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  • 1
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 2725-2725
    Abstract: Cutaneous T cell lymphoma (CTCL) is an incurable skin homing T cell malignancy. We have previously reported p38 as therapeutic targets for CTCL.1 However, the mechanism underlying p38 signaling is not completely understood. To further investigate p38 and its downstream signaling components, we examined public database of gene expression and found that p38γ is overexpressed in CTCL as compared to normal T cells. In addition, p38γ has negligible expression in normal lymphoid tissues, with the exception of high level expressed in smooth and cardiac muscle cells. We have demonstrated that p38γ over-expression increases cell proliferation and knockdown of p38γ causes Hut78 cell death. p38γ plays an important role in inflammation-associated tumorigenesis3 and inhibition of its activity has emerged as a strategy to treat a spectrum of cancers.4 The transcription factor, NFATc4, downstream of p38γ, is also significantly up-regulated in CTCL cells by microarray analysis, and it is at non-detectable level in normal T cells.1We have demonstrated that shRNA-mediated knockdown of p38γ reduced NFATc4 mRNA levels in Hut78 cells, and that inhibition of NFATc4 by siRNA reduces the proliferation of CTCL cells. We also found that the cytokine IL17A functions downstream of p38γ and NFATc4, as knockdown of either p38γ or NFATc4 significantly reduced IL17A mRNA levels in Hut78 cells. This result suggests that IL17A is a target for transcriptionally activated NFATc4. Previously we have shown that IL17A rescues Hut78 cells from apoptosis induced by combined inhibition of NFAT and NFkB (treated with curcumin and Ly2228820). This implicates IL17A as a key mediator for CTCL survival. Therefore, we propose a novel p38γ - NFATc4 - IL17A signaling pathway in malignant T cells that promotes the survival of CTCL which provides potential therapeutic target against this disease. To further define the role of p38 and identify targets that increase the antitumor efficacy of p38 inhibition, we performed a synthetic lethal RNA interference (RNAi) screen in Hut78 cells treated with 10 µM of the p38 MAPK inhibitor Ly2228820. We transduced control and Ly2228820-treated Hut78 cells with a pooled retroviral RNAi library consisting of 4290 shRNAs that targeted more than 1000 genes involved in human cancers. If a shRNA from the library is not toxic to the control cells, but causes cell death in Ly2228820-treated cells, the gene targeted by this shRNA would be identified by the screen as synthetically lethal to p38 inhibition. Among many hits identified from the screen, we selected UCHL5 for further analysis. UCHL5encodes a deubiquitin enzyme that cleaves K48-linked polyubiquitin chains and plays an important role in the regulation of protein stability. Interestingly, combination of Ly2228820 and b-AP15, a small molecule inhibitor of UCHL5, significantly reduced the protein levels of NFATc4 isoform but not other NFAT isoforms. NFATc4 protein levels are known to be regulated by ubiquitin-proteasome pathway.2 Our finding thus suggests UCHL5 as a potential new regulator that stabilizes NFATc4 protein. Further studies are needed to confirm this prediction. More importantly, combination of Ly2228820 and b-AP15 enhanced apoptosis in CTCL cell lines (HH and Hut78) and primary Sézary cells, but was not toxic in normal PBMC cells. In summary, our findings suggest that the p38γ - NFATc4 - IL17A signaling pathway plays an important role in the survival of CTCL. In addition, improving the efficacy of targeting this pathway via p38 may also benefit from combined inhibition of UCHL5, a potentially important regulator of NFATc4 that needs further characterization. Reference: 1 Bliss-Moreau M, Coarfa C, Gunaratne PH, Guitart J, Krett NL, Rosen ST (2015). Identification of p38beta as a therapeutic target for the treatment of Sezary syndrome. The Journal of investigative dermatology135:599-608. 