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Canella A, Nazzaro M, Artomov M, Rao Venkata LP, Thomas D, Lyberger J, Ukhatov A, Xing YL, Miller K, Behbehani G, Amankulor NM, Petritsch CK, Rajappa P. BRAF V600E in a preclinical model of pleomorphic Xanthoastrocytoma: Analysis of the tumor microenvironment and immune cell infiltration dynamics in vivo. Mol Ther Oncol 2024; 32:200808. [PMID: 38784952 PMCID: PMC11112369 DOI: 10.1016/j.omton.2024.200808] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
Low-grade glioma (LGG) is the most common brain tumor affecting pediatric patients (pLGG) and BRAF mutations constitute the most frequent genetic alterations. Within the spectrum of pLGGs, approximately 70%-80% of pediatric patients diagnosed with transforming pleomorphic xanthoastrocytoma (PXA) harbor the BRAF V600E mutation. However, the impact of glioma BRAF V600E cell regulation of tumor-infiltrating immune cells and their contribution to tumor progression remains unclear. Moreover, the efficacy of BRAF inhibitors in treating pLGGs is limited compared with their impact on BRAF-mutated melanoma. Here we report a novel immunocompetent RCAS-BRAF V600E murine glioma model. Pathological assessment indicates this model seems to be consistent with diffuse gliomas and morphological features of PXA. Our investigations revealed distinct immune cell signatures associated with increased trafficking and activation within the tumor microenvironment (TME). Intriguingly, immune system activation within the TME also generated a pronounced inflammatory response associated with dysfunctional CD8+ T cells, increased presence of immunosuppressive myeloid cells and regulatory T cells. Further, our data suggests tumor-induced inflammatory processes, such as cytokine storm. These findings suggest a complex interplay between tumor progression and the robust inflammatory response within the TME in preclinical BRAF V600E LGGs, which may significantly influence animal survival.
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Affiliation(s)
- Alessandro Canella
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Matthew Nazzaro
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Mykyta Artomov
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Diana Thomas
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Justin Lyberger
- Department of Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Aleksandr Ukhatov
- Department of Electrical Engineering. Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Yao Lulu Xing
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Gregory Behbehani
- Department of Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, OH, USA
| | - Nduka M. Amankulor
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Prajwal Rajappa
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ciurea SO, Kongtim P, Srour S, Chen J, Soebbing D, Shpall E, Rezvani K, Nakkula R, Thakkar A, Troy EC, Cash AA, Behbehani G, Cao K, Schafer J, Champlin RE, Lee DA. Results of a phase I trial with Haploidentical mbIL-21 ex vivo expanded NK cells for patients with multiply relapsed and refractory AML. Am J Hematol 2024; 99:890-899. [PMID: 38444268 DOI: 10.1002/ajh.27281] [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: 11/10/2023] [Revised: 01/27/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024]
Abstract
Natural killer (NK)-cells have potent anti-tumor effects, yet it remains unclear if they are effective for patients with relapsed acute myeloid leukemia (AML). In a phase I clinical trial, we treated 12 patients (median age 60 years) with refractory AML (median 5 lines of prior therapy, median bone marrow blast count of 47%) with fludarabine/cytarabine followed by 6 infusions of NK-cells expanded from haploidentical donors using K562 feeder cells expressing membrane-bound IL21 and 4-1BBL. Patients received 106-107/kg/dose. No toxicity or graft-versus-host disease (GVHD) was observed and MTD was not reached. Seven patients (58.3%) responded and achieved a complete remission (CR) with/without count recovery. Median time to best response was 48 days. Five responding patients proceeded to a haploidentical transplant from the same donor. After a median follow-up of 52 months, 1-year overall survival (OS) for the entire group was 41.7%, better for patients who responded with CR/CRi (57.14%), and for patients who responded and underwent transplantation (60%). Persistence and expansion of donor-derived NK-cells were identified in patients' blood, and serum IFNγ levels rose concurrently with NK cell infusions. A higher count-functional inhibitory KIR was associated with higher likelihood of achieving CR/CRi. In conclusion, we observed a significant response to ex vivo expanded NK-cell administration in refractory AML patients without adverse effects.
