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  • 1
    Online Resource
    Online Resource
    Elsevier BV ; 2017
    In:  Best Practice & Research Clinical Haematology Vol. 30, No. 1-2 ( 2017-03), p. 77-83
    In: Best Practice & Research Clinical Haematology, Elsevier BV, Vol. 30, No. 1-2 ( 2017-03), p. 77-83
    Type of Medium: Online Resource
    ISSN: 1521-6926
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
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  • 2
    Online Resource
    Online Resource
    IGI Global ; 2019
    In:  International Journal of Reliable and Quality E-Healthcare Vol. 8, No. 1 ( 2019-01), p. 1-10
    In: International Journal of Reliable and Quality E-Healthcare, IGI Global, Vol. 8, No. 1 ( 2019-01), p. 1-10
    Abstract: Patient participation in health care is widely considered as crucial for the development of improved health systems and the refined management of chronic conditions. Against this background, however, there are divergent views and contradictions regarding its definition and actual content and scope. Moreover, there is no consensus as to the appropriate interventions, hence assessing their impact remains a challenge. The authors herein comment on the terms that are most commonly used for defining patient involvement in health care and underline the barriers identified in everyday clinical practice that may be responsible for failing to fully materialize its potential impact and/or endorsing it in real life.
    Type of Medium: Online Resource
    ISSN: 2160-9551 , 2160-956X
    URL: Issue
    URL: Issue
    Language: English
    Publisher: IGI Global
    Publication Date: 2019
    detail.hit.zdb_id: 2703660-1
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  • 3
    Online Resource
    Online Resource
    IGI Global ; 2019
    In:  International Journal of Reliable and Quality E-Healthcare Vol. 8, No. 1 ( 2019-01), p. 11-22
    In: International Journal of Reliable and Quality E-Healthcare, IGI Global, Vol. 8, No. 1 ( 2019-01), p. 11-22
    Abstract: Patient empowerment is evident nowadays through the increased role undertaken by patients in the evaluation of healthcare, shaping health policy and involvement in clinical research. But are physicians willing and able to empower their patients? The biopsychosocial model offers a holistic approach to care by including the subjective experience of illness into clinical processes. Within this context, effective communication is key as it can contribute towards better clinical outcomes for patients as well as protect physicians from burnout due to emotional exhaustion. Hematological malignancies are the focus of this contribution as their nature and management pose serious challenges for patients to understand and physicians to explain. Physicians can play a pivotal role in encouraging patients' empowerment by educating them about their illness, supporting them in self-management and involving them in their care. Communication skills training, availability of consultation tools and e-health applications can support physicians in their new role.
    Type of Medium: Online Resource
    ISSN: 2160-9551 , 2160-956X
    URL: Issue
    URL: Issue
    Language: English
    Publisher: IGI Global
    Publication Date: 2019
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  • 4
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 3005-3005
