Hematology
Abstract
BACKGROUND. Chimeric antigen receptor T-cell (CAR-T) therapies have revolutionized treatment for relapsed/refractory multiple myeloma (RRMM). However, cytokine release syndrome (CRS), a common and potentially severe complication, requires inpatient monitoring, limiting access and increasing costs. Wearable devices could support outpatient CAR-T delivery, but feasibility for CRS detection versus standard care remains unproven. METHOD. We conducted a prospective, single-center observational pilot study to assess the feasibility of using wearable devices for monitoring vital signs and detecting CRS. Thirty patients receiving idecabtagene vicleucel (ide-cel) or ciltacabtagene autoleucel (cilta-cel) were enrolled; 25 with sufficient monitoring data were evaluable. Sensors collected skin and axillary temperature, oxygen saturation, respiratory and heart rate, and motion. Peripheral blood cytokines were analyzed pre- and post-infusion using a multiplex proteomic platform. The primary outcome was feasibility, assessed by CRS detection sensitivity and specificity; secondary outcomes included adherence, lead time, and performance of models integrating wearable and cytokine data. RESULTS. CRS occurred in 20 of 25 patients. The best-performing wearable model detected 18 or 20 CRS episodes with a sensitivity of 0.72 (mean 0.75; 95% CI 0.60–0.91) and a specificity of 0.80 (mean 0.76; 95% CI 0.68–0.84), and a median lead time of 7:00 hours before nursing recognition. Median adherence during high-risk periods was 71%. Cytokine changes paralleled temperature elevations, and IFN-γ emerged as a consistent biomarker. CONCLUSION. Wearable devices are feasible for early CRS detection and may support outpatient CAR-T care. Larger outpatient studies are warranted. TRIAL REGISTRATION. This study did not meet the criteria for ClinicalTrials.gov registration.
Authors
Sridevi Rajeeve, Matt Wilkes, Nicole Zahradka, Lewis Tomalin, Mujahid Quidwai, Darren Pan, Nicholas J. Calafat, Martin Cusack, Adolfo Aleman, Kseniya Serebryakova, Katerina Kappes, Hayley Jackson, Sarita Agte, Santiago Thibaud, Larysa Sanchez, Shambavi Richard, Joshua Richter, Cesar Rodriguez, Hearn Jay Cho, Ajai Chari, Sundar Jagannath, Alessandro Laganà, Adriana C. Rossi, Samir Parekh
Abstract
BACKGROUND. Asparaginase is essential for curing acute lymphoblastic leukemia (ALL), but its use is limited by asparaginase-associated pancreatitis (AAP), a severe and unpredictable toxicity lacking validated prospective biomarkers. We sought to define early systemic molecular features of susceptibility to AAP. METHODS. We performed longitudinal lipidomic and proteomic profiling in two independent pediatric ALL cohorts (n = 161; 79 AAP cases, 82 controls) using paired blood samples collected before asparaginase exposure and at the end of induction therapy (including a single dose of asparaginase), thereby capturing pre-injury biology rather than consequences of pancreatitis. We applied differential abundance and network-based analyses, and integrated lipid–cytokine associations using proteomics. RESULTS. Across cohorts, we identified a reproducible lysophosphatidylcholine (LPC)–centered signature characterized by attenuated induction therapy-associated LPC responses and disruption of LPC co-regulation at the network level. Proteomic profiling revealed enrichment of cytokine signaling pathways, and integrative analyses demonstrated altered lipid–cytokine coupling, including a flip in association direction for LPC species and interleukin-18 (IL-18) between cases and controls. Although IL-18/LPC ratios do not differ globally, elevated post-induction IL-18/LPC ratios identify AAP risk within a protocol-defined very high-risk ALL subgroup (AUC = 0.81). CONCLUSION. These findings support a systems-level model in which failure of coordinated lipid–immune responses under therapeutic stress confers vulnerability to AAP, providing a framework for validation and mitigation strategies. TRIAL REGISTRATION. NCT00400946; NCT01574274; NCT03020030 (parent trials). FUNDING. Servier Pharmaceuticals (IIT-95014-027-USA); SDRC (P30DK116074); Stanford SPARK; Fonds de Recherche du Québec – Santé; Fondation Charles-Bruneau; The Leukemia & Lymphoma Society of Canada.
