1
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Wight J, Blombery P, Lickiss J, Burgess M, Gould C, Minson A, Swain F, Sabdia MB, Gandhi MK, Birchley A, Keane C, Hawkes EA. Systemic diffuse large B-cell lymphoma involving the central nervous system have high rates of defective antigen presentation and immune surveillance. Haematologica 2024. [PMID: 38511272 DOI: 10.3324/haematol.2023.284600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Indexed: 03/22/2024] Open
Abstract
Not available.
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Affiliation(s)
- Joel Wight
- Austin Health, Heidelberg, Australia; Olivia Newton John Cancer Research Institute, Victoria, Australia; The University of Melbourne, Melbourne, Australia; Townsville University Hospital, Townsville.
| | - Piers Blombery
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. 7. Princess Alexandra Hospital, Brisbane
| | - Jennifer Lickiss
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria
| | | | - Clare Gould
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria
| | - Adrian Minson
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. 7. Princess Alexandra Hospital, Brisbane
| | | | | | - Maher K Gandhi
- Princess Alexandra Hospital, Brisbane, Australia; Mater Research Institute, The University of Queensland, Brisbane, Australia; University of Queensland, Brisbane
| | | | - Colm Keane
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane
| | - Eliza A Hawkes
- Austin Health, Heidelberg, Australia; Olivia Newton John Cancer Research Institute, Victoria, Australia; The University of Melbourne, Melbourne, Australia; La Trobe University, Melbourne
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2
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Casey M, Lee C, Kwok WY, Law SC, Corvino D, Gandhi MK, Harrison SJ, Nakamura K. Regulatory T cells hamper the efficacy of T-cell-engaging bispecific antibody therapy. Haematologica 2024; 109:787-798. [PMID: 37767564 PMCID: PMC10905103 DOI: 10.3324/haematol.2023.283758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
T-cell-engaging bispecific antibodies (T-BsAb) have produced impressive clinical responses in patients with relapsed/refractory B-cell malignancies, although treatment failure remains a major clinical challenge. Growing evidence suggests that a complex interplay between immune cells and tumor cells is implicated in the mechanism of action and therefore, understanding immune regulatory mechanisms might provide a clue for how to improve the efficacy of T-BsAb therapy. Here, we investigated the functional impact of regulatory T (Treg) cells on anti-tumor immunity elicited by T-BsAb therapy. In a preclinical model of myeloma, the activation and expansion of Treg cells in the bone marrow were observed in response to anti-B-cell maturation antigen (BCMA) T-BsAb therapy. T-BsAb triggered the generation of induced Treg cells from human conventional CD4 cells after co-culture with tumor cells. Moreover, T-BsAb directly activated freshly isolated circulating Treg cells, leading to the production of interleukin-10 and inhibition of T-BsAb-mediated CD8 T-cell responses. The activation of Treg cells was also seen in bone marrow samples from myeloma patients after ex vivo treatment with T-BsAb, further supporting that T-BsAb have an impact on Treg homeostasis. Importantly, transient ablation of Treg cells in combination with T-BsAb therapy dramatically improved effector lymphocyte activities and disease control in the preclinical myeloma model, leading to prolonged survival. Together, this information suggests that therapy-induced activation of Treg cells critically regulates anti-tumor immunity elicited by T-BsAb therapy, with important implications for improving the efficacy of such treatment.
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Affiliation(s)
- Mika Casey
- Immune Targeting in Blood Cancers Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD
| | - Carol Lee
- Immune Targeting in Blood Cancers Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD
| | - Wing Yu Kwok
- Immune Targeting in Blood Cancers Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD
| | - Soi Cheng Law
- Mater Research, University of Queensland, Brisbane, QLD
| | - Dillon Corvino
- Institute of Experimental Oncology, University Hospital Bonn, Bonn
| | | | - Simon J Harrison
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville
| | - Kyohei Nakamura
- Immune Targeting in Blood Cancers Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD.
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3
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Gandhi MK, Kelly GL. EBNA2: a viral maestra conducting a symphony orchestra. Blood 2024; 143:384-385. [PMID: 38300609 DOI: 10.1182/blood.2023022744] [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] [Indexed: 02/02/2024] Open
Affiliation(s)
- Maher K Gandhi
- Mater Research
- University of Queensland
- Princess Alexandra Hospital
| | - Gemma L Kelly
- The Walter and Eliza Hall Institute
- The University of Melbourne
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4
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Bednarska K, Chowdhury R, Tobin JWD, Swain F, Keane C, Boyle S, Khanna R, Gandhi MK. Epstein-Barr virus-associated lymphomas decoded. Br J Haematol 2024; 204:415-433. [PMID: 38155519 DOI: 10.1111/bjh.19255] [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: 07/28/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023]
Abstract
Epstein-Barr virus (EBV)-associated lymphomas cover a range of histological B- and T-cell non-Hodgkin and Hodgkin lymphoma subtypes. The role of EBV on B-cell malignant pathogenesis and its impact on the tumour microenvironment are intriguing but incompletely understood. Both the International Consensus Classification (ICC) and 5th Edition of the World Health Organization (WHO-HAEM5) proposals give prominence to the distinct clinical, prognostic, genetic and tumour microenvironmental features of EBV in lymphoproliferative disorders. There have been major advances in our biological understanding, in how to harness features of EBV and its host immune response for targeted therapy, and in using EBV as a method to monitor disease response. In this article, we showcase the latest developments and how they may be integrated to stimulate new and innovative approaches for further lines of investigation and therapy.
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Affiliation(s)
- Karolina Bednarska
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Rakin Chowdhury
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Joshua W D Tobin
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona Swain
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Colm Keane
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Stephen Boyle
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rajiv Khanna
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Maher K Gandhi
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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5
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Casey M, Lee C, Hoyte SM, Johnston RL, Kwok WY, Law SC, Gandhi MK, Harrison SJ, Nakamura K. Harnessing the cytotoxic granule exocytosis to augment the efficacy of T-cell-engaging bispecific antibody therapy. Haematologica 2024. [PMID: 38268493 DOI: 10.3324/haematol.2023.284435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 01/26/2024] Open
Abstract
T-cell-engaging bispecific antibody (T-BsAb, also known as BiTE) therapy has emerged as a powerful therapeutic modality against multiple myeloma. Given that T-BsAb therapy redirects endogenous T cells to eliminate tumor cells, reinvigorating dysfunctional T cells may be a potential approach to improve the efficacy of T-BsAb. While various immunostimulatory cytokines can potentiate effector T-cell functions, the optimal cytokine treatment for T-BsAb therapy is yet to be established, partly due to a concern of cytokine release syndrome driven by aberrant interferon (IFN)-γ production. Here, we functionally screen immunostimulatory cytokines to determine an ideal combination partner for T-BsAb therapy. This approach reveals IL-21 as a potential immunostimulatory cytokine with the ability to augment T-BsAb-mediated release of granzyme B and perforin, without increasing IFN-γ release. Transcriptome profiling and functional characterization strongly support that IL-21 selectively targets the cytotoxic granule exocytosis pathway, but not pro-inflammatory responses. Notably, IL-21 modulates multiple steps of cytotoxic effector functions including upregulation of co-activating CD226 receptor, increasing cytotoxic granules, and promoting cytotoxic granule delivery at the immunological synapse. Indeed, T-BsAb-mediated myeloma-killing is cytotoxic granule-dependent, and IL-21 priming significantly augments cytotoxic activities. Furthermore, in vivo IL-21 treatment induces cytotoxic effector reprogramming in bone marrow T cells, showing synergistic anti-myeloma effects in combination with T-BsAb therapy. Together, harnessing the cytotoxic granule exocytosis pathway by IL-21 may be a potential approach to achieve better responses by T-BsAb therapy.
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Affiliation(s)
- Mika Casey
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD
| | - Carol Lee
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD
| | - Sharon M Hoyte
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD
| | - Rebecca L Johnston
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD
| | - Wing Yu Kwok
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD
| | - Soi Cheng Law
- Mater Research, University of Queensland, Brisbane, QLD
| | | | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne VIC Australia; Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville
| | - Kyohei Nakamura
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD.
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6
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Khanna R, Gandhi MK. EBV-infected hematopoietic stem cells drive CAEBV. Blood 2024; 143:2-4. [PMID: 38175680 DOI: 10.1182/blood.2023022739] [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] [Indexed: 01/05/2024] Open
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7
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Gandhi MK, Keane C. Expanding the bacterial origins of nodular lymphocyte-predominant Hodgkin lymphoma. Haematologica 2023; 108:3195-3196. [PMID: 37381755 PMCID: PMC10690891 DOI: 10.3324/haematol.2023.283392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
Not available.
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Affiliation(s)
- Maher K Gandhi
- Mater Research, University of Queensland, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland
| | - Colm Keane
- Princess Alexandra Hospital, Brisbane, Queensland, Australia; Frazer Institute, University of Queensland, Brisbane, Queensland.
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8
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Subramanian S, Thoms JAI, Huang Y, Cornejo-Páramo P, Koch FC, Jacquelin S, Shen S, Song E, Joshi S, Brownlee C, Woll PS, Chacon-Fajardo D, Beck D, Curtis DJ, Yehson K, Antonenas V, O'Brien T, Trickett A, Powell JA, Lewis ID, Pitson SM, Gandhi MK, Lane SW, Vafaee F, Wong ES, Göttgens B, Alinejad-Rokny H, Wong JWH, Pimanda JE. Genome-wide transcription factor-binding maps reveal cell-specific changes in the regulatory architecture of human HSPCs. Blood 2023; 142:1448-1462. [PMID: 37595278 PMCID: PMC10651876 DOI: 10.1182/blood.2023021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 08/20/2023] Open
Abstract
Hematopoietic stem and progenitor cells (HSPCs) rely on a complex interplay among transcription factors (TFs) to regulate differentiation into mature blood cells. A heptad of TFs (FLI1, ERG, GATA2, RUNX1, TAL1, LYL1, LMO2) bind regulatory elements in bulk CD34+ HSPCs. However, whether specific heptad-TF combinations have distinct roles in regulating hematopoietic differentiation remains unknown. We mapped genome-wide chromatin contacts (HiC, H3K27ac, HiChIP), chromatin modifications (H3K4me3, H3K27ac, H3K27me3) and 10 TF binding profiles (heptad, PU.1, CTCF, STAG2) in HSPC subsets (stem/multipotent progenitors plus common myeloid, granulocyte macrophage, and megakaryocyte erythrocyte progenitors) and found TF occupancy and enhancer-promoter interactions varied significantly across cell types and were associated with cell-type-specific gene expression. Distinct regulatory elements were enriched with specific heptad-TF combinations, including stem-cell-specific elements with ERG, and myeloid- and erythroid-specific elements with combinations of FLI1, RUNX1, GATA2, TAL1, LYL1, and LMO2. Furthermore, heptad-occupied regions in HSPCs were subsequently bound by lineage-defining TFs, including PU.1 and GATA1, suggesting that heptad factors may prime regulatory elements for use in mature cell types. We also found that enhancers with cell-type-specific heptad occupancy shared a common grammar with respect to TF binding motifs, suggesting that combinatorial binding of TF complexes was at least partially regulated by features encoded in DNA sequence motifs. Taken together, this study comprehensively characterizes the gene regulatory landscape in rare subpopulations of human HSPCs. The accompanying data sets should serve as a valuable resource for understanding adult hematopoiesis and a framework for analyzing aberrant regulatory networks in leukemic cells.