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Affiliation(s)
- Stefan O Ciurea
- Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology/Oncology, The University of California, Orange, California, USA
| | - Piyanuch Kongtim
- Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology/Oncology, The University of California, Orange, California, USA
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Doris Soebbing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robin Nakkula
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Aarohi Thakkar
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Ella C Troy
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Alex A Cash
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | | | - Kai Cao
- Department of Laboratory Medicine, Division of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dean A Lee
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
- Division of Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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3
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Shindiapina P, Pietrzak M, Seweryn M, McLaughlin E, Zhang X, Makowski M, Ahmed E, Pearson R, Kitzler R, Le-Rademacher JG, Little RF, Akpek G, Ayala E, Devine SM, Kaplan LD, Noy A, Popat UR, Hsu JW, Morris LE, Mendizabal A, Wachsman W, Williams N, Sharma N, Hofmeister CC, Forman SJ, Navarro WH, Alvarnas JC, Ambinder RF, Malvestutto C, Choe H, Behbehani G, Lozanski G, Blaser B, Baiocchi R. Update on Comparative Analysis of Immune Reconstitution in HIV-Positive Recipients of Allogeneic and Autologous Stem Cell Transplant on the BMT CTN 0903/AMC-080 and BMT CTN 0803/AMC-071 Trials. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Goswami S, Mani R, Nunes J, Chiang CL, Zapolnik K, Hu E, Frissora F, Mo X, Walker LA, Yan P, Bundschuh R, Beaver L, Devine R, Tsai YT, Ventura A, Xie Z, Chen M, Lapalombella R, Walker A, Mims A, Larkin K, Grieselhuber N, Bennett C, Phelps M, Hertlein E, Behbehani G, Vasu S, Byrd JC, Muthusamy N. PP2A is a therapeutically targetable driver of cell fate decisions via a c-Myc/p21 axis in human and murine acute myeloid leukemia. Blood 2022; 139:1340-1358. [PMID: 34788382 PMCID: PMC8900275 DOI: 10.1182/blood.2020010344] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 10/30/2021] [Indexed: 11/20/2022] Open
Abstract
Dysregulated cellular differentiation is a hallmark of acute leukemogenesis. Phosphatases are widely suppressed in cancers but have not been traditionally associated with differentiation. In this study, we found that the silencing of protein phosphatase 2A (PP2A) directly blocks differentiation in acute myeloid leukemia (AML). Gene expression and mass cytometric profiling revealed that PP2A activation modulates cell cycle and transcriptional regulators that program terminal myeloid differentiation. Using a novel pharmacological agent, OSU-2S, in parallel with genetic approaches, we discovered that PP2A enforced c-Myc and p21 dependent terminal differentiation, proliferation arrest, and apoptosis in AML. Finally, we demonstrated that PP2A activation decreased leukemia-initiating stem cells, increased leukemic blast maturation, and improved overall survival in murine Tet2-/-Flt3ITD/WT and human cell-line derived xenograft AML models in vivo. Our findings identify the PP2A/c-Myc/p21 axis as a critical regulator of the differentiation/proliferation switch in AML that can be therapeutically targeted in malignancies with dysregulated maturation fate.
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Affiliation(s)
- Swagata Goswami
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Molecular, Cellular, and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH
| | | | - Jessica Nunes
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Molecular, Cellular, and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH
| | - Chi-Ling Chiang
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Kevan Zapolnik
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Eileen Hu
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Frank Frissora
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Xiaokui Mo
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Logan A Walker
- Biophysics Graduate Program, University of Michigan, Ann Arbor, MI
| | - Pearlly Yan
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Ralf Bundschuh
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, OH
- Department of Physics, The Ohio State University, Columbus, OH; and
| | - Larry Beaver
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Raymond Devine
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Yo-Ting Tsai
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Ann Ventura
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Zhiliang Xie
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Min Chen
- College of Pharmacy, The Ohio State University, Columbus, OH
| | - Rosa Lapalombella
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Alison Walker
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Alice Mims
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Karilyn Larkin
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Nicole Grieselhuber
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Chad Bennett
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Mitch Phelps
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- College of Pharmacy, The Ohio State University, Columbus, OH
| | - Erin Hertlein
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Gregory Behbehani
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- College of Pharmacy, The Ohio State University, Columbus, OH
| | - Natarajan Muthusamy
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
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5
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Vasu S, Sharma N, Walker A, Wall SA, Blachly J, Behbehani G, Choe H, Thakkar A, Nakkula RJ, Troy EC, Szuminski N, De Lima M, ODonnell L, Lee DA. A Phase I Clinical Trial Testing the Safety of IL-21-Expanded, Third-Party Donor-Derived Natural Killer Cells for Relapsed/Refractory Acute Myeloid Leukemia and Myelodysplastic Syndrome. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00437-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Ciurea SO, Kongtim P, Soebbing D, Trikha P, Behbehani G, Rondon G, Olson A, Bashir Q, Gulbis AM, Indreshpal K, Rezvani K, Shpall EJ, Bassett R, Cao K, Martin AS, Devine S, Horowitz M, Pasquini M, Lee DA, Champlin RE. Decrease post-transplant relapse using donor-derived expanded NK-cells. Leukemia 2021; 36:155-164. [PMID: 34312462 PMCID: PMC8727305 DOI: 10.1038/s41375-021-01349-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023]
Abstract
In this phase I/II clinical trial, we investigated the safety and efficacy of high doses of mb-IL21 ex vivo expanded donor-derived NK cells to decrease relapse in 25 patients with myeloid malignancies receiving haploidentical stem-cell transplantation (HSCT). Three doses of donor NK cells (1 × 105-1 × 108 cells/kg/dose) were administered on days -2, +7, and +28. Results were compared with an independent contemporaneously treated case-matched cohort of 160 patients from the CIBMTR database.After a median follow-up of 24 months, the 2-year relapse rate was 4% vs. 38% (p = 0.014), and disease-free survival (DFS) was 66% vs. 44% (p = 0.1) in the cases and controls, respectively. Only one relapse occurred in the study group, in a patient with the high level of donor-specific anti-HLA antibodies (DSA) presented before transplantation. The 2-year relapse and DFS in patients without DSA was 0% vs. 40% and 72% vs. 44%, respectively with HR for DFS in controls of 2.64 (p = 0.029). NK cells in recipient blood were increased at day +30 in a dose-dependent manner compared with historical controls, and had a proliferating, mature, highly cytotoxic, NKG2C+/KIR+ phenotype.Administration of donor-derived expanded NK cells after haploidentical transplantation was safe, associated with NK cell-dominant immune reconstitution early post-transplant, preserved T-cell reconstitution, and improved relapse and DFS. TRIAL REGISTRATION: NCT01904136 ( https://clinicaltrials.gov/ct2/show/NCT01904136 ).