    Abstract: Until quite recently, the prevailing view, adopted by the WHO 2008 Classification, was that mantle-cell lymphoma (MCL) originates from a peripheral B cell located within the inner mantle zone, an area comprised of naïve pre-germinal center (GC) type B cells. However, this notion has been challenged by molecular and functional evidence. Indeed, MCL is characterized by a skewed repertoire of immunoglobulin heavy variable (IGHV) genes and by some imprint of somatic hypermutation (SHM) in the clonotypic IGHV genes of the great majority (~70%) of cases, indicating antigen selection. Furthermore, both relapsed/refractory and treatment-naïve patients with MCL exhibit remarkable responses to B-cell receptor signaling inhibitors, strongly supporting a role for microenvironmental triggering in the natural history of MCL. In the present study, we sought to obtain additional insight into MCL ontogeny through a combined morphologic, immunohistochemical and immunogenetic analysis of 230 patients with a diagnosis of MCL according to the 2008 WHO Classification criteria. The study group included 139 nodal, 32 extranodal, 18 primary splenic MCLs as well as 41 bone marrow biopsies (BMB) infiltrated by MCL. Morphologically, 144/206 (70%) cases were ascribed to the common variety, while 48/206 (23.3%) and 14/206 (6.7%) were characterized as blastoid or pleomorphic variant, respectively. The immunohistochemical analysis (on paraffin sections) focused on CD27, DBA.44 and IRF4 (MUM1), markers not normally expressed by the naïve pre-germinal centre B-cell of the inner mantle zone. The results were as follows: (i) 117/214 (54.7%) cases positive for CD27 expression; (ii) 18/176 (10.2%) cases positive for DBA.44; (iii) 53/98 (54%) cases positive for IRF4. Amongst CD27+ cases, 10/86 (11.6%) were also positive for DBA.44, whereas 27/51 (52.9%) were also positive for IRF4. Immunogenetic information regarding IGHV-IGHD-IGHJ gene rearrangements was available for 167 cases of the study. Fifty of 167 cases (30%) carried IGHV genes with no SHM (100% identity to the germline, GI), whereas the remaining 117 cases (70%) bore some imprint of SHM: in particular, 95/167 cases (56.8%) carried IGHV genes with 97-99.9% GI, while 22/167 cases (13.2%) carried IGHV genes with 〈 97% GI. In keeping with the literature, the IGHV gene repertoire of the present cohort was remarkably biased, with the IGHV3-21, IGHV4-34, IGHV3-23, IGHV1-8 and IGHV5-51 genes accounting for 51% of cases (85/167). The following noteworthy observations were made from the combined assessment of morphological, immunohistochemical and immunogenetic results. (1) DBA.44 was not detected in any of the 21 extranodal MCL cases analyzed, was rare in nodal MCL (5/108, 4.6%), whereas, in contrast, was significantly enriched among primary splenic MCL (6/14, 42.8%; p 〈 0.01 for both comparisons). (2) Unexpectedly, CD27 expression was more prevalent among cases with minimal/borderline SHM (56/91, 61.5%) or no SHM (100% GI: 23/46, 50%), whereas it was less frequent among cases with a significant SHM load ( 〈 97% GI: 6/20, 30%; p=0.01 for comparison to 100% GI cases). (3) CD27 expression was significantly (p 〈 0.05) more frequent amongst cases classified as pleomorphic (11/14 cases, 78.6%) versus either blastoid (38/46 cases, 60.8%) or common (65/131 cases, 49.6%). (4) IRF4 was detected in cases from all SHM categories: 10/16 (62.5%) cases with 100 GI%, 14/30 (46.6%) cases with 97-99.9% GI and 3/6 (50%) cases with 〈 97% GI. (5) Blastoid cytology was less frequent in primary splenic MCL (2/18 cases, 11.1%) compared to either nodal (33/126 cases, 26.2%) or extranodal MCL (8/28 cases, 28.5%), however the difference did not reach significance likely due to small numbers. In conclusion, we document the remarkable immunohistochemical and immunogenetic heterogeneity of MCL. Certain profiles, identified here for the first time, are in sharp contrast to those of the naïve pre-germinal centre B-cell of the inner mantle zone (IG-unmutated, CD27-, IRF4-, DBA.44-), which is the postulated MCL progenitor according to the WHO 2008 classification. These findings strongly support antigen drive in a significant fraction of MCL cases. Furthermore, they raise the intriguing possibility that many ontogenetic pathways may give rise to MCL or, alternatively, that several types of normal B cells may serve as MCL progenitors. Disclosures Stamatopoulos: Janssen Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
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  • 5
