Pub Date : 2024-09-01Epub Date: 2024-05-21DOI: 10.1080/10428194.2024.2349950
Luan Phan, Danielle Hammond, Nathaniel R Wilson, Emma M Groarke, Mrinal M Patnaik, Naveen Pemmaraju
VEXAS syndrome is a recently described entity characterized by systemic inflammatory and hematologic manifestations. The disease was first characterized by Beck et al. in 2020 in a study characterizing 25 patients with undiagnosed adult-onset inflammatory syndromes. While the literature regarding VEXAS syndrome has grown exponentially since 2020, there is still much to be understood. This lack of information leads to challenges in both the diagnosis and treatment of patients with VEXAS syndrome. Patients will often have a variety of clinical symptoms that can lead to missed or delayed diagnoses. Additionally, awareness of VEXAS syndrome is still developing among clinicians. In this comprehensive review, we summarize the current literature regarding VEXAS syndrome, and explore clinical updates of this emerging disease state. Our aim of this review is to increase awareness regarding this new disease state and identify research areas to better understand future treatment approaches for patients with VEXAS syndrome.
{"title":"VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic): clinical review in a rapidly emerging field.","authors":"Luan Phan, Danielle Hammond, Nathaniel R Wilson, Emma M Groarke, Mrinal M Patnaik, Naveen Pemmaraju","doi":"10.1080/10428194.2024.2349950","DOIUrl":"10.1080/10428194.2024.2349950","url":null,"abstract":"<p><p>VEXAS syndrome is a recently described entity characterized by systemic inflammatory and hematologic manifestations. The disease was first characterized by Beck et al. in 2020 in a study characterizing 25 patients with undiagnosed adult-onset inflammatory syndromes. While the literature regarding VEXAS syndrome has grown exponentially since 2020, there is still much to be understood. This lack of information leads to challenges in both the diagnosis and treatment of patients with VEXAS syndrome. Patients will often have a variety of clinical symptoms that can lead to missed or delayed diagnoses. Additionally, awareness of VEXAS syndrome is still developing among clinicians. In this comprehensive review, we summarize the current literature regarding VEXAS syndrome, and explore clinical updates of this emerging disease state. Our aim of this review is to increase awareness regarding this new disease state and identify research areas to better understand future treatment approaches for patients with VEXAS syndrome.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31DOI: 10.1080/10428194.2024.2387728
Marc S Schwartz, Lori S Muffly
Outcomes in adult and pediatric patients with acute lymphoblastic leukemia (ALL) have improved over successive generations due to rigorously conducted clinical trials and incorporation of novel therapeutic agents. Despite these advances, approximately 20% of high-risk pediatric patients and 50% of adults with ALL will fail to achieve long-term remission with frontline chemotherapy protocols, mostly due to relapse. The ability to predict which patients with ALL are more likely to relapse allows for early intensification of therapy and/or incorporation of novel immunotherapies with the goal of relapse prevention. In this review, we outline the most robust clinical predictors of relapse in ALL with a focus on measurable residual disease (MRD) and genomics. We also discuss application of these prognostic tools in different clinical settings including frontline treatment, pre-/post-allogeneic stem cell transplant, and pre-/post-Chimeric Antigen Receptor T-cell therapy.
