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  • 1
    In: Blood, American Society of Hematology, Vol. 120, No. 21 ( 2012-11-16), p. 4844-4844
    Abstract: Abstract 4844 Introduction CHOP-based chemotherapy is a standard I line regimen for most non-Hodgkin's lymphomas (NHL). All prognostic indices, like international prognostic index (IPI) for DLBCL, follicular lymphoma IPI (FLIPI), mantle cell lymphoma IPI (MIPI) assess the risk associated both with lymphoma and the patient's performance status/age. No co-morbidity scale is used on a large scale in evaluation of younger patients. The effect of diabetes mellitus (DM) was assessed in a large, multicenter, retrospective analysis. Materials and methods 610 young NHL patients (median age 55 years, range 18–86) treated with (R)-CHOP chemotherapy, from 7 PLRG centers were assessed (427 DLBCL, 70 MCL, 45 FL, 22 MZL, 8 CLL/SLL and 38 PTCL). Medical records of all non-Hodgkin's lymphoma patients treated with first line CHOP-based therapy have been reviewed in order to collect data concerning the type of lymphoma, coexistence of DM, type and treatment of DM, modification of treatment during (immuno)-chemotherapy and finally overall survival and cause of death. Patients with impaired glucose tolerance and post-steroid hyperglycemia/ diabetes which developed only after initiation of treatment were classified as non-diabetic patients. Results There were 43/610 (7%) diabetic patients. Type 2 DM was diagnosed in 40 patients (6.5%), one patient (0.16%) had LADA (Latent Autoimmune Diabetes of Adulthood) and two patients had prior post-steroid diabetes. The median duration of diabetes prior to lymphoma diagnosis was 5 years (range 1–25 years). Body Mass Index (BMI) at the moment of diagnosis was calculated for 31 patients (median 28.1, range 20.3–42.8). Six patients (19.4%) had normal weight while 25 (80.6%) patients were either overweighed (16, 51.6%) or obese (9, 29%). Age and other risk factor distribution was similar between diabetic and non-diabetic patients. Diabetic patients had significantly shorter survival compared to those without DM, with median OS of 3.3 years versus not reached at average observation of 5 years (p=0.001, Figure 1). Diabetes treatment modification undertaken during chemotherapy did not influence survival (p=0.64). Lymphoma progression was the most common cause of death in both DM and non-DM patients (41% and 45.5% respectively), followed by cardiovascular diseases (29.5% and 31% respectively). In DM patients we observed doubling of fatalities due to complications (predominantly infectious): 23.5% compared to 12.5 % in non diabetic patients. Conclusions Diabetic patients had shorter survival than non-diabetic patients in the analyzed group (p=0.001). While diabetic and non-diabetic patients had similar mortality rate due to lymphoma or cardiovascular complications, deaths secondary to infection complications were twice as frequent in DM cases. It probably correlates with sustained immunosuppression, aggravated by (immuno)-chemotherapy. Disclosures: Jurczak: Pharmacyclics: 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: 2012
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  • 2
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 819-819
    Abstract: The classical Hodgkin lymphoma (cHL) is characterized by a presence of rare malignant Reed-Sternberg (RS) cells surrounded by abundant reactive infiltrate. Tumor RS cells express multiple cytokines, chemokines and immunoregulatory proteins, such as PD-L1 or galectin-1, that enhance recruitment of the infiltrating cells and allow malignant cells to escape from host immune surveillance. Since targeting these immunomodulatory molecules is a highly promising therapeutic strategy in cHL, identification of pathways and mechanisms orchestrating tumor immune evasion and supporting RS cell survival can further reveal targetable vulnerabilities of cHL. Expression of immunoregulatory proteins in cHL is modulated by tumor-specific activity of certain pro-survival transcription factors, such as NFκB and STATs. Since the activity of these transcription factors is modulated by oncogenic PIM1/2/3 serine/threonine kinases, we hypothesized that PIMs may support RS cell survival and foster their immune privilege. For these reasons, we investigated PIM1/2/3 expression in cHL and determined mechanisms underlying their expression. Furthermore, we assessed impact of PIM inhibition on expression of key factors engaged in development of the immunosuppressive microenvironment and HRS cell survival. Our analyses revealed that PIM1/2/3 are ubiquitously