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  • 1
    In: Blood, American Society of Hematology, Vol. 107, No. 3 ( 2006-02-01), p. 1116-1123
    Abstract: Adult patients with acute lymphoblastic leukemia (ALL) who are stratified into the standard-risk (SR) group due to the absence of adverse prognostic factors relapse in 40% to 55% of the cases. To identify complementary markers suitable for further treatment stratification in SR ALL, we evaluated the predictive value of minimal residual disease (MRD) and prospectively monitored MRD in 196 strictly defined SR ALL patients at up to 9 time points in the first year of treatment by quantitative polymerase chain reaction (PCR). Frequency of MRD positivity decreased from 88% during early induction to 13% at week 52. MRD was predictive for relapse at various follow-up time points. Combined MRD information from different time points allowed definition of 3 risk groups (P 〈 .001): 10% of patients with a rapid MRD decline to lower than 10-4 or below detection limit at day 11 and day 24 were classified as low risk and had a 3-year relapse rate (RR) of 0%. A subset of 23% with an MRD of 10-4 or higher until week 16 formed the high-risk group, with a 3-year RR of 94% (95% confidence interval [CI] 83%-100%). The remaining patients whose RR was 47% (31%-63%) represented the intermediate-risk group. Thus, MRD quantification during treatment identified prognostic subgroups within the otherwise homogeneous SR ALL population who may benefit from individualized treatment.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 3139-3139
    Abstract: Combinations of purine analogues with the therapeutic anti-CD20 antibody Rituximab induce a high number of complete clinical remissions in CLL patients. Therefore, the detection of minimal residual disease (MRD) appears particularly warranted after such regimens. However, Rituximab prevents the assessment of CD20, one mainstay of flow cytometric MRD detection (MRD flow) in CLL. As no comparative analysis of MRD flow to ASO primer IGH real-time quantitative PCR (RQ-PCR) after Rituximab has been performed so far, doubts remained regarding the diagnostic utility of MRD flow in this clinical setting. We compared results obtained by RQ-PCR to 4-color 3-tube MRD flow in 574 samples from 69 patients randomized to receive fludarabine and cyclophosphamide (FC) or FC plus Rituximab (FCR). Thus we were able to investigate how treatment with FC and FCR impacts on the performance of DNA-based RQ-PCR and of antibody-dependent flow cytometric MRD detection. With 58.4 % positive and 27.0 % negative samples by both assays, we found a qualitative concordance between MRD flow and RQ-PCR of 85.4 % (490/574 samples). Only very few samples were exactly quantifiable with one method and negative by the other method (0.7% MRD flow pos/RQ-PCR neg and 1.4% MRD flow neg/RQ-PCR pos samples). Most discordant samples (12.5% of all samples) were MRD negative by flow but positive by RQ-PCR at low levels outside the quantitative range of MRD detection. We calculated a median quantitative range of 10−4 and a median sensitivity of 2×10−5 in those samples, demonstrating a higher sensitivity of PCR to detect low-level MRD. Considering a threshold of 10−4 for MRD positivity, 94% of all samples showed concordant results by both methods. The cases that were discordantly classified as to this threshold usually comprised samples with residual CLL cells close to 10−4 (3.7% RQ-PCR pos/MRD flow neg and 2.3% RQ-PCR neg/MRD flow pos samples). Quantitative MRD levels determined by both methods were closely correlated irrespective of therapy (Spearman r = 0.95 in FCR, r = 0.96 in FC). We next classified all samples according to the PCR result and compared MRD flow detection rates between the treatment arms. Regarding PCR positive samples within the quantitative range, MRD flow was positive in 96.8% and 98.0% of samples from the FCR and FC arms, respectively. Positive MRD flow results were recorded in 33.7% (FCR) and 40.0% (FC) of samples that concomitantly yielded PCR positive results outside the quantitative range. Within the PCR negative samples, MRD flow detected residual CLL cells in comparable proportions of samples (FCR 2.3% vs. FC 3.4%). We compared the MRD results obtained using combinations that include CD20 (CD20/CD5/CD19/CD43, CD79b/CD20/CD19/CD5) to the MRD results from the combination CD81/CD22/CD19/CD5 in