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The spectrum of sickle cell disease. 镰状细胞疾病谱。
IF 10.1 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-02-01 Epub Date: 2024-10-01 DOI: 10.1002/ajh.27494
Barbara J Bain
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引用次数: 0
Blood Plasma Methylated DNA Markers in the Detection of Lymphoma: Discovery, Validation, and Clinical Pilot. 血浆甲基化 DNA 标记在淋巴瘤检测中的应用:发现、验证和临床试验。
IF 10.1 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-02-01 Epub Date: 2024-11-20 DOI: 10.1002/ajh.27533
Thomas E Witzig, William R Taylor, Douglas W Mahoney, William R Bamlet, Patrick H Foote, Kelli N Burger, Karen A Doering, Mary E Devens, Jacquelyn R Arndt, Maria C O'Connell, Calise K Berger, Anne J Novak, James R Cerhan, Jacquelyn Hennek, Slava Katerov, Hatim T Allawi, Dragan Jevremovic, Linda N Dao, Rondell P Graham, John B Kisiel

Lymphoma is one of the leading causes of cancer and cancer deaths and yet has not been amenable to population screening. The role of methylated DNA markers (MDMs) in the detection of lymphoma has not been extensively studied. We aimed to discover, validate, and test tissue-derived MDMs of lymphoma in archival plasma specimens. Reduced representation bisulfite sequencing (RRBS) was performed on a discovery set of frozen tissues. MDMs identified were converted to methylation-specific PCR assays and validated on independent formalin-fixed, paraffin-embedded (FFPE) tissues. Target enrichment long-probe quantitative-amplified signal (TELQAS) assays were developed and assayed in plasma-extracted, bisulfite-converted DNA from independent treatment-naïve lymphoma patients and healthy controls. Prediction of cancer status was modeled using random forest model with in silico cross-validation. After discovery and validation in tissue, 16 TELQAS assays (ZNF503, VWA5B1, HOXA9, GABRG3, ITGA5, MAX.chr17.7190, BNC1, CDK20, MAX.chr4.4069, TPBG, DNAH14, SYT6, CACNG8, FAM110B, ADRA1D, and NRN1) were selected for testing in plasma. These detected 78% (95% CI, 74%-82%) of lymphoma cases at 90% specificity. Excluding marginal zone and T-cell lymphomas, sensitivity increased to 84% (80%-88%). MDMs in plasma show promise to detect lymphoma and are candidates for inclusion in multi-cancer detection studies.

淋巴瘤是导致癌症和癌症死亡的主要原因之一,但却不适合进行人群筛查。甲基化DNA标记物(MDM)在淋巴瘤检测中的作用尚未得到广泛研究。我们的目标是在存档血浆标本中发现、验证和测试淋巴瘤的组织衍生甲基化标记物。我们对一组发现的冷冻组织进行了还原表征亚硫酸氢盐测序(RRBS)。将鉴定出的 MDMs 转化为甲基化特异性 PCR 检测,并在独立的福尔马林固定、石蜡包埋(FFPE)组织上进行验证。开发了靶标富集长探针定量扩增信号(TELQAS)检测方法,并在独立的治疗无效淋巴瘤患者和健康对照者血浆提取的亚硫酸氢盐转化 DNA 中进行了检测。癌症状态的预测采用随机森林模型,并进行了硅交叉验证。在组织中进行发现和验证后,选择了16种TELQAS检测方法(ZNF503、VWA5B1、HOXA9、GABRG3、ITGA5、MAX.chr17.7190、BNC1、CDK20、MAX.chr4.4069、TPBG、DNAH14、SYT6、CACNG8、FAM110B、ADRA1D和NRN1)在血浆中进行测试。在特异性为 90% 的情况下,检测出 78%(95% CI,74%-82%)的淋巴瘤病例。排除边缘区淋巴瘤和T细胞淋巴瘤后,灵敏度增加到84%(80%-88%)。血浆中的MDMs显示出检测淋巴瘤的前景,是多种癌症检测研究的候选对象。
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引用次数: 0
Oh node: Extranodal nodular involvement of chronic lymphocytic leukemia in the colon. 结节慢性淋巴细胞白血病结肠外结节受累。
IF 10.1 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-02-01 Epub Date: 2024-08-28 DOI: 10.1002/ajh.27467
Michael Keith Alister Zimmerman, Lindsay Wilde
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引用次数: 0
Prognostic significance of mutation type and chromosome fragility in Fanconi anemia. 范可尼贫血症突变类型和染色体脆性的预后意义。
IF 10.1 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-02-01 Epub Date: 2024-11-19 DOI: 10.1002/ajh.27520