Authors
Cheng-Yu Tsai, Na Bo, Thai Hoa Tran, Maisam Abu-El-Haija, Gayathri Swaminathan, Bomi Lee, Sudhir Ghandikota, Li Wen, Yves Théorêt, Steven D. Mittelman, Elena J. Ladas, Anil G. Jegga, Lewis B. Silverman, Ying Ding, Sohail Z. Husain
Abstract
Human γδ T cells are a rare but functionally diverse lymphocyte subset critical for tumor surveillance and antimicrobial immunity. Although they express natural killer (NK) cell-associated receptors such as Killer-cell Immunoglobulin-like Receptors (KIRs), the relevance of KIR expression on γδ T cells remains largely unexplored. Using flow cytometry, ATAC-seq and RNA-seq, we identified KIR expression as a marker that distinguished two functionally and molecularly distinct γδ T cell subsets. KIR⁺ γδ T cells exhibited an advanced, memory-like differentiation state characterized by heightened cytotoxicity, stable epigenetic remodeling and a predominant IFNγ-producing profile. In contrast, KIR⁻ γδ T cells maintained a naïve-like phenotype and preferentially produced IL-17 upon polarization. Notably, KIR+ γδ T cells were consistently observed across individuals but were significantly enriched in cytomegalovirus (CMV)-seropositive donors, suggesting that chronic antigenic stimulation could promote the emergence of KIR⁺ effector γδ T cells. These findings reveal a functional dichotomy in human γδ T cells defined by KIR expression, linking IFNγ-driven cytotoxicity with KIR⁺ cells and IL-17 production with KIR⁻ cells. This insight advances our understanding of γδ T cell heterogeneity and has implications for viral immunity, immune memory and the development of γδ T cell-based immunotherapies.
Authors
Mahya Razmi, Yeganeh Almasi, Marilee Larrivée, Jonathan B. Angel, Alexandre Blais, Zakia Djaoud
Abstract
Mixed hematopoietic chimerism after hematopoietic cell transplantation (HCT) can modulate the immune system and induce tolerance to allogeneic tissues. However, bone marrow conditioning-related toxicities preclude wider adoption of HCT for transplant allotolerance. We sought agents that reduced conditioning intensity, while promoting durable mixed chimerism after HCT across complete major histocompatibility complex (MHC) mismatch in diabetic mice, permitting islet allotransplantation and diabetes reversal. We systematically tested baricitinib (JAK1/2 inhibitor), venetoclax (Bcl2 inhibitor), and αCD47 antibody, agents in current clinical use, and quantified hematopoietic chimerism after HCT. Combined with αCD117 antibody, transient T cell depletion, and just 10 centigray (cGy) total body irradiation (TBI), these agents enabled durable mixed chimerism and matching allo-islet tolerance, to cure diabetes without evidence of GVHD. Thus, we have developed a conditioning regimen to promote allogeneic mixed hematopoietic chimerism and transplanted islet allotolerance that minimizes conditioning radiation and cures diabetes, a significant achievement.
Authors
Stephan A. Ramos, Preksha Bhagchandani, Diego M. Burgos, Xueying Gu, Richard Rodriguez, Nadia Nourin, Martin Neukam, Shiva Pathak, Judith Shizuru, Seung K. Kim
Abstract
We previously reported that excessive angiotensin-II (AT)->AT receptor-1 (ATR1) signaling results in sickle cell anemia (SCA)-associated nephropathy. Herein, we showed hyperangiotensinemia in SCA results from high erythroid cell-generated reactive oxygen species (ROS), which oxidized angiotensinogen (ATGN) and favored its rapid conversion to AT. Increased AT->ATR1 signaling in SCA erythroid cells generated ROS and created a positive feedback loop of ROS->oxidized ATGN->AT->ATR1-> ROS, perpetuating the hyperangiotensinemia. ATR1-blocker, losartan, reduced erythrocyte ROS, oxidized-AGTN, and AT levels. The ROS->AT->ATR1->ROS loop was driven by sickle erythropoiesis as it was reproduced when WT mice were transplanted with SCA hematopoiesis. Using SCA and WT mice with germline- and erythroid-specific ATR1-deficiency, we found that stress-erythropoiesis, but not steady-state-erythropoiesis, was critically dependent on erythroid AT->ATR1 signaling, which acted in harmony with increased erythropoietin signaling. Further, instead of the canonical AT->ATR1-> NADPH-oxidase->ROS signaling in steady-state erythropoiesis, AT->ATR1 signaling in stress-erythroid cells increased mitochondrial mass and dysfunctional mitochondria, which thereby increased ROS. SCA mice with erythroid-specific ATR1 deficiency had decreased RBC accumulation of dysfunctional mitochondria and decreased ROS, which reduced SCA-associated nephropathy. Overall, we demonstrated that AT->ATR1 signaling was essential for stress-erythropoiesis but led to increased dysfunctional mitochondria retention in mature RBCs, which generated ROS and perpetuated hyperangiotensinemia, resulting in end-organ damage.
