Trainee Pearls: Recent Episodes

The EBMT Trainee Committee

Welcome to “Trainee Pearls”, a new initiative brought to you by the EBMT Trainee Committee to deliver the most important messages (“the pearls”) of high-profile research works in hematology and bone marrow transplant to our fellow trainees all over the world. The topics will span from classical hematology to more focused bone marrow transplant research. The selected research article will be discussed directly with young authors who have been involved with the published work.

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Allogeneic hematopoietic cell transplantation (HCT) in patients with myelodysplastic syndrome (MDS) improves overall survival. The authors evaluated the impact of MDS genetics on the benefit of HCT in a biological assignment (donor v no donor) study.https://pubmed.ncbi.nlm.nih.gov/37607457/ALSO AS VIDEO ONhttps://youtu.be/JbHS_-2sJQcCONNECT WITH UShttps://twitter.com/TheEBMT_Traineehttps://www.ebmt.org/trainee-committeehttps://twitter.com/CarmeloGurnari

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In this study, Nathanial and colleagues systematically analyzed CD19 CAR-T cells of 10 children with R/R B-ALL enrolled in the CARPALL trial via high-throughput single-cell gene expression and T cell receptor sequencing of infusion products and serial blood and bone marrow samples up to 5 years after infusion. Article: https://www.nature.com/articles/s41591-023-02415-3

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https://youtu.be/z_aJgRHpEaI

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Chimeric antigen receptor (CAR) T-cell therapy is a promising option for patients with heavily treated multiple myeloma. Point-of-care manufacturing can increase the availability of these treatments worldwide. Aina and colleagues assessed the safety and activity of ARI0002h, a BCMA-targeted CAR T-cell therapy developed by academia, in patients with relapsed or refractory multiple myeloma. https://pubmed.ncbi.nlm.nih.gov/37414060/

ALSO AS VIDEO ON https://youtu.be/Ymgg22roWGU

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Immunotherapy with chimeric antigen receptor (CAR)–expressing T cells that target the disialoganglioside GD2 expressed on tumor cells may be a therapeutic option for patients with high-risk neuroblastoma. In an academic, phase 1–2 clinical trial, the investigators enrolled patients (1 to 25 years of age) with relapsed or refractory, high-risk neuroblastoma in order to test autologous, third-generation GD2-CAR T cells expressing the inducible caspase 9 suicide gene (GD2-CART01).https://www.nejm.org/doi/full/10.1056/NEJMoa2210859ALSO AS VIDEO ON YOUTUBE

https://youtu.be/o1DVDcrrHFA

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The presence of TP53 mutations is associated with an unfavorable outcome  in patients allografted for acute myeloid leukemia (AML), leading some  to question the benefit of an allogeneic stem cell transplantation  (allo-SCT) for this patient group, although this has not been studied in  a large cohort.  Article: https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34268  ALSO AS AUDIO ON
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Richter transformation (RT) is a paradigmatic evolution of chronic  lymphocytic leukemia (CLL) into a very aggressive large B cell lymphoma  conferring a dismal prognosis. The mechanisms driving RT remain largely  unknown.  

Article: https://www.nature.com/articles/s41591-022-01927-8  

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https://open.spotify.com/show/2M1PWPZGW9Bz7PL5eh103Y  

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Risk stratification and therapeutic decision-making for myelodysplastic syndromes (MDS) are based on the International Prognostic Scoring System–Revised (IPSS-R), which considers hematologic parameters and cytogenetic abnormalities. Somatic gene mutations are not yet used in the risk stratification of patients with MDS. Combining genomic profiling with hematologic and cytogenetic parameters, the IPSS-M improves the risk stratification of patients with MDS and represents a valuable tool for clinical decision-making.

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Schimke immuno-osseous dysplasia (SIOD) is a multisystem disorder that  is inherited in an autosomal recessive pattern. It usually manifests  first with growth failure. Other features of the disease are generally  noted in the ensuing evaluation of the growth failure or develop in the  following years.   

