1
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Müller TR, Gao Y, Wu J, Ribeiro O, Chen P, Bergman P, Blennow O, Hansson L, Mielke S, Nowak P, Vesterbacka J, Akber M, Söderdahl G, Smith CIE, Loré K, Chen MS, Ljungman P, Ingelman-Sundberg HM, Ljunggren HG, Österborg A, Sette A, Grifoni A, Aleman S, Buggert M. Memory T cells effectively recognize the SARS-CoV-2 hypermutated BA.2.86 variant. Cell Host Microbe 2024; 32:156-161.e3. [PMID: 38211584 DOI: 10.1016/j.chom.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
T cells are critical in mediating the early control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection. However, it remains unknown whether memory T cells can effectively cross-recognize new SARS-CoV-2 variants with a broad array of mutations, such as the emergent hypermutated BA.2.86 variant. Here, we report in two separate cohorts, including healthy controls and individuals with chronic lymphocytic leukemia, that SARS-CoV-2 spike-specific CD4+ and CD8+ T cells induced by prior infection or vaccination demonstrate resilient immune recognition of BA.2.86. In both cohorts, we found largely preserved SARS-CoV-2 spike-specific CD4+ and CD8+ T cell magnitudes against mutated spike epitopes of BA.2.86. Functional analysis confirmed that both cytokine expression and proliferative capacity of SARS-CoV-2 spike-specific T cells to BA.2.86-mutated spike epitopes are similarly sustained. In summary, our findings indicate that memory CD4+ and CD8+ T cells continue to provide cell-mediated immune recognition to highly mutated emerging variants such as BA.2.86.
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Affiliation(s)
- Thomas R Müller
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yu Gao
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jinghua Wu
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Oriana Ribeiro
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Puran Chen
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Clinical Immunology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Mielke
- Department of Laboratory Medicine, Division of Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Laboratory for Molecular Infection Medicine Sweden MIMS, Umeå University, Umeå, Sweden
| | - Jan Vesterbacka
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mira Akber
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Söderdahl
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - C I Edvard Smith
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Division of Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Loré
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Hanna M Ingelman-Sundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Alessandro Sette
- Center for Vaccine Innovation, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, CA 92037, USA
| | - Alba Grifoni
- Center for Vaccine Innovation, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Buggert
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden.
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2
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Ingelman-Sundberg HM, Blixt L, Wullimann D, Wu J, Gao Y, Healy K, Muschiol S, Bogdanovic G, Åberg M, Kjellander C, Grifoni A, Sette A, Aleman S, Chen P, Blennow O, Hansson L, Ljunggren HG, Chen MS, Buggert M, Österborg A. Systemic and mucosal adaptive immunity to SARS-CoV-2 during the Omicron wave in patients with chronic lymphocytic leukemia. Haematologica 2024; 109:646-651. [PMID: 37646668 PMCID: PMC10828773 DOI: 10.3324/haematol.2023.282894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Hanna M Ingelman-Sundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, Karolinska University Hospital Solna, Stockholm.
| | - Lisa Blixt
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Haematology, Karolinska University Hospital Solna, Stockholm
| | - David Wullimann
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Jinghua Wu
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Yu Gao
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Katie Healy
- Department of Dental Medicine, Karolinska Institutet, Huddinge
| | - Sandra Muschiol
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm
| | - Gordana Bogdanovic
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm
| | - Mikael Åberg
- Department of Medical Sciences, Clinical Chemistry and Science for Life Laboratory, Uppsala University, Uppsala
| | | | - Alba Grifoni
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, CA 92037
| | - Soo Aleman
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm
| | - Puran Chen
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Ola Blennow
- Dept of Infectious Diseases, Dept of Transplantation, Karolinska University Hospital and Dept of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Haematology, Karolinska University Hospital Solna, Stockholm
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | | | - Marcus Buggert
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Haematology, Karolinska University Hospital Solna, Stockholm
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3
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Cai C, Gao Y, Adamo S, Rivera-Ballesteros O, Hansson L, Österborg A, Bergman P, Sandberg JK, Ljunggren HG, Björkström NK, Strålin K, Llewellyn-Lacey S, Price DA, Qin C, Grifoni A, Weiskopf D, Wherry EJ, Sette A, Aleman S, Buggert M. SARS-CoV-2 vaccination enhances the effector qualities of spike-specific T cells induced by COVID-19. Sci Immunol 2023; 8:eadh0687. [PMID: 38064569 PMCID: PMC7615587 DOI: 10.1126/sciimmunol.adh0687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023]
Abstract
T cells are critical for immune protection against severe COVID-19, but it has remained unclear whether repeated exposure to SARS-CoV-2 antigens delivered in the context of vaccination fuels T cell exhaustion or reshapes T cell functionality. Here, we sampled convalescent donors with a history of mild or severe COVID-19 before and after SARS-CoV-2 vaccination to profile the functional spectrum of hybrid T cell immunity. Using combined single-cell technologies and high-dimensional flow cytometry, we found that the frequencies and functional capabilities of spike-specific CD4+ and CD8+ T cells in previously infected individuals were enhanced by vaccination, despite concomitant increases in the expression of inhibitory receptors such as PD-1 and TIM3. In contrast, CD4+ and CD8+ T cells targeting non-spike proteins remained functionally static and waned over time, and only minimal effects were observed in healthy vaccinated donors experiencing breakthrough infections with SARS-CoV-2. Moreover, hybrid immunity was characterized by elevated expression of IFN-γ, which was linked with clonotype specificity in the CD8+ T cell lineage. Collectively, these findings identify a molecular hallmark of hybrid immunity and suggest that vaccination after infection is associated with cumulative immunological benefits over time, potentially conferring enhanced protection against subsequent episodes of COVID-19.
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Affiliation(s)
- Curtis Cai
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yu Gao
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sarah Adamo
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Olga Rivera-Ballesteros
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Johan K. Sandberg
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas K. Björkström
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kristoffer Strålin
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Sian Llewellyn-Lacey
- Division of Infection and Immunity, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - David A. Price
- Division of Infection and Immunity, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
- Systems Immunity Research Institute, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Chuan Qin
- Beijing Key Laboratory for Animal Models of Emerging and Reemerging Infectious Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
- National Health Commission Key Laboratory of Human Disease Comparative Medicine, Comparative Medicine Center, Peking Union Medical College, Beijing, China
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, California, USA
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, USA
| | - E. John Wherry
- Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
- Parker Institute for Cancer Immunotherapy, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
| | - Alessandro Sette
- National Health Commission Key Laboratory of Human Disease Comparative Medicine, Comparative Medicine Center, Peking Union Medical College, Beijing, China
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, USA
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Buggert
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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4
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Mattsson A, Sylvan SE, Axelsson P, Ellin F, Kjellander C, Larsson K, Lauri B, Lewerin C, Scharenberg C, Tätting L, Johansson H, Österborg A, Hansson L. Idelalisib (PI3Kδ inhibitor) therapy for patients with relapsed/refractory chronic lymphocytic leukemia: A Swedish nation-wide real-world report on consecutively identified patients. Eur J Haematol 2023; 111:715-721. [PMID: 37501508 DOI: 10.1111/ejh.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES We examined the efficacy and toxicity of the PI3Kδ inhibitor idelalisib in combination with rituximab salvage therapy in consecutively identified Swedish patients with chronic lymphocytic leukemia (CLL). METHODS AND RESULTS Thirty-seven patients with relapsed/refractory disease were included. The median number of prior lines of therapy was 3 (range 1-11); the median age was 69 years (range 50-89); 22% had Cumulative Illness Rating Scale (CIRS) >6 and 51% had del(17p)/TP53 mutation. The overall response rate was 65% (all but one was partial response [PR]). The median duration of therapy was 9.8 months (range 0.9-44.8). The median progression-free survival was 16.4 months (95% CI: 10.4-26.3) and median overall survival had not been reached (75% remained alive at 24 months of follow-up). The most common reason for cessation of therapy was colitis (n = 8, of which seven patients experienced grade ≥3 colitis). The most common serious adverse event was grade ≥3 infection, which occurred in 24 patients (65%). CONCLUSIONS Our real-world results suggest that idelalisib is an effective and relatively safe treatment for patients with advanced-stage CLL when no other therapies exist. Alternative dosing regimens and new PI3K inhibitors should be explored, particularly in patients who are double-refractory to inhibitors of BTK and Bcl-2.
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MESH Headings
- Humans
- Middle Aged
- Aged
- Aged, 80 and over
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Phosphatidylinositol 3-Kinases
- Sweden/epidemiology
- Rituximab
- Lymphoma, B-Cell
- Recurrence
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Affiliation(s)
- Agnes Mattsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | | | - Per Axelsson
- Department of Hematology, Helsingborg's Hospital, Helsingborg, Sweden
| | - Fredrik Ellin
- Department of Medicine, Kalmar County Hospital, Kalmar, Sweden
| | - Christian Kjellander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine, Capio St Göran Hospital, Stockholm, Sweden
| | - Karin Larsson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, Sunderbyn Luleå, Sweden
| | - Catharina Lewerin
- Section of Coagulation and Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Love Tätting
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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5
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Andersson ML, Johansson H, Österborg A, Månsson-Broberg A, Hansson L, Palma M. Incidence of cardiovascular and bleeding events and reasons for discontinuation in patients with chronic lymphocytic leukemia treated with ibrutinib-A retrospective analysis on consecutive patients from a well-defined region. Eur J Haematol 2023; 111:748-756. [PMID: 37565648 DOI: 10.1111/ejh.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Ibrutinib treatment is associated with cardiovascular side effects, in particular atrial fibrillation (AF) and hypertension, as well as increased risk of bleeding. Here, we aimed at describing the incidence of these events during long-term follow-up in patients with chronic lymphocytic leukemia treated outside clinical trials as well as identifying clinical factors predictive of developing AF. Additionally, other reasons for treatment withdrawal were analyzed. METHODS The study was retrospective, data were collected from medical records. RESULTS A total of 134 patients were identified. Median follow-up was 32 months (range 3-103) and median duration of ibrutinib treatment was 26 months (range 1-103). Of 110 patients with no prior history of AF, 24.5% were diagnosed during treatment. Newly diagnosed or worsening of pre-existing hypertension occurred in 15.7%. Sixty-six % of the patients experienced bleeding events, of which 7.5% grade 3-4. Treatment discontinuation and dose reduction occurred in 68% and 47% of the patients, respectively, mostly due to toxicity. CONCLUSIONS The incidence of AF was high and at a median follow-up of 2.5 years, two-thirds of the patients discontinued treatment mostly due to bleeding and infections. Treatment-related toxicity of any grade should be regarded as a concern of prolonged ibrutinib therapy.