individual samples. We found that CD20 is undetectable on residual CLL cells and therefore not informative for MRD flow in patients from the FCR arm up to 180 days after the last Rituximab infusion. For the same period of time benign B cells are significantly less frequent in patients after FCR than after FC (p & lt;0.0001) and often account for less than 1 cell in 10,000 leukocytes after this therapy regimen. Thus the efficient reduction of background non-CLL B-cells by Rituximab likely explains the high specificity and sensitivity of MRD flow after FCR treatment. In summary, MRD assessment by flow and PCR are equally effective for MRD quantification in Rituximab treated CLL patients within the sensitivity range of 10−4, while PCR is more sensitive for detecting MRD below that level. The use of Rituximab does not influence MRD detection neither by flow nor by RQ-PCR.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 1411-1411
    Abstract: Minimal residual disease (MRD) assessment via next generation sequencing (NGS) of immunoglobulin (Ig) and T-cell receptor (TR) gene rearrangements for lymphoid malignancies is currently under extensive development. NGS MRD has a potential to overcome the limitations of current techniques; laboriousness and difficult interpretation of qPCR for Ig/TR and low sensitivity of flow cytometry. However, amplicon-based NGS MRD has potential pitfalls that have to be addressed before it can be safely introduced for clinical decision making. Multi-center concordance in the experimental setting, quality control and interpretation of the results need to be achieved in order to surpass the advantages of qPCR, which is currently rigorously standardized within the EuroMRD consortium. Our aim was to test the stability and reproducibility of an optimized Ig heavy chain (IGH) based NGS approach for MRD assessment in a multi-center setting within the EuroClonality NGS Consortium on two different sequencing platforms. A one-step PCR library preparation approach was tested in seven institutions (Kiel, Salamanca, Milano, Bristol, London, Prague, Torino). Serial dilutions (10-1 to 10-5) of diagnostic DNA into polyclonal DNA as well as follow-up samples of 30 B-cell precursor ALLs with known complete IGH rearrangements were sequenced on the MiSeq. Serial dilutions of five different diagnostic ALL samples and libraries from polyclonal control were sequenced in parallel on both the MiSeq and Ion Torrent platforms. All samples were spiked with pre-defined copy numbers of five reference IGH sequences as a calibrator. FR2 primers, harboring platform-specific sequencing adapters, were used during the one-step PCR with 500ng of DNA per sample (75,000 copies). Negative and positive controls (27 pooled B-cell lines) were used for testing assay stability and reproducibility among the labs. Purpose-built bioinformatics methods were applied to analyze data. MRD results were compared to results of EuroMRD-based qPCR results. A total of 333 libraries were sequenced in 29 deep sequencing runs producing 194 million reads. The IGH gene rearrangements of all 27 pooled positive B-cell line controls were identified in all centers. NGS MRD analysis in 116 ALL follow-up samples revealed MRD positivity in 69/116 samples vs. 66/116 samples in qPCR, with discrepancies concerning samples with low MRD (R2=0.81). The dilution experiments gave similar results for both platforms, with a minimum sensitivity of 10-4 (as currently required by most treatment protocols using qPCR) for all tested assays. The correlation between MRD levels obtained by the two NGS platforms was good (R2=0.84). Ratios of reads containing reference IGH sequences were highly consistent in intra- and inter-laboratory analyses, independent of the total number of reads in the sample. When comparing platforms, in 10-1 dilution samples sequenced on MiSeq the ratio of reads harboring reference sequences was 2.1 to 2.7 times lower than in remaining dilutions, while on the Ion Torrent it was only 0.9 to 1.3 times, reflecting the competition with the leukemic clone. The correlation of the amounts of spiked-in sequences with the representation of reads harboring these sequences was slightly better for the Ion Torrent (R2=0.88) than for the MiSeq (R2=0.79). Amplification efficiency of each primer was checked by analyzing libraries from healthy polyclonal control. All primer sequences were present in all