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Clinical applications of circulating tumor cells in metastasis and therapy 循环肿瘤细胞在转移及治疗中的临床应用
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-08-22 DOI: 10.1186/s13045-025-01733-y
Chuan Yang, Can Liu, Chenglai Xia, Liwu Fu
Circulating tumor cells (CTCs), which serve as an early indicator of tumors in peripheral blood, are closely associated with unfavorable prognoses in individuals with cancer. Gaining a thorough understanding of the heterogeneity and specific trajectory of CTCs during metastasis can yield valuable insights for the development of effective cancer treatment strategies. This review critically examines the contemporary knowledge of the in vivo process of CTCs, with a focus on the four key stages: dissemination, homing, colonization, and macro-metastasis. Each stage is discussed in terms of its associated characteristics, including epithelial-mesenchymal transition (EMT), dormancy, organotropism, and awakening. We also discuss recent advancements in CTC isolation, detection, cultivation and its potential applications. Additionally, it provides a comprehensive elucidation of the intricate mechanisms of immune evasion and drug resistance in CTCs, aiming to identify novel targets for cancer therapy. Finally, an overview of CTC interventions is presented, which may facilitate the development of personalized therapeutic approaches for patients and improve their metastasis-free prognostic outcomes.
循环肿瘤细胞(CTCs)作为外周血肿瘤的早期指标,与癌症患者的不良预后密切相关。深入了解ctc在转移过程中的异质性和特定轨迹可以为开发有效的癌症治疗策略提供有价值的见解。这篇综述批判性地考察了ctc在体内过程的当代知识,重点关注四个关键阶段:传播、归巢、定植和大转移。每个阶段都根据其相关特征进行讨论,包括上皮-间质转化(EMT)、休眠、器官亲和性和觉醒。本文还讨论了CTC的分离、检测、培养及其潜在应用的最新进展。此外,它还全面阐明了ctc免疫逃避和耐药的复杂机制,旨在发现癌症治疗的新靶点。最后,概述了CTC干预措施,这可能有助于患者个性化治疗方法的发展,并改善其无转移预后。
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引用次数: 0
Immunosenescence and cancer: molecular hallmarks, tumor microenvironment remodeling, and age-specific immunotherapy challenges 免疫衰老和癌症:分子标志、肿瘤微环境重塑和年龄特异性免疫治疗挑战
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-08-22 DOI: 10.1186/s13045-025-01735-w
Qianwen Liu, Jingfeng Li, Xiuqiao Sun, Jiayu Lin, Zhengwei Yu, Yue Xiao, Dan Li, Baofa Sun, Haili Bao, Yihao Liu
Immunosenescence, the age-related decline in immune function, profoundly impacts cancer progression and therapeutic outcomes by fostering a tumor-promoting microenvironment and impairing immune surveillance. This review delineates eleven molecular hallmarks of immunosenescence, including genomic instability, telomere attrition, epigenetic dysregulation, mitochondrial dysfunction, and chronic inflammation, which collectively drive immune cell dysfunction and systemic immunosuppression. Aging reshapes the tumor microenvironment (TME) through recruitment of immunosuppressive cells, senescence-associated secretory phenotypes (SASP), and metabolic reprogramming, contributing to therapy resistance and poor prognosis in elderly patients. While immunotherapies such as immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T-cell immunotherapy (CAR-T) cells show promise, their efficacy in aging populations is limited by T cell exhaustion, myeloid bias, and altered intercellular communication. Emerging strategies—including senolytics, epigenetic modulators (e.g., histone deacetylase (HDAC) inhibitor), and metabolic interventions (e.g., spermidine, nicotinamide mononucleotide (NMN))—highlight potential avenues to rejuvenate aged immunity. Single-cell multi-omics (single cell RNA-seq, single cell ATAC-seq) further unravel immune cell heterogeneity, revealing tissue-specific chromatin accessibility dynamics and novel targets like interleukin-34 (IL-34) for microglia-mediated neuroinflammation. However, challenges persist in translating preclinical findings to clinical practice, necessitating age-tailored trials and biomarker-driven approaches. By integrating mechanistic insights with translational innovations, this review underscores the urgency of addressing immunosenescence to optimize cancer immunotherapy for aging populations, ultimately bridging the gap between aging biology and precision oncology.
