Targeted antibody-based therapy has been used successfully to treat cancers. Recent studies have demonstrated that tumor cells treated with antibodies specific for beta 2-microglobulin (beta(2)M) or major histocompatibility complex (MHC) class I molecules undergo apoptosis in vitro and in vivo (mouse models).
Antibodies against beta(2)M or MHC class I induce tumor cell apoptosis by 1) recruiting MHC class I molecules to lipid rafts and activating LYN kinase and the signal-transducing enzyme phospholipase C-gamma2-dependent c-Jun N-terminal kinase signaling pathway and 2) expelling interleukin 6 and insulin-like growth factor 1 receptors out of lipid rafts and inhibiting the growth and survival factor-induced activation of the phosphatidylinositol 3-kinase/Akt and extracellular signal-related kinase pathways.
Consequently, mitochondrial integrity is compromised, and the caspase-9-dependent cascade is activated in treated tumor cells. However, although beta(2)M and MHC class I are expressed on normal hematopoietic cells, which is a potential safety concern, the monoclonal antibodies were selective to tumