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Chiodin G, Drennan S, Martino EA, Ondrisova L, Henderson I, del Rio L, Tracy I, D’Avola A, Parker H, Bonfiglio S, Scarfò L, Sutton LA, Strefford JC, Forster J, Brake O, Potter KN, Sale B, Lanham S, Mraz M, Ghia P, Stevenson FK, Forconi F. High surface IgM levels associate with shorter response to ibrutinib and BTK bypass in patients with CLL. Blood Adv 2022; 6:5494-5504. [PMID: 35640238 PMCID: PMC9631698 DOI: 10.1182/bloodadvances.2021006659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/21/2022] [Indexed: 11/20/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) cells have variably low surface IgM (sIgM) levels/signaling capacity, influenced by chronic antigen engagement at tissue sites. Within these low levels, CLL with relatively high sIgM (CLLhigh) progresses more rapidly than CLL with low sIgM (CLLlow). During ibrutinib therapy, surviving CLL cells redistribute into the peripheral blood and can recover sIgM expression. Return of CLL cells to tissue may eventually recur, where cells with high sIgM could promote tumor growth. We analyzed time to new treatment (TTNT) following ibrutinib in 70 patients with CLL (median follow-up of 66 months) and correlated it with pretreatment sIgM levels and signaling characteristics. Pretreatment sIgM levels correlated with signaling capacity, as measured by intracellular Ca2+ mobilization (iCa2+), in vitro (r = 0.70; P < .0001). High sIgM levels/signaling strongly correlated with short TTNT (P < .05), and 36% of patients with CLLhigh vs 8% of patients with CLLlow progressed to require a new treatment. In vitro, capacity of ibrutinib to inhibit sIgM-mediated signaling inversely correlated with pretherapy sIgM levels (r = -0.68; P = .01) or iCa2+ (r = -0.71; P = .009). In patients, sIgM-mediated iCa2+ and ERK phosphorylation levels were reduced by ibrutinib therapy but not abolished. The residual signaling capacity downstream of BTK was associated with high expression of sIgM, whereas it was minimal when sIgM expression was low (P < .05). These results suggested that high sIgM levels facilitated CLL cell resistance to ibrutinib in patients. The CLL cells, surviving in the periphery with high sIgM expression, include a dangerous fraction that is able to migrate to tissue and receive proliferative stimuli, which may require targeting by combined approaches.
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Affiliation(s)
- Giorgia Chiodin
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Samantha Drennan
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- T-Cypher Bio, Oxford, United Kingdom
| | - Enrica A. Martino
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Haematology, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - Laura Ondrisova
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Molecular Medicine, CEITEC Masaryk University, Brno, Czech Republic
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Isla Henderson
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Luis del Rio
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ian Tracy
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Annalisa D’Avola
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| | - Helen Parker
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Silvia Bonfiglio
- Strategic Research Program on CLL and B-cell Neoplasia Unit, Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lydia Scarfò
- Strategic Research Program on CLL and B-cell Neoplasia Unit, Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lesley-Ann Sutton
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; and
| | - Jonathan C. Strefford
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jade Forster
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Oliver Brake
- Haematology Department, Cancer Care Directorate, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Kathleen N. Potter
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Benjamin Sale
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Stuart Lanham
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Marek Mraz
- Molecular Medicine, CEITEC Masaryk University, Brno, Czech Republic
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Ghia
- Strategic Research Program on CLL and B-cell Neoplasia Unit, Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Freda K. Stevenson
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Francesco Forconi
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Haematology Department, Cancer Care Directorate, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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2
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Forconi F, Lanham SA, Chiodin G. Biological and Clinical Insight from Analysis of the Tumor B-Cell Receptor Structure and Function in Chronic Lymphocytic Leukemia. Cancers (Basel) 2022; 14:663. [PMID: 35158929 PMCID: PMC8833472 DOI: 10.3390/cancers14030663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
The B-cell receptor (BCR) is essential to the behavior of the majority of normal and neoplastic mature B cells. The identification in 1999 of the two major CLL subsets expressing unmutated immunoglobulin (Ig) variable region genes (U-IGHV, U-CLL) of pre-germinal center origin and poor prognosis, and mutated IGHV (M-CLL) of post-germinal center origin and good prognosis, ignited intensive investigations on structure and function of the tumor BCR. These investigations have provided fundamental insight into CLL biology and eventually the mechanistic rationale for the development of successful therapies targeting BCR signaling. U-CLL and M-CLL are characterized by variable low surface IgM (sIgM) expression and signaling capacity. Variability of sIgM can in part be explained by chronic engagement with (auto)antigen at tissue sites. However, other environmental elements, genetic changes, and epigenetic signatures also contribute to the sIgM variability. The variable levels have consequences on the behavior of CLL, which is in a state of anergy with an indolent clinical course when sIgM expression is low, or pushed towards proliferation and a more aggressive clinical course when sIgM expression is high. Efficacy of therapies that target BTK may also be affected by the variable sIgM levels and signaling and, in part, explain the development of resistance.