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 1464-1464
    Abstract: Hepatitis C virus (HCV) infection is a well-established risk factor for the development of B cell non-Hodgkin lymphoma (B-NHL). Two main pathways have been proposed to explain the role of the virus in lymphomagenesis: 1) transformation of B cells either directly by oncogenic viral proteins, or by a hit-and-run mechanism inducing a mutator phenotype, and 2) chronic antigenic stimulation through the B cell receptor (BcR) in conjunction to the binding of the viral E2 protein to its receptor CD81. There are however conflicting data regarding whether the BcR of the lymphomatous cells are capable of directly recognizing viral proteins or, rather, they possess a rheumatoid factor (RF) activity, binding instead polyclonal immunoglobulin (IG) within immune complexes trapping the virus. To further elucidate the role of antigenic stimulation in the natural history of HCV-associated B-NHL, we analyzed the IG gene repertoire of both heavy and light chains expressed by neoplastic cells in 41 cases of HCV-associated NHL, including: 29 marginal zone lymphoma (MZL); 7 diffuse large B-cell lymphoma (DLBCL) of which 3 originated from transformed MZL ; and 5 other low-grade B-cell NHL. Tumor cells were obtained from blood in 39 cases, bone marrow and a lymph node biopsy in 1 case each. Forty-three productive IGHV-IGHD-IGHJ gene rearrangements were obtained, which displayed a clear biased gene composition as 3 IGHV genes contributed to almost half of the repertoire: IGHV1-69 (11/43, 25,6%), IGHV3-7 (5/43, 11.6%), IGHV3-21 (4/43, 9.3%). This was also true for both IGHD genes (IGHD3-22: 12/43, 27.9%), and IGHJ genes (IGHJ4: 17/43, 39.5%; IGHJ3: 17/43, 25.6%). All but 3 sequences carried somatic hypermutations (SHM) in their IGHV genes with a median identity to the germline of 97.6% (range 86.5-100%). Thirty-eight productive IG light chain rearrangement sequences were obtained from 36 cases, of which 30 (78.9%) were IGK. Similarly, they exhibited strong gene usage bias with an over-representation of IGKV3-20 (9/30, 30%), as well as IGKJ1 (11/30, 33.3%) and IGKJ2 (6/30, 20%). IG light chain sequences were found to harbor similar SHM load with a 97% median identity to germline (range 91-100%). As previously described, we observed preferential pairing of heavy and light chain genes, with 6 of the 9 IGHV1-69 cases (with available light chain sequence data) being associated with IGKV3-20. Using established criteria, we found 5 cases (11.6%) carrying stereotyped BcR i.e. IGHV-IGHD-IGHJ gene rearrangements with quasi-identical amino-acid (AA) sequences, including the highly variable complementary determining region 3 (CDR3). Three cases concerned IGHV3-7/IGHD3-22/IGHJ3 rearrangements with an 18 AA-long CDR3, and 2 concerned IGHV1-69/IGHD3-22/IGHJ4 rearrangements with a 13 AA-long CDR3. Identity within the CDR3 extended to AA encoded by randomly inserted N-region nucleotides. We failed to establish correlations between histological categories and IG repertoire, probably due to the uneven distribution of lymphoma subtypes within our cohort. In contrast, most if not all sequences with biased IG gene usage, including the 5 stereotyped BcR ones, were found amongst the 28/41 cases (68.3%) with mixed cryoglobulinemia type II and/or positive for RF (MC/RF+). These two categories of patients differed also regarding the SHM load of their IGHV genes since MC/RF+ cases were signlificantly less mutated than MC/RF- cases (median identity to germline: 97.9% vs 95.9%, p= 0.048). We then searched for similar sequences in public databases and collaborative studies. Stereotyped BcR sequences similar to those of our cases were detected in HCV-associated lymphoma, but also in other HCV-negative B-cell maligancies e.g. MALT lymphoma (some associated with RF) and chronic lymphocytic leukemia, non malignant B cells with RF activity, and non malignant marginal zone