bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Genetic Contribution to the Aetiology of Thalidomide Associated VTE.
Authors: Morgan Gareth J. , Johnson David C. , Crowley John , Shaughnessy John , Sonneveld Pieter , Durie Brian , Ramos Christine , Van Ness Brian G. , Barlogie Bart , Hoering Antje , Haessler Jeff , Baris Dalsu , Katz Michael , Rajkumar Vincent S. , Goldschmidt H. 
Published: October 2019

Abstract
We have taken a genetic strategy to define the mechanisms underlying the increased risk of VTE in myeloma patient treated with thalidomide using clinical trial data derived from the MRC, ECOG, Little Rock and HOVON trial groups. Baseline VTE rates in the MRC IX study, (CTD vs CVAD; n=748 no prophylactic anticoagulation), were 14%. Rates in both arms were equal but in the thalidomide arm, thrombotic events were all DVT’s or PE’s, whereas in the CVAD arm they split equally between line related and VTE’s. In the other comparison (CTD vs MP; n=542), the VTE rate was 17%, all in the thalidomide arm. Rates were similar or higher (30%) in the other trials depending on the intensity of treatment used.
We carried out a nested case control on DNA from MRC IX on 90 VTE (45 thalidomide, 45 non-thalidomide related), matched to 180 controls. SNPlex analysis for 60 SNPs in the coagulation cascade, DNA repair, thalidomide, metabolism and myeloma specific pathways, identified 7 genes which affected risk (NBS1, MTHFR, Ku80, Cyp3A5, LGAL52 and IL12B). This suggests three major pathways contribute to the risk of thalidomide related VTE, metabolism of thalidomide, tumour responsiveness and some pro-thrombotic factors. These factors differ from non-thalidomide related risk where a strong pro-inflammatory response is most relevant. We tested this hypothesis further using an expanded panel of 3,404 SNPs (BOAC panel), using the Megalle system. Statistical analysis of this data defined the top 20 thalidomide and non-thalidomide associated SNPs, which were consistent with the initial hypothesis, the results of which exclude variation in the coagulation cascade as being a significant risk factor. We explored this hypothesis further using pathway-based analysis focussing on the MTHFR, DNA repair and WNT pathways on data from the ECOG, HOVON and Little Rock data sets. The biological relevance of the SNPs and genes identified was validated by correlating the level of expression using the Affymetrix U133 CHIP with genetic variation at the DNA level. To verify the relevance of DNA repair variability to tumour response further, we correlated gene expression profiling with response and again Ku80 was identified as one of a cluster of genes defining increased risk. The data suggests that the risk of thalidomide related VTE relates to rapid tumour lysis combined with a prothrombotic tendency, whereas in line related thrombosis, risk is dependent upon a strong proinflammatory response. We are building this genetic data into a clinical risk model in order to allow us to develop a rationale for intervention strategies.
Surgical Resection Alone in Children with Limited Stage Lymphocyte Predominant Hodgkin’s Lymphoma - The Experience of the EuroNet-PHL Group.
Authors: Mauz-Koerholz Christine , Hasenclever Dirk , Gorde-Grosjean Stephanie , Dörffel Wolfgang , Schellong Günther , Shankar Ananth , Hall Georgina , Wallace William H. , Korholz Dieter , Landman-Parker Judith 
Published: October 2019

Abstract
Introduction: Lymphocyte predominant Hodgkin’s lymphoma (LP) is a rare CD20-positive subtype of Hodgkin’s lymphoma which was only recently recognised as a separate disease entity. Most patients present with localised stage IA or IIA disease and usually, the disease has a relatively indolent clinical course. Up until recently, children with LP were treated alike classical Hodgkin’s lymphoma and received chemotherapy +/− radiotherapy. Two published reports of surgical resection alone in 19 children with LP (Pellegrino 2003, Murphy 2003) suggest that this may be an effective therapeutic option for a select group of children with limited stage disease. Study objectives: Can a proportion of children with limited LP be cured by surgery alone if resection is complete? Is a watch and wait strategy after surgery alone safe for those patients with residual disease after resection? What is the risk of relevant upstaging at relapse and of transformation into an aggressive B-cell lymphoma?
Methods: European study groups participating in the EuroNet-PHL inter-group were requested to report their experience of surgery alone in children with LP. Surgery as single treatment modality has been used on a case by case basis for several years by the SFCE (France), the DAL / GPOH (Germany), and more recently by the UKCCSG (UK). Individual data of 57 patients were collected using a common CRF. 11 cases already published by Pellegrino were updated and are included.