由于进行了严格的临床试验并采用了新型治疗药物,成人和儿童急性淋巴细胞白血病(ALL)患者的治疗效果在一代又一代的患者身上得到了改善。尽管取得了这些进步,但仍有约 20% 的高风险儿科患者和 50% 的成人 ALL 患者无法通过一线化疗方案获得长期缓解,主要原因是复发。如果能够预测哪些ALL患者更有可能复发,就可以及早加强治疗和/或采用新型免疫疗法,从而达到预防复发的目的。在这篇综述中,我们概述了ALL复发的最可靠临床预测指标,重点是可测量残留疾病(MRD)和基因组学。我们还讨论了这些预后工具在不同临床环境中的应用,包括一线治疗、异体干细胞移植前后和嵌合抗原受体T细胞治疗前后。
{"title":"Predicting relapse in acute lymphoblastic leukemia.","authors":"Marc S Schwartz, Lori S Muffly","doi":"10.1080/10428194.2024.2387728","DOIUrl":"https://doi.org/10.1080/10428194.2024.2387728","url":null,"abstract":"<p><p>Outcomes in adult and pediatric patients with acute lymphoblastic leukemia (ALL) have improved over successive generations due to rigorously conducted clinical trials and incorporation of novel therapeutic agents. Despite these advances, approximately 20% of high-risk pediatric patients and 50% of adults with ALL will fail to achieve long-term remission with frontline chemotherapy protocols, mostly due to relapse. The ability to predict which patients with ALL are more likely to relapse allows for early intensification of therapy and/or incorporation of novel immunotherapies with the goal of relapse prevention. In this review, we outline the most robust clinical predictors of relapse in ALL with a focus on measurable residual disease (MRD) and genomics. We also discuss application of these prognostic tools in different clinical settings including frontline treatment, pre-/post-allogeneic stem cell transplant, and pre-/post-Chimeric Antigen Receptor T-cell therapy.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1080/10428194.2024.2396046
Anna Østergaard, Judith M Boer, Frank N van Leeuwen, Rob Pieters, Monique L Den Boer
Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents and in recent decades, the survival rates have risen to >90% in children largely due the introduction of risk adapted therapy. Therefore, knowledge of factors influencing risk of relapse is important. The transcription factor IKAROS is a regulator of lymphocyte development and alterations of its coding gene, IKZF1, are frequent in ALL and are associated with higher relapse risk. This concise review will discuss the normal function of IKAROS together with the effect of gene alterations in ALL such as relieved energy restriction and altered response to anti-leukemic drugs. Besides the biology, the clinical impact of gene alterations in the different subtypes of ALL will be discussed. Finally, possibilities for treating ALL with IKZF1 alterations will be considered including novel therapies like cell signaling inhibitors and immunotherapy.
急性淋巴细胞白血病(ALL)是儿童和青少年中最常见的恶性肿瘤,近几十年来,儿童的存活率已上升到90%以上,这主要归功于风险适应疗法的引入。因此,了解影响复发风险的因素非常重要。转录因子IKAROS是淋巴细胞发育的调节因子,其编码基因IKZF1的改变在ALL中很常见,并与较高的复发风险相关。这篇简明综述将讨论 IKAROS 的正常功能,以及基因改变对 ALL 的影响,如能量限制的缓解和对抗白血病药物反应的改变。除了生物学方面,还将讨论基因改变对不同亚型 ALL 的临床影响。最后,还将探讨治疗IKZF1基因改变的ALL的可能性,包括细胞信号抑制剂和免疫疗法等新型疗法。
{"title":"<i>IKZF1</i> in acute lymphoblastic leukemia: the rise before the fall?","authors":"Anna Østergaard, Judith M Boer, Frank N van Leeuwen, Rob Pieters, Monique L Den Boer","doi":"10.1080/10428194.2024.2396046","DOIUrl":"https://doi.org/10.1080/10428194.2024.2396046","url":null,"abstract":"<p><p>Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents and in recent decades, the survival rates have risen to >90% in children largely due the introduction of risk adapted therapy. Therefore, knowledge of factors influencing risk of relapse is important. The transcription factor IKAROS is a regulator of lymphocyte development and alterations of its coding gene, <i>IKZF1</i>, are frequent in ALL and are associated with higher relapse risk. This concise review will discuss the normal function of IKAROS together with the effect of gene alterations in ALL such as relieved energy restriction and altered response to anti-leukemic drugs. Besides the biology, the clinical impact of gene alterations in the different subtypes of ALL will be discussed. Finally, possibilities for treating ALL with <i>IKZF1</i> alterations will be considered including novel therapies like cell signaling inhibitors and immunotherapy.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1080/10428194.2024.2396542
Michiel van den Brand, Alexandar Tzankov, Marijn Scheijde-Vermeulen, Ellis Barbé, Stefan Dirnhofer, Frank Stenner, Konnie Hebeda, Martine Chamuleau, Daphne de Jong