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Affiliation(s)
- Shruthi Subramanian
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Julie A. I. Thoms
- School of Biomedical Sciences, University of New South Wales, Sydney, Australia
| | - Yizhou Huang
- Centre for Health Technologies and the School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | | | - Forrest C. Koch
- School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Sydney, Australia
| | | | - Sylvie Shen
- Bone Marrow Transplant Laboratory, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Emma Song
- Bone Marrow Transplant Laboratory, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Swapna Joshi
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Chris Brownlee
- Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Petter S. Woll
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Diego Chacon-Fajardo
- Centre for Health Technologies and the School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - Dominik Beck
- Centre for Health Technologies and the School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - David J. Curtis
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
| | - Kenneth Yehson
- Blood Transplant and Cell Therapies Laboratory, NSW Health Pathology, Westmead, NSW, Australia
| | - Vicki Antonenas
- Blood Transplant and Cell Therapies Laboratory, NSW Health Pathology, Westmead, NSW, Australia
| | | | - Annette Trickett
- Bone Marrow Transplant Laboratory, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Jason A. Powell
- Centre for Cancer Biology, SA Pathology, University of South Australia, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Ian D. Lewis
- Centre for Cancer Biology, SA Pathology, University of South Australia, Adelaide, Australia
| | - Stuart M. Pitson
- Centre for Cancer Biology, SA Pathology, University of South Australia, Adelaide, Australia
| | - Maher K. Gandhi
- Blood Cancer Research Group, Mater Research, The University of Queensland, Brisbane, QLD, Australia
| | - Steven W. Lane
- Cancer Program, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Fatemeh Vafaee
- School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Sydney, Australia
- UNSW Data Science Hub, University of New South Wales, Sydney, Australia
| | - Emily S. Wong
- Victor Chang Cardiac Research Institute, Sydney, Australia
- School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Berthold Göttgens
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, United Kingdom
| | - Hamid Alinejad-Rokny
- BioMedical Machine Learning Lab, Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Jason W. H. Wong
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - John E. Pimanda
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, Australia
- Haematology Department, Prince of Wales Hospital, Sydney, Australia
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George H, Gunawardana J, Keane C, Hicks RJ, Gandhi MK. A coordinated strategy for a simple, pragmatic approach to the early identification of the ultra-high-risk patient with diffuse large B-cell lymphoma. Intern Med J 2023; 53:1105-1109. [PMID: 37032307 DOI: 10.1111/imj.16078] [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: 01/26/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most frequent aggressive lymphoma seen in clinical practice. Despite huge strides in understanding its biology, front-line therapy has remained unchanged for decades. Roughly one-third of patients have primary refractory or relapse following the end of conventional first-line therapy. The outcome of patients with primary refractory disease and those with early relapse (defined as relapse less than 1 year from the end of therapy) is markedly inferior to those with later relapse and is exemplified by dismal overall survival. In this article, the authors term patients with features that identify them as being at particularly high-risk for either primary refractory disease or early relapse, as 'ultra-high-risk'. As new treatment options become established (e.g. bispecific T-cell engagers, chimeric antigen receptor 'CAR' T-cells and antibody-drug conjugates), it is likely that there will be a push to incorporate some of these agents into the first-line setting for patients identified as ultra-high-risk. In this review, the authors outline advances in positron emission tomography, widely available laboratory assays and clinical prognosticators, which can detect a high proportion of patients with ultra-high-risk disease. Since these approaches are pragmatic and able to be adopted widely, they could be incorporated into routine clinical practice.
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Affiliation(s)
| | - Jay Gunawardana
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Colm Keane
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rod J Hicks
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Maher K Gandhi
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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10
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Gandhi MK. Genetic susceptibility to EBV-related disease. Blood 2023; 141:1499-1500. [PMID: 36995704 DOI: 10.1182/blood.2022019180] [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] [Indexed: 03/31/2023] Open
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11
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Agrawal P, David KA, Chen Z, Sundaram S, Kim SH, Vaca R, Lin Y, Singer S, Malecek MK, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Gandhi MK, Keane C, Bond DA, Folstad M, Chang J, Mier-Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust SA, Matnani R, Kumar P, Ollila TA, Cai J, Spurgeon SE, Sieg AG, Cleveland J, Epperla N, Karmali R, Naik S, Smith SM, Rubenstein JL, Kahl BS, Chadburn A, Evens AM, Martin P. EBV-positive PCNSL in older patients: incidence, characteristics, tumor pathology, and outcomes across a large multicenter cohort. Leuk Lymphoma 2023:1-9. [PMID: 36960939 DOI: 10.1080/10428194.2023.2191152] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The objective of this multicenter retrospective study was to examine the incidence, patient characteristics, pathology, and outcomes associated with Epstein-Barr virus (EBV)-related CNS lymphoma (CNSL) in older patients. Among 309 CNSL patients aged ≥60, 11.7% had EBV + tumors of which 72.2% were solid organ transplant (SOT)-related post-transplant lymphoproliferative disorders (PTLD). Younger age, SOT or autoimmune disease, and immunosuppressive treatment correlated highly with EBV-positivity. EBV + tumors were associated with absent C-MYC and BCL6 expression. EBV + PTLD was more likely to be associated with the absence of CD5 expression. EBV + non-PTLD had better median OS (not reached) compared to EBV + PTLD (10.8 months) and EBV-negative patients (43 months). Multivariable Cox regression analysis showed that age, performance status, and PTLD were negative predictors of OS. EBV status and immunosuppressive treatment were not correlated with OS. Our findings merit further investigation of EBV + PCNSL tumors and EBV-directed therapies.
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Affiliation(s)
- Prashasti Agrawal
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Zhengming Chen
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | | | - Seo-Hyun Kim
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Ryan Vaca
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Mary-Kate Malecek
- Department of Medicine, Division of Hematology & Oncology, Washington University School of Medicine, University City, MO, USA
| | - Jordan Carter
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Adam Zayac
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Myung Sun Kim
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Nishitha Reddy
- Department of Medicine, Division of Hematology & Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas Ney
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Alma Habib
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | | | - Jerome Graber
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Veronika Bachanova
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Sidra Salman
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Jean A Vendiola
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Nasheed Hossain
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Mazie Tsang
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | | | - Colm Keane
- Princess Alexandria Hospital, Brisbane, Australia
| | - David A Bond
- Department of Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Matthew Folstad
- Department of Medicine, Division of Hematology, Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA
| | - Julie Chang
- Department of Medicine, Division of Hematology, Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA
| | | | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Priya Rajakumar
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Parameswaran Venugopal
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Stephanie Berg
- Department of Medicine and Cancer Biology, Loyola University, Chicago, IL, USA
| | - Michael Glantz
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | | | - Rahul Matnani
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pallavi Kumar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Johnny Cai
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Stephen E Spurgeon
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Alex G Sieg
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Joseph Cleveland
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Narendranath Epperla
- Department of Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Reem Karmali
- Division of Hematology Oncology, Northwestern University, Chicago, IL, USA
| | - Seema Naik
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Sonali M Smith
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - James L Rubenstein
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Brad S Kahl
- Department of Medicine, Division of Hematology & Oncology, Washington University School of Medicine, University City, MO, USA
| | - Amy Chadburn
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Peter Martin
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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12
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Tobin JWD, Green MR, Gandhi MK. The PO4-tential for Less Toxic CAR T-cell Therapies. Cancer Immunol Res 2022; 10:1422. [PMID: 36327248 DOI: 10.1158/2326-6066.cir-22-0793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has yielded remarkable and durable responses for some patients with relapsed and refractory blood cancers. However, life-threatening toxicities such as immune effector cell-associated neurotoxicity syndrome (ICANS) remain a challenge for broad delivery of such therapies. In this issue, Tang and colleagues demonstrate an association between hypophosphatemia and CAR T cell-induced ICANS. Prospective studies are required to establish if phosphate monitoring is an early predictor for ICANS occurrence and if maintenance of phosphate levels has a role as a preventative strategy. See related article by Tang et al., p. 1433 (4).
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Affiliation(s)
- Joshua W D Tobin
- Mater Research University of Queensland, Brisbane, Queensland, Australia.,MD Anderson Cancer Center, Houston, Texas
| | | | - Maher K Gandhi
- Mater Research University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
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13
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Burgess M, Keane C, Tobin JW, Law SC, Griffin A, Gill D, Ewing AD, Atkinson V, Mollee P, Sabdia MB, Saunders NA, Gandhi MK. Resolution of melanoma to PD-1 blockade but simultaneous rapid progression of concomitant chronic lymphocytic leukemia. Acta Haematol 2022; 146:166-171. [PMID: 36273464 DOI: 10.1159/000527631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022]
Abstract
Here we present a novel case of a patient with Chronic Lymphocytic Leukaemia (CLL) who received CTLA-4 and then PD-1 immune-checkpoint blockade (ICB) as treatment for concomitant metastatic melanoma. Whereas the metastatic melanoma was responsive to ICB, the CLL rapidly progressed (but responded to ICB cessation and ibrutinib). There were no new genetic mutational drivers to explain the altered clinical course. PD-1/PD-L1/PD-L2 and CTLA-4/CD80/CD86 expression was not increased in CLL B-cells, CD8+ or CD4+ T-cell subsets or monocytes. The patient’s CLL B-cells demonstrated strikingly prolonged in-vitro survival during PD-1 blockade, which was not observed in samples taken before or after ICB, or with other patients. To our knowledge, a discordant clinical course to ICB coupled with these biological features has not been reported in a patient with dual malignancies.
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Affiliation(s)
- Melinda Burgess
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Colm Keane
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Josh Wd Tobin
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Soi C Law
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Alison Griffin
- Queensland Institute of Medical Research, Herston, Queensland, Australia
| | - Devinder Gill
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Adam D Ewing
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | | | - Peter Mollee
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Muhammed B Sabdia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas A Saunders
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Maher K Gandhi
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
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14
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Gunawardana J, Law SC, Sabdia MB, Bednarska K, Brosda S, Zaharia A, Tsang H, de Long LM, Burgess M, Talaulikar D, Lee JN, Jude E, Hawkes EA, Jain S, Nath K, Gould C, Swain F, Tobin JWD, Keane C, Birch S, Shanavas M, Snell C, Gandhi MK. Abstract A17: The immune checkpoints TIGIT and PD-1 are markedly upregulated in NLPHL compared to classical Hodgkin Lymphoma. Blood Cancer Discov 2022. [DOI: 10.1158/2643-3249.lymphoma22-a17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Hodgkin lymphoma (HL) comprises two distinct disease entities based on clinical, morphologic and genotypic characteristics. Relative to classical Hodgkin Lymphoma (cHL), nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is rare, and its tumor microenvironment (TME) is very poorly characterized. With the exception of rituximab, there are no targeted treatments nor advances in the treatment of NLPHL for decades. Unlike cHL, the utility of immune-checkpoint blockade (ICB) has not been evaluated in NLPHL. Diagnostic samples were collected from 49 NLPHL patients from 4 Australian centres and compared with stage-matched cHL patients (and with normal lymph nodes). An integrative transcriptomic, proteomic, T-cell clonal and functional analysis was performed to enable a comparison of the composition of the TME and its contribution to immune-evasion in NLPHL with cHL. 730 cancer-immune related genes were digitally quantified. Relative to cHL, gene set enrichment analysis identified T-cell receptor (TCR) and immune-checkpoint signaling pathway dysregulation in NLPHL. Most striking was prominent differential expression of the immune-transcriptome, particularly enrichment for programmed cell death-1 (PD-1) and T-cell Ig and ITIM domain (TIGIT) in NLPHL versus cHL. These were also over expressed compared to normal lymph nodes. Consistent with this, there was also upregulation of numerous T-cell markers (CD247, CD3D, GZMK, CD28, EOMES) in NLPHL. In contrast, immunosuppressive macrophage (CD163, CD36, CD68, COLEC12, MARCO) and regulatory T-cell genes (FOXP3) were higher in cHL. Importantly, PD-L1 and CD155 (respective ligands for PD-1 and TIGIT) were expressed at the surface of NLPHL and cHL malignant B-cells. Multispectral immunofluorescent microscopy showed intratumoral TIGIT+CD4+ and PD-1+CD4+ T-cells were markedly increased in NLPHL versus cHL and localised within NLPHL follicles. Expanded populations of intratumoral CD4+ T-cell clones were predominantly PD-1+ and frequently also TIGIT+. Multi-parameter flow cytometry and dimensionality reduction was used to establish the distribution of immune checkpoints within circulating T-cell subsets. PD-1+TIGIT+CD4+ T-cells were raised in circulating Treg, TH1 and TH2 subsets in NLPHL versus cHL, and PD-1+TIGIT+ TH2 T-cells displayed raised levels of the exhaustion marker EOMES, collectively indicating systemic T-cell dysfunction. To functionally demonstrate the utility of ICB to stimulate T-cells, an assay using cHL and/or NLPHL cell-lines co-cultured with a genetically engineered effector T-cell-line was developed. This showed that TIGIT/PD-1 dual-blockade was more effective than mono-blockade in inducing NLPHL and cHL tumor-directed CD4+ T-cell activation. Overall, our results indicate that immune-evasion mechanisms in NLPHL are distinct to those operative in cHL, with markedly greater T-cell, PD-1 and TIGIT dysregulation. PD-1 and/or TIGIT blockade warrants evaluation in NLPHL.
Citation Format: Jay Gunawardana, Soi C. Law, Muhammed B. Sabdia, Karolina Bednarska, Sandra Brosda, Andreea Zaharia, Hennes Tsang, Lilia M. de Long, Melinda Burgess, Dipti Talaulikar, Justina N. Lee, Emily Jude, Eliza A. Hawkes, Sanjiv Jain, Karthik Nath, Clare Gould, Fiona Swain, Joshua W. D. Tobin, Colm Keane, Simone Birch, Mohamed Shanavas, Cameron Snell, Maher K. Gandhi. The immune checkpoints TIGIT and PD-1 are markedly upregulated in NLPHL compared to classical Hodgkin Lymphoma [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A17.