expressed in primary and cultured RS cell lines. At least one PIM isoform was expressed in each cell line and in 97% of 67 primary cHL biopsies. RS cells treated with JAK1/2/3 inhibitor exhibited reduced PIM1 and PIM2 levels. Genetic inhibition of canonical NFkB activity with IkB super-repressor or shRNA-mediated ablation of alternative NFkB pathway led to decrease of PIM2 and PIM3, suggesting that PIM-1/2/3 expresion in cHL depends at least in part on JAK-STAT and NFkB activity. To assess the role of PIM kinases in cell viability, we silenced expression of each PIM isoform (individually or simultaneously) in HDLM-2 cells. Knockdowns of individual PIM isoforms were associated with marked increased in remaining isoforms expression and were not associated with toxicity. In marked contrast, downregulation of all three isoforms increased cellular apoptosis by 17%. For this reason, for subsequent studies we used a newly developed pan-PIM inhibitor (SEL24-B489). The inhibitor was toxic to all cells with IC50 ranging from 3-5 µM. To determine mechanisms underlying toxicity, we assessed the activities of specific PIM substrates: 4EBP1, S6, and p65 (RelA). SEL24-B489 rapidly decreased PIM-dependent phosphorylation of these molecules in all tested cell lines. Furthermore, it reduced DNA binding activity of the NFκB-p65 complexes, indicating that PIM kinases modulate NFκB activity in cHL. For this reason, we next assessed the consequences of PIM inhibition on NFκB-dependent transcription. SEL24-B489 significantly downregulated mRNA of NFkB target genes associated with HRS cell survival and proliferation, such as Bfl-1, RelB and CD40. In cells treated with PIM inhibitor SEL24-B489 we also found markedly decreased expression NFkB-dependent cytokines and chemokines specifically shaping pro-tumoral microenvironment, such as IL-8, CCL5 and IL-13. In addition, cell lines exposed to SEL24-B489 treatment exhibited decreased expression of immunomodulatory PD-L1 and Gal-1 proteins. Finally, we investigated the efficacy of SEL24-B489 in vivo in the murine xenograft model using HDLM-2 cells. In contrast to animals exposed to vehicle alone, we observed inhibition of tumor growth by 95,8% in SEL24-B489-treated animals (p=0,0002). Consistent with the in vitro data, we observed strong downregulation of phospho-S6, GAL-1 and PD-L1 proteins in tumor sections from PIM inhibitor-treated animals. Taken together, we demonstrated that the oncogenic PIM-1/2/3 kinases are expressed in RS cells and their activity can be specifically blocked using a pan-PIM inhibitor SEL24-B489. PIM inhibition significantly reduced activity of specific PIM substrates and decreased the expression of NFκB-dependent pro-survival genes and key immunomodulatory proteins. These results highlight the pleiotropic activity of SEL24-B489 and indicate that PIM kinases are promising therapeutic targets in cHL. Disclosures Czardybon: Selvita S.A.: Employment. Galezowski:Selvita S.A.: Employment. Windak:Selvita S.A.: Employment. Brzozka:Selvita S.A.: Employment.
    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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  • 3
    In: British Journal of Haematology, Wiley
    Abstract: Previous studies suggest that postautologous stem cell transplant (ASCT) recovery of polyclonal immunoglobulin from immunoparesis in patients with multiple myeloma is a positive prognostic marker. We performed a longitudinal analysis of polyclonal immunoglobulin concentrations and unique B‐cell sequences in patients enrolled in the phase 3 ATLAS trial that randomized 180 subjects to either carfilzomib, lenalidomide, dexamethasone (KRd) or lenalidomide (R) maintenance. In the KRd arm, standard‐risk patients with minimal residual disease negativity after six cycles de‐escalated to R alone after cycle 8. One year from the initiation of maintenance at least partial recovery of polyclonal immunoglobulin was observed in more patients on the R arm (58/66, p   〈  0.001) and in those who de‐escalated from KRd to R (27/38, p   〈  0.001) compared to the KRd arm (9/36). In patients who switched from KRd to R, the concentrations of uninvolved immunoglobulin and the number of B‐cell unique sequences increased over time, approaching values observed in the R arm. There were no differences in progression‐free survival between the patients with at least partial immunoglobulin recovery and the remaining population. Our analysis indicates that patients receiving continuous therapy after ASCT experience prolonged immunoparesis, limiting prognostic significance of polyclonal immunoglobulin recovery in this setting.
