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Melnick, Ari

https://orcid.org/0000-0002-8074-2287

Mayo Clinic

Weill Cornell Medicine

Citations 24

Abstract A033: Inhibitors of GRK2-targeting-microRNAs: New therapeutic strategies for MALT1-dependent lymphomas
Cheng, Jing, Smyers, Mei , Trotta, Matt, Maurer, Lisa M., Chandran, Uma , Xia, Min , McAllister‐Lucas, Linda M. , Cheng, Jing, Carleton, Neil M. , Maurer, Lisa M. , Melnick, Ari , Lucas, Peter C.

Blood Cancer Discovery | June 24, 2026 | Volume: 7 | Issue: 3_Supplement | Pages: A033-A033

10.1158/2643-3249.lymphoma26-a033 Get It

Abstract Background: Antigen receptor stimulation induces assembly of the CARMA1-BCL10-MALT1 (CBM) signaling complex, which leads to activation of downstream transcriptional regulators including NF-κB and subsequent lymphocyte activation. Gain-of-function mutations in B-cell receptor subunits, CARMA1, or BCL10 which lead to constitutive activation of MALT1 underly the pathogenesis of multiple lymphoid malignancies, including activated B-cell–type diffuse large B-cell lymphoma (ABC-DLBCL). During previous efforts to identify regulators of MALT1 activity in lymphocytes, we discovered that G-protein-coupled receptor kinase 2 (GRK2) binds to MALT1, inhibits MALT1 scaffolding and proteolytic activities, and functions as a tumor suppressor in MALT1-dependent lymphomas. Notably, GRK2 mRNA expression is markedly lower in a subset of DLBCL tumors in comparison to normal B cells and lower GRK2 is associated with decreased patient survival in ABC-DLBCL. In light of these findings, we investigated the molecular mechanisms regulating GRK2 expression and then characterized the roles of specific GRK2-targeting miRNAs in ABC-DLBCL. Methods and Results: After finding that global impairment of miRNA processing through DICER1 depletion leads to increased GRK2 protein, we conducted bioinformatic analyses of patient tumor samples and microRNA Data Integration Portal screening to identify candidate microRNAs that target GRK2 in ABC-DLBCL. Direct targeting of GRK2 by candidate miRNAs was then confirmed by GRK2 3’UTR reporter assay. We tested for expression of three candidate microRNAs in ABC-DLBCL cells and observed elevated expression in both OCI-LY3 and TMD8 cells, which exhibited reduced GRK2 mRNA expression compared with primary B cells. Inhibition of candidate miRNAs in ABC-DLBCL cells, using anti-miRNA Locked Nucleic Acids (LNA) inhibitors, led to enhanced GRK2 expression, reduced MALT1 activity and decreased cell proliferation. Conversely, stable overexpression of candidate microRNAs led to reduced GRK2 expression, enhanced MALT1 activity and increased cell proliferation. In vivo, treatment of mice with inhibitors of candidate microRNAs abrogates the growth of ABC-DLBCL xenograft tumors. Conclusion: We have identified three miRNAs that negatively regulate GRK2 expression in ABC-DLBCL. By targeting GRK2 for downregulation, these miRNAs promote MALT1 oncoprotein scaffold and protease activities. Furthermore, inhibitors of these miRNAs enhance GRK2 expression and thereby suppress MALT1 activity and MALT1-dependent tumor cell proliferation in vitro and inhibit MALT1-dependent tumor growth in vivo. MicroRNA inhibitors that enhance GRK2 expression could represent a new approach for restraining MALT1-dependent lymphoma. Citation Format: Jing Cheng, Mei Smyers, Matt Trotta, Neil M. Carleton, Lisa M. Maurer, Uma R. Chandran, Min Xia, Ari M. Melnick, Peter C. Lucas, Linda M. McAllister-Lucas. Inhibitors of GRK2-targeting-microRNAs: New therapeutic strategies for MALT1-dependent lymphomas [abstract]. In: Proceedings of the Fifth AACR International Meeting on Advances in Malignant Lymphoma: From Discovery to Clinical Impact; 2026 Jun 24-27; Philadelphia, PA. Philadelphia (PA): AACR; Blood Cancer Discov 2026;7(3_Suppl):Abstract nr A033.
Abstract 2061: MicroRNAs targeting tumor suppressor GRK2: Novel potential therapeutic strategies for restraining MALT1-dependent DLBCL.
Cheng, Jing, Smyers, Mei , Trotta, Matt, Chandran, Uma , Xia, Min, Melnick, Ari M., McAllister-Lucas, Linda M., Carleton, Neil M. , Maurer, Lisa M. , Melnick, Ari , Lucas, Peter C. , McAllister‐Lucas, Linda M.