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Affiliation(s)
- Jay Gunawardana
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Soi C. Law
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Muhammed B. Sabdia
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Karolina Bednarska
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Sandra Brosda
- 2Diamantina Institute, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Andreea Zaharia
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Hennes Tsang
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Lilia M. de Long
- 2Diamantina Institute, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Melinda Burgess
- 3Diamantina Institute, University of Queensland, Translational Research Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia,
| | - Dipti Talaulikar
- 4ACT Pathology, Canberra Health Services, Canberra, ACT, Australia,
| | - Justina N. Lee
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | - Emily Jude
- 5Austin Health, Heidelberg, VIC, Australia,
| | - Eliza A. Hawkes
- 6Olivia Newton John Cancer Research and Wellness Centre, Austin Health and Monash University, Melbourne, VIC, Australia,
| | - Sanjiv Jain
- 7The Canberra Hospital, Canberra, ACT, Australia,
| | - Karthik Nath
- 8Memorial Sloan Kettering Cancer Center, New York, NY,
| | - Clare Gould
- 9Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,
| | - Fiona Swain
- 3Diamantina Institute, University of Queensland, Translational Research Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia,
| | - Joshua W. D. Tobin
- 10Mater Research, University of Queensland, Translational Research Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia,
| | - Colm Keane
- 3Diamantina Institute, University of Queensland, Translational Research Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia,
| | - Simone Birch
- 11Princess Alexandra Hospital, Brisbane, QLD, Australia,
| | - Mohamed Shanavas
- 1Mater Research, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia,
| | | | - Maher K. Gandhi
- 10Mater Research, University of Queensland, Translational Research Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia,
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15
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Gandhi MK, Keane C. CD4 T Cells: the complicated key to unlocking the immune environment of classical Hodgkin Lymphoma. Haematologica 2022; 108:945-946. [PMID: 35833302 PMCID: PMC10071127 DOI: 10.3324/haematol.2022.281440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Maher K Gandhi
- Mater Research, University of Queensland, Brisbane, Queensland; Haematology Dept., Princess Alexandra Hospital, Brisbane, Queensland
| | - Colm Keane
- Haematology Dept., Princess Alexandra Hospital, Brisbane, Queensland; University of Queensland Diamantina Institute, Brisbane, Queensland
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16
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Shanavas M, Law SC, Hertzberg M, Hicks RJ, Seymour JF, Li Z, Merida de Long L, Nath K, Sabdia MB, Gunawardana J, Gandhi MK, Keane C. Intratumoral T-cell receptor repertoire is predictive of interim PET scan results in patients with diffuse large B-cell lymphoma treated with rituximab/cyclophosphamide/doxorubicin/prednisolone/vincristine (R-CHOP) chemoimmunotherapy. Clin Transl Immunology 2021; 10:e1351. [PMID: 34745610 PMCID: PMC8548874 DOI: 10.1002/cti2.1351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/14/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives A diverse intratumoral T‐cell receptor (TCR) repertoire is associated with improved survival in diffuse large B‐cell lymphoma (DLBCL) treated with rituximab/cyclophosphamide/doxorubicin/prednisolone/vincristine (R‐CHOP) chemoimmunotherapy. We explored the impact of intratumoral TCR repertoire on interim PET (iPET) done after four cycles of R‐CHOP, the relationships between intratumoral and circulating repertoire, and the phenotypes of expanded clonotypes. Methods We sequenced the third complementarity‐determining region of TCRβ in tumor samples, blood at pre‐therapy and after four cycles of R‐CHOP in 35 patients enrolled in ALLGNHL21 trial in high‐risk DLBCL. We correlated the TCR diversity metrics with iPET status, gene expression profiles and HLA‐class I genotypes. We then sequenced the FACS‐sorted peripheral blood T cells in six patients, and pentamer‐sorted EBV‐specific CD8+ T cells in one patient from this cohort. Results Compared with iPET− patients, the intratumoral TCR repertoire in iPET+ patients was characterised by higher cumulative frequency of abundant clonotypes and higher productive clonality. There was a variable overlap between circulating and intratumoral repertoires, with the dominant intratumoral clonotypes more likely to be detected in the blood. The majority of shared clonotypes were CD8+ PD‐1HI T cells, and CD8+ T cells had the largest clonal expansions in tumor and blood. In a patient with EBV+ DLBCL, EBV‐specific intratumoral clonotypes were trackable in the blood. Conclusion This study demonstrates that clonally expanded intratumoral TCR repertoires are associated with iPET+ and that the blood can be used to track tumor‐associated antigen‐specific clonotypes. These findings assist the rationale design and therapeutic monitoring of immunotherapeutic strategies in DLBCL.
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Affiliation(s)
- Mohamed Shanavas
- Mater Research University of Queensland Brisbane QLD Australia.,Department of Haematology Mater Hospital Brisbane QLD Australia
| | - Soi-Cheng Law
- Mater Research University of Queensland Brisbane QLD Australia
| | - Mark Hertzberg
- Department of Haematology Prince of Wales Hospital and University of NSW Randwick NSW Australia
| | - Rodney J Hicks
- Department of Cancer Imaging Peter MacCallum Cancer Centre East Melbourne Melbourne VIC Australia
| | - John F Seymour
- Department of Haematology Peter MacCallum Cancer Centre Royal Melbourne Hospital & University of Melbourne Parkville VIC Australia
| | - Zhixiu Li
- Centre for Genomics and Personalised Health School of Biomedical Sciences, Faculty of Health Translational Research Institute Queensland University of Technology (QUT) Woolloongabba QLD Australia
| | | | - Karthik Nath
- Mater Research University of Queensland Brisbane QLD Australia
| | | | - Jay Gunawardana
- Mater Research University of Queensland Brisbane QLD Australia
| | - Maher K Gandhi
- Mater Research University of Queensland Brisbane QLD Australia.,Department of Haematology Princess Alexandra Hospital Brisbane QLD Australia
| | - Colm Keane
- Mater Research University of Queensland Brisbane QLD Australia.,Department of Haematology Princess Alexandra Hospital Brisbane QLD Australia
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17
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Law SC, Hoang T, O'Rourke K, Tobin JWD, Gunawardana J, Loo-Oey D, Bednarska K, Merida de Long L, Sabdia MB, Hapgood G, Blyth E, Clancy L, Hennig S, Keane C, Gandhi MK. Successful treatment of Epstein-Barr virus-associated primary central nervous system lymphoma due to post-transplantation lymphoproliferative disorder, with ibrutinib and third-party Epstein-Barr virus-specific T cells. Am J Transplant 2021; 21:3465-3471. [PMID: 33942495 DOI: 10.1111/ajt.16628] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/30/2021] [Accepted: 04/23/2021] [Indexed: 01/25/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) occurring following organ transplantation (post-transplantation lymphoproliferative disorder [PTLD]) is a highly aggressive non-Hodgkin lymphoma. It is typically treated with high-dose methotrexate-based regimens. Outcomes are dismal and clinical trials are lacking. It is almost always Epstein-Barr virus (EBV) associated. Two patients (CA1-2) presented with EBV-associated PCNSL after renal transplant. CA1 was on hemodialysis and had prior disseminated cryptococcus and pseudomonas bronchiectasis, precluding treatment with methotrexate. CA2 was refractory to methotrexate. Both were treated off-label with the first-generation Bruton's tyrosine kinase inhibitor ibrutinib for 12 months. Cerebrospinal fluid penetration at therapeutic levels was confirmed in CA1 despite hemodialysis. Both patients entered remission by 2 months. Sequencing confirmed absence of genetic aberrations in human leukocyte antigen (HLA) class I/II and antigen-presentation/processing genes, indicating retention of the ability to present EBV-antigens. Between Weeks 10 and 13, they received third-party EBV-specific T cells for consolidation with no adverse effects. They remain in remission ≥34 months since therapy began. The strength of these findings led to an ongoing phase I study (ACTRN12618001541291).
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Affiliation(s)
- Soi C Law
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Thanh Hoang
- Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Kacey O'Rourke
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Joshua W D Tobin
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Jay Gunawardana
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Dorothy Loo-Oey
- Proteomics Core Facility, Translational Research Institute, Woolloongabba, QLD, Australia
| | - Karolina Bednarska
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Lilia Merida de Long
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Muhammed B Sabdia
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Greg Hapgood
- Haematology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Emily Blyth
- Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Leighton Clancy
- Cellular Therapies, NSW Government Health Pathology, Westmead, NSW, Australia
| | - Stefanie Hennig
- Certara Inc., Princeton, New Jersey.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Colm Keane
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Haematology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Maher K Gandhi
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Haematology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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18
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Gould C, Lickiss J, Kankanige Y, Yerneni S, Lade S, Gandhi MK, Chin C, Yannakou CK, Villa D, Slack GW, Markham JF, Tam CS, Nelson N, Seymour JF, Dickinson M, Neeson PJ, Westerman D, Blombery P. Characterisation of immune checkpoints in Richter syndrome identifies LAG3 as a potential therapeutic target. Br J Haematol 2021; 195:113-118. [PMID: 34426978 DOI: 10.1111/bjh.17789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/09/2021] [Accepted: 08/07/2021] [Indexed: 12/17/2022]
Abstract
Richter syndrome (RS), an aggressive lymphoma occurring in the context of chronic lymphocytic leukaemia/small lymphocytic lymphoma, is associated with poor prognosis when treated with conventional immunochemotherapy, therefore, improved treatments are required. Immune checkpoint blockade has shown efficacy in some B-cell malignancies and modest responses in early clinical trials for RS. We investigated the immune checkpoint profile of RS as a basis to inform rational therapeutic investigations in RS. Formalin-fixed, paraffin-embedded biopsies of RS (n = 19), de novo diffuse large B-cell lymphoma (DLBCL; n = 58), transformed indolent lymphomas (follicular [tFL], n = 16; marginal zone [tMZL], n = 24) and non-transformed small lymphocytic lymphoma (SLL; n = 15) underwent gene expression profiling using the NanoString Human Immunology panel. Copy number assessment was performed using next-generation sequencing. Immunohistochemistry (IHC) for LAG3 and PD-1 was performed. LAG3 gene expression was higher in RS compared to DLBCL (P = 0·0002, log2FC 1·96), tFL (P < 0·0001, log2FC 2·61), tMZL (P = 0·0004, log2FC 1·79) and SLL (P = 0·0057, log2FC 1·45). LAG3 gene expression correlated with the gene expression of human leukocyte antigen Class I and II, and related immune genes and immune checkpoints. IHC revealed LAG3 protein expression on both malignant RS cells and tumour-infiltrating lymphocytes. Our findings support the investigation of LAG3 inhibition to enhance anti-tumour responses in RS.
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Affiliation(s)
- Clare Gould
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jennifer Lickiss
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yamuna Kankanige
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Satwica Yerneni
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Stephen Lade
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Maher K Gandhi
- Mater Research, University of Queensland, Brisbane, Australia.,Haematology, Princess Alexandra Hospital, Brisbane, Australia
| | - Collin Chin
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, Vancouver, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, Vancouver, Canada.,Centre for Lymphoid Cancer and Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, Canada
| | - John F Markham
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Constantine S Tam
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Niles Nelson
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - John F Seymour
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Michael Dickinson
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Paul J Neeson
- University of Melbourne, Melbourne, Australia.,Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Westerman
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Piers Blombery
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
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19
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Tobin JWD, Crothers A, Ma TE, Mollee P, Gandhi MK, Scuffham P, Hapgood G. A cost-effectiveness analysis of front-line treatment strategies in early-stage follicular lymphoma. Leuk Lymphoma 2021; 62:3484-3492. [PMID: 34323129 DOI: 10.1080/10428194.2021.1957866] [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] [Indexed: 10/20/2022]
Abstract
Recent data suggest the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT + RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT + RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT + RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modeling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT + RM ($52,476). ICT + RM is cost-effective in early-stage FL from the Australian taxpayer perspective.
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Affiliation(s)
- Joshua W D Tobin
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Crothers
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ti Eric Ma
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
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20
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Abstract
Follicular lymphoma (FL) is the most common indolent B-cell lymphoma. Advanced stage disease is considered incurable and is characterized by a prolonged relapsing/remitting course. A significant minority have less favorable outcomes, particularly those with transformed or early progressive disease. Recent advances in our understanding of the unique genetic and immune biology of FL have led to increasingly potent and precise novel targeted agents, suggesting that a chemotherapy-future may one day be attainable. The current pipeline of new therapeutics is unprecedented. Particularly exciting is that many agents have non-overlapping modes of action, offering potential new combinatorial options and synergies. This review provides up-to-date clinical and mechanistic data on these new therapeutics. Ongoing dedicated attention to basic, translational and clinical research will provide further clarity as to when and how to best use these agents, to improve efficacy without eliciting unnecessary toxicity.