Results: 49 patients with initial stage IA achieved a CR after surgery. In 8 patients (5 in IA, 1 in IIA, 2 in IIIA) resection was incomplete. At a median observation time of 43 months (max. 172 months) all patients are alive. In the CR group 13 relapses were observed, all occurring early within 26 months of resection. Freedom from progression is estimated to be 67% (95% CI [59%; 75%]). Of the 8 patients who had incomplete resection 6 patients relapsed (p=0.008), of whom one (initial stage IIIA) relapsed as non-Hodgkin lymphoma. Of the 16 stage IA patients who experienced a relapse, 9 had a local relapse alone and the remaining 7 relapsed with stage II A. The rate of upstaging (B-symptoms or relapse stage > II) was 0% (95%-CI: [0%; 21%]).
Conclusion: If complete resection is achieved, a substantial proportion (about 2/3 in our series) of surgically treated stage IA patients experience long-term remission and may be actually cured. Nevertheless, as most of the relapses occurred in the initially involved lymph node region, a better evaluation of the remission status after surgery may be obtained if FDG-PET is combined with CT/MRI. Based on these data we have designed a Europe-wide study in FDG-PET-negative stage IA-IIA LP to prospectively confirm these promising results in a larger cohort.
Identification of Prognostic Factors in Early Unfavorable Stage Hodgkin’s Lymphoma (HL): An Individual Patient Data Meta-Analysis.
Authors: Bohlius Julia , Haverkamp Heinz , Diehl Volker , Eghbali Houchingue , Ferme Christopher , Franklin Jeremy , Pfistner Beate , Schiller Petra , Raemaekers John , Engert Andreas , Henry-Amar Michel 
Published: October 2019

Abstract
Background: In patients with early unfavorable stage HL, generally defined as stage I and II patients with mediastinal bulk, elevated ESR, 3 3 involved nodal regions, older age or extranodal involvement, progression-free-survival (PFS) is low compared to patients with early favorable or advanced stages disease. This indicates suboptimal treatment strategies and clinical heterogeneity within the group of patients with early unfavorable stage HL. An international collaborative study was initiated to identify factors that may predict for poor prognosis in this patient group.
Methods: Medline and Cochrane Library were systematically searched for randomized controlled trials (n>100 patients per study arm) in early stage HL patients with one or more risk factors receiving 4–6 cycles of ABVD or similar chemotherapy plus radiotherapy. Individual patient data were collected and risk factors for PFS (including disease progression, relapse or death) identified using multivariate analysis (linear stepwise proportional hazards) stratified by study.
Results: Six studies were identified; data from 4,490 adult patients enrolled between 08/1982 and 01/2003 were available for analysis. The median follow up was 64 months; 663 patients experienced an event leading to an overall 5-year PFS rate of 85% (95% CI 83%–88%). Six factors were significantly (P<0.01) associated with poor PFS: male gender (Hazard ratio (HR) 1.69), age (HR per additional life year 1.03), B symptoms (HR 1.25), anemia (HR per 1 g/dL Hb decrease 1.09), WBC (HR per 1000 WBC increase 1.02) and large mediastinal tumor (HR 1.54). Split into quintiles by predicted risk, observed 5-year PFS rates differed significantly (p<0.001): 80% of patients with early unfavorable stage HL achieved 5-year PFS rates ranging from 84% (95% CI 81%–87%) to 92% (95% CI 90%–94%) while 20% of patients had poor 5-year PFS, i.e. 76% (95% CI 73%–79%). Compared to low risk patients, those with high risk were more often male (81% vs 40%), older (median age 50 vs 29 years) and presented more often with B symptoms (62% vs 28%) and large mediastinal tumor (42% vs 27%). These data show that among stage I and II patients with at least one risk factor heterogeneity exists.
Conclusion: Using basic characteristics and routine tests, it is possible to identify a subgroup of early unfavorable stage patients with poor PFS while receiving 4–6 cycles of ABVD or similar chemotherapy plus radiotherapy. For these patients, treatment optimization is open to discussion in particular when compared to that of patients with advanced stage disease.
A Phase II Trial of FM (Oral Fludarabine and Mitoxantrone) Chemotherapy Followed by Yttrium 90 (90Y) Ibritumomab Tiuxetan (Zevalin®) for Previously Untreated Follicular Lymphoma (FL) Patients.