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Affiliation(s)
- Francesco Forconi
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton SO16 6YD, UK; (S.A.L.); (G.C.)
- Department of Haematology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Stuart A. Lanham
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton SO16 6YD, UK; (S.A.L.); (G.C.)
| | - Giorgia Chiodin
- School of Cancer Sciences, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton SO16 6YD, UK; (S.A.L.); (G.C.)
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Chiodin G, Allen JD, Bryant DJ, Rock P, Martino EA, Valle-Argos B, Duriez PJ, Watanabe Y, Henderson I, Blachly JS, McCann KJ, Strefford JC, Packham G, Geijtenbeek TBH, Figdor CG, Wright GW, Staudt LM, Burack R, Bowden TA, Crispin M, Stevenson FK, Forconi F. Insertion of atypical glycans into the tumor antigen-binding site identifies DLBCLs with distinct origin and behavior. Blood 2021; 138:1570-1582. [PMID: 34424958 PMCID: PMC8554650 DOI: 10.1182/blood.2021012052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022] Open
Abstract
Glycosylation of the surface immunoglobulin (Ig) variable region is a remarkable follicular lymphoma-associated feature rarely seen in normal B cells. Here, we define a subset of diffuse large B-cell lymphomas (DLBCLs) that acquire N-glycosylation sites selectively in the Ig complementarity-determining regions (CDRs) of the antigen-binding sites. Mass spectrometry and X-ray crystallography demonstrate how the inserted glycans are stalled at oligomannose-type structures because they are buried in the CDR loops. Acquisition of sites occurs in ∼50% of germinal-center B-cell-like DLBCL (GCB-DLBCL), mainly of the genetic EZB subtype, irrespective of IGHV-D-J use. This markedly contrasts with the activated B-cell-like DLBCL Ig, which rarely has sites in the CDR and does not seem to acquire oligomannose-type structures. Acquisition of CDR-located acceptor sites associates with mutations of epigenetic regulators and BCL2 translocations, indicating an origin shared with follicular lymphoma. Within the EZB subtype, these sites are associated with more rapid disease progression and with significant gene set enrichment of the B-cell receptor, PI3K/AKT/MTORC1 pathway, glucose metabolism, and MYC signaling pathways, particularly in the fraction devoid of MYC translocations. The oligomannose-type glycans on the lymphoma cells interact with the candidate lectin dendritic cell-specific intercellular adhesion molecule 3 grabbing non-integrin (DC-SIGN), mediating low-level signals, and lectin-expressing cells form clusters with lymphoma cells. Both clustering and signaling are inhibited by antibodies specifically targeting the DC-SIGN carbohydrate recognition domain. Oligomannosylation of the tumor Ig is a posttranslational modification that readily identifies a distinct GCB-DLBCL category with more aggressive clinical behavior, and it could be a potential precise therapeutic target via antibody-mediated inhibition of the tumor Ig interaction with DC-SIGN-expressing M2-polarized macrophages.