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
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    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 4
    In: Blood, American Society of Hematology, Vol. 130, No. 12 ( 2017-09-21), p. 1418-1429
    Abstract: PIM kinases are ubiquitously expressed in RS cells of cHL. PIM inhibition decreases NFκB and STAT3/5 activity, cell viability, and expression of immunoregulatory proteins PD-L1/2 and galectin-1.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2017
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  • 5
    In: British Journal of Haematology, Wiley, Vol. 198, No. 1 ( 2022-07), p. 73-81
    Abstract: The efficacy of salvage treatment of diffuse large B‐cell lymphoma (DLBCL) patients who relapse or progress (rrDLBCL) after initial therapy is limited. Efficacy and safety of ofatumumab with iphosphamide, etoposide and cytarabine (O‐IVAC) was evaluated in a single‐arm study. Dosing was modified for elderly patients. Patients received up to six cycles of treatment. The primary end‐point was the overall response rate (ORR). Patients were evaluated every two cycles and then six and 12 months after treatment. Other end‐points included progression‐free survival (PFS), event‐free survival (EFS), overall survival (OS) and safety. Seventy‐seven patients received salvage treatment with O‐IVAC. The average age was 56.8 years; 39% had an Eastern Cooperative Oncology Group (ECOG) performance status of at least 3; 78% had disease of Ann Arbor stage 3 or 4; 58% received one or more prior salvage therapies. The ORR for O‐IVAC was 54.5%. The median duration of study follow‐up was 70 months. The median PFS and EFS were 16.3 months each. The median OS was 22.7 months. Age, ECOG performance status and the number of prior therapy lines were independent predictors of survival. Treatment‐related mortality was 15.5%. O‐IVAC showed a high response rate in a difficult‐to‐treat population and is an attractive treatment to bridge to potentially curative therapies.
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 6
    In: Blood, American Society of Hematology, Vol. 108, No. 11 ( 2006-11-16), p. 5385-5385
    Abstract: Allogeneic HSCT offers a long term remission for CML patients. We compared results of MRD and MUD HSCT in 82 pts with CML, treated between 1999 and 2005. In MRD group, 61 pts (median age 39, range 8–54 yrs) were conditioned with BuCy2 regimen. 50 pts were in chronic, 7 in acceleration and 4 in 2nd chronic phase. 38 pts received peripheral blood (PB) and 23 bone marrow (BM) cells. Prophylaxis of graft versus host disease (GVHD) consisted of cyclosporin (CsA) and methotrexate (MTX). 21 pts (median age 31, range 11–51 yrs) transplanted from MUD were conditioned with BuCy2 (n=13) or TBI-based regimen (n=8). All MUD patients received thymoglobulin. This group comprised of 14 pts in chronic and 3 with accelerated, 1 in blastic phase and 3 in 2nd chronic phase. 10 pts received PB and 11 BM cells. CsA+MTX was given as GVHD prophylaxis. MUD group differed from MRD group by following factors: younger age (p=0.020), longer time to HSCT (p 〈 0.001), use of imatinib before HSCT (p=0.039), and higher pre-transplant (Gratwohl) risk score (p 〈 0.001). Results: Hematopoietic recovery occurred in all pts in MRD group, and in 95% in MUD group. Probability of overall survival for all pts was OS=0.72±0.05. 42 pts developed acute GVHD 〉 2 grade (26 in MFD and 16 in MUD) and 27 pts extensive chronic GVHD (23 in MFD and 4 in MUD). Mean survival, estimated 5-yrs OS, probabilities of GVHD incidence, relapse and non-relapse mortality (Kaplan-Meier method) with respect to transplantation method, are shown in Table. TABLE: Results of transplantation in MRD and MUD groups Probability MRD-HSCT (n=61) MUD-HSCT (n=21) P Mean survival (years) 5.6 (95%CI=4.9–6.3) 3.6 (95%CI=2.4–4.7) 0.0020 Overall survival 0.75±0.05 0.60±0.11 0.0759 Relapse incidence 0.12±0.04 0.25±0.12 0.1950 Non-relapse mortality 0.22±0.05 0.41±0.11 0.0311 Acute GVHD≥2 0.45±0.06 0.79±0.10 0.0175 Chronic extensive GVHD 0.47±0.07 (n=57) 0.35±0.14 (n=15) 0.3103 Factors predicting negative outcome by multivariate analysis were: acute GVHD≥2 (p=0.0097, HR=1.81, 95%CI=1.12−2.94), and pre-transplant risk score 〉 2 (p=0.0280, HR=1.61, 95%CI=1.06−2.00). MUD-HSCT or use of imatinib before HSCT did not predict for OS. Conclusion: In the era of tyrosine kinase inhibitors, results of MRD− and MUD-HSCT show that HSCT still remains an important therapeutic option for CML patients.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
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  • 7
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 25 ( 2014-09-01), p. 2705-2711