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Affiliation(s)
- Maria L Andersson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Månsson-Broberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Marzia Palma
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
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6
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Chen P, Bergman P, Blennow O, Hansson L, Mielke S, Nowak P, Söderdahl G, Österborg A, Smith CIE, Vesterbacka J, Wullimann D, Cuapio A, Akber M, Bogdanovic G, Muschiol S, Åberg M, Loré K, Sällberg Chen M, Buggert M, Ljungman P, Aleman S, Ljunggren HG. Real-world assessment of immunogenicity in immunocompromised individuals following SARS-CoV-2 mRNA vaccination: a one-year follow-up of the prospective clinical trial COVAXID. EBioMedicine 2023; 94:104700. [PMID: 37453361 PMCID: PMC10365982 DOI: 10.1016/j.ebiom.2023.104700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Immunocompromised patients have varying responses to SARS-CoV-2 mRNA vaccination. However, there is limited information available from prospective clinical trial cohorts with respect to long-term immunogenicity-related responses in these patient groups following three or four vaccine doses, and in applicable cases infection. METHODS In a real-world setting, we assessed the long-term immunogenicity-related responses in patients with primary and secondary immunodeficiencies from the prospective open-label clinical trial COVAXID. The original clinical trial protocol included two vaccine doses given on days 0 and 21, with antibody titres measured at six different timepoints over six months. The study cohort has subsequently been followed for one year with antibody responses evaluated in relation to the third and fourth vaccine dose, and in applicable cases SARS-CoV-2 infection. In total 356/539 patients were included in the extended cohort. Blood samples were analysed for binding antibody titres and neutralisation against the Spike protein for all SARS-CoV-2 variants prevailing during the study period, including Omicron subvariants. SARS-CoV-2 infections that did not require hospital care were recorded through quarterly in-person, or phone-, interviews and assessment of IgG antibody titres against SARS-CoV-2 Nucleocapsid. The original clinical trial was registered in EudraCT (2021-000175-37) and clinicaltrials.gov (NCT04780659). FINDINGS The third vaccine dose significantly increased Spike IgG titres against all the SARS-CoV-2 variants analysed in all immunocompromised patient groups. Similarly, neutralisation also increased against all variants studied, except for Omicron. Omicron-specific neutralisation, however, increased after a fourth dose as well as after three doses and infection in many of the patient subgroups. Noteworthy, however, while many patient groups mounted strong serological responses after three and four vaccine doses, comparably weak responders were found among patient subgroups with specific primary immunodeficiencies and subgroups with immunosuppressive medication. INTERPRETATION The study identifies particularly affected patient groups in terms of development of long-term immunity among a larger group of immunocompromised patients. In particular, the results highlight poor vaccine-elicited neutralising responses towards Omicron subvariants in specific subgroups. The results provide additional knowledge of relevance for future vaccination strategies. FUNDING The present studies were supported by grants from the Swedish Research Council, the Knut and Alice Wallenberg Foundation, Nordstjernan AB, Region Stockholm, and Karolinska Institutet.
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Affiliation(s)
- Puran Chen
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Clinical Immunology, Karolinska Institutet, Stockholm, Sweden
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Karolinska Comprehensive Cancer Center, Stockholm, Sweden; Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Söderdahl
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - C I Edvard Smith
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Vesterbacka
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - David Wullimann
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Cuapio
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mira Akber
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gordana Bogdanovic
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Muschiol
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Åberg
- Department of Medical Sciences, Clinical Chemistry, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Karin Loré
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Marcus Buggert
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Karolinska Comprehensive Cancer Center, Stockholm, Sweden; Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden.
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7
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Andersson M, Wu J, Wullimann D, Gao Y, Aberg M, Muschiol S, Healy K, Naud S, Bogdanovic G, Palma M, Mellstedt H, Chen P, Ljunggren HG, Hansson L, Sallberg Chen M, Buggert M, Ingelman-Sundberg HM, Osterborg A. Local and Systemic Immunity During Five Vaccinations Against SARS-CoV-2 in Zanubrutinib-Treated Patients With Chronic Lymphocytic Leukemia. J Hematol 2023; 12:170-175. [PMID: 37692865 PMCID: PMC10482612 DOI: 10.14740/jh1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/14/2023] [Indexed: 09/12/2023] Open
Abstract
Background Patients with chronic lymphocytic leukemia (CLL) are vulnerable to coronavirus disease 2019 (COVID-19) and are at risk of inferior response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, especially if treated with the first-generation Bruton's tyrosine kinase inhibitor (BTKi) ibrutinib. We aimed to evaluate the impact of the third-generation BTKi, zanubrutinib, on systemic and mucosal response to SARS-CoV-2 vaccination. Methods Nine patients with CLL with ongoing zanubrutinib therapy were included and donated blood and saliva during SARS-CoV-2 vaccination, before vaccine doses 3 and 5 and 2 - 3 weeks after doses 3, 4, and 5. Ibrutinib-treated control patients (n = 7) and healthy aged-matched controls (n = 7) gave blood 2 - 3 weeks after vaccine dose 5. We quantified reactivity and neutralization capacity of SARS-CoV-2-specific IgG and IgA antibodies (Abs) in both serum and saliva, and reactivity of T cells activated with viral peptides. Results Both zanubrutinib- and ibrutinib-treated patients had significantly, up to 1,000-fold, lower total spike-specific Ab levels after dose 5 compared to healthy controls (P < 0.01). Spike-IgG levels in serum from zanubrutinib-treated patients correlated well to neutralization capacity (r = 0.68; P < 0.0001) and were thus functional. Mucosal immunity (specific IgA in serum and saliva) was practically absent in zanubrutinib-treated patients even after five vaccine doses, whereas healthy controls had significantly higher levels (tested in serum after vaccine dose 5) (P < 0.05). In contrast, T-cell reactivity against SARS-CoV-2 peptides was equally high in zanubrutinib- and ibrutinib-treated patients as in healthy control donors. Conclusions In our small cohort of zanubrutinib-treated CLL patients, we conclude that up to five doses of SARS-CoV-2 vaccination induced no detectable IgA mucosal immunity, which likely will impair the primary barrier defence against the infection. Systemic IgG responses were also impaired, whereas T-cell responses were normal. Further and larger studies are needed to evaluate the impact of these findings on disease protection.
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Affiliation(s)
- Maria Andersson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- These authors contributed equally to this article
| | - Jinghua Wu
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- These authors contributed equally to this article
| | - David Wullimann
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Yu Gao
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Aberg
- Department of Medical Sciences, Clinical Chemistry and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Sandra Muschiol
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Katie Healy
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sabrina Naud
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Gordana Bogdanovic
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Marzia Palma
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hakan Mellstedt
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Puran Chen
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - Marcus Buggert
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hanna M. Ingelman-Sundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital Solna, Stockholm, Sweden
- These authors contributed equally to this article
| | - Anders Osterborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- These authors contributed equally to this article
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8
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Müller TR, Sekine T, Trubach D, Niessl J, Chen P, Bergman P, Blennow O, Hansson L, Mielke S, Nowak P, Vesterbacka J, Akber M, Olofsson A, Amaya Hernandez SP, Gao Y, Cai C, Söderdahl G, Smith CIE, Österborg A, Loré K, Sällberg Chen M, Ljungman P, Ljunggren HG, Karlsson AC, Saini SK, Aleman S, Buggert M. Additive effects of booster mRNA vaccination and SARS-CoV-2 Omicron infection on T cell immunity across immunocompromised states. Sci Transl Med 2023; 15:eadg9452. [PMID: 37437015 PMCID: PMC7615622 DOI: 10.1126/scitranslmed.adg9452] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
Suboptimal immunity to SARS-CoV-2 mRNA vaccination has frequently been observed in individuals with various immunodeficiencies. Given the increased antibody evasion properties of emerging SARS-CoV-2 subvariants, it is necessary to assess whether other components of adaptive immunity generate resilient and protective responses against infection. We assessed T cell responses in 279 individuals, covering five different immunodeficiencies and healthy controls, before and after booster mRNA vaccination, as well as after Omicron infection in a subset of patients. We observed robust and persistent Omicron-reactive T cell responses that increased markedly upon booster vaccination and correlated directly with antibody titers across all patient groups. Poor vaccination responsiveness in immunocompromised or elderly individuals was effectively counteracted by the administration of additional vaccine doses. Functionally, Omicron-reactive T cell responses exhibited a pronounced cytotoxic profile and signs of longevity, characterized by CD45RA+ effector memory subpopulations with stem cell-like properties and increased proliferative capacity. Regardless of underlying immunodeficiency, booster-vaccinated and Omicron-infected individuals appeared protected against severe disease and exhibited enhanced and diversified T cell responses against conserved and Omicron-specific epitopes. Our findings indicate that T cells retain the ability to generate highly functional responses against newly emerging variants, even after repeated antigen exposure and a robust immunological imprint from ancestral SARS-CoV-2 mRNA vaccination.
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Affiliation(s)
- Thomas R. Müller
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Takuya Sekine
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Darya Trubach
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Julia Niessl
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Puran Chen
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Clinical Immunology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Mielke
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Laboratory for Molecular Infection Medicine Sweden MIMS, Umeå University, Sweden
| | - Jan Vesterbacka
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Mira Akber
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Olofsson
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susana Patricia Amaya Hernandez
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Yu Gao
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Curtis Cai
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Söderdahl
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - C. I. Edvard Smith
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Loré
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Medicine Huddinge, Hematology, Karolinska Institutet, Stockholm
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annika C. Karlsson
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Laboratory, Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sunil Kumar Saini
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Buggert
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
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9
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Smedby KE, Wästerlid T, Tham E, Haider Z, Joelsson J, Thorvaldsdottir B, Krstic A, Wahlin BE, Foroughi-Asl H, Karlsson C, Eloranta S, Saft L, Palma M, Kwiecinska A, Hansson L, Österborg A, Wirta V, Rassidakis G, Sander B, Sonnevi K, Rosenquist R. The BioLymph study - implementing precision medicine approaches in lymphoma diagnostics, treatment and follow-up: feasibility and first results. Acta Oncol 2023; 62:560-564. [PMID: 37415362 DOI: 10.1080/0284186x.2023.2218556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023]
Affiliation(s)
- K E Smedby
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - T Wästerlid
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - E Tham
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Z Haider
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Joelsson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - B Thorvaldsdottir
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Krstic
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - B E Wahlin
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Huddinge, Karolinska Institutet
| | | | - C Karlsson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - L Saft
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - M Palma
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - A Kwiecinska
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
| | - L Hansson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - A Österborg
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - V Wirta
- Science for Life Laboratory, Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Royal Insititute of Technology, Stockholm, Sweden
- Genomic Medicine Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - G Rassidakis
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
| | - B Sander
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
- Dept of Laboratory Medicine, Karolinska Institutet Stockholm, Sweden
| | - K Sonnevi
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Huddinge, Karolinska Institutet
| | - R Rosenquist
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
- Genomic Medicine Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
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10
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Gao Y, Cai C, Wullimann D, Niessl J, Rivera-Ballesteros O, Chen P, Lange J, Cuapio A, Blennow O, Hansson L, Mielke S, Nowak P, Vesterbacka J, Akber M, Perez-Potti A, Sekine T, Müller TR, Boulouis C, Kammann T, Parrot T, Muvva JR, Sobkowiak M, Healy K, Bogdanovic G, Muschiol S, Söderdahl G, Österborg A, Hellgren F, Grifoni A, Weiskopf D, Sette A, Loré K, Sällberg Chen M, Ljungman P, Sandberg JK, Smith CIE, Bergman P, Ljunggren HG, Aleman S, Buggert M. Immunodeficiency syndromes differentially impact the functional spectrum of SARS-CoV-2-specific T cells elicited by mRNA vaccination. Immunity 2022; 55:1732-1746.e5. [PMID: 35961317 PMCID: PMC9293955 DOI: 10.1016/j.immuni.2022.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/05/2022] [Accepted: 07/13/2022] [Indexed: 11/19/2022]
Abstract
Many immunocompromised patients mount suboptimal humoral immunity after SARS-CoV-2 mRNA vaccination. Here, we assessed the single-cell profile of SARS-CoV-2-specific T cells post-mRNA vaccination in healthy individuals and patients with various forms of immunodeficiencies. Impaired vaccine-induced cell-mediated immunity was observed in many immunocompromised patients, particularly in solid-organ transplant and chronic lymphocytic leukemia patients. Notably, individuals with an inherited lack of mature B cells, i.e., X-linked agammaglobulinemia (XLA) displayed highly functional spike-specific T cell responses. Single-cell RNA-sequencing further revealed that mRNA vaccination induced a broad functional spectrum of spike-specific CD4+ and CD8+ T cells in healthy individuals and patients with XLA. These responses were founded on polyclonal repertoires of CD4+ T cells and robust expansions of oligoclonal effector-memory CD45RA+ CD8+ T cells with stem-like characteristics. Collectively, our data provide the functional continuum of SARS-CoV-2-specific T cell responses post-mRNA vaccination, highlighting that cell-mediated immunity is of variable functional quality across immunodeficiency syndromes.