Authors
Parul Rai, Swarnava Roy, Paritha Arumugam, Diamantis G. Konstantinidis, Sithara Raju Ponny, Marthe-Sandrine Eiymo Mwa Mpollo, Archana Shrestha, Theodosia A. Kalfa, Punam Malik
Abstract
Vaso-occlusive episodes (VOEs) or acute pain events, involving complex interactions between sickle erythrocytes and other blood cells, are a hallmark of sickle cell disease (SCD). In this study, we analyzed changes in peripheral blood transcriptomes between steady state and VOEs in individuals with SCD. We followed a cohort of 174 individuals with SCD with or without chronic pain and collected peripheral blood at clinic visits (steady state) and during hospitalizations (VOEs). We performed RNA-Seq profiling of CD45+ leukocytes and CD71+ erythroid cells. Pathways linked to complement activation, coagulation, and IL-6/JAK/STAT3 signaling were enriched during VOEs in the CD45+ cells. Contrastingly, the CD71+ cells showed an enrichment of pathways related to the cell cycle, such as mTORC1 signaling and the G2M checkpoint during VOEs. We then analyzed the expression changes of genes in patients with longitudinal data to determine potential biomarkers for VOEs. Expression of 4 genes — FAM20A, IL1B, MS4A4A, and SERPINB2 — was elevated during VOEs compared with steady state in the majority of patients. Furthermore, our results indicate that patients experiencing chronic pain exhibited 44% increased enrichment of significant pathways during VOEs when compared with patients without chronic pain.
Authors
Varsha Bhat, Justin J. Yoo, Srija Ponna, Alka A. Potdar, Ashwin P. Patel, G. Karen Yu, Greg Gibson, Vivien A. Sheehan
Abstract
Fanconi anemia (FA) is the most common bone marrow failure (BMF) syndrome. Beyond a role in DNA repair, FA genes have a role in suppressing DNA-RNA hybrids, termed R-loops, which can be generated via RNA polymerase (RNAP)-mediated transcription. However, how these processes, including a role in fate determination of hematopoietic stem cells (HSCs), are related to BMF is largely unknown. Additionally, single FA gene knockouts in mice do not recapitulate most phenotypes observed in FA patients. Thus, we generated a mouse model for FA by introducing heterozygous Setd2, which restricts RNAP-dependent transcription. Here, we show that FA patient-derived cells and Setd2+/– Fanca–/– HSCs share increased R-loop as well as dsRNA levels, and a ribosomal biogenesis defect. Further, Setd2+/– Fanca–/– HSCs display cell cycle arrest, mitotic errors and BMF phenotypes. Importantly, utilizing our Setd2+/– Fanca–/– mice, we discovered that Juglone, a pan RNAP inhibitor, reduces R-loop and dsRNA and reverses ribosomal biogenesis defects and mitotic errors, thereby rescuing BMF. In conclusion, this study establishes a novel mouse model that underscores a key role for R-loop formation, ribosomal biogenesis defects and mitotic errors in HSCs in driving BMF in Fanconi anemia. We also introduce a potential therapeutic avenue based upon pan-inhibition of RNA polymerases utilizing Juglone.
Authors
Michihiro Hashimoto, Xiaomin Feng, Jie Bai, Huimin Zeng, Tian Li, Jue Li, Terumasa Umemoto, Paul R. Andreassen, Gang Huang
Abstract
Mutations in protein tyrosine phosphatase non-receptor type 11 (PTPN11) have been considered late acquired mutations in acute myeloid leukemia (AML) development. Using single-cell DNA sequencing, we found that PTPN11 mutations can occur as initiating events in some patients with AML when accompanied by strong oncogenic drivers, commonly NPM1 mutations. The resulting AML has a diverse set of variably differentiated myeloid cells with few myeloid cells that lack leukemic mutations. The role of Ptpn11 as a codriver was confirmed in a murine model that exhibits an AML phenotype with a comparable immune diversity that is serially engraftable and reconstituted from early precursor cells. Furthermore, lineage-negative bone marrow cells from these mice reconstitute the full diversity of mature myeloid cells, and these cells exhibit an altered cytokine response after physiologic stimulation. Our work highlights how PTPN11-mutated AML is derived from a multitude of codominant and late acquired aberrations that have a previously unrecognized differentiated myeloid clonal expansion potentially contributing to pathogenesis of the disease.
