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  • 1
    In: BMC Medical Genetics, Springer Science and Business Media LLC, Vol. 6, No. 1 ( 2005-12)
    Type of Medium: Online Resource
    ISSN: 1471-2350
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2005
    detail.hit.zdb_id: 2041359-2
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  • 2
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 1421-1421
    Abstract: Abstract 1421 Poster Board I-444 Conflicting results in the field of cancer stem cells have reignited debate regarding the frequency and identity of cells with the ability to self renew and to propagate the complete phenotype of the malignancy. Initially it was suggested by different studies that cancer stem cells represent only a small minority of the malignant population and that the immunophenotypes of these cells resemble a rather immature type in the cell hierarchy. More recent data from our own and other groups have challenged these findings by demonstrating that cells at different maturity levels within the leukemic hierarchy have cancer stem cell abilities and that the frequency of the leukemia maintaining cell is higher than previously thought (Cancer Cell 2008, 14(1), p47-58). We use an in vivo NOD/scid IL2Rγnull (NSG) mouse intra-femoral transplant model to determine the clonogenicity of sorted candidate leukemic stem cell populations, characterized by specific immunophenotypes. We selected the surface markers CD10 and CD20, in order to differentiate between rather immature and more mature cells. Furthermore we carried out limiting dilution experiments on sorted (CD20) and unsorted leukemic blasts to investigate the frequency of the proposed leukemic stem cells. Flow sorted ALL blasts of CD19+CD20low and CD19+CD20high as well as of CD19+CD10low and CD19+CD10high immunophenotype were transplanted into NSG mice. Sorts were performed on primary patient material and on leukemic blasts that had been harvested following prior passage in mice. Different subtypes of ALL were included (high risk: BCR/ABL (t9;22) positive (patients L4967, L4951, L49101, L8849, L2510), high hyperdiploid/MRD positive high risk (L754, L835), intermediate risk: high WBC/MRD negative (L736, L784), age 〉 10 years (L803)). CD20 sorts were performed on primary patient material (L4951, L49101, L754, L835 and L776), on secondary samples harvested from engrafted primary mice (L4967, L4951, L2510, L736 and L754) and on tertiary samples harvested from engrafted secondary mice (L4967 and L736). In total 151 mice were transplanted, with 122 showing engraftment in consecutive bone marrow punctures or in bone marrow harvests. CD10 sorts were performed on primary patient material (L784 and L49101) and on secondary samples harvested from engrafted primary mice (L4951, L8849, L2510 and L803) with 31 out of 52 mice transplanted with sorted material showing engraftment as seen with CD20 sorted cells. Blasts of all selected immunophenotypes were able to engraft the leukemia in unconditioned NSG mice as determined by 5 color flow cytometry. In particular, sorted cells of both fractions were able to reconstitute the complete phenotype of the leukemia. Harvested cells from engrafted mice could then be re-sorted into high and low antigen expressing fractions and successfully re-engrafted on secondary and tertiary mice. Cell purities of transplanted cells were usually higher than 90% (range 67-100%). The ability of all populations to serially engraft mice demonstrates long-term self-renewal capacity. Two additional patients were used in the limiting dilution assays (high WBC/t(4;11) high risk (L826); low WBC/MRD negative low risk (L792)) and experiments were performed on primary unsorted and secondary sorted material. Cell numbers necessary for ALL engraftment differed between individual leukemias but as little as 100 cells proved to be sufficient in one unsorted and in both the CD19+CD20low and CD19+CD20high fractions (Table 1). Mice transplanted with 10 cells only are still under observation. Table 1 Patient Transplant Population Cell dose Mice engrafted/transplanted L4951 Secondary CD20 high 500 3/3 CD20 low 3/3 CD20 high 100 3/3 CD20 low 3/3 L2510 Secondary CD20 high 3,000 2/4 CD20 low 4/4 CD20 high 300 0/4 CD20 low 1/4 L49101 Primary Unsorted 500 3/4 100 0/4 L792 Primary Unsorted 1,000 5/5 100 1/5 L826 Primary Unsorted 1,000 3/4 100 0/4 In conclusion we present strong evidence that leukemia-propagating cells are much more prevalent than previously thought and that blasts of diverse immunophenotype are able to serially reconstitute the complete leukemia in immune-deficient mice. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 5356-5356
