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Comparison of TP53 mutations in myelodysplasia and acute leukemia suggests divergent roles in initiation and progression 比较骨髓增生异常和急性白血病中的 TP53 基因突变,发现它们在发病和发展过程中发挥着不同的作用
Pub Date : 2024-03-01 DOI: 10.1016/j.bneo.2024.100004
Ashwini Jambhekar , Emily E. Ackerman , Berk A. Alpay , Galit Lahav , Scott B. Lovitch

Abstract

TP53 mutation predicts adverse prognosis in many cancers, including myeloid neoplasms, but the mechanisms by which specific mutations affect disease biology, and whether they differ between disease categories, remain unknown. We analyzed TP53 mutations in 4 myeloid neoplasm subtypes (myelodysplastic syndrome [MDS], acute myeloid leukemia [AML], AML with myelodysplasia-related changes [AML-MRC], and therapy-related AML), and identified differences in mutation types, spectrum, and hot spots between disease categories and in comparison to solid tumors. Missense mutations in the DNA-binding domain were most common across all categories, whereas inactivating mutations and mutations outside the DNA binding domain were more common in AML-MRC than in MDS. TP53 mutations in MDS were more likely to retain transcriptional activity, and comutation profiles were distinct between disease categories and mutation types. Our findings suggest that mutated TP53 contributes to initiation and progression of neoplasia via distinct mechanisms, and support the utility of specific identification of TP53 mutations in myeloid malignancies.

摘要TP53突变可预测包括骨髓性肿瘤在内的许多癌症的不良预后,但特定突变影响疾病生物学的机制及其在不同疾病类别中是否存在差异仍是未知数。我们分析了4种骨髓肿瘤亚型(骨髓增生异常综合征[MDS]、急性髓性白血病[AML]、骨髓增生异常相关病变的急性髓性白血病[AML-MRC]和治疗相关的急性髓性白血病)中的TP53突变,发现了不同疾病类别之间以及与实体瘤相比在突变类型、谱系和热点方面的差异。在所有类别中,DNA结合域的错义突变最为常见,而失活突变和DNA结合域外的突变在AML-MRC中比在MDS中更为常见。MDS中的TP53突变更有可能保留转录活性,不同疾病类别和突变类型之间的突变情况也各不相同。我们的研究结果表明,突变的TP53通过不同的机制促进了肿瘤的发生和发展,并支持对骨髓恶性肿瘤中的TP53突变进行特异性鉴定。
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引用次数: 0
Multiple myeloma–associated DIS3 gene is essential for hematopoiesis, but loss of DIS3 is insufficient for myelomagenesis 多发性骨髓瘤相关 DIS3 基因对造血至关重要,但 DIS3 基因缺失不足以导致骨髓瘤形成
Pub Date : 2024-03-01 DOI: 10.1016/j.bneo.2024.100005
Hiroto Ohguchi , Yasuyo Ohguchi , Sho Kubota , Kan Etoh , Ai Hamashima , Shingo Usuki , Takako Yokomizo-Nakano , Jie Bai , Takeshi Masuda , Yawara Kawano , Takeshi Harada , Mitsuyoshi Nakao , Takashi Minami , Teru Hideshima , Kimi Araki , Goro Sashida
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引用次数: 0
Patients with Castleman disease report mild COVID-19 symptoms and mount a humoral response to SARS-CoV-2 vaccination 卡斯特曼病患者出现轻微的 COVID-19 症状,并对接种 SARS-CoV-2 疫苗产生体液反应
Pub Date : 2024-03-01 DOI: 10.1016/j.bneo.2024.100002
Saishravan Shyamsundar , Sheila K. Pierson , Caoilfhionn M. Connolly , Mayan Teles , Dorry L. Segev , William A. Werbel , Frits van Rhee , Corey Casper , Joshua D. Brandstadter , Ariela Noy , David C. Fajgenbaum

