khwaja A. Synergistic induction of cell death in haematological malignancies by combined phosphoinositide-3-kinase and BET bromodomain inhibition. Br J Haematol 2015; 170:275-8. [PMID: 25640480 DOI: 10.1111/bjh.13283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Steven Tinsley
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Koremu Meja
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Clare Shepherd
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London Cancer Institute, London, UK.
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Beshyah AS, AlBhaisi SA, Krishnanreddy K, Khwaja A. INFERIOR VENA CAVA FILTERS IN THE INTENSIVE CARE UNIT POPULATION: SINGLE CENTER EXPERIENCE IN THE UNITED ARAB EMIRATES. Intensive Care Med Exp 2015. [PMCID: PMC4797255 DOI: 10.1186/2197-425x-3-s1-a970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Meja K, Stengel C, Sellar R, Huszar D, Davies BR, Gale RE, Linch DC, Khwaja A. PIM and AKT kinase inhibitors show synergistic cytotoxicity in acute myeloid leukaemia that is associated with convergence on mTOR and MCL1 pathways. Br J Haematol 2014; 167:69-79. [PMID: 24975213 DOI: 10.1111/bjh.13013] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 04/11/2014] [Accepted: 05/29/2014] [Indexed: 01/20/2023]
Abstract
PIM kinases (PIM1, 2 and 3) are involved in cell proliferation and survival signalling and are emerging targets for the therapy of various malignancies. We found that a significant proportion of primary acute myeloid leukaemia (AML) samples showed PIM1 and PIM2 expression by quantitative reverse transcription polymerase chain reaction. Therefore, we investigated the effects of a novel ATP-competitive pan-PIM inhibitor, AZD1897, on AML cell growth and survival. PIM inhibition showed limited single agent activity in AML cell lines and primary AML cells, including those with or without FLT3-internal tandem duplication (ITD) mutation. However, significant synergy was seen when AZD1897 was combined with the Akt inhibitor AZD5363, a compound that is in early-phase clinical trials. AML cells from putative leukaemia stem cell subsets, including CD34+38- and CD34+38+ fractions, were equivalently affected by dual PIM/Akt inhibition when compared with bulk tumour cells. Analysis of downstream signalling pathways showed that combined PIM/Akt inhibition downregulated mTOR outputs (phosphorylation of 4EBP1 and S6) and markedly reduced levels of the anti-apoptotic protein MCL1. The combination of PIM and Akt inhibition holds promise for the treatment of AML.
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Affiliation(s)
- Koremu Meja
- Department of Haematology, University College London Cancer Institute, London, UK
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Abstract
Some studies have suggested that cases of acute myeloid leukemia (AML) with low levels of FLT3 internal tandem duplications (FLT3(ITD)) do not have a worse prognosis if there is a concomitant NPM1 mutation, although this is controversial. To clarify this therapeutically important issue, we have analyzed FLT3(ITD) and NPM1(MUT) levels in 1609 younger adult cases of cytogenetically intermediate-risk AML. The cumulative incidence of relapse was increased in NPM1(MUT) cases by the presence of a FLT3(ITD), but did not differ markedly according to FLT3(ITD) level. This remained true when allowance was made for poor leukemic cell purity by adjustment of the FLT3(ITD) level to the measured NPM1(MUT) level. If consolidation therapies are to be determined by relapse risk, then NPM1(MUT) cases with low-level FLT3(ITD) should not be considered as good risk without further studies. AML 12 and AML 15 are registered at http://www.controlled-trials.com under ISRCTN17833622 and ISRCTN17161961, respectively.
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Affiliation(s)
- David C Linch
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
| | - Robert K Hills
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Alan K Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Asim Khwaja
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
| | - Rosemary E Gale
- Department of Haematology, University College London Cancer Institute, London, United Kingdom; and
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Abstract
A PI3Kδ-selective inhibitor shows impressive clinical activity in chronic lymphocytic leukemia and indolent B cell non-Hodgkin's lymphomas. In these malignancies, the PI3K pathway is not mutationally activated as in many other cancers, but it is important for mediating supportive cues from the cancer microenvironment and the B cell antigen receptor.