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Affiliation(s)
- Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Piyanuch Kongtim
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Doris Soebbing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Prashant Trikha
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory Behbehani
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alison M Gulbis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kaur Indreshpal
- GMP Laboratory, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,GMP Laboratory, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,GMP Laboratory, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kai Cao
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew St Martin
- Center for International Bone Marrow Transplant Research, Milwaukee, WI, USA
| | | | - Mary Horowitz
- Center for International Bone Marrow Transplant Research, Milwaukee, WI, USA
| | - Marcelo Pasquini
- Center for International Bone Marrow Transplant Research, Milwaukee, WI, USA
| | - Dean A Lee
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ozga M, Blachly J, Eisfeld A, Grieselhuber N, Larkin K, Walker A, Bhatnagar B, Behbehani G, Long M, Haque T, Vasu S, Zhao W, Jones D, Byrd JC, Mims AS, Saygin C. Type of prior genotoxic insult determines the genomic characteristics of therapy-related myeloid neoplasms. Am J Hematol 2021; 96:E223-E225. [PMID: 33761147 DOI: 10.1002/ajh.26170] [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] [Received: 02/11/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Michael Ozga
- Department of Internal Medicine The Ohio State University Columbus Ohio USA
| | - James Blachly
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Ann‐Kathrin Eisfeld
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Nicole Grieselhuber
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Karilyn Larkin
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Alison Walker
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Bhavana Bhatnagar
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Gregory Behbehani
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Meixiao Long
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Tamanna Haque
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Sumithira Vasu
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Weiqiang Zhao
- Department of Pathology The Ohio State University Columbus Ohio USA
| | - Daniel Jones
- Department of Pathology The Ohio State University Columbus Ohio USA
| | - John C. Byrd
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Alice S. Mims
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio USA
| | - Caner Saygin
- Department of Internal Medicine The Ohio State University Columbus Ohio USA
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Sahasrabudhe K, Rebechi M, Huang Y, Behbehani G, Bhatnagar B, Blachly JS, Blaser BW, Borate U, Garzon R, Haque TZ, Larkin KT, Long M, Mims AS, Saad AA, Vasu S, Walker AR, Wall SA. Effect of induction intensity on survival in patients with acute myeloid leukemia. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19004 Background: Acute Myeloid Leukemia (AML) has traditionally been treated frontline with intensive induction chemotherapy in patients fit enough for this treatment. The FDA has approved several oral targeted therapies for AML in recent years. The survival impact of these agents vs induction chemotherapy is unknown. Methods: In this single-center, retrospective study, patients diagnosed with AML from 2015-2020 were included if they received treatment with either high intensity chemotherapy (HiC) or lower intensity targeted therapy (LITT). HiC was defined as a regimen containing cytarabine + anthracycline given on a “7+3” based schedule. Patients treated with liposomal cytarabine-daunorubicin were excluded. LITT was defined as venetoclax, gilteritinib, enasidenib, or ivosidenib alone or in combination with a hypomethylating agent. Patients fell into four groups: HiC only, LITT only, HiC followed by LITT, and LITT followed by HiC with assignment censored at transplant. Overall survival (OS) was estimated using Kaplan-Meier method and patients receiving any HiC vs LITT only were compared using log-rank test. Results: A total of 332 patients were included: 177 received HiC only, 116 LITT only, 32 HiC before LITT, and 7 LITT before HiC. Baseline characteristics and OS data are outlined in the table. The any HiC group had a lower median age and more patients with WBC >10 K/µL at diagnosis, as well as more patients receiving allogeneic hematopoietic cell transplant (HCT). OS was superior in the any HiC group vs LITT only group. Receipt of any HiC remained predictive of OS after adjusting for age (HR 0.65, 95% CI 0.44-0.96, p = 0.03); however, was no longer predictive of OS after adjusting for age and receipt of HCT. Conclusions: While HiC was associated with superior OS compared to LITT only treatment in univariable analysis, the survival benefit was no longer apparent after adjusting for age and receipt of HCT. The results suggest that intensity of AML treatment is less impactful on prognosis than ability to receive HCT. Differences in age were likely confounded by clinical trial eligibility and prescribing information specifically affecting patients receiving LITT. In the era of LITT, prospective randomized studies of intensity of AML therapy, particularly in non-favorable risk disease, are imperative to striking a balance between toxicity and cure for patients of all ages.[Table: see text]
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Affiliation(s)
| | - Melanie Rebechi
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ying Huang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | - Uma Borate
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ramiro Garzon
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Meixiao Long
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alice S. Mims
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ayman A. Saad
- The Ohio State University Comprehensive Cancer Center, Division of Hematology, Columbus, OH
| | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alison R. Walker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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9