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Affiliation(s)
- Giorgia Chiodin
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Dean J Bryant
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Philip Rock
- Department of Pathology and Laboratory Medicine/Hematopathology, University of Rochester Medical Center, Rochester, NY
| | - Enrica A Martino
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
- Division of Hematology, Azienda Policlinico-Ospedale Vittorio Emanuele, University of Catania, Catania, Italy
| | - Beatriz Valle-Argos
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Patrick J Duriez
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Yasunori Watanabe
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, United Kingdom
| | - Isla Henderson
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - James S Blachly
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Katy J McCann
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Jonathan C Strefford
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Graham Packham
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Teunis B H Geijtenbeek
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Carl G Figdor
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - George W Wright
- Biometric Research Branch, Division of Cancer Diagnosis and Treatment
| | - Louis M Staudt
- Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; and
| | - Richard Burack
- Department of Pathology and Laboratory Medicine/Hematopathology, University of Rochester Medical Center, Rochester, NY
| | - Thomas A Bowden
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, United Kingdom
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Freda K Stevenson
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
| | - Francesco Forconi
- School of Cancer Sciences, Cancer Research United Kingdom Southampton Centre, Faculty of Medicine
- Haematology Department, Cancer Care Directorate, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom
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4
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Valle-Argos B, Chiodin G, Bryant DJ, Taylor J, Lemm E, Duriez PJ, Rock PJ, Strefford JC, Forconi F, Burack RW, Packham G, Stevenson FK. DC-SIGN binding to mannosylated B-cell receptors in follicular lymphoma down-modulates receptor signaling capacity. Sci Rep 2021; 11:11676. [PMID: 34083646 PMCID: PMC8175722 DOI: 10.1038/s41598-021-91112-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
In follicular lymphoma (FL), surface immunoglobulin (sIg) carries mandatory N-glycosylation sites in the variable regions, inserted during somatic hypermutation. These glycosylation sites are tumor-specific, indicating a critical function in FL. Added glycan unexpectedly terminates at high mannose (Mann) and confers capability for sIg-mediated interaction with local macrophage-expressed DC-SIGN lectin resulting in low-level activation of upstream B-cell receptor signaling responses. Here we show that despite being of low-level, DC-SIGN induces a similar downstream transcriptional response to anti-IgM in primary FL cells, characterized by activation of pathways associated with B-cell survival, proliferation and cell-cell communication. Lectin binding was also able to engage post-transcriptional receptor cross-talk pathways since, like anti-IgM, DC-SIGN down-modulated cell surface expression of CXCR4. Importantly, pre-exposure of a FL-derived cell line expressing sIgM-Mann or primary FL cells to DC-SIGN, which does not block anti-IgM binding, reversibly paralyzed the subsequent Ca2+ response to anti-IgM. These novel findings indicate that modulation of sIg function occurs in FL via lectin binding to acquired mannoses. The B-cell receptor alternative engagement described here provides two advantages to lymphoma cells: (i) activation of signaling, which, albeit of low-level, is sufficient to trigger canonical lymphoma-promoting responses, and (ii) protection from exogenous antigen by paralyzing anti-IgM-induced signaling. Blockade of this alternative engagement could offer a new therapeutic strategy.
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MESH Headings
- Calcium/metabolism
- Calcium Signaling
- Cell Adhesion Molecules/genetics
- Cell Adhesion Molecules/metabolism
- Cell Line, Tumor
- Gene Expression Regulation, Neoplastic
- Glycosylation
- Humans
- Immunoglobulin M/immunology
- Lectins, C-Type/genetics
- Lectins, C-Type/metabolism
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/metabolism
- Protein Binding
- Receptors, Antigen, B-Cell/metabolism
- Receptors, CXCR4/metabolism
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Signal Transduction
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Affiliation(s)
- Beatriz Valle-Argos
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Giorgia Chiodin
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Dean J Bryant
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Joe Taylor
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Elizabeth Lemm
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Patrick J Duriez
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Philip J Rock
- Pathology Department, University of Rochester Medical Center, NY, USA
| | - Jonathan C Strefford
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Francesco Forconi
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Richard W Burack
- Pathology Department, University of Rochester Medical Center, NY, USA
| | - Graham Packham
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK.
| | - Freda K Stevenson
- Cancer Research UK Centre, Cancer Sciences Unit, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK.