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Affiliation(s)
- Karthik Nath
- Mater Research Institute, University of Queensland, Brisbane, QLD 4101, Australia;
| | - Maher K. Gandhi
- Mater Research Institute, University of Queensland, Brisbane, QLD 4101, Australia;
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
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21
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Affiliation(s)
- Joshua W. D. Tobin
- Mater Research University of Queensland Brisbane Queensland Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
| | - Maher K. Gandhi
- Mater Research University of Queensland Brisbane Queensland Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
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22
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Affiliation(s)
- Mark Hertzberg
- Mark Hertzberg, MBBS, PhD, Department of Haematology, Prince of Wales Hospital and University of New South Wales, Sydney, NSW, Australia; David J.L. Joske, MBBS, Department of Haematology, Sir Charles Gairdner Hospital, and University of Western Australia, Perth, WA, Australia; and Maher K. Gandhi, MBChB, PhD, Mater Research Institute, University of Queensland, and Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - David J L Joske
- Mark Hertzberg, MBBS, PhD, Department of Haematology, Prince of Wales Hospital and University of New South Wales, Sydney, NSW, Australia; David J.L. Joske, MBBS, Department of Haematology, Sir Charles Gairdner Hospital, and University of Western Australia, Perth, WA, Australia; and Maher K. Gandhi, MBChB, PhD, Mater Research Institute, University of Queensland, and Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Mark Hertzberg, MBBS, PhD, Department of Haematology, Prince of Wales Hospital and University of New South Wales, Sydney, NSW, Australia; David J.L. Joske, MBBS, Department of Haematology, Sir Charles Gairdner Hospital, and University of Western Australia, Perth, WA, Australia; and Maher K. Gandhi, MBChB, PhD, Mater Research Institute, University of Queensland, and Princess Alexandra Hospital, Brisbane, QLD, Australia
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23
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Gunawardana J, Lee JN, Bednarska K, Murigneux V, Long LM, Sabdia MB, Birch S, Tobin JWD, Gandhi MK. Genetic aberrations of
NLRC5
are associated with downregulated MHC‐I antigen presentation and impaired T‐cell immunity in follicular lymphoma. eJHaem 2020; 1:517-526. [PMID: 35845006 PMCID: PMC9176136 DOI: 10.1002/jha2.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Jay Gunawardana
- Mater Research University of Queensland, Translational Research Institute Brisbane Queensland Australia
| | - Justina N. Lee
- Diamantina Institute University of Queensland Brisbane Queensland Australia
| | - Karolina Bednarska
- Mater Research University of Queensland, Translational Research Institute Brisbane Queensland Australia
| | - Valentine Murigneux
- Diamantina Institute University of Queensland Brisbane Queensland Australia
- QFAB Bioinformatics Institute for Molecular Bioscience University of Queensland Brisbane Queensland Australia
| | - Lilia Merida Long
- Mater Research University of Queensland, Translational Research Institute Brisbane Queensland Australia
| | - Muhammed B. Sabdia
- Mater Research University of Queensland, Translational Research Institute Brisbane Queensland Australia
| | - Simone Birch
- Princess Alexandra Hospital Brisbane Queensland Australia
| | - Joshua W. D. Tobin
- Mater Research University of Queensland, Translational Research Institute Brisbane Queensland Australia
| | - Maher K. Gandhi
- Mater Research University of Queensland, Translational Research Institute Brisbane Queensland Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
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24
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Lewis KL, Chin CK, Manos K, Casey J, Hamad N, Crawford J, Ho SJ, Issa S, Grigg A, Wood P, Gandhi MK, Do B, Nastoupil L, Hawkes EA, Cheah CY. Ibrutinib for central nervous system lymphoma: the Australasian Lymphoma Alliance/MD Anderson Cancer Center experience. Br J Haematol 2020; 192:1049-1053. [PMID: 32677095 DOI: 10.1111/bjh.16946] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022]
Abstract
Primary and secondary central nervous system lymphomas (PCNSL/SCNSL) are aggressive rare malignancies with dismal outcomes. Encouraging data have emerged from Phase I/II clinical trials treating relapsed/refractory PCNSL/SCNSL with ibrutinib. We analysed 33 patients who received ibrutinib, alone or with other therapies, for PCNSL (n = 9) or SCNSL (n = 24). The objective response rate was 58% (complete response 55%). The median progression-free survival and overall survival for patients with PCNSL were both 3·1 months; for SCNSL, 10·2 and 11·5 months respectively. Only one invasive fungal infection was observed, despite concurrent or recent use of dexamethasone 8-16 mg daily in 14 patients (42%). Ibrutinib has encouraging activity in these aggressive malignancies.
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Affiliation(s)
- Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia.,Linear Clinical Research, Nedlands, WA, Australia
| | - Collin K Chin
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Kate Manos
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia
| | - John Casey
- Department of Haematology, The Townsville Hospital, Townsville, QLD, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, UNSW, Sydney, NSW, Australia
| | - Julie Crawford
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, WA, Australia
| | - Shir-Jing Ho
- Department of Haematology, St George Hospital, Sydney, NSW, Australia
| | - Samar Issa
- Department of Haematology, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia
| | - Peter Wood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Bryan Do
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Eliza A Hawkes
- Department of Clinical Haematology, Austin Health, Heidelberg, VIC, Australia.,Department of Haematology, Eastern Health, Box Hill, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia.,Linear Clinical Research, Nedlands, WA, Australia.,Department of Haematology, Pathwest Laboratory Medicine, Perth, WA, Australia
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25
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Affiliation(s)
- Joshua W D Tobin
- Joshua W.D. Tobin, MD and Colm Keane, MD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia; Jay Gunawardana, PhD, Mater Research, University of Queensland, Brisbane, Queensland, Australia; and Maher K. Gandhi, MD, PhD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Colm Keane
- Joshua W.D. Tobin, MD and Colm Keane, MD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia; Jay Gunawardana, PhD, Mater Research, University of Queensland, Brisbane, Queensland, Australia; and Maher K. Gandhi, MD, PhD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jay Gunawardana
- Joshua W.D. Tobin, MD and Colm Keane, MD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia; Jay Gunawardana, PhD, Mater Research, University of Queensland, Brisbane, Queensland, Australia; and Maher K. Gandhi, MD, PhD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Maher K Gandhi
- Joshua W.D. Tobin, MD and Colm Keane, MD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia; Jay Gunawardana, PhD, Mater Research, University of Queensland, Brisbane, Queensland, Australia; and Maher K. Gandhi, MD, PhD, Mater Research, University of Queensland, Brisbane, Queensland, AustraliaPrincess Alexandra Hospital, Brisbane, Queensland, Australia
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26
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Tobin JWD, Rule G, Colvin K, Calvente L, Hodgson D, Bell S, Dunduru C, Gallo J, Tsang ES, Tan X, Wong J, Pearce J, Campbell R, Tneh S, Shorten S, Ng M, Cochrane T, Tam CS, Abro E, Hawkes E, Hodges G, Kansara R, Talaulikar D, Gilbertson M, Johnston AM, Savage KJ, Villa D, Morris K, Ratnasingam S, Janowski W, Kridel R, Cheah CY, MacManus M, Matigian N, Mollee P, Gandhi MK, Hapgood G. Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance. Blood Adv 2019; 3:2804-2811. [PMID: 31570492 PMCID: PMC6784528 DOI: 10.1182/bloodadvances.2019000458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/17/2019] [Accepted: 07/04/2019] [Indexed: 01/17/2023] Open
Abstract
Management practices in early-stage (I/II) follicular lymphoma (FL) are variable and include radiation (RT), systemic therapy, or combined modality therapy (CMT). There is a paucity of data regarding maintenance rituximab in this cohort. We conducted an international retrospective study of patients with newly diagnosed early-stage FL staged with positron emission tomography (PET)-computed tomography and bone marrow biopsy. Three hundred sixty-five patients (stage I, n = 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n = 85) and active treatment (n = 280). The latter consisted of RT alone (n = 171) or systemic therapy (immunochemotherapy [n = 63] or CMT [n = 46]). Forty-nine systemically treated patients received maintenance rituximab; 72.7% of stage I patients received RT alone, compared to 42.6% with stage II (P < .001). Active therapies yielded comparable overall response rates (P = .87). RT alone and systemic therapy without maintenance rituximab yielded similar progression-free survival (PFS) (hazard ratio [HR], 1.32; 95% confidence interval [CI], 0.77-2.34; P = .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P = .017). The incidence of transformation was lower with systemic therapy compared to RT or WW (HR, 0.20; 95% CI, 0.070-0.61; P = .034). Overall survival was similar among all practices, including WW (P = .40). In the largest comparative assessment of management practices in the modern era, variable practices each resulted in similar excellent outcomes. Randomized studies are required to determine the optimal treatment in early-stage FL.
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Affiliation(s)
- Joshua W D Tobin
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gabrielle Rule
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Katherine Colvin
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Lourdes Calvente
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Hodgson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stephen Bell
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Chengetai Dunduru
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - James Gallo
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Erica S Tsang
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Xuan Tan
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jonathan Wong
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Jessica Pearce
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Robert Campbell
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Shao Tneh
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Sophie Shorten
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Melissa Ng
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Constantine S Tam
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Emad Abro
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Eliza Hawkes
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Georgina Hodges
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Roopesh Kansara
- Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada
| | - Dipti Talaulikar
- Department of Haematology, Canberra Hospital, Canberra, ACT, Australia
| | - Michael Gilbertson
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Anna M Johnston
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Kerry J Savage
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Diego Villa
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kirk Morris
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Sumi Ratnasingam
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - Wojt Janowski
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Nicholas Matigian
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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27
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Tobin JWD, Keane C, Gunawardana J, Mollee P, Birch S, Hoang T, Lee J, Li L, Huang L, Murigneux V, Fink JL, Matigian N, Vari F, Francis S, Kridel R, Weigert O, Haebe S, Jurinovic V, Klapper W, Steidl C, Sehn LH, Law SC, Wykes MN, Gandhi MK. Progression of Disease Within 24 Months in Follicular Lymphoma Is Associated With Reduced Intratumoral Immune Infiltration. J Clin Oncol 2019; 37:3300-3309. [PMID: 31461379 PMCID: PMC6881104 DOI: 10.1200/jco.18.02365] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Understanding the immunobiology of the 15% to 30% of patients with follicular lymphoma (FL) who experience progression of disease within 24 months (POD24) remains a priority. Solid tumors with low levels of intratumoral immune infiltration have inferior outcomes. It is unknown whether a similar relationship exists between POD24 in FL. PATIENTS AND METHODS Digital gene expression using a custom code set—five immune effector, six immune checkpoint, one macrophage molecules—was applied to a discovery cohort of patients with early- and advanced-stage FL (n = 132). T-cell receptor repertoire analysis, flow cytometry, multispectral immunofluorescence, and next-generation sequencing were performed. The immune infiltration profile was validated in two independent cohorts of patients with advanced-stage FL requiring systemic treatment (n = 138, rituximab plus cyclophosphamide, vincristine, prednisone; n = 45, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone), with the latter selected to permit comparison of patients experiencing a POD24 event with those having no progression at 5 years or more. RESULTS Immune molecules showed distinct clustering, characterized by either high or low expression regardless of categorization as an immune effector, immune checkpoint, or macrophage molecule. Low programmed death-ligand 2 (PD-L2) was the most sensitive/specific marker to segregate patients with adverse outcomes; therefore, PD-L2 expression was chosen to distinguish immune infiltrationHI (ie, high PD-L2) FL biopsies from immune infiltrationLO (ie, low PD-L2) tumors. Immune infiltrationHI tissues were highly infiltrated with macrophages and expanded populations of T-cell clones. Of note, the immune infiltrationLO subset of patients with FL was enriched for POD24 events (odds ratio [OR], 4.32; c-statistic, 0.81; P = .001), validated in the independent cohorts (rituximab plus cyclophosphamide, vincristine, prednisone: OR, 2.95; c-statistic, 0.75; P = .011; and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone: OR, 7.09; c-statistic, 0.88; P = .011). Mutations were equally proportioned across tissues, which indicated that degree of immune infiltration is capturing aspects of FL biology distinct from its mutational profile. CONCLUSION Assessment of immune-infiltration by PD-L2 expression is a promising tool with which to help identify patients who are at risk for POD24.