splenic B cells. Sequence similarity extended to some shared AA replacements, e.g. identical AA introduced by HSM at the same positions. In conclusion we confirm the highly biased IG repertoire of HCV-associated lymphoma. However this feature seems to be linked essentially to the presence of a MC and/or RF. As quasi-identical sequences are found in HCV-negative malignant and normal B cells, our data support the hypothesis that HCV-associated lymphomatous cells originate from precursors endowed with auto-immune properties rather than B cells expressing an anti-virus BcR. Disclosures Stamatopoulos: Gilead Sciences: Research Funding; Janssen Pharmaceuticals: Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2015
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  • 6
    In: Blood, American Society of Hematology, Vol. 120, No. 21 ( 2012-11-16), p. 1587-1587
    Abstract: Abstract 1587 Monoclonal B-cell lymphocytosis (MBL) with an immunophenotype consistent with marginal zone origin (MBL-MZ), that can be either CD5− or CD5+ but atypical for CLL, and also lacking an IGH/CCND1 translocation, is an increasingly recognised entity with poorly understood biological background and clinical significance. In particular, it is not yet clarified whether it represents a precursor state to one of the distinct lymphoma entities recognized by WHO as deriving from MZ cells or whether it constitutes a novel entity, likely with similar ontogeny. To obtain insight into this issue we retrospectively evaluated a series of 71 patients (male/female: 35/36, median age: 73.3 years) with lymphocytosis (median lymphocyte count: 5.77 × 109/l) detected incidentally on a routine blood test. No case had lymphadenopathy, organomegaly or any clinical features to suggest a concurrent marginal zone lymphoma. Hemoglobin and platelet counts were normal in all cases; 15/57 (26%) cases had paraproteinemia. Peripheral blood immunophenotyping revealed the presence of a clonal B-cell population with Matutes score 〈 2 in all cases. Individual markers were expressed as follows: CD5: 15/71, CD23: 7/70, CD79β: 60/64, FMC7: 50/67, CD49d: 35/35, CD38: 6/53. In 8/45 cases assessed with CT-scan and/or ultrasound, borderline splenomegaly was observed. Histopathological examination of the bone marrow biopsy (BMB) was available in 11 cases and demonstrated mostly mixed patterns of neoplastic lymphocytic inflitration from small B cells. Karyotype data were available in 66 cases; 48/66 (72.7%) had abnormal karyotype. Main cytogenetic findings are as follows: (1) translocations: n=16 cases of which 3 carried t(2;7)(p11;q21/22); (2) isochromosome 17q: n=8; (3) trisomy 12: n=8; (4) del(7q): n=7; (5) trisomy 3: n=4. Immunogenetic analysis revealed overusage of the IGHV4–34 gene (15/63, 23.8%). Notably, the IGHV1–2 gene was utilized by a single case, thus sharply contrasting (p 〈 0.0001) splenic marginal-zone lymphoma (SMZL) with a reported frequency of IGHV1–2 in excess of 30%. Seven of 63 rearrangements (11.1%) carried IGHV genes with no somatic mutations, whereas the remainder (56/63, 88.9%) exhibited some impact of somatic hypermutation (SHM), ranging from minimal to (mostly) pronounced. Overall, cases of the present study exhibited a significantly (p 〈 0.005) higher SHM load compared to SMZL. With a median follow-up of 4.9 years (0.8–20), 54 cases (group A) remain stable with no signs of progression. The remaining 17 cases (group B) have MBL along with clinical or histopathologic evidence of lymphoma. In particular: (i) a female with MBL as an incidental finding, also carrying t(2;7), was eventually diagnosed with gastric MALT lymphoma at +11 months from presentation; immunogenetic analysis confirmed clonal identity between the MBL and the lymphoma; (ii) 2 cases developed lymphadenopathy; (iii) a single case developed diffuse large B cell lymphoma of the skin; and, (iv) 13 cases developed splenomegaly and, thus, can be considered as either SMZL or splenic