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  • 1
    In: Blood, American Society of Hematology, Vol. 139, No. 11 ( 2022-03-17), p. 1670-1683
    Abstract: Pediatric and young adult (YA) patients with acute myeloid leukemia (AML) who relapse after allogeneic hematopoietic cell transplantation (HCT) have an extremely poor prognosis. Standard salvage chemotherapy and donor lymphocyte infusions (DLIs) have little curative potential. Previous studies showed that natural killer (NK) cells can be stimulated ex vivo with interleukin-12 (IL-12), -15, and -18 to generate memory-like (ML) NK cells with enhanced antileukemia responses. We treated 9 pediatric/YA patients with post-HCT relapsed AML with donor ML NK cells in a phase 1 trial. Patients received fludarabine, cytarabine, and filgrastim followed 2 weeks later by infusion of donor lymphocytes and ML NK cells from the original HCT donor. ML NK cells were successfully generated from haploidentical and matched-related and -unrelated donors. After infusion, donor-derived ML NK cells expanded and maintained an ML multidimensional mass cytometry phenotype for & gt;3 months. Furthermore, ML NK cells exhibited persistent functional responses as evidenced by leukemia-triggered interferon-γ production. After DLI and ML NK cell adoptive transfer, 4 of 8 evaluable patients achieved complete remission at day 28. Two patients maintained a durable remission for & gt;3 months, with 1 patient in remission for & gt;2 years. No significant toxicity was experienced. This study demonstrates that, in a compatible post-HCT immune environment, donor ML NK cells robustly expand and persist with potent antileukemic activity in the absence of exogenous cytokines. ML NK cells in combination with DLI present a novel immunotherapy platform for AML that has relapsed after allogeneic HCT. This trial was registered at https://clinicaltrials.gov as #NCT03068819.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
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  • 2
    In: Biology of Blood and Marrow Transplantation, Elsevier BV, Vol. 25, No. 3 ( 2019-03), p. 556-561
    Type of Medium: Online Resource
    ISSN: 1083-8791
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
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    detail.hit.zdb_id: 2057605-5
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  • 3
    In: Experimental Hematology, Elsevier BV, Vol. 88 ( 2020-08), p. 42-55
    Type of Medium: Online Resource
    ISSN: 0301-472X
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    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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  • 4
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 1970-1970
    Abstract: Myelodysplastic syndromes (MDS) are hematopoietic stem cell (HSC) disorders characterized by ineffective hematopoiesis and cellular dysplasia with high rates of transformation to leukemia. The only cure is hematopoietic stem cell transplant, which is associated with significant morbidity and mortality, thus there is a need to better delineate the pathogenesis of MDS and identify novel targets for treatment. Recent studies suggest that deregulated innate immune signaling, and, in particular, enhanced toll like receptor (TLR) signaling, may contribute to the pathogenesis of MDS. The TLRs are a family of pattern recognition receptors that play a central role in innate immunity. Specifically, TLR2 and its binding partners, TLR1 and TLR6, are markedly elevated in the CD34+ cells of patients with MDS compared to healthy controls (Wei et al, Leukemia 2013). Thus, we hypothesize that enhanced TLR2 signaling may contribute to the pathogenesis of MDS. To elucidate the contribution of TLR2 signaling to MDS, we used a well-characterized mouse model of MDS (mice expressing the NUP98-HOXD13 fusion from the hematopoietic Vav-1 promoter) to determine the effects of loss or gain of TLR2 signaling on disease progression. These "NHD13" mice have cytopenias, dysplasia, marrow hypercellularity, and increased apoptosis by 4-7 months of age; transgenic mice die by 14 months of age of leukemia or cytopenias (Lin et al, Blood 2005).Of note, similar to human HSCs, we find increased expression of TLR2 by flow cytometry on the HSCs of NHD13 mice compared to controls. Given the association of enhanced TLR2 signaling with MDS, we predicted that loss of TLR2 would improve outcomes in NHD13 mice. To this end, these mice were crossed to Tlr2-/- mice to generate 4 groups: NHD13+;Tlr2-/-; NHD13+;Tlr2+/+, NHD13-;Tlr2-/- and NHD13-;Tlr2+/+. Surprisingly, loss of TLR2 is associated with significantly worse survival with a median survival of 313 days for NHD13+;Tlr2-/-, and 367 days for NHD13+;Tlr2+/+(p=0.01; with the majority of mice dying from leukemia); and loss of TLR2 did not improve cytopenias. Ongoing experiments are aimed at determining the effects of TLR2 loss on HSC cycling, apoptosis, and function in the NHD13 mice and their