Long-Term Outcomes in Patients With Chronic Lymphocytic Leukemia Treated With Ibrutinib: Focus on Hypertension and Cardiovascular Toxicity

BACKGROUND: Continuous ibrutinib administration is needed to maintain efficacy in patients with chronic lymphocytic leukemia (CLL) and, as such, long-term toxicity is a concern. The authors report the 5-year follow-up of patients with CLL who received treatment with ibrutinib with a focus on hypertension and cardiovascular toxicities. METHODS: Patient characteristics were assessed, including blood pressure, cardiovascular disease, disease progression, and death. Univariate logistic regression analysis assessed the relation of patient characteristics and the development of new or worsened hypertension. The incidence of hypertensive outcomes was evaluated using competing risk. Survival was estimated using the Kaplan-Meier method. RESULTS: Three hundred patients with CLL who were treated with ibrutinib on clinical trials were included. The median patient age at study enrollment was 65 years (range, 29-83 years). Seventy percent of patients were men, and 88% were Caucasian. Sixty-nine percent of patients had hypertension at baseline, and 47% were on antihypertensive medication. Eighty-eight percent had relapsed or refractory CLL. New-onset and worsening hypertension were common, occurring in 68.5% and 38% of patients, respectively. Systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg was observed in 16.9% of patients. Hypertension was reversible after ibrutinib discontinuation. Older age, male sex, tobacco use, and chronic kidney disease were associated with ibrutinib-related hypertension. Baseline hypertension was not associated with major adverse cardiovascular events in ibrutinib-treated patients nor with event-free or overall survival. CONCLUSIONS: Hypertension is a common toxicity in patients with CLL who receive ibrutinib but is manageable in most patients. Other than chronic kidney disease, baseline cardiovascular disease did not affect ibrutinib-related hypertension nor was hypertension associated with major adverse cardiovascular events or survival. PLAIN LANGUAGE SUMMARY: Ibrutinib is an effective treatment for patients with chronic lymphocytic leukemia. Ibrutinib is a well tolerated therapy, however hypertension can develop or worsen in patients receiving ibrutinib and other cardiovascular events are significant challenges to the use of this drug. This may be particularly true in patients with heart disease. Short-term side effects may worsen heart disease, but the long-term impact is unknown. The long-term results of ibrutinib on heart disease and hypertension are described

Reverse Phase Protein Array Profiling Identifies Recurrent Protein Expression Patterns of DNA Damage-Related Proteins across Acute and Chronic Leukemia: Samples from Adults and the Children\u27s Oncology Group

DNA damage response (DNADR) recognition and repair (DDR) pathways affect carcinogenesis and therapy responsiveness in cancers, including leukemia. We measured protein expression levels of 16 DNADR and DDR proteins using the Reverse Phase Protein Array methodology in acute myeloid (AML) (n = 1310), T-cell acute lymphoblastic leukemia (T-ALL) (n = 361) and chronic lymphocytic leukemia (CLL) (n = 795) cases. Clustering analysis identified five protein expression clusters; three were unique compared to normal CD34+ cells. Individual protein expression differed by disease for 14/16 proteins, with five highest in CLL and nine in T-ALL, and by age in T-ALL and AML (six and eleven proteins, respectively), but not CLL (n = 0). Most (96%) of the CLL cases clustered in one cluster; the other 4% were characterized by higher frequencies of deletion 13q and 17p, and fared poorly (p \u3c 0.001). T-ALL predominated in C1 and AML in C5, but both occurred in all four acute-dominated clusters. Protein clusters showed similar implications for survival and remission duration in pediatric and adult T-ALL and AML populations, with C5 doing best in all. In summary, DNADR and DDR protein expression was abnormal in leukemia and formed recurrent clusters that were shared across the leukemias with shared prognostic implications across diseases, and individual proteins showed age- and disease-related differences

A Comparative Study of Different Methodologies for Fault Diagnosis in Multivariate Quality Control

