Ibrutinib impairs the phagocytosis of rituximab-coated leukemic cells from chronic lymphocytic leukemia patients by human macrophages

We have read with great interest the recent article of Kohrt, H.E. et al1 showing that Ibrutinib prevented NK cell mediated cytotoxicity of antibody-coated CLL cells in vitro. They also found that the concurrent treatment with Ibrutinib and rituximab or trastuzumab reduces the therapeutic efficacy of both anti-CD20 antibodies in a mouse model, while the sequential treatment with Ibrutinib and rituximab restored its anti-lymphoma activity. Since macrophages are the most important effector cells in CD20-directed cytotoxicity in murine models2,3 and they probably play a key role in human anti-CD20 therapy4,5, we determined whether Ibrutinib interferes the capacity of human macrophages to mediate phagocytosis of rituximab-coated CLL cells. To address this issue, macrophages differentiated from healthy peripheral blood monocytes were treated with or without Ibrutinib for 30 minutes and then cultured for 1, 2 or 3 hours with CFSE-labeled CLL cells or rituximab-coated CFSE-labeled CLL cells. Then, cells were tripsinized and the proportion of macrophages that have taken up CFSE-labeled CLL cells (CFSE+ macrophages) were scored by flow cytometry and verified using confocal microscopy, as previously described6. As expected, we found that the cultures with rituximab-coated CLL cells showed the highest percentage of CFSE+ macrophages, which increase in a time dependent manner (open circles in Figure 1A). Ibrutinib was able to reduce these values in all the times evaluated (solid circles in Figure 1A). Low percentages of CFSE+ macrophages were obtained in cultures with uncoated CLL cells, which were not modified by Ibrutinib (open and solid squares in Figure 1A). In addition, we found that Ibrutinib diminishes the percentage of CFSE+ macrophages in the cultures with rituximab-coated cells in a dose dependent manner (Figure 1B), which was not associated to a decreased viability of the macrophages (not shown). Moreover, the inhibitory effect of Ibrutinib was not limited to rituximab since comparable results were obtained when campath-coated CFSE-labeled CLL cells were employed (Figure 1C). Similar results were found when macrophages from CLL patients were used: mean±SE of the % of CFSE+ macrophages: 26.8 ± 2.1 vs, 17.3 ± 2.7 vs 10.8 ± 0.7 for rituximab-coated CFSE-labeled CLL cells alone, with 0.5μM or 5μM of Ibrutinib (n= 6). Representative dot plots are shown in Figure 1D. The results obtained by flow cytometry analysis were validated by confocal microscopy quantifying the number of macrophages that engulfed at least one tumor target cell (Figure 1E). A representative experiment is shown in Figure 1F. In addition, by performing a binding assay at 4oC, we confirmed that Ibrutinib did not reduce the binding of rituximab-coated CFSE-labeled CLL cells to macrophages (Figure 1G). Interestingly, while the presence of Ibrutinib during the assay impairs the phagocytosis of rituximab-coated CLL cells, when Ibrutinib was washed out, macrophages recovered their phagocytic capacity in a time-dependent manner (Figure 1H). In conclusion we found that the presence of Ibrutinib impairs the phagocytosis of rituximab-opsonized CLL cells by human macrophages, which was restored when the inhibitor was removed from the cultures. Our results, and those obtained by Kohrt et al1 suggest that the sequential administration of Ibrutinib followed by rituximab, and not the concurrent treatment of the patients with these agents, might enhance their anti-tumor activity in vivo.Fil: Borge, Mercedes. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Almejún, María Belén. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Cátedra de Microbiología, Parasitología e Inmunología; ArgentinaFil: Podaza, Enrique Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Colado, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Fernández Grecco, Horacio. Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Cabrejo, María. Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos ; ArgentinaFil: Giordano, Mirta Nilda. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentin

Neutrophils from chronic lymphocytic leukemia patients exhibit an increased capacity to release extracellular traps (NETs)