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Affiliation(s)
- Yu Gao
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Curtis Cai
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David Wullimann
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julia Niessl
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olga Rivera-Ballesteros
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Puran Chen
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joshua Lange
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Cuapio
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Mielke
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institute, Stockholm, Sweden; Laboratory for Molecular Infection Medicine Sweden MIMS, Umeå University, Umeå, Sweden
| | - Jan Vesterbacka
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Mira Akber
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andre Perez-Potti
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Takuya Sekine
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thomas R Müller
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Boulouis
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Kammann
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tiphaine Parrot
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jagadeeswara Rao Muvva
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michal Sobkowiak
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katie Healy
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gordana Bogdanovic
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Muschiol
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Söderdahl
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrika Hellgren
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Karin Loré
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Sandberg
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C I Edvard Smith
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Peter Bergman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Marcus Buggert
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden.
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11
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Healy K, Pin E, Chen P, Söderdahl G, Nowak P, Mielke S, Hansson L, Bergman P, Smith CIE, Ljungman P, Valentini D, Blennow O, Österborg A, Gabarrini G, Al-Manei K, Alkharaan H, Sobkowiak MJ, Yousef J, Mravinacova S, Cuapio A, Xu X, Akber M, Loré K, Hellström C, Muschiol S, Bogdanovic G, Buggert M, Ljunggren HG, Hober S, Nilsson P, Aleman S, Sällberg Chen M. Salivary IgG to SARS-CoV-2 indicates seroconversion and correlates to serum neutralization in mRNA-vaccinated immunocompromised individuals. Med 2022; 3:137-153.e3. [PMID: 35075450 PMCID: PMC8770252 DOI: 10.1016/j.medj.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/20/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Immunocompromised individuals are highly susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Whether vaccine-induced immunity in these individuals involves oral cavity, a primary site of infection, is presently unknown. METHODS Immunocompromised patients (n = 404) and healthy controls (n = 82) participated in a prospective clinical trial (NCT04780659) encompassing two doses of the mRNA BNT162b2 vaccine. Primary immunodeficiency (PID), secondary immunodeficiencies caused by human immunodeficiency virus (HIV) infection, allogeneic hematopoietic stem cell transplantation (HSCT)/chimeric antigen receptor T cell therapy (CAR-T), solid organ transplantation (SOT), and chronic lymphocytic leukemia (CLL) patients were included. Salivary and serum immunoglobulin G (IgG) reactivities to SARS-CoV-2 spike were measured by multiplex bead-based assays and Elecsys anti-SARS-CoV-2 S assay. FINDINGS IgG responses to SARS-CoV-2 spike antigens in saliva in HIV and HSCT/CAR-T groups were comparable to those of healthy controls after vaccination. The PID, SOT, and CLL patients had weaker responses, influenced mainly by disease parameters or immunosuppressants. Salivary responses correlated remarkably well with specific IgG titers and the neutralizing capacity in serum. Receiver operating characteristic curve analysis for the predictive power of salivary IgG yielded area under the curve (AUC) = 0.95 and positive predictive value (PPV) = 90.7% for the entire cohort after vaccination. CONCLUSIONS Saliva conveys vaccine responses induced by mRNA BNT162b2. The predictive power of salivary spike IgG makes it highly suitable for screening vulnerable groups for revaccination. FUNDING Knut and Alice Wallenberg Foundation, Erling Perssons family foundation, Region Stockholm, Swedish Research Council, Karolinska Institutet, Swedish Blood Cancer Foundation, PID patient organization of Sweden, Nordstjernan AB, Center for Medical Innovation (CIMED), Swedish Medical Research Council, and Stockholm County Council (ALF).
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Affiliation(s)
- Katie Healy
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Pin
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Puran Chen
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Söderdahl
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Piotr Nowak
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Laboratory for Molecular Infection Medicine Sweden MIMS, Umeå University, Umeå, Sweden
| | - Stephan Mielke
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - C I Edvard Smith
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Per Ljungman
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Davide Valentini
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Gabarrini
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Khaled Al-Manei
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hassan Alkharaan
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- College of Dentistry, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Jamil Yousef
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Sara Mravinacova
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Angelica Cuapio
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Xinling Xu
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mira Akber
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Karin Loré
- Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Hellström
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Sandra Muschiol
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gordana Bogdanovic
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Buggert
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Sophia Hober
- Division of Protein Technology, Department of Protein Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Peter Nilsson
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Soo Aleman
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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12
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Blixt L, Bogdanovic G, Buggert M, Gao Y, Hober S, Healy K, Johansson H, Kjellander C, Mravinacova S, Muschiol S, Nilsson P, Palma M, Pin E, Smith CIE, Stromberg O, Sällberg Chen M, Zain R, Hansson L, Österborg A. Covid-19 in patients with chronic lymphocytic leukemia: clinical outcome and B- and T-cell immunity during 13 months in consecutive patients. Leukemia 2022; 36:476-481. [PMID: 34564699 PMCID: PMC8475381 DOI: 10.1038/s41375-021-01424-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 01/01/2023]
Abstract
We studied clinical and immunological outcome of Covid-19 in consecutive CLL patients from a well-defined area during month 1-13 of the pandemic. Sixty patients (median age 71 y, range 43-97) were identified. Median CIRS was eight (4-20). Patients had indolent CLL (n = 38), had completed (n = 12) or ongoing therapy (n = 10). Forty-six patients (77%) were hospitalized due to severe Covid-19 and 11 were admitted to ICU. Severe Covid-19 was equally distributed across subgroups irrespective of age, gender, BMI, CLL status except CIRS (p < 0.05). Fourteen patients (23%) died; age ≥75 y was the only significant risk factor (p < 0.05, multivariate analysis with limited power). Comparing month 1-6 vs 7-13 of the pandemic, deaths were numerically reduced from 32% to 18%, ICU admission from 37% to 15% whereas hospitalizations remained frequent (86% vs 71%). Seroconversion occurred in 33/40 patients (82%) and anti-SARS-CoV-2 antibodies were detectable at six and 12 months in 17/22 and 8/11 patients, respectively. Most (13/17) had neutralizing antibodies and 19/28 had antibodies in saliva. SARS-CoV-2-specific T-cells (ELISpot) were detected in 14/17 patients. Covid-19 continued to result in high admission even among consecutive and young early- stage CLL patients. A robust and durable B and/or T cell immunity was observed in most convalescents.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- B-Lymphocytes/immunology
- COVID-19/complications
- COVID-19/immunology
- COVID-19/transmission
- COVID-19/virology
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/virology
- Male
- Middle Aged
- Prognosis
- SARS-CoV-2/immunology
- SARS-CoV-2/isolation & purification
- T-Lymphocytes/immunology
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Affiliation(s)
- Lisa Blixt
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Gordana Bogdanovic
- Department of Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Buggert
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Yu Gao
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sophia Hober
- Department of Protein Science, SciLifeLab and KTH Royal Institute of Technology, Stockholm, Sweden
| | - Katie Healy
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Sara Mravinacova
- Department of Protein Science, SciLifeLab and KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sandra Muschiol
- Department of Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Nilsson
- Department of Protein Science, SciLifeLab and KTH Royal Institute of Technology, Stockholm, Sweden
| | - Marzia Palma
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Pin
- Department of Protein Science, SciLifeLab and KTH Royal Institute of Technology, Stockholm, Sweden
| | - C I Edvard Smith
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olga Stromberg
- Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | | | - Rula Zain
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Rare Diseases, Department of Clinical Genetics, Karolinska University, Hospital, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden.
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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13
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Blixt L, Wullimann D, Aleman S, Lundin J, Chen P, Gao Y, Cuapio A, Akber M, Lange J, Rivera-Ballesteros O, Buggert M, Ljunggren HG, Hansson L, Österborg A. T cell immune responses following vaccination with mRNA BNT162b2 against SARS-CoV2 in patients with chronic lymphocytic leukemia: results from a prospective open-label clinical trial. Haematologica 2022; 107:1000-1003. [PMID: 35045694 PMCID: PMC8968881 DOI: 10.3324/haematol.2021.280300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lisa Blixt
- Dept of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden; Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - David Wullimann
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Lundin
- Dept of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden; Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Puran Chen
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Yu Gao
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Cuapio
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mira Akber
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Joshua Lange
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Olga Rivera-Ballesteros
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Buggert
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Dept of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Dept of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden; Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Anders Österborg
- Dept of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden; Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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14
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Gao Y, Cai C, Grifoni A, Müller TR, Niessl J, Olofsson A, Humbert M, Hansson L, Österborg A, Bergman P, Chen P, Olsson A, Sandberg JK, Weiskopf D, Price DA, Ljunggren HG, Karlsson AC, Sette A, Aleman S, Buggert M. Ancestral SARS-CoV-2-specific T cells cross-recognize the Omicron variant. Nat Med 2022; 28:472-476. [PMID: 35042228 PMCID: PMC8938268 DOI: 10.1038/s41591-022-01700-x] [Citation(s) in RCA: 269] [Impact Index Per Article: 134.5] [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: 12/30/2021] [Accepted: 01/14/2022] [Indexed: 11/10/2022]
Abstract
The emergence of the SARS-CoV-2 variant-of-concern Omicron (B.1.1.529) has destabilized global efforts to control the impact of COVID-19. Recent data have suggested that B.1.1.529 can readily infect people with naturally acquired or vaccine-induced immunity, facilitated in some cases by viral escape from antibodies that neutralize ancestral SARS-CoV-2. However, severe disease appears to be relatively uncommon in such individuals, highlighting a potential role for other components of the adaptive immune system. We report here that SARS-CoV-2 spike-specific CD4+ and CD8+ T cells induced by prior infection or BNT162b2 vaccination provide extensive immune coverage against B.1.1.529. The median relative frequencies of SARS-CoV-2 spike-specific CD4+ T cells that cross-recognized B.1.1.529 in previously infected or BNT162b2-vaccinated individuals were 84% and 91%, respectively, and the corresponding median relative frequencies for SARS-CoV-2 spike-specific CD8+ T cells were 70% and 92%, respectively. Pairwise comparisons across groups further revealed that SARS-CoV-2 spike-reactive CD4+ and CD8+ T cells were functionally and phenotypically similar in response to the ancestral strain or B.1.1.529. Collectively, our data indicate that established SARS-CoV-2 spike-specific CD4+ and CD8+ T cell responses, especially after BNT162b2 vaccination, remain largely intact against B.1.1.529.