    Abstract: Negative [ 18 F]fluorodeoxyglucose (FDG) –positron emission tomography (PET)/computed tomography (CT) after two cycles of chemotherapy indicates a favorable prognosis in Hodgkin lymphoma (HL). We hypothesized that the negative predictive value would be even higher in patients responding rapidly enough to be PET negative after one cycle. This prospective study aimed to assess the prognostic value of PET after one cycle of chemotherapy in HL and to assess the dynamics of FDG uptake after one cycle (PET1) and after two cycles (PET2). Patients and Methods All PET scans were read by two blinded, independent reviewers in different countries, according to the Deauville five-point scale. The main end point was progression-free survival (PFS) after 2 years. Results A total of 126 patients were included, and all had PET1; 89 patients had both PET1 and PET2. The prognostic value of PET1 was statistically significant with respect to both PFS and overall survival. Two-year PFS for PET1-negative and PET1-positive patients was 94.1% and 40.8%, respectively. Among those with both PET1 and PET2, 2-year PFS was 98.3% and 38.5% for PET1-negative and PET1-positive patients and 90.2% and 23.1% for PET2-negative and PET2-positive patients, respectively. No PET1-negative patient was PET2 positive. Conclusion PET after one cycle of chemotherapy is highly prognostic in HL. No other prognostic tool identifies a group of patients with HL with a more favorable outcome than those patients with a negative PET1. In the absence of precise pretherapeutic predictive markers, PET1 is the best method for response-adapted strategies designed to select patients for less intensive treatment.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
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  • 8
    In: Blood, American Society of Hematology, Vol. 140, No. Supplement 1 ( 2022-11-15), p. 10486-10487
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
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  • 9
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 5382-5382
    Abstract: Background: Some animal studies suggested that severity of aGVHD after allogeneic myeloablative hematopoietic cell transplantation (HCT) was affected not only by the histoincompatibility between donor and recipient cells but also by the inflammatory cytokines released during the conditioning regimen. Furthermore it was also shown that delayed transplantation reduced acute GVHD mortality and increased overall survival in normal mice. Our own human studies indicated that delay in stem cells infusion to 72 hours increased the recovery of absolute neutrophil (ANC) and platelet (PLT) counts. Based on these data we hypothesized that delay infusion of stem cells might reduce the incidence and severity of aGVHD without extending the duration of pancytopenia, thus improving OS. Here we retrospectively compared the incidence of grade II-IV aGVHD, time to ANC & gt;500/uL and PLT & gt;50,000/uL recovery and 100-day survival in 65 chronic myeloid leukemia patients from our center1 who received infusion of stem cells 72 hours (Group-72) to 57 similar patients from the comparable center2 but receiving stem cells 24 hours after the end of conditioning regimen (Group-24). Both groups did not differ in the EBMT pre-transplant (Gratwohl) risk score, however more patients (77%) were transplanted with peripheral blood in Group-24 compared to Group-72 (15%). All patients were conditioned with standard dose of busulfan (16mg/kg) and cyclophosphamide 120mg/kg, and received for aGVHD prophylaxis a short course of methotrexate and cyclosporine. Results: The increase of ANC & gt;500/uL occurred after a median 19 (10–92) days in Group-72 and 20 (13–80) days in Group-24, whereas PLT count & gt; 50,000/uL was achieved at a median of 27 (10–129) days in Group-72 and 22 (12–284) days in Group-24. The probability of reaching ANC & gt;500/ul was not statistically different between two groups (p=0.15) whereas the probability of reaching PLT & gt;50,000/ul was suggestively greater in Group-24 compared to Group-72 (RR=1.44, 95%CI [0.98–2.13], p=0.06). Data of acute GVHD grade were missing in 9 patients from Group-72. Grade II-IV aGVHD was scored in 29 (51%) patients in Group-24 and in 24 (43%) patients in Group-72. The probability of developing grade II-IV aGVHD was similar in both groups (p=0.15). Before day 100, six patients (11%) died in Group-24 and 15 (23%) in Group-72. The probability of 100-day survival was statistically significantly higher in Group-24 (0,89± 0.12) compared to Group-72 (0.76± 0.12), p=0.02. The increased mortality in Group-72 mainly resulted from infectious complications. Conclusion: Delay in allogeneic transplantation did not decrease the incidence of grade II-IV aGVHD and did not improve overall survival, therefore should not be recommended for further clinical studies.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
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  • 10
    Online Resource
    Online Resource
    American Society of Hematology ; 1997
    In:  Blood Vol. 89, No. 4 ( 1997-02-15), p. 1462-1464
    In: Blood, American Society of Hematology, Vol. 89, No. 4 ( 1997-02-15), p. 1462-1464
    Type of Medium: Online Resource
    ISSN: 1528-0020 , 0006-4971
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 1997
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