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Vasu S, Bhatnagar B, Blachly J, Behbehani G, Nakkula RJ, Trikha P, Szuminski N, ODonnell L, Lee DA. A Phase I Clinical Trial Testing the Safety of IL-21-Expanded, Off-the-Shelf, Natural Killer Cells for Relapsed/Refractory Acute Myeloid Leukemia and Myelodysplastic Syndrome. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Ozga M, Huang Y, Blachly JS, Grieselhuber NR, Wall S, Larkin K, Haque T, Walker AR, Bhatnagar B, Behbehani G, Vasu S, Maakaron JE, Lustberg M, Mims AS. The Incidence of Invasive Fungal Infections in Patients With AML Treated With a Hypomethylating Agent. Clin Lymphoma Myeloma Leuk 2020; 21:e76-e83. [PMID: 32921593 DOI: 10.1016/j.clml.2020.08.013] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Newly diagnosed patients with acute myeloid leukemia (AML) who receive induction with a hypomethylating agent (HMA) are often neutropenic with an increased risk for invasive fungal infections (IFIs). This study analyzed the incidence and risk factors for IFIs in these patients, evaluated clinical patterns in antifungal prophylaxis, and assessed the diagnostic utility of tests in this setting. PATIENTS AND METHODS We studied 117 newly diagnosed patients with AML treated with HMAs at our center, divided into groups based on concern for IFI (cIFI: all possible, probable, and proven IFIs) versus no concern for IFI. The Fisher exact test compared patients with cIFI versus without, and a multivariable logistic regression model estimated odds for cIFI. RESULTS Sixty-seven (57%) patients had cIFI, with 48 possible IFIs, 17 probable, and 2 proven cases. There was no difference in incidence based on home zip code, but the presence of chronic obstructive pulmonary disease was highly associated with cIFI (P = .001), as was male gender (P = .01). Neutropenia at treatment initiation was borderline in significance (P = .08). In diagnostics, 9% of patients had positive serum fungal markers, and 30 patients underwent bronchoscopy, with only 27% of cases yielding positive results. There was a difference in treatment regimens between patients receiving antifungal prophylaxis with mold coverage versus without mold coverage with respect to cIFI (P = .04). CONCLUSIONS cIFI in patients with AML treated with HMAs remains significant, especially in males and those with chronic obstructive pulmonary disease, who were found to be at higher risk. This may prompt clinicians to consider anti-mold prophylaxis in this setting.
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Affiliation(s)
- Michael Ozga
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ying Huang
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - James S Blachly
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicole R Grieselhuber
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sarah Wall
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Karilyn Larkin
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Tamanna Haque
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alison R Walker
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bhavana Bhatnagar
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Gregory Behbehani
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sumithira Vasu
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Mark Lustberg
- Division of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alice S Mims
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH.
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11
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Ozga M, Blachly JS, Grieselhuber NR, Larkin KT, Walker AR, Bhatnagar B, Behbehani G, Long M, Haque TZ, Vasu S, Zhao W, Jones D, Byrd JC, Mims AS, Saygin C. Type of prior genotoxic insult determines the genomic characteristics of therapy-related acute myeloid leukemia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7515 Background: Therapy-related AML (tAML) is a long-term complication of cytotoxic cancer therapy. It is characterized by adverse genetics and inferior survival outcomes when compared to de novo AML. A proposed mechanism in tAML pathogenesis includes treatment-induced selection of clones harboring pre-existing mutations (i.e. clonal hematopoiesis, CH). We hypothesize that genotoxic therapies used to treat prior malignancy drive leukemogenesis through different mechanisms leading to unique clonal compositions. Methods: AML patients (pts) treated at The Ohio State University between 2015-2018 were included. Genetic profiling was performed using Miseq Illumina platform with a 49-gene targeted sequencing panel at our clinical laboratory. Results: We studied 337 AML pts (Table), of whom 53% had smoking history. Mutations involving ASXL1 were more common in smokers vs non-smokers (14% vs 5.8%, p= .001), while JAK2 mutations were more common in non-smokers (8% vs 1.2%, p= .003). Regarding specific genotoxic therapies and mutations in tAML, we investigated common CH-associated mutations including DNMT3A, TET2, and ASXL1 (DTA mutations). In tAML pts, those exposed to radiotherapy experienced a higher frequency of DTA (52% vs 27%, p= .05), NPM1 (21% vs 0%, p= .002), and SRSF2 (15% vs 0%, p= .01) mutations, and conversely, a lower incidence of TP53 mutations (21% vs 46%, p= .04). Pts with history of cytotoxic chemotherapy had a lower incidence of DTA mutations, including those who received platinum agents (8% vs 49%, p= .005) and taxanes (7% vs 52%, p< .001), but had a higher incidence of TP53 mutations (75% vs 25%, p< .001 for platinum; 53% vs 25%, p= .04 for taxanes). Similarly, alkylators and anthracyclines were associated with lower incidence of DNMT3A (0% vs 20%, p= .009) and ASXL1 (0% vs 12.5%, p= .04) mutations. Conclusions: Different genotoxic agents demonstrate unique effects in leukemia development. Our data suggest that CH clones with DTA mutations may be enriched with smoking and radiotherapy, while cytotoxic chemotherapy may confer a higher incidence of TP53 mutations. Given the adverse prognosis of TP53 mutated AML, identification of pre-existing CH clones might influence treatment selection in solid tumor pts receiving anticancer therapy. [Table: see text]
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Affiliation(s)
- Michael Ozga
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | - Bhavana Bhatnagar
- Ohio State University Comprehensive Cancer Center, Division of Hematology, Columbus, OH
| | | | | | | | | | | | | | - John C. Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alice S. Mims
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Caner Saygin
- The Ohio State University Wexner Medical Center, Columbus, OH
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12