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Affiliation(s)
- Yu Gao
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Curtis Cai
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Thomas R Müller
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julia Niessl
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Olofsson
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Marion Humbert
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Puran Chen
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annika Olsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Johan K Sandberg
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK.,Systems Immunity Research Institute, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annika C Karlsson
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA.,Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Infectious Diseases and Dermatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Buggert
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden.
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15
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Bergman P, Blennow O, Hansson L, Mielke S, Nowak P, Chen P, Söderdahl G, Österborg A, Smith CIE, Wullimann D, Vesterbacka J, Lindgren G, Blixt L, Friman G, Wahren-Borgström E, Nordlander A, Gomez AC, Akber M, Valentini D, Norlin AC, Thalme A, Bogdanovic G, Muschiol S, Nilsson P, Hober S, Loré K, Chen MS, Buggert M, Ljunggren HG, Ljungman P, Aleman S. Safety and efficacy of the mRNA BNT162b2 vaccine against SARS-CoV-2 in five groups of immunocompromised patients and healthy controls in a prospective open-label clinical trial. EBioMedicine 2021; 74:103705. [PMID: 34861491 PMCID: PMC8629680 DOI: 10.1016/j.ebiom.2021.103705] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/21/2021] [Accepted: 11/04/2021] [Indexed: 01/06/2023] Open
Abstract
Background Patients with immunocompromised disorders have mainly been excluded from clinical trials of vaccination against COVID-19. Thus, the aim of this prospective clinical trial was to investigate safety and efficacy of BNT162b2 mRNA vaccination in five selected groups of immunocompromised patients and healthy controls. Methods 539 study subjects (449 patients and 90 controls) were included. The patients had either primary (n=90), or secondary immunodeficiency disorders due to human immunodeficiency virus infection (n=90), allogeneic hematopoietic stem cell transplantation/CAR T cell therapy (n=90), solid organ transplantation (SOT) (n=89), or chronic lymphocytic leukemia (CLL) (n=90). The primary endpoint was seroconversion rate two weeks after the second dose. The secondary endpoints were safety and documented SARS-CoV-2 infection. Findings Adverse events were generally mild, but one case of fatal suspected unexpected serious adverse reaction occurred. 72.2% of the immunocompromised patients seroconverted compared to 100% of the controls (p=0.004). Lowest seroconversion rates were found in the SOT (43.4%) and CLL (63.3%) patient groups with observed negative impact of treatment with mycophenolate mofetil and ibrutinib, respectively. Interpretation The results showed that the mRNA BNT162b2 vaccine was safe in immunocompromised patients. Rate of seroconversion was substantially lower than in healthy controls, with a wide range of rates and antibody titres among predefined patient groups and subgroups. This clinical trial highlights the need for additional vaccine doses in certain immunocompromised patient groups to improve immunity. Funding Knut and Alice Wallenberg Foundation, the Swedish Research Council, Nordstjernan AB, Region Stockholm, Karolinska Institutet, and organizations for PID/CLL-patients in Sweden.
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Affiliation(s)
- Peter Bergman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Mielke
- Department of Laboratory Medicine, Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Laboratory for Molecular Infection Medicine Sweden MIMS, Umeå University, Sweden
| | - Puran Chen
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Söderdahl
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - C I Edvard Smith
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - David Wullimann
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Vesterbacka
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Lindgren
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lisa Blixt
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Friman
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna Nordlander
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Angelica Cuapio Gomez
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mira Akber
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Davide Valentini
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anna-Carin Norlin
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Thalme
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Gordana Bogdanovic
- Dept of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Muschiol
- Dept of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Nilsson
- Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sophia Hober
- Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Karin Loré
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Marcus Buggert
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Hematology, Karolinska Institutet, Stockholm
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
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16
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Wahlin BE, Övergaard N, Peterson S, Digkas E, Glimelius I, Lagerlöf I, Johansson A, Palma M, Hansson L, Linderoth J, Goldkuhl C, Molin D. Real‐world data on treatment concepts in classical Hodgkin lymphoma in Sweden 2000–2014, focusing on patients aged >60 years. eJHaem 2021; 2:400-412. [PMID: 35844675 PMCID: PMC9175745 DOI: 10.1002/jha2.202] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/08/2022]
Abstract
Treatment for patients > 60 years with classical Hodgkin lymphoma (cHL) is problematic; there is no gold standard, and outcome is poor. Using the Swedish Lymphoma Registry, we analysed all Swedish patients diagnosed with cHL between 2000 and 2014 (N = 2345; median age 42 years; 691 patients were >60 years). The median follow‐up time was 6.7 years. Treatment for elderly patients consisted mainly of ABVD or CHOP, and the younger patients were treated with ABVD or BEACOPP (with no survival difference). In multivariable analysis of patients > 60 years, ABVD correlated with better survival than CHOP (p = 0.027), and ABVD became more common over time among patients aged 61–70 years (p = 0.0206). Coinciding with the implementation of FDG‐PET/CT, the fraction of advanced‐stage disease increased in later calendar periods, also in the older patient group. Survival has improved in cHL patients > 60 years (p = 0.027), for whom ABVD seems superior to CHOP.
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Affiliation(s)
- Björn Engelbrekt Wahlin
- Division of Haematology, Department of Medicine, Huddinge Karolinska Institutet Stockholm Sweden
- Haematology unit Karolinska University Hospital Stockholm Sweden
| | - Ninja Övergaard
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
| | | | | | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
| | - Ingemar Lagerlöf
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
- Department of Haematology University Hospital of Linköping Linköping Sweden
| | | | - Marzia Palma
- Haematology unit Karolinska University Hospital Stockholm Sweden
| | - Lotta Hansson
- Haematology unit Karolinska University Hospital Stockholm Sweden
| | | | - Christina Goldkuhl
- Department of Oncology Sahlgrenska University Hospital Gothenburg Sweden
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
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17
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Lundin J, Mulder TA, Kättström M, Wästerlid T, Uddevik A, Mellstedt H, Heimersson K, Hansson L, Palma M, Österborg A. Temporary cessation of ibrutinib results in reduced grade 3-4 infections and durable remissions-Interim analysis of an on-off-repeat Phase 1b/2 study in patients with chronic lymphocytic leukemia. EJHaem 2021; 2:525-529. [PMID: 35844699 PMCID: PMC9176042 DOI: 10.1002/jha2.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
Ibrutinib is used continuously in CLL. This phase 1b/2 study interim analysis explored on-off-repeat dosing to reduce toxicity. After 12 months, 16/22 patients (73%) remained in first off-phase irrespective if initial CR/PR or TP53 aberration. Grade 3-4 infections were reduced from 55% to 5% during a similarly long off-phase (P < .01). Treg and exhausted T-cells increased (P = .01). Six patients restarted ibrutinib at early progression and remain drug-sensitive. Our interim analysis shows a durable off-phase in most patients, with reduced infections and cost-saving potential. If toxicity-driven permanent cessation of ibrutinib will be affected will be explored in the extended study.
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Affiliation(s)
- Jeanette Lundin
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
| | - Tom A. Mulder
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Magdalena Kättström
- Department of Medicine, Section of HematologyÖrebro University HospitalÖrebroSweden
| | - Tove Wästerlid
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Anders Uddevik
- Department of Medicine, Section of HematologyGävle HospitalGävleSweden
| | - Håkan Mellstedt
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Kia Heimersson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Lotta Hansson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
| | - Marzia Palma
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
| | - Anders Österborg
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
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18
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Leeksma AC, Baliakas P, Moysiadis T, Puiggros A, Plevova K, Van der Kevie-Kersemaekers AM, Posthuma H, Rodriguez-Vicente AE, Tran AN, Barbany G, Mansouri L, Gunnarsson R, Parker H, Van den Berg E, Bellido M, Davis Z, Wall M, Scarpelli I, Österborg A, Hansson L, Jarosova M, Ghia P, Poddighe P, Espinet B, Pospisilova S, Tam C, Ysebaert L, Nguyen-Khac F, Oscier D, Haferlach C, Schoumans J, Stevens-Kroef M, Eldering E, Stamatopoulos K, Rosenquist R, Strefford JC, Mellink C, Kater AP. Genomic arrays identify high-risk chronic lymphocytic leukemia with genomic complexity: a multi-center study. Haematologica 2021; 106:87-97. [PMID: 31974198 PMCID: PMC7776256 DOI: 10.3324/haematol.2019.239947] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/22/2020] [Indexed: 01/15/2023] Open
Abstract
Complex karyotype (CK) identified by chromosome-banding analysis (CBA) has shown prognostic value in chronic lymphocytic leukemia (CLL). Genomic arrays offer high-resolution genome-wide detection of copy-number alterations (CNAs) and could therefore be well equipped to detect the presence of a CK. Current knowledge on genomic arrays in CLL is based on outcomes of single center studies, in which different cutoffs for CNA calling were used. To further determine the clinical utility of genomic arrays for CNA assessment in CLL diagnostics, we retrospectively analyzed 2293 arrays from 13 diagnostic laboratories according to established standards. CNAs were found outside regions captured by CLL FISH probes in 34% of patients, and several of them including gains of 8q, deletions of 9p and 18p (p<0.01) were linked to poor outcome after correction for multiple testing. Patients (n=972) could be divided in three distinct prognostic subgroups based on the number of CNAs. Only high genomic complexity (high-GC), defined as ≥5 CNAs emerged as an independent adverse prognosticator on multivariable analysis for time to first treatment (Hazard ratio: 2.15, 95% CI: 1.36-3.41; p=0.001) and overall survival (Hazard ratio: 2.54, 95% CI: 1.54-4.17; p<0.001; n=528). Lowering the size cutoff to 1 Mb in 647 patients did not significantly improve risk assessment. Genomic arrays detected more chromosomal abnormalities and performed at least as well in terms of risk stratification compared to simultaneous chromosome banding analysis as determined in 122 patients. Our findings highlight genomic array as an accurate tool for CLL risk stratification.