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Affiliation(s)
- Joshua W D Tobin
- Mater Research, University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Colm Keane
- Mater Research, University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jay Gunawardana
- Mater Research, University of Queensland, Brisbane, QLD, Australia
| | - Peter Mollee
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Simone Birch
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Thanh Hoang
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Justina Lee
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Li Li
- Ochsner Health System, New Orleans, LA
| | - Li Huang
- Ochsner Health System, New Orleans, LA
| | | | - J Lynn Fink
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Nicholas Matigian
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Frank Vari
- Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - Santiyagu Francis
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Robert Kridel
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Oliver Weigert
- Laboratory for Experimental Leukemia and Lymphoma Research, Munich, Germany.,German Cancer Consortium, Munich Germany.,German Cancer Research Center, Heidelberg, Germany
| | - Sarah Haebe
- Laboratory for Experimental Leukemia and Lymphoma Research, Munich, Germany.,German Cancer Consortium, Munich Germany.,German Cancer Research Center, Heidelberg, Germany
| | - Vindi Jurinovic
- Laboratory for Experimental Leukemia and Lymphoma Research, Munich, Germany.,German Cancer Consortium, Munich Germany.,German Cancer Research Center, Heidelberg, Germany
| | | | - Christian Steidl
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Soi-Cheng Law
- Mater Research, University of Queensland, Brisbane, QLD, Australia
| | - Michelle N Wykes
- Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Mater Research, University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
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28
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Keane C, Tobin J, Gunawardana J, Francis S, Gifford G, Gabrielli S, Gill A, Stevenson W, Talaulikar D, Gould C, Jain S, Birch S, Hertzberg M, Gandhi MK. The tumour microenvironment is immuno-tolerogenic and a principal determinant of patient outcome in EBV-positive diffuse large B-cell lymphoma. Eur J Haematol 2019; 103:200-207. [PMID: 31211907 PMCID: PMC6899834 DOI: 10.1111/ejh.13274] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 03/18/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Epstein-Barr virus-positive diffuse large B-cell lymphoma (EBV-pos DLBCL) is a recently identified entity. Data regarding outcome to frontline immuno-chemotherapy are conflicting. Although the prognostic impact of the tumour microenvironment (TME) in EBV-neg DLBCL is well-established, it remains untested whether the TME influences survival in EBV-pos DLBCL. There are no data with new digital gene expression technologies that simultaneously interrogate the virus, B cells and the tumour microenvironment (TME). METHODS We used the NanoString™ platform in a population-based cohort of 433 patients to establish if the technology could detect EBV in the tumour biopsies and to investigate the influence that EBV has on the complex tumour microenvironment of DLBCL. RESULTS Incidence of EBV-pos DLBCL was 6.9% with 5-year survival of 65% vs 82% in EBV-neg DLBCL (P = 0.018). EBV-pos tissues had similar expression of T-cell genes compared to EBV-neg DLBCL but higher levels of the antigen-presenting molecule B2M. This was countered by elevated PD-L1, PD-L2, LAG3 and TIM3 immune checkpoints and a higher CD163/CD68 "M2" macrophage score. CONCLUSION In EBV-pos DLBCL, the TME is immuno-tolerogenic and may explain the poor outcomes seen in this subtype of DLBCL.
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Affiliation(s)
- Colm Keane
- Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Joshua Tobin
- Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jay Gunawardana
- Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Santiyagu Francis
- Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Grace Gifford
- Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sara Gabrielli
- Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Gill
- Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - William Stevenson
- Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Dipti Talaulikar
- Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Australia National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Clare Gould
- Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sanjiv Jain
- Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Australia National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Simone Birch
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Pathology Queensland, Brisbane, Queensland, Australia
| | - Mark Hertzberg
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Maher K Gandhi
- Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
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29
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Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a distinct disease closely related to classical nodular sclerosing Hodgkin lymphoma. Conventional diagnostic paradigms utilising clinical, morphological and immunophenotypical features can be challenging due to overlapping features with other B-cell lymphomas. Reliable diagnostic and prognostic biomarkers that are applicable to the conventional diagnostic laboratory are largely lacking. Nuclear factor kappa B (NF-κB) and Janus kinase/signal transducers and activators of transcription (JAK-STAT) signalling pathways are characteristically dysregulated in PMBCL and implicated in several aspects of disease pathogenesis, and the latter pathway in host immune evasion. The tumour microenvironment is manipulated by PMBCL tumours to avoid T-cell mediated destruction via strategies that include loss of tumour cell antigenicity, T-cell exhaustion and activation of suppressive T-regulatory cells. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) and DA-EPOCH-R (dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, rituximab) are the most common first-line immunochemotherapy regimens. End of treatment positron emission tomography scans are the recommended imaging modality and are being evaluated to stratify patients for radiotherapy. Relapsed/refractory disease has a relatively poor outcome despite salvage immunochemotherapy and subsequent autologous stem cell transplantation. Novel therapies are therefore being developed for treatment-resistant disease, targeting aberrant cellular signalling and immune evasion.
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Affiliation(s)
- Charlotte Lees
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
- Princess Alexandra Hospital Southside Clinical UnitFaculty of MedicineUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
| | - Colm Keane
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
- Department of HaematologyPrincess Alexandra HospitalBrisbaneQLDAustralia
| | - Maher K. Gandhi
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
- Department of HaematologyPrincess Alexandra HospitalBrisbaneQLDAustralia
| | - Jay Gunawardana
- Blood Cancer Research GroupMater ResearchUniversity of QueenslandTranslational Research InstituteBrisbaneQLDAustralia
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30
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Law SC, Haigh OL, Walpole CM, Keane C, Miles JJ, Gandhi MK, Radford KJ, Steptoe RJ. Simple, rapid and inexpensive typing of common HLA class I alleles for immunological studies. J Immunol Methods 2018; 465:72-76. [PMID: 30537479 DOI: 10.1016/j.jim.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/22/2022]
Abstract
Current HLA-typing methods are typically designed to provide exquisitely-detailed identification of multiple HLA-alleles to satisfy the requirements for organ and bone marrow transplantation or genetic studies. Many human immunological studies, on the other hand, focus around only a small number of HLA alleles that are abundant or of relevance to specific diseases. Consequently, for such studies, many HLA typing approaches are not cost-effective and are potentially complicated, slow and not easily performed in-house. Work-flow would be streamlined by a simple, inexpensive and rapid typing method able to be performed in-house. We outline a straightforward approach that provides appropriate data for much immunological research. In a predominantly Caucasian population, flow cytometry using anti-HLA-A2, -B8 and -B7 antibodies consistently and accurately screened for samples carrying the highly-abundant HLA class I alleles HLA-A*02:01, -B*08:01 and -B*07:02 that form the focus of immunological studies. Next, we describe a straightforward and simple strategy for design and use of allele-specific PCR primers to identify, at high-resolution, alleles of interest. When combined with a simple gDNA extraction technique this provides reliable, simple and inexpensive in-house HLA typing demonstrated here for highly-abundant HLA class I alleles.
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Affiliation(s)
- Soi Cheng Law
- University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Oscar L Haigh
- Mater Research UQ, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Carina M Walpole
- Mater Research UQ, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Colm Keane
- University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - John J Miles
- Australian Institute of Tropical Medicine & Health, James Cook University, Cairns, Queensland, Australia
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Kristen J Radford
- Mater Research UQ, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Raymond J Steptoe
- University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia.
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Cui Q, Vari F, Cristino AS, Salomon C, Rice GE, Sabdia MB, Guanzon D, Palma C, Mathew M, Talaulikar D, Jain S, Han E, Hertzberg MS, Gould C, Crooks P, Thillaiyampalam G, Keane C, Gandhi MK. Circulating cell-free miR-494 and miR-21 are disease response biomarkers associated with interim-positron emission tomography response in patients with diffuse large B-cell lymphoma. Oncotarget 2018; 9:34644-34657. [PMID: 30410665 PMCID: PMC6205167 DOI: 10.18632/oncotarget.26141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/08/2018] [Indexed: 12/21/2022] Open
Abstract
MicroRNA (miRNA)s are dysregulated in Diffuse large B-cell lymphoma (DLBCL), where they reflect the malignant B-cells and the immune infiltrate within the tumor microenvironment. There remains a paucity of data in DLBCL regarding cell-free (c-f) miRNA as disease response biomarkers. Immunosuppressive monocyte/macrophages, which are enriched in DLBCL, are disease response markers in DLBCL, with miRNA key regulators of their immunosuppressive function. Our aim was to determine whether plasma miRNA that reflect the activity of the malignant B-cell and/or immunosuppressive monocytes/macrophages, have value as minimally-invasive disease response biomarkers in DLBCL. Quantification of 99 DLBCL tissues, to select miRNA implicated in immunosuppressive monocytes/macrophage biology, found miR-494 differentially elevated. In a discovery cohort (22 patients), pre-therapy c-f miR-494 and miR-21 but not miR-155 were raised relative to healthy plasma. Both miR-494 and miR-21 levels 3-6 months reduced post immuno-chemotherapy. The validation cohort (56 patients) was from a prospective clinical trial. Interestingly, in sequential samples both miRNAs decreased in patients becoming Positron Emission Tomography/Computerized Tomography (PET/CT)-ve, but not in those remaining interim-PET/CT+. Patient monocytes were phenotypically and functionally immunosuppressive with ex-vivo monocyte depletion enhancing T-cell proliferation in patient but not healthy samples. Pre-therapy monocytes showed an immunosuppressive transcriptome and raised levels of miR-494. MiR-494 was present in all c-f nanoparticle fractions but was most readily detectable in unfractionated plasma. Circulating c-f miR-494 and miR-21 are disease response biomarkers with differential response stratified by interim-PET/CT in patients with DLBCL. Further studies are required to explore their manipulation as potential therapeutic targets.
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Affiliation(s)
- Qingyan Cui
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Frank Vari
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | | | - Carlos Salomon
- University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia.,University of Concepción, Concepción, Chile
| | - Gregory E Rice
- University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Muhammed B Sabdia
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Dominic Guanzon
- University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Carlos Palma
- University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Marina Mathew
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Dipti Talaulikar
- Canberra Hospital, Garran, ACT, Australia.,Australia National University Medical School, Garran, ACT, Australia
| | | | - Erica Han
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | | | - Clare Gould
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Pauline Crooks
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | | | - Colm Keane
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
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Vari F, Arpon D, Keane C, Hertzberg MS, Talaulikar D, Jain S, Cui Q, Han E, Tobin J, Bird R, Cross D, Hernandez A, Gould C, Birch S, Gandhi MK. Immune evasion via PD-1/PD-L1 on NK cells and monocyte/macrophages is more prominent in Hodgkin lymphoma than DLBCL. Blood 2018; 131:1809-1819. [PMID: 29449276 PMCID: PMC5922274 DOI: 10.1182/blood-2017-07-796342] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [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: 07/13/2017] [Accepted: 02/09/2018] [Indexed: 12/21/2022] Open
Abstract
Much focus has been on the interaction of programmed cell death ligand 1 (PD-L1) on malignant B cells with programmed cell death 1 (PD-1) on effector T cells in inhibiting antilymphoma immunity. We sought to establish the contribution of natural killer (NK) cells and inhibitory CD163+ monocytes/macrophages in Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL). Levels of PD-1 on NK cells were elevated in cHL relative to DLBCL. Notably, CD3-CD56hiCD16-ve NK cells had substantially higher PD-1 expression relative to CD3-CD56dimCD16+ cells and were expanded in blood and tissue, more marked in patients with cHL than patients with DLBCL. There was also a raised population of PD-L1-expressing CD163+ monocytes that was more marked in patients with cHL compared with patients with DLBCL. The phenotype of NK cells and monocytes reverted back to normal once therapy (ABVD [doxorubicin 25 mg/m2, bleomycin 10 000 IU/m2, vinblastine 6 mg/m2, dacarbazine 375 mg/m2, all given days 1 and 15, repeated every 28 days] or R-CHOP [rituximab 375 mg/m2, cyclophosphamide 750 mg/m2 IV, doxorubicin 50 mg/m2 IV, vincristine 1.4 mg/m2 (2 mg maximum) IV, prednisone 100 mg/day by mouth days 1-5, pegfilgrastim 6 mg subcutaneously day 4, on a 14-day cycle]) had commenced. Tumor-associated macrophages (TAMs) expressed high levels of PD-L1/PD-L2 within diseased lymph nodes. Consistent with this, CD163/PD-L1/PD-L2 gene expression was also elevated in cHL relative to DLBCL tissues. An in vitro functional model of TAM-like monocytes suppressed activation of PD-1hi NK cells, which was reversed by PD-1 blockade. In line with these findings, depletion of circulating monocytes from the blood of pretherapy patients with cHL and patients with DLBCL enhanced CD3-CD56hiCD16-ve NK-cell activation. We describe a hitherto unrecognized immune evasion strategy mediated via skewing toward an exhausted PD-1-enriched CD3-CD56hiCD16-ve NK-cell phenotype. In addition to direct inhibition of NK cells by the malignant B cell, suppression of NK cells can occur indirectly by PD-L1/PD-L2-expressing TAMs. The mechanism is more prominent in cHL than DLBCL, which may contribute to the clinical sensitivity of cHL to PD-1 blockade.
