The combination of FLT3 and DNA methyltransferase inhibition is synergistically cytotoxic to FLT3/ITD acute myeloid leukemia cells

Effective treatment regimens for elderly acute myeloid leukemia (AML) patients harboring internal tandem duplication mutations in the FMS-like tyrosine kinase-3 (FLT3) gene (FLT3/ITD) are lacking and represent a significant unmet need. Recent data on the effects of FLT3 tyrosine kinase inhibitors on FLT3/ITD+ AML showed promising clinical activity, including in elderly patients. DNA methyltransferase (DNMT) inhibitors such as decitabine (5-aza-2-deoxycytidine, DEC) and 5-azacitidine (AZA) demonstrated clinical benefit in AML, are well tolerated and are associated with minimal increases in FLT3 ligand, which can represent a potential resistance mechanism to FLT3 inhibitors. In addition, both FLT3 and DNMT inhibition are associated with the induction of terminal differentiation of myeloid blasts. Consequently, there is a strong theoretical rationale for combining FLT3 and DNMT inhibition for FLT3/ITD+ AML. We therefore sought to study the anti-leukemic effects of DEC, AZA and FLT3 inhibitors, either as single agents or in combination, on AML cell lines and primary cells derived from newly diagnosed and relapsed AML patients. Our studies indicate that combined treatment using FLT3 inhibition and hypomethylation confers synergistic anti-leukemic effects, including apoptosis, growth inhibition and differentiation. The simultaneous administration of AZA and FLT3 inhibition appears to be the most efficacious combination in this regard. These drugs may provide a novel therapeutic approach for FLT3/ITD+ AML, in particular for older patients

Monomorphic post-transplant lymphoproliferative disorder of the tongue: case report and review of literature

<p>Abstract</p> <p>Background</p> <p>Post-transplant lymphoproliferative disorder (PTLD) is a spectrum of hematological diseases arising in context of immunosuppression after organ transplantation. PTLD can involve any organ; however, it is extremely rare in oral cavity.</p> <p>Methods</p> <p>Using morphologic and immunophenotypic approaches we have studied a case of monomorphic PTLD of the tongue that developed in a patient following unilateral kidney and pancreas transplantation on immunosuppressive therapy. Additionally, cases of PTLD in the oral cavity were reviewed in the English literature.</p> <p>Results</p> <p>The neoplasm showed large cell morphology and B-cell phenotype. In situ hybridization for Epstein-Barr virus was positive. Complete remission was obtained after decreasing immunosuppressive therapy. The patient remained in remission at 790 days' follow up.</p> <p>Conclusion</p> <p>This rare case increased our awareness of PTLD in the oral cavity of patients following solid organ transplantation and immunosuppressive therapy.</p

Association of acute myeloid leukemias most immature phenotype with risk groups and outcomes

The precise phenotype and biology of acute myeloid leukemia stem cells remain controversial, in part because the “gold standard” immunodeficient mouse engraftment assay fails in a significant fraction of patients and identifies multiple cell-types in others. We sought to analyze the clinical utility of a novel assay for putative leukemia stem cells in a large prospective cohort. The leukemic clone’s most primitive hematopoietic cellular phenotype was prospectively identified in 109 newly-diagnosed acute myeloid leukemia patients, and analyzed against clinical risk groups and outcomes. Most (80/109) patients harbored CD34+CD38− leukemia cells. The CD34+CD38− leukemia cells in 47 of the 80 patients displayed intermediate aldehyde dehydrogenase expression, while normal CD34+CD38− hematopoietic stem cells expressed high levels of aldehyde dehydrogenase. In the other 33/80 patients, the CD34+CD38− leukemia cells exhibited high aldehyde dehydrogenase activity, and most (28/33, 85%) harbored poor-risk cytogenetics or FMS-like tyrosine kinase 3 internal tandem translocations. No CD34+ leukemia cells could be detected in 28/109 patients, including 14/21 patients with nucleophosmin-1 mutations and 6/7 acute promyelocytic leukemia patients. The patients with CD34+CD38− leukemia cells with high aldehyde dehydrogenase activity manifested a significantly lower complete remission rate, as well as poorer event-free and overall survivals. The leukemic clone’s most immature phenotype was heterogeneous with respect to CD34, CD38, and ALDH expression, but correlated with acute myeloid leukemia risk groups and outcomes. The strong clinical correlations suggest that the most immature phenotype detectable in the leukemia might serve as a biomarker for “clinically-relevant” leukemia stem cells. ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01349972","term_id":"NCT01349972"}}NCT01349972

Colorectal cancer in patients of advanced age is associated with increased incidence of BRAF p.V600E mutation and mismatch repair deficiency

IntroductionThe highest incidence of colorectal cancer (CRC) is in patients diagnosed at 80 years or older highlighting a need for understanding the clinical and molecular features of these tumors. Methods. In this retrospective cohort study, 544 CRCs underwent next generation sequencing and mismatch repair (MMR) evaluation. Molecular and clinical features were compared between 251 patients with traditional-onset CRC (50-69 years at diagnosis) and 60 with late-onset CRC (&gt;80 years at diagnosis).ResultsLate-onset CRC showed a significantly higher rate of right-sided tumors (82% vs 35%), MMR deficiency (35% vs. 8%) and BRAF p.V600E mutations (35% vs. 8%) and a significantly lower rate of stage IV disease (15% vs 28%) and APC mutations (52% vs. 78%). Association of these features with advanced age was supported by stratifying patients into 6 age groups (&lt;40, 40-49, 50-59, 60-69, 70-79 and &gt;80 years). However, the age-related rise in MMR deficient (dMMR) CRC was only seen in the female patients with an incidence of 48% (vs. 10% in the male patient) in the &gt;80y group. In addition, BRAF p.V600E was significantly enriched in MMR deficient CRC of advanced age (67% in late-onset CRC). Categorizing CRC by mutational profiling, late-onset CRC revealed a significantly higher rate of dMMR/BRAF+APC- (18% vs. 2.0%), dMMR/BRAF-APC- (8.3% vs. 1.2%) and MMR proficient (pMMR)/BRAF+APC- (12% vs. 4.0%) as compared to traditional-onset CRC.DiscussionIn summary, there was a higher rate of dMMR and BRAF p.V600E in late-onset CRC, independently or in combination. The higher incidence of dMMR in late-onset CRC in females is most likely predominantly driven by BRAF p.V600E induced hypermethylation. Prospective studies with treatment plans designed specifically for these older patients are warranted to improve their outcomes