免疫衰老,即与年龄相关的免疫功能下降,通过培养促进肿瘤的微环境和损害免疫监测,深刻影响癌症的进展和治疗结果。本文综述了免疫衰老的11个分子特征,包括基因组不稳定、端粒磨损、表观遗传失调、线粒体功能障碍和慢性炎症,它们共同驱动免疫细胞功能障碍和全身免疫抑制。衰老通过募集免疫抑制细胞、衰老相关分泌表型(SASP)和代谢重编程重塑肿瘤微环境(TME),导致老年患者治疗抵抗和预后不良。虽然免疫疗法如免疫检查点抑制剂(ICIs)和嵌合抗原受体T细胞免疫疗法(CAR-T)细胞显示出希望,但它们在老年人群中的疗效受到T细胞衰竭、骨髓偏倚和细胞间通讯改变的限制。新兴策略——包括抗衰老药物、表观遗传调节剂(如组蛋白去乙酰化酶(HDAC)抑制剂)和代谢干预(如亚精胺、烟酰胺单核苷酸(NMN))——强调了恢复老年免疫的潜在途径。单细胞多组学(单细胞RNA-seq,单细胞ATAC-seq)进一步揭示了免疫细胞的异质性,揭示了组织特异性染色质可及性动力学和白细胞介素-34 (IL-34)等新靶点在小胶质细胞介导的神经炎症中的作用。然而,将临床前研究结果转化为临床实践仍然存在挑战,需要针对年龄的试验和生物标志物驱动的方法。通过将机制见解与转化创新相结合,本综述强调了解决免疫衰老问题以优化针对老龄化人群的癌症免疫治疗的紧迫性,最终弥合衰老生物学和精确肿瘤学之间的差距。
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引用次数: 0
Target neutrophil heterogeneity and plasticity in cancer 肿瘤中靶中性粒细胞的异质性和可塑性
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-08-12 DOI: 10.1186/s13045-025-01731-0
Ye Feng, Guang Liu, Haiqing Li, Lin Cheng
Neutrophils have long been regarded as cells of a limited lifespan, known to produce pro-inflammatory molecules, and primarily engaged in combating infections. However, recent advancements in single-cell analysis and molecular biology have revealed their remarkable heterogeneity and plasticity, particularly within the context of tumors. This review explores the development and diversity of neutrophils under both physiological and pathological conditions, with a particular focus on their roles in cancer. The discussion encompasses the emergence of distinct neutrophil subtypes, particularly senescent neutrophils, within tumors and their context-dependent functions in tumorigenesis, progression, metastasis, and recurrence. The plasticity of these cells, driven by intrinsic factors and the tumor microenvironment, allows them to be reprogrammed between pro-tumor and anti-tumor phenotypes. This process is influenced by cytokines, metabolic reprogramming, and interactions with other immune cells. The potential of targeting and engineering neutrophil as a therapeutic avenue for cancer treatment is further underscored, including the use of senolytic agents, metabolic inhibitors, and reprogramming strategies. Finally, future research directions are proposed to further elucidate the mechanisms underlying neutrophil heterogeneity and plasticity, with the aim of developing novel therapeutic approaches to modulate neutrophil function in cancer.
中性粒细胞长期以来被认为是寿命有限的细胞,已知能产生促炎分子,主要参与对抗感染。然而,单细胞分析和分子生物学的最新进展揭示了它们显著的异质性和可塑性,特别是在肿瘤的背景下。这篇综述探讨了中性粒细胞在生理和病理条件下的发育和多样性,特别关注它们在癌症中的作用。讨论包括不同的中性粒细胞亚型的出现,特别是衰老中性粒细胞,在肿瘤内及其在肿瘤发生、进展、转移和复发中的环境依赖功能。这些细胞的可塑性,由内在因素和肿瘤微环境驱动,允许它们在促肿瘤和抗肿瘤表型之间重新编程。这一过程受细胞因子、代谢重编程以及与其他免疫细胞的相互作用的影响。靶向和工程中性粒细胞作为癌症治疗途径的潜力进一步强调,包括使用衰老药物,代谢抑制剂和重编程策略。最后,提出了未来的研究方向,以进一步阐明中性粒细胞异质性和可塑性的机制,以开发新的治疗方法来调节中性粒细胞在癌症中的功能。
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引用次数: 0
Mitophagy’s impacts on cancer and neurodegenerative diseases: implications for future therapies 线粒体自噬对癌症和神经退行性疾病的影响:对未来治疗的影响
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-08-01 DOI: 10.1186/s13045-025-01727-w
Jason Huang, Vincent Truong Pham, Shaozi Fu, Gang Huang, Ya-Guang Liu, Lei Zheng
Substantial evidence supports an inverse relationship between cancer and neurodegenerative diseases (NDDs), but few studies investigate the biological mechanisms underlying this phenomenon. While previous explanations—such as inflammation, reactive oxygen species (ROS), genetic mutations, and cell death—remain significant, they ultimately converge on mitophagy. This review identifies mitophagy as a pivotal factor in the development of both cancer and NDDs, while also evaluating specific mechanisms and processes to clarify how mitophagy connects these opposing disease trajectories. By examining these factors, we aim to uncover the underlying mechanisms that explain the inverse relationship between cancer and NDDs, which will help develop therapeutic strategies that target common factors for both conditions.