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Affiliation(s)
- Bart Vanhaesebroeck
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK.
| | - Asim Khwaja
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK
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Linch M, Sanz-Garcia M, Rosse C, Riou P, Peel N, Madsen CD, Sahai E, Downward J, Khwaja A, Dillon C, Roffey J, Cameron AJ, Parker PJ. Regulation of polarized morphogenesis by protein kinase C iota in oncogenic epithelial spheroids. Carcinogenesis 2014; 35:396-406. [PMID: 24072773 PMCID: PMC3908745 DOI: 10.1093/carcin/bgt313] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 08/07/2013] [Accepted: 08/24/2013] [Indexed: 12/20/2022] Open
Abstract
Protein kinase C iota (PKCι), a serine/threonine kinase required for cell polarity, proliferation and migration, is commonly up- or downregulated in cancer. PKCι is a human oncogene but whether this is related to its role in cell polarity and what repertoire of oncogenes acts in concert with PKCι is not known. We developed a panel of candidate oncogene expressing Madin-Darby canine kidney (MDCK) cells and demonstrated that H-Ras, ErbB2 and phosphatidylinositol 3-kinase transformation led to non-polar spheroid morphogenesis (dysplasia), whereas MDCK spheroids expressing c-Raf or v-Src were largely polarized. We show that small interfering RNA (siRNA)-targeting PKCι decreased the size of all spheroids tested and partially reversed the aberrant polarity phenotype in H-Ras and ErbB2 spheroids only. This indicates distinct requirements for PKCι and moreover that different thresholds of PKCι activity are required for these phenotypes. By manipulating PKCι function using mutant constructs, siRNA depletion or chemical inhibition, we have demonstrated that PKCι is required for polarization of parental MDCK epithelial cysts in a 3D matrix and that there is a threshold of PKCι activity above and below which, disorganized epithelial morphogenesis results. Furthermore, treatment with a novel PKCι inhibitor, CRT0066854, was able to restore polarized morphogenesis in the dysplastic H-Ras spheroids. These results show that tightly regulated PKCι is required for normal-polarized morphogenesis in mammalian cells and that H-Ras and ErbB2 cooperate with PKCι for loss of polarization and dysplasia. The identification of a PKCι inhibitor that can restore polarized morphogenesis has implications for the treatment of Ras and ErbB2 driven malignancies.
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Affiliation(s)
- Mark Linch
- Department of Protein Phosphorylation, Cancer Research UK London Research Institute, London WC2A 3LY, UK
- Sarcoma Unit, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Marta Sanz-Garcia
- Department of Protein Phosphorylation, Cancer Research UK London Research Institute, London WC2A 3LY, UK
| | - Carine Rosse
- Department of Protein Phosphorylation, Cancer Research UK London Research Institute, London WC2A 3LY, UK
| | - Philippe Riou
- Department of Protein Phosphorylation, Cancer Research UK London Research Institute, London WC2A 3LY, UK
| | - Nick Peel
- Department of Protein Phosphorylation, Cancer Research UK London Research Institute, London WC2A 3LY, UK
| | | | | | - Julian Downward
- Department of Signal Transduction Laboratories, Cancer Research UK London Research Institute, London WC2A 3LY, UK
| | - Asim Khwaja
- Department of Haematology, UCL Cancer Institute, University College London, London WC1E 6BT, UK
| | - Christian Dillon
- Cancer Research Technology Discovery Laboratories, Wolfson Institute for Biomedical Research, University College London, London WC1E 6BT, UK and
| | - Jon Roffey
- Cancer Research Technology Discovery Laboratories, Wolfson Institute for Biomedical Research, University College London, London WC1E 6BT, UK and