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5
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Haselager MV, Kielbassa K, Ter Burg J, Bax DJC, Fernandes SM, Borst J, Tam C, Forconi F, Chiodin G, Brown JR, Dubois J, Kater AP, Eldering E. Changes in Bcl-2 members after ibrutinib or venetoclax uncover functional hierarchy in determining resistance to venetoclax in CLL. Blood 2020; 136:2918-2926. [PMID: 32603412 DOI: 10.1182/blood.2019004326] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 12/04/2019] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) cells cycle between lymph node (LN) and peripheral blood (PB) and display major shifts in Bcl-2 family members between those compartments. Specifically, Bcl-XL and Mcl-1, which are not targeted by the Bcl-2 inhibitor venetoclax, are increased in the LN. Because ibrutinib forces CLL cells out of the LN, we hypothesized that ibrutinib may thereby affect expression of Bcl-XL and Mcl-1 and sensitize CLL cells to venetoclax. We investigated expression of Bcl-2 family members in patients under ibrutinib or venetoclax treatment, combined with dissecting functional interactions of Bcl-2 family members, in an in vitro model of venetoclax resistance. In the PB, recent LN emigrants had higher Bcl-XL and Mcl-1 expression than did cells immigrating back to the LN. Under ibrutinib treatment, this distinction collapsed; significantly, the pretreatment profile reappeared in patients who relapsed on ibrutinib. However, in response to venetoclax, Bcl-2 members displayed an early increase, underlining the different modes of action of these 2 drugs. Profiling by BH3 mimetics was performed in CLL cells fully resistant to venetoclax due to CD40-mediated induction of Bcl-XL, Mcl-1, and Bfl-1. Several dual or triple combinations of BH3 mimetics were highly synergistic in restoring killing of CLL cells. Lastly, we demonstrated that proapoptotic Bim interacts with antiapoptotic Bcl-2 members in a sequential manner: Bcl-2 > Bcl-XL > Mcl-1 > Bfl-1. Combined, the data indicate that Bcl-XL is more important in venetoclax resistance than is Mcl-1 and provide biological rationale for potential synergy between ibrutinib and venetoclax.
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MESH Headings
- Adenine/administration & dosage
- Adenine/analogs & derivatives
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Drug Resistance, Neoplasm/drug effects
- Female
- Gene Expression Regulation, Leukemic/drug effects
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Piperidines/administration & dosage
- Proto-Oncogene Proteins c-bcl-2/antagonists & inhibitors
- Proto-Oncogene Proteins c-bcl-2/biosynthesis
- Sulfonamides/administration & dosage
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Affiliation(s)
- Marco V Haselager
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
| | - Karoline Kielbassa
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
| | - Johanna Ter Burg
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Danique J C Bax
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jannie Borst
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Constantine Tam
- Peter MacCallum Cancer Centre and St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia; and
| | - Francesco Forconi
- Cancer Sciences and Haematology Department, University of Southampton, Southampton, United Kingdom
| | - Giorgia Chiodin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Julie Dubois
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnon P Kater
- Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Eldering
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
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6
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Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter MA, Herling CD, De Paoli L, Delgado J, Rabe KG, Gentile M, Doubek M, Mauro FR, Chiodin G, Mattsson M, Bahlo J, Cutrona G, Kotaskova J, Deambrogi C, Smedby KE, Spina V, Bruscaggin A, Wu W, Moia R, Bianchi E, Gerber B, Zucca E, Gillessen S, Ghielmini M, Cavalli F, Stussi G, Hess MA, Baumann TS, Neri A, Ferrarini M, Rosenquist R, Forconi F, Foà R, Pospisilova S, Morabito F, Stilgenbauer S, Döhner H, Parikh SA, Wierda WG, Montserrat E, Gaidano G, Hallek M, Rossi D. International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia. Blood 2020; 135:1859-1869. [PMID: 32267500 DOI: 10.1182/blood.2019003453] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [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: 09/23/2019] [Accepted: 02/12/2020] [Indexed: 02/08/2023] Open
Abstract