大量证据支持癌症和神经退行性疾病(ndd)之间的反比关系,但很少有研究调查这一现象背后的生物学机制。虽然之前的解释——如炎症、活性氧(ROS)、基因突变和细胞死亡——仍然很重要,但它们最终都集中在线粒体自噬上。这篇综述确定了线粒体自噬是癌症和ndd发展的关键因素,同时也评估了特定的机制和过程,以阐明线粒体自噬如何将这些相反的疾病轨迹联系起来。通过检查这些因素,我们的目标是揭示解释癌症和ndd之间反向关系的潜在机制,这将有助于制定针对这两种情况的共同因素的治疗策略。
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引用次数: 0
Necroptosis in cancer: insight from epigenetic, post-transcriptional and post-translational modifications 癌症中的坏死性下垂:从表观遗传、转录后和翻译后修饰的见解
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-07-30 DOI: 10.1186/s13045-025-01726-x
Jinxin Tang, Yan Zhuang, Yibo Zhang, Hongkun Hu, Hua Wang, Haodong Xu, Yintao Li, Chao Tu
Necroptosis represents a distinct form of programmed cell death that exhibits characteristics of both necrosis and apoptosis. Due to its potential to activate anti-cancer immune responses, utilizing necroptosis to enhance immune activity within the tumor microenvironment has garnered significant attention. However, effectively regulating necroptosis in cancer remains a formidable challenge. Epigenetic, post-transcriptional and post-translational modifications are three primary mechanisms that alter molecular expression patterns without changing DNA sequence, playing crucial roles in cancer progression. While these modifications have been shown to significantly influence cancer development, their specific roles in regulating necroptosis in cancer have not been systematically elucidated. This review explores the role and mechanism of epigenetic, post-transcriptional and post-translational modification in the regulation of necroptosis in cancer, identifying potential regulatory targets and their therapeutic implications, thereby providing systematic theoretical support for necroptosis as an emerging target for cancer therapy.
坏死性上睑下垂是一种不同形式的程序性细胞死亡,具有坏死和细胞凋亡的特点。由于其激活抗癌免疫反应的潜力,利用坏死下垂增强肿瘤微环境内的免疫活性已经引起了极大的关注。然而,有效调节肿瘤坏死下垂仍然是一个艰巨的挑战。表观遗传修饰、转录后修饰和翻译后修饰是在不改变DNA序列的情况下改变分子表达模式的三种主要机制,在癌症进展中起着至关重要的作用。虽然这些修饰已被证明显著影响癌症的发展,但它们在调节癌症坏死性坏死中的具体作用尚未被系统阐明。本文探讨了表观遗传、转录后和翻译后修饰在肿瘤坏死下垂调控中的作用和机制,确定了潜在的调控靶点及其治疗意义,从而为坏死下垂作为癌症治疗的新兴靶点提供了系统的理论支持。
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引用次数: 0
Targeting CD276 with Adapter-CAR T-cells provides a novel therapeutic strategy in small cell lung cancer and prevents CD276-dependent fratricide 靶向CD276的适配器car - t细胞为小细胞肺癌提供了一种新的治疗策略,并可预防CD276依赖性的兄弟姐妹杀
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-07-28 DOI: 10.1186/s13045-025-01729-8
Beate Kristmann, Niels Werchau, Lakshmi Suresh, Elisabeth L. Pezzuto, Sophia Scheuermann, Simon Krost, Karin Schilbach, Moustafa Moustafa-Oglou, Anna-Sophia Mast, Miriam Droste, André Felsberger, Lukas Kiefer, Pierre Abramowski, Lars Zender, Joerg Mittelstaet, Christian M. Seitz