samples on both platforms, however, the differences between four libraries prepared from the same sample sequenced on the MiSeq were 2.6 times higher than in one library from this sample sequenced in five replicates on the Ion Torrent. The newly developed IGH assay shows robust intra and inter-laboratory reproducibility, which is the first step towards the safe use of this new MRD technique in a multi-center setting. The distribution of reference sequences and sequences of primers confirmed that the main source of differences between platform strategies is the library preparation and not the platform itself. Using the same amount of DNA, the sensitivity of the method is similar to qPCR. The performance and costs of the assay are similar for both the MiSeq and Ion Torrent. MRD analysis via NGS has therefore a great potential to replace qPCR as the gold standard for MRD-guided therapy in ALL, provided that thorough standardization can be achieved. Support: NV15-30626A, GBP302/12/G101. Disclosures Langerak: Roche: Other: Lab services in the field of MRD diagnostics provided by Dept of Immunology, Erasmus MC (Rotterdam); DAKO: Patents & Royalties: Licensing of IP and Patent on Split-Signal FISH. Royalties for Dept. of Immunology, Erasmus MC, Rotterdam, NL; InVivoScribe: Patents & Royalties: Licensing of IP and Patent on BIOMED-2-based methods for PCR-based Clonality Diagnostics..
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2015
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
    In: HemaSphere, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 3 ( 2019-06), p. e255-
    Type of Medium: Online Resource
    ISSN: 2572-9241
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2922183-3
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  • 5
    In: Hematology, Informa UK Limited, Vol. 24, No. 1 ( 2019-01-01), p. 337-348
    Type of Medium: Online Resource
    ISSN: 1607-8454
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2019
    detail.hit.zdb_id: 2035573-7
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  • 6
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 2346-2346
    Abstract: Abstract 2346 Poster Board II-323 A strong sequence-based evidence supporting a role for antigen in the development of CLL is the existence of subsets of patients with stereotyped heavy complementarity-determining region 3 (HCDR3) sequences. Stereotyped HCDR3s are often defined by the selective association of certain IGHD genes in specific reading frames (RF) with certain IGHJ genes, especially IGHJ6. To gain insight into the mechanisms shaping the IG repertoire and also determine the developmental stage when restrictions in HCDR3 are imposed, we investigated the molecular features of incomplete IGHD-IGHJ rearrangements (IDJR) in a series of 830 patients with CLL. IDJRs were detected in 272/830 cases (32.7%). No associations were identified between the occurrence of IDJRs and IGHV gene usage or mutational status in the complete IGHV-D-J rearrangement from the coding IGH allele. A trend for higher IDJR frequency was evident, however, in certain subsets with stereotyped HCDR3s, in particular subset #1 (IGHV1-5-7/IGHD6-19/IGHJ4; 13/33 cases, 40%), #7 (IGHV1-69/IGHD3-3/IGHJ6; 10/21 cases, 48%) and #8 (IGHV4-39/IGHD6-13/IGHJ5; 5/12 cases, 41%). Sequence analysis of the IDJRs revealed: (i) increased frequency of IGHD2 subgroup genes (115/238 cases, 48%), especially IGHD2-2; (ii) equal distribution of the three RFs of the IGHD genes; (iii) increased recombination frequency between 5`genes of the IGHD cluster and 3` genes of the IGHJ cluster, suggestive of secondary rearrangements on the same allele. Overall, 205/238 (86%) IDJRs were considered as potentially functional (PF), since they did not carry a stop codon at the IGHD-J junction. Of note, 26/28 (93%) IDJRs detected in cases from subsets #1, 7 and 8 could be assigned to the PF category. In the group of CLL cases carrying PF IDJRs, comparison of the IGHD gene repertoire in IDJRs vs. complete, expressed IGHV-D-J rearrangements (CE-VDJRs) revealed: (i) statistically significant (p 〈 0.001) selection of the IGHD3-3 and IGHD6-19 genes in RF2 and RF3, respectively, among CE-VDJRs (especially those assigned to subsets #7 and #1, respectively); (ii) preferential usage of RFs encoding for hydrophilic peptides among CE-VDJRs. At a subsequent stage, we compared the repertoire of the IDJRs from the CLL cohort