Most patients with chronic lymphocytic leukemia (CLL) are diagnosed with early-stage disease and managed with active surveillance. The individual course of patients with early-stage CLL is heterogeneous, and their probability of needing treatment is hardly anticipated at diagnosis. We aimed at developing an international prognostic score to predict time to first treatment (TTFT) in patients with CLL with early, asymptomatic disease (International Prognostic Score for Early-stage CLL [IPS-E]). Individual patient data from 11 international cohorts of patients with early-stage CLL (n = 4933) were analyzed to build and validate the prognostic score. Three covariates were consistently and independently correlated with TTFT: unmutated immunoglobulin heavy variable gene (IGHV), absolute lymphocyte count higher than 15 × 109/L, and presence of palpable lymph nodes. The IPS-E was the sum of the covariates (1 point each), and separated low-risk (score 0), intermediate-risk (score 1), and high-risk (score 2-3) patients showing a distinct TTFT. The score accuracy was validated in 9 cohorts staged by the Binet system and 1 cohort staged by the Rai system. The C-index was 0.74 in the training series and 0.70 in the aggregate of validation series. By meta-analysis of the training and validation cohorts, the 5-year cumulative risk for treatment start was 8.4%, 28.4%, and 61.2% among low-risk, intermediate-risk, and high-risk patients, respectively. The IPS-E is a simple and robust prognostic model that predicts the likelihood of treatment requirement in patients with early-stage CLL. The IPS-E can be useful in clinical management and in the design of early intervention clinical trials.
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MESH Headings
- Aged
- Biomarkers, Tumor/genetics
- Clinical Trials as Topic/statistics & numerical data
- Combined Modality Therapy
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Mutation
- Nomograms
- Prognosis
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Adalgisa Condoluci
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Petra Langerbeins
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | | | - Carmen D Herling
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | | | | | - Michael Doubek
- Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | | | - Giorgia Chiodin
- Cancer Sciences Division, University of Southampton, Southampton, United Kingdom
| | | | - Jasmin Bahlo
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | | | - Jana Kotaskova
- Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Clara Deambrogi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Valeria Spina
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Wei Wu
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elena Bianchi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Bernhard Gerber
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Georg Stussi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mark A Hess
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Antonino Neri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | | | - Francesco Forconi
- Cancer Sciences Division, University of Southampton, Southampton, United Kingdom
- Southampton University Hospital Trust, Southampton, United Kingdom
| | - Robin Foà
- Division of Hematology, Sapienza University, Rome, Italy
| | - Sarka Pospisilova
- Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Fortunato Morabito
- Biotechnology Research Unit Aprigliano, Cosenza, Italy
- Augusta Victoria Hospital, Jerusalem, Israel
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany; and
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany; and
| | | | | | - Emili Montserrat
- Hospital Clinic, Barcelona, Spain
- Institute of Hematology and Oncology, University of Barcelona, Barcelona, Spain
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Michael Hallek
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Davide Rossi
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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7
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Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter M, Herling C, De Paoli L, Delgado J, Gentile M, Doubek M, Mauro F, Chiodin G, Mattsson M, Bahlo J, Cutrona G, Kotaskova J, Deambrogi C, Moia R, Gerber B, Zucca E, Ghielmini M, Cavalli F, Stüssi G, Neri A, Ferrarini M, Rosenquist R, Forconi F, Foà R, Pospisilova S, Morabito F, Wierda W, Montserrat E, Gaidano G, Hallek M, Rossi D. INTERNATIONAL PROGNOSTIC SCORE FOR EARLY STAGE CHRONIC LYMPHOCYTIC LEUKEMIA (IPS-A). Hematol Oncol 2019. [DOI: 10.1002/hon.51_2629] [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: 11/10/2022]
Affiliation(s)
- A. Condoluci
- Experimental Hematology; Institute of Oncology Research; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - L. Terzi di Bergamo