Survival rates in Small Cell Lung Cancer (SCLC) remain dismal, posing a huge medical need for novel therapies. T-cells, engineered to express chimeric antigen receptors (CAR-T) have demonstrated clinical activity against a variety of haematological malignancies. Yet, efficacy against solid tumour entities remains limited. In this study, we investigated the expression of CD276 (B7-H3), an immune checkpoint molecule and promising target antigen for CAR-T therapy in SCLC, at the RNA and protein level. We further developed novel Fab-based adapter molecules (AM) targeting CD276 and optimized our previously established modular Adapter CAR-T (AdCAR-T) platform as well as AM dosing schemes. CD276 is broadly expressed across SCLC subtypes, representing a promising target for CAR-T therapy. We describe that T-cell activation and CAR-signalling induces CD276-expression on CAR-T, resulting in CD276-dependent fratricide, limiting anti-CD276-CAR-T expansion and activity. The AdCAR-T platform allows CAR-T expansion in absence of CD276 targeting. Novel CD276 targeted AMs demonstrate potent in vitro and in vivo activity against SCLC. Intermittent AM-dosing allows functional persistence of AdCAR-T in vivo in contrast to CD276-targeted conventional CAR-T. AdCAR-T in vivo expansion and activity is further promoted by introducing activation-induced, AM remote controlled, IL-18 secretion into the AdCAR-T design. We identified CD276 as a promising target antigen, uniformly expressed in SCLC and demonstrate the therapeutic potential of novel anti-CD276 Fab-based AM in combination with optimized, IL-18 armoured AdCAR-T.
小细胞肺癌(SCLC)的生存率仍然很低,对新疗法提出了巨大的医学需求。表达嵌合抗原受体(CAR-T)的t细胞已被证明具有抗多种血液系统恶性肿瘤的临床活性。然而,对实体肿瘤实体的疗效仍然有限。在这项研究中,我们研究了CD276 (B7-H3)在RNA和蛋白质水平上的表达,CD276是一种免疫检查点分子,也是CAR-T治疗SCLC的有希望的靶抗原。我们进一步开发了新的基于fab的靶向CD276的适配器分子(AM),并优化了我们之前建立的模块化适配器CAR-T (AdCAR-T)平台以及AM给药方案。CD276在SCLC亚型中广泛表达,代表着CAR-T治疗的一个有希望的靶点。我们描述了t细胞激活和car信号传导诱导CAR-T上cd276的表达,导致cd276依赖性的杀兄弟性,限制了抗cd276 -CAR-T的扩增和活性。AdCAR-T平台允许CAR-T在缺乏CD276靶向的情况下进行扩增。新型靶向CD276的AMs在体外和体内对SCLC具有有效的活性。与靶向cd276的传统CAR-T相比,间歇性am给药允许AdCAR-T在体内的功能持久性。通过在AdCAR-T设计中引入激活诱导的AM遥控IL-18分泌,进一步促进AdCAR-T在体内的扩增和活性。我们发现CD276是一个有希望的靶抗原,在SCLC中均匀表达,并证明了新型抗CD276 Fab-based AM与优化的IL-18装甲AdCAR-T联合的治疗潜力。
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引用次数: 0
Iparomlimab and tuvonralimab (QL1706) plus chemotherapy and bevacizumab for EGFR-mutant patients with advanced non-small cell lung cancer after failure of EGFR-tyrosine kinase inhibitors: updated results from cohort 5 in the DUBHE-L-201 study Iparomlimab和tuvonralimab (QL1706)联合化疗和贝伐单抗治疗egfr -酪氨酸激酶抑制剂治疗失败后晚期非小细胞肺癌患者:DUBHE-L-201研究中队列5的最新结果
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-07-26 DOI: 10.1186/s13045-025-01728-9
Yaxiong Zhang, Yan Huang, Yunpeng Yang, Yuanyuan Zhao, Hongyun Zhao, Ningning Zhou, Likun Chen, Ting Zhou, Gang Chen, Shen Zhao, Huaqiang Zhou, Hui Li, Xiaoyan Kang, Li Zhang, Wenfeng Fang