to that of 174 IDJRs obtained from patients with pre-B acute lymphoblastic leukemia (ALL). Except for higher frequency of (i) the IGHD7-27 and IGHJ6 genes and (ii) IGHD-IGHD gene fusions in pre-B ALL, the overall configuration of IDJRs did not differ significantly in CLL vs. pre-B ALL. In conclusion, these results document that the early stages of IG gene rearrangements in pre-B ALL and CLL do not show intrinsic, disease-specific differences. The detailed molecular characterization and comparison of the IGHD and IGHJ gene repertoires in IDJRs vs. CE-VDJRs in CLL provides further support for the notion that CLL development is not stochastic but directed by selection operating at the IG protein level. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 7
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 538-538
    Abstract: Outcome for patients with adult ALL after relapse is poor, even if a second remission is achieved by salvage therapy and is consolidated by an allogeneic stem cell transplantation. There is considerable evidence from studies in childhood ALL and other hematologic malignancies that administration of salvage therapy in early molecular relapse may improve prognosis. We therefore investigated the value of continuous MRD-monitoring in prospectively monitored standard risk patients of the German Multicenter ALL-studies 06/99 and 07/03 during and after maintenance treatment beyond the first year of therapy. MRD was assessed by quantitative realtime PCR using clone-specific primers for the leukemia-specific Ig/TCR gene rearrangements. MRD high risk-patients (those with MRD & gt; 10−4 at two successive time points after induction during the first year of therapy) are candidates for early therapy escalation according to the study protocol and were thus excluded from this analysis. Of the 108 remaining patients (77 male, 31 female), 30 (28%) became MRD-positive again after a median follow-up of 18 months after the end of consolidation treatment. Of these, 17 (57%) already relapsed. When only considering patients with MRD measurable within the quantitative range of the PCR 16/19 (84%) already relapsed. Of the MRD-negative patients only 5 of 78 (6%) have relapsed after a median follow up of 23 month after end of initial therapy. After conversion to MRD positivity, the median time to relapse was 9.5 months, with a median time to relapse of only 2.5 months once the patients’ MRD was within the quantitative range of the PCR assay. Taken together, these data indicate that, if done at regular intervals, MRD-monitoring allows for accurate and timely identification of patients in need for treatment escalation in the vast majority of cases and may help to avoid overtreatment for those patients who are cured by conventional chemotherapy alone.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 8
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 2799-2799
    Abstract: Background: Adult patients with relapsed acute lymphoblastic leukemia (ALL) are candidates for allogeneic stem cell transplantation (SCT), if feasible. Despite the intensity of SCT treatment at least 40% of patients relapse. Survival is additionally negatively influenced by a high transplant related mortality. Therefore, markers that distinguish patients who will benefit from SCT from those who might profit from different therapeutic modalities or modification of SCT are highly warranted. Kinetics of minimal residual disease (MRD) can serve as molecular parameter of chemoresistance of the leukemia. The purpose of the current study was to investigate whether molecular resistance to front-line therapy can be overcome by allo-SCT following myeloablative conditioning. Methods: MRD was analyzed before and after myeloablative SCT in adult patients with Philadelphia negative relapsed ALL. MRD kinetics were compared to previous molecular response to first-line treatment. For this purpose, cases with persistent detectable disease 〉 1×E–04 at day+71/112 of first-line therapy were classified as primarily molecularly chemoresistant (PMR), cases with MRD values below 1×E–04 around day+71/112 of first-line treatment were categorized as primarily molecularly chemosensitive (PMS). Relapsed ALL patients were included if they had been treated according to the GMALL trials 06/99 or 07/03 with prospective MRD monitoring, and if they had bone marrow samples taken after relapse until day+100 after