Chronic lymphocytic leukemia (CLL) is characterized by immune defects that contribute to a high rate of infections and autoimmune cytopenias. Neutrophils are the first line of innate immunity and respond to pathogens through multiple mechanisms, including the release of neutrophil extracellular traps (NETs). These web-like structures composed of DNA, histones, and granular proteins are also produced under sterile conditions and play important roles in thrombosis and autoimmune disorders. Here we show that neutrophils from CLL patients are more prone to release NETs compared to those from age-matched healthy donors (HD). Increased generation of NETs was not due to higher levels of elastase, myeloperoxidase, or reactive oxygen species production. Instead, we found that plasma from CLL patients was able to prime neutrophils from HD to generate higher amounts of NETs upon activation. Plasmatic IL-8 was involved in the priming effect since its depletion reduced plasma capacity to enhance NETs release. Finally, we found that culture with NETs delayed spontaneous apoptosis and increased the expression of activation markers on leukemic B cells. Our study provides new insights into the immune dysregulation in CLL and suggests that the chronic inflammatory environment typical of CLL probably underlies this inappropriate neutrophil priming.Fil: Podaza, Enrique Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Sabbione, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Risnik, Denise Mariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Almejún, María Belén. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Fisiología, Biología Molecular y Celular; ArgentinaFil: Colado, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Fernández Grecco, Horacio. Servicio de Hematología, Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Cabrejo, María del Rosario. Servicio de Hematología, Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Bezares, Raimundo F.. Servicio de Hematología, Hospital Municipal Dr. Teodoro Alvarez; ArgentinaFil: Trevani, Analía Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Expression and function of cathelicidin hCAP18/LL-37 in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of clonal Bcellsin peripheral blood and lymphoid tissues 1. Circulating CLL cells are non-dividing Blymphocytes, but a significant fraction of the clone proliferates in lymphoid tissues wherethey receive a plethora of signals from the microenvironment that promote their survivaland expansion 2. Cathelicidins are a family of proteins with antibacterial functions mainlyexpressed by neutrophils, macrophages and epithelial cells 3. In humans, the only memberof this family, hCAP18, is encoded by the gene CAMP. The cleavage of hCAP18 generatesthe antimicrobial peptide LL-37, which has been recently implicated in the promotion oftumor growth, through direct stimulation of malignant cells, initiation of angiogenesis andrecruitment of immune cells 4. In this study, we investigated the role of hCAP18/LL-37 inCLL.Fil: Podaza, Enrique Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Palacios, Florencia. The Feinstein Institute for Medical Research. Karches Center for Oncology Research; Estados UnidosFil: Croci Russo, Diego Omar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; ArgentinaFil: Risnik, Denise Mariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Yan, Xiao J.. The Feinstein Institute for Medical Research. Karches Center for Oncology Research; Estados UnidosFil: Almejún, María Belén. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Colado, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Elías, Esteban Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Morande, Pablo Elías. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Fernández Grecco, Horacio. Sanatorio Municipal Dr. Julio Méndez. Servicio de Hematología; ArgentinaFil: Rabinovich, Gabriel Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Chiorazzi, Nicholas. The Feinstein Institute for Medical Research. Karches Center for Oncology Research; Estados UnidosFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Síndromes linfoproliferativos crónicos

El objetivo de la presente guía es confeccionar pautas de diagnóstico y tratamiento de los síndromes linfoproliferativos, teniendo en cuenta las recomendaciones de expertos así como las publicaciones internacionales relacionadas al tema, la disponibilidad de recursos locales y la experiencia de los especialistas convocados. La misma contempla: establecer pautas diagnósticas, clasificar y establecer factores pronósticos, unificar recomendaciones terapéuticas y contribuir a la toma de decisiones terapéuticas.Fil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Bistmas, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Cabrejo, María del Rosario. Sanatorio Méndez; ArgentinaFil: Custidiano, Rosario. Instituto Alexander Fleming.; ArgentinaFil: Dupont, Juan. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Ferini, Gonzalo. Hospital Italiano; ArgentinaFil: Fernandez Grecco, Horacio. No especifíca;Fil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Kornblihtt, Laura Inés. Hospital de Clínicas, Uba; ArgentinaFil: Kruss, Mariana. Hospital Italiano; ArgentinaFil: Miroli, Augusto. Hospital Italiano; ArgentinaFil: Pavlovsky, Miguel A.. Fundación Para Combatir la Leucemia; ArgentinaFil: Riveros, Dardo Alberto. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Rodríguez, Cecilia. Gobierno de la Provincia de Cordoba. Hospital de Clinicas.; ArgentinaFil: Slavutsky, Irma Rosa. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Revisiting the role of interleukin-8 in chronic lymphocytic leukemia