wild-type (WT) sibling controls. Conversely, we are asking how stimulation of TLR2 affects disease by treating NHD13 mice chronically with a TLR1/2 agonist (PAM3CSK4) or a TLR2/6 agonist (PAM2CSK4) or water control. NHD13 mice receiving PAM2CSK4 had elevated white blood cell and hemoglobin counts after five months as compared to mice receiving PAM3CSK4 and control mice, while mice receiving PAM3CSK4 demonstrated a higher incidence of thrombocytopenia, suggesting that TLR2 signaling may contribute to cytopenias. Strikingly, however, we found that treatment with the TLR2/6 agonist (PAM2CSK4) significantly (p 〈 0.0001) accelerates the time to leukemia and death (but not the TLR1/2 agonist, PAM3CSK4), with deaths occurring as early as 70 days of life, mostly from leukemia. After four months of treatment, 100% of control and 93% of PAM3CSK4 treated NHD13 mice were alive, while only 37.5% of PAM2CSK4 treated NHD13 mice were alive (p= 0.0002). This raises the intriguing possibility that there are heterodimer-specific effects of TLR2 signaling on premalignant HSCs. Historically, the association of TLR2 with TLR1 versus TLR6 was thought to expand the ligand spectrum without altering downstream signaling (Farhat et al, J Leuk Biol 2008), however recent data (and our own findings) suggest that there may be heterodimer-specific differences (Rolf et al, Euro J of Immunology 2015). Furthermore, while expression of TLR2 itself correlates with low-risk disease and longer survival, high expression of TLR6 is associated with higher-risk disease and increased marrow blasts (Wei et al, Leukemia 2013). We are currently exploring the mechanisms behind the heterodimer-specific effects of TLR2 signaling on leukemogenesis and survival in the NHD13 mice by elucidating the effects of PAM3CSK4 versus PAM2CSK4 on HSC cycling, apoptosis, and function, as well as determining the downstream signaling pathways (utilizing mass cytometry) and target genes that are uniquely activated by the different agonists. Ultimately, an understanding of TLR1/2 versus TLR2/6 stimulation effects on WT and premalignant HSCs is critical to the development of targeted therapies toward this pathway. 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: 2016
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  • 5
    In: Blood, American Society of Hematology, Vol. 132, No. Supplement 1 ( 2018-11-29), p. 1806-1806
    Abstract: Prior studies from our lab and others have demonstrated a role for Toll-like receptor 2 (TLR2) in regulating both normal and premalignant hematopoietic stem and progenitor cells (HSPCs), however the contributions of its binding partners, TLR1 and TLR6, remain unknown. In CD34+ bone marrow cells of patients with myelodysplastic syndrome (MDS), increased TLR2 was associated with lower-risk disease, elevated rates of apoptosis associated with improved prognosis, and enhanced survival. Conversely, increased levels of TLR6, but not TLR1, was associated with higher-risk disease and an increased percentage of bone marrow blasts (Zeng et al., Exp Cell Res 2016 and Wei et al., Leukemia 2013). These data suggest that there may be heterodimer-specific effects of TLR2 signaling on HSPCs influencing disease progression. To elucidate the unique contributions of the heterodimer pairs in MDS pathogenesis and leukemogenesis, we utilized a well-established mouse model of MDS that expresses the NUP98-HOXD13 fusion from the hematopoietic Vav-1 promoter. The "NHD13" mice recapitulate many of the salient features of human MDS and succumb to cytopenias or leukemia by 14 months of age (Lin et al., Blood 2005). Importantly, we observed significantly increased expression of TLRs 1, 2, and 6 on the c-Kit+, Sca-1+, Lineage- ("KSL") HSPCs of the NHD13 mice, similar to the increased expression of these TLRs on CD34+ cells of MDS patients. To begin to delineate the heterodimeric differences, NHD13 mice were treated chronically with either PAM2CSK4 (PAM2), a TLR2/6-specific agonist, or PAM3CSK4 (PAM3), a TLR1/2-specific agonist, to assess the effects on cytopenias and survival. After five months of treatment, a significant increase was observed in the total number of white blood cells in NHD13 mice treated with PAM2 (p=0.007), but not PAM3 (vs. vehicle (water)-treated controls), a finding that was not recapitulated in wild-type (WT) controls. On the contrary, a significant decrease in the total number of platelets in both NHD13 and WT mice treated with PAM3 was observed as compared to vehicle-treated controls (p=0.024 and p=0.011, respectively). Further supporting the existence of heterodimer-specific differences, death was expedited in NHD13 mice treated with PAM2 as compared to those treated with PAM3 (p=0.019), with a median survival of 243 days vs. 338 for the PAM3-treated cohort. The cause of death, as determined by a hematopathologist based on cytology and blast percentage, was most often due to leukemia. To investigate the potential mechanism through which