{"title":"The diagnosis of Burkitt lymphoma: how do pathologists apply criteria in daily practice?","authors":"Michiel van den Brand, Alexandar Tzankov, Marijn Scheijde-Vermeulen, Ellis Barbé, Stefan Dirnhofer, Frank Stenner, Konnie Hebeda, Martine Chamuleau, Daphne de Jong","doi":"10.1080/10428194.2024.2396542","DOIUrl":"https://doi.org/10.1080/10428194.2024.2396542","url":null,"abstract":"","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1080/10428194.2024.2391905
Folashade Adekunle, Kyungmin Ko, Jeffrey Craig, Elizabeth Courville, Eli Williams, Nadine Aguilera, Ifeyinwa E Obiorah
Plasma cell neoplasms (PCN) have infrequently been reported in patients with myelodysplastic syndrome (MDS) and even more rarely in those with myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN). We report the clinicopathologic features of 26 patients with bone marrow myelodysplasia accompanied by PCN, including 21 patients with MDS and 5 with MDS/MPN. The clinicopathologic features of the MDS/MPN-PCN were compared to those of the MDS-PCN group and 68 cases of MDS/MPN without PCN, respectively. The MDS/MPN-PCN group was notable for increased reticulin fibrosis > grade 1 when compared to both the MDS/MPN (p = 0.007) and MDS-PCN (p = 0.02) groups. MDS/MPN-PCN was associated with worse overall survival when compared with MDS-PCN (p = 0.03) and but not with MDS/MPN. Notably, hemoglobin level <8 g/dl (p = 0.008), and IDH2 somatic mutation (p = 0.003) were independent predictors of poor overall survival in all patients with MDS/MPN. Analysis of larger cohorts is required to confirm these associations and provide an insight into the pathogenesis.
{"title":"Concurrent myelodysplastic malignancies and plasma cell neoplasms; a clinicopathological study with prognostic implications.","authors":"Folashade Adekunle, Kyungmin Ko, Jeffrey Craig, Elizabeth Courville, Eli Williams, Nadine Aguilera, Ifeyinwa E Obiorah","doi":"10.1080/10428194.2024.2391905","DOIUrl":"https://doi.org/10.1080/10428194.2024.2391905","url":null,"abstract":"<p><p>Plasma cell neoplasms (PCN) have infrequently been reported in patients with myelodysplastic syndrome (MDS) and even more rarely in those with myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN). We report the clinicopathologic features of 26 patients with bone marrow myelodysplasia accompanied by PCN, including 21 patients with MDS and 5 with MDS/MPN. The clinicopathologic features of the MDS/MPN-PCN were compared to those of the MDS-PCN group and 68 cases of MDS/MPN without PCN, respectively. The MDS/MPN-PCN group was notable for increased reticulin fibrosis > grade 1 when compared to both the MDS/MPN (<i>p</i> = 0.007) and MDS-PCN (<i>p</i> = 0.02) groups. MDS/MPN-PCN was associated with worse overall survival when compared with MDS-PCN (<i>p</i> = 0.03) and but not with MDS/MPN. Notably, hemoglobin level <8 g/dl (<i>p</i> = 0.008), and <i>IDH2</i> somatic mutation (<i>p</i> = 0.003) were independent predictors of poor overall survival in all patients with MDS/MPN. Analysis of larger cohorts is required to confirm these associations and provide an insight into the pathogenesis.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1080/10428194.2024.2394583
Jan-Paul Bohn, Valentina Stolzlechner, Georg Göbel, Markus Pirklbauer, Dominik Wolf, Normann Steiner
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and characterized by a highly heterogeneous clinical course. The CLL-IPI and the OCLL-1 scores are among the best validated tools to predict time-to-first-treatment. In both models, elevated beta-2-microglobulin plasma level (B2M) is an independent prognostic factor. Yet, B2M is commonly increased in patients with chronic kidney disease (CKD) per se and both models were not adjusted for CKD. We analyzed the clinical outcomes of 297 treatment-naive CLL patients between 2000 and 2022. B2M was more frequently elevated in CKD patients and lost prognostic significance at the threshold > 2.5 mg/L. Both CLL-IPI and OCLL-1 failed to facilitate prognostic segregation in CKD patients. 22.2% of CKD patients were assigned to a higher CLL-IPI risk group due to elevated B2M. Our results suggest that both models overestimate the risk for disease progression and need to be interpreted with caution in CKD patients.