lymphoma/leukemia unclassifiable (SLLU). Groups A and B did not differ in terms of demographics, diagnostic blood counts (including clonal MBL count) and SHM status; the only difference concerned cytogenetic profiles, with i(17)(q10) and del(7q) being almost exclusive to group A. In conclusion, we demonstrate that MBL-MZ can be the presenting feature of occult MZ lymphoma, most frequently SMZL/SLLU. However, in a sizeable proportion of cases, MBL-MZ remains stable over time with no evidence of organ involvement and distinct immunogenetic features from SMZL, thereby raising the possibility that it might represent a newcomer to the spectrum of B-cell lymphoproliferations of MZ origin. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2012
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  • 7
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 4350-4350
    Abstract: In chronic lymphocytic leukemia (CLL) monoclonal B cells expand and progressively accumulate in the bone marrow, eventually migrating to secondary lymphoid organs for even greater proliferation. At both sites, CLL cells engage in complex, incompletely defined cellular and molecular interactions involving multiple cell types such as T cells, myeloid cells, mesenchymal stromal cells, and matrix, collectively referred to as the "tumor microenvironment". This microenvironment is critical for the survival and proliferation of CLL cells, and data indicate that T cells and myeloid cells have an important role in these processes. In this study, we focus on two cells types: CD4+ T lymphocytes and myeloid-derived suppressor cells (MDSCs). In CLL patients, these populations are altered and impact on clinical outcome. CD4+ T cells comprise several subtypes, and CLL patients often have expanded Th2 and Tregs populations, consistent with the immunosuppressive status of these patients. Moreover, patients with higher numbers of another CD4+ subset, Th17 cells that produce IL-17 and other pro-inflammatory cytokines, can have longer survival times. Although studied minimally in CLL, MDSCs are known suppressors of T cell proliferation in vitro, and expand along with malignant cells in several cancers. However, no information is available about their effects on CD4+ T cell differentiation or on B-cell biology in CLL. In a cohort of 56 untreated CLL patients, we first explored correlation of the numbers of MDSCs and autologous T cells, using flow cytometry. CD3+ cell numbers significantly paralleled total MDSCs and monocyte-like MDSCs (mMDSCs) (P = 0.002, Spearman r = 0.44; P = 0.004, Spearman r = 0.41, respectively). Interestingly, MDSCs correlated with CD4+ and CD8+ T-cells (P 〈 0.001, Spearman r = 0.646; P 〈 0.001, Spearman r = 0.61, respectively). However, the correlation of MDSC subpopulations with CD4+ and CD8+ cells differed: mMDSCs associated significantly with CD4+ cells (P 〈 0.001, Spearman r = 0.73) and granulocyte-like MDSCs (gMDSCs) with CD8+ cells (P= 0.008; Spearman r = 0.45). Furthermore, although gMDSCs did not correlate with the numbers of CD4+ T-cells, we observed that they positively paralleled Tregs defined as CD3+/CD4+/CD25+/CD127-/FoxP3+ cells (P = 0.020, Spearman r = 0.44). Other subpopulations are currently under study. To address the effect of MDSCs on CD4+ cell differentiation, we FACS sorted CD3+/CD45RO- naïve CD4+ lymphocytes and stimulated them in vitro with anti-CD3/CD28 beads and IL2 in the presence or absence of mMDSCs (HLA-DRlo/CD11b+/CD33+/CD14+), gMDSCs (HLA-DRlo/CD11b+/CD33+/CD15+) or monocytes (HLA-DRhi/CD11b+/CD14+); these studies involved samples from 3 CLLs and 3 healthy controls (HCs). On day 7, cells were harvested and cytokine production was quantified by intracellular flow cytometry as the percentages of the following populations: Th1 (INFγ), Th2 (IL-4), Tregs (FoxP3), Th17 (IL-17A and IL-17F), Th9 (IL-9) and Th22 (IL-22). Culturing CLL or HC T cells in the absence of MDSCs revealed a lower percentage of