enhanced TLR2/6 signaling accelerates leukemogenesis and death in NHD13 mice, the HSPCs of premalignant NHD13 mice treated with PAM2 or PAM3 were characterized by flow cytometry and evaluated for cell cycling and cell death. Both the total number and frequency of KSL cells were significantly increased in NHD13 mice treated with PAM2 (p=0.007 and p 〈 0.0001, respectively), but not PAM3, vs. water-treated controls. No significant changes were noted in either cell cycling or apoptosis following agonist treatment. A microarray of bone marrow KSL cells revealed that stimulation of the TLR2/6 pathway is associated with an activated c-Myc signature, suggesting that enhanced signaling through this pathway, but not TLR1/2, may enhance leukemogenesis via Myc activation. Further, the expression levels of six downstream targets of c-Myc, including BAX, APEX1, ODC1, FKBP4, NCL, and HSPD1, were significantly increased in both WT and NHD13 mice following PAM2 treatment. Evaluation of serum cytokines also revealed heterodimer-specific alterations, including increased IL-6 levels in NHD13 mice treated with PAM2, but not PAM3. These data corroborate numerous previous reports linking IL-6 to MDS pathogenesis and transformation to acute myeloid leukemia. Ongoing studies involving mass cytometry, IL-6knockout mice, and pharmacological inhibitors of both IL-6 and c-Myc aim to further elucidate the mechanism through which TLR2/6-specific activation accelerates leukemogenesis and death in the NHD13 mouse model of MDS. These studies hope to inform more targeted therapeutics that could potentially delay MDS progression and reduce off-target effects. 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: 2018
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  • 6
    In: Frontiers in Pediatrics, Frontiers Media SA, Vol. 10 ( 2022-3-24)
    Abstract: Hematopoietic cell transplant is a curative therapy for many pediatric patients with high risk acute lymphoblastic leukemia. Its therapeutic mechanism is primarily based on the generation of an alloreactive graft-versus-leukemia effect that can eliminate residual leukemia cells thus preventing relapse. However its efficacy is diminished by the concurrent emergence of harmful graft-versus-host disease disease which affects healthly tissue leading to significant morbidity and mortality. The purpose of this review is to describe the interventions that have been trialed in order to augment the beneficial graft-versus leukemia effect post-hematopoietic cell transplant while limiting the harmful consequences of graft-versus-host disease. This includes many emerging and promising strategies such as ex vivo and in vivo graft manipulation, targeted cell therapies, T-cell engagers and multiple pharmacologic interventions that stimulate specific donor effector cells.
    Type of Medium: Online Resource
    ISSN: 2296-2360
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 7
    In: Pediatric Blood & Cancer, Wiley, Vol. 67, No. 1 ( 2020-01)
    Abstract: Chronic granulomatous disease (CGD) is an immune deficiency characterized by defective neutrophil function and increased risk of life‐threatening infections. Allogeneic hematopoietic cell transplantation is curative for CGD, and conditioning regimen impacts transplant‐related outcomes. We report a single‐center prospective study (NCT01821781) of four patients with CGD transplanted using a reduced‐intensity conditioning regimen (RIC) containing alemtuzumab, fludarabine, melphalan, and thiotepa. Patients had early immune reconstitution with low incidence of infections. Disease‐free survival was 75% at a median of five years after transplant. This RIC regimen presents an alternative approach for transplant of patients with CGD who may not tolerate busulfan‐based conditioning.
    Type of Medium: Online Resource
    ISSN: 1545-5009 , 1545-5017
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2130978-4
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  • 8
    In: Blood, American Society of Hematology, Vol. 131, No. 9 ( 2018-03-01), p. 1032-1035
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2018
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 9
    Online Resource
    Online Resource
    Frontiers Media SA ; 2016
    In:  Frontiers in Immunology Vol. 7 ( 2016-09-28)
    In: Frontiers in Immunology, Frontiers Media SA, Vol. 7 ( 2016-09-28)
    Type of Medium: Online Resource
    ISSN: 1664-3224
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2016
    detail.hit.zdb_id: 2606827-8
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  • 10
    Online Resource
    Online Resource
    Frontiers Media SA ; 2020
    In:  Frontiers in Immunology Vol. 11 ( 2020-8-18)
    In: Frontiers in Immunology, Frontiers Media SA, Vol. 11 ( 2020-8-18)
    Type of Medium: Online Resource
    ISSN: 1664-3224
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2020
    detail.hit.zdb_id: 2606827-8
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