María José Ramírez, Roser Pujol, Jordi Minguillón, Massimo Bogliolo, Ilaria Persico, Debora Cavero, Aurora de la Cal, Paula Río, Susana Navarro, José Antonio Casado, Almudena Bailador, Antonio Sanchez de la Fuente, Miguel López de Heredia, Francisco Almazán, M Luisa Antelo, Bienvenida Argilés, Isabel Badell, Marta Baragaño, Cristina Beléndez, Mar Bermúdez, Marta Bernués, María Isabel Buedo, Estela Carrasco, Albert Català, Dolors Costa, Isabel Cuesta, Rafael Fernandez-Delgado, Ana Fernández-Teijeiro, Ángela Figuera, Marta García, Ainhoa Gondra, Macarena González, Soledad González Muñiz, Ines Hernández-Rodríguez, Fátima Ibañez, Nicholas John Kelleher, Francisco Lendínez, Mónica López, Ricardo López-Almaraz, Inmaculada Marchante, Carmen Mendoza, José Nieto, Emilio Ojeda, Salvador Payán-Pernía, Irene Peláez, Inmaculada Pérez de Soto, Raquel Portugal, María A Ramos-Arroyo, Alexandra Regueiro, Ana Rodríguez, Jordi Rosell, Raquel Saez, José Sánchez, Martha Sánchez, MªLeonor Senent, María Tapia, Juan Pablo Trujillo-Quintero, José Manuel Vagace, Jaime Verdú-Amorós, Victória Verdugo, Isabel Vidales, Jasson Villarreal, Cristina Díaz-de-Heredia, Julián Sevilla, Juan Antonio Bueren, Jordi Surrallés

Fanconi anemia (FA) is a rare genetic disease characterized by high phenotypic and genotypic heterogeneity, and extreme chromosome fragility. To better understand the natural history of FA, identify genetic risk and prognostic factors, and develop novel therapeutic strategies, the Spanish Registry of Patients with FA collects data on clinical features, chromosome fragility, genetic subtypes, and DNA sequencing with informed consent of participating individuals. In this article, we describe the clinical evolution of 227 patients followed up for up to 30 years, for whom our data indicate a cumulative cancer incidence of 86% by age 50. We found that patients with lower chromosome fragility had a milder malformation spectrum and better outcomes in terms of later-onset hematologic impairment, less severe bone marrow failure, and lower cancer risk. We also found that outcomes were better for patients with mutations leading to mutant FANCA protein expression (genetic hypomorphism) than for patients lacking this protein. Likewise, prognosis was consistently better for patients with biallelic mutations in FANCD2 (mainly hypomorphic mutations) than for patients with biallelic mutations in FANCA and FANCG, with the lack of the mutant protein in patients with biallelic mutations in FANCG contributing to their poorer outcomes. Our results regarding the clinical impact of chromosome fragility and genetic hypomorphism suggest that mutant FA proteins retain residual activity. This finding should encourage the development of novel therapeutic strategies aimed at partially or fully enhancing mutant FA function, thereby preventing or delaying bone marrow failure and cancer in patients with FA. Clinical Trial Registration number: NCT06490510.

范可尼贫血症(Fanconi anemia,FA)是一种罕见的遗传性疾病,其特点是表型和基因型高度异质性以及染色体极度脆弱。为了更好地了解范可尼贫血症的自然病史,确定遗传风险和预后因素,并开发新型治疗策略,西班牙范可尼贫血症患者登记处收集了有关临床特征、染色体脆性、遗传亚型的数据,并在参与个体知情同意的情况下进行了 DNA 测序。在本文中,我们描述了对 227 名患者长达 30 年的随访的临床演变情况,我们的数据显示,这些患者到 50 岁时的累积癌症发病率为 86%。我们发现,染色体脆性较低的患者的畸形谱较轻,在较晚出现血液学损害、较轻的骨髓衰竭和较低的癌症风险方面的预后较好。我们还发现,与缺乏 FANCA 蛋白的患者相比,突变导致 FANCA 蛋白表达变异(基因低畸形)的患者预后更好。同样,FANCD2 双重突变(主要是低形态突变)患者的预后一直好于 FANCA 和 FANCG 双重突变患者,FANCG 双重突变患者缺乏突变蛋白是导致其预后较差的原因。我们关于染色体脆性和基因低畸形的临床影响的研究结果表明,突变的FA蛋白仍具有残余活性。这一发现将有助于开发新的治疗策略,部分或完全增强突变FA的功能,从而预防或延缓FA患者的骨髓衰竭和癌症。临床试验注册号:NCT06490510:NCT06490510。
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引用次数: 0
Novel Flow Cytometric Antibody Panel and Dedicated Analysis Algorithm for Automated Fully Standardized Minimal Residual Disease Detection in Chronic Lymphocytic Leukemia
IF 12.8 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-01-25 DOI: 10.1002/ajh.27604
Robby Engelmann, Juan Flores-Montero, Joyce Schilperoord-Vermeulen, Matthias Ritgen, Paul J. Hengeveld, Saskia Kohlscheen, Georgiana Grigore, Rafael Fluxa Rodriguez, Quentin Lecrevisse, Jan Philippé, Neus Villamor, Paula Fernandez, Leire Burgos, Jacques J. M. van Dongen, Alberto Orfao, Anton W. Langerak, Sebastian Böttcher