Article:  https://www.nejm.org/doi/10.1056/NEJMoa2117028?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed   

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https://podcasts.apple.com/us/podcast/trainee-pearls/id1596786132 

https://open.spotify.com/show/2M1PWPZGW9Bz7PL5eh103Y  

YOUTUBE 

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Oncogenic alterations underlying B-cell acute lymphoblastic leukemia  (B-ALL) in adults remain incompletely elucidated. To uncover novel  oncogenic drivers, Marie and her team performed RNA-seq and whole-genome  analyses in a large cohort of unresolved B-ALL. Marie and colleagues  identified a novel subtype characterized by a distinct gene expression  signature and the unique association of two genomic microdeletions.   Article link: https://ashpublications.org/blood/article/doi/10.1182/blood.2021014723/484449/Concurrent-CDX2-cis-deregulation-and-UBTF-ATXN7L3

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Hemophagocytic lymphohistiocytosis (HLH; hemophagocytic syndrome) is a  rare syndrome of potentially fatal, uncontrolled hyperinflammation.  Allogeneic hematopoietic stem cell transplantation is indicated in  primary, recurrent or progressive HLH, but information about its  outcomes in the adult population is limited.

Rafal works at the Department of Hematology, Transplantation and  Internal Medicine, Medical University of Warsaw, Warsaw, Poland. And he  is part of YoungEHA.

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Progression and persistence of malignancies are influenced by the local  tumor microenvironment, and future eradication of currently incurable  tumors will, in part, hinge on our understanding of malignant cell  biology in the context of their nourishing surroundings.  Article: https://www.nature.com/articles/s41590-021-00931-3 

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Histopathology is elementary in the diagnostics of patients with MDS,  but its high-dimensional data are underused. By elucidating the  association of morphologic features with clinical variables and  molecular genetics, this study highlights the vast potential of  convolutional neural networks in understanding MDS pathology and how  genetics is reflected in BM morphology. Article: https://bloodcancerdiscov.aacrjournals.org/content/2/3/238

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Clonal hematopoiesis (CH) is an age-related, asymptomatic condition in  which leukemia-associated somatic mutations are detected in the blood of  individuals without a hematologic malignancy. In the nontransplant  setting, CH is uniformly associated with adverse outcomes, including an  elevated risk of developing hematologic malignancies and an increased  risk of nonhematologic outcomes because of altered inflammatory  signaling.  Current evidence has thus been insufficient to resolve  disagreement about whether to screen older candidate donors for CH, and  some transplant centers have begun excluding donors found to have CH on  the basis of the assumption that the adverse associations of native CH  also apply in the context of transplant. This study performed a  comprehensive analysis of samples from donors age 40 years or older to  determine the impact of CH on overall recipient outcomes, risk of DCL,  and measures of graft alloimmune activity.  Article: https://ascopubs.org/doi/full/10.1200/JCO.21.02286

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Hurler syndrome, also known as mucopolysaccharidosis Type IH (MPS-IH),  Hurler's disease, and formerly gargoylism, is a genetic disorder that  results in the buildup of large sugar molecules called  glycosaminoglycans (GAGs) in lysosomes. The inability to break down  these molecules results in a wide variety of symptoms caused by damage  to several different organ systems, including but not limited to the  nervous system, skeletal system, eyes, and heart. Allogeneic  hematopoietic stem-cell transplantation is the standard of care for  Hurler syndrome (mucopolysaccharidosis type I, Hurler variant [MPSIH]).  However, this treatment is only partially curative and is associated  with complications.

Join our conversation with Francesca Tucci from  Pediatric Immunohematology and Bone Marrow Transplantation and the San  Raffaele Telethon Institute for Gene Therapy, Milan, Italy (Article:  https://www.nejm.org/doi/full/10.1056/NEJMoa2106596). 

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VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently described autoinflammatory syndrome characterized by diffuse inflammatory manifestations, predisposition to hematological malignancy, and an association with a high rate of thrombosis. VEXAS is attributed to somatic mutations in the UBA1 gene in hematopoietic stem and progenitor cells with myeloid restriction in mature forms.

Join our conversation with Emma Groarke from the National Cancer Institute, USA, to understand how it was discovered and more.

Article:  https://www.nejm.org/doi/10.1056/NEJMoa2026834?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed

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Clinical evolution, genetic landscape and trajectories of clonal hematopoiesis in SAMD9/SAMD9L syndromes. Sahoo SS, et al. Nat Med. 2021 Oct;27(10):1806-1817. doi: 10.1038/s41591-021-01511-6