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Affiliation(s)
| | - Panagiotis Baliakas
- Dept of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Karla Plevova
- University Hospital Brno, Masaryk University, Brno, Czech Republic
| | | | - Hidde Posthuma
- Dept of Clinical Genetics, Amsterdam University Medical Centers, Univ of Amsterdam, The Netherlands
| | | | - Anh Nhi Tran
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Gisela Barbany
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Larry Mansouri
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rebeqa Gunnarsson
- Division of Clinical Genetics, Dept of Laboratory Medicine, Lund University, Lund, Sweden
| | - Helen Parker
- Cancer Genomics, Academic Unit of Cancer Sciences, University of Southampton, Southampton, UK
| | - Eva Van den Berg
- Dept of Genetics, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Mar Bellido
- Dept of Genetics, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Zadie Davis
- Dept of Molecular Pathology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Meaghan Wall
- Cytogenetics department, St Vincent Hospital Melbourne, Victoria, Australia
| | - Ilaria Scarpelli
- Oncogenomic laboratory, Dept of Hematology, Lausanne University Hospital (CHUV), Switzerland
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | - Marie Jarosova
- University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Ghia
- Dept. of Experimental Oncology, IRCCS Ospedale San Raffaele, Università Vita-Salute, Milan
| | - Pino Poddighe
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | - Blanca Espinet
- Laboratori de Citogenetica Molecular, Servei de Patologia, Hospital del Mar, Barcelona, Spain
| | - Sarka Pospisilova
- CEITEC, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Constantine Tam
- St Vincent Hospital Melbourne, Peter MacCallum Cancer Center, University of Melbourne, Australia
| | - Loïc Ysebaert
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Florence Nguyen-Khac
- Service d'Hematologie Biologique, Hopital Pitié-Salpetriere, APHP, Paris, France
| | - David Oscier
- Dept of Molecular Pathology, Royal Bournemouth Hospital, Bournemouth, UK
| | | | - Jacqueline Schoumans
- Oncogenomic laboratory, Dept of Hematology, Lausanne University Hospital (CHUV), Switzerland
| | - Marian Stevens-Kroef
- Radboud University Medical Center, Dept of Human Genetics, Nijmegen, The Netherlands
| | - Eric Eldering
- Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Richard Rosenquist
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Clemens Mellink
- Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Arnon P Kater
- Hematology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
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19
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Mattsson A, Sylvan SE, Asklid A, Wiggh J, Winqvist M, Lundin J, Mansouri L, Rosenquist R, Johansson H, Österborg A, Hansson L. Risk-adapted bendamustine + rituximab is a tolerable treatment alternative for elderly patients with chronic lymphocytic leukaemia: a regional real-world report on 141 consecutive Swedish patients. Br J Haematol 2020; 191:426-432. [PMID: 32779190 PMCID: PMC7689859 DOI: 10.1111/bjh.17032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
Bendamustine + rituximab (BR) is the current first-line standard-of-care for chronic lymphocytic leukaemia (CLL) in fit patients aged 66-70 years, whereas chlorambucil + CD20 antibody is recommended in older patients with co-morbidities. This retrospective real-world study investigated whether risk-adapted BR was safe and effective in elderly patients. All 141 CLL patients in the Stockholm region (diagnosed from 2007 to 2016, identified from regional registries) who had received BR as first (n = 84) or later line (n = 57) were analysed. Median age was 72 years, 49% had Binet stage C, 40% had Cumulative Illness Rating Scale (CIRS) score ≥ 6, 20% Eastern Cooperative Oncology Group (ECOG) score 2. None had del(17p). Only 15% of patients aged ≥80 years received full-dose bendamustine and 65% of them postponed rituximab until cycle 2. Corresponding numbers in patients 73-79 years were 21% and 36% and in <73 years, 63% and 33%. Overall response rate was 83% (first line) and 67% (later line) (P < 0·022) equally distributed between age subsets. ECOG, immunoglobulin heavy chain variable region (IGHV) mutational status and cytogenetics, but not treatment line and age, were significant factors on progression-free survival (PFS) in multivariate analysis. Infections and neutropenia/thrombocytopenia (≥grade 3) were similar across age subgroups. In summary, BR was well tolerated even in patients ≥80 years, with similar efficacy and safety as in less old patients, provided that carefully adapted dosing was applied.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bendamustine Hydrochloride/administration & dosage
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Rituximab/administration & dosage
- Sweden/epidemiology
- Treatment Outcome
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Affiliation(s)
- Agnes Mattsson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of Internal MedicineSödersjukhusetStockholmSweden
| | - Sandra E. Sylvan
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Anna Asklid
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of OncologyKarolinska University HospitalStockholmSweden
| | - Joel Wiggh
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Maria Winqvist
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Jeanette Lundin
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Larry Mansouri
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Richard Rosenquist
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Hemming Johansson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Anders Österborg
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Lotta Hansson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
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20
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Asklid A, Eketorp Sylvan S, Mattsson A, Winqvist M, Johansson H, Österborg A, Hansson L. A real-world study of first-line therapy in 280 consecutive Swedish patients ≥80 years with newly diagnosed diffuse large B-cell lymphoma: very elderly (≥85 years) do well on curative intended therapy. Leuk Lymphoma 2020; 61:2136-2144. [PMID: 32449636 DOI: 10.1080/10428194.2020.1765233] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This real-world study investigated outcome of first-line treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL). All (n = 292) new DLBCL patients ≥80 years diagnosed in the Stockholm region from 2000-2015 were included. Median age was 85 years, most had good performance status and low comorbidity score. CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) was used in 60/230 patients, R-CHOP in 170/230. Only 12% of patients aged 80-84 years and 6% of ≥85 years received full-dose chemotherapy. Infections (≥ grade III) occurred in 49% and 37% in the two age groups, respectively. Addition of rituximab resulted in a similar and significant improvement in both age subsets regarding complete remission, progression-free (PFS) and overall survival (OS). Rituximab, performance status and stage, but not age, were significantly associated with PFS and OS by multivariate analysis. Strictly consecutive patients ≥85 years from a well-defined geographical region responded to and tolerated R-CHOP equally well as patients aged 80-84 years.
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Affiliation(s)
- Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Agnes Mattsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Stockholm, Sweden
| | - Maria Winqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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21
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Bozovic G, Larsson H, Wuttge DM, Håkansson M, Hansson L, Ingemansson R, Brunnström H, Andréasson K. Successful lung transplantation in a patient with rheumatoid arthritis suffering from obliterative bronchiolitis. Scand J Rheumatol 2020; 49:334-335. [PMID: 32295451 DOI: 10.1080/03009742.2020.1727006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G Bozovic
- Department of Medical Imaging and Physiology, Skane University Hospital , Lund, Sweden
| | - H Larsson
- Department of Respiratory Medicine and Allergology, Skane University Hospital , Lund, Sweden
| | - D M Wuttge
- Section of Rheumatology, Department of Clinical Sciences, Lund University , Lund, Sweden
| | - M Håkansson
- Section of Pulmonology, Helsingborg Hospital , Helsingborg, Sweden
| | - L Hansson
- Department of Respiratory Medicine and Allergology, Skane University Hospital , Lund, Sweden
| | - R Ingemansson
- Department of Cardiothoracic Surgery, Skane University Hospital , Lund, Sweden
| | - H Brunnström
- Laboratory Medicine Region Skane, Pathology, Department of Clinical Sciences Lund, Lund University , Lund, Sweden
| | - K Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University , Lund, Sweden
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22
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Saarento O, Kastrup M, Hansson L. The Nordic comparative study on sectorized psychiatry: characteristics of repeat users of emergency outpatient services in two Nordic psychiatric services. A 1-year follow-up study. Eur Psychiatry 2020; 13:35-40. [DOI: 10.1016/s0924-9338(97)86749-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/1997] [Accepted: 09/02/1997] [Indexed: 10/18/2022] Open
Abstract
SummaryTo characterise frequent use of psychiatric emergency outpatients services, this paper reports results from a prospective investigation of use of psychiatric services by new patients in two Nordic psychiatric services, Frederiksberg in Denmark and Oulu in Finland. One year treated incidence cohorts were used. Total number of patients included was 1,055. The repeat user was defined as a patient having at least three emergency outpatient contacts during a 1-year follow-up. The repeat users constituted 15.8% of the sample and 70.8% of all the emergency contacts in Frederiksberg. In Oulu the respective figures were 9.3% and 33.8%. The number of planned outpatient contacts or the number of hospital admissions of the repeat users did not differ from the non-repeaters. Repeaters in Frederiksberg were more likely to be self-referrals, male, divorced or unmarried, living with their parents, without their own housing, unemployed, aged between 25 and 44 years, and to have a diagnosis of dependency or personality disorder. In Oulu they did not differ from the other patients with regard to sociodemographic or diagnostic characteristics.
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23
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Svensson B, Hansson L. Perceived curative factors and their relationship to outcome: a study of schizophrenic patients in a comprehensive treatment program based on cognitive therapy. Eur Psychiatry 2020; 13:365-71. [DOI: 10.1016/s0924-9338(99)80704-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/1998] [Revised: 08/31/1998] [Accepted: 09/16/1998] [Indexed: 10/18/2022] Open
Abstract
SummaryTwenty-eight schizophrenic and other long-term mentally ill patients who were given cognitive therapy sessions twice a week in the context of a comprehensive inpatient treatment program were assessed every 5 weeks regarding perceived curative factors. The assessments were made by a self-rating questionnaire (Curative Factors Questionnaire [CFQ]) and a qualitative assessment from the patients of what they perceived as helpful in treatment. The results showed that milieu therapeutic elements and therapy sessions were perceived as the most helpful throughout the treatment period. No correlations were found between patient characteristics and perceived curative factors. The factors “instillation of hope”, “problem solution” and “learning I’m not alone” as rated in the initial phase of treatment showed a positive relationship with a favourable outcome of treatment at discharge.