<p>Submicroscopic levels of leukemic cells that persist after treatment are commonly designated as measurable residual disease (MRD). The last decade has witnessed a growing body of evidence proving the prognostic significance of MRD for both progression-free and overall survival in chronic lymphocytic leukemia (CLL) [<span>1, 2</span>]. Moreover, MRD detection is now increasingly used to tailor treatment in accordance with the needs of the individual patient [<span>3</span>]. Currently accepted flow cytometry assays reach a detection limit of 10<sup>−4</sup>, but logically, MRD detection with higher sensitivity (e.g., 10<sup>−5</sup>) holds promise for further improved prediction.</p><p>The European Research Initiative on CLL (ERIC) has successfully developed a standardized 4-color MRD flow assay featuring a fixed combination of markers, gates, and instructions for the application of gates with a sensitivity of 10<sup>−4</sup> [<span>4</span>]. The more recent ERIC 8-color MRD flow tube reportedly achieves a sensitivity of 10<sup>−5</sup> [<span>5</span>], but lacks the precise description of an analysis strategy. Therefore, we assessed the reproducibility of the current benchmark ERIC 8-color CLL MRD method (Figure 1A, Figure S1A, Table S1, see also supplemental materials and methods). A total of 99 samples from our dilution experiments were acquired and fully blinded. MRD levels were reported by four recognized experts with long-standing experience in CLL MRD flow (including multicentric international trials performed at national MRD reference laboratories). MRD levels down to an expected MRD level of 10<sup>−4</sup> were reproducibly and accurately reported by the experts (average agreement to expected: 92%). However, MRD levels between 10<sup>−4</sup> and 10<sup>−5</sup> from the dilution series were scored as expected in 74% of all cases only. Importantly, 23% of normal donor samples were considered MRD positive, albeit usually at very low levels (mean reported level: 5.3 × 10<sup>−5</sup> range: 7.3 × 10<sup>−6</sup>–1 × 10<sup>−4</sup>). Furthermore, the data suggested personal biases of individual experts (compare Figure 1A, left and right panels). Despite the described variability, we acknowledge that the accuracy of the ERIC 8-color CLL MRD method at levels below 10<sup>−4</sup> might be better than reported herein if the individual pre-therapeutic immunophenotype is known. Conversely, we hypothesized that reproducible MRD assessments might be demanding even at levels above 10<sup>−4</sup> for operators with lesser experience.</p><figure><picture><source media="(min-width: 1650px)" srcset="/cms/asset/1cdd94d0-67bd-4377-815f-208888bd3680/ajh27604-fig-0001-m.jpg"/><img alt="Details are in the caption following the image" data-lg-src="/cms/asset/1cdd94d0-67bd-4377-815f-208888bd3680/ajh27604-fig-0001-m.jpg" loading="lazy" src="/cms/asset/575305f7-070d-401f-b370-023f2cbef650/ajh27604-fig-0001-m.png" title="Details are in the caption foll
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引用次数: 0
NOTCH1 Mutations Are Associated With Therapy-Resistance in Patients With B-Cell Lymphoma Treated With CD20xCD3 Bispecific Antibodies
IF 12.8 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-01-25 DOI: 10.1002/ajh.27601
Emil R. Kyvsgaard, Morten Grauslund, Lene Sjø, Linea Cecilie Melchior, Trine Lønbo Grantzau, Lise Mette Rahbek Gjerdrum, Trine Trab, Lærke Sloth Andersen, Anne Ortved Gang, Marie Breinholt, Michael Boe Møller, Jacob Haaber Christensen, Thomas Stauffer Larsen, Michael Roost Clausen, Caroline H. Riley, Carsten U. Niemann, Kirsten Grønbæk, Martin Hutchings, Simon Husby
<p>CD20 × CD3 bispecific antibodies such as glofitamab, epcoritamab, and mosunetuzumab are novel T cell engaging antibodies which have all shown convincing results and obtained FDA and EMA approval for the treatment of relapsed/refractory diffuse large B cell lymphomas (DLBCL) or follicular lymphoma (FL) with ≥ 2 prior lines of treatment [<span>1</span>]. However, approximately 50% of patients do not achieve remission when treated with single agent CD20 × CD3 bispecific antibodies.