Iparomlimab and tuvonralimab (QL1706), a bifunctional anti-programmed death-1/cytotoxic T-lymphocyte antigen-4 antibody, in combination with bevacizumab and doublet chemotherapy was tolerable and showed preliminary antitumor activity in advanced non-small cell lung cancer (NSCLC) in DUBHE-L-201 study. Here, we report the updated data of long-term survival prognosis and safety from cohort 5. Epidermal growth factor receptor (EGFR)-mutant patients who progressed on EGFR-tyrosine kinase inhibitors (TKIs) were enrolled in cohort 5 and received QL1706 (5 mg/kg) combined with bevacizumab, pemetrexed and carboplatin in a three-week cycle for up to four cycles followed by maintenance therapy of QL1706, bevacizumab and pemetrexed. Survival outcomes and adverse events were followed up. As of July 5, 2024, the median duration of response, progression-free survival (PFS), and overall survival (OS) in the 31 patients in cohort 5 was 11.33 months (95% confidence interval [CI]: 4.17–19.91), 8.51 months (95% CI: 5.72–13.31), and 26.51 months (95% CI: 12.81-not reached), respectively. In 23 (74.2%) patients who received subsequent anticancer therapy after disease progression, the median PFS was 10.02 months. The median PFS (8.51 months vs. 5.95 months, P = 0.622) and median OS (30.19 months vs. 10.68 months, P = 0.177) appeared longer in patients with 21L858R mutation compared to those with 19Del, although the differences were not statistically significant. Grade ≥ 3 treatment-related adverse events occurred in 13 (41.9%) patients. Nineteen (61.3%) patients had immune-related adverse events, of whom one (3.2%) were grade ≥ 3. No new safety signal was observed. QL1706 combining pemetrexed, carboplatin, and bevacizumab showed long-term favorable prognosis and manageable safety profile for advanced EGFR-mutant patients with NSCLC after failure of EGFR-TKIs.
在dubhel -201研究中,Iparomlimab和tuvonralimab (QL1706)是一种双功能抗程序性死亡-1/细胞毒性t淋巴细胞抗原-4抗体,联合贝伐单抗和双药化疗在晚期非小细胞肺癌(NSCLC)中是耐受的,并显示出初步的抗肿瘤活性。在这里,我们报告了队列5的长期生存预后和安全性的最新数据。使用EGFR-酪氨酸激酶抑制剂(TKIs)治疗进展的表皮生长因子受体(EGFR)突变患者被纳入队列5,在3周周期内接受QL1706 (5 mg/kg)联合贝伐单抗、培美曲塞和卡铂治疗,最长可达4个周期,随后接受QL1706、贝伐单抗和培美曲塞的维持治疗。随访生存结局和不良事件。截至2024年7月5日,队列5中31例患者的中位缓解时间、无进展生存期(PFS)和总生存期(OS)分别为11.33个月(95%可信区间[CI]: 4.17-19.91)、8.51个月(95% CI: 5.72-13.31)和26.51个月(95% CI: 12.81-未达到)。在疾病进展后接受后续抗癌治疗的23例(74.2%)患者中,中位PFS为10.02个月。21L858R突变患者的中位PFS(8.51个月比5.95个月,P = 0.622)和中位OS(30.19个月比10.68个月,P = 0.177)比19Del突变患者更长,但差异无统计学意义。13例(41.9%)患者发生≥3级治疗相关不良事件。19例(61.3%)患者出现免疫相关不良事件,其中1例(3.2%)≥3级。未观察到新的安全信号。QL1706联合培美曲塞、卡铂和贝伐单抗治疗EGFR-TKIs失败后的晚期egfr突变NSCLC患者显示出良好的长期预后和可管理的安全性。
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引用次数: 0
Circular RNA signature of aggressive CLL with t(14;19)(q32;q13). An ERIC study t侵袭性CLL的环状RNA特征(14;19)(q32;q13)。ERIC研究
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-07-22 DOI: 10.1186/s13045-025-01725-y
Eleonora Roncaglia, Enrico Gaffo, Giulia Calabretto, Moritz Fürstenau, Kerry A. Rogers, Panagiotis Baliakas, Chenghua Cui, Cecelia Miller, Claudia Haferlach, Karla Plevova, David Oscier, Zadie Davis, Florence Nguyen-Khac, Gian Matteo Rigolin, Anastasia Athanasiadou, Fanny Baran-Marszak, Alberto Valiente, Maria José Terol, Pau Abrisqueta, Blanca Espinet, Anna Puiggros, Annalisa Martines, Laura Bonaldi, Francesca Romana Mauro, Lydia Scarfò, Thomas Chatzikonstantinou, Eugen Tausch, Karl-Anton Kreuzer, Arnon Kater, Francesc Bosch, Michael Doubek, Panagiotis Panagiotidis, Olga Kalashnikova, Federica Frezzato, Valeria Ruocco, Silvia Orsi, Kimia Salek, Roberto Merlo, Alberto Caregari, Ilias Glogovitis, Alessandro Cellini, Francesco Angotzi, Andrea Serafin, Shuhua Yi, Barbara Eichhorst, Jennifer A. Woyach, Antonio Cuneo, Paolo Ghia, Kostas Stamatopoulos, Livio Trentin, Andrea Visentin, Stefania Bortoluzzi