cytokine-producing cells (24% vs. 55%; P = 0.017) in CLL, which was mainly due to a reduction in IL-4+ cells (P = 0.066). However, when analyzing the effects of MDSC subsets on the polarization of CLL or HC T cell, gMDSCs promoted significantly more FoxP3+ and less IL-22+ cells in CLL than in HC (P = 0.025 and P = 0.048, respectively). When analyzing only CLL T cells, supplementation with mMDSCs induced a reduction in IL-22+ cells (P = 0.027) and an insignificant increase of IL-4+ and IL-17+ cells. Conversely monocytes supported an expansion of INFγ+ T-cells (P=0.066), and gMDSCS promoted an increase of IL-9+ cells (P = 0.046) and a reduction of FoxP3+ cells (P = 0.019). In summary, in CLL the absolute numbers of total MDSCs and T cells are tightly linked. There is a significant correlation between CD4+ T cells and mMDSCs, and between CD8+ T cells and gMDSCs. Additionally, in CLL naïve CD4+ differentiation appears reduced compared to HC, in concordance with lower T-cell responses previously reported. Moreover, the preliminary aspects of the study suggest that CLL mMDSCs promote an expansion of Th2, Th17 cells and a reduction of Th22 cells, and monocytes enhance Th1s. Unexpectedly, since we observed a significant positive correlation in the PBMCs, gMDSCs may reduce Tregs and augment Th9. These findings depict differential consequences of CLL T cell - MDSC / mMDSC / gMDSC interactions. Disclosures Stamatopoulos: Abbvie: Honoraria, Other: Travel expenses; Gilead: Consultancy, Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Janssen: Honoraria, Other: Travel expenses, Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
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  • 8
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 3199-3199
    Abstract: The classification of CLL patients according to the somatic hypermutation status (SHM) of the immunoglobulin heavy variable (IGHV) genes, namely mutated (M-CLL) versus unmutated (U-CLL), reflects fundamental differences in disease biology and clinical course. Realizing this, here we followed a compartmentalized approach and addressed the issue of prognostication separately for M-CLL and U-CLL. In a multi-institutional cohort of 2366 patients [M-CLL, n=1364 (58%); U-CLL, n=1002 (42%)] consolidated within ERIC, the European Initiative in CLL, we assessed the clinical impact of 'traditional' (age and clinical stage at the time of diagnosis, gender, CD38 expression, FISH detected abnormalities included in the Döhner hierarchical model of cytogenetic aberrations), and novel prognosticators (recurrent mutations within the TP53, SF3B1, NOTCH1, MYD88, and BIRC3 genes; IGHV gene usage; membership in stereotyped subsets) within M-CLL and U-CLL. Our statistical approach was based both on Cox regression models and recursive partitioning algorithms; internal validation was performed via bootstrapping procedures. Given the retrospective nature of our study, time-to-first-treatment (TTFT) was the primary endpoint. As expected, M-CLL exhibited significantly longer TTFT compared to U-CLL [median TTFT: not yet reached (M-CLL) vs 1.9 years (95% CI: 0.01-12.3 years, U-CLL), p 〈 0.0001]. Advanced clinical stages (Binet B-C) were associated with shorter TTFT in both M-CLL and U-CLL; a significantly worse outcome was also identified for Binet C versus Binet B cases (p 〈 0.0001). Binet A patients received our special focus, representing 90% and 67% of M-CLL and U-CLL studied cases, respectively. Amongst Binet A M-CLL cases, TP53 aberrations [TP53abs, deletions of chromosome 17p, del(17p) and/or TP53 mutations], stereotyped subset #2 membership and trisomy 12 were identified as equally adverse prognostic indicators [median TTFT: 5.5 (95% CI: 0.2-12.8), 4 (95% CI: 0.6-6.8) and 7.3 (95% CI: 0.7-13.4) years, respectively; p-value: non-significant when applying the log-rank test for all paired comparisons); of note, TP53abs were mutually exclusive with the other two features. Amongst