scholarly journals Resistance to ABT-199 induced by microenvironmental signals in chronic lymphocytic leukemia can be counteracted by CD20 antibodies or kinase inhibitors

Author(s):  
R. Thijssen ◽  
E. Slinger ◽  
K. Weller ◽  
C. R. Geest ◽  
T. Beaumont ◽  
...  
2018 ◽  
Vol 40 (4) ◽  
pp. 261-267 ◽  
Author(s):  
K Tari ◽  
Z Shamsi ◽  
H Reza Ghafari ◽  
A Atashi ◽  
M Shahjahani ◽  
...  

Chronic lymphocytic leukemia (CLL) is increased proliferation of B-cells with peripheral blood and bone marrow involvement, which is usually observed in older people. Genetic mutations, epigenetic changes and miRs play a role in CLL pathogenesis. Del 11q, del l17q, del 6q, trisomy 12, p53 and IgVH mutations are the most important genetic changes in CLL. Deletion of miR-15a and miR-16a can increase bcl2 gene expression, miR-29 and miR-181 deletions decrease the expression of TCL1, and miR-146a deletion prevents tumor metastasis. Epigenetic changes such as hypo- and hypermethylation, ubiquitination, hypo- and hyperacetylation of gene promoters involved in CLL pathogenesis can also play a role in CLL. Expression of CD38 and ZAP70, presence or absence of mutation in IgVH and P53 mutation are among the factors involved in CLL prognosis. Use of monoclonal antibodies against surface markers of B-cells like anti-CD20 as well as tyrosine kinase inhibitors are the most important therapeutic approaches for CLL.


Author(s):  
Tadeusz Robak ◽  
Magda Witkowska ◽  
Piotr Smolewski

The use of the Bruton’s tyrosine kinase (BTK) inhibitors has changed the management and clinical history of patients with chronic lymphocytic leukemia (CLL). BTK is a critical molecule that interconnects B-cell antigen receptor (BCR) signaling. BTKIs are classified into two categories: irreversible (covalent) inhibitors and reversible (non-covalent) inhibitors. Ibrutinib is the first irreversible BTK inhibitor approved by the U.S. Food and Drug Administration in 2013 as a breakthrough therapy in CLL patients. Subsequently, several studies evaluated the efficacy and safety of new agents with reduced toxicity when compared with ibrutinib. Two other irreversible, second-generation BTK inhibitors, acalabrutinib and zanubrutinib, were developed to reduce ibrutinib-mediated adverse effects. Additionally, new reversible BTK inhibitors are currently under development in an early phase studies to improve their activity and to diminish adverse effects. This review summarizes the pharmacology, clinical efficacy, safety, dosing, drug-drug interactions associated with the treatment of CLL with BTK inhibitors, and examines its further implications.


2019 ◽  
Vol 12 ◽  
pp. 1179545X1989457
Author(s):  
Tahseen Hamamyh ◽  
Mohamed A Yassin

Autoimmune hemolytic anemia is one of the differential diagnoses for anemia in patients with lymphoproliferative neoplasia, such as chronic lymphocytic leukemia, who experience sudden drop in hemoglobin. The association between autoimmune hemolytic anemia and chronic myeloid leukemia on the contrary is unusual. Here we present a patient with a background of chronic myeloid leukemia treated previously with Tyrosine Kinase Inhibitors, then developed autoimmune hemolysis simultaneously with chronic myeloid leukemia relapse. Hemolysis was treated with steroids with good response.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2467-2467
Author(s):  
Lina Reslan ◽  
Stéphane Dalle ◽  
Cindy Tournebize ◽  
Stephanie Herveau ◽  
Emeline Cros ◽  
...  

Abstract Abstract 2467 GA101, a novel glycoengineered type II IgG1 antibody against CD20, has shown a direct and immune effector cell-mediated cytotoxicity in numerous B-cell disorders. Chronic Lymphocytic Leukemia (CLL) is the most common hematologic malignancy in the western world. Since circulating mature B-CLL cells express high levels of antiapoptotic proteins that are implicated in the survival mechanism, we investigated whether the effects of GA101 compared to rituximab, induces apoptosis in these cells and what mechanism underlies GA101-mediated cytotoxicity. CLL cells were isolated from peripheral blood samples by density gradient centrifugation and B lymphocytes were purified by a negative selection method using the EasySep® B Cell Enrichment Cocktail. Cell viability was measured flow cytometrically by annexinV binding. We assessed the mitochondrial transmembrane potential (ΔΨm) by staining with 3,3-dihexyloxacarbocyanine iodide (DiOC6[3]), the generation of reactive oxygen species by staining with Dihydroethidine (DHE) as well as cytochrome c release. Moreover, the expression of several apoptosis-regulating proteins, including the Bcl-2 family proteins (Bcl-2, Bcl-XL, Mcl-1, Bax, Bak and Bad) and the activation of the caspase cascade were evaluated by immunoblotting on 34 fresh peripheral blood B-CLL specimens. We showed that GA101 initiates an early extensive cell death. The average decrease of viability of freshly isolated and purified CLL cells 24 hours post-treatment with 10μg/ml of anti CD20 antibodies were 37.6% for GA101 (n=11) and 28.8% for Rituximab (n=11). The GA101-induced cell death was paralleled by a rapid loss of mitochondrial membrane potential accompanied with the production of ROS and cytochrome c release that occurred significantly as early as 3 hours post-treatment. However, rituximab was unable to initiate a loss of ΔΨm and the production of ROS. The use of antioxidants such as N-acetyl cysteine and L-ascorbic acid were unable to circumvent either the GA101-induced cell death or the loss of ΔΨm. However, the preincubation of CLL cells with Z-VAD.fmk (N-benzyloxycarbonyl-Val-Ala-Asp fluoromethyl ketone), a broad caspase inhibitor, abolished the exposure of phosphatidylserine residues, the generation of reactive oxygen species and reversed the loss of ΔΨm. Furthermore no change was observed in the expression level of Bcl2 pro-survival family members, while GA101 induced the pro-apoptotic proteins such as Bax and Bak and caused cleavage of the active form of caspase 9 and 3 and the proteolytic cleavage of PARP, in 5 out of 9 patients studied. Altogether, these data show that GA101 induced-cell death in B-CLL cells, unlike what has been observed in cell lines, is mediated by a caspase-dependent mechanism involving the loss of ΔΨm and the generation of ROS. Ongoing studies aim to analyze the role, the conformational changes and the cellular redistribution of Bax and Bak in response to GA101 and the modifications of other apoptosis-related proteins in CLL cells. Disclosures: No relevant conflicts of interest to declare.


2014 ◽  
Vol 12 (5S) ◽  
pp. 801-803
Author(s):  
John C. Byrd

In the treatment of chronic lymphocytic leukemia (CLL), select genomic studies can assist in risk stratification of newly diagnosed patients. Chemoimmunotherapy targeting CD20 offers a survival advantage in symptomatic patients both with and without these high-risk genetic features, though patients with del(17p13.1) have poor outcomes and require specific intervention. Obinutuzumab plus chlorambucil is a treatment standard for untreated elderly patients and is superior to rituximab plus chlorambucil. In the setting of relapsed CLL, the new kinase inhibitors have the potential to completely change the treatment paradigm of CLL.


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