In Chronic Lymphocytic Leukemia (CLL), t(14;19)(q32;q13), leading to the overexpression of BCL3, is found in ∼1% of cases and is associated with an aggressive disease. In this study, leveraging a large CLL patient cohort collected thanks to an international collaboration, we investigate for the first time the circular transcriptome (circRNAome) associated with the rare t(14;19), in comparison with CLL without t(14;19) and B cells of age-matched healthy donors. We described the circRNAs commonly dysregulated in CLL, including circCSNK1G3 and circEXOC6B(3–5), which were depleted, and circZNF609 and circLPAR3, which were overexpressed in malignant cells. Of importance, we disclosed the circRNA signature of CLL with t(14;19), formed by circRNAs with expression significantly altered specifically in link with this lesion, ectopically expressed like circCDK14(3–4), circCORO1C, circCLEC2D, and circEMB, or downregulated like circCEP70(3–6). Several of these molecules were previously shown to be dysregulated or play a role in cancer, whereas most of the signature circRNAs deserve further investigation. CLL patients with high circCORO1C and circCLEC2D expression had significantly worse clinical outcomes, with shorter time to first treatment and overall survival. This study disclosed new molecular features of the aggressive CLL subtype with t(14;19).
在慢性淋巴细胞白血病(CLL)中,t(14;19)(q32;q13)导致BCL3过表达,在约1%的病例中发现,并与侵袭性疾病相关。在这项研究中,利用国际合作收集的大量CLL患者队列,我们首次研究了与罕见t(14;19)相关的环状转录组(circRNAome),与无t的CLL(14;19)和年龄匹配的健康供者的B细胞进行比较。我们描述了在CLL中通常失调的circRNAs,包括circCSNK1G3和circEXOC6B(3-5),它们被耗尽,以及circZNF609和circLPAR3,它们在恶性细胞中过表达。重要的是,我们揭示了CLL的circRNA特征(14;19),由与该病变相关的表达显著改变的circRNA形成,如circCDK14(3-4), circccoro1c, circcec2d和circEMB,或下调如circCEP70(3-6)。这些分子中的一些先前被证明是失调的或在癌症中发挥作用,而大多数特征环状rna值得进一步研究。circCORO1C和circec2d高表达的CLL患者临床预后明显差,首次治疗时间短,总生存期短。这项研究揭示了带有t的侵袭性CLL亚型新的分子特征(14;19)。
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引用次数: 0
Phase I first-in-human dose escalation study of the oral casein kinase 1α and cyclin dependent kinase 7/9 inhibitor BTX A51 in advanced MDS and AML 口服酪蛋白激酶1α和细胞周期蛋白依赖性激酶7/9抑制剂BTX A51治疗晚期MDS和AML的I期首次人体剂量递增研究
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-07-15 DOI: 10.1186/s13045-025-01724-z
Brian J. Ball, Wenbin Xiao, Gautam Borthakur, Le Xuan Truong Nguyen, Melissa Valerio, Avanthika Venkatachalam, Guido Marcucci, Anthony S. Stein, Dung Luong Thai, David N. Cook, Kyle Chan, Sonali Persaud, Ross L. Levine, Omar Abdel-Wahab, Yinon Ben-Neriah, Eytan M. Stein