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Benner B, Quiroga DM, Good L, Sun S, Savardekar H, Duggan MC, Konda B, Verschraegen CF, Kendra KL, Shah MH, Rupert R, Monk P, Shah HA, Noonan AM, Bixel KL, Hays JL, Behbehani G, Pietrzak M, Carson WE, Wesolowski R. A pilot study of Bruton’s tyrosine kinase inhibitor ibrutinib alone and in combination with PD-1 inhibitor nivolumab in patients with metastatic solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3111 Background: Myeloid-derived suppressor cells (MDSC) are expanded in cancer and promote immune suppression. We have shown that ibrutinib inhibits migration and immunosuppressive function of MDSC. Moreover, the combination of ibrutinib and a PD-L1 inhibitor has been found to have synergistic anti-tumor effects in a multiple solid tumor mouse models. Therefore, we conducted a pilot study testing the combination of ibrutinib and nivolumab in patients with metastatic solid tumors. Methods: Sixteen patients with advanced solid tumors were recruited to this trial. Ibrutinib was dosed as an oral single agent, starting 7 days prior to cycle 1 of nivolumab and given until cycle 1, day 8 of nivolumab. Nivolumab was administered intravenously on days 1 and 15 on 28-day cycles. Patients had blood samples collected prior to initiation of ibrutinib, day 1 of cycle 1, day 8 of cycle 1, day 1 of cycle 2, and at the time of disease progression. From these specimens, we measured circulating MDSC levels, other circulating immune subsets, T cell proliferation, and cytokines/chemokines levels. Circulating MDSC levels were measured by mass spectrometry. T cell function was evaluated by CFSE to monitor proliferating cells by dye dilution and cytokine/chemokine levels were measured with a U-PLEX assay. Data were analyzed using two-tailed, paired Student's t-tests to assess statistical significance. Results: An increase in circulating MDSC (22% to 28%; SD 9.158) levels was observed following 7 days of single-agent ibrutinib compared to baseline. However, in combination therapy, MDSC levels decreased (19%; SD 13.17) prior to cycle 2. Despite increasing levels of circulating MDSC, T cell function improved throughout the study. Furthermore, plasma levels of chemokines associated with MDSC recruitment and migration significantly decreased with ibrutinib treatment (IL-12, CCL2, CCL3, and CCL4). Of the 16 patients, four achieved a partial response and four achieved stable disease. Median progression free survival was 3.5 months and median overall survival was 11.5 months. Conclusions: The combination of ibrutinib and nivolumab was well tolerated, demonstrated early signs of immune modulation, and showed preliminary signs of promising clinical activity in patients with metastatic solid tumors. Clinical trial information: NCT03525925 .
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Affiliation(s)
- Brooke Benner
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Steven Sun
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Bhavana Konda
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | - Manisha H. Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - John L. Hays
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - William Edgar Carson
- The Ohio State University Comprehensive Cancer Center, Department of Surgery, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, and Richard J. Solove Research Institute, Columbus, OH
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13
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Curley T, Koenig KL, Mani S, Lustberg M, Behbehani G, Bhatnagar B, Blachly JS, Haque TZ, Larkin KT, Long M, Mims AS, Vasu S, Wall SA, Byrd JC, Walker AR, Grieselhuber NR. Diagnostic utility of bronchoscopy in newly diagnosed acute leukemia patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19510 Background: Over 40% of newly diagnosed acute leukemia patients receiving induction therapy develop acute respiratory failure. Bronchoscopy is a valuable tool for evaluating airway disease, but its diagnostic yield in this setting has not been fully explored. Methods: We performed a retrospective chart review of 75 newly diagnosed acute leukemia patients who had bronchoscopies. Data recorded prior to bronchoscopy included age, diagnosis, induction treatment regimen, chest imaging, assisted ventilation, duration of neutropenia and antibiotic therapy and microbiological studies. Bronchoalveolar lavage (BAL) cultures were sorted by organism, as well as by other pathologic findings. The primary outcome was antibiotic change supported by culture data. Results: The study population is summarized in the table. Induction regimen backbones included 7+3 (51), 7+4+ATRA (2), decitabine (12), hyperCVAD (2), AYA (3), other (1) and none (4); 18 patients were treated on clinical trial. Average days of neutropenia was 10.92 and average days of antibiotic therapy was 10.57. Thirty-eight patients had chest infiltrates, 11 received NIPPV, and 17 were mechanically ventilated. We identified 24 patients with +BAL studies. Of these, 37.5% (9) had + blood, urine or sputum studies before bronchoscopy, but only 3 had cultures positive for the same organism as the BAL. Of 51 patients with –BAL studies, 33.3% (17) had prior negative cultures. Infections were most commonly bacterial (15, 62.5%), followed by viral (5, 20.8%) and fungal (4, 16.7%). The most common organisms were rhinovirus, vancomycin sensitive Enterococcus (4, 16.7% each) followed by VRE, Candida albicans and MRSA (2, 8.3% each). Five patients (6.7%) had alveolar hemorrhage. Of the 24 patients with +BAL cultures, bronchoscopy findings supported changing antibiotics in 18. In contrast, antibiotics were changed in 16 patients without +BAL cultures. Conclusions: We investigated the utility of bronchoscopy on AL patients during their initial admission. BAL cultures were positive in 32% of newly diagnosed AL patients undergoing bronchoscopy. However, +BAL cultures identified a new organism in 87.5% and guided antibiotic therapy in 75% of these patients. Further studies will be needed to establish predictors of bronchoscopy findings in this patient population. [Table: see text]
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Affiliation(s)
- Thomas Curley
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Shylaja Mani
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mark Lustberg
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | | | - Meixiao Long
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alice S. Mims
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - John C. Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alison R. Walker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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14
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Snyder KJ, Zitzer NC, Gao Y, Choe HK, Sell NE, Neidemire-Colley L, Devine R, Behbehani G, Pietrzak M, Vaddi K, Baiocchi R, Ranganathan P. PRMT5 promotes STAT-1 mediated T cell inflammatory response and is a therapeutic target for acute graft-versus-host disease. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.87.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Introduction
T cell mediated acute graft-versus-host disease (aGVHD) is the main cause of non-relapse mortality in allogeneic hematopoietic cell transplant recipients. Protein arginine methyltransferase 5 (PRMT5) is a post-translational modifier and promotes activation of memory TH cells. We investigate mechanisms by which PRMT5 regulates T cell function and propose PRMT5 inhibition as a therapeutic strategy for aGVHD.