Abstract

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in increased morbidity and mortality in patients with impaired immunity, hematologic malignancies, and on immunosuppressive regimens. COVID-19 can cause a cytokine storm with some patients benefiting from blockade of the proinflammatory cytokine, interleukin 6 (IL-6). Because Castleman disease (CD) is an atypical lymphoproliferative disorder that can involve a cytokine storm and often requires immunosuppressive therapies, including IL-6 inhibition, we sought to evaluate outcomes after COVID-19 and SARS-CoV-2 vaccination in patients with CD. We administered a survey in April 2021 to characterize experiences with COVID-19 and SARS-CoV-2 vaccination among 300 patients enrolled in ACCELERATE, a CD natural history registry. Among 128 respondents, the prevalence of SARS-CoV-2 infection (16/95, 17%), severe disease (1/16, 6%), vaccination rates (112/128, 88%), and vaccine adverse effects after dose 1 (62/112, 55%) were comparable with that of the general US population. Although there were 2 cases of CD flares occurring shortly after SARS-CoV-2 infection (n = 1) and vaccination (n = 1), >100 patients that were infected and/or vaccinated did not experience CD flares. Among patients with CD, the median antispike titer 6 months after the second vaccine dose was comparable to that of individuals with other immune-related diseases and healthy populations. Despite being on immunosuppressive therapies, patients with CD do not appear to be at increased risk of poor COVID-19 outcomes and can mount a humoral response to SARS-CoV-2 vaccination. This study was registered at www.ClinicalTrials.gov as #NCT02817997.

摘要 严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)感染引起的冠状病毒病 2019(COVID-19)导致免疫力低下、血液系统恶性肿瘤和接受免疫抑制治疗的患者发病率和死亡率增加。COVID-19 可引起细胞因子风暴,一些患者可从阻断促炎细胞因子白细胞介素 6(IL-6)中获益。由于卡斯特曼病(CD)是一种非典型淋巴细胞增生性疾病,可引起细胞因子风暴,通常需要采用免疫抑制疗法,包括抑制 IL-6,因此我们试图评估 CD 患者接种 COVID-19 和 SARS-CoV-2 疫苗后的疗效。我们于 2021 年 4 月进行了一项调查,以了解 CD 自然病史登记系统 ACCELERATE 的 300 名登记患者接种 COVID-19 和 SARS-CoV-2 疫苗后的经历。在128名受访者中,SARS-CoV-2感染率(16/95,17%)、重症率(1/16,6%)、疫苗接种率(112/128,88%)和第一剂后疫苗不良反应(62/112,55%)与美国普通人群相当。虽然有 2 例 CD 病例在感染 SARS-CoV-2 (1 例)和接种疫苗(1 例)后不久复发,但 100 例感染和/或接种疫苗的患者均未出现 CD 复发。在 CD 患者中,第二剂疫苗接种 6 个月后的抗梭形细胞滴度中位数与其他免疫相关疾病患者和健康人群相当。尽管CD患者正在接受免疫抑制疗法,但COVID-19不良后果的风险似乎并没有增加,而且他们还能对SARS-CoV-2疫苗接种产生体液反应。该研究已在 www.ClinicalTrials.gov 注册,注册号为 #NCT02817997。
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引用次数: 0
KIR3DL1-HLA-Bw status in CML is associated with achievement of TFR: the POKSTIC trial, a multicenter observational study CML 中的 KIR3DL1-HLA-Bw 状态与 TFR 的实现有关:多中心观察研究 POKSTIC 试验
Pub Date : 2024-03-01 DOI: 10.1016/j.bneo.2024.100001
Hiroshi Ureshino , Yasunori Ueda , Shin Fujisawa , Kensuke Usuki , Hideo Tanaka , Masaya Okada , Shugo Kowata , Kazunori Murai , Asao Hirose , Motohiro Shindo , Takashi Kumagai , Tomoharu Takeoka , Kazuharu Kamachi , Keisuke Kidoguchi , Takero Shindo , Satoshi Iyama , Junki Inamura , Takafumi Nakao , Tsutomu Kobayashi , Eri Kawata , Shinya Kimura

Abstract

Achievement of treatment-free remission (TFR) after tyrosine kinase inhibitor (TKI) discontinuation in patients who show a durable deep molecular response (DMR) during TKI treatment of chronic myeloid leukemia in chronic phase (CML-CP) is a therapeutic goal; however, the prognostic factors that predict successful achievement of TFR are unclear. Previously, we reported that killer immunoglobulin-like receptor (KIR) and HLA polymorphisms are associated with achievement of a DMR. Here, we investigated the association between KIR and HLA polymorphisms and TFR. We conducted the POKSTIC (POlymorphisms of Killer immunoglobulin-like receptor, which affect Stop Tyrosine kinase Inhibitor in patients with Chronic myeloid leukemia) trial, a multicenter collaborative observational study that enrolled 76 patients with CML-CP. The median age was 63 years (interquartile range [IQR], 49-70). Of 76 patients, 42 (56.6%; 95% confidence interval [CI], 47.7-66.8 at 6 months) discontinued TKIs without molecular relapse; the median follow-up time for TFR was 24 months (IQR, 16-64). KIR genotyping and allele typing did not identify risk factors for molecular relapse; however, univariate and multivariate analysis identified the combination of KIR3DL1-HLA-Bw4 (an HLA-B allele) as an independent factor for a higher risk of molecular relapse (hazard ratio, 2.206; 95% CI, 1.112-4.376; P = .024). Notably, patients at higher risk of relapse had a significantly lower number of natural killer (NK) cells at TKI discontinuation than the other patients (CD16+/CD56+ NK cells: median 499.63 cells per μL vs 629.17 cells per μL, respectively; P = .049). Thus, KIR3DL1-HLA-Bw status reflects NK cell responses and is associated with TFR. The study is registered with the UMIN Clinical Trials Registry as #UMIN000041798.