Cancer Research | April 3, 2026 | Volume: 86 | Issue: 7_Supplement | Pages: 2061-2061

10.1158/1538-7445.am2026-2061 Get It

Abstract Introduction/Objectives: The CARMA1-BCL10-MALT1 (CBM) signalosome plays crucial role in mediating antigen receptor-induced activation of NF-κB transcription factor and subsequent lymphocyte activation. The effector protein of the signalosome, MALT1, functions both as a scaffold to recruit downstream NF-κB signaling machinery, and as a protease to cleave and inactivate multiple substrates including negative regulators of NF-κB. Constitutive MALT1 activation, which can occur as a result of gain-of-function mutations of the B cell receptor, CARMA1, BCL10 or chromosomal translocation involving the MALT1 gene, underlies the pathogenesis of multiple lymphoid malignancies including activated B-cell type-diffuse large B-cell lymphoma (ABC-DLBCL) and MALT lymphoma. We previously identified G-protein-coupled receptor kinase 2 (GRK2) as a tumor suppressor in MALT1-dependent lymphomas which binds MALT1 and inhibits MALT1 scaffolding and proteolytic activities. Accordingly, GRK2 mRNA levels are markedly lower in a subset of DLBCL tumors compared to normal B cells and lower GRK2 level in ABC-DLBCL is associated with reduced patient survival. In current study, we sought to investigate the mechanism of how GRK2 levels are regulated in ABC-DLBCL. Methods/Results: Using DICER1 depleted cells, we showed that globally impaired miRNA processing leads to increased GRK2 protein levels. We then conducted bioinformatic analyses of patient tumor samples and performed screening via microRNA Data Integration Portal to identify microRNAs that target GRK2 in ABC-DLBCL. Further GRK2 3’UTR reporter assay confirmed direct targeting of GRK2 by candidate miRNAs. ABC-DLBCL cell lines, OCI-LY3 and TMD8, which demonstrate reduced GRK2 mRNA expression compared to primary B cells, show elevated expression of candidate GRK2-targeting microRNAs. Stable overexpression of miR-125a, 125b, or 148b in OCI-LY3 or TMD8 cells led to reduced GRK2 expression, enhanced MALT1 activity and increased cell proliferation. Conversely, in vitro inhibition of candidate miRNAs using anti-miRNA Locked Nucleic Acids (LNA) inhibitors led to enhanced GRK2 expression, reduced MALT1 activity and decreased cell proliferation. Importantly, treatment of mice with inhibitors of miR-125b and miR-148b abrogates the growth of ABC-DLBCL xenograft tumors in vivo. Conclusion: We have identified miRNAs that negatively regulate GRK2 expression in ABC-DLBCL. These GRK2-targeting miRNAs serve a pro-tumorigenic role by promoting MALT1 oncoprotein’s scaffold and protease activity. Furthermore, inhibitors of these miRNAs can enhance GRK2 expression and thereby suppress MALT1 activity and MALT1-dependent tumor cell proliferation, both in vitro and in vivo. These studies suggest that microRNA inhibitors which enhance GRK2 expression could represent a novel approach for restraining MALT1-dependent lymphomagenesis. Citation Format: Jing Cheng, Mei Smyers, Matt Trotta, Neil M. Carleton, Lisa M. Maurer, Uma R. Chandran, Min Xia, Ari M. Melnick, Peter C. Lucas, Linda M. McAllister-Lucas. MicroRNAs targeting tumor suppressor GRK2: Novel potential therapeutic strategies for restraining MALT1-dependent DLBCL [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 2061.
Sparse whole genome sequencing and machine learning of AML genomes reveals novel, clinically relevant genetics.
Baslan, Timour , Belleau, Pascal, Zhang, Yanming , Sun, Zhuoxin , Kleppe, Maria, Paietta, Elisabeth , Cripe, Larry D., Fernández, Hugo F. , Tallman, Martin S. , Rowe, Jacob M. , Litzow, Mark R. , Dimitrova, Nevenka , Luger, Selina M. , Deschênes, Astrid , Garrett-Bakelman, Francine E. , Lazarus, Hillard M. , Melnick, Ari , Levine, Ross L. , Krasnitz, Alexander , Lowe, Scott W.