</p><p>Subgroup analysis of pivotal phase I/II trials have identified elevated LDH > 250 U/L, high tumor burden, and refractory disease as risk factors for lack of response to bispecific antibodies for refractory/relapsed DLBCL [<span>1</span>]. Downregulated TP53 target signatures, upregulated expression of MYC target genes, truncating mutations in <i>MS4A1</i> (the gene encoding CD20), and loss of CD20 antigen have been identified as predictive factors for lack of response [<span>2-5</span>]. Previously, tumor mutations in <i>TP53</i> have been associated with poor response to both immunochemotherapy (i.e. R-CHOP) and CD19 CAR-T cell therapy in patients with B-cell lymphoma, but have not yet been examined thoroughly with long-term follow-up in patients treated with CD20 × CD3 bispecific antibodies.</p><p>In this retrospective study, we included patients from Rigshospitalet, Copenhagen, and Vejle University Hospital, both in Denmark, who received CD20 × CD3 bispecific antibodies between 2017 and 2023 as part of phase 1 or phase 2 clinical trials. The full list of regimens used are shown in Table S1. For exhaustive methods used, refer to the Supporting Information S1.</p><p>We collected pre-treatment formalin-fixed and paraffin-embedded (FFPE) archival specimens from 106 patients, of which 56 had sufficient DNA quantity and tumor involvement for clinical grade diagnostic next-generation sequencing (NGS). NGS was performed with a custom lymphoma panel designed in-house covering 59 commonly mutated genes in lymphoid malignancies.</p><p>We examined pre-treatment tumors from 56 patients with B-cell NHL, who received CD20 × CD3 bispecific antibodies between 2017 and 2023 and had sufficient tissue for NGS sequencing. The median age at first administration of CD20 × CD3 bispecific antibody was 70 years, 60.7% were male, and the median number of prior lines of therapy was three (Table S1). Median follow-up time was 24.2 months. Mutational profiling was additionally performed on 14 paired post-CD20 × CD3 bispecific antibody relapse samples.</p><p>Of all mutations found in pre-CD20 × CD3-treatment biopsies <i>NOTCH1</i> (detected in 4/56 [7%] of patients, Figure S1), along with <i>BRAF</i> and <i>EZH2,</i> had the strongest association with inferior PFS in a univariate Cox model (HR: 3.46, 95% CI 1.16–10.3, <i>p</i> = 0.026, Tables S2 and S4, Figure S8). Furthermore, pre-CD20 × CD3-treatment <i>NOTCH1</i> mutated tumors conferred significantly worse outcomes in Kaplan–Mei
{"title":"NOTCH1 Mutations Are Associated With Therapy-Resistance in Patients With B-Cell Lymphoma Treated With CD20xCD3 Bispecific Antibodies","authors":"Emil R. Kyvsgaard, Morten Grauslund, Lene Sjø, Linea Cecilie Melchior, Trine Lønbo Grantzau, Lise Mette Rahbek Gjerdrum, Trine Trab, Lærke Sloth Andersen, Anne Ortved Gang, Marie Breinholt, Michael Boe Møller, Jacob Haaber Christensen, Thomas Stauffer Larsen, Michael Roost Clausen, Caroline H. Riley, Carsten U. Niemann, Kirsten Grønbæk, Martin Hutchings, Simon Husby","doi":"10.1002/ajh.27601","DOIUrl":"https://doi.org/10.1002/ajh.27601","url":null,"abstract":"&lt;p&gt;CD20 × CD3 bispecific antibodies such as glofitamab, epcoritamab, and mosunetuzumab are novel T cell engaging antibodies which have all shown convincing results and obtained FDA and EMA approval for the treatment of relapsed/refractory diffuse large B cell lymphomas (DLBCL) or follicular lymphoma (FL) with ≥ 2 prior lines of treatment [&lt;span&gt;1&lt;/span&gt;]. However, approximately 50% of patients do not achieve remission when treated with single agent CD20 × CD3 bispecific antibodies.&lt;/p&gt;\u0000&lt;p&gt;Subgroup analysis of pivotal phase I/II trials have identified elevated LDH &gt; 250 U/L, high tumor burden, and refractory disease as risk factors for lack of response to bispecific antibodies for refractory/relapsed DLBCL [&lt;span&gt;1&lt;/span&gt;]. Downregulated TP53 target signatures, upregulated expression of MYC target genes, truncating mutations in &lt;i&gt;MS4A1&lt;/i&gt; (the gene encoding CD20), and loss of CD20 antigen have been identified as predictive factors for lack of response [&lt;span&gt;2-5&lt;/span&gt;]. Previously, tumor mutations in &lt;i&gt;TP53&lt;/i&gt; have been associated with poor response to both immunochemotherapy (i.e. R-CHOP) and CD19 CAR-T cell therapy in patients with B-cell lymphoma, but have not yet been examined thoroughly with long-term follow-up in patients treated with CD20 × CD3 bispecific antibodies.