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MESH Headings
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- B7-H1 Antigen/immunology
- Bleomycin/administration & dosage
- Cyclophosphamide/administration & dosage
- Dacarbazine/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Hodgkin Disease/drug therapy
- Hodgkin Disease/immunology
- Hodgkin Disease/pathology
- Humans
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Lymph Nodes/immunology
- Lymph Nodes/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Macrophages/immunology
- Macrophages/pathology
- Male
- Models, Immunological
- Monocytes/immunology
- Monocytes/pathology
- Neoplasm Proteins/immunology
- Prednisone/administration & dosage
- Programmed Cell Death 1 Receptor/immunology
- Rituximab
- Tumor Escape
- Vinblastine/administration & dosage
- Vincristine/administration & dosage
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Affiliation(s)
- Frank Vari
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - David Arpon
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - Colm Keane
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Dipti Talaulikar
- Canberra Hospital, Canberra, ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia; and
| | | | - Qingyan Cui
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - Erica Han
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - Josh Tobin
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Robert Bird
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Donna Cross
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Annette Hernandez
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Clare Gould
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Simone Birch
- Department of Pathology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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McKee SJ, Tuong ZK, Kobayashi T, Doff BL, Soon MS, Nissen M, Lam PY, Keane C, Vari F, Moi D, Mazzieri R, Leggatt G, Gandhi MK, Mattarollo SR. B cell lymphoma progression promotes the accumulation of circulating Ly6Clo monocytes with immunosuppressive activity. Oncoimmunology 2017; 7:e1393599. [PMID: 29308328 DOI: 10.1080/2162402x.2017.1393599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 09/15/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 12/16/2022] Open
Abstract
Monocytosis is considered a poor prognostic factor for many cancers, including B cell lymphomas. The mechanisms by which different monocyte subsets support the growth of lymphoma is poorly understood. Using a pre-clinical mouse model of B cell non-Hodgkin's lymphoma (B-NHL), we investigated the impact of tumor progression on circulating monocyte levels, subset distribution and their activity, with a focus on immune suppression. B-NHL development corresponded with significant expansion initially of classical (Ly6Chi) and non-classical (Ly6Clo) monocytes, with accumulation and eventual predominance of Ly6Clo cells. The lymphoma environment promoted the conversion, preferential survival and immune suppressive activity of Ly6Clo monocytes. Ly6Clo monocytes expressed higher levels of immunosuppressive genes including PD-L1/2, Arg1, IDO1 and CD163, compared to Ly6Chi monocytes. Both monocyte subsets suppressed CD8 T cell proliferation and IFN-γ production in vitro, but via different mechanisms. Ly6Chi monocyte suppression was contact dependent, while Ly6Clo monocytes suppressed via soluble mediators, including IDO and arginase. Ly6Clo monocytes could be selectively depleted in tumor-bearing hosts by liposomal doxorubicin treatment, further enhanced by co-administration of anti-4-1BB monoclonal antibody. This treatment led to a reduction in tumor growth, but failed to improve overall survival. Analogous immunosuppressive monocytes were observed in peripheral blood of diffuse large B cell lymphoma patients and actively suppressed human CD8 T cell proliferation. This study highlights a potential immune evasion strategy deployed by B cell lymphoma involving accumulation of circulating non-classical monocytes with immunosuppressive activity.
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Affiliation(s)
- Sara J McKee
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Zewen K Tuong
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Takumi Kobayashi
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Brianna L Doff
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Megan Sf Soon
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Michael Nissen
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Pui Yeng Lam
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Colm Keane
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.,Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Frank Vari
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Davide Moi
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Roberta Mazzieri
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Graham Leggatt
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Maher K Gandhi
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.,Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Stephen R Mattarollo
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
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Arulogun S, Hertzberg M, Gandhi MK. Recent treatment advances in Hodgkin lymphoma: a concise review. Intern Med J 2017; 46:1364-1369. [PMID: 26929077 DOI: 10.1111/imj.13051] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/08/2016] [Accepted: 02/20/2016] [Indexed: 11/29/2022]
Abstract
The majority of patients with Hodgkin lymphoma enjoy durable remissions following front-line treatment. This typically involves combination chemotherapy with or without radiotherapy. A significant minority of patients experience relapsed/refractory disease, of whom only approximately half can be 'salvaged' with conventional second-line treatments. Until recently, for those patients either failing or who are not fit for salvage, there have been few curative alternatives. Furthermore, there is a significant risk of delayed treatment complications to conventional therapies, including secondary malignancies and cardiac disease. However, novel targeted therapies are producing excellent results in clinical trials. They provide additional treatment options for those with relapsing/refractory disease; they may have potential in front-line therapy. The anti-CD30 antibody brentuximab vedotin (BV) has been tested as monotherapy and in combination in a variety of clinical settings, including in relapsed/refractory patients and as consolidative therapy following standard second-line therapy. Nivolumab and pembrolizumab, currently used in other malignancies that are known to utilise the programmed death pathway for survival, have shown outstanding results when used as single agents in heavily pre-treated (including BV refractory) patients. Individualising and adapting a patient's treatment course, whether augmenting or rationalising therapy, based on an interim positron emission tomography/computed tomography response is an important strategy currently under exploration to minimise toxicity while maximising response. Further work is needed to explore clinical and biological factors associated with improved outcomes. Knowledge of these factors combined with the movement of novel therapies into the front-line setting will enable individualised therapy to enhance clinical responses and minimise toxicities.
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Affiliation(s)
- S Arulogun
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - M Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - M K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Blood Cancer Research Laboratory, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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35
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Keane C, Gould C, Jones K, Hamm D, Talaulikar D, Ellis J, Vari F, Birch S, Han E, Wood P, Le-Cao KA, Green MR, Crooks P, Jain S, Tobin J, Steptoe RJ, Gandhi MK. The T-cell Receptor Repertoire Influences the Tumor Microenvironment and Is Associated with Survival in Aggressive B-cell Lymphoma. Clin Cancer Res 2017; 23:1820-1828. [PMID: 27649554 DOI: 10.1158/1078-0432.ccr-16-1576] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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: 06/23/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the relationship between the intra-tumoral T-cell receptor (TCR) repertoire and the tumor microenvironment (TME) in de novo diffuse large B-cell lymphoma (DLBCL) and the impact of TCR on survival.Experimental Design: We performed high-throughput unbiased TCRβ sequencing on a population-based cohort of 92 patients with DLBCL treated with conventional (i.e., non-checkpoint blockade) frontline "R-CHOP" therapy. Key immune checkpoint genes within the TME were digitally quantified by nanoString. The primary endpoints were 4-year overall survival (OS) and progression-free survival (PFS).Results: The TCR repertoire within DLBCL nodes was abnormally narrow relative to non-diseased nodal tissues (P < 0.0001). In DLBCL, a highly dominant single T-cell clone was associated with inferior 4-year OS rate of 60.0% [95% confidence interval (CI), 31.7%-79.6%], compared with 79.8% in patients with a low dominant clone (95% CI, 66.7%-88.5%; P = 0.005). A highly dominant clone also predicted inferior 4-year PFS rate of 46.6% (95% CI, 22.5%-76.6%) versus 72.6% (95% CI, 58.8%-82.4%, P = 0.008) for a low dominant clone. In keeping, clonal expansions were most pronounced in the EBV+ DLBCL subtype that is known to express immunogenic viral antigens and is associated with particularly poor outcome. Increased T-cell diversity was associated with significantly elevated PD-1, PD-L1, and PD-L2 immune checkpoint molecules.Conclusions: Put together, these findings suggest that the TCR repertoire is a key determinant of the TME. Highly dominant T-cell clonal expansions within the TME are associated with poor outcome in DLBCL treated with conventional frontline therapy. Clin Cancer Res; 23(7); 1820-8. ©2016 AACR.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Female
- High-Throughput Nucleotide Sequencing
- Humans
- Kaplan-Meier Estimate
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Prednisone/administration & dosage
- Prognosis
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Rituximab/administration & dosage
- Tumor Microenvironment/genetics
- Vincristine/administration & dosage
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Affiliation(s)
- Colm Keane
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia.
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Clare Gould
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kimberley Jones
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - David Hamm
- Adaptive Biotechnologies, Seattle, Washington
| | - Dipti Talaulikar
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Australian National University Medical School, Australian Capital Territory, Australia
| | - Jonathan Ellis
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Frank Vari
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Simone Birch
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | - Erica Han
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Peter Wood
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kim-Anh Le-Cao
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Michael R Green
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Pauline Crooks
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Sanjiv Jain
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Josh Tobin
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Raymond J Steptoe
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia.
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Hertzberg M, Gandhi MK, Trotman J, Butcher B, Taper J, Johnston A, Gill D, Ho SJ, Cull G, Fay K, Chong G, Grigg A, Lewis ID, Milliken S, Renwick W, Hahn U, Filshie R, Kannourakis G, Watson AM, Warburton P, Wirth A, Seymour JF, Hofman MS, Hicks RJ. Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14. Haematologica 2016; 102:356-363. [PMID: 28143954 DOI: 10.3324/haematol.2016.154039] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/03/2016] [Indexed: 01/11/2023] Open
Abstract
In the treatment of diffuse large B-cell lymphoma, a persistently positive [18F]fluorodeoxyglucose positron emission tomography (PET) scan typically carries a poor prognosis. In this prospective multi-center phase II study, we sought to establish whether treatment intensification with R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) chemotherapy followed by 90Y-ibritumomab tiuxetan-BEAM (BCNU, etoposide, cytarabine, and melphalan) for high-risk diffuse large B-cell lymphoma patients who are positive on interim PET scan after 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, and prednisone) can improve 2-year progression-free survival from a historically unfavorable rate of 40% to a rate of 65%. Patients received 4 cycles of R-CHOP-14, followed by a centrally-reviewed PET performed at day 17-20 of cycle 4 and assessed according to International Harmonisation Project criteria. Median age of the 151 evaluable patients was 57 years, with 79% stages 3-4, 54% bulk, and 54% International Prognostic Index 3-5. Among the 143 patients undergoing interim PET, 101 (71%) were PET-negative (96 of whom completed R-CHOP), 42 (29%) were PET-positive (32 of whom completed R-ICE and 90Y-ibritumomab tiuxetan-BEAM). At a median follow up of 35 months, the 2-year progression-free survival for PET-positive patients was 67%, a rate similar to that for PET-negative patients treated with R-CHOP-14 (74%, P=0.11); overall survival was 78% and 88% (P=0.11), respectively. In an exploratory analysis, progression-free and overall survival were markedly superior for PET-positive Deauville score 4 versus score 5 (P=0.0002 and P=0.001, respectively). Therefore, diffuse large B-cell lymphoma patients who are PET-positive after 4 cycles of R-CHOP-14 and who switched to R-ICE and 90Y-ibritumomab tiuxetan-BEAM achieved favorable survival outcomes similar to those for PET-negative R-CHOP-14-treated patients. Further studies are warranted to confirm these promising results. (Registered at: ACTRN12609001077257).