Blood | December 5, 2025 | Volume: 146 | Issue: Supplement 1 | Pages: 5263-5263

10.1182/blood-2025-5263 Get It

Abstract Copy Number Alterations (CNAs), including chromosomal gains and losses, shape the genetics and clinical management of acute myeloid leukemia (AML), particularly in complex karyotypes (e.g. CK-AML). Traditionally, AML associated CNAs have been studied using cytogenetic approaches, i.e., karyotyping, that are limited in resolution and sensitivity. Here, low-coverage, sparse whole genome sequencing followed by machine learning applied to over 600 AML patient samples (ECOG-ARCIN trials: E1900, E3999) reveals novel genetic, biologic, and clinical correlates in AML disease. We find that multi-variate Cox-regression analysis applied to the data identifies select patients exhibiting focal and cryptic hemizygous deletions at 17q, 21q, and 3p, in otherwise diploid genomes, associate with inferior survival compared to other patients (median overall survival; OS = 65.5 compared to 421 days, Chi-square test pval=6x10-11), independent of factors such as age, treatment, and karyotype complexity status. In addition, we confirm that amplifications at 11q23, encoding the KM2TA gene, are associated with inferior outcome, and further identify unique breakpoint event features as well as transcriptional signatures suggestive of distinctive KM2TA-translocation independent biology. Applying machine learning approaches to the data, more specifically Non-negative Matrix Factorization (NMF), we develop a prognostic model that captures clinically adverse, cryptic variation such as focal 5q deletions, missed by conventional chromosome analysis and thereby, adds novel, complementary information to traditional, cytogenetic based risk-stratification (e.g. ELN). The model also associates gain of chromosome 8 in Intermediate risk patients with worse outcome compared to other Intermediate risk patients (median OS = 186 compared to 446 days, Chi-square test pval=0.005) and identifies a subgroup of patients within the adverse risk category that lack deletions on chromosomes 5, 7, and 17, and that fare better than the rest of the adverse risk patients (median OS = 188 compared to 97.5 days, Chi-square test pval=0.02), likely reflecting previously identified “atypical” CK-AML patients. Last, we develop a prognostic classifier based on a combination of Neural-Network and Random-Forest based learning, that predicts disease outcome with high accuracy and is based on a three genomic feature list on chromosome bands 5q31.2, 7q31.33, and 8q24, suggesting potential for clinical implementation. Altogether, our results show that low coverage, sparse whole genome sequencing combined with advanced learning methods can be applied clinically to support the diagnosis and clinical management of AML disease as well as serve as a powerful tool to further a basic understanding of the genetics and biology of CNAs in myeloid neoplasms and other cancers.
487 | MicroRNAs TARGET TUMOR SUPPRESSOR GRK2 IN MALT1‐DEPENDENT DIFFUSE LARGE B‐CELL LYMPHOMA
Cheng, Jing , Smyers, M., Trotta, M., Chandran, Uma , Xia, Min , McAllister‐Lucas, Linda M. , Carleton, Neil M. , Maurer, Lisa M. , Melnick, Ari , Lucas, Peter C.

Hematological Oncology | June 16, 2025 | Volume: 43 | Issue: S3 | Pages: No page available

10.1002/hon.70096_487 Get It

TMIC-03. CARD9 BLOCKADE OFFERS A NEW OPPORTUNITY TO REPROGRAM TUMOR-ASSOCIATED MACROPHAGES IN GLIOBLASTOMA
Yerneni, Saigopalakrishna S. , Crentsil, Hannah E. , Debom, Gabriela Nogueira, Klei, Linda R. , Smyers, Mei , Sneiderman, Chaim, Schwab, Kristina, Acharya, Rajesh , Wu, Yijen , Ekambaram, Prasanna , Hu, Dong , Gough, Pete J, Bertin, John , Bao, Riyue , McAllister‐Lucas, Linda M. , Azambuja, Juliana H. , Maurer, Lisa M. , Sneiderman, Chaim T. , Foley, Kevin P. , Melnick, Ari , Kohanbash, Gary , Lucas, Peter C.

Neuro-Oncology | November 11, 2024 | Volume: 26 | Issue: Supplement_8 | Pages: viii297-viii297