&lt;/p&gt;\u0000&lt;p&gt;In this retrospective study, we included patients from Rigshospitalet, Copenhagen, and Vejle University Hospital, both in Denmark, who received CD20 × CD3 bispecific antibodies between 2017 and 2023 as part of phase 1 or phase 2 clinical trials. The full list of regimens used are shown in Table S1. For exhaustive methods used, refer to the Supporting Information S1.&lt;/p&gt;\u0000&lt;p&gt;We collected pre-treatment formalin-fixed and paraffin-embedded (FFPE) archival specimens from 106 patients, of which 56 had sufficient DNA quantity and tumor involvement for clinical grade diagnostic next-generation sequencing (NGS). NGS was performed with a custom lymphoma panel designed in-house covering 59 commonly mutated genes in lymphoid malignancies.&lt;/p&gt;\u0000&lt;p&gt;We examined pre-treatment tumors from 56 patients with B-cell NHL, who received CD20 × CD3 bispecific antibodies between 2017 and 2023 and had sufficient tissue for NGS sequencing. The median age at first administration of CD20 × CD3 bispecific antibody was 70 years, 60.7% were male, and the median number of prior lines of therapy was three (Table S1). Median follow-up time was 24.2 months. Mutational profiling was additionally performed on 14 paired post-CD20 × CD3 bispecific antibody relapse samples.&lt;/p&gt;\u0000&lt;p&gt;Of all mutations found in pre-CD20 × CD3-treatment biopsies &lt;i&gt;NOTCH1&lt;/i&gt; (detected in 4/56 [7%] of patients, Figure S1), along with &lt;i&gt;BRAF&lt;/i&gt; and &lt;i&gt;EZH2,&lt;/i&gt; had the strongest association with inferior PFS in a univariate Cox model (HR: 3.46, 95% CI 1.16–10.3, &lt;i&gt;p&lt;/i&gt; = 0.026, Tables S2 and S4, Figure S8). Furthermore, pre-CD20 × CD3-treatment &lt;i&gt;NOTCH1&lt;/i&gt; mutated tumors conferred significantly worse outcomes in Kaplan–Mei","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"38 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring the Clinical Diversity of Castleman Disease and TAFRO Syndrome: A Japanese Multicenter Study on Lymph Node Distribution Patterns
IF 12.8 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-01-25 DOI: 10.1002/ajh.27612
Mizuna Otsuka, Tomohiro Koga, Remi Sumiyoshi, Shoichi Fukui, Yuko Kaneko, Takayuki Shimizu, Atsushi Katsube, Shingo Yano, Yasufumi Masaki, Makoto Ide, Hajime Yoshifuji, Masayasu Kitano, Yasuharu Sato, Naoki Sawa, Hiroaki Niiro, Naoya Nakamura, David C. Fajgenbaum, Frits van Rhee, Atsushi Kawakami
Individuals diagnosed with Castleman disease (CD) and TAFRO syndrome (characterized by thrombocytopenia, anasarca, fever, bone marrow fibrosis, and organomegaly) displays a wide range of clinical symptoms, including varying patterns of lymph node enlargement, systemic inflammation, and impaired organ function. Some patients may present with both CD and TAFRO syndrome concurrently. A retrospective study conducted across multiple centers in Japan examined 321 cases to determine if the quantity and position of swollen lymph nodes could forecast the clinical progression and intensity of these conditions. Interestingly, the study revealed that patients with TAFRO syndrome exhibited lymphadenopathy across all ranges of lymph node region counts. Moreover, no specific clinical patterns were associated with the number of affected lymph node regions in CD patients, regardless of whether they also had TAFRO syndrome. These results enhance our understanding of the clinical variability in CD and TAFRO syndrome, suggesting that a comprehensive clinical evaluation, rather than relying solely on lymph node count, is crucial for effectively managing these conditions. Additional studies are required to establish reliable diagnostic markers and to predict disease severity at the time of diagnosis, ultimately improving patient outcomes.