Searches for lepton-flavour-violating decays of the Higgs boson into eτ and μτ in \sqrt{s} = 13 TeV pp collisions with the ATLAS detector

Abstract This paper presents direct searches for lepton flavour violation in Higgs boson decays, H → eτ and H → μτ, performed using data collected with the ATLAS detector at the LHC. The searches are based on a data sample of proton-proton collisions at a centre-of-mass energy s $$\sqrt{s}$$ = 13 TeV, corresponding to an integrated luminosity of 138 fb−1. Leptonic (τ → ℓνℓντ) and hadronic (τ → hadrons ντ) decays of the τ-lepton are considered. Two background estimation techniques are employed: the MC-template method, based on data-corrected simulation samples, and the Symmetry method, based on exploiting the symmetry between electrons and muons in the Standard Model backgrounds. No significant excess of events is observed and the results are interpreted as upper limits on lepton-flavour-violating branching ratios of the Higgs boson. The observed (expected) upper limits set on the branching ratios at 95% confidence level, B $$\mathcal{B}$$ (H → eτ) < 0.20% (0.12%) and B $$\mathcal{B}$$ (H → μτ ) < 0.18% (0.09%), are obtained with the MC-template method from a simultaneous measurement of potential H → eτ and H → μτ signals. The best-fit branching ratio difference, B $$\mathcal{B}$$ (H → μτ) → B $$\mathcal{B}$$ (H → eτ), measured with the Symmetry method in the channel where the τ-lepton decays to leptons, is (0.25 ± 0.10)%, compatible with a value of zero within 2.5σ

Measurement of the polarisation of W bosons produced in top-quark decays using dilepton events at root s=13 TeV with the ATLAS experiment

A measurement of the polarisation of $W$ bosons produced in top-quark decays is presented, using proton-proton collision data at a centre-of-mass energy of $\sqrt{s} = 13$ TeV. The data were collected by the ATLAS detector at the Large Hadron Collider and correspond to an integrated luminosity of 139 fb$^{-1}$. The measurement is performed selecting $t\bar{t}$ events decaying into final states with two charged leptons (electrons or muons) and at least two $b$-tagged jets. The polarisation is extracted from the differential cross-section distribution of the $\cos{\theta^{*}}$ variable, where $\theta^{*}$ is the angle between the momentum direction of the charged lepton from the $W$ boson decay and the reversed momentum direction of the $b$-quark from the top-quark decay, both calculated in the $W$ boson rest frame. Parton-level results, corrected for the detector acceptance and resolution, are presented for the $\cos{\theta^{*}}$ angle. The measured fractions of longitudinal, left- and right-handed polarisation states are found to be $f_{0} = 0.684 \pm 0.005\,\mathrm{(stat.)} \pm 0.014\,\mathrm{(syst.)}$, $f_{\mathrm{L}} = 0.318 \pm 0.003\,\mathrm{(stat.)} \pm 0.008\,\mathrm{(syst.)}$ and $f_{\mathrm{R}} = -0.002 \pm 0.002\,\mathrm{(stat.)} \pm 0.014\,\mathrm{(syst.)}$, in agreement with the Standard Model prediction

Measurement of the charge asymmetry in top-quark pair production in association with a photon with the ATLAS experiment

A measurement of the charge asymmetry in top-quark pair (tt ̄) production in association with a photon is presented. The measurement is performed in the single-lepton tt ̄ decay channel using proton–proton collision data collected with the ATLAS detector at the Large Hadron Collider at CERN at a centre-of-mass-energy of 13 TeV during the years 2015–2018, corresponding to an integrated luminosity of 139 fb−1. The charge asymmetry is obtained from the distribution of the difference of the absolute rapidities of the top quark and antiquark using a profile likelihood unfolding approach. It is measured to be AC=−0.003±0.029 in agreement with the Standard Model expectation

Measurement of the total and differential Higgs boson production cross-sections at √s = 13 TeV with the ATLAS detector by combining the H → ZZ * → 4ℓ and H → γγ decay channels

The total and differential Higgs boson production cross-sections are measured through a combined statistical analysis of the H → ZZ * → 4ℓ and H → γγ decay channels. The results are based on a dataset of 139 fb −1 of proton–proton collisions at a centre-of-mass energy of 13 TeV, recorded by the ATLAS detector at the Large Hadron Collider. The measured total Higgs boson production cross-section is 55.5−3.8+4.0 pb, consistent with the Standard Model prediction of 55.6 ± 2.5 pb. All results from the two decay channels are compatible with each other, and their combination agrees with the Standard Model predictions. A combined statistical interpretation of the measured fiducial cross-sections as a function of the Higgs boson transverse momentum is performed in order to probe the Yukawa couplings to the bottom and charm quarks. A similar interpretation is performed by including also the constraints from the measurements of Higgs boson production in association with a W or Z boson in the H → bb¯ and cc¯ decay channels. [Figure not available: see fulltext.