| | - Angus J.M. Cameron
- Department of Protein Phosphorylation, Cancer Research UK London Research Institute, London WC2A 3LY, UK
| | - Peter J. Parker
- Department of Protein Phosphorylation, Cancer Research UK London Research Institute, London WC2A 3LY, UK
- Division of Cancer Studies, King’s College London, London SE1 1UL, UK
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Uttenthal B, Martinez-Davila I, Ivey A, Craddock C, Chen F, Virchis A, Kottaridis P, Grimwade D, Khwaja A, Stauss H, Morris EC. Wilms' Tumour 1 (WT1) peptide vaccination in patients with acute myeloid leukaemia induces short-lived WT1-specific immune responses. Br J Haematol 2013; 164:366-75. [PMID: 24422723 PMCID: PMC4253125 DOI: 10.1111/bjh.12637] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/06/2013] [Indexed: 12/04/2022]
Abstract
Wilms’ Tumour 1 (WT1) is a zinc finger transcription factor that is over-expressed in acute myeloid leukaemia (AML). Its restricted expression in normal tissues makes it a promising target for novel immunotherapies aiming to accentuate the cytotoxic T lymphocyte (CTL) response against AML. Here we report a phase I/II clinical trial of subcutaneous peptide vaccination with two separate HLA-A2-binding peptide epitopes derived from WT1, together with a pan-DR binding peptide epitope (PADRE), in Montanide adjuvant. Eight HLA-A2-positive patients with poor risk AML received five vaccination cycles at 3-weekly intervals. The three cohorts received 0·3, 0·6 and 1 mg of each peptide, respectively. In six patients, WT1-specific CTL responses were detected using enzyme-linked immunosorbent spot assays and pWT126/HLA-A*0201 tetramer staining, after ex vivo stimulation with the relevant WT1 peptides. However, re-stimulation of these WT1-specific T cells failed to elicit secondary expansion in all four patients tested, suggesting that the WT1-specific CD8+ T cells generated following vaccination may be functionally impaired. No correlation was observed between peptide dose, cellular immune response, reduction in WT1mRNA expression and clinical response. Larger studies are indicated to confirm these findings.
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Affiliation(s)
- Benjamin Uttenthal
- UCL Division of Infection and Immunity, Department of Immunology, University College London, London, UK
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Blombery P, Kothari J, Yong K, Allen C, Gale RE, Khwaja A. Plasma cell neoplasm associated chronic neutrophilic leukemia with membrane proximal and truncatingCSF3Rmutations. Leuk Lymphoma 2013; 55:1661-2. [DOI: 10.3109/10428194.2013.842990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ahmad OF, Keane MG, McCartney S, Khwaja A, Bloom SL. Azathioprine-associated myelodysplastic syndrome in two patients with ulcerative colitis. Frontline Gastroenterol 2013; 4:205-209. [PMID: 28839727 PMCID: PMC5369798 DOI: 10.1136/flgastro-2012-100276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/24/2013] [Accepted: 02/25/2013] [Indexed: 02/04/2023] Open
Abstract
Azathioprine is a commonly used immunosuppressive agent in post-transplantation regimens and autoimmune diseases. An increased risk of lymphoma with thiopurine therapy in patients with inflammatory bowel disease has been described previously; however, there are few reported cases of azathioprine therapy-related myelodysplastic syndrome and acute myeloid leukaemia. We report two patients with ulcerative colitis who subsequently developed azathioprine-related myelodysplastic syndrome. It is imperative that gastroenterologists remain vigilant for this rare complication as this subset of patients has a particularly poor prognosis. These cases are also important in considering the risk of open-ended thiopurine therapy.