{"title":"Exploring the Clinical Diversity of Castleman Disease and TAFRO Syndrome: A Japanese Multicenter Study on Lymph Node Distribution Patterns","authors":"Mizuna Otsuka, Tomohiro Koga, Remi Sumiyoshi, Shoichi Fukui, Yuko Kaneko, Takayuki Shimizu, Atsushi Katsube, Shingo Yano, Yasufumi Masaki, Makoto Ide, Hajime Yoshifuji, Masayasu Kitano, Yasuharu Sato, Naoki Sawa, Hiroaki Niiro, Naoya Nakamura, David C. Fajgenbaum, Frits van Rhee, Atsushi Kawakami","doi":"10.1002/ajh.27612","DOIUrl":"https://doi.org/10.1002/ajh.27612","url":null,"abstract":"Individuals diagnosed with Castleman disease (CD) and TAFRO syndrome (characterized by thrombocytopenia, anasarca, fever, bone marrow fibrosis, and organomegaly) displays a wide range of clinical symptoms, including varying patterns of lymph node enlargement, systemic inflammation, and impaired organ function. Some patients may present with both CD and TAFRO syndrome concurrently. A retrospective study conducted across multiple centers in Japan examined 321 cases to determine if the quantity and position of swollen lymph nodes could forecast the clinical progression and intensity of these conditions. Interestingly, the study revealed that patients with TAFRO syndrome exhibited lymphadenopathy across all ranges of lymph node region counts. Moreover, no specific clinical patterns were associated with the number of affected lymph node regions in CD patients, regardless of whether they also had TAFRO syndrome. These results enhance our understanding of the clinical variability in CD and TAFRO syndrome, suggesting that a comprehensive clinical evaluation, rather than relying solely on lymph node count, is crucial for effectively managing these conditions. Additional studies are required to establish reliable diagnostic markers and to predict disease severity at the time of diagnosis, ultimately improving patient outcomes.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"113 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combination of Biological Aging and Genetic Susceptibility Helps Identifying At‐Risk Population of Venous Thromboembolism: A Prospective Cohort Study of 394 041 Participants 生物衰老和遗传易感性的结合有助于识别静脉血栓栓塞的高危人群:一项包含394041名参与者的前瞻性队列研究
IF 12.8 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-01-22 DOI: 10.1002/ajh.27605
Zhensheng Hu, Jiatang Xu, Runnan Shen, Liling Lin, Yangfan Su, Chaoyu Xie, Guochang You, Yi Zhou, Kai Huang
Phenotypic age acceleration (PhenoAgeAccel) is a novel clinical aging indicator. This study was carried out to investigate the relationship between PhenoAgeAccel and the incidence of VTE, as well as to integrate PhenoAgeAccel with genetic susceptibility to improve risk stratification of VTE. The study included 394 041 individuals from the UK Biobank. Phenotypic age was calculated based on actual age and clinical biomarkers. PhenoAgeAccel presents the residual obtained from a linear regression of phenotypic age against actual age, reflecting the rate of aging. Significant associations were observed between PhenoAgeAccel and higher risk of VTE (Hazard ratio [HR] 1.37, 95% CI: 1.32–1.42), deep vein thrombosis (DVT, HR 1.35, 95% CI: 1.29–1.42), and PE (pulmonary embolism, HR 1.41, 95% CI: 1.34–1.48) in the findings. PhenoAgeAccel exhibited a significant additive interaction with genetic susceptibility. Biologically older participants with high genetic risk have a 3.83 (95% CI: 3.51–4.18) folds risk of VTE, a 3.59 (95% CI: 3.21–4.03) folds risk of DVT, and 4.39 (95% CI: 3.88–4.98) folds risk of PE, in comparison to biologically younger participants with low genetic risk. Mediation analyses indicated that PhenoAgeAccel mediated approximately 6% of the association between cancer and VTE, and about 20% of the association between obesity and VTE. Our study indicated that PhenoAgeAccel is significantly associated with higher risk of VTE, and can be combined with genetic risk to improve VTE risk stratification. Additionally, PhenoAgeAccel holds promise as a clinical biomarker for guiding targeted prevention and treatment strategies for VTE.