Binet A U-CLL cases, TP53abs, SF3B1 mutations and deletion of chromosome 11q [del(11q)] had an overall similar adverse impact [median TTFT for TP53abs, SF3B1 mutations and del(11q): 1.8 (95% CI: 0.01-4.4), 2 (95% CI: 0.01-7.7) and 2.1 (95% CI: 0.01-8.1) years, respectively, p-value: non-significant when applying the log-rank test for all paired comparisons]. Within the remaining Binet A U-CLL cases [i.e. those lacking TP53abs and/or SF3B1 mutations and/or del(11q)] , the only parameter associated with shorter TTFT was male gender (median TTFT: 3.5 years, 95% CI: 0.5-8.1 years). Based on these findings, we developed two prognostic indices for assessing TTFT tailored specifically to M-CLL and U-CLL, respectively. Within M-CLL (Figure 1A), 4 subgroups were identified: (i) very high risk: Binet C with identical 5- and 10-year treatment-probability (TP) of 92%; (ii) high risk: Binet B, 5y-TP and 10y-TP: 64% and 84%, respectively; (iii) intermediate risk: Binet A with one of the following: TP53abs or +12 or subset #2 membership, 5y-TP and 10y-TP: 40% and 55%, respectively; and (iv) low risk: Binet A nonTP53abs/+12/subset#2, 5y-TP and 10y-TP: 12% and 25%, respectively. Within U-CLL (Figure 1B), 5 subgroups were identified: (i) very high risk: Binet C with 5- and 10-year TP of 100%; (ii) high risk: Binet B, identical 5y-TP and 10y-TP: 90% and 100%, respectively; (iii) intermediate risk: Binet A with one of the following: TP53abs or SF3B1 mutations or del(11q), 5y-TP and 10y-TP: 78% and 98%, respectively; (v) low risk: Binet A, male nonTP53abs/SF3B1mut/del(11q), 5y-TP and 10y-TP: 65% and 85%, respectively and (iv) very low risk: Binet A, female nonTP53abs/SF3B1mut/del(11q), 5y-TP and 10y-TP: 45% and 65%, respectively. In conclusion, we identified clinicobiological parameters with distinct prognostic implications for M-CLL and U-CLL. These parameters were used in order to develop prognostic indices tailored to SHM status that were found capable of distinguishing subgroups with markedly different outcomes. We argue that such a compartmentalized approach may supersede previous attempts, thus overcoming the pronounced heterogeneity of CLL and optimizing prognostication. PB and TM contributed equally as first authors Figure 1 Figure 1. Disclosures Rosenquist: Gilead Sciences: Speakers Bureau.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
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  • 9
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 2025-2025
    Abstract: Despite the remarkable clinical results obtained with the novel kinase inhibitors i.e. the BTK inhibitor Ibrutinib and the PI3Kδ inhibitor idelalisib in both relapsed/refractory and treatment-naïve patients, most patients achieve only partial responses underscoring the existence of resistance mechanisms that warrant further investigation. Here we explored two major mechanisms that may underlie less than optimal responses to BcR inhibition by ibrutinib, namely resistance to apoptosis due to a decreased dependence on proximal BcR signaling as it might be occurring in the context of BcR anergy; and, "bypass" activation from other non-BcR immune pathways, in particular the Toll-like receptors (TLRs). The study group included 33 CLL patients who received ibrutinib as monotherapy in 1st (n=4) or subsequent lines (n=29) of treatment. CLL cells were isolated by negative selection from peripheral blood samples collected prior to treatment initiation and, thereafter, at fixed sampling times throughout the 1st year of treatment. In keeping with the literature, we observed decreased ERK phosphorylation after 1 and 3 months of treatment as assessed by flow cytometry (p=0.0002 and 〈 0.0001 respectively; n=25). We also report for the first time a significant reduction in basal intracellular Ca2+ levels at 1 and 3 months of Ibrutinib treatment compared to the pre-treatment paired samples (p=0.04 and 0.006 respectively; n=27). These were accompanied by