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Affiliation(s)
- Omer F Ahmad
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Margaret G Keane
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London Hospital, London, UK
| | - Stuart L Bloom
- Department of Gastroenterology, University College London Hospital, London, UK
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Nutter F, Khwaja A, Haylor J. Seliciclib inhibits renal hypertrophy but not fibrosis in the rat following subtotal nephrectomy. Nephron Clin Pract 2013; 122:114-22. [PMID: 23689642 DOI: 10.1159/000350248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND 5/6 subtotal nephrectomy (SNx) is a non-immune stimulus used to induce renal fibrosis. The ability of seliciclib, a cyclin-dependent kinase inhibitor, to reduce kidney hypertrophy and extracellular matrix (ECM) deposition has been examined in the SNx rat. METHODS Wistar rats were subjected to SNx under isoflurane anaesthesia. The acute effect of seliciclib 28 mg/kg (5 days) on compensatory renal growth (CRG), kidney protein and DNA was determined. In chronic studies albuminuria, hypertension and GFR were monitored. Ki67, apoptag and α-smooth muscle actin were determined by immunohistochemistry together with Masson's trichrome staining. The effect of a maximum non-hypotensive dose of seliciclib 28 mg/kg (8 weeks) was determined. RESULTS Acutely, the remnant kidney developed CRG. Seliciclib 28 mg/kg inhibited both CRG by 45% and increased kidney protein by 48% without affecting increased kidney DNA. Chronically, SNx rats developed albuminuria, hypertension, low GFR with increased tubulointerstitial cell proliferation, apoptosis, myofibroblast accumulation and enhanced ECM deposition. Seliciclib 28 mg/kg (8 weeks) had no effect on either renal function or renal pathology. Plasma concentrations of seliciclib exceeded 5 µM throughout the study. CONCLUSIONS Despite inhibition of early renal hypertrophy, a maximum non-hypotensive dose of seliciclib 28 mg/kg had no impact on the progression of kidney fibrosis in the SNx rat.
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Affiliation(s)
- F Nutter
- Academic Unit of Nephrology, Department of Infection and Immunity, Medical School Sheffield, Sheffield, UK
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El Minshawy O, Ghabrah T, Hamza A, Fadl A, Adam M, El Bassuoni E, Saran R, Tilea A, Sands R, Kiser M, Han SW, Stack A, Finkelstein F, Eisele G, Kotanko P, Levin N, Gillespie B, Krane V, Bhuvanakrishna T, Burnapp L, Hilton R, Sibley-Allen C, Blake G, Goldsmith D, Taylor-Stokes G, Ozbay AB, Sayers J, Marx SE, Yanai M, Okada K, Takeuchi K, Matsuyama K, Nitta K, Takahashi S, Delanaye P, Cavalier E, Moranne O, Lutteri L, Bruyere O, Krzesinski JM, Silverwood RJ, Richards M, Pierce M, Hardy R, Sattar N, Ferro C, Savage C, Kuh D, Nitsch D, Shin JH, Kim SH, Yu SH, Oberdhan D, Krasa HB, Cheng R, Hays RD, Chapman A, Perrone R, Cole JC, Tilea A, Hedgeman E, Steffick D, Rein-Weston A, Banerjee T, Powe N, Rios-Burrows N, Williams D, Saran R, Nagasawa Y, Yamamoto R, Shinzawa M, Hasuike Y, Kuragano T, Rakugi H, Isaka Y, Nakanishi T, Iseki K, Yamagata K, Tsuruya K, Yoshida H, Fujimoto S, Asahi K, Watanabe T, Moriyama T, Warren S, Rutherford P, Van Den Bosch J, Kusztal M, Trafidlo E, Madziarska K, Augustyniak-Bartosik H, Golebiowski T, Krajewska M, Rymaszewska J, Weyde W, Klinger M, Sato Y, Fujimoto S, Konta T, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Yoshida H, Asahi K, Kurahashi I, Ohashi Y, Watanabe T, Elsayed I, Khwaja A, Siddall S, Mortimer F, Ando M, Hara M, Tsuchiya K, Nitta K, Hiwatashi A, Hagiwara