表型年龄加速(PhenoAgeAccel)是一种新的临床衰老指标。本研究旨在探讨PhenoAgeAccel与VTE发病率之间的关系,并将PhenoAgeAccel与遗传易感性相结合,以改善VTE的风险分层。这项研究包括来自英国生物银行的394041个人。表型年龄根据实际年龄和临床生物标志物计算。表现型年龄与实际年龄线性回归得到的残差,反映了衰老的速度。结果显示,PhenoAgeAccel与静脉血栓栓塞(风险比[HR] 1.37, 95% CI: 1.32-1.42)、深静脉血栓形成(风险比[HR] 1.35, 95% CI: 1.29-1.42)和PE(肺栓塞,风险比[HR] 1.41, 95% CI: 1.34-1.48)的高风险之间存在显著关联。PhenoAgeAccel与遗传易感性表现出显著的加性相互作用。与生物学上较年轻、遗传风险较低的参与者相比,具有高遗传风险的年龄较大的参与者发生静脉血栓栓塞的风险为3.83倍(95% CI: 3.51-4.18), DVT的风险为3.59倍(95% CI: 3.21-4.03), PE的风险为4.39倍(95% CI: 3.88-4.98)。中介分析表明,PhenoAgeAccel介导了癌症和静脉血栓栓塞之间约6%的关联,以及肥胖和静脉血栓栓塞之间约20%的关联。我们的研究表明,PhenoAgeAccel与VTE的高风险显著相关,并且可以与遗传风险联合使用来改善VTE的风险分层。此外,PhenoAgeAccel有望作为指导静脉血栓栓塞的靶向预防和治疗策略的临床生物标志物。
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引用次数: 0
CM313 Monotherapy in Patients With Relapsed/Refractory Multiple Myeloma or Marginal Zone Lymphoma: A Multicenter, Phase 1 Dose-Escalation and Dose-Expansion Trial CM313单药治疗复发/难治性多发性骨髓瘤或边缘区淋巴瘤:一项多中心、1期剂量递增和剂量扩大试验
IF 12.8 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-01-22 DOI: 10.1002/ajh.27573
Huixing Zhou, Zhongxia Huang, Baijun Fang, Hongmei Jing, Zhongjun Xia, Yuqin Song, Zhen Cai, Gang An, Ling Qin, Li Bao, Xin Li, Yuzhang Liu, Yanrong Wang, Ling Li, Wenming Chen
<p>Multiple myeloma (MM) accounts for approximately one-tenth of all hematological malignancies. Although immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs) have significantly prolonged survival of MM patients, relapses are almost inevitable [<span>1</span>]. Patients refractory to IMiDs and PIs have a poor prognosis, highlighting the urgency to develop new agents with target specificity in patients with relapsed/refractory MM (RRMM). CD38 is a type 2 transmembrane glycoprotein highly expressed in hematological malignancies and low in normal tissues, permitting CD38-targeting antibody a novel therapeutic option for RRMM. Currently, two anti-CD38 monoclonal antibodies, daratumumab and isatuximab, have been approved for the treatment of RRMM [<span>2-4</span>].</p><p>CM313 is a novel humanized monoclonal antibody with a unique complementarity-determining region sequence that facilitates its high affinity to a spectrum of CD38-positive cells. Preclinical studies showed its comparable in vitro killing activities in target cells and anti-tumor activities with daratumumab, without obvious off-target toxicity [<span>5</span>]. CM313 also demonstrated encouraging efficacy and favorable safety in patients with immune thrombocytopenia [<span>6</span>]. Here, we report the first-in-human phase 1 trial of CM313 monotherapy in patients with RRMM and marginal zone lymphoma (MZL).</p><p>This was a multicenter, open-label phase 1 trial consisting of a dose-escalation phase and a dose-expansion phase (NCT04818372). Eligible RRMM patients had a confirmed diagnosis of MM based on the International Myeloma Working Group guidelines, measurable disease, an Eastern Cooperative Oncology Group performance-status score of ≤ 2 points, and prior treatment with IMiDs and PIs. Key exclusion criteria were primary refractory MM, diagnosis of amyloidosis, plasma-cell leukemia, or polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) syndrome, confirmed central nervous system metastases, and prior therapy with anti-CD38 monoclonal antibodies. Detailed eligibility criteria for RRMM and MZL patients are presented in the Supporting Information. Patients in the dose-escalation phase received 9 escalating doses of CM313 intravenously (0.006, 0.06, 0.3, 1.0, 2.0, 4.0, 8.0, 16, and 24 mg/kg) once in a 21-day observation period for dose-limiting toxicities (DLTs), then once weekly (QW) for the next 7 doses, then every 2 weeks (Q2W) for 8 doses, and then every 4 weeks (Q4W) onwards until disease progression or unacceptable toxicities. In the dose-expansion phase, CM313 was administered intravenously at doses of 4.0 and 16 mg/kg QW for 8 doses, then Q2W for 8 doses, and then Q4W thereafter until disease progression or unacceptable toxicities (Figure S1A).</p><p>Primary endpoints were safety and tolerability in the dose-escalation phase and overall response rate (ORR) in the dose-expansion phase. Secondary endpoints included clinical benefi