Authors: Zinzani Pier Luigi , Pulsoni Alessandro , Balocco Manuela , Tani Monica , Fanti Stefano , Perrotti Alessio , Castellucci Paolo , Zaja Francesco , Fabbri Alberto , Zaccaria Alfonso , Voso Maria Teresa , Fattori Pierpaolo , Guardigni Luciano , Gentilini Patrizia , Cabras Maria Giuseppina , De Renzo Amalia , Rigacci Luigi 
Published: October 2019

Abstract
We conducted a prospective, multicenter, single-arm, open-label, non-randomized, phase II study to evaluate the efficacy and safety of 90Y Ibritumomab Tiuxetan of a new approach combining induction chemotherapy with oral Fludarabine and Mitoxantrone (FM) followed by consolidation with 90Y Ibritumomab Tiuxetan for patients with previously untreated FL. Patient eligibility was represented by: age ≥ 18 years with biopsy-proven, untreated; stage II – IV FL grade I–II; WHO performance status of 0 to 2. All patients signed a written informed consent. Patients were treated with standard FM chemotherapy (Fludarabine was administered orally at the dose 40 mg/m2/day for 3 consecutive days) every 28 days for 6 cycles. Patients were restaged 4 to 8 weeks after completion of the sixth cycle of FM. Patients achieving at least a PR after 6 cycles of FM chemotherapy were eligible for consolidation with 90Y Ibritumomab Tiuxetan provided the granulocyte count was > 1500/μL, the platelet count >100.000/μL, lymphocytes expressing the CD20 antigen and the bone marrow examination at the completion of FM demonstrated < 25% involvement with lymphoma. All patients were to receive a single dose of 90Y Ibritumomab Tiuxetan 14.8 MBq/kg (0.4 mCi/kg) up to a maximum dose of 1184 MBq (32 mCi). At data reporting for this abstract, 62 patients were enrolled and 41 were evaluable for response. Of these 41 patients, all are evaluable for induction FM regimen and 19 of them also are evaluable after 90Y Ibritumomab Tiuxetan treatment. 15 were male and 26 female; the median age was 52.5 years (range 36–70); 5 were stage II, 12 stage III, and 24 stage IV. After the FM treatment the OR rate was 100%, including 73% complete remissions (CR + CRu) and 27% PR. Time to event analyses, including TTP and duration of response are pending further follow-up. Treatment was well tolerated; grade ≥ 3 AEs were seen in 20 patients; the most common grade ≥ 3 AEs was neutropenia. Among the actual 19 evaluable patients subsequentially treated with 90Y Ibritumomab Tiuxetan, 3/5 (60%) patients improved their remission status from PR to CR. The 90Y Ibritumomab Tiuxetan toxicity included grade ≥ 3 hematologic AEs in 12 patients. These preliminary data indicate: 1) FM regimen including oral fludarabine presents the same activity of i.v. formulation one without significant gastrointestinal toxicity and with a better patient compliance; 2) feasibility, tolerability, and efficacy of the FM plus 90Y Ibritumomab Tiuxetan regimen for untreated FL. Final efficacy and safety data will be presented.
Molecular Inhibition of mTOR with Temsirolimus (TORISEL™, CCI-779) Is a Promising Strategy in Relapsed NHL: The University of Chicago Phase II Consortium.
Authors: Smith Sonali M. , Pro Barbara , Smith Scott , Stiff Patrick , Lester Eric , Modi Sanjiv , Dancey Janet , Vokes Everett E. , van Besien Koen 
Published: October 2019

Abstract
Mammalian target of rapamycin (mTOR) is a highly conserved serine/threonine kinase positioned at the juncture of several signal transduction pathways frequently disrupted in cancer. Downstream effectors, S6KI and 4EBP1, regulate cell cycle kinetics and cell growth via translational modulation, and this is effectively halted by rapamycin. Temsirolimus (TORISEL™, CCI-779) is a rapamycin ester derivative with cell cycle inhibitory properties. We conducted a phase II study of temsirolimus 25 mg IV over 30 minutes weekly in three cohorts of patients with relapsed/refractory NHL: Group A (diffuse large B-cell lymphoma, DLCL), Group B (follicular lymphoma, FL), Group C (small lymphocytic lymphoma/chronic lymphocytic leukemia [SLL/CLL] and other indolent B-cell lymphomas). Correlative studies in primary tumor tissue and in peripheral blood samples include phosphorylated p70S6K, total and phosphorylated 4EBP1, PTEN status, p21 status, and p27 status. Forty patients are registered, of which 21 are evaluable for response. Six patients are inevaluable and 13 too early for response evaluation; all patients were included in toxicity evaluation. There were 22 males/18 females with a median age of 59 (range, 29–83). Primary tumor samples were collected in 10 patients, with biomarker analysis pending. Histologic subtypes include 7 DLCL, 14 FL, and 13 CLL/SLL. Of 21 evaluable patients for response, there were 3 complete remissions (all FL) and 5 partial remissions (1 DLCL, 3 FL, 1 SLL), for an overall response rate of 40%. An additional 10 patients (5 FL, 6 CLL/SLL) had minor responses or stable disease; only 3 pts had progressive disease as their best response. The median follow-up is 4 months (range, 1–15 months). Grade 1–2 non-hematologic toxicities (except where noted) include increased hepatic enzymes (10 pts), skin rash (13 pts), fatigue (18 pts; grade 3 in 2 pts), hypercholesterolemia (22 pts), hyperglycemia (21 pts; grade 3 in 1 pt), hypertriglyceridemia (20 pts; grade 3 in 1 pt). Six patients were removed from study due to pneumonitis; 4 of these patients were symptomatic (cough, fevers, dyspnea) and 2 were asymptomatic but had pulmonary abnormalities on staging CT scans. Grade 3 and 4 hematologic toxicities include thrombocytopenia (5 pts), lymphopenia (5 pts), and leucopenia (2 pts). In summary, temsirolimus shows preliminary but encouraging activity across multiple B-NHL subtypes, complementing the published activity in mantle cell lymphoma. Careful attention must be paid to pulmonary toxicity. However, the early activity, including disease regression and stabilization, suggests that future combinations with cytotoxics or other biologics may be warranted, and that mTOR inhibition in NHL is a promising strategy.