2 Fan Y, Xie P, Zhang T, Zhang H, Gu D, She M et al (2008). Regulation of the stability and transcriptional activity of NFATc4 by ubiquitination. FEBS letters582:4008-4014. 3 Qi X, Yin N, Ma S, Lepp A, Tang J, Jing W et al (2015). p38gamma MAPK Is a Therapeutic Target for Triple-Negative Breast Cancer by Stimulation of Cancer Stem-Like Cell Expansion. Stem cells33:2738-2747. 4 Yin N, Qi X, Tsai S, Lu Y, Basir Z, Oshima K et al (2015). p38gamma MAPK is required for inflammation-associated colon tumorigenesis. Oncogene. Disclosures Querfeld: Actelion: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees, 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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  • 2
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 1485-1485
    Abstract: Cutaneous T-cell Lymphoma (CTCL) is a heterogeneous group of diseases, derived from skin resident or skin homing T-cells, with Mycosis Fungoides (MF) and Sezary Syndrome (SS) being the most common subtypes. Although CTCL is the best-studied group among T-cell malignancies, our understanding of its pathogenesis remains limited, due to the paucity of comprehensive, large-scale genomic studies. Recent whole exome and targeted sequencing approaches have primarily elucidated mutations in genes affecting immune synapse signaling (PLCG1, CD28, JAK3) and epigenetic modulation (ARID1A, DNMT3A) in both MF and SS. In search of novel genetic alterations, we applied deep targeted sequencing in 71 freshly cryopreserved skin or peripheral blood samples derived from 61 patients with CTCL, including patients with MF, SS, primary cutaneous anaplastic large cell lymphoma (pcALCL), pleomorphic small/medium sized CD4+ CTCL and CD8+ CTCL. Genomic DNA was sequenced for the entire coding region of 585 known cancer-related genes on a HiSeq2500 Illumina instrument with a mean depth of 1000X. Sequences were analyzed for base substitutions, in-frame or frameshift insertions and deletions and splicing variants. Known germline variants reported at dbSNP and the 1,000 Genomes Project data were excluded, while confirmed somatic variants previously reported at the COSMIC database were included. Only variants with an allele frequency above 2% were further analyzed, in order to eliminate false positive data. Recurrent mutations were identified in genes responsible for tumor suppression (TP53, FAT1, FAT3), DNA damage response (ATM, MDC1), DNA mismatch repair (MSH3), chromatin remodeling (ARID1B), histone methylation (MLL2, MLL3, KDM6A) and DNA methylation (DNMT1). Moreover recurrent mutations pointed to robust activation of the three following signaling pathways: Receptor Tyrosine Kinase (IRS2, FOXO3) JAK/STAT (JAK3, STAT5A/B, SOCS1) and NOTCH (NOTCH1, NOTCH2). Finally, at a subclonal level we paradoxically identified mutations of the Androgen Receptor (AR) gene. Interestingly, the presence of large cell features correlated with a higher accumulation of molecular events, since transformed MF and pcALCL had a significantly higher number of genetic alterations compared to untransformed MF (Figure 1). In sum, the genomic landscape occurring from our targeted sequencing approach highlights the pathologic complexity of these neoplasms, suggesting multiple non-redundant mechanisms leading to lymphomagenesis. The characterization of this cohort is expected to provide an opportunity to comprehend intra-CTCL molecular heterogeneity and offer a better classification of CTCL entities along with novel potential therapeutic targets. Figure 1. Figure 1. Disclosures Levine: Foundation Medicine: Consultancy; CTI BioPharma: Membership on an entity's Board of Directors or advisory committees; Loxo Oncology: Membership on an entity's Board of Directors or advisory committees. van den Brink:Merck: Honoraria; Boehringer Ingelheim: Consultancy, Other: Advisory board attendee; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Regeneron: Honoraria; Tobira Therapeutics: Other: Advisory board attendee. Palomba:Janssen: Consultancy.