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24
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Hansson L, Lind T, Öhlund I, Wiklund U, Rydberg A. Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case‐control study. J Hum Nutr Diet 2020; 33:566-573. [DOI: 10.1111/jhn.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- L. Hansson
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - T. Lind
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - I. Öhlund
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - U. Wiklund
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
| | - A. Rydberg
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
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25
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Sylvan SE, Asklid A, Johansson H, Klintman J, Bjellvi J, Tolvgård S, Kimby E, Norin S, Andersson PO, Karlsson C, Karlsson K, Lauri B, Mattsson M, Sandstedt AB, Strandberg M, Österborg A, Hansson L. First-line therapy in chronic lymphocytic leukemia: a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013. Haematologica 2019; 104:797-804. [PMID: 30467205 PMCID: PMC6442960 DOI: 10.3324/haematol.2018.200204] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to investigate long-term outcome following first-line therapy in consecutive chronic lymphocytic leukemia (CLL) patients in a well-defined geographic area: Sweden. All patients diagnosed with CLL (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) treated first line (n=1053) and for those, an in-depth analysis was performed. End points were overall response rate, progression-free survival (PFS), overall survival (OS), and safety. Median age was 71 years; 53% had Rai stage III-IV and 97% had performance status grade 0-2. Fluorescence in situ hybridization (FISH) was performed in 57% of patients: 15% had del(17p). Chlorambucil + prednisone was used in 39% (5% also received rituximab). Fludarabine+cyclophosphamide+rituximab or fludarabine+cyclophosphamide was used in 43% and bendamustine + rituximab in 6%. Overall response rate was 64%; chlorambucil 43%, fludarabine+cyclophosphamide+rituximab 84%, fludarabine+cyclophosphamide 75% and bendamustine + rituximab 75%. Median PFS and OS was 24 and 58 months, respectively, both were significantly associated (multivariate analysis) with type of treatment, del(17p), performance status, gender, age and geographical region (OS only). Chlorambucil-treated patients had a median PFS and OS of only 9 and 33 months, respectively. Chlorambucil usage declined gradually throughout the study period, but one-third of patients still received chlorambucil + rituximab in 2013. Infections ≥grade III were significantly associated with treatment; chlorambucil 19% versus fludarabine+cyclophosphamide+rituximab 30%. Richter transformation occurred in 5.5% of the patients, equally distributed across therapies. This is the largest retrospective, real-world cohort of consecutive first-line treated CLL patients with a complete follow up. In elderly patients, an unmet need for more effective, well-tolerated therapies was identified.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Bendamustine Hydrochloride/administration & dosage
- Chlorambucil/administration & dosage
- Chromosome Deletion
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 17/metabolism
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Prednisolone/administration & dosage
- Registries
- Retrospective Studies
- Rituximab/administration & dosage
- Survival Rate
- Sweden/epidemiology
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
| | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Oncology, Karolinska University Hospital, Stockholm
| | | | - Jenny Klintman
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund
- Department of Translational Medicine, Lund University
| | - Jenny Bjellvi
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | | | - Eva Kimby
- Department of Internal Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Stefan Norin
- Department of Internal Medicine Huddinge, Karolinska Institutet, Stockholm
| | | | - Claes Karlsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Hematology, Karolinska University Hospital, Stockholm
| | - Karin Karlsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, Sunderbyn-Luleå
| | | | | | | | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Hematology, Karolinska University Hospital, Stockholm
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Hematology, Karolinska University Hospital, Stockholm
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26
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Winqvist M, Andersson PO, Asklid A, Karlsson K, Karlsson C, Lauri B, Lundin J, Mattsson M, Norin S, Sandstedt A, Rosenquist R, Späth F, Hansson L, Österborg A. Long-term real-world results of ibrutinib therapy in patients with relapsed or refractory chronic lymphocytic leukemia: 30-month follow up of the Swedish compassionate use cohort. Haematologica 2018; 104:e208-e210. [PMID: 30514799 DOI: 10.3324/haematol.2018.198820] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maria Winqvist
- Department of Hematology, Karolinska University Hospital, Stockholm .,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | | | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | | | - Claes Karlsson
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, Sunderbyn-Luleå
| | - Jeanette Lundin
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | | | - Stefan Norin
- Department of Internal Medicine, Karolinska Institutet, Stockholm
| | | | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| | - Florentin Späth
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
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Daneshmanesh AH, Hojjat-Farsangi M, Ghaderi A, Moshfegh A, Hansson L, Schultz J, Vågberg J, Byström S, Olsson E, Olin T, Österborg A, Mellstedt H. A receptor tyrosine kinase ROR1 inhibitor (KAN0439834) induced significant apoptosis of pancreatic cells which was enhanced by erlotinib and ibrutinib. PLoS One 2018; 13:e0198038. [PMID: 29856777 PMCID: PMC5983484 DOI: 10.1371/journal.pone.0198038] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/11/2018] [Indexed: 12/18/2022] Open
Abstract
There is a great unmet medical need in pancreatic carcinoma (PC) for novel drugs with other mechanisms of action than existing. PC cells express the onco-fetal RTK ROR1, absent on most normal post-partem cells. ROR1 is involved in proliferation, survival, EMT and metastasis of tumor cells in various malignancies. A small molecule inhibitor (KAN0439834) (530 Da) targeting the TK domain of ROR1 was developed and the activity in ROR1 expressing human PC cell lines (n = 8) evaluated. The effects were compared to a murine mAb against the external part of ROR1, gemcitabine, erlotinib and ibrutinib. KAN0439834 induced significant apoptosis of the tumor cells. EC50 values for KAN0439834 varied between 250–650 nM depending on the cell line. The corresponding values for erlotinib and ibrutinib were 10–40 folds higher. KAN0439834 was much more effective in inducing tumor cell death than the ROR1 mAb although both inhibited ROR1 phosphorylation and downstream non-canonical Wnt pathway molecules. Combination of KAN0439834 with erlotinib or ibrutinib had significant additive effects on tumor cell death. A first-in-class small molecule ROR1 inhibitor (KAN0439834) showed promising in vitro activity against a number of human PC cell lines. Interesting is the additive effects of erlotinib and ibrutinib which warrants further studies as both these agents are in clinical trials for pancreatic carcinoma.
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Affiliation(s)
- Amir Hossein Daneshmanesh
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Mohammad Hojjat-Farsangi
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Amineh Ghaderi
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Ali Moshfegh
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Johan Schultz
- Kancera AB, Karolinska Institutet Science Park, Stockholm, Sweden
| | - Jan Vågberg
- Kancera AB, Karolinska Institutet Science Park, Stockholm, Sweden
| | | | - Elisabeth Olsson
- Kancera AB, Karolinska Institutet Science Park, Stockholm, Sweden
| | - Thomas Olin
- Kancera AB, Karolinska Institutet Science Park, Stockholm, Sweden
| | - Anders Österborg
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Håkan Mellstedt
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
- * E-mail:
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28
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Palma M, Hansson L, Mulder TA, Adamson L, Näsman-Glaser B, Eriksson I, Heimersson K, Ryblom H, Mozaffari F, Svensson A, Gentilcore G, Österborg A, Mellstedt H. Lenalidomide as immune adjuvant to a dendritic cell vaccine in chronic lymphocytic leukemia patients. Eur J Haematol 2018; 101:68-77. [PMID: 29569742 DOI: 10.1111/ejh.13065] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We previously showed that immunization with ex vivo- generated autologous dendritic cells loaded with apoptotic tumor cells (Apo-DC) potentiated tumor-specific immunity in chronic lymphocytic leukemia (CLL) patients. Here, we evaluated safety and immunogenicity of Apo-DC in combination with lenalidomide, granulocyte-macrophage colony-stimulating factor (GM-CSF), and low-dose cyclophosphamide (CTX). METHODS Ten previously untreated patients with slowly progressing CLL received 5 Apo-DC vaccinations and lenalidomide orally for 24 weeks either alone (cohort I, n = 5) or together with subcutaneous GM-CSF and intravenous CTX (cohort II, n = 5). Tumor-specific T-cell responses were measured by proliferation and IFN-γ ELISPOT assays. Immune monitoring was performed by flow cytometry. RESULTS Dose-limiting toxicity was observed in 3/10 patients, 2 in cohort I and one in cohort II. One patient developed autoimmune hemolytic anemia and another grade 4 thrombocytopenia. Vaccine-induced immune responses were seen in 5/5 and 4/5 patients in cohort I and II, respectively. The expression of immune checkpoints on T cells did not change significantly. CONCLUSIONS Lenalidomide alone or in combination with GM-CSF and low-dose CTX as immune adjuvant to the Apo-DC vaccine elicited tumor-specific T-cell responses in CLL patients. However, unexpected toxicity was observed and caution is suggested in further exploring this drug as immune adjuvant in CLL.
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Affiliation(s)
- Marzia Palma
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tom A Mulder
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Adamson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Ingrid Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Kia Heimersson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Harriet Ryblom
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Fariba Mozaffari
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ann Svensson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Giusy Gentilcore
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Mellstedt
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Björklund AT, Carlsten M, Sohlberg E, Liu LL, Clancy T, Karimi M, Cooley S, Miller JS, Klimkowska M, Schaffer M, Watz E, Wikström K, Blomberg P, Wahlin BE, Palma M, Hansson L, Ljungman P, Hellström-Lindberg E, Ljunggren HG, Malmberg KJ. Complete Remission with Reduction of High-Risk Clones following Haploidentical NK-Cell Therapy against MDS and AML. Clin Cancer Res 2018; 24:1834-1844. [DOI: 10.1158/1078-0432.ccr-17-3196] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/08/2018] [Accepted: 01/30/2018] [Indexed: 11/16/2022]
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30
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Kokhaei P, Hojjat-Farsangi M, Mozaffari F, Moshfegh A, Pak F, Rashidy-Pour A, Palma M, Hansson L, Österborg A, Mellstedt H. Autologous T cells expressing the oncogenic transcription factor KLF6-SV1 prevent apoptosis of chronic lymphocytic leukemia cells. PLoS One 2018; 13:e0192839. [PMID: 29432497 PMCID: PMC5809069 DOI: 10.1371/journal.pone.0192839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/31/2018] [Indexed: 12/31/2022] Open
Abstract
Crosstalk between leukemic cells and the tumor microenvironment is of importance in chronic lymphocytic leukemia (CLL). T cells seem to sustain the survival of CLL cells by various mechanisms. The Krüppel-like family of transcription factors (KLFs) are identified as regulators of proliferation and cell death. In the present study, we analyzed the expression of the wild type (WT) gene KLF6 and the oncogenic splice variant 1 (KLF6-SV1) at the mRNA level in subsets of T cells from CLL patients (n = 29), multiple myeloma patients (n = 6) and normal donors (n = 10). RNA Silencing was used for wtKLF6 and KLF6-SV1. Tumor cell apoptosis was measured. A significant overexpression of wtKLF6 and KLF6-SV1 in T cells of CLL patients compared to normal donors and myeloma patients was noted (p<0.002). Western blot showed that both wtKLF6 and KLF6-SV1 were expressed in purified T cells from CLL patients. KLF6-SV1 siRNA transfection induced a significant down-regulation of KLF6-SV1 in CLL T cells, which lost the capability to sustain the growth of leukemic cells. However, no such a significant effect was seen after wtKLF6 transfection of the autologous T cells. The results suggest that KLF6-SV1 may play a role in the regulation of survival CLL cells.
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MESH Headings
- Aged
- Aged, 80 and over
- Apoptosis/genetics
- Female
- Gene Expression
- Humans
- Kruppel-Like Factor 6/antagonists & inhibitors
- Kruppel-Like Factor 6/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Multiple Myeloma/genetics
- Multiple Myeloma/pathology
- Oncogenes
- Protein Isoforms/antagonists & inhibitors
- Protein Isoforms/genetics
- RNA Interference
- RNA, Messenger/genetics
- RNA, Neoplasm/genetics
- RNA, Small Interfering/genetics
- T-Lymphocytes/metabolism
- Transfection
- Tumor Microenvironment/genetics
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Affiliation(s)
- Parviz Kokhaei
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Cancer Research Center and Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Hojjat-Farsangi
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- The Persian Gulf Marine Biotechnology Medicine Research Center and Department of Immunology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Fariba Mozaffari
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Ali Moshfegh
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Fatemeh Pak
- Cancer Research Center and Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Rashidy-Pour
- Physiology Research Center and Department of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Marzia Palma
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Lotta Hansson
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Anders Österborg
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Håkan Mellstedt
- Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- * E-mail:
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Hansson L, Asklid A, Diels J, Eketorp-Sylvan S, Repits J, Søltoft F, Jäger U, Österborg A. Ibrutinib versus previous standard of care: an adjusted comparison in patients with relapsed/refractory chronic lymphocytic leukaemia. Ann Hematol 2017; 96:1681-1691. [PMID: 28762081 PMCID: PMC5569664 DOI: 10.1007/s00277-017-3061-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/30/2016] [Accepted: 07/03/2017] [Indexed: 10/26/2022]
Abstract
This study explored the relative efficacy of ibrutinib versus previous standard-of-care treatments in relapsed/refractory patients with chronic lymphocytic leukaemia (CLL), using multivariate regression modelling to adjust for baseline prognostic factors. Individual patient data were collected from an observational Stockholm cohort of consecutive patients (n = 144) diagnosed with CLL between 2002 and 2013 who had received at least second-line treatment. Data were compared with results of the RESONATE clinical trial. A multivariate Cox proportional hazards regression model was used which estimated the hazard ratio (HR) of ibrutinib versus previous standard of care. The adjusted HR of ibrutinib versus the previous standard-of-care cohort was 0.15 (p < 0.0001) for progression-free survival (PFS) and 0.36 (p < 0.0001) for overall survival (OS). A similar difference was observed also when patients treated late in the period (2012-) were compared separately. Multivariate analysis showed that later line of therapy, male gender, older age and poor performance status were significant independent risk factors for worse PFS and OS. Our results suggest that PFS and OS with ibrutinib in the RESONATE study were significantly longer than with previous standard-of-care regimens used in second or later lines in routine healthcare. The approach used, which must be interpreted with caution, compares patient-level data from a clinical trial with outcomes observed in a daily clinical practice and may complement results from randomised trials or provide preliminary wider comparative information until phase 3 data exist.