Different methodologies for fault diagnosis in multivariate quality control have been proposed in recent years. These methods work in the space of the original measured variables and have performed reasonably well when there is a reduced number of mildly correlated quality and/or process variables with a well-conditioned covariance matrix. These approaches have been introduced by emphasizing their positive or negative virtues, generally on an individual basis, so it is not clear for the practitioner the best method to be used. This paper provides a comprehensive study of the performance of diverse methodological approaches when tested on a large number of distinct simulated scenarios. Our primary aim is to highlight key weaknesses and strengths in these methods as well as clarifying their relationships and the requirements for their implementation in practice.Vidal Puig, S.; Ferrer, A. (2014). A Comparative Study of Different Methodologies for Fault Diagnosis in Multivariate Quality Control. Communications in Statistics - Simulation and Computation. 43(5):986-1005. doi:10.1080/03610918.2012.720745S9861005435Arteaga, F., & Ferrer, A. (2010). How to simulate normal data sets with the desired correlation structure. Chemometrics and Intelligent Laboratory Systems, 101(1), 38-42. doi:10.1016/j.chemolab.2009.12.003Doganaksoy, N., Faltin, F. W., & Tucker, W. T. (1991). Identification of out of control quality characteristics in a multivariate manufacturing environment. Communications in Statistics - Theory and Methods, 20(9), 2775-2790. doi:10.1080/03610929108830667Fuchs, C., & Benjamini, Y. (1994). Multivariate Profile Charts for Statistical Process Control. Technometrics, 36(2), 182-195. doi:10.1080/00401706.1994.10485765Hawkins, D. M. (1991). Multivariate Quality Control Based on Regression-Adiusted Variables. Technometrics, 33(1), 61-75. doi:10.1080/00401706.1991.10484770Editorial Board. (2007). Computational Statistics & Data Analysis, 51(8), iii-v. doi:10.1016/s0167-9473(07)00125-9Hayter, A. J., & Tsui, K.-L. (1994). Identification and Quantification in Multivariate Quality Control Problems. Journal of Quality Technology, 26(3), 197-208. doi:10.1080/00224065.1994.11979526HOCHBERG, Y. (1988). A sharper Bonferroni procedure for multiple tests of significance. Biometrika, 75(4), 800-802. doi:10.1093/biomet/75.4.800HOMMEL, G. (1988). A stagewise rejective multiple test procedure based on a modified Bonferroni test. Biometrika, 75(2), 383-386. doi:10.1093/biomet/75.2.383Kourti, T., & MacGregor, J. F. (1996). Multivariate SPC Methods for Process and Product Monitoring. Journal of Quality Technology, 28(4), 409-428. doi:10.1080/00224065.1996.11979699Li, J., Jin, J., & Shi, J. (2008). Causation-BasedT2Decomposition for Multivariate Process Monitoring and Diagnosis. Journal of Quality Technology, 40(1), 46-58. doi:10.1080/00224065.2008.11917712Mason, R. L., Tracy, N. D., & Young, J. C. (1995). Decomposition ofT2 for Multivariate Control Chart Interpretation. Journal of Quality Technology, 27(2), 99-108. doi:10.1080/00224065.1995.11979573Mason, R. L., Tracy, N. D., & Young, J. C. (1997). A Practical Approach for Interpreting Multivariate T2 Control Chart Signals. Journal of Quality Technology, 29(4), 396-406. doi:10.1080/00224065.1997.11979791Murphy, B. J. (1987). Selecting Out of Control Variables With the T 2 Multivariate Quality Control Procedure. The Statistician, 36(5), 571. doi:10.2307/2348668Rencher, A. C. (1993). The Contribution of Individual Variables to Hotelling’s T 2 , Wilks’ Λ, and R 2. Biometrics, 49(2), 479. doi:10.2307/2532560Roy, J. (1958). Step-Down Procedure in Multivariate Analysis. The Annals of Mathematical Statistics, 29(4), 1177-1187. doi:10.1214/aoms/1177706449Runger, G. C., Alt, F. B., & Montgomery, D. C. (1996). Contributors to a multivariate statistical process control chart signal. Communications in Statistics - Theory and Methods, 25(10), 2203-2213. doi:10.1080/03610929608831832Sankoh, A. J., Huque, M. F., & Dubey, S. D. (1997). Some comments on frequently used multiple endpoint adjustment methods in clinical trials. Statistics in Medicine, 16(22), 2529-2542. doi:10.1002/(sici)1097-0258(19971130)16:223.0.co;2-jTukey, J. W., Ciminera, J. L., & Heyse, J. F. (1985). Testing the Statistical Certainty of a Response to Increasing Doses of a Drug. Biometrics, 41(1), 295. doi:10.2307/253066

Photoswitchable diacylglycerols enable optical control of protein kinase C.

Increased levels of the second messenger lipid diacylglycerol (DAG) induce downstream signaling events including the translocation of C1-domain-containing proteins toward the plasma membrane. Here, we introduce three light-sensitive DAGs, termed PhoDAGs, which feature a photoswitchable acyl chain. The PhoDAGs are inactive in the dark and promote the translocation of proteins that feature C1 domains toward the plasma membrane upon a flash of UV-A light. This effect is quickly reversed after the termination of photostimulation or by irradiation with blue light, permitting the generation of oscillation patterns. Both protein kinase C and Munc13 can thus be put under optical control. PhoDAGs control vesicle release in excitable cells, such as mouse pancreatic islets and hippocampal neurons, and modulate synaptic transmission in Caenorhabditis elegans. As such, the PhoDAGs afford an unprecedented degree of spatiotemporal control and are broadly applicable tools to study DAG signaling