{"title":"Reduced prognostic value of beta-2-microglobulin for time to first treatment in CLL patients with compromised kidney function.","authors":"Jan-Paul Bohn, Valentina Stolzlechner, Georg Göbel, Markus Pirklbauer, Dominik Wolf, Normann Steiner","doi":"10.1080/10428194.2024.2394583","DOIUrl":"https://doi.org/10.1080/10428194.2024.2394583","url":null,"abstract":"<p><p>Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and characterized by a highly heterogeneous clinical course. The CLL-IPI and the OCLL-1 scores are among the best validated tools to predict time-to-first-treatment. In both models, elevated beta-2-microglobulin plasma level (B2M) is an independent prognostic factor. Yet, B2M is commonly increased in patients with chronic kidney disease (CKD) <i>per se</i> and both models were not adjusted for CKD. We analyzed the clinical outcomes of 297 treatment-naive CLL patients between 2000 and 2022. B2M was more frequently elevated in CKD patients and lost prognostic significance at the threshold > 2.5 mg/L. Both CLL-IPI and OCLL-1 failed to facilitate prognostic segregation in CKD patients. 22.2% of CKD patients were assigned to a higher CLL-IPI risk group due to elevated B2M. Our results suggest that both models overestimate the risk for disease progression and need to be interpreted with caution in CKD patients.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1080/10428194.2024.2392839
Alena Sophie Ehrmann, Alex Zadro, Eugen Tausch, Christof Schneider, Stephan Stilgenbauer, Daniel Mertens
In chronic lymphocytic leukemia (CLL), TP53 mutations or deletions on chromosome 17p lead to adverse prognosis and reduced levels of miR-34a, which targets NOTCH1. Also, hyperactivated NOTCH1 signaling is crucial for CLL progression. Here we explored the interaction between p53, miR-34a, and NOTCH1 in CLL. We investigated the effect of p53 and miR-34a on NOTCH1 signaling and expression in CLL cells with altered TP53. Our results indicate that miR-34a reduces NOTCH1 3' UTR activity but might not be a mediator between p53 signaling and NOTCH1. p53 activation increases miR-34a expression and NOTCH1 protein levels, correlating with decreased NOTCH1 and miR-34a levels in primary CLL cells with TP53 alterations. Some samples with high NOTCH1 levels presented increased BCL-2, suggesting an anti-apoptotic mechanism of a potentially direct p53-NOTCH1 relation in CLL. This study deepens the understanding of the p53-miR-34a-NOTCH1 signaling network, providing insights that could guide future therapeutic strategies for CLL.