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Affiliation(s)
- Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. .,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | | | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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32
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Gilljam M, De Monestrol I, Hansson L, Krantz C, Lindblad A. 298 Liver transplantation for CF in Sweden. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Palma M, Gentilcore G, Heimersson K, Mozaffari F, Näsman-Glaser B, Young E, Rosenquist R, Hansson L, Österborg A, Mellstedt H. T cells in chronic lymphocytic leukemia display dysregulated expression of immune checkpoints and activation markers. Haematologica 2016; 102:562-572. [PMID: 27927767 PMCID: PMC5394965 DOI: 10.3324/haematol.2016.151100] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [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: 06/14/2016] [Accepted: 11/17/2016] [Indexed: 12/13/2022] Open
Abstract
Chronic lymphocytic leukemia is characterized by impaired immune functions largely due to profound T-cell defects. T-cell functions also depend on co-signaling receptors, inhibitory or stimulatory, known as immune checkpoints, including cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and programmed death-1 (PD-1). Here we analyzed the T-cell phenotype focusing on immune checkpoints and activation markers in chronic lymphocytic leukemia patients (n=80) with different clinical characteristics and compared them to healthy controls. In general, patients had higher absolute numbers of CD3+ cells and the CD8+ subset was particularly expanded in previously treated patients. Progressive patients had higher numbers of CD4+ and CD8+ cells expressing PD-1 compared to healthy controls, which was more pronounced in previously treated patients (P=0.0003 and P=0.001, respectively). A significant increase in antigen-experienced T cells was observed in patients within both the CD4+ and CD8+ subsets, with a significantly higher PD-1 expression. Higher numbers of CD4+ and CD8+ cells with intracellular CTLA-4 were observed in patients, as well as high numbers of proliferating (Ki67+) and activated (CD69+) CD4+ and CD8+ cells, more pronounced in patients with active disease. The numbers of Th1, Th2, Th17 and regulatory T cells were substantially increased in patients compared to controls (P<0.05), albeit decreasing to low levels in pre-treated patients. In conclusion, chronic lymphocytic leukemia T cells display increased expression of immune checkpoints, abnormal subset distribution, and a higher proportion of proliferating cells compared to healthy T cells. Disease activity and previous treatment shape the T-cell profile of chronic lymphocytic leukemia patients in different ways.
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Affiliation(s)
- Marzia Palma
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden .,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Giusy Gentilcore
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Kia Heimersson
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Fariba Mozaffari
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Näsman-Glaser
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Emma Young
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Lotta Hansson
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Österborg
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Håkan Mellstedt
- Immune and Gene Therapy Laboratory, Department of Oncology & Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden
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34
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Winqvist M, Asklid A, Andersson PO, Karlsson K, Karlsson C, Lauri B, Lundin J, Mattsson M, Norin S, Sandstedt A, Hansson L, Österborg A. Real-world results of ibrutinib in patients with relapsed or refractory chronic lymphocytic leukemia: data from 95 consecutive patients treated in a compassionate use program. A study from the Swedish Chronic Lymphocytic Leukemia Group. Haematologica 2016; 101:1573-1580. [PMID: 27198718 PMCID: PMC5479603 DOI: 10.3324/haematol.2016.144576] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/18/2016] [Indexed: 12/22/2022] Open
Abstract
Ibrutinib, a Bruton's tyrosine kinase inhibitor is approved for relapsed/refractory and del(17p)/TP53 mutated chronic lymphocytic leukemia. Discrepancies between clinical trials and routine health-care are commonly observed in oncology. Herein we report real-world results for 95 poor prognosis Swedish patients treated with ibrutinib in a compassionate use program. Ninety-five consecutive patients (93 chronic lymphocytic leukemia, 2 small lymphocytic leukemia) were included in the study between May 2014 and May 2015. The median age was 69 years. 63% had del(17p)/TP53 mutation, 65% had Rai stage III/IV, 28% had lymphadenopathy ≥10cm. Patients received ibrutinib 420 mg once daily until progression. At a median follow-up of 10.2 months, the overall response rate was 84% (consistent among subgroups) and 77% remained progression-free. Progression-free survival and overall survival were significantly shorter in patients with del(17p)/TP53 mutation (P=0.017 and P=0.027, log-rank test); no other factor was significant in Cox proportional regression hazards model. Ibrutinib was well tolerated. Hematomas occurred in 46% of patients without any major bleeding. Seven patients had Richter's transformation. This real-world analysis on consecutive chronic lymphocytic leukemia patients from a well-defined geographical region shows the efficacy and safety of ibrutinib to be similar to that of pivotal trials. Yet, del(17p)/TP53 mutation remains a therapeutic challenge. Since not more than half of our patients would have qualified for the pivotal ibrutinib trial (RESONATE), our study emphasizes that real-world results should be carefully considered in future with regards to new agents and new indications in chronic lymphocytic leukemia.
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MESH Headings
- Adenine/analogs & derivatives
- Aged
- Aged, 80 and over
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Chromosome Aberrations
- Compassionate Use Trials
- Disease Progression
- Drug Resistance, Neoplasm
- Female
- Humans
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Piperidines
- Proportional Hazards Models
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Pyrazoles/administration & dosage
- Pyrazoles/adverse effects
- Pyrazoles/therapeutic use
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
- Pyrimidines/therapeutic use
- Recurrence
- Retreatment
- Retrospective Studies
- Sweden
- Treatment Outcome
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Affiliation(s)
- Maria Winqvist
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - P O Andersson
- Department of Hematology, South Älvsborg Hospital, Borås, Sweden
| | - Karin Karlsson
- Department of Hematology and Vascular Disorders, Skåne University Hospital, Lund, Sweden
| | - Claes Karlsson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, Sunderbyn Luleå, Sweden
| | - Jeanette Lundin
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Mattsson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Stefan Norin
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandstedt
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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35
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Asklid A, Winqvist M, Eketorp Sylvan S, Mattsson A, Björgvinsson E, Søltoft F, Repits J, Diels J, Österborg A, Hansson L. Outcomes of second-line treatment in chronic lymphocytic leukemia - a population-based study from a well defined geographical region between 2003 and 2013. Leuk Lymphoma 2016; 58:1219-1223. [PMID: 27894205 DOI: 10.1080/10428194.2016.1246727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anna Asklid
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,b Department of Oncology , Karolinska University Hospital , Stockholm , Sweden
| | - Maria Winqvist
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,d Department of Hematology , Karolinska University Hospital Solna , Stockholm , Sweden
| | | | - Agnes Mattsson
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,c Department of Internal Medicine , Södersjukhuset , Stockholm , Sweden
| | - Einar Björgvinsson
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,b Department of Oncology , Karolinska University Hospital , Stockholm , Sweden
| | | | | | | | - Anders Österborg
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,d Department of Hematology , Karolinska University Hospital Solna , Stockholm , Sweden
| | - Lotta Hansson
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,d Department of Hematology , Karolinska University Hospital Solna , Stockholm , Sweden
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Winqvist M, Mozaffari F, Palma M, Eketorp Sylvan S, Hansson L, Mellstedt H, Österborg A, Lundin J. Phase I-II study of lenalidomide and alemtuzumab in refractory chronic lymphocytic leukemia (CLL): effects on T cells and immune checkpoints. Cancer Immunol Immunother 2016; 66:91-102. [PMID: 27815572 PMCID: PMC5222940 DOI: 10.1007/s00262-016-1922-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/27/2016] [Indexed: 11/21/2022]
Abstract
This phase I–II study explored safety, immunomodulatory and clinical effects of lenalidomide (weeks 1–16) and alemtuzumab (weeks 5–16) in 23 patients with refractory chronic lymphocytic leukemia. Most patients had Rai stage III/IV disease and were heavily pretreated (median 4 prior therapies), and 61% had del(17p)/del(11q). Eleven of 19 evaluable patients (58%) responded, with a median response duration of 12 months (1–29+); time to progression was short in non-responders. Lenalidomide had a narrow therapeutic dose range, 2.5 mg/day was not efficient, and maximum tolerated dose was 5 mg/day. Grade 3–4 neutropenia and thrombocytopenia occurred in 84 and 55%, 30% had febrile neutropenia, and CMV-reactivation requiring valganciclovir occurred in 30% of patients. The frequency of proliferating (Ki67+) CD8+ T cells was increased at week 4, with further increase in both the CD4+ and CD8+ subsets (p < 0.01 and <0.05), which was accompanied by significant upregulation of HLA-DR after addition of alemtuzumab. Antigen-experienced cells increased at week 4 as the frequency of effector memory cells increased in the CD8+ subset (p < 0.003), while effector cells decreased in both the CD8+ and CD4+ subsets (p < 0.0001 and p < 0.01). The Th1/Th2 balance was unchanged at week 4 but shifted toward a Th2 profile after combination therapy. At end of treatment, the frequency of Th17 and regulatory T cells was reduced (p < 0.01), naïve T cells decreased, and effector memory T cells increased (p < 0.05 and p < 0.01). Granzyme B+ T cells increased at 30-week follow-up (p < 0.05). PD-1 expression was unaffected. In conclusion, low-dose lenalidomide and alemtuzumab induced major perturbations of T cells, including increased proliferative activity and cytotoxic potential.
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Affiliation(s)
- Maria Winqvist
- Department of Hematology, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Fariba Mozaffari
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Marzia Palma
- Department of Hematology, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Mellstedt
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Lundin
- Department of Hematology, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Affiliation(s)
- C. Henderson
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - H. Stuart
- Centre for Health Services and Policy ResearchAbramsky HallQueen's UniversityKingstonONCanada
| | - L. Hansson
- Department of Health SciencesLund UniversityLundSweden
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Hansson L, Stjernswärd S, Svensson B. Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009-2014: an evaluation of a national antistigma programme. Acta Psychiatr Scand 2016; 134 Suppl 446:71-9. [PMID: 27426648 DOI: 10.1111/acps.12609] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Public stigma of mental illness is still a major problem where numerous population studies during the last decade have mainly shown no improvements. A Swedish national antistigma campaign has been running 2010-2014. The aim of this study was to investigate changes in public stigma during this period as compared to baseline in 2009. METHODS Yearly population surveys were made between 2009 and 2014 including assessments of mental health literacy, attitudes, and intended future behaviour. Two surveys were made, one including a nationally representative sample and one including a representative sample from three original campaign regions. Multiple regression analyses, also including age, gender, education, and familiarity with mental illness were made to investigate yearly changes in public stigma compared to baseline. RESULTS Mental health literacy improved significantly in the campaign regions between 2009 and 2014, as did intended future behaviour. Attitudes toward mental illness also improved significantly. Improvements were also shown in the national population surveys, but the time pattern of these compared to that of the original campaign regions indicated that these changes took place mainly after the campaign had been extended to a further five Swedish regions. CONCLUSION The results of our surveys suggest that a campaign primarily based on social contact theory and involving people with lived experience of mental illness may, even in a rather short-term perspective, have a significant positive impact on mental health literacy, attitudes, and intentions of social contact with people with mental illness.