Preclinical In Vitro and In Vivo Evidence Support a Therapeutic Role for the CD70 Directed Monoclonal Antibody (SGN-70) in Waldenström’s Macroglobulinemia (WM).
Authors: Hatjiharissi Evdoxia , Ho Allen W. , Xu Lian , O’Connor Kelly E. , Hunter Zachary R. , Santos Daniel D. , Manning Robert , Leleu Xavier , Moreau Anne-Sophie , Patterson Christopher J. , McEarchern Julie A. , Law Che-Leung , Grewal Iqbal S. , Munshi Nikhil C. , Treon Steven P. 
Published: October 2019

Abstract
Introduction: WM is a B-cell disorder characterized by bone marrow (BM) infiltration of lymphoplasmacytic cells (LPC), along with excess mast cells (MC) which support the growth and survival of BM LPC through multiple TNF-family ligands including CD40L, APRIL and BLyS/BAFF. Importantly, BM LPC stimulate cell surface expression of TNF-family ligands through release of sCD27 which induces CD70 on MC. We therefore have sought the development of agents which could target CD27-CD70 interactions. As such, we examined the therapeutic potential of directly targeting CD70 using the fully humanized monoclonal antibody SGN-70 (Seattle Genetics, Inc., Bothell WA).
Methods-Results: As part of these studies, we used flow cytometric analysis to evaluate the expression of CD70 on primary WM patient BM LPC and MC, as well as 2 WM cell lines (BCWM.1 and WM-WSU). These studies demonstrated cell surface expression of CD70 on BM LPC and MC from 20/26 (77%) and 10/11 (90%) WM patients, respectively. We next assessed the ability of the SGN-70 antibody to eradicate primary WM LPC (n=5) and WM cell lines by assessing for direct induction of apoptosis, complement dependent cytotoxicity (CDC), antibody-dependent cell-mediated cytotoxicity (ADCC) as well as induction of TNF family ligands on primary WM MC and the LAD2 MC line. Following incubation of WM LPC with SGN-70 (0.01–20 μg/ml), no direct induction of apoptosis or CDC activity was observed. However, SGN-70 mediated significant dose-dependent ADCC against WM LPC and MC at concentrations of 0.1–20 ug/ml. Importantly, SGN-70 blocked sCD27-induced expression of CD40L and APRIL on primary WM MC and LAD2 MC. To further evaluate the therapeutic potential of SGN-70 in an in vivo model, SCID-hu mice bearing BCWM.1 WM cells were treated with SGN-70 (1 mg/kg, i.p., qOD) Serum human IgM and sCD27 levels were measured by ELISA to monitor for tumor engraftment and disease progression. SGN-70 initiated 6 weeks following tumor engraftment blocked tumor growth in 12/12 treated mice, whereas all 5 untreated mice demonstrated disease progression. The results of these studies provide the framework for clinical trials to examine the therapeutic potential of the SGN-70 monoclonal antibody in WM.
Long Term Clinical Benefit of Lenalidomide (Revlimid) Treatment in Patients with Myelodysplastic Syndrome without Del 5q Cytogenetic Abnormalities.