{"title":"The NOTCH1 and miR-34a signaling network is affected by <i>TP53</i> alterations in CLL.","authors":"Alena Sophie Ehrmann, Alex Zadro, Eugen Tausch, Christof Schneider, Stephan Stilgenbauer, Daniel Mertens","doi":"10.1080/10428194.2024.2392839","DOIUrl":"https://doi.org/10.1080/10428194.2024.2392839","url":null,"abstract":"<p><p>In chronic lymphocytic leukemia (CLL), <i>TP53</i> mutations or deletions on chromosome 17p lead to adverse prognosis and reduced levels of miR-34a, which targets NOTCH1. Also, hyperactivated NOTCH1 signaling is crucial for CLL progression. Here we explored the interaction between p53, miR-34a, and NOTCH1 in CLL. We investigated the effect of p53 and miR-34a on NOTCH1 signaling and expression in CLL cells with altered <i>TP53</i>. Our results indicate that miR-34a reduces NOTCH1 3' UTR activity but might not be a mediator between p53 signaling and NOTCH1. p53 activation increases miR-34a expression and NOTCH1 protein levels, correlating with decreased NOTCH1 and miR-34a levels in primary CLL cells with <i>TP53</i> alterations. Some samples with high NOTCH1 levels presented increased BCL-2, suggesting an anti-apoptotic mechanism of a potentially direct p53-NOTCH1 relation in CLL. This study deepens the understanding of the p53-miR-34a-NOTCH1 signaling network, providing insights that could guide future therapeutic strategies for CLL.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-18DOI: 10.1080/10428194.2024.2390582
Pharsai Prasertsan, Edward B McNeil, Natsaruth Songthawee, Shevachut Chavananon, Pornpun Sripornsawan, Thampapon Chaisujyakorn, Thirachit Chotsampancharoen
Tumor lysis syndrome (TLS) in childhood leukemia was assessed retrospectively in 252 patients in a single tertiary center in Thailand during 2009-2019. Fifty-one (20.2%) developed TLS during their induction chemotherapy; 60.7% (31/51) were spontaneous TLS and 47% (24/51) developed clinical TLS. The predictive score model consisted of white blood cell (WBC) count more than 50,000 cells/mm3, glomerular filtration rate less than 90, and aspartate transaminase more than 44 units/L. The TLS development rates were 11.1%, 46.2%, and 78.5% in the low, intermediate, and high-risk groups, respectively. Death during the first induction phase in patients with TLS was significantly higher than in the patients without TLS. However, the 5-year overall survival rates for the children with and without TLS were not significantly different.
{"title":"Risk factors and development of a predictive score model for tumor lysis syndrome in childhood leukemia: a 10-year experience from a single tertiary hospital in Thailand.","authors":"Pharsai Prasertsan, Edward B McNeil, Natsaruth Songthawee, Shevachut Chavananon, Pornpun Sripornsawan, Thampapon Chaisujyakorn, Thirachit Chotsampancharoen","doi":"10.1080/10428194.2024.2390582","DOIUrl":"https://doi.org/10.1080/10428194.2024.2390582","url":null,"abstract":"<p><p>Tumor lysis syndrome (TLS) in childhood leukemia was assessed retrospectively in 252 patients in a single tertiary center in Thailand during 2009-2019. Fifty-one (20.2%) developed TLS during their induction chemotherapy; 60.7% (31/51) were spontaneous TLS and 47% (24/51) developed clinical TLS. The predictive score model consisted of white blood cell (WBC) count more than 50,000 cells/mm<sup>3</sup>, glomerular filtration rate less than 90, and aspartate transaminase more than 44 units/L. The TLS development rates were 11.1%, 46.2%, and 78.5% in the low, intermediate, and high-risk groups, respectively. Death during the first induction phase in patients with TLS was significantly higher than in the patients without TLS. However, the 5-year overall survival rates for the children with and without TLS were not significantly different.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-18DOI: 10.1080/10428194.2024.2392823
Dat Ngo, Jose Tinajero, Joo Y Song, Huiyan Ma, Elizabeth Quirk, Paul Koller, Hoda Pourhassan, Vaibhav Agrawal, Anthony S Stein, Guido Marcucci, Lindsey Murphy, Stephen J Forman, Vinod Pullarkat, Ibrahim Aldoss
Reactive pleocytosis in the CSF has been observed with blinatumomab but has not been well-described. We performed a retrospective study of 88 patients who received intrathecal chemotherapy (IT) while on blinatumomab with CSF analyzed to determine if pleocytosis had an impact efficacy and safety. Blinatumomab was used for relapsed/refractory 62.5%, MRD-positive 31.8%, and consolidation in MRD-negative 5.7%. The incidence of pleocytosis in CSF was 51% and was more frequent after day 15 (55.8% vs. 18.2%, p = 0.025). Pleocytosis did not impact CR, clearance of MRD positivity, PFS and OS rates. Lower incidence of non-CNS extramedullary relapse was seen (3.7% vs. 30.8%, p = 0.011) with pleocytosis in CSF. Analysis of CSF by flow cytometry showed median CD4:CD8 ratio of 1.34. In conclusion, CSF pleocytosis is prevalent with blinatumomab but only demonstrated lower rates of non-CNS extramedullary relapse but no impact on CNS relapse or neurotoxicity.