- Experimental Hematology; Institute of Oncology Research; Bellinzona Switzerland
| | - P. Langerbeins
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - M. Hoechstetter
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - C. Herling
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - L. De Paoli
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - J. Delgado
- Hematology; Hospital Clínic de Barcelona; Barcelona Spain
| | - M. Gentile
- Hematology; Azienda Ospedaliera (AO) of Cosenza; Cosenza Italy
| | - M. Doubek
- Hematology and Oncology; University Hospital of Brno; Brno Czech Republic
| | - F.R. Mauro
- Hematology; Sapienza University; Rome Italy
| | - G. Chiodin
- Hematology; Southampton University; Southampton United Kingdom
| | - M. Mattsson
- Immunology; Genetics and Pathology, Uppsala University; Uppsala Sweden
| | - J. Bahlo
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - G. Cutrona
- Hematology; IRCCS Ospedale Policlinico San Martino; Genoa Italy
| | - J. Kotaskova
- Hematology and Oncology; University Hospital of Brno; Brno Czech Republic
| | - C. Deambrogi
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - R. Moia
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - B. Gerber
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - E. Zucca
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - M. Ghielmini
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - F. Cavalli
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - G. Stüssi
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - A. Neri
- Hematology; University of Milan; Milan Italy
| | | | - R. Rosenquist
- Immunology; Genetics and Pathology, Uppsala University; Uppsala Sweden
| | - F. Forconi
- Hematology; Southampton University; Southampton United Kingdom
| | - R. Foà
- Hematology; Sapienza University; Rome Italy
| | - S. Pospisilova
- Hematology and Oncology; University Hospital of Brno; Brno Czech Republic
| | - F. Morabito
- Hematology; Augusta Victoria Hospital; Jerusalem Israel
| | - W.G. Wierda
- MD Anderson Cancer Center; University of Texas; Houston United States
| | - E. Montserrat
- Hematology; Hospital Clínic de Barcelona; Barcelona Spain
| | - G. Gaidano
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - M. Hallek
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - D. Rossi
- Experimental Hematology; Institute of Oncology Research; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
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8
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Drennan S, Chiodin G, D'Avola A, Tracy I, Johnson PW, Trentin L, Steele AJ, Packham G, Stevenson FK, Forconi F. Ibrutinib Therapy Releases Leukemic Surface IgM from Antigen Drive in Chronic Lymphocytic Leukemia Patients. Clin Cancer Res 2019; 25:2503-2512. [PMID: 30373751 DOI: 10.1158/1078-0432.ccr-18-1286] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/26/2018] [Accepted: 10/25/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE In chronic lymphocytic leukemia (CLL), disease progression associates with surface IgM (sIgM) levels and signaling capacity. These are variably downmodulated in vivo and recover in vitro, suggesting a reversible influence of tissue-located antigen. Therapeutic targeting of sIgM function via ibrutinib, an inhibitor of Bruton tyrosine kinase (BTK), causes inhibition and tumor cell redistribution into the blood, with significant clinical benefit. Circulating CLL cells persist in an inhibited state, offering a tool to investigate the effects of drug on BTK-inhibited sIgM. EXPERIMENTAL DESIGN We investigated the consequences of ibrutinib therapy on levels and function of sIgM in circulating leukemic cells of patients with CLL. RESULTS At week 1, there was a significant increase of sIgM expression (64% increase from pretherapy) on CLL cells either recently released from tissue or persisting in blood. In contrast, surface IgD (sIgD) and a range of other receptors did not change. SIgM levels remained higher than pretherapy in the following 3 months despite gradual cell size reduction and ongoing autophagy and apoptotic activity. Conversely, IgD and other receptors did not increase and gradually declined. Recovered sIgM was fully N-glycosylated, another feature of escape from antigen, and expression did not increase further during culture in vitro. The sIgM was fully capable of mediating phosphorylation of SYK, which lies upstream of BTK in the B-cell receptor pathway. CONCLUSIONS This specific IgM increase in patients underpins the key role of tissue-based engagement with antigen in CLL, confirms the inhibitory action of ibrutinib, and reveals dynamic adaptability of CLL cells to precision monotherapy.See related commentary by Burger, p. 2372.