Authors: Raza Azra , Reeves James E. , Feldman Eric J. , Deeg H. Joachim , Dreisbach Luke , Schiffer Charles A. , Shammo Jamile M. , Klimek Virginia M. , Greenberg Peter L. , Bennett John M. , DeWald Gordon W. , Zeldis Jerome B. , Wride Kenton , Schmidt Michele , Knight Robert D. , List Alan F. 
Published: October 2019

Abstract
Background: MDSs are clonal hematopoietic stem cell malignancies characterized by cytopenias resulting from ineffective hematopoiesis. A phase 2 study of lenalidomide (MDS-002) demonstrated hematological improvement in patients with MDS without an associated deletion 5q cytogenetic abnormality (List AF, et al. Haematologica2006;91[suppl1]:379[abst 1032]). We now report multicenter results after 〉2 yrs follow-up.
Methods: A total of 214 pts with transfusion-dependent anemia were categorized into the following IPSS MDS risk groups after central review of bone marrow morphology, karyotype, and peripheral blood findings: Low/Int-1 (168 [78%]); Int-2/High (8 [4%]); and unclassified (38 [18%]). Patients were unclassified for missing or inadequate marrow studies for central review (morphology [29] or cytogenetic [7]) or other diagnoses (AML [1], atypical CML [1]). Patients were evaluated for frequency and duration of red blood cell transfusion independence (RBC-TI) (IWG criteria), hemoglobin (Hgb) response, and safety. The starting dose of lenalidomide was 10 mg (daily or daily × 3 wks q28d cycle).
Results: Overall, 56 (26%) of 214 enrolled patients achieved RBC-TI. Median time to RBC-TI was 5 wks, median duration of RBC-TI response was 41.0 wks (range, 8.0–136.4), and median Hgb increase achieved during RBC-TI was 3.2 g/dL (range, 1.0–9.8). An additional 36 patients experienced a ≥ 50% reduction in RBC transfusions (overall hematological improvement in 92 [43%] patients). Overall, 47 (22%) patients had an abnormal karyotype at baseline and 9 (19%) patients achieved a cytogenetic response (4 complete). The most common drug-related grade 3/4 adverse events (AEs) were neutropenia and thrombocytopenia (25% and 20%, respectively). Deep vein thrombosis occurred in only 2 (1%) patients. The duration of RBC-TI was ≥ 52 weeks in 21 (38%) patients. Among these 21 patients, 14 (67%) did not require a lenalidomide dose reduction during the first 52 weeks of treatment. Analyses of response variables will be presented. Dose-limiting neutropenia/thrombocytopenia was not reported after 52 weeks. The most commonly reported AEs after 52 weeks were mild-moderate diarrhea and fatigue (38% and 29%, respectively).
Conclusion: Lenalidomide is an active, well-tolerated treatment in MDS patients with transfusion-dependent anemia that is not associated with a deletion 5q abnormality. The rate of erythroid hematologic improvement and duration of RBC-TI is encouraging and offers a possible alternative to cytokine therapy.
Treatment with the Anti-CD20 Antibody (B1) and Irradiation Result in Synergistic Cytotoxicity That Is Dependent on MAPK Activation.
Authors: Ivanov Andrei , Cragg Mark S. , Illidge Tim M. 
Published: October 2019

Abstract
Radioimmunotherapy using radiolabeled anti-CD20 antibodies (mAb) is an effective new treatment in non-Hodgkin lymphoma with high response rates. However, the molecular mechanisms behind these impressive clinical responses are poorly understood. To elucidate these mechanisms we studied the signaling events evoked in a panel of lymphoma cell lines following treatment with anti-CD20 mAb alone or in combination with irradiation. In all three lymphoma cell-lines tested a synergistic cytotoxic effect was observed when the anti-CD20 mAb B1 was combined with irradiation. The additive effect seen with B1 mAb and radiation was not observed with Rituximab and could be reversed with MEK inhibitors U0126 and PD98059 as well as siRNA targeting MEK1 or 2. Moreover, addition of U0126 reversed the decrease in clonogenic survival triggered by treatment with B1 and irradiation. To further probe the mechanism of this synergistic cell death we used cell lines over-expressing BCL2 or crmA, to block mitochondrial and death receptor pathways, respectively. Although BCL2 and crmA over-expression mediated protection against radiation alone, it had no impact on the increased cytotoxicity induced by B1+irradiation. Morphological studies revealed gross vacuolization of the cytoplasm, yet relatively well preserved nuclei in cells treated with B1+irradiation. Taken together our data indicate that activation of the MAPK cascade is an important factor that contributes to the synergistic effect of anti-CD20 (B1) antibody and irradiation and provides important new insights into how this treatment may work in the clinic.