Materials and Methods
PRMT5 expression and function was evaluated in T cells of healthy and aGVHD mice and humans. We assessed T cell proliferation and effector function, using C220, a novel PRMT5 inhibitor. We tested effects of PRMT5 inhibition using in vivo mouse models of aGVHD, where mice received T cell depleted bone marrow + allogeneic splenocytes. In graft-versus-leukemia (GVL) experiments, P815 tumor cells were administered. Mice were treated with C220 or vehicle and monitored for survival and clinical aGVHD scores.
Results
PRMT5 expression and function is upregulated in T cells of mice and humans with aGVHD. Inhibition of PRMT5 reduces T cell proliferation, perturbs cell cycle and downregulates STAT-1 mediated interferon response. Administration of C220 improved survival in aGVHD mouse models and maintained tumor specific CTL response contributing to retention of Graft versus leukemia (GVL) effect.
Conclusions
Inhibition of PRMT5 using C220, down-regulates T cell proliferative and effector response, induces cell-cycle arrest, reduces interferon response and perturbs signaling pathways. C220 shows potent biological activity in vivo by reducing aGVHD clinical severity and prolonging survival in mouse models without compromising GVL. Therefore, PRMT5 is a novel and druggable target for aGVHD.
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Affiliation(s)
- Katiri Jenna Snyder
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Nina C. Zitzer
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Yandi Gao
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Hannah K. Choe
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Natalie E. Sell
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Lotus Neidemire-Colley
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Raymond Devine
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Gregory Behbehani
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | | | | | - Robert Baiocchi
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Parvathi Ranganathan
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
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15
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Shindiapina P, Pietrzak M, Seweryn M, McLaughlin E, Zhang X, Makowski M, Lyberger J, Chang H, Ahmed E, Pearson R, Kitzler R, Le-Rademacher JG, Little RF, Akpek G, Ayala E, Devine SM, Kaplan LD, Noy A, Popat UR, Hsu JW, Morris LE, Mendizabal A, Krishnan A, Hofmeister CC, Forman SJ, Navarro WH, Alvarnas JC, Ambinder RF, Behbehani G, Lozanski G, Baiocchi R. Comparative Analysis of Immune Reconstitution in HIV-Positive Recipients of Allogeneic and Autologous Stem Cell Transplant on the BMT-CTN-0903/AMC-080 and BMT-CTN-0803/AMC-071 Trials. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Bagwell CB, Hunsberger B, Hill B, Herbert D, Bray C, Selvanantham T, Li S, Villasboas JC, Pavelko K, Strausbauch M, Rahman A, Kelly G, Asgharzadeh S, Gomez-Cabrero A, Behbehani G, Chang H, Lyberger J, Montgomery R, Zhao Y, Inokuma M, Goldberger O, Stelzer G. Multi-site reproducibility of a human immunophenotyping assay in whole blood and peripheral blood mononuclear cells preparations using CyTOF technology coupled with Maxpar Pathsetter, an automated data analysis system. Cytometry B Clin Cytom 2019; 98:146-160. [PMID: 31758746 DOI: 10.1002/cyto.b.21858] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/31/2022]
Abstract
High-dimensional mass cytometry data potentially enable a comprehensive characterization of immune cells. In order to positively affect clinical trials and translational clinical research, this advanced technology needs to demonstrate a high reproducibility of results across multiple sites for both peripheral blood mononuclear cells (PBMC) and whole blood preparations. A dry 30-marker broad immunophenotyping panel and customized automated analysis software were recently engineered and are commercially available as the Fluidigm® Maxpar® Direct™ Immune Profiling Assay™. In this study, seven sites received whole blood and six sites received PBMC samples from single donors over a 2-week interval. Each site labeled replicate samples and acquired data on Helios™ instruments using an assay-specific acquisition template. All acquired sample files were then automatically analyzed by Maxpar Pathsetter™ software. A cleanup step eliminated debris, dead cells, aggregates, and normalization beads. The second step automatically enumerated 37 immune cell populations and performed label intensity assessments on all 30 markers. The inter-site reproducibility of the 37 quantified cell populations had consistent population frequencies, with an average %CV of 14.4% for whole blood and 17.7% for PBMC. The dry reagent coupled with automated data analysis is not only convenient but also provides a high degree of reproducibility within and among multiple test sites resulting in a comprehensive yet practical solution for deep immune phenotyping.