SCT. Real-time quantitative (RQ)-PCR analysis of patient specific immunoglobulin and T-cell receptor gene rearrangements were used as targets for quantification of MRD. Results: 25 patients were eligible (15 T- and 10 B-lineage ALL). Median age was 22 (16–45) years. Median disease-free survival after front-line therapy was 17 (3 to 52) months. Eleven cases were classified as molecularly chemoresistant to front-line therapy, 14 ALL cases were categorized as primarily molecularly chemosensitive. In keeping with molecular response to initial treatment, PMR cases showed only a modest reduction of MRD in response to salvage chemotherapy with a median MRD value of 3×E–01 (range 2×E–03 to 1×E+00) before SCT. Median MRD levels within the first 100 days after myeloablative SCT decreased to 4×E–04 with a range between MRD negativity and 1.0×E+00. PMS cases showed a significantly better response to salvage chemotherapy: In contrast to PMR cases who were MRD positive prior to SCT in all analysed cases, four out of 7 PMS cases were MRD negative pre-SCT (range: MRD negativity to 4.2×E–03). Also within 100 days after SCT 13/16 analysed samples were MRD negative (compared to only 4/11 analysed PMR samples, p=0.02, see Figure). Taken together, these results show for relapsed ALL that molecular chemoresistance to front-line therapy correlates with a poor molecular response to second-line treatment in transplant recipients. Figure Figure
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 9
    In: Blood, American Society of Hematology, Vol. 107, No. 6 ( 2006-03-15), p. 2271-2278
    Abstract: To evaluate the prognostic impact of minimal residual disease (MRD), quantitative real-time polymerase chain reaction (RQ-PCR) of clonal IGH rearrangements was performed in 29 patients with mantle cell lymphoma (MCL) treated with high-dose radiochemotherapy and autologous stem cell transplantation (ASCT). Fourteen of 27 patients evaluable for MRD after ASCT achieved complete clinical and molecular remission, whereas 13 patients had detectable MRD within the first year after ASCT. Molecular remission after ASCT was strongly predictive for improved outcome, with a median progression-free survival (PFS) of 92 months in the MRD-negative group compared with 21 months in the MRD-positive group (P 〈 .001). Median overall survival (OS) was 44 months in the MRD-positive group and has not been reached in the MRD-negative group (P 〈 .003). In multivariate analysis, molecular remission and bulky disease were independent prognostic factors for PFS (P = .001 and P = .021, respectively). While cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP)–like cytoreduction had only modest influence, ara-C–containing mobilization and myeloablative radiochemotherapy significantly reduced MRD. Quantitative MRD measured in the stem cell products of 27 patients was not predictive for molecular remission. We conclude that sequential quantitative monitoring of residual disease after ASCT is a powerful indicator for treatment outcome in MCL and defines subgroups of patients with a significantly different prognosis.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Blood, American Society of Hematology, Vol. 104, No. 8 ( 2004-10-15), p. 2600-2602
    Abstract: The aim of this study was to investigate if graft-versus-leukemia (GVL) activity conferred by allogeneic stem cell transplantation (allo-SCT) is effective in chronic lymphocytic leukemia (CLL) with unmutated VH gene status. The kinetics of residual disease (MRD) were measured by quantitative allele-specific immunoglobulin heavy chain (IgH) polymerase chain reaction (PCR) in 9 patients after nonmyeloablative allo-SCT for unmutated CLL. Despite an only modest decrease in the early posttransplantation phase, MRD became undetectable in 7 of 9 patients (78%) from day +100 onwards subsequent to chronic graft-versus-host disease or donor lymphocyte infusions. With a median follow-up of 25 months (range, 14-37 months), these 7 patients remain in continuous clinical and molecular remission. In contrast, PCR negativity was achieved in only 6 of 26 control patients (23%) after autologous SCT for unmutated CLL and it was not durable. Taken together, this study shows for the first time that GVL-mediated immunotherapy might be effective in CLL with unmutated VH.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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