attenuated Ca2+ fluxes after BcR cross-linking compared to the pre-treatment paired samples (p=0.0022 and 0.0004 respectively; n=23), implying a significant decrease in BCR signaling capacity. Using chemiluminesence-based protein arrays and Western Blotting, we assessed the activation of key molecules participating in immune signaling pathways and found that the phosphorylation status of critical MAP kinases (pERK, pJNK, pp38, pAKT), pIKB, and STATs (pSTAT1, pSTAT3) decreased at 1 month of treatment (n=13). Interestingly, only molecules proximal to BTK remained inhibited after 6 months of therapy (pBTK, pPLCγ2), while the phosphorylation of the downstream MAPks (pERK, pp38) increased above baseline levels at 6 months (n=13). We then studied the effects of Ibrutinib on the capacity of CLL cells to respond to additional immune pathways such as TLR. We stimulated primary cells from 13 CLL cases with specific TLR ligands for TLR1/2, TLR2/6, TLR7 and TLR9 and assessed the functional outcome after 24 hours by flow cytometric determination of CD25 and CD86 expression as a measure of cell activation. Based on the pattern of responses observed in cells collected at +1 month under treatment in comparison to the pre-treatment sample, cases were subdivided in two subsets: the first (8/13 cases, 61%) displays significantly augmented functional responses to TLR triggering ('TLR responders') while the second (5/13 cases, 39%) shows an opposite pattern i.e. attenuated responses ('TLR non-responders'). No significant differences in TLR1, TLR2, TLR6, TLR7, TLR9 expression (flow cytometry) were identified between the two subsets either pre-treatment or at +1 month under ibrutinib. Probing into the mechanisms implicated in the observed responses, we found that at +1 month under Ibrutinib TLR9 stimulation with CpG in 'TLR responders' resulted in higher activation of several TLR-pathway signaling molecules, including the MAPKs, STATs and SRC kinases. The exact opposite i.e. dampened activation of these molecules was observed in 'TLR non-responders'. Interestingly, in 2/2 'TLR non-responders' for whom data was available, upregulation of basal Ca2+ levels was noted at +1 month under ibrutinib, while, in contrast, 5/5 TLR responders did not show any such upregulation. In conclusion, we confirm and significantly extend previous observations that CLL cells under ibrutinib treatment display a molecular profile of B cells anergized through the BcR. Importantly, we show for the first time a dichotomous pattern of TLR pathway signaling capacity under ibrutinib whereby one subset of case exhibits augmented while the other exhibits dampened responses to TLR triggering. In the latter subset, longitudinally elevated basal calcium levels and constitutive activation of MAPK signaling allude to severely diminished immune receptor signaling capacity. Studies are underway to correlate these findings with in vivo clinical response and patient outcome. Disclosures Coscia: Mundipharma: Honoraria; ROCHE: Honoraria, Other: Advisory board; Janssen: Honoraria; Gilead: Honoraria; Karyopharm: Research Funding. Stamatopoulos:Abbvie: Honoraria, Other: Travel expenses; Novartis: Honoraria, Research Funding; Gilead: Consultancy, Honoraria, Research Funding; Janssen: Honoraria, Other: Travel expenses, Research Funding. Ghia:Roche: Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Speakers Bureau; Gilead: Consultancy, Honoraria, Research Funding, Speakers Bureau; Adaptive: Consultancy; Abbvie: Consultancy, Honoraria.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Blood, American Society of Hematology, Vol. 123, No. 8 ( 2014-02-20), p. 1199-1206
    Abstract: Clonal B-cell lymphocytosis of potential marginal-zone origin (CBL-MZ) rarely progresses to a well-recognized lymphoma. CBL-MZ does not require treatment in the absence of progressive disease.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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