M, Tsuruoka S, Usui J, Nagai K, Kai H, Morito N, Saito C, Yoh K, Hosojima M, Saito A, Yamagata K, Stack AG, Chernenko T, Abdalla AA, Saran R, Nguyen HT, Hedgeman E, Hannigan A, Casserly LF, Abd ElHafeez S, Gad Z, Sallam S, Tripepi G, Zoccali C, ElWakil H, Awad N, Sestigiani E, Tedesco D, Mandreoli M, Ubaldi G, Olmeda F, Monti M, Rucci P, Gibertoni D, Santoro A, Zaza G, Bernich P, Lupo A, Rogacev KS, Seiler S, Zawada AM, Fliser D, Heine GH, Douros A, Schaeffner E, Jakob O, Kreutz R, Ebert N, Gerasimovska Kitanovska B, Bogdanovska S, Severova Andreevska G, Gerasimovska V, Sikole A, Rakov V, Schiepe F, Rutkowski B, Zdrojewski T, Bandosz P, Zdrojewski L, Rutkowski M, Gaciong Z, Solnica B, Jedrzejczyk T, Krol E, Wyrzykowski B, Nacak H, van Diepen M, de Goeij MCM, Dekker FW, Suzuki K, Konta T, Kamei K, Sato H, Kudo K, Nagasawa A, Ichikawa K, Kubota I, Clavero R, Vasquez N, Tapia B, Aldunate T, Heleniak Z, Cieplinska M, Pryczkowska M, Szychlinski T, Bartosinska E, Wiatr H, Kotlowska H, Tylicki L, Rutkowski B, So B, Methven S, Hair MD, Jardine AG, MacGregor MS, Jankowski V, Schulz A, Zidek W, Jankowski J, Holmar J, Fridolin I, Uhlin F, Luman M, Fernstrom A, Rodriguez I, Ortega O, Hinostroza J, Cobo G, Gallar P, Mon C, Herrero JC, Ortiz M, Di Giogia C, Oliet A, Vigil A, Premuzic V, Vrdoljak A, Fucek M, Karanovic S, Vukovic-Lela I, Kos J, Fistrek M, Dika Z, Cvitkovic A, Juric D, Laganovic M, Rogic D, Katalinic L, Jelakovic B, Vrdoljak A, Fucek M, Premuzic V, Karanovic S, Vukovic Lela I, Kos J, Fistrek M, Cvitkovic A, Jelakovic B, Deger SM, Onec K, Derici UB, Guz G, Ozturk MA, Sindel S, Arinsoy T, Hojs N, Bevc S, Hojs R, Ekart R, Koycheva R, Cholakov V, Penev M, Andreev J, Iliev R, Macia M, Jarque A, del Castillo N, Mendez ML, Martin JA, Tevar E, Bermudez C, NasrAllah MM, Osman N, Osanlou O, Greer AB, Morgan H, Archer T, Ryan N, Khalil A, Ahmed S, Melemadathil S, Ashok AV, El-Wakil HS, Asaad SH, Nawar MM, Adam AG, Abdel-Gawad MM. Epidemiology - renal outcomes. Nephrol Dial Transplant 2013; 28:i140-i154. [DOI: 10.1093/ndt/gft109] [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: 09/02/2023] Open
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Stengel C, Jenner E, Meja K, Mayekar S, Khwaja A. Proliferation of PTEN-deficient haematopoietic tumour cells is not affected by isoform-selective inhibition of p110 PI3-kinase and requires blockade of all class 1 PI3K activity. Br J Haematol 2013; 162:285-9. [PMID: 23594092 DOI: 10.1111/bjh.12353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/18/2013] [Indexed: 02/01/2023]
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Marafioti T, Copie-Bergman C, Calaminici M, Paterson JC, Shende VH, Liu H, Baia M, Ramsay AD, Agostinelli C, Brière J, Clear A, Du MQ, Piccaluga PP, Masir N, Nacheva EP, Sujobert P, Shanmugam K, Grogan TM, Brooks SP, Khwaja A, Ardeshna K, Townsend W, Pileri SA, Haioun C, Linch D, Gribben JG, Gaulard P, Isaacson PG. Another look at follicular lymphoma: immunophenotypic and molecular analyses identify distinct follicular lymphoma subgroups. Histopathology 2013; 62:860-75. [PMID: 23509938 DOI: 10.1111/his.12076] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/27/2012] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to analyse the immunophenotypic and molecular features of a large series of follicular lymphomas, focusing in particular on atypical cases that fail to express CD10 and/or bcl-2. Such cases present diagnostic pitfalls, especially with regard to the differential diagnosis from follicular hyperplasia and marginal zone B-cell lymphoma. Therefore, we also included an immunohistochemical evaluation