多发性骨髓瘤(MM)约占所有血液恶性肿瘤的十分之一。尽管免疫调节药物(IMiDs)和蛋白酶体抑制剂(pi)可以显著延长MM患者的生存期,但复发几乎是不可避免的。IMiDs和pi难治性患者预后较差,这凸显了开发针对复发/难治性MM (RRMM)患者的靶向特异性新药的紧迫性。CD38是一种2型跨膜糖蛋白,在血液恶性肿瘤中高表达,在正常组织中表达较低,这使得靶向CD38的抗体成为治疗RRMM的新选择。目前,两种抗cd38单克隆抗体daratumumab和isatuximab已被批准用于治疗RRMM[2-4]。CM313是一种新型人源化单克隆抗体,具有独特的互补决定区序列,有利于其对cd38阳性细胞的高亲和力。临床前研究表明,其对靶细胞的体外杀伤活性和抗肿瘤活性与daratumumab相当,无明显的脱靶毒性bb0。CM313在免疫性血小板减少症患者中也显示出令人鼓舞的疗效和良好的安全性。在这里,我们报告了CM313单药治疗RRMM和边缘带淋巴瘤(MZL)患者的首次人体1期试验。这是一项多中心、开放标签的1期临床试验,包括剂量递增期和剂量扩展期(NCT04818372)。符合条件的RRMM患者根据国际骨髓瘤工作组指南确诊MM,疾病可测量,东部肿瘤合作组绩效状态评分≤2分,既往接受IMiDs和pi治疗。主要的排除标准是原发性难治性MM、淀粉样变性诊断、浆细胞白血病或多神经病变、器官肿大、内分泌病变、单克隆伽玛病、皮肤变化(POEMS)综合征、确认中枢神经系统转移,以及既往抗cd38单克隆抗体治疗。RRMM和MZL患者的详细资格标准见辅助信息。剂量递增阶段的患者在21天的剂量限制性毒性(dlt)观察期内接受9次静脉注射CM313剂量递增(0.006、0.06、0.3、1.0、2.0、4.0、8.0、16和24 mg/kg),然后在接下来的7个剂量中每周(QW)一次,然后在8个剂量中每2周(Q2W)一次,然后每4周(Q4W)一次,直到疾病进展或不可接受的毒性。在剂量扩展阶段,CM313以4.0和16 mg/kg的剂量静脉注射,连续8次,然后Q2W,连续8次,然后Q4W,直到疾病进展或不可接受的毒性(图S1A)。主要终点是剂量递增期的安全性和耐受性,以及剂量扩展期的总缓解率(ORR)。次要终点包括临床获益率(CBR)、反应时间、反应持续时间(DOR)、无进展生存期(PFS)、总生存期(OS)、药代动力学、药效学和免疫原性。本研究的设计和程序详见辅助资料。在2021年4月15日至2023年8月3日期间,41名RRMM患者和3名MZL患者入组了该试验。截至研究结束(2024年4月3日),6名患者仍在接受治疗,38名患者因疾病进展(n = 31[70.5%])、受试者决定(n = 4[9.1%])或研究者决定(n = 3[6.8%])而停止治疗(图S1B)。在RRMM患者中,自诊断以来的中位时间为4.4年(范围0.9-10.3),患者接受过中位3(范围2-10)种既往治疗。所有41例RRMM患者先前均接受过pi和IMiDs(表S1)。MZL患者的基线人口统计学和疾病特征见表S2。没有dlt达到24 mg/kg的报告,也没有达到最大耐受剂量。59.1%(26/44)的患者报告了32例输注相关反应(IRRs),为1级或2级,除了1.0 mg/kg队列中1例RRMM患者在第一次输注时发生3级反应。59.1%(26/44)的患者在第一次输注时发生IRRs, 12.5%(5/40)的患者在随后的输注中发生IRRs(图S2)。所有的IRRs或自发消退,或经治疗消退,中位持续时间为1.5小时(范围0 - 151.4)。除IRRs外,最常见的治疗不良事件(teae)是白细胞计数减少(47.7%)和淋巴细胞计数减少(43.2%)(表S3)。25例(56.8%)患者报告了≥3级teae, 19例(43.2%)患者报告了≥3级药物相关teae。10例(22.7%)患者报告了严重不良事件(SAEs), 6例(13.6%)患者报告了药物相关的SAEs。没有teae导致永久性停药。 16 mg/kg组中有1例患者发生TEAE导致死亡(呼吸衰竭),这被认为与研究药物无关。该患者在死亡前3天报告了2级COVID-19。所有入组患者的中位随访为19.4个月(范围3.6-36.5),RRMM患者的中位随访为19.3个月(范围4.5-36.5)。副蛋白百分比变化的瀑布图如图1A所示。所有RRMM患者的ORR为36.6%(15/41,95%可信区间[CI] 22.1%-53.1%), 16 mg/kg剂量组的ORR为44.4% (8/18,95% CI 21.5%-69.2%)。所有RRMM患者的CBR为46.3% (19/41,95% CI 30.7%-62.6%), 16 mg/kg剂量组的CBR为50.0% (9/18,95% CI 26.0%-74.0%)(表S4)。在对治疗有反应的患者中,中位反应时间为0.9个月(范围0.5-2.8),DOR为16.4个月(95% CI 6.6-NR)。在接受16 mg/kg CM313治疗的患者中,中位缓解时间为1.3个月(范围0.9-2.8),中位DOR为16.4个月(范围3.7-NR)(图S3和表S4)。RRMM患者的治疗反应和生存期。(A)副蛋白与基线的最大变化百分比。≤1.0 mg/kg队列包括0.006、0.06、0.3和1.0 mg/kg队列。(B)无进展生存期。(C)总生存率。dFLC,血清游离轻链差异;RRMM,复发/难治性多发性骨髓瘤。所有RRMM患者的中位PFS为4.3个月(95% CI 2.3-8.5), 16 mg/kg队列的中位PFS为4.6个月(95% CI 2.0-17.9)(图1B和表S4)。中位OS未达到(95% CI 19.5-NR)。在所有RRMM患者中,12个月和24个月的OS率分别为80.5% (95% CI 64.8%-89.7%)和60.5% (95% CI 41.6%-75.0%),在16 mg/kg队列中,OS率分别为88.9% (95% CI 62.4%-97.1%)和67.3% (95% CI 36.6%-85.6%)(图1C和表S4)。MZL患者的治疗反应和生存期见表S5。通过观察到的最大血清浓度和浓度-时间曲线下的面积来测量,CM313暴露以大于剂量比例的方式增加(图S4和表S6)。CM313的消除是非线性的、时变的。随着剂量的增加和多次给药,平均消除半衰期增加,清除率降低(表S6)。受体占用(CD3+ T细胞、CD14+单核细胞和CD19+ B细胞)在单次给药后2小时达到60%-100%,并在治疗期间保持较高的占用率(图S5)。在剂量递增和剂量扩张阶段,所有剂量组RRMM患者外周血NK细胞(总数和CD38+)计数与基线相比下降了80%-100%(图S6)。本试验所有患者治疗相关抗药物抗体均为阴性。这项首次人体研究表明,CM313单药治疗对既往接受过三线治疗的RRMM患者具有良好的耐受性,并显示出令人鼓舞的疗效。IRRs和其他teae通常是可以忍受和管理的。通过CM313单药治疗,RRMM患者获得了快速(中位缓解时间,0.9个月)、深度(24.4%
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引用次数: 0
Erdheim-Chester Disease With Significant Response of Large Vessel Disease to Cobimetinib Monotherapy Cobimetinib单药治疗对大血管疾病有显著反应的Erdheim-Chester病
IF 12.8 1区 医学 Q1 HEMATOLOGY Pub Date : 2025-01-22 DOI: 10.1002/ajh.27606
Nehaal Ahmed, Jithma P. Abeykoon, Angela Collie, Matthew J. Koster

Conflicts of Interest

The authors declare no conflicts of interest.

利益冲突作者声明无利益冲突。
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引用次数: 0
期刊
American Journal of Hematology
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