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Affiliation(s)
- L Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - S Stjernswärd
- Department of Health Sciences, Lund University, Lund, Sweden
| | - B Svensson
- Department of Health Sciences, Lund University, Lund, Sweden
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Khan AS, Hojjat-Farsangi M, Daneshmanesh AH, Hansson L, Kokhaei P, Österborg A, Mellstedt H, Moshfegh A. Dishevelled proteins are significantly upregulated in chronic lymphocytic leukaemia. Tumour Biol 2016; 37:11947-11957. [DOI: 10.1007/s13277-016-5039-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/28/2016] [Indexed: 10/21/2022] Open
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Hojjat-Farsangi M, Jeddi-Tehrani M, Daneshmanesh AH, Mozaffari F, Moshfegh A, Hansson L, Razavi SM, Sharifian RA, Rabbani H, Österborg A, Mellstedt H, Shokri F. Spontaneous Immunity Against the Receptor Tyrosine Kinase ROR1 in Patients with Chronic Lymphocytic Leukemia. PLoS One 2015; 10:e0142310. [PMID: 26562161 PMCID: PMC4642968 DOI: 10.1371/journal.pone.0142310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/19/2015] [Indexed: 12/03/2022] Open
Abstract
Background ROR1 is a receptor tyrosine kinase expressed in chronic lymphocytic leukemia (CLL) and several other malignancies but absent in most adult normal tissues. ROR1 is considered an onco-fetal antigen. In the present study we analysed spontaneous humoral and cellular immunity against ROR1 in CLL patients. Materials and Methods Antibodies against ROR1 were analysed in 23 patients and 20 healthy donors by ELISA and Western blot. Purified serum IgG from patients was tested for cytotoxicity against CLL cells using the MTT viability assay. A cellular immune response against ROR1 derived HLA-A2 restricted 9 aa and 16 aa long peptides were analysed using peptide loaded dendritic cells co-cultured with autologous T cells from CLL patients (n = 9) and healthy donors (n = 6). IFN-γ, IL-5 and IL-17A-secreting T cells were assessed by ELISPOT and a proliferative response using a H3-thymidine incorporation assay. Results The majority of CLL patients had antibodies against ROR1. Significantly higher titers of anti-ROR1 antibodies were noted in patients with non-progressive as compared to progressive disease. The extracellular membrane-close ROR1 KNG domain seemed to be an immunodominant epitope. Ten patients with high titers of anti-ROR1 binding antibodies were tested for cytotoxicity. Five of those had cytotoxic anti-ROR1 antibodies against CLL cells. ROR1-specific IFN-γ and IL-17A producing T cells could be detected in CLL patients, preferentially in non-progressive as compared to patients with progressive disease (p<0.05). Conclusion ROR1 seemed to spontaneously induce a humoral as well as a T cell response in CLL patients. The data support the notion that ROR1 might be a specific neo-antigen and may serve as a target for immunotherapy.
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MESH Headings
- Amino Acid Sequence
- Antibodies/blood
- Antibodies/immunology
- Antibody-Dependent Cell Cytotoxicity/immunology
- Blotting, Western
- Enzyme-Linked Immunosorbent Assay
- Female
- HLA-A2 Antigen/immunology
- Humans
- Immunity/immunology
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Interferon-gamma/immunology
- Interferon-gamma/metabolism
- Interleukin-17/immunology
- Interleukin-17/metabolism
- Interleukin-5/immunology
- Interleukin-5/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
- Molecular Sequence Data
- Peptides/immunology
- Prognosis
- Receptor Tyrosine Kinase-like Orphan Receptors/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
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Affiliation(s)
- Mohammad Hojjat-Farsangi
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Amir Hossein Daneshmanesh
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
| | - Fariba Mozaffari
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
| | - Ali Moshfegh
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
- Department of Hematology-Oncology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Seyed Mohsen Razavi
- Clinic of Hematology and Oncology, Firozgar Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ramazan Ali Sharifian
- Clinic of Hematology and Oncology, Vali-Asr Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hodjattallah Rabbani
- Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Anders Österborg
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
- Department of Hematology-Oncology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Håkan Mellstedt
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Fazel Shokri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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Berglind D, Hansson L, Tynelius P, Rasmussen F. Levels of objectively measured physical activity and sedentary behavior in the PRIMROSE trial. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.068] [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: 11/12/2022] Open
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Bjorklund A, Carlsten M, Liu L, Schaffer M, Watz E, Palma M, Hansson L, Mollgard L, Cooley S, Miller J, Ljungman P, Hellstrom-Lindberg E, Ljunggren H, Malmberg K. 54 ADOPTIVELY TRANSFERRED HAPLOIDENTICAL NK CELLS AGAINST REFRACTORY MDS, HIGH-RISK MDS AND REFRACTORY AML AS A BRIDGE TO TRANSPLANTATION. COMPLETE REMISSION ASSOCIATED WITH DETECTABLE NK CELLS. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Forsman AK, Wahlbeck K, Aaro LE, Alonso J, Barry MM, Brunn M, Cardoso G, Cattan M, de Girolamo G, Eberhard-Gran M, Evans-Lacko S, Fiorillo A, Hansson L, Haro JM, Hazo JB, Hegerl U, Katschnig H, Knappe S, Luciano M, Miret M, Nordentoft M, Obradors-Tarrago C, Pilgrim D, Ruud T, Salize HJ, Stewart-Brown SL, Tomasson K, van der Feltz-Cornelis CM, Ventus DBJ, Vuori J, Varnik A. Research priorities for public mental health in Europe: recommendations of the ROAMER project. Eur J Public Health 2015; 25:249-54. [DOI: 10.1093/eurpub/cku232] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Hansson L, Öhlund I, Lind T, Stecksén-Blicks C, Rydberg A. Dietary intake in infants with complex congenital heart disease: a case-control study on macro- and micronutrient intake, meal frequency and growth. J Hum Nutr Diet 2014; 29:67-74. [DOI: 10.1111/jhn.12285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L. Hansson
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
| | - I. Öhlund
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
| | - T. Lind
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
| | - C. Stecksén-Blicks
- Department of Odontology; Pediatric Dentistry Umeå University; Umeå Sweden
| | - A. Rydberg
- Department of Clinical Science; Pediatric Unit Umeå University; Umeå Sweden
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Hansson L, Lindberg U, Inghammar M, Skog I. WS8.6 Bacterial flora in the airways after lung transplantation in patients with cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Eketorp Sylvan S, Lundin J, Ipek M, Palma M, Karlsson C, Hansson L. Alemtuzumab (anti-CD52 monoclonal antibody) as single-agent therapy in patients with relapsed/refractory chronic lymphocytic leukaemia (CLL)—a single region experience on consecutive patients. Ann Hematol 2014; 93:1725-33. [DOI: 10.1007/s00277-014-2105-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
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Sylvan SE, Lundin J, Ipek M, Palma M, Karlsson C, Hansson L. P27. Alemtuzumab (anti-CD52 monoclonal antibody) as single-agent therapy in patients with relapsed/refractory chronic lymphocytic leukaemia (CLL) – a single region experience on consecutive patients. J Immunother Cancer 2014. [PMCID: PMC4072199 DOI: 10.1186/2051-1426-2-s2-p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Eketorp Sylvan S, Hansson L, Karlsson C, Norin S, Lundin J, Osterborg A. Outcomes of patients with fludarabine-refractory chronic lymphocytic leukemia: a population-based study from a well-defined geographic region. Leuk Lymphoma 2014; 55:1774-80. [PMID: 24237446 DOI: 10.3109/10428194.2013.827786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with fludarabine-refractory (FR) chronic lymphocytic leukemia (CLL) receive novel agents in pivotal, non-randomised phase-2 trials. Understanding outcome of FR-CLL in health-care may provide important contextual information. Records from 1301 patients (Stockholm-Cancer-Registry 1991-2010) identified 92 FR-patients; bulky lymph-nodes (BFR-group), double-refractory (DR-group), or Others'-group for outcome-analysis. Median age was 69 years 67% had Rai-stage III/IV with median 3 prior therapies. Overall response-rate was 20%; significantly lower in BFR (8%, p = 0.01) and DR (20%, p = 0.01) than in 'Others' (31%). Time-to-treatment-failure (months) was significantly longer in 'Others' (9.2) than in BFR/DR (5.3/4.4) (p < 0.01) and significantly longer (p < 0.05) in antibody-treated patients (9.1) compared to other regimens (5.2). Early-death occurred in 5%, ≥ grade III-infections in 20%. Median overall-survival (OS) was 18 months; 29 in BFR vs. 13 in DR (p = 0.054). Male sex was the only prognostic factor on OS (p = 0.01, HR 2.2, multivariate-Cox-regression). Our results, without external referrals, facilitate interpretation of non-randomised trials/novel drugs in advanced-stage-CLL.
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Affiliation(s)
- Sandra Eketorp Sylvan
- Departments of Hematology and Oncology, Karolinska University Hospital , Stockholm , Sweden
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Abstract
Recent field experiments with impregnated wooden sticks have demonstrated a pronounced use by small rodents of mineral supplies, especially sodium, and such findings seemed related to vole damage to forestry seedlings. Consumption of the bark of experimentally introduced aspen twigs and of sodium-impregnated sticks by voles (mainly or onlyMicrotus agrestis) correlated significantly on clear-cuts but not on unmanipulated abandoned fields. Such a correlation appeared when abandoned fields were cut continuously in summer. At vole peak densities, bark of pine seedlings experimentally fertilized with sodium was consumed but not bark of seedlings fertilized with calcium or control seedlings. Field pine seedlings attacked by voles had significantly higher levels of calcium, sodium, and phosphorus than the nearest untouched seedling. However, sodium and phosphorus contents correlated strongly. Sodium and calcium supply to voles in laboratory feeding trials did not diminish the moderate interest in pine bark. Such conditions are, however, assumed to mimic a situation of bark sampling in low-density populations. Sodium, and possibly also calcium, requirements are concluded to be partial determinants of the destructive bark consumption by voles at the peaks of their multiannual population cycles.
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Affiliation(s)
- L Hansson
- Department of Wildlife Ecology, Swedish University of Agricultural Sciences, 5-750 07, Uppsala, Sweden
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Krjukova J, Hansson L, Meyer P, Gilljam M, Lindblad A, Eriksson-Hollsin A, Vebert-Olesen H, Pressler T, Finstad PL, Mared L, Hjelte L. 252 Survey of malignancies at Scandinavian CF centers. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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