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Affiliation(s)
| | | | - Beth Hill
- Verity Software House, Topsham, Maine
| | | | | | | | - Stephen Li
- Fluidigm Canada Inc., Markham, Ontario, Canada
| | | | | | | | - Adeeb Rahman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gregory Kelly
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | | | | | - Yujiao Zhao
- Yale School of Medicine, New Haven, Connecticut
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17
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Underwood B, Zhao Q, Walker AR, Mims AS, Vasu S, Behbehani G, Blachly JS, Larkin KT, Wang TF, Bhatnagar B. Incidence, characteristics, and risk factors of venous thromboembolism in adolescent and young adult acute lymphoblastic leukemia patients receiving peg-asparaginase. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18520] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18520 Background: Venous thromboembolism (VTE) is common in acute lymphoblastic leukemia (ALL) patients (pts) receiving peg-asparaginase (ASNase) however there is limited data regarding the incidence of VTE and risk factors for VTE in adolescent and young adults (AYA) treated with ASNase. Methods: This is a single institutional retrospective analysis of AYA pts with ALL who received ASNase from January 2013 to December 2018. Time to VTE was calculated from date of starting treatment to onset of VTE or censored at last assessment date, treating death as a competing risk. The cumulative incidence of VTE was estimated and the Fine and Gray regression models accounting for competing risks were used to examine the association between risk factors and VTE. Results: Forty-six AYA ALL patients were included. Pt characteristics are shown in the Table. Twenty pts had a VTE following ASNase with the cumulative incidence rate of 35% (95% CI: 22-48%) at 100 days. The most common VTE sites were cerebral (n=6) and upper extremity (n=6). Nine pts (43%) had at least one recurrent VTE. After initial VTE, ASNase was continued in 13 pts (62%), stopped in 6 pts (29%), and dose reduced in 2 pts (10%). Nine pts (45%) of those who developed VTE received antithrombin. Out of the 6 pts with VTE who had ASNase discontinued or dose reduced, 2 (33%) had progression of ALL. The hazard ratios (HR) for risk of VTE from univariable regression models are listed in Table 1. Male sex was associated with increased VTE risk, with HR=3.33 (95% CI: 1.13-9.77). Conclusions: Our study estimated the incidence of VTE in the AYA cohort. Only male sex was identified as a risk factor for VTE. Additional studies are needed to assess VTE risk factors in AYA pts with ALL. Pt characteristics and hazard ratios for risk of VTE. [Table: see text]
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Affiliation(s)
| | | | | | - Alice S. Mims
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | - Tzu-Fei Wang
- The Ohio State University, Division of Hematology, Columbus, OH
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18
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Jeon JY, Zhao Q, Buelow DR, Phelps M, Walker AR, Mims AS, Vasu S, Behbehani G, Blachly J, Blum W, Klisovic RB, Byrd JC, Garzon R, Baker SD, Bhatnagar B. Preclinical activity and a pilot phase I study of pacritinib, an oral JAK2/FLT3 inhibitor, and chemotherapy in FLT3-ITD-positive AML. Invest New Drugs 2019; 38:340-349. [PMID: 31102119 DOI: 10.1007/s10637-019-00786-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 03/28/2019] [Accepted: 04/18/2019] [Indexed: 12/20/2022]
Abstract
Activating FLT3 internal tandem duplication (FLT3-ITD) mutations in acute myeloid leukemia (AML) associate with inferior outcomes. We determined that pacritinib, a JAK2/FLT3 inhibitor, has in vitro activity against FLT3-ITD and tyrosine kinase domain (TKD) mutations. Therefore, we conducted a phase I study of pacritinib in combination with chemotherapy in AML patients with FLT3 mutations to determine the pharmacokinetics and preliminary toxicity and clinical activity. Pacritinib was administered at a dose of 100 mg or 200 mg twice daily following a 3 + 3 dose-escalation in combination with cytarabine and daunorubicin (cohort A) or with decitabine induction (cohort B). A total of thirteen patients were enrolled (five in cohort A; eight in cohort B). Dose limiting toxicities include hemolytic anemia and grade 3 QTc prolongation in two patients who received 100 mg. Complete remission was achieved in two patients in cohort A, one of whom had a minor D835Y clone at baseline. One patient in cohort B achieved morphologic leukemia free state. Seven patients (two in cohort A; five in cohort B) had stable disease. In conclusion, pacritinib, an inhibitor of FLT3-ITD and resistant-conferring TKD mutations, was well tolerated and demonstrated preliminary anti-leukemic activity in combination with chemotherapy in patients with FLT3 mutations.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/pharmacokinetics
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged-Ring Compounds/adverse effects
- Bridged-Ring Compounds/pharmacokinetics
- Bridged-Ring Compounds/pharmacology
- Bridged-Ring Compounds/therapeutic use
- Cell Line, Tumor
- Cell Survival/drug effects
- Cytarabine/adverse effects
- Cytarabine/therapeutic use
- Daunorubicin/adverse effects
- Daunorubicin/therapeutic use
- Decitabine/adverse effects
- Decitabine/therapeutic use
- Drug Resistance, Neoplasm/drug effects
- Female
- Humans
- Janus Kinase 2/antagonists & inhibitors
- Kaplan-Meier Estimate
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Mutation
- Pilot Projects
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/pharmacokinetics
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/adverse effects
- Pyrimidines/pharmacokinetics
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- fms-Like Tyrosine Kinase 3/antagonists & inhibitors
- fms-Like Tyrosine Kinase 3/genetics
- fms-Like Tyrosine Kinase 3/metabolism
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Affiliation(s)
- Jae Yoon Jeon
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Daelynn R Buelow
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Mitch Phelps
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Alison R Walker
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Alice S Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Gregory Behbehani