Authors
Sydney Fobare, Chia Sharpe, Kate Quinn, Kinsey Bryant, Linde A. Miles, Robert L. Bowman, Carolyn Cheney, Casie Furby, Marissa Long, Kaytlynn Fyock, Ben Wronowski, James R. Lerma, Krzysztof Mrózek, Deedra Nicolet, Thomas M. Sesterhenn, Megan E. Johnstone, Jianmin Pan, Shesh N. Rai, Chandrashekhar Pasare, Nives Zimmermann, Wen-Mei Yu, Cheng-Kui Qu, Andrew Carroll, Richard Stone, Eunice S. Wang, Jonathan Kolitz, Bayard Powell, John P. Perentesis, Ann-Kathrin Eisfeld, Erin Hertlein, John C. Byrd
Abstract
Systemic Epstein-Barr virus–positive (EBV-positive) T/NK cell lymphoproliferative diseases of childhood (sEBV+T/NK-LPD) are a spectrum of rare diseases that have highly variable biological behavior, from indolent conditions to highly aggressive malignancies. Clinicians currently face substantial challenges in promptly assessing disease severity and predicting patient outcomes, leading to limitations in treatment planning. To address this challenge, we constructed a comprehensive triage system to aid in rapid clinical interventions. The study included 156 patients with newly diagnosed sEBV+T/NK-LPD from 42 institutions. An independent prospective cohort of 35 newly enrolled patients was further included to evaluate the model’s performance. An additional 45 patients from the literature and 18 patients who underwent hematopoietic stem cell transplantation were included to test the score’s generalizability. An integrative machine learning strategy was applied to identify robust and optimal factors and to integrate multiple algorithms to enhance the system’s performance and stability. This system, termed COLLAPSED, identifies critical factors and provides a stable, high-performing ensemble. This model was validated externally and simplified into a risk score to improve interpretability and accessibility. The COLLAPSED system substantially enhances clinicians’ ability to rapidly and precisely identify high-risk patients, thus enabling timely clinical decision-making and expedited initiation of potentially lifesaving treatments.
Authors
Pujun Guan, Zihang Chen, Hanze Dong, Xia Guo, Juan Huang, Tian Dong, Mi Wang, Xiaoxi Lu, Fei Huang, Wenbin Li, Yuan Tang, Li Zhang, Ling Pan, Ju Gao, Shikun Wang, Rongbo Liu, Wenyan Zhang, Sha Zhao, Weiping Liu
Abstract
The contribution of 9p deletion to B-cell acute lymphoblastic leukemia (B-ALL) has remained elusive since its discovery more than 40 years ago. Here we show that loss of CD72 is recurrent in B-ALL cases containing PAX5 deletions, and that Cd72 haploinsufficiency drives B-ALL development in Pax5+/− mice. Mechanistically, Cd72+/-;Pax5+/- precursor B cells exhibit an inflammatory transcriptional profile characterized by a decrease in Myd88 expression, a finding that aligns with our previous studies of B-ALL development in Pax5+/- mice following exposure to immune stressors. These combined genomic analyses and functional models provide compelling evidence that co-deletion of two contiguous genes, Pax5 and Cd72, drives B-cell leukemogenesis.
Authors
Belén Ruiz-Corzo, Ana Casado-García, Ninad Oak, Paula Somoza-Cotillas, Andrea López-Álvarez de Neyra, Jorge Martínez-Cano, Alba Pérez-Pons, Elena G. Sánchez, Oscar Blanco, Diego Alonso-López, Javier De Las Rivas, Susana Riesco, Pablo Prieto-Matos, Francisco Javier Garcia-Criado, Maria Begoña Garcia-Cenador, Alberto Orfao, Manuel Ramírez-Orellana, César Cobaleda, Carolina Vicente-Dueñas, Kim E. Nichols, Isidro Sánchez-García
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