使用blinatumomab后观察到脑脊液中出现反应性多细胞,但尚未对此进行详细描述。我们对88例在使用blinatumomab期间接受鞘内化疗(IT)的患者进行了回顾性研究,并对CSF进行了分析,以确定多核细胞是否会影响疗效和安全性。62.5%的复发/难治患者、31.8%的MRD阳性患者和5.7%的MRD阴性患者接受了Blinatumomab的巩固治疗。CSF中多细胞的发生率为51%,第15天后更常见(55.8% vs. 18.2%,p = 0.025)。胸水细胞增多并不影响CR、MRD阳性清除率、PFS和OS率。CSF中出现多核细胞的非中枢神经系统髓外复发率较低(3.7% vs. 30.8%,p = 0.011)。流式细胞术对 CSF 的分析表明,CD4:CD8 比率的中位数为 1.34。总之,脑脊液多核细胞增多在使用 blinatumomab 时很常见,但只显示出非中枢神经系统髓外复发率较低,而对中枢神经系统复发或神经毒性没有影响。
{"title":"The characterization and the impact of CSF pleocytosis during blinatumomab therapy for adult acute lymphoblastic leukemia.","authors":"Dat Ngo, Jose Tinajero, Joo Y Song, Huiyan Ma, Elizabeth Quirk, Paul Koller, Hoda Pourhassan, Vaibhav Agrawal, Anthony S Stein, Guido Marcucci, Lindsey Murphy, Stephen J Forman, Vinod Pullarkat, Ibrahim Aldoss","doi":"10.1080/10428194.2024.2392823","DOIUrl":"https://doi.org/10.1080/10428194.2024.2392823","url":null,"abstract":"<p><p>Reactive pleocytosis in the CSF has been observed with blinatumomab but has not been well-described. We performed a retrospective study of 88 patients who received intrathecal chemotherapy (IT) while on blinatumomab with CSF analyzed to determine if pleocytosis had an impact efficacy and safety. Blinatumomab was used for relapsed/refractory 62.5%, MRD-positive 31.8%, and consolidation in MRD-negative 5.7%. The incidence of pleocytosis in CSF was 51% and was more frequent after day 15 (55.8% vs. 18.2%, <i>p</i> = 0.025). Pleocytosis did not impact CR, clearance of MRD positivity, PFS and OS rates. Lower incidence of non-CNS extramedullary relapse was seen (3.7% vs. 30.8%, <i>p</i> = 0.011) with pleocytosis in CSF. Analysis of CSF by flow cytometry showed median CD4:CD8 ratio of 1.34. In conclusion, CSF pleocytosis is prevalent with blinatumomab but only demonstrated lower rates of non-CNS extramedullary relapse but no impact on CNS relapse or neurotoxicity.</p>","PeriodicalId":18047,"journal":{"name":"Leukemia & Lymphoma","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}