Abstract The proliferation and survival of malignant B cells in chronic lymphocytic leukemia (CLL) depend on signals from the microenvironment in lymphoid tissues. Among a plethora of soluble factors, IL-8 has been considered one of the most relevant to support CLL B cell progression in an autocrine fashion, even though the expression of IL-8 receptors, CXCR1 and CXCR2, on leukemic B cells has not been reported. Here we show that circulating CLL B cells neither express CXCR1 or CXCR2 nor they respond to exogenous IL-8 when cultured in vitro alone or in the presence of monocytes/nurse-like cells. By intracellular staining and ELISA we show that highly purified CLL B cells do not produce IL-8 spontaneously or upon activation through the B cell receptor. By contrast, we found that a minor proportion (<0.5%) of contaminating monocytes in enriched suspensions of leukemic cells might be the actual source of IL-8 due to their strong capacity to release this cytokine. Altogether our results indicate that CLL B cells are not able to secrete or respond to IL-8 and highlight the importance of methodological details in in vitro experiments

The Expression of Sphingosine-1 Phosphate Receptor-1 in Chronic Lymphocytic Leukemia Cells Is Impaired by Tumor Microenvironmental Signals and Enhanced by Piceatannol and R406

Chronic lymphocytic leukemia (CLL) is characterized by the progressive accumulation of clonal B lymphocytes. Proliferation occurs in lymphoid tissues upon interaction of leukemic cells with a supportive microenvironment. Therefore, the mobilization of tissue-resident CLL cells into the circulation is a useful therapeutic strategy to minimize the reservoir of tumor cells within survival niches. Because the exit of normal lymphocytes from lymphoid tissues depends on the presence of sphingosine-1 phosphate (S1P) and the regulated expression of S1P receptor-1 (S1PR1), we investigated whether the expression and function of S1PR1 can be modulated by key microenvironment signals. We found that activation of CLLcells with CXCL12, fibroblast CD40L(+), BCR cross-linking, or autologous nurse-like cells reduces their S1PR1 expression and the migratory response toward S1P. Moreover, we found that S1PR1 expression was reduced in the proliferative/activated subset of leukemic cells compared with the quiescent subset from the same patient. Similarly, bone marrow-resident CLL cells expressing high levels of the activation marker CD38 showed a lower expression of S1PR1 compared with CD38(low) counterparts. Finally, given that treatment with BCR-associated kinase inhibitors induces a transient redistribution of leukemic cells from lymphoid tissues to circulation, we studied the effect of the Syk inhibitors piceatannol and R406 on S1PR1 expression and function. We found that they enhance S1PR1 expression in CLL cells and their migratory response toward S1P. Based on our results, we suggest that the regulated expression of S1PR1 might modulate the egress of the leukemic clone from lymphoid tissues.Fil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Remes Lenicov, Federico. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Nannini, Paula Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Alicandú, María M. de los Ríos. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Podaza, Enrique Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Ceballos, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Fernandez Grecco, Horacio. Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Cabrejo, María. Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Morande, Pablo Elías. Instituto Pasteur de Montevideo; Uruguay. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Oppezzo, Pablo. Instituto Pasteur de Montevideo; UruguayFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Second generation BTK inhibitors impair the anti-fungal response of macrophages and neutrophils

BTK inhibitors (BTKi) play a major role in the treatment of Chronic Lymphocytic Leukemia (CLL). Ibrutinib, the first in class BTKi, impairs macrophage and neutrophil functions and also cell-mediated effector mechanisms of action of anti-CD20 mAb. Acalabrutinib, recently approved for CLL treatment, and spebrutinib, are second generation BTKi with greater selectivity for BTK. Because ibrutinib was linked with fungal invasive infections, we aimed to evaluate the effect of second generation BTKi on macrophage and neutrophil response to fungi. We found that acalabrutinib impaired macrophage M1-polarization and their response to C. albicans and A. fumigatus as reported for ibrutinib, while spebrutinib showed a milder inhibition. On the other hand, neutrophil activation in response to C. albicans and A. fumigatus were strongly and comparably inhibited by the three BTKi. These results show that second generation BTKi also have detrimental effects on macrophages and neutrophils that may impair the anti-microbial innate-immune response. We found that the anti-CD20 mAb mechanism of action mediated by macrophages was not inhibited by second generation BTKi, while that mediated by NK cells was impaired by spebrutinib. The lower interference of second generation BTKi with anti-CD20 mAb suggests they represent a better option for combination therapy.Fil: Colado, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Marin Franco, Jose Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Elías, Esteban Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Amondarain, Mikele. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Vergara Rubio, Maricef. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Universidad de los Andes; VenezuelaFil: Sarapura Martínez, Valeria Judith. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Cordini, Gregorio. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Fuentes, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Balboa, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Fernández Grecco, Horacio. Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Pavlovsky, Miguel. Fundación Para Combatir la Leucemia; ArgentinaFil: Bezares, Raimundo F.. Hospital General de Agudos Dr. Teodoro Álvarez; ArgentinaFil: Morande, Pablo Elías. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