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - James Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - William Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca B Klisovic
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Ramiro Garzon
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Sharyn D Baker
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Bhavana Bhatnagar
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
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Bhatnagar B, Walker AR, Mims AS, Vasu S, Klisovic RB, Behbehani G, Blachly JS, Larkin KT, Long M, Zhao Q, Ranganathan P, Byrd JC, Blum WG, Garzon R. Phase 1 study of selinexor plus mitoxantrone, etoposide, and cytarabine in acute myeloid leukemia. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Alice S. Mims
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Sumithira Vasu
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | | | - Qiuhong Zhao
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - John C. Byrd
- The Ohio State University, Division of Hematology, Columbus, OH
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Grierson P, Lillard K, Behbehani G, Combs K, Bhattacharyya S, Samir A, Groden J. Abstract PR3: The BLM helicase facilitates RNA polymerase l-mediated ribosomal RNA transcription. Cancer Res 2011. [DOI: 10.1158/1538-7445.fbcr11-pr3] [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
Bloom's syndrome (BS) is an autosomal recessive disorder that is invariably characterized by cancer predisposition and idiopathic growth retardation. The BLM helicase, mutations of which lead to BS, localizes to the nucleolus of the cell, the site of RNA polymerase l-mediated ribosomal RNA (rRNA) transcription. rRNA transcription is fundamental for ribosome biogenesis and therefore protein synthesis, cellular growth and proliferation; its inhibition limits cellular growth and proliferation as well as bodily growth. Disorders with defective ribosome biogenesis, such as Diamond-Blackfan anemia and Shwachman-Diamond syndrome, display similar cancer predisposition and growth abnormalities to BS. The objective of this study was to investigate a potential mechanism underlying the proportional dwarfism of BS. We tested the hypothesis that the BLM helicase facilitates rRNA transcription as a component of an RNA polymerase I-associated complex, which when deficient has the potential to lead to proportional dwarfism. We report that nucleolar BLM facilitates RNA polymerase I-mediated rRNA transcription using H3-uridine pulse-chase assays and nuclear run-on assays in cells with an innate or experimentally induced BLM deficiency. In vitro helicase assays demonstrate that BLM unwinds GC-rich hybrid RNA/DNA nucleic acid substrates predicted to form in the nucleolus during rRNA transcription; the persistence of such structures inhibits progression of the RNA polymerase I transcription complex. Immunofluorescence studies using actinomycin D at a concentration that inhibits RNA polymerase I demonstrate the dependence of BLM nucleolar localization upon ongoing RNA polymerase l-mediated rRNA transcription. Finally, in vivo protein co-immunoprecipitation shows that BLM physically associates with RNA polymerase I in the nucleolus. These studies suggest that nucleolar BLM interacts with RNA polymerase I and facilitates rRNA transcription by modulating rDNA structure. Given the intricate relationship between rDNA metabolism and growth, our data may help to understand the etiology of the proportional dwarfism in Bloom's syndrome. Furthermore, this work provides greater understanding of the mechanisms regulating rRNA transcription and ribosome biogenesis, processes currently being exploited in cancer therapeutics.
This abstract is also presented as Poster B34.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the Second AACR International Conference on Frontiers in Basic Cancer Research; 2011 Sep 14-18; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2011;71(18 Suppl):Abstract nr PR3.
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Affiliation(s)
| | - Kate Lillard
- 2University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Kelly Combs
- 2University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Acharya Samir
- 1The Ohio State University College of Medicine, Columbus, OH
| | - Joanna Groden
- 1The Ohio State University College of Medicine, Columbus, OH
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Abstract
Members of the SNF2 (Sucrose Non-Fermenter) family of chromatin-remodeling proteins function in processes ranging from DNA repair to transcription to methylation. Using differential display, we recently identified a novel member of the SNF2 family that is highly expressed at the mRNA level in proliferating cells and is down-regulated during apoptosis. We have named this gene PASG (Proliferation-Associated SNF2-like Gene). Northern blot analysis of adult mouse tissues shows PASG to be highly expressed in proliferating organs such as thymus, bone marrow, and testis and absent from nonproliferative tissues such as brain and heart. In situ hybridization analysis of mouse embryos shows that PASG is differentially expressed during development, with highest expression in developing face, limbs, skeletal muscle, heart, and tail. In vitro, PASG expression correlates with a shift from a quiescent to a proliferative state. Mice null for PASG (also known as LSH or Hells) are reported to die perinatally, although the mechanism for lethality is unclear (Geiman and Muegge, 2000). To test the hypothesis that PASG functions in cell proliferation, we compared 5-bromodeoxyuridine (BrdU) incorporation in C33A cells transiently transfected with PASG versus empty vector and found that PASG transfected cells showed a significant decrease in the amount of BrdU incorporation. These findings suggest that PASG plays a role in cell proliferation and may function in the development of multiple cell lineages during murine embryogenesis.
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Affiliation(s)
- E H Raabe
- Physician Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Tabibzadeh I, Behbehani G, Nakhai R. Use of gambusia fish in the malaria eradication programme of Iran. Bull World Health Organ 1970; 43:623-6. [PMID: 5313079 PMCID: PMC2427781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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