摘要在酪氨酸激酶抑制剂(TKI)治疗慢性期髓性白血病(CML-CP)期间出现持久深度分子反应(DMR)的患者停用TKI后实现无治疗缓解(TFR)是一项治疗目标;然而,预测成功实现TFR的预后因素尚不清楚。以前,我们曾报道过杀伤性免疫球蛋白样受体(KIR)和 HLA 多态性与 DMR 的实现有关。在此,我们研究了 KIR 和 HLA 多态性与 TFR 之间的关联。我们开展了 POKSTIC(影响慢性髓性白血病患者酪氨酸激酶抑制剂停药的杀手免疫球蛋白样受体多态性)试验,这是一项多中心合作观察性研究,共招募了 76 名 CML-CP 患者。中位年龄为 63 岁(四分位数间距 [IQR],49-70)。76 名患者中,42 人(56.6%;95% 置信区间 [CI],47.7-66.8,6 个月)停用 TKIs 后未出现分子复发;TFR 的中位随访时间为 24 个月(IQR,16-64)。KIR 基因分型和等位基因分型并未发现分子复发的风险因素;但单变量和多变量分析发现,KIR3DL1-HLA-Bw4(HLA-B 等位基因)组合是分子复发风险较高的独立因素(危险比为 2.206;95% CI 为 1.112-4.376;P = .024)。值得注意的是,复发风险较高的患者在停用 TKI 时的自然杀伤(NK)细胞数量明显低于其他患者(CD16+/CD56+ NK 细胞:中位数分别为 499.63 cells per μL vs 629.17 cells per μL;P = .049)。因此,KIR3DL1-HLA-Bw 状态反映了 NK 细胞反应并与 TFR 相关。该研究已在 UMIN 临床试验注册中心注册,注册号为 #UMIN000041798。
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引用次数: 0
Real-world comparison of daratumumab-based regimens in relapsed/refractory multiple myeloma using health record data 利用健康记录数据对基于达拉单抗的复发性/难治性多发性骨髓瘤治疗方案进行真实世界比较
Pub Date : 2024-03-01 DOI: 10.1016/j.bneo.2024.100003
Benjamin A. Derman , Jacob Ambrose , Laura L. Fernandes , Christina M. Zettler , Eric Hansen , Andrew J. Belli , Ching-Kun Wang

Abstract

Daratumumab (dara)-based triplet therapies are commonly used in the second-line (2L) and third-line (3L) settings in relapsed/refractory multiple myeloma (RRMM), usually in combination with dexamethasone and either bortezomib (dara-Vd), carfilzomib (dara-Kd), or pomalidomide (dara-Pd). We performed a real-world (rw) analysis to directly compare these regimens, to our knowledge, for the first time. This was an observational, retrospective cohort study using COTA’s rw database of patients with MM who have initiated 2L or 3L therapy with dara-Vd, dara-Kd, or dara-Pd. rw time to next treatment (rwTTNT) and rw overall survival (rwOS) were analyzed using the Kaplan-Meier method. Comparative analyses were conducted using a trimmed inverse probability of treatment weighting method to control for potential confounders. A total of 639 patients received a dara-based regimen as either 2L or 3L therapy (dara-Vd, n = 201; dara-Kd, n = 122; and dara-Pd, n = 316). A high proportion had functional (52%) or cytogenetic (26%) high-risk disease; 49% were lenalidomide refractory. Median rwTTNT for dara-Vd was 7.6 months and was 12.9 months for dara-Kd (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.49-0.99). Similarly, median rwTTNT for dara-Vd was 6.9 months and 15.3 months for dara-Pd (HR, 0.57; 95% CI, 0.43-0.77). Median rwTTNT for dara-Pd was 15.7 months, and for dara-Kd 13.2 months (HR, 1.1; 95% CI, 0.8-1.6). No regimen was associated with superior rwOS. Among patients with RRMM receiving 2L or 3L therapy with a dara-based triplet, dara-Vd was associated with inferior rwTTNT compared with both dara-Kd and dara-Pd. dara-Vd may not be a suitable control arm for most phase 3 studies.