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Affiliation(s)
- Samantha Drennan
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Giorgia Chiodin
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Annalisa D'Avola
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Ian Tracy
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Peter W Johnson
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Livio Trentin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Andrew J Steele
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Graham Packham
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Freda K Stevenson
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom
| | - Francesco Forconi
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, Southampton, United Kingdom.
- Haematology Department, Cancer Care Directorate, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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9
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Martini V, Gattazzo C, Frezzato F, Trimarco V, Pizzi M, Chiodin G, Severin F, Scomazzon E, Guzzardo V, Saraggi D, Raggi F, Martinello L, Facco M, Visentin A, Piazza F, Brunati AM, Semenzato G, Trentin L. Cortactin, a Lyn substrate, is a checkpoint molecule at the intersection of BCR and CXCR4 signalling pathway in chronic lymphocytic leukaemia cells. Br J Haematol 2017; 178:81-93. [PMID: 28419476 DOI: 10.1111/bjh.14642] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/31/2016] [Indexed: 12/17/2022]
Abstract
Cortactin (CTTN) is a substrate of the Src kinase Lyn that is known to play an actin cytoskeletal regulatory role involved in cell migration and cancer progression following its phosphorylation at Y421. We recently demonstrated that Cortactin is overexpressed in patients with chronic lymphocytic leukaemia (CLL). This work was aimed at defining the functional role of Cortactin in these patients. We found that Cortactin is variably expressed in CLL patients both in the peripheral blood and lymph nodes and that its expression correlates with the release of matrix metalloproteinase 9 (MMP-9) and the motility of neoplastic cells. Cortactin knockdown, by siRNA, induced a reduction in MMP-9 release as well as a decrease of migration capability of leukaemic B cells in vitro, also after chemotactic stimulus. Furthermore, Cortactin phosphorylation was lowered by the Src kinase-inhibitor PP2 with a consequent decrease of MMP-9 release in culture medium. An impaired migration, as compared to control experiments without Cortactin knockdown, was observed following CXCL12 triggering. Reduced Cortactin expression and phosphorylation were also detected both in vivo and in vitro after treatment with Ibrutinib, a Btk inhibitor. Our results highlight the role of Cortactin in CLL as a check-point molecule between the BCR and CXCR4 signalling pathways.