PET-adapted therapy after three cycles of ABVD for all stages of Hodgkin lymphoma: results of the GATLA LH-05 trial

The role of Ann Arbor staging in determining treatment intensity after achieving a negative positron emission tomography (PET) has not been established in classical Hodgkin lymphoma (cHL). Patients with stage I–IV cHL, received three cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and an interim PET scan (PET3). PET3-negative patients received no further therapy. PET3-positive patients received three additional cycles of ABVD plus involved-field radiation therapy or salvage chemotherapy, if refractory to ABVD, and were re-evaluated by PET scan (PET6). Study endpoints were 3-year progression-free survival (PFS) and overall survival (OS) rates. Two hundred and thirty-nine patients with early-stage and 138 with advanced-stage were evaluable. Overall, 260 patients (70%) were PET3-negative and had higher 3-year PFS (90% vs. 65%; P < 0 0001) and OS (98% vs. 92%; P = 0 007) rates than PET3-positive patients. All PET3-negative patients, regardless of disease stage at diagnosis, achieved similarly good PFS (90–91%; P = 0 76) and OS (97–99%). The only independent prognostic factor for PFS was PET3-negativity (Hazard ratio 3 8; 95% confidence interval 2 4–6 3; P < 0 0001). This study suggests that cHL patients who achieve a negative PET3 following ABVD have an excellent outcome, regardless of stage at diagnosis. An appropriately powered, phase III trial will be necessary to confirm these findings.Fil: Pavlovsky, Astrid. Fundación Para Combatir la Leucemia; Argentina. Centro de Hematología Pavlovsky; ArgentinaFil: Fernández, Isolda. Fundación Para Combatir la Leucemia; Argentina. Centro de Hematología Pavlovsky; ArgentinaFil: Kurgansky, Nicolas. Doctus; ArgentinaFil: Prates, Virginia. Hospital Italiano de La Plata; ArgentinaFil: Zoppegno, Lucia. Hospital General San Martín; ArgentinaFil: Negri, Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Privado de Hematología y Hemoterapia; ArgentinaFil: Milone, Gustavo. Fundación Para Combatir la Leucemia; ArgentinaFil: Cerutti, Ider. Idhea Clinica Hematologica Dr Cerutti Ider; ArgentinaFil: Zabaljauregui, Soledad. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Mariano, Romina. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Grecco, Horacio F.. Sanatorio Dr. Julio Méndez; ArgentinaFil: Basquiera, Ana Lisa. Hospital Privado Universitario de Cordoba.; ArgentinaFil: Saba, Silvia. Hospital Rodolfo Rossi; ArgentinaFil: Rudoy, Silvia. Clínica Modelo de Morón; ArgentinaFil: Sackmann, Federico. Fundación Para Combatir la Leucemia; ArgentinaFil: Castano, Vanesa. Idhea Clinica Hematologica Dr Cerutti Ider; ArgentinaFil: Remaggi, Guillermina. Fundación Para Combatir la Leucemia; ArgentinaFil: Cabrejo, María del Rosario. Sanatorio Dr. Julio Méndez; ArgentinaFil: Roveri, Eriberto. Idhea Clinica Hematologica Dr Cerutti Ider; ArgentinaFil: Casale, María Florencia. Instituto Privado de Hematología y Hemoterapia; Argentina. Hospital General Centeno; ArgentinaFil: Cabane, Vanina. Clínica Dr. Roberto Raña; ArgentinaFil: Taus, Rossana. Hospital Rodolfo Rossi; ArgentinaFil: Venturini, Claudia. Instituto Privado de Hematología y Hemoterapia; ArgentinaFil: Sakamoto, Francisco. Instituto Privado de Hematología y Hemoterapia; ArgentinaFil: Varela, Ana I.. Sanatorio Las Lomas Sociedad Anonima.; ArgentinaFil: Riddick, Maximiliano Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Departamento de Matemáticas; ArgentinaFil: Pavlovsky, Santiago. Fundación Para Combatir la Leucemia; Argentin