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Affiliation(s)
- Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital and University of NSW, Randwick, NSW, Australia
| | - Maher K Gandhi
- The University of Queensland Diamantina Institute Woolloongabba, Brisbane, QLD, Australia.,Department of Haematology, Princess Alexandra Hospital Brisbane, QLD, Australia
| | - Judith Trotman
- Department of Haematology, Repatriation General Hospital Concord and University of Sydney, NSW, Australia
| | | | - John Taper
- Nepean Cancer Care Centre, Nepean Hospital Nepean, NSW, Australia
| | - Amanda Johnston
- Department of Haematology, Westmead Hospital, NSW, Australia
| | - Devinder Gill
- Department of Haematology, Princess Alexandra Hospital Brisbane, QLD, Australia
| | - Shir-Jing Ho
- Department of Haematology, St George Hospital Kogarah, NSW, Australia
| | - Gavin Cull
- Department of Haematology, Sir Charles Gairdner Hospital Perth, WA, Australia
| | - Keith Fay
- Department of Haematology, Royal North Shore Hospital, St Leonard's, NSW, Australia
| | - Geoff Chong
- Olivia Newton John Cancer & Wellness Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - Andrew Grigg
- Department of Haematology, Austin Hospital, Heidelberg, VIC, Australia
| | - Ian D Lewis
- Department of Haematology, Royal Adelaide Hospital Adelaide, SA, Australia
| | - Sam Milliken
- Department of Haematology, St Vincent's Hospital Darlinghurst, NSW, Australia
| | - William Renwick
- Department of Haematology, Royal Melbourne Hospital Parkville, VIC, Australia
| | - Uwe Hahn
- Department of Haematology, The Queen Elizabeth Hospital, SA, Australia
| | - Robin Filshie
- Department of Haematology, St Vincent's Hospital Melbourne, VIC, Australia
| | - George Kannourakis
- Ballarat Oncology and Haematology Service and Fiona Elsey Cancer Research Institute, Ballarat, VIC, Australia
| | - Anne-Marie Watson
- Department of Haematology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Pauline Warburton
- Department of Haematology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Andrew Wirth
- Department of Radiation Oncology, Peter MacCallum Cancer Centre East Melbourne, VIC, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre East Melbourne and University of Melbourne, Parkville, VIC, Australia
| | - Michael S Hofman
- Department of Cancer Imaging, Peter MacCallum Cancer Centre East Melbourne, VIC, Australia
| | - Rodney J Hicks
- Department of Cancer Imaging, Peter MacCallum Cancer Centre East Melbourne, VIC, Australia
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Khamenehfar A, Gandhi MK, Chen Y, Hogge DE, Li PCH. Dielectrophoretic Microfluidic Chip Enables Single-Cell Measurements for Multidrug Resistance in Heterogeneous Acute Myeloid Leukemia Patient Samples. Anal Chem 2016; 88:5680-8. [PMID: 27149245 DOI: 10.1021/acs.analchem.5b04446] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The front-line treatment for adult acute myeloid leukemia (AML) is anthracycline-based combination chemotherapy. However, treatment outcomes remain suboptimal with relapses frequently observed. Among the mechanisms of treatment failure is multidrug resistance (MDR) mediated by the ABCB1, ABCC1, and ABCG2 drug-efflux transporters. Although genetic and phenotypic heterogeneity between leukemic blast cells is a well-recognized phenomenon, there remains minimal data on differences in MDR activity at the individual cell level. Specifically, functional assays that can distinguish the variability in MDR activity between individual leukemic blasts are lacking. Here, we outline a new dielectrophoretic (DEP) chip-based assay. This assay permits measurement of drug accumulation in single cells, termed same-single-cell analysis in the accumulation mode (SASCA-A). Initially, the assay was optimized in pretherapy samples from 20 adults with AML whose leukemic blasts had MDR activity against the anthracyline daunorubicin (DNR) tested using multiple MDR inhibitors. Parameters tested were initial drug accumulation, time to achieve signal saturation, fold-increase of DNR accumulation with MDR inhibition, ease of cell trapping, and ease of maintaining the trapped cells stationary. This enabled categorization into leukemic blast cells with MDR activity (MDR(+)) and leukemic blast cells without MDR activity (MDR(-ve)). Leukemic blasts could also be distinguished from benign white blood cells (notably these also lacked MDR activity). MDR(-ve) blasts were observed to be enriched in samples taken from patients who went on to enter complete remission (CR), whereas MDR(+) blasts were frequently observed in patients who failed to achieve CR following front-line chemotherapy. However, pronounced variability in functional MDR activity between leukemic blasts was observed, with MDR(+) cells not infrequently seen in some patients that went on to achieve CR. Next, we tested MDR activity in two paired AML patient samples. Pretherapy samples taken from patients that achieved CR to front-line chemotherapy were compared with samples taken at time of subsequent relapse. MDR(+) cells were frequently observed in leukemic blast cells in both pretherapy and relapsed samples, consistent with MDR as a mechanism of relapse in these patients. We demonstrate the ability of a new DEP microfluidic chip-based assay to identify heterogeneity in MDR activity in leukemic blasts. The test provides a platform for future studies to characterize the mechanistic basis for heterogeneity in MDR activity at the individual cell level.
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Affiliation(s)
| | - Maher K Gandhi
- The University of Queensland , Diamantina Institute, 37 Kent Street, Woolloongabba, Queensland, Australia
| | | | - Donna E Hogge
- Terry Fox Laboratory, BC Cancer Agency , 675 West 10th Avenue, Vancouver, British Columbia, Canada
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Jones K, Wockner L, Brennan RM, Keane C, Chattopadhyay PK, Roederer M, Price DA, Cole DK, Hassan B, Beck K, Gottlieb D, Ritchie DS, Seymour JF, Vari F, Crooks P, Burrows SR, Gandhi MK. The impact of HLA class I and EBV latency-II antigen-specific CD8(+) T cells on the pathogenesis of EBV(+) Hodgkin lymphoma. Clin Exp Immunol 2015; 183:206-20. [PMID: 26422112 PMCID: PMC4711160 DOI: 10.1111/cei.12716] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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] [Accepted: 09/22/2015] [Indexed: 12/20/2022] Open
Abstract
In 40% of cases of classical Hodgkin lymphoma (cHL), Epstein–Barr virus (EBV) latency‐II antigens [EBV nuclear antigen 1 (EBNA1)/latent membrane protein (LMP)1/LMP2A] are present (EBV+cHL) in the malignant cells and antigen presentation is intact. Previous studies have shown consistently that HLA‐A*02 is protective in EBV+cHL, yet its role in disease pathogenesis is unknown. To explore the basis for this observation, gene expression was assessed in 33 cHL nodes. Interestingly, CD8 and LMP2A expression were correlated strongly and, for a given LMP2A level, CD8 was elevated markedly in HLA‐A*02–versus HLA‐A*02+ EBV+cHL patients, suggesting that LMP2A‐specific CD8+ T cell anti‐tumoral immunity may be relatively ineffective in HLA‐A*02– EBV+cHL. To ascertain the impact of HLA class I on EBV latency antigen‐specific immunodominance, we used a stepwise functional T cell approach. In newly diagnosed EBV+cHL, the magnitude of ex‐vivo LMP1/2A‐specific CD8+ T cell responses was elevated in HLA‐A*02+ patients. Furthermore, in a controlled in‐vitro assay, LMP2A‐specific CD8+ T cells from healthy HLA‐A*02 heterozygotes expanded to a greater extent with HLA‐A*02‐restricted compared to non‐HLA‐A*02‐restricted cell lines. In an extensive analysis of HLA class I‐restricted immunity, immunodominant EBNA3A/3B/3C‐specific CD8+ T cell responses were stimulated by numerous HLA class I molecules, whereas the subdominant LMP1/2A‐specific responses were confined largely to HLA‐A*02. Our results demonstrate that HLA‐A*02 mediates a modest, but none the less stronger, EBV‐specific CD8+ T cell response than non‐HLA‐A*02 alleles, an effect confined to EBV latency‐II antigens. Thus, the protective effect of HLA‐A*02 against EBV+cHL is not a surrogate association, but reflects the impact of HLA class I on EBV latency‐II antigen‐specific CD8+ T cell hierarchies.
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Affiliation(s)
- K Jones
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L Wockner
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R M Brennan
- Cellular Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - C Keane
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
| | - P K Chattopadhyay
- ImmunoTechnology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Roederer
- ImmunoTechnology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - D A Price
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - D K Cole
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - B Hassan
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - K Beck
- Tissue Engineering and Reparative Dentistry, Cardiff University School of Dentistry, Cardiff, UK
| | - D Gottlieb
- Blood and Marrow Transplant Service, Westmead Hospital, Sydney, Australia
| | - D S Ritchie
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - J F Seymour
- University of Melbourne, Melbourne, Australia
| | - F Vari
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - P Crooks
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - S R Burrows
- Cellular Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - M K Gandhi
- Blood Cancer Research, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
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Affiliation(s)
- Qingyan Cui
- a University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland , Australia and
| | - Maher K Gandhi
- a University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland , Australia and.,b Princess Alexandra Hospital , Brisbane , Queensland , Australia
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Keane C, Vari F, Hertzberg M, Cao KAL, Green MR, Han E, Seymour JF, Hicks RJ, Gill D, Crooks P, Gould C, Jones K, Griffiths LR, Talaulikar D, Jain S, Tobin J, Gandhi MK. Ratios of T-cell immune effectors and checkpoint molecules as prognostic biomarkers in diffuse large B-cell lymphoma: a population-based study. Lancet Haematol 2015; 2:e445-55. [PMID: 26686046 DOI: 10.1016/s2352-3026(15)00150-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Risk-stratification of diffuse large B-cell lymphoma (DLBCL) requires identification of patients with disease that is not cured, despite initial treatment with R-CHOP. The prognostic importance of the revised International Prognostic Index (R-IPI) and cell of origin of the malignant B cell are established in DLBCL. We aimed to develop a novel, easily applicable, tissue-based prognostic biomarker based on quantification of the tumour microenvironment that is independent of and additive to the R-IPI and cell of origin. METHODS We performed digital hybridisation on the NanoString platform to assess the relation between immune effector and inhibitory (checkpoint) genes in 252 formalin-fixed, paraffin-embedded DLBCL tissue specimens obtained from patients treated with R-CHOP. We used a tree-based survival model to quantify net antitumoral immunity (using ratios of immune effector to checkpoint genes) and to generate a cutoff as an outcome predictor in 158 of the 252 patients. We validated this model in tissue (n=233) and blood (n=140) samples from two independent cohorts treated with R-CHOP. FINDINGS T-cell and NK-cell immune effector molecule expression correlated with tumour-associated macrophage and PD-1/PD-L1 axis markers, consistent with malignant B cells triggering a dynamic checkpoint response to adapt to and evade immune surveillance. The ratio of CD4*CD8 to (CD163:CD68[M2])*PD-L1 was better able to stratify overall survival than was any one immune marker or combination, distinguishing groups with disparate 4-year overall survival. 94 (59%) of 158 patients had a score above the cutoff and 4-year overall survival of 92·1% (95% CI 82·9-96·7), and the remaining 64 (41%) patients had a score below the cutoff and 4-year overall survival of 47·0% (32·8-60·5; hazard ratio [HR] 8·3, 95% CI 4·3-17·3; p<0·0001). The CD4*CD8:M2*PD-L1 immune ratio was independent of and added to the R-IPI and cell of origin. Tissue findings in the independent tissue cohort accorded with those in our initial tissue cohort. 139 (60%) of 233 patients had a score above the cutoff and 4-year overall survival of 75·6% (95% CI 64·6-83·6), with the remaining 94 (40%) patients having a score below the cutoff (63·5% [52·5-72·7]; HR 1·9, 95% CI 1·1-3·3; p=0·0067). INTERPRETATION Ratios of immune effectors to checkpoints augment the cell of origin and R-IPI in DLBCL and are applicable to paraffin-embedded biopsy specimens. These findings might have potential implications for selection of patients for checkpoint blockade within clinical trials. FUNDING Leukaemia Foundation of Queensland, Kasey-Anne Oklobdzijato Memorial Fund, the Australasian Leukaemia and Lymphoma Group (Malcolm Broomhead Bequest), the Australian Cancer Research Foundation, and the Cancer Council of Queensland.
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Affiliation(s)
- Colm Keane
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia; Genomics Research Centre, Griffith University, Southport, QLD, Australia
| | - Frank Vari
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Kim-Anh Lê Cao
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Michael R Green
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Erica Han
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - John F Seymour
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Devinder Gill
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Pauline Crooks
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Clare Gould
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kimberley Jones
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, Griffith University, Southport, QLD, Australia
| | - Dipti Talaulikar
- Canberra Hospital, Canberra, ACT, Australia; Australian National University Medical School, Acton, ACT, Australia
| | | | - Josh Tobin
- Australian National University Medical School, Acton, ACT, Australia
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia.
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Taylor E, Jones M, Hourigan MJ, Johnson DW, Gill DS, Isbel N, Hawley CM, Marlton P, Gandhi MK, Campbell SB, Mollee P. Cessation of immunosuppression during chemotherapy for post-transplant lymphoproliferative disorders in renal transplant patients. Nephrol Dial Transplant 2015; 30:1774-9. [PMID: 26188340 DOI: 10.1093/ndt/gfv260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 08/21/2014] [Accepted: 05/15/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The optimal reduction of immunosuppressive therapy (IST) in renal transplant patients with post-transplant lymphoproliferative disorders (PTLDs) is uncertain. As chemotherapy is immunosuppressive, IST may be stopped during this time without compromising graft function. Subsequent long-term reduction of IST reduces relapse risk, but may increase risk of graft rejection. METHODS We performed a retrospective, matched cohort study of adult renal transplant patients in whom IST was ceased during chemotherapy and resumed at lower dose (calcineurin inhibitor at 50%, prednisolone ≤10 mg daily, no third agent) approximately 6 weeks after chemotherapy. Outcomes were compared with those of renal transplant patients without PTLD, matched for creatinine at equivalent time post-transplant that PTLD was diagnosed in cases, as well as for age, gender and year of transplant. RESULTS Twenty-four cases of PTLD occurring at a median of 9.2 years post-transplant were compared with 83 matched controls. PTLD cases were followed for a median of 11.9 years. Using competing risks analysis, time to 25% increase in serum creatinine was not significantly different between the two groups [adjusted hazard ratio (HR) 1.8, 95% confidence interval (CI) 0.89-3.6]. Similar results were obtained using multivariable Cox regression analysis (HR 1.19, 95% CI 0.44-3.23). Only one PTLD case experienced a ≥25% increase in creatinine <6 months after IST cessation in the setting of progressive PTLD and death. Three cases recommenced dialysis, compared with three controls (HR 2.5, 95% CI 0.47-13.00). Five-year patient survival rates for cases and controls were 70 and 94%, respectively (P = 0.01). CONCLUSIONS IST can be safely ceased during chemotherapy for PTLD in renal transplant patients. Furthermore, long-term reduction in IST is not associated with a significant difference in renal function deterioration. Prospective trials are needed to address the optimal reduction of IST in PTLDs.