of stathmin, which is strongly expressed by germinal centre B cells, as a putative new marker for follicular lymphomas, particularly those with an atypical phenotype. METHODS AND RESULTS Two hundred and five follicular lymphomas were investigated with immunohistochemistry and fluorescence in-situ hybridization (FISH). The use of three distinct anti-bcl-2 antibodies together with CD10 expression data and FISH analysis for bcl-2 and bcl-6 rearrangements allowed subclassification of follicular lymphoma into four distinct subgroups: (i) CD10-positive/bcl-2-positive, (ii) CD10-positive/bcl-2-negative, (iii) CD10-negative/bcl-2-positive, and (iv) CD10-negative/bcl-2-negative. All cases were bcl-6-positive. STMN1 (stathmin) was shown to be helpful in diagnosing bcl-2-negative and/or CD10-negative follicular lymphomas, and in their distinction from marginal zone B-cell lymphoma. CONCLUSIONS Combined immunohistological and molecular analyses reveal that follicular lymphomas showing an atypical immunophenotypic and molecular profile exist, and we demonstrate that STMN1 represents a novel useful diagnostic marker for these.
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Affiliation(s)
- Teresa Marafioti
- Department of Histopathology, University College Hospital, London, UK.
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Bhavsar PJ, Infante E, Khwaja A, Ridley AJ. Analysis of Rho GTPase expression in T-ALL identifies RhoU as a target for Notch involved in T-ALL cell migration. Oncogene 2013; 32:198-208. [PMID: 22349824 PMCID: PMC3378627 DOI: 10.1038/onc.2012.42] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 01/06/2012] [Accepted: 01/06/2012] [Indexed: 01/04/2023]
Abstract
NOTCH1 is frequently mutated in T-cell acute lymphoblastic leukaemia (T-ALL), and can stimulate T-ALL cell survival and proliferation. Here we explore the hypothesis that Notch1 also alters T-ALL cell migration. Rho GTPases are well known to regulate cell adhesion and migration. We have analysed the expression levels of Rho GTPases in primary T-ALL samples compared with normal T cells by quantitative PCR. We found that 5 of the 20 human Rho genes are highly and consistently upregulated in T-ALL, and 3 further Rho genes are expressed in T-ALL but not detectable in normal T cells. Of these, RHOU expression is highly correlated with the expression of the Notch1 target DELTEX-1. Inhibition of Notch1 signalling with a γ-secretase inhibitor (GSI) or Notch1 RNA interference reduced RhoU expression in T-ALL cells, whereas constitutively active Notch1 increased RhoU expression. In addition, Notch1 or RhoU depletion, or GSI treatment, inhibits T-ALL cell adhesion, migration and chemotaxis. These results indicate that NOTCH1 mutation stimulates T-ALL cell migration through RhoU upregulation that could contribute to the leukaemia cell dissemination.
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Affiliation(s)
- Parag J. Bhavsar
- Randall Division of Cell and Molecular Biophysics, King’s College London, New Hunt’s House, Guy’s Campus, London SE1 1UL, UK
| | - Elvira Infante
- Randall Division of Cell and Molecular Biophysics, King’s College London, New Hunt’s House, Guy’s Campus, London SE1 1UL, UK
- National Institute for Health Research (NIHR), Biomedical Research Centre, Guy’s and St Thomas’ NHS and King’s College London, London, UK
| | - Asim Khwaja
- UCL Cancer Institute, University College London, London, UK
| | - Anne J. Ridley
- Randall Division of Cell and Molecular Biophysics, King’s College London, New Hunt’s House, Guy’s Campus, London SE1 1UL, UK
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