10.1093/neuonc/noae165.1181 Get It

Abstract BACKGROUND Glioblastoma (GBM), one of the deadliest primary tumors of the central nervous system, is characterized by a highly immunosuppressive tumor microenvironment (TME). Tumor-associated macrophages and microglia (TAMs) are a dominant population of immune cells in the GBM TME and substantially contribute to immunosuppression, tumor progression, and treatment resistance. Elucidating the molecular mechanisms underlying TAM behavior is crucial to the development of effective immuno-therapeutic strategies for treating GBM. The adaptor protein, Caspase Recruitment Domain-containing protein 9 (CARD9) is primarily expressed in myeloid cells and its activation triggers assembly of the CARD9-BCL10-MALT1 (CBM) complex, which then promotes activation of NF-κB and/or MAPK pathways. The aim of this study was to investigate the role of the CBM complex in the GBM TME and assess its potential as a therapeutic target. METHODS/RESULTS In silico analyses revealed that GBM tumors demonstrate increased CARD9 and MALT1 expression in comparison to non-tumor brain tissue, with CARD9 expressed only within the myeloid compartment. Using co-culture, scratch wound, and transwell assays, we found that GBM tumor cells induce macrophage M2 polarization and migration via a mechanism that is dependent on CARD9/MALT1 signaling within macrophages. scRNA-Seq and flow-cytometric analysis of orthotopic syngeneic immunocompetent GBM tumor models revealed that the GBM TME is dominated by macrophages. Disruption of MALT1 protease activity within the TME leads to reduced tumor infiltration by immunosuppressive TAMs, remodeling of TAMs toward an immunoreactive anti-tumor phenotype, and improved survival of GBM-bearing mice. Additionally, we found that tumor growth was abrogated when GBM-bearing mice were treated with either a MALT1-protease inhibitor or a CARD9 inhibitor. CONCLUSIONS Our study suggests that blockade of the CARD9-MALT1 signaling axis impairs GBM-induced macrophage recruitment and M2 polarization and inhibits tumor progression. These findings nominate the CARD9-MALT1 signaling axis as a new target for TAM-directed immunotherapy for the treatment of GBM.
Genomic profiling for clinical decision making in lymphoid neoplasms
Leval, Laurence de , Alizadeh, Ash A. , Bergsagel, P. Leif , Campo, Elı́as , Davies, Andrew , Doǧan, Ahmet , Fitzgibbon, Jude , Horwitz, Steven M. , Melnick, Ari , Morice, William G. , Nadel, Bertrand , Rosenquist, Richard , Rossi, Davide , Advani, Ranjana H. , Allen, Carl E. , Ansell, Stephen M. , Chan, Wing C. , Cook, James R. , Cook, Lucy , d’Amore, Francesco, Dirnhofer, Stefan , Dreyling, Martin , Dunleavy, Kieron , Hodson, Daniel J. , Klapper, Wolfram , Kim, Won Seog , King, Rebecca L. , Ko, Young Hyeh , LaCasce, Ann S. , Lenz, Georg , Pasqualucci, Laura , Rosenwald, Andreas , Miguel, Jesús F. San , Staudt, Louis M. , Weigert, Oliver , Wilson, Wyndham H. , Wu, Catherine J. , Bagg, Adam , Dirnhofer, S , Bergsagel, P. Leif , de Leval, Laurence , Melnick, Ari , Morin, Ryan D , Nadel, Bertrand , Pileri, Stefano , Rosenquist, Richard , Salaverria, Itziar , Steidl, Christian , Treon, Steven , Zelenetz, Andrew D , Allen, Carl E , Ansell, Stephen M , Chan, Wing C , Cook, James R , Cook, Lucy B , d'Amore, Francesco , Dreyling, Martin , Dunleavy, Kieron , Feldman, Andrew L , Fend, Falko , Gaulard, Philippe , Ghia, Paolo , Gribben, John G. , Hermine, Olivier , Hodson, Daniel J , Hsi, Eric D , Inghirami, Giorgio , Jaffe, Elaine S , Karube, Kennosuke , Kataoka, Keisuke , Klapper, Wolfram , King, Rebecca L , Hyeh, Young , LaCasce, Ann Steward , Lenz, Georg , Piris, Miguel , Pittaluga, Stefania , Pasqualucci, Laura , Quintanilla-Martinez, Leticia , Rodig, Scott J , Rosenwald, Andreas , Salles, Gilles A , San-Miguel, Jesus , Savage, Kerry J , Sehn, Laurie H , Semenzato, Gianpietro , Staudt, Louis M , Swerdlow, Steven H , Tam, Constantine S , Trotman, Judith , Vose, Julie , Weigert, Oliver , Wilson, Wyndham H , Winter, Jane N , Wu, Catherine J , Zinzani, Pier Luigi , Zucca, Emanuele , Bagg, Adam , Scott, David W , Morice, William George , Campo, Elías , Advani, Ranjana H , Dogan, Ahmet , Davies, Andrew , Fitzgibbon, Jude , Horwitz, Steven M , Alizadeh, Ash A , Pileri, Stefano , Salaverría, Itziar , Steidl, Christian , Treon, Steven P. , Zelenetz, Andrew D. , Feldman, Andrew L. , Ghia, Paolo , Hermine, Olivier , Hsi, Eric D. , Inghirami, Giorgio , Jaffe, Elaine S. , Karube, Kennosuke , Martin-Subero, Jose Ignacio , Piris, Miguel Á. , Pittaluga, Stefania , Quintanilla‐Martínez, Leticia , Salles, Gilles , Savage, Kerry J. , Sehn, Laurie H. , Swerdlow, Steven H. , Tam, Constantine S. , Vose, Julie M. , Winter, Jane N. , Zinzani, Pier Luigi , Zucca, Emanuele , Scott, David W.