BTX A51, a first-in-class oral small molecule inhibitor of casein kinase 1α (CK1α) and cyclin-dependent kinase (CDK) 7 and 9, induces apoptosis of leukemic cells by activating p53 and inhibiting expression of Mcl1. Here, we report on the results of the phase 1 clinical trial of BTX A51 in patients with relapsed or refractory AML and MDS. Adult patients with R/R AML and high-risk MDS were enrolled into eight potential doses ranging from 1 to 42 mg dosed orally three days/week for 21 or 28 days out of a 28-day cycle. The maximum tolerated dose, recommended phase 2 dose (RP2D), safety, pharmacokinetics (PK), and pharmacodynamics (PD) of BTX A51 were investigated. Thirty-one patients were enrolled and received treatment with BTX A51. Median age was 75 (range 22- 84) and 55% were male. Most patients (97%) had received prior treatment with venetoclax and hypomethylating agents. The most common treatment-emergent adverse events of any grade were nausea (67%), emesis (63%), hypokalemia (53%), and diarrhea (40%). Two patients experienced hepatic toxicity as DLTs, which resolved upon holding treatment. No treatment-related deaths occurred. The recommended phase 2 dose was 21 mg dosed three days/week for 4 weeks of a 28-day cycle. BTX A51 increased the expression of p53 and reduced the expression of MCL1 and RNA polymerase II phosphorylation in pre- and post-treatment immunocytochemistry studies. Overall, 3 patients (10%) experienced complete remission with incomplete count recovery (CRi). All 3 responding patients had RUNX1 mutations and the CR/CRi rate for RUNX1-mutated patients receiving BTX A51 at efficacious doses (11 mg or higher) was 30%. Ex-vivo studies confirmed higher efficacy of BTX A51 on RUNX1-mutated myeloblasts and demonstrated synergy with azacitidine and venetoclax. Although the overall efficacy was modest, this study lays the groundwork for future studies with improved patient selection and combination approaches. NCT04872166.
BTX A51是一种酪蛋白激酶1α (CK1α)和细胞周期蛋白依赖性激酶(CDK) 7和9的口服小分子抑制剂,通过激活p53和抑制Mcl1的表达诱导白血病细胞凋亡。在这里,我们报告BTX A51在复发或难治性AML和MDS患者中的1期临床试验结果。患有R/R AML和高风险MDS的成年患者被纳入8个潜在剂量,范围为1至42毫克,口服3天/周,为期21或28天。研究了BTX A51的最大耐受剂量、推荐2期剂量(RP2D)、安全性、药代动力学(PK)和药效学(PD)。31例患者接受BTX A51治疗。中位年龄为75岁(22- 84岁),55%为男性。大多数患者(97%)之前接受过venetoclax和低甲基化药物的治疗。最常见的治疗不良事件是恶心(67%)、呕吐(63%)、低钾血症(53%)和腹泻(40%)。2例患者作为dlt出现肝毒性,在坚持治疗后消退。无治疗相关死亡发生。推荐的2期剂量为21毫克,每周3天,为期4周,28天周期。在治疗前后的免疫细胞化学研究中,BTX A51增加了p53的表达,降低了MCL1和RNA聚合酶II磷酸化的表达。总体而言,3名患者(10%)经历了完全缓解和不完全计数恢复(CRi)。所有3例应答患者均有RUNX1突变,接受有效剂量(11mg或更高)BTX A51治疗的RUNX1突变患者的CR/CRi率为30%。离体研究证实BTX A51对runx1突变的成髓细胞有更高的疗效,并与阿扎胞苷和venetoclax有协同作用。虽然总体疗效不高,但本研究为未来改进患者选择和联合方法的研究奠定了基础。NCT04872166。
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引用次数: 0
Development and validation of a prognostic staging system for primary plasma cell leukemia 原发性浆细胞白血病预后分期系统的开发与验证
IF 28.5 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-07-15 DOI: 10.1186/s13045-025-01723-0
Mengru Tian, Gang An, Weijun Fu, Wenqiang Yan, Lu Li, Chunyan Sun, Zhenyu Li, Lijuan Chen, Aijun Liao, Guangxun Gao, Xiaoqi Qin, Mengyao Li, Chunrui Li, Hua Xue, Li Gao, Yi Wang, Aili He, Fan Zhou, Dongmei Guo, Yujun Dong, Zhihong Fang, Xiaoxia Chu, Jianqing Mi, Chengcheng Fu, Hui Zeng, Shuling Hou, Xiaotao Wang, Hua Wang, Yongqiang Wei, Xinyue Liang, Xingcheng Yi, Yue Sun, Lugui Qiu, Yun Dai, Fengyan Jin