摘要基于达拉单抗(dara)的三联疗法常用于复发性/难治性多发性骨髓瘤(RRMM)的二线(2L)和三线(3L)治疗,通常与地塞米松和硼替佐米(dara-Vd)、卡非佐米(dara-Kd)或泊马度胺(dara-Pd)联合使用。据我们所知,我们首次进行了真实世界(rw)分析,以直接比较这些治疗方案。这是一项观察性、回顾性队列研究,使用的是 COTA 的 rw 数据库,研究对象是使用 dara-Vd、dara-Kd 或 dara-Pd 开始 2L 或 3L 治疗的 MM 患者。采用 Kaplan-Meier 法分析了 rw 下次治疗时间 (rwTTNT) 和 rw 总生存期 (rwOS)。比较分析采用修剪的逆治疗概率加权法,以控制潜在的混杂因素。共有639名患者接受了以达拉为基础的2L或3L治疗方案(达拉-Vd,n = 201;达拉-Kd,n = 122;达拉-Pd,n = 316)。高比例患者患有功能性(52%)或细胞遗传学(26%)高危疾病;49%为来那度胺难治性患者。dara-Vd 的中位 rwTTNT 为 7.6 个月,dara-Kd 为 12.9 个月(危险比 [HR],0.70;95% 置信区间 [CI],0.49-0.99)。同样,达拉-Vd 的中位 rwTTNT 为 6.9 个月,达拉-Pd 为 15.3 个月(HR,0.57;95% CI,0.43-0.77)。dara-Pd 的中位 rwTTNT 为 15.7 个月,dara-Kd 为 13.2 个月(HR,1.1;95% CI,0.8-1.6)。没有一种方案的rwOS更优。在接受2L或3L达拉三联疗法的RRMM患者中,与达拉-Kd和达拉-Pd相比,达拉-Vd的rwTTNT较差。
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引用次数: 0
Frequent response monitoring in chronic lymphocytic leukemia clinical trials: what is the value? 慢性淋巴细胞白血病临床试验中的频繁反应监测:价值何在?
Pub Date : 2024-02-15 DOI: 10.1016/j.bneo.2024.100006
Agnes Mattsson , Jeanette Lundin , Tom A. Mulder , Sandra E. Sylvan , Marzia Palma , Lotta Hansson ∗ , Anders Österborg ∗
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引用次数: 0
Multiple myeloma-associated DIS3 gene is essential for hematopoiesis but loss of DIS3 is insufficient for myelomagenesis 多发性骨髓瘤相关 DIS3 基因对造血至关重要,但 DIS3 基因缺失不足以导致骨髓瘤形成
Pub Date : 2024-02-01 DOI: 10.1016/j.bneo.2024.100005
Hiroto Ohguchi, Yasuyo Ohguchi, Sho Kubota, Kan Etoh, Ai Hamashima, Shingo Usuki, Takako Yokomizo-Nakano, Jie Bai, Takeshi Masuda, Y. Kawano, Takeshi Harada, Mitsuyoshi Nakao, Takashi Minami, T. Hideshima, Kimi Araki, G. Sashida
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引用次数: 0
Castleman disease patients report mild COVID-19 symptoms and mount a humoral response to SARS-CoV-2 vaccination 卡斯特曼病患者出现轻微的 COVID-19 症状,并对接种 SARS-CoV-2 疫苗产生体液反应
Pub Date : 2024-02-01 DOI: 10.1016/j.bneo.2024.100002
S. Shyamsundar, S. Pierson, C. Connolly, M. Teles, D. Segev, W. Werbel, F. van Rhee, Corey Casper, Joshua D. Brandstadter, Ariela Noy, D. Fajgenbaum
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引用次数: 0
Frequent response monitoring in chronic lymphocytic leukemia clinical trials: what is the value? 慢性淋巴细胞白血病临床试验中的频繁反应监测:价值何在?
Pub Date : 2024-02-01 DOI: 10.1016/j.bneo.2024.100006
Agnes Mattsson, J. Lundin, T. Mulder, S. E. Sylvan, M. Palma, L. Hansson, Anders Österborg
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引用次数: 0
Real-world Comparison of Daratumumab-Based Regimens in Relapsed/Refractory Multiple Myeloma Using Health Record Data 利用健康记录数据对基于达拉单抗的复发性/难治性多发性骨髓瘤治疗方案进行真实世界比较
Pub Date : 2024-02-01 DOI: 10.1016/j.bneo.2024.100003
B. Derman, J. Ambrose, L. Fernandes, C. Zettler, E. Hansen, A. Belli, Ching-Kun Wang
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引用次数: 0
期刊
Blood Neoplasia
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