Blood | August 24, 2022 | Volume: 140 | Issue: 21 | Pages: 2193-2227

10.1182/blood.2022015854 Get It

Abstract With the introduction of large-scale molecular profiling methods and high-throughput sequencing technologies, the genomic features of most lymphoid neoplasms have been characterized at an unprecedented scale. Although the principles for the classification and diagnosis of these disorders, founded on a multidimensional definition of disease entities, have been consolidated over the past 25 years, novel genomic data have markedly enhanced our understanding of lymphomagenesis and enriched the description of disease entities at the molecular level. Yet, the current diagnosis of lymphoid tumors is largely based on morphological assessment and immunophenotyping, with only few entities being defined by genomic criteria. This paper, which accompanies the International Consensus Classification of mature lymphoid neoplasms, will address how established assays and newly developed technologies for molecular testing already complement clinical diagnoses and provide a novel lens on disease classification. More specifically, their contributions to diagnosis refinement, risk stratification, and therapy prediction will be considered for the main categories of lymphoid neoplasms. The potential of whole-genome sequencing, circulating tumor DNA analyses, single-cell analyses, and epigenetic profiling will be discussed because these will likely become important future tools for implementing precision medicine approaches in clinical decision making for patients with lymphoid malignancies.
The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee
Campo, Elı́as , Jaffe, Elaine S. , Cook, James R. , Quintanilla‐Martínez, Leticia , Brousset, Pierre , Cerroni, Lorenzo , Dirnhofer, Stefan , Friedberg, Jonathan W. , King, Rebecca L., Miguel, Jesús F. San , Seymour, John F. , Advani, Ranjana H. , Ansell, Stephen M. , Au, Wing-Yan, Bergsagel, Leif, Cohen, Jeffrey I. , d’Amore, Francesco, Ghobrial, Irene M. , Kim, Won-Seog, Kumar, Shaji , LaCasce, Ann S. , Laurent, Camille , Lenz, Georg, Leonard, John P. , Link, Michael P., López‐Guillermo, Armando , Mateos, María‐Victoria , Melnick, Ari , Nakamura, Shigeo, Narbaitz, Marina, Pavlovsky, Astrid , Pro, Barbara, Sander, Birgitta , Smith, Sonali M. , Staudt, Louis M. , Thieblemont, Catherine, Tousseyn, Thomas , Wilson, Wyndham H., Yoshino, Tadashi, Dreyling, Martin , Winter, Jane N., Bergsagel, P. Leif , Dirnhofer, S , Bergsagel, P. Leif , Brousset, Pierre , Dogan, Ahmet , Feldman, Andrew L , Ghia, Paolo , Salles, Gilles A , San-Miguel, Jesus , Seymour, John F , Treon, Steven , Vose, Julie , Zucca, Emanuele , Barrionuevo, Carlos , Davies, Andrew , Falini, Brunangelo , Ghobrial, Irene M , Goodlad, John R , Gribben, John G. , Hsi, Eric D , Kahl, Brad S , Kumar, Shaji K , LaCasce, Ann Steward , Mateos, María-Victoria , Macintyre, Elizabeth , Melnick, Ari , Morschhauser, Franck , Pileri, Stefano , Piris, Miguel , Rajkumar, Vincent, Shipp, Margaret Ann , Smith, Sonali M , Zinzani, Pier Luigi , Dreyling, Martin , Scott, David W , Zelenetz, Andrew D , Jaffe, Elaine S , Campo, Elías , Advani, Ranjana H , Quintanilla-Martinez, Leticia , Swerdlow, Steven H. , Anderson, Kenneth C. , Leval, Laurence de , Doǧan, Ahmet , Feldman, Andrew L. , Fend, Falko , Gaulard, Philippe , Ghia, Paolo , Horwitz, Steven M. , Salles, Gilles , Treon, Steven P. , Vose, Julie M. , Zucca, Emanuele , Chan, Wing C., Davies, Andrew , Falini, Brunangelo , Hsi, Eric D. , Kahl, Brad S. , Kim, Won Seog , Lenz, Georg , Macintyre, Elizabeth , Morschhauser, Franck , Pileri, Stefano , Piris, Miguel Á. , Rajkumar, S. Vincent , Rosen, Steven T. , Sehn, Laurie H. , Thiéblemont, Catherine , Wilson, Wyndham H. , Yoshino, Tadashi, Zinzani, Pier Luigi , Scott, David W. , Winter, Jane N. , Zelenetz, Andrew D.

Blood | June 2, 2022 | Volume: 140 | Issue: 11 | Pages: 1229-1253

10.1182/blood.2022015851 Get It

Abstract Since the publication of the Revised European-American Classification of Lymphoid Neoplasms in 1994, subsequent updates of the classification of lymphoid neoplasms have been generated through iterative international efforts to achieve broad consensus among hematopathologists, geneticists, molecular scientists, and clinicians. Significant progress has recently been made in the characterization of malignancies of the immune system, with many new insights provided by genomic studies. They have led to this proposal. We have followed the same process that was successfully used for the third and fourth editions of the World Health Organization Classification of Hematologic Neoplasms. The definition, recommended studies, and criteria for the diagnosis of many entities have been extensively refined. Some categories considered provisional have now been upgraded to definite entities. Terminology for some diseases has been revised to adapt nomenclature to the current knowledge of their biology, but these modifications have been restricted to well-justified situations. Major findings from recent genomic studies have impacted the conceptual framework and diagnostic criteria for many disease entities. These changes will have an impact on optimal clinical management. The conclusions of this work are summarized in this report as the proposed International Consensus Classification of mature lymphoid, histiocytic, and dendritic cell tumors.
Allogeneic Transplantation in Fit Older Adults Is Feasible and Encouragingly Efficacious. Post Remission Data from the Prospective ECOG-ACRIN (E2906) Clinical Study
Sun, Zhuoxin , Rowe, Jacob M. , Tallman, Martin S. , Paietta, Elisabeth , Luger, Selina M. , Foran, James M. , Litzow, Mark R. , Ofran, Yishai , Claxton, David F. , Arber, Daniel A. , Melnick, Ari , Levine, Ross L. , Godwin, John E. , Lazarus, Hillard M.