    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: Blood, American Society of Hematology, Vol. 120, No. 21 ( 2012-11-16), p. 2643-2643
    Abstract: Abstract 2643 Background: Granulomatous mycosis fungoides (GMF) is a variant of MF/cutaneous T-cell lymphoma characterized by a prominent granulomatous infiltrate in addition to the malignant lymphoid infiltrate. The diagnosis of GMF remains challenging due to variable clinical and histopathologic features. The significance of granuloma formation in CTCL is unclear and whether patients with GMF have a distinct prognosis compared to patients with classic type of MF is controversial. Data are scarce and long term results are not available. Objectives: To evaluate the clinical, histopathologic, prognostic significance and therapeutic responses of patients with GMF and to compare results to age and stage-matched patients with classic type of MF. Methods: A single center retrospective case-case study was performed at Memorial Sloan-Kettering Cancer Center of 430 patients with a diagnosis of MF between January 1981 and April 2012. Available histopathology slides were reviewed for the presence of granulomas or histiocytes comprising ≥ 25% of the atypical lymphoid infiltrate. Each identified case was matched with two classic MF cases via age and TNMB stage. For each case meeting criteria, the medical records, photographs, and histopathology slides were reviewed. Results: Twenty-seven patients with GMF were identified representing 6.3% of all MF patients at our center. Patient demographics were similar between the GMF group and case-control classic MF group, with a male-to-female ratio of 2.1:1 and a median age of 57. Most GMF patients (69%) present at early stages (IA-IIA). Patients with GMF had a longer onset of disease prior to diagnosis (median, 4.5 years vs 3.0 years). Skin manifestations of granulomatous MF showed a great variability, but were not distinguishable from those of classic MF. Histological findings showed an atypical predominantly CD4+ lymphocytic infiltrate with either granuloma formation or histiocytes with giant cells. TCR rearrangement was positive in 70% of cases. Features of GMF were present at initial diagnosis in 17 patients. In 10 patients, granulomatous infiltrates appeared at an average of 5.4 years after MF diagnosis. Secondary malignancies developed in 38% of patients with GMF compared to 23% of patients in the case-control classic MF group. Among the GMF patients, there was a trend towards fewer CRs to any treatment (38% vs 54%; p = 0.21); fewer PRs or CRs with topical therapy (57% vs 83%; p = 0.002) and with UV-light therapy (62% vs 90%; p = 0.008). Significantly more GMF patients received systemic therapy (66.7%) compared to classic MF patients (32.7%; p = 0.006). They also required a longer time to achieve best response (median 35 months vs 9 months, p = 0.002) compared to the control group. Disease progression to higher stage was seen in 46% of cases in the GMF group compared to 30% of cases in the classic MF group (p = 0.23). The 5-year and 10-year progression-free survival rates were significantly lower in the GMF group (59% and 33%, respectively) compared to the control group (84% and 56%, respectively; p = 0.02). However, the 5-year and 10-year overall survival rates were similar between GMF (86% and 72%, respectively) and classic MF patients (85% and 85%; p = 0.54). Conclusion: Our study presents the largest series on GMF in the United States. Most patients with GMF show similar clinical features when compared to patients with conventional MF. The clinical features do not reflect the histologic findings of granulomas. More frequent disease progression and poorer response to skin-directed therapies are seen in GMF patients compared to classic MF; however, overall survival is not significantly different. The majority of GMF patients present with granulomatous features at initial diagnosis and in subsequent biopsies suggesting that this entity has a unique relationship with its microenvironment. 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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  • 4
    In: Blood, American Society of Hematology, Vol. 138, No. Supplement 1 ( 2021-11-05), p. 4487-4487