The existing risk models for multiple myeloma (MM) are suboptimal for the stratification of patients with primary plasma cell leukemia (pPCL), a rare and peculiar MM. In this study, we aimed to develop a staging system for pPCL defined as the presence of ≥ 5% circulating plasma cells (CPC) according to the new diagnostic criteria, utilizing one of the largest series of patients with pPCL. This multicenter retrospective study included 340 patients with pPCL (the training cohort) from 25 centers nationwide in China. The prognostic impact of baseline characteristics and cytogenetic abnormalities was evaluated. Univariate and multivariate analyses were conducted to identify variables predicting overall survival (OS) to develop a staging system. Its performance was then validated in an independent cohort (n = 80). Genome-wide DNA and RNA sequencing were performed to explore the molecular basis for inter-stage clinical heterogeneity. Del(17p), t(4;14), and t(14;16), but not 1q+, were verified as high-risk cytogenetic abnormalities (HRCAs) of pPCL. HRCA, elevated LDH, and thrombocytopenia had the highest impact on OS and were used to create a simple algorithm, stratifying patients with pPCL into stages I, II, and III, with median OS of 54.1, 24.0, and 5.4 months (II vs. I: HR, 1.986; 95% CI, 1.034–3.814; P = 0.0394; III vs. II: HR, 3.206; 95% CI, 1.757–5.852; P = 0.0001) in the training cohort and 62.1, 31.6, and 21.8 months (II vs. I: HR, 2.013; 95% CI, 0.954–4.251; P = 0.0664; III vs. II: HR, 2.694; 95% CI, 1.136–6.392; P = 0.0245) in the independent validation cohort. The accuracy (c-index 0.711) was higher than other models. Moreover, patients with different stages had highly diverse genomic and transcriptomic aberrations. We propose a pPCL-specific staging system based on LDH, thrombocytopenia, and cytogenetic abnormalities, which warrants further validation, particularly in a prospective setting.
原发性浆细胞白血病(pPCL)是一种罕见和特殊的MM,现有的多发性骨髓瘤(MM)风险模型对于pPCL患者的分层并不理想。在本研究中,我们旨在根据新的诊断标准,利用最大的pPCL患者系列之一,建立一个pPCL的分期系统,该分期系统定义为存在≥5%的循环浆细胞(CPC)。这项多中心回顾性研究包括来自中国25个中心的340例pPCL患者(培训队列)。评估基线特征和细胞遗传学异常对预后的影响。进行单因素和多因素分析,以确定预测总生存期(OS)的变量,以建立分期系统。然后在独立队列(n = 80)中验证其性能。进行全基因组DNA和RNA测序以探索分期间临床异质性的分子基础。证实Del(17p)、t(4;14)和t(14;16)为pPCL的高危细胞遗传学异常(HRCAs),但不证实1q+。HRCA、LDH升高和血小板减少对生存期的影响最大,并用于创建一个简单的算法,将pPCL患者分为I、II和III期,中位生存期为54.1、24.0和5.4个月(II对I: HR, 1.986;95% ci, 1.034-3.814;p = 0.0394;III vs. II: HR, 3.206;95% ci, 1.757-5.852;P = 0.0001)和62.1、31.6和21.8个月(II vs. I: HR, 2.013;95% ci, 0.954-4.251;p = 0.0664;III vs. II: HR, 2.694;95% ci, 1.136-6.392;P = 0.0245)。准确率(c-index 0.711)高于其他模型。此外,不同阶段的患者具有高度不同的基因组和转录组畸变。我们提出了一种基于LDH、血小板减少症和细胞遗传学异常的ppcl特异性分期系统,这需要进一步验证,特别是在前瞻性设置中。
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引用次数: 0
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Journal of Hematology & Oncology
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