Blood | November 24, 2021 | Volume: 138 | Issue: Supplement 1 | Pages: 413-413

10.1182/blood-2021-149356 Get It

Abstract Introduction: Allogeneic stem cell transplantation (alloSCT) is the most effective post remission anti-leukemia strategy. However, the associated toxicity is a barrier for its routine adoption as standard of care in older adults. Studies of AML patients who underwent alloSCT are mainly retrospective as randomized controlled trials comparing transplantation to non-transplantation are very difficult to conduct. We herein present prospective data from a randomized controlled phase III study, E2906, designed to compare two intensive chemotherapy arms. Patients who achieved remission and had a donor were to proceed to alloSCT after induction or first consolidation, at investigator discretion. Non-transplanted patients received 2 cycles of consolidation and then underwent a second randomization between observation and decitabine maintenance. Herein are reported all patients who received alloSCT either on protocol during first remission (CR1) or at other post induction time-points. Patients and Methods: Enrolled to E2906 study were 727 AML patients age 60 years and over. AlloSCT was performed in 166 patients, of whom 71 received alloSCT as part of the study and 95 received alloSCT off protocol. 105 patients (66/71 on protocol, 39/95 off protocol) received alloSCT at CR1/CRi1/LFS1 (CR: 92, CRi: 9 LFS: 4). Patients were followed for a median of 33.6 months from diagnosis and 29.1 months from transplant. No patients received decitabine maintenance prior to alloSCT. Overall survival (OS) is defined as the time from allo transplant to death from any cause, with follow-up censored at the date of last contact. Disease free survival (DFS) is defined as the time from alloSCT transplant to relapse or death of any cause. The censored follow-up time for patients without relapse or death information is the date of last contact. Kaplan-Meier estimates were used to estimate OS and DFS. DFS and OS were compared between subgroups using log rank tests. A cumulative incidence analysis, with death without prior relapse as competing events, was performed to evaluate the subgroup effect on time to relapse after transplant. Results: Patient characteristics of those who received alloSCT at CR1/CRi1/LFS1 are similar to the general distribution of AML patients eligible for intensive chemotherapy. Median age was 66 years, 52% were male and 88% with ECOG PS of 0-1. Cytogenetic data were available for 85 patients of whom 26% presented with unfavorable cytogenetics. Minimal residual disease (MRD) status prior to alloSCT was available for 44 patients of whom 19 (43%) achieved a MRD negative state. Long-term OS and DFS rates for all 105 patients who underwent alloSCT at CR1/CRi1/LFS1 are encouraging (Figure 1). OS and DFS at two years were 56.4% and 53.6% and 49.4%, 45.6% and 42.9%, 39% at 3 and 4 years, respectively. Age above or below 65 years, gender, induction regimen (3+7 or clofarabine) and MRD status prior to transplantation had no impact on outcome. Survival curves by intermediate or adverse cytogenetic risk are not significantly different. The numbers of patients with CRi1 or LFS1 are too small to compare with patients in CR1. Nevertheless, 36/38 patients that were alive and remain in first remission at the time of data cutoff, are patients who achieved CR1 and only 2/38 are patients transplanted at CRi1 or LFS1. Notably, the non-relapse mortality (NRM) was not significantly different for patients less or over 65 years. NRM at 6 months and 2 years for patients over and under 65 years of age were 4.4%, 8.4% and 15.6%, 24.0% respectively. Relapse during the first year post alloSCT is the main barrier for longer survival, particularly in patients with adverse cytogenetics and MRD positivity prior to transplantation (Figure 2). Conclusions: Fit older patients, including those over age 65, who undergo an alloSCT in CR1, can expect a 4-year survival of 43% with an acceptable NRM rate. The NRM was, surprisingly, not higher than for a typically younger cohort of AML. Relapse within one year after transplant is the major limitation to prolonged survival and this finding reflects the biology of the leukemia in these patients. In this patient population, novel post remission strategies should either be complimentary to alloSCT or competitive with updated outcome of alloSCT. Figure 1 Figure 1. Disclosures Ofran: Medison Israel: Consultancy; Janssen: Consultancy; Pfizer: Consultancy; Astellas: Consultancy; AbbVie: Consultancy. Claxton: Astellas: Other: Clinical Trial; Novartis: Research Funding; Astex: Research Funding; Cyclacel: Research Funding; Daiichi Sankyo: Research Funding; Incyte: Research Funding. Tallman: Syros: Membership on an entity's Board of Directors or advisory committees; Kura: Membership on an entity's Board of Directors or advisory committees; NYU Grand Rounds: Honoraria; Innate Pharma: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Biosight: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Jazz Pharma: Membership on an entity's Board of Directors or advisory committees; Oncolyze: Membership on an entity's Board of Directors or advisory committees; KAHR: Membership on an entity's Board of Directors or advisory committees; Orsenix: Membership on an entity's Board of Directors or advisory committees; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding; Rafael Pharmaceuticals: Research Funding; Glycomimetics: Research Funding; Biosight: Research Funding; Orsenix: Research Funding; Abbvie: Research Funding; Mayo Clinic: Honoraria; UC DAVIS: Honoraria; Northwell Grand Rounds: Honoraria; NYU Grand Rounds: Honoraria; Danbury Hospital Tumor Board: Honoraria; Acute Leukemia Forum: Honoraria; Miami Leukemia Symposium: Honoraria; New Orleans Cancer Symposium: Honoraria; ASH: Honoraria; NCCN: Honoraria. Melnick: Constellation: Consultancy; Epizyme: Consultancy; Daiichi Sankyo: Research Funding; Sanofi: Research Funding; Janssen Pharmaceuticals: Research Funding; KDAC Pharma: Membership on an entity's Board of Directors or advisory committees. Levine: Prelude: Membership on an entity's Board of Directors or advisory committees; Ajax: Membership on an entity's Board of Directors or advisory committees; Zentalis: Membership on an entity's Board of Directors or advisory committees; Mission Bio: Membership on an entity's Board of Directors or advisory committees; QIAGEN: Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria; Lilly: Honoraria; Morphosys: Consultancy; Janssen: Consultancy; Incyte: Consultancy; Astellas: Consultancy; Imago: Membership on an entity's Board of Directors or advisory committees; Auron: Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria; Celgene: Research Funding; Roche: Honoraria, Research Funding; C4 Therapeutics: Membership on an entity's Board of Directors or advisory committees; Isoplexis: Membership on an entity's Board of Directors or advisory committees. Lazarus: Bristol Myer Squibb: Membership on an entity's Board of Directors or advisory committees. Luger: Syros: Honoraria; Agios: Honoraria; Daiichi Sankyo: Honoraria; Jazz Pharmaceuticals: Honoraria; Brystol Myers Squibb: Honoraria; Acceleron: Honoraria; Astellas: Honoraria; Pfizer: Honoraria; Onconova: Research Funding; Celgene: Research Funding; Biosight: Research Funding; Hoffman LaRoche: Research Funding; Kura: Research Funding. Foran: gamida: Honoraria; aptose: Research Funding; syros: Honoraria; boehringer ingelheim: Research Funding; kura: Research Funding; takeda: Research Funding; abbvie: Research Funding; trillium: Research Funding; revolution medicine: Honoraria; certara: Honoraria; actinium: Research Funding; OncLive: Honoraria; pfizer: Honoraria; servier: Honoraria; bms: Honoraria; novartis: Honoraria; taiho: Honoraria; sanofi aventis: Honoraria; h3bioscience: Research Funding; aprea: Research Funding; sellas: Research Funding; stemline: Research Funding. Litzow: Jazz: Other: Advisory Board; AbbVie: Research Funding; Omeros: Other: Advisory Board; Amgen: Research Funding; Actinium: Research Funding; Astellas: Research Funding; Pluristem: Research Funding; Biosight: Other: Data monitoring committee.
Molecular classification improves risk assessment in adult BCR-ABL1– negative B-ALL
Paietta, Elisabeth , Wang, Victoria , Gu, Zhaohui , Buck, Georgina , Pei, Deqing, Levine, Ross L. , Cheng, Zhongshan , Pounds, Stanley , Racevskis, Janis, Bařinka, Jan , Zhang, Yanming , Dewald, Gordon W., Alejos, David , Luger, Selina M. , Foroni, Letizia, Patel, Bela , Melnick, Ari , Marks, David I. , Moorman, Anthony V. , Wiernik, Peter H. , Rowe, Jacob M. , Tallman, Martin S. , Goldstone, Anthony H., Litzow, Mark R. , Gu, Zhaohui , Harvey, Richard , Lazarus, Hillard M , Fielding, Adele K , Melnick, Ari , Mullighan, Charles G , Litzow, Mark R. , Pounds, Stanley B , Roberts, Kathryn G. , Cheng, Cheng , Abdel‐Wahab, Omar , Wu, Gang , Qu, Chunxu , Shi, Lei Gang , Willman, Cheryl L. , Harvey, Richard C. , Ketterling, Rhett P. , Lazarus, Hillard M. , Fielding, Adele K. , Mullighan, Charles G.