    Abstract: Primary cutaneous CD30+ T-cell lymphoproliferative disorders (CD30+ LPD) are the second most common cutaneous lymphomas. According to the World Health Organization (WHO), CD30+ LPD include primary cutaneous anaplastic large cell lymphoma (pcALCL) and lymphomatoid papulosis (LyP) as well as borderline lesions. pcALCL and LyP is thought to represent two ends of a spectrum of diseases that have different clinical presentations, clinical courses, and prognoses in their classic forms, but share the same histology of medium to large CD30+ atypical lymphoid cell infiltrates. Because the behavior of these entities is different clinically and prognostically, we aim to search for oncogenic genomic variants using whole exome sequencing (WES) that drive the development of LyP and pcALCL. Clinical information, pathology, immunohistochemistry, and T-cell rearrangements on six cases of LyP and five cases of pcALCL were reviewed to confirm the rendered diagnosis prior to WES of all specimens. All cases of CD30 LPD had recurrent mutations in at least one of the epigenetic modifying genes, with the most frequent mutations found in the mixed lineage methyltransferase family involved in the methylation of H3K4: CREBBP (27%), KMT2A (36%), KMT2D (36%), SETD2 (27%), and SMARCA4 (27%) (Figure). Within the JAK/STAT pathway, mutations of STAT3 were observed in 2 cases of pcALCL (n=2, 18%), STAT5B in one case of LyP (n=1, 9%) and JAK1 mutation in one case of LyP(n=1, 9%). Lastly, mutations were also identified in the T-cell signaling pathway. 3/5 cases of pcALCL demonstrated loss of function mutations in EOMES, a T-box transcription factor important in lymphocyte development. We had two cases of C-ALCL and one case of LyP with NOTCH1 mutations supporting the importance of this gene in T-cell lymphomas. TP53 mutations and copy number loss is more characteristic of aggressive lymphomas and these abnormalities were absent in pcALCL and LyP and may explain the indolent nature of CD30+ LPD. While the JAK/STAT pathway, T-signaling, and epigenetic alterations possibly play a role in the pathogenesis of these diseases, genes involved in cell-cycle control and apoptosis (ie. TP53) that are characteristic of more aggressive diseases were not identified. Extending this investigation to a larger number of samples will allow us to detect additional mutations that may help distinguish between CD30+ LPDs of LyP and pcALCL as well as other histologic mimics such as systemic ALCL and large cell transformation of MF. Figure 1 Figure 1. Disclosures Abdulla: Caris Life Licenses: Current Employment. Zain: Kiyoaw Kirin, Secura Bio, Seattle Genetics: Honoraria; Secura Bio, DaichiSankyo, Abbvie: Research Funding; Secura Bio, Ono , Legend, Kiyowa Kirin, Myeloid Therapeutics Verastem Daichi Sankyo: Consultancy.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2021
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  • 5
    In: Blood, American Society of Hematology, Vol. 140, No. Supplement 1 ( 2022-11-15), p. 4934-4935
    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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  • 6
    In: International Journal of Radiation Oncology*Biology*Physics, Elsevier BV, Vol. 85, No. 3 ( 2013-3), p. 747-753
    Type of Medium: Online Resource
    ISSN: 0360-3016
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2013
    detail.hit.zdb_id: 1500486-7
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  • 7
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    Online Resource
    Springer Science and Business Media LLC ; 2020
    In:  Current Hematologic Malignancy Reports Vol. 15, No. 4 ( 2020-08), p. 333-342
    In: Current Hematologic Malignancy Reports, Springer Science and Business Media LLC, Vol. 15, No. 4 ( 2020-08), p. 333-342
    Type of Medium: Online Resource
    ISSN: 1558-8211 , 1558-822X
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2374151-X
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  • 8
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2012
    In:  Current Treatment Options in Oncology Vol. 13, No. 1 ( 2012-3), p. 102-121
    In: Current Treatment Options in Oncology, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2012-3), p. 102-121
    Type of Medium: Online Resource
    ISSN: 1527-2729 , 1534-6277
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 2090563-4
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  • 9
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 10, No. 2 ( 2015-2-6), p. e0113482-
    Type of Medium: Online Resource
    ISSN: 1932-6203
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2015
    detail.hit.zdb_id: 2267670-3
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  • 10
    In: Blood Cancer Journal, Springer Science and Business Media LLC, Vol. 10, No. 11 ( 2020-11-09)
    Type of Medium: Online Resource
    ISSN: 2044-5385
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2600560-8
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