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Affiliation(s)
- Emma Taylor
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Mark Jones
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Matthew J Hourigan
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Devinder S Gill
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Nicole Isbel
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Paula Marlton
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Maher K Gandhi
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Scott B Campbell
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Peter Mollee
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
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Scott LM, Gandhi MK. Deregulated JAK/STAT signalling in lymphomagenesis, and its implications for the development of new targeted therapies. Blood Rev 2015; 29:405-15. [PMID: 26123794 DOI: 10.1016/j.blre.2015.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 11/17/2014] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/09/2023]
Abstract
Gene expression profiling has implicated several intracellular signalling cascades, including the JAK/STAT pathway, in the pathogenesis of particular subtypes of lymphoma. In marked contrast to the situation in patients with either acute lymphoblastic leukaemia or a myeloproliferative neoplasm, JAK2 coding sequence mutations are rare in lymphoma patients with an activated JAK/STAT "signature". This is instead the consequence of mutational events that result in the increased expression of non-mutated JAK2; positively or negatively affect the activity of other components of the JAK/STAT pathway; or establish an autocrine signalling loop that drives JAK-mediated cytokine-independent proliferation. Here, we detail these genetic lesions, their functional consequences, and impact on patient outcome. In light of the approval of a JAK1/JAK2 inhibitor for the treatment of myelofibrosis, and preliminary studies evaluating the efficacy of other JAK inhibitors, the therapeutic potential of compounds that target JAK/STAT signalling in the treatment of patients with lymphoma is also discussed.
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Affiliation(s)
- Linda M Scott
- University of Queensland Diamantina Institute, University of Queensland, Translational Research Institute, Brisbane, Australia.
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, University of Queensland, Translational Research Institute, Brisbane, Australia; Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
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Scherer F, Kurtz DM, Green MR, Newman AM, Klass DM, Zhou L, Krishnan R, Liu CL, Glover C, Ohgami RS, Hicks RJ, Keane C, Kong KA, Faham M, Hertzberg MS, Gandhi MK, Advani RH, Levy R, Diehn M, Alizadeh AA. Pre-treatment circulating tumor DNA as a biomarker for disease burden in diffuse large B cell lymphoma (DLBCL). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Aaron M. Newman
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Daniel M. Klass
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Li Zhou
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Rashi Krishnan
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Chih Long Liu
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Cynthia Glover
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Rodney J Hicks
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Colm Keane
- Princess Alexandra Hospital, Brisbane, Australia
| | | | | | | | | | - Ranjana H. Advani
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Ronald Levy
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Ash A. Alizadeh
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
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Arpon DR, Gandhi MK, Martin JH. A new frontier in haematology - combining pharmacokinetic with pharmacodynamic factors to improve choice and dose of drug. Br J Clin Pharmacol 2015; 78:274-81. [PMID: 24433338 DOI: 10.1111/bcp.12318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/31/2013] [Indexed: 12/14/2022] Open
Abstract
The issue of tailored dosing adjusted according to a range of patient-specific factors other than bodyweight or body surface area is of large and increasing clinical and financial concern. Even if it is known that dosing alterations are likely to be required for parameters such as body composition, gender and pharmacogenetics, the amount of dosing change is unknown. Thus, pharmacokinetically guided dosing is making a resurgence, particularly in areas of medicine where there are cost constraints or safety issues, such as in haematology medications. However, the evidence to support the behaviour is minimal, particularly when long-term outcomes are considered. In haematology, there are particular issues around efficacy, toxicity and overall cost. Newer targeted agents, such as the monoclonal antibody rituximab and the tyrosine kinase inhibitor imatinib, whilst clearly being highly effective, are dosed on a milligram per square metre (rituximab) or fixed dose basis (imatinib), regardless of body composition, tumour aspects or comorbidity. This review questions this practice and raises important clinical issues; specifically, the clinical potential for combined pharmacokinetically and pharmacodynamically guided dosing of new targeted agents in haematological malignancies. This pharmacokinetically and pharmacodynamically guided dosing is an emerging area of clinical pharmacology, driven predominantly by toxicity, efficacy and cost issues, but also because reasonable outcomes are being noted with more appropriately dosed older medications adjusted for patient-specific factors. Clinical trials to investigate the optimization of rituximab dose scheduling are required.
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Affiliation(s)
- David Rey Arpon
- School of Medicine, University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, Australia; Translational Research Institute, Woolloongabba, Queensland, Australia
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Jones K, Wockner L, Thornton A, Gottlieb D, Ritchie DS, Seymour JF, Kumarasinghe G, Gandhi MK. HLA class I associations with EBV+ post-transplant lymphoproliferative disorder. Transpl Immunol 2015; 32:126-30. [DOI: 10.1016/j.trim.2015.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
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Fink SEK, Gandhi MK, Nourse JP, Keane C, Jones K, Crooks P, Jöhrens K, Korfel A, Schmidt H, Neumann S, Tiede A, Jäger U, Dührsen U, Neuhaus R, Dreyling M, Borchert K, Südhoff T, Riess H, Anagnostopoulos I, Trappe RU. A comprehensive analysis of the cellular and EBV-specific microRNAome in primary CNS PTLD identifies different patterns among EBV-associated tumors. Am J Transplant 2014; 14:2577-87. [PMID: 25130212 DOI: 10.1111/ajt.12858] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 04/11/2014] [Revised: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 01/25/2023]
Abstract
Primary central nervous system (pCNS) posttransplant lymphoproliferative disorder (PTLD) is a complication of solid organ transplantation characterized by poor outcome. In contrast to systemic PTLD, Epstein-Barr virus (EBV)-association of pCNS PTLD is almost universal, yet viral and cellular data are limited. To identify differences in the pattern of EBV-association of pCNS and systemic PTLD, we analyzed the expression of latent and lytic EBV transcripts and the viral and cellular microRNAome in nine pCNS (eight EBV-associated) and in 16 systemic PTLD samples (eight EBV-associated). Notably although 15/16 EBV-associated samples exhibited a viral type III latency pattern, lytic transcripts were also strongly expressed. Members of the ebv-miR-BHRF1 and ebv-miR-BART clusters were expressed in virtually all EBV-associated PTLD samples. There were 28 cellular microRNAs differentially expressed between systemic and pCNS PTLD. pCNS PTLD expressed lower hsa-miR-199a-5p/3p and hsa-miR-143/145 (implicated in nuclear factor kappa beta and c-myc signaling) as compared to systemic PTLD. Unsupervised nonhierarchical clustering of the viral and cellular microRNAome distinguished non-EBV-associated from EBV-associated samples and identified a separate group of EBV-associated pCNS PTLD that displayed reduced levels of B cell lymphoma associated oncomiRs such as hsa-miR-155, -21, -221 and the hsa-miR-17-92 cluster. EBV has a major impact on viral and cellular microRNA expression in EBV-associated pCNS PTLD.
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Affiliation(s)
- S E K Fink
- Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
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Tran H, Brighton T, Grigg A, McRae S, Dixon J, Thurley D, Gandhi MK, Truman M, Marlton P, Catalano J. A multi-centre, single-arm, open-label study evaluating the safety and efficacy of fixed dose rituximab in patients with refractory, relapsed or chronic idiopathic thrombocytopenic purpura (R-ITP1000 study). Br J Haematol 2014; 167:243-51. [PMID: 25041261 DOI: 10.1111/bjh.13029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
Abstract
The efficacy of a fixed-dose rituximab schedule was prospectively explored in primary/acute refractory, relapsed or chronic (platelet count >10 × 10(9) /l and ≤50 × 10(9) /l) idiopathic thrombocytopenic purpura (ITP). Patients received two doses of rituximab (1000 mg) on days 1 and 15 and were followed-up on weeks 1-8, 12, 26, 39 and 52. A total of 122 patients were included in the safety population; efficacy was analysed in 108 patients. Overall response rate (ORR) at week 8, defined as the proportion of patients achieving complete response (CR; platelet count >150 × 10(9) /l) or partial response (PR; platelet count >50 × 10(9) /l) was 44%. Therapeutic response, defined as achieving a response at week 8, with at least a minor response (MR; platelet count >30 × 10(9) /l), sustained up to weeks 26 and 52 and accompanied by a reduction in ITP medications, was achieved in 44% (week 26) and 35% (week 52) of patients, respectively. Treatment was well tolerated with no safety concerns. While this study failed to meet its primary endpoint of an ORR of 50%, the efficacy of two fixed doses of rituximab appear to provide similar efficacy to the standard 375 mg/m(2) four-dose schedule in relapsed/chronic ITP.
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Affiliation(s)
- Huyen Tran
- Monash Medical Centre, Clayton, Vic., Australia; Australian Centre for Bloods Diseases, Monash University, Melbourne, Vic., Australia
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Aya-Bonilla C, Camilleri E, Haupt LM, Lea R, Gandhi MK, Griffiths LR. In silico analyses reveal common cellular pathways affected by loss of heterozygosity (LOH) events in the lymphomagenesis of Non-Hodgkin's lymphoma (NHL). BMC Genomics 2014; 15:390. [PMID: 24885312 PMCID: PMC4041994 DOI: 10.1186/1471-2164-15-390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/02/2014] [Indexed: 11/16/2022] Open
Abstract
Background The analysis of cellular networks and pathways involved in oncogenesis has increased our knowledge about the pathogenic mechanisms that underlie tumour biology and has unmasked new molecular targets that may lead to the design of better anti-cancer therapies. Recently, using a high resolution loss of heterozygosity (LOH) analysis, we identified a number of potential tumour suppressor genes (TSGs) within common LOH regions across cases suffering from two of the most common forms of Non-Hodgkin’s lymphoma (NHL), Follicular Lymphoma (FL) and Diffuse Large B-cell Lymphoma (DLBCL). From these studies LOH of the protein tyrosine phosphatase receptor type J (PTPRJ) gene was identified as a common event in the lymphomagenesis of these B-cell lymphomas. The present study aimed to determine the cellular pathways affected by the inactivation of these TSGs including PTPRJ in FL and DLBCL tumourigenesis. Results Pathway analytical approaches identified that candidate TSGs located within common LOH regions participate within cellular pathways, which may play a crucial role in FL and DLBCL lymphomagenesis (i.e., metabolic pathways). These analyses also identified genes within the interactome of PTPRJ (i.e. PTPN11 and B2M) that when inactivated in NHL may play an important role in tumourigenesis. We also detected genes that are differentially expressed in cases with and without LOH of PTPRJ, such as NFATC3 (nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 3). Moreover, upregulation of the VEGF, MAPK and ERBB signalling pathways was also observed in NHL cases with LOH of PTPRJ, indicating that LOH-driving events causing inactivation of PTPRJ, apart from possibly inducing a constitutive activation of these pathways by reduction or abrogation of its dephosphorylation activity, may also induce upregulation of these pathways when inactivated. This finding implicates these pathways in the lymphomagenesis and progression of FL and DLBCL. Conclusions The evidence obtained in this research supports findings suggesting that FL and DLBCL share common pathogenic mechanisms. Also, it indicates that PTPRJ can play a crucial role in the pathogenesis of these B-cell tumours and suggests that activation of PTPRJ might be an interesting novel chemotherapeutic target for the treatment of these B-cell tumours. Electronic supplementary material The online version of this article (doi: 10.1186/1471-2164-15-390) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Lyn R Griffiths
- Genomics Research Centre, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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Keane C, Vari F, Hertzberg MS, Green MR, Han E, Seymour JF, Hicks RJ, Gill DS, Crooks P, Gould C, Jones K, Radford K, Griffiths L, Talaulikar D, Jain S, Tobin J, Gandhi MK. Net antitumoral immunity and the predictive power of conventional prognosticators in diffuse large B-cell lymphoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Colm Keane
- Princess Alexandra Hospital, Brisbane, Australia
| | - Frank Vari
- Translational Research Institute, Brisbane, Australia
| | | | | | - Erica Han
- Translational Research Institute, Brisbane, Australia
| | | | - Rodney J Hicks
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | | | | | - Clare Gould
- Translational Research Institute, Brisbane, Australia
| | | | | | | | | | - Sanjiv Jain
- Australian National University, Canberra, Australia
| | - Josh Tobin
- Australian National University, Canberra, Australia
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Kurtz DM, Green MR, Bratman SV, Liu CL, Glover C, Keane C, Kong K, Faham M, Miklos DB, Advani RH, Levy R, Hertzberg MS, Gandhi MK, Diehn M, Alizadeh AA. Noninvasive monitoring of cellular versus acellular tumor DNA from immunoglobulin genes for DLBCL. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Chih-Long Liu
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Colm Keane
- Princess Alexandra Hospital, Brisbane, Australia
| | | | | | - David Bernard Miklos
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA
| | | | - Ronald Levy
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | | | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
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