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Affiliation(s)
- Veronica Martini
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Cristina Gattazzo
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Federica Frezzato
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Valentina Trimarco
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Marco Pizzi
- Department of Medicine, General Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Giorgia Chiodin
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Filippo Severin
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Edoardo Scomazzon
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Vincenza Guzzardo
- Department of Medicine, General Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Deborah Saraggi
- Department of Medicine, General Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Flavia Raggi
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Leonardo Martinello
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Monica Facco
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Andrea Visentin
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Francesco Piazza
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | | | - Gianpietro Semenzato
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
| | - Livio Trentin
- Department of Medicine, Haematology and Clinical Immunology Branch, Padua University School of Medicine, University of Padova, Padova, Italy.,Venetian Institute of Molecular Medicine (VIMM), University of Padova, Padova, Italy
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10
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Trimarco V, Ave E, Facco M, Chiodin G, Frezzato F, Martini V, Gattazzo C, Lessi F, Giorgi CA, Visentin A, Castelli M, Severin F, Zambello R, Piazza F, Semenzato G, Trentin L. Cross-talk between chronic lymphocytic leukemia (CLL) tumor B cells and mesenchymal stromal cells (MSCs): implications for neoplastic cell survival. Oncotarget 2016; 6:42130-49. [PMID: 26517523 PMCID: PMC4747215 DOI: 10.18632/oncotarget.6239] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/05/2015] [Indexed: 02/07/2023] Open
Abstract
Leukemic cells from Chronic Lymphocytic Leukemia (CLL) patients interact with stromal cells of the surrounding microenvironment. Mesenchymal Stromal Cells (MSCs) represent the main population in CLL marrow stroma, which may play a key role for disease support and progression. In this study we evaluated whether MSCs influence in vitro CLL cell survival. MSCs were isolated from the bone marrow of 46 CLL patients and were characterized by flow cytometry analysis. Following co-culture of MSCs and leukemic B cells, we demonstrated that MSCs were able to improve leukemic B cell viability, this latter being differently dependent from the signals coming from MSCs. In addition, we found that the co-culture of MSCs with leukemic B cells induced an increased production of IL-8, CCL4, CCL11, and CXCL10 chemokines. As far as drug resistance is concerned, MSCs counteract the cytotoxic effect of Fludarabine/Cyclophosphamide administration in vivo, whereas they do not protect CLL cells from the apoptosis induced by the kinase inhibitors Bafetinib and Ibrutinib. The evidence that leukemic clones are conditioned by environmental stimuli suggest new putative targets for therapy in CLL patients.
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Affiliation(s)
- Valentina Trimarco
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Elisa Ave
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Monica Facco
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Giorgia Chiodin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Federica Frezzato
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Veronica Martini
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Cristina Gattazzo
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Federica Lessi
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Carlo Alberto Giorgi
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Andrea Visentin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Monica Castelli
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Filippo Severin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Renato Zambello
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Francesco Piazza
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Gianpietro Semenzato
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Livio Trentin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
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11
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Visentin A, Facco M, Frezzato F, Castelli M, Trimarco V, Martini V, Gattazzo C, Severin F, Chiodin G, Martines A, Bonaldi L, Gianesello I, Pagnin E, Boscaro E, Piazza F, Zambello R, Semenzato G, Trentin L. Integrated CLL Scoring System, a New and Simple Index to Predict Time to Treatment and Overall Survival in Patients With Chronic Lymphocytic Leukemia. Clin Lymphoma Myeloma Leuk 2015; 15:612-20.e1-5. [PMID: 26233718 DOI: 10.1016/j.clml.2015.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/09/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Several prognostic factors have been identified to predict the outcome of patients with chronic lymphocytic leukemia (CLL), but only a few studies analyzed more markers together. PATIENTS AND METHODS Taking advantage of a population of 608 patients, we identified the strongest prognostic markers of survival and, subsequently, in a cohort of 212 patients we integrated data of cytogenetic lesions, IGHV mutational status, and CD38 expression in a new and easy scoring system we called the integrated CLL scoring system (ICSS). ICSS defines 3 groups of risk: (1) low risk (patients with 13q(-) or normal fluorescence in-situ hybridization analysis results, mutated IGHV, and CD38) (2) high risk (all 11q(-) or 17p(-) patients and/or all unmutated IGHV and CD38(+) patients); and (3) intermediate risk (all remaining patients). RESULTS Using only these 3 already available prognostic factors, we were able to properly redefine patients and better predict the clinical course of the disease. CONCLUSION ICSS could become a useful tool for CLL patients' management.
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Affiliation(s)
- Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Monica Facco
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Federica Frezzato
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Monica Castelli
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Valentina Trimarco
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Veronica Martini
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Cristina Gattazzo
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Filippo Severin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Giorgia Chiodin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | | | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, IOV-IRCSS, Padua, Italy
| | - Ilaria Gianesello
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
| | - Elisa Pagnin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
| | - Elisa Boscaro
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
| | - Francesco Piazza
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy
| | - Gianpietro Semenzato
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy.
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy; Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Avanzata, Italy.
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