    Abstract: Fungal infections (FI) remain a major threat for patients during allogeneic stem cell transplantation (SCT). There is an ongoing controversy regarding the best fungal prophylaxis. The current study was performed to retrospectively compare three different antifungal medications (itraconazole (ITRA), fluconazole (FLU), and amphotericin B (AMB) preparations) during SCT with regard to FI, survival and complications (toxicity, GVHD, engraftment). 116 children (mean age 10.1 years, female n=48, mean body weight (bw) 27.5 kg) transplanted between March 1998 and August 2003 with complete clinical, microbiological and radiological data were included. Four patients receiving a different antifungal medication (combination therapy ± caspofungin) were excluded. The underlying diseases included acute and chronic leukemias (n=71), inborn metabolic or immunological diseases, lymphomas and bone marrow failure syndromes. In 53 children (46%) a matched family donor was available; in 45 patients (39%) a matched unrelated donor was chosen. In the remaining patients alternative donors (haploidentical, mismatch-related or -unrelated, cord-blood) were selected. Forty children received FLU, 23 patients received AMB-preparations, and 53 children received ITRA. ITRA was given intravenously from day +3 after SCT (10mg/kg bw for 3 days as “loading”, afterwards 5mg/kg bw) until oral medication (ITRA solution) became possible. All prophylactic regimen were continued until day +100 after SCT. In AMB patients FLU was administered after discharge. The three groups did not differ with regard to demographic data, underlying diseases or type of transplantation, only the follow-up period was significantly shorter in the ITRA group. We observed three new FI in the FLU/AMB group (fusariosis n=1, aspergillosis n=2) and one new FI in the ITRA group (candidiasis n=1) (p = 0.377). A change of the antimycotic regimen was necessary in 27/40 (68%) of the FLU, in 21% of the ITRA and in 30% of the AMB patients. Toxicity was minimal in the FLU and ITRA groups and only rarely necessitated a change of the prophylaxis. At day +100 after SCT, 10/63 (16%) of the patients in the FLU/AMB group and 4/53 (8%) in the ITRA group had died (p = 0.139). At the end of the study period (12-31-2004) we observed 17/63 (27%) deaths in the FLU/AMB group compared to 6/53 (8%) in the ITRA group (p & lt; 0.029), with a median follow-up of 5.7 years in the AMB, 4.5 years in the FLU and 2.0 years in the ITRA group. In three children the FI was regarded as the cause of death (not in the candidemia-patient), in the remaining patients relapse (n=5), viral infections (n=6), SCT-related toxicity (n=4) and other infection (n=5) were the cause of death without statistical differences between the groups. The incidence of acute and chronic graft versus host disease (GVHD) differed not significantly between the study groups but the time to engraftment (leukocyte count & gt; 1000/μl) lasted significantly longer in the ITRA group (14.8 days vs. 19.3 days, p & lt; 0.000). Our results indicate that ITRA (oral and intravenous) starting on day 3 after SCT is a safe prophylaxis in pediatric SCT, the analysis of FI is hampered by low numbers. The issues of survival (ITRA group performed better than AMB/FLU) and engraftment (ITRA group longer than AMB/FLU) will be addressed by longer follow-up during ongoing studies.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 1348-1348
    Abstract: There is an ongoing controversy as to whether cancer is always maintained by a rare population of highly specialized cancer stem cells or whether cancer-propagating cells may be more abundant in some cancer types. We have previously shown that in a heterogeneous group of childhood ALL different blast populations, regardless of their expression of the progenitor/stem cell marker CD34 or the lymphoid differentiation antigen CD19, contain leukemia-initiating activity (Cancer Cell 2008, 14(1), 47–58). By profiling B cell transcription factor expression, these different populations appeared to mirror stages of normal B cell development. Here we extend our experiments to another lymphoid differentiation marker, CD20, to provide further evidence that ALL blasts at different stages of maturation possess the ability to re-initiate the leukemia. Patient Transplant Mice Population Cell dose Engrafted L736 Secondary 9 CD20High 10.000–100.000 6 11 CD20−/Low 10 Tertiary 4 CD20High 10.000 4 4 CD20−/Low 1 L754 Primary 4 CD20High 100.000 2 4 CD20−/Low 3 Secondary 11 CD20High 5.000-100.000 9 11 CD20−/Low 7 A67 Secondary 6 CD20High 9.000-20.000 6 6 CD20−/Low 6 Unsorted bone marrow cells from 3 different ALL patients (L736, L754 and A67) were transplanted into 12 primary mice. Bone marrow was harvested from leukemic mice and flow sorted candidate populations (CD19+CD20−/Low and CD19+CD20High) were re-transplanted into 52 secondary and 8 tertiary mice. As expected from our previous experiments both CD19+CD20−/Low and CD19+CD20High cells were able to re-establish the disease in unconditioned NOD/scid y−/− mice (see table). Leukemic engraftment ranged from 0.5 to 73% as determined by flow cytometry on bone marrow aspirates. Both populations re-established the complete phenotype of the original leukemia including CD20−/Low and CD20High blasts. These results were confirmed by directly sorting primary ALL blasts from L754 without prior passage in the mice. Cell purity after flow sorting was high (81–99%) and low numbers of cells engrafted (5000 for both CD19+CD20−/Low and CD19+CD20High). The three patients reflected different ALL subtypes (L736 intermediate risk ALL: high WBC/MRD low risk, L754:high hyperdiploid/MRD high risk; and A67: high risk ALL/t(9;22)). In conclusion, these results confirm our previous observation that ALL blasts irrespective of the expression of lymphoid differentiation markers are able to engraft immune-deficient mice. Therefore, leukemia-propagating cells in childhood ALL may be more abundant than previously thought.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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