Blood | April 25, 2021 | Volume: 138 | Issue: 11 | Pages: 948-958

10.1182/blood.2020010144 Get It

Abstract Genomic classification has improved risk assignment of pediatric, but not adult B-lineage acute lymphoblastic leukemia (B-ALL). The international UKALLXII/ECOG-ACRIN E2993 (#NCT00002514) trial accrued 1229 adolescent/adult patients with BCR-ABL1− B-ALL (aged 14 to 65 years). Although 93% of patients achieved remission, 41% relapsed at a median of 13 months (range, 28 days to 12 years). Five-year overall survival (OS) was 42% (95% confidence interval, 39, 44). Transcriptome sequencing, gene expression profiling, cytogenetics, and fusion polymerase chain reaction enabled genomic subtyping of 282 patient samples, of which 264 were eligible for trial, accounting for 64.5% of E2993 patients. Among patients with outcome data, 29.5% with favorable outcomes (5-year OS 65% to 80%) were deemed standard risk (DUX4-rearranged [9.2%], ETV6-RUNX1/-like [2.3%], TCF3-PBX1 [6.9%], PAX5 P80R [4.1%], high-hyperdiploid [6.9%]); 50.2% had high-risk genotypes with 5-year OS of 0% to 27% (Ph-like [21.2%], KMT2A-AFF1 [12%], low-hypodiploid/near-haploid [14.3%], BCL2/MYC-rearranged [2.8%]); 20.3% had intermediate-risk genotypes with 5-year OS of 33% to 45% (PAX5alt [12.4%], ZNF384/-like [5.1%], MEF2D-rearranged [2.8%]). IKZF1 alterations occurred in 86% of Ph-like, and TP53 mutations in patients who were low-hypodiploid (54%) and BCL2/MYC-rearranged (33%) but were not independently associated with outcome. Of patients considered high risk based on presenting age and white blood cell count, 40% harbored subtype-defining genetic alterations associated with standard- or intermediate-risk outcomes. We identified distinct immunophenotypic features for DUX4-rearranged, PAX5 P80R, ZNF384-R/-like, and Ph-like genotypes. These data in a large adult B-ALL cohort treated with a non–risk-adapted approach on a single trial show the prognostic importance of genomic analyses, which may translate into future therapeutic benefits.
Dynamic Assembly of a Feedback Complex to Regulate Oncogenic B-Cell Receptor-Signaling
Chen, Zhengshan , Chan, Lai N. , Klemm, Lars, Chan, Wing C. , Forman, Stephen J. , Berkel, Patrick van, Geng, Huimin , Luger, Selina M. , Litzow, Mark, Vaidehi, Nagarajan , Paietta, Elisabeth , Meffre, Eric , Weinstock, David M. , Müschen, Markus , Lee, Jae Woong , Kume, Kohei , Xiao, Gang , Cosgun, Kadriye Nehir , Chen, Liting , Chen, Chun‐Wei , Ma, Ning , Zammarchi, Francesca , Melnick, Ari , Ngo, Vu N. , McManus, Michael T.

Blood | February 14, 2020 | Volume: 134 | Issue: Supplement_1 | Pages: 393-393

10.1182/blood-2019-131270 Get It

Background: Studying gene expression and clinical outcome data from 136 clinical trials for patients with cancer (~21,000 patients with 26 cancer types), we found CD25 as one of the strongest predictors of poor clinical outcome in patients with B-cell malignancies, but not in other cancer types. This was unexpected because CD25 is known as one of three chains of the IL2 receptor on T-cells and NK-cells. Interleukin-2 (IL2) functions as essential T-cell growth factor. IL2 signals through b- and g-, but not a-chains (CD25) of its heterotrimeric receptor. CD25-deficiency causes lymphoproliferation and autoimmunity, however, its mechanistic role is unclear. Results: Our experiments based on genetic mouse models and engineered patient-derived B-cell leukemia and lymphoma xenografts revealed that CD25 expressed on B-cells is not an IL2 receptor chain, but in fact binds downstream signaling molecules of the B-cell receptor (BCR). Through these interactions, CD25 mediates negative feedback to BCR signaling in response to antigen-encounter in normal B-cells. Defects in CD25-/-B-cells were not replicated in mice that express CD25 but lack expression of the IL2 cytokine. These findings demonstrate IL2-independent functions of CD25 in B-cells and B-cell derived leukemia and lymphoma. To comprehensively study the interactome of the short cytoplasmic tail of CD25, we performed proximity-dependent biotin identification (BioID). This analysis revealed that the CD25 tail exerts negative feedback control through recruitment of the PKCβ-scaffold RACK1 and the inhibitory phosphatase SHIP1 (see schematic, left). Interestingly, the cytoplasmic tail of CD25 harbors a PKCβ-substrate motif and mutation of a central serine residue (S268) to A268 compromised interactions with PKCβ, its scaffold RACK1 and SHIP1, demonstrating that feedback control was dependent on PKCβ-mediated phosphorylation of CD25-S268. A genetic observation in a family with monogenic autoimmunity confirmed the functional importance of the cytoplasmic CD25-tail motif: a mutation immediately preceding S268 compromised CD25-surface translocation, which was restored by homology-directed repair of the S268. In vitro kinase assay with 62 candidate kinases against recombinant cytoplasmic tail of CD25-S268 or -A268 identified PKCβ as top-ranking kinase hit for CD25-S268 but not CD25-A268. Our genetic studies revealed that PKCβ is required for cell-membrane translocation of CD25, but also transcriptional expression of CD25 via NF-κB activation. Therefore, PKCβ act as critical effector molecule downstream of CD25 to mediate B-cell selection during normal B-cell development and calibrate oncogenic BCR signaling in B-cell tumors. In B-cell malignancies, BCR-dependent survival and proliferation signals are often substituted by oncogenic BCR-mimics (e.g. BCR-ABL1, JAK2, BRAFV600E, LMP2A, CD79B mutations; see schematic, right). Accordingly, we identified CD25 surface-expression as biomarker of oncogenic BCR-signaling and predictor of poor clinical outcomes. CD25-/-B-cell leukemia failed to initiate fatal disease in transplant recipients. Owing to imbalances of oncogenic BCR-signaling and p53-checkpoint activation, CD25-/- B-cell leukemia failed to initiate fatal disease in transplant recipients. In patient-derived xenograft models of drug-resistant B-cell malignancies, treatment with a CD25-specific antibody drug-conjugate (ADCT-301) extended survival of transplant recipients or eradicated disease. These findings identified CD25 as previously unrecognized feedback regulator of oncogenic BCR-signaling and provide a rationale for therapeutic targeting of CD25 in refractory B-cell malignancies. Figure Disclosures Zammarchi: ADC Therapeutics: Employment. Van Berkel:ADC Therapeutics: Research Funding. Melnick:Constellation: Consultancy; Janssen: Research Funding; Epizyme: Consultancy. Luger:Celgene: Research Funding; Cyslacel: Research Funding; Pfizer: Honoraria; Seattle Genetics: Research Funding; Agios: Honoraria; Ariad: Research Funding; Biosight: Research Funding; Kura: Research Funding; Onconova: Research Funding; Genetech: Research Funding; Jazz: Honoraria; Daichi Sankyo: Honoraria. Meffre:AbbVie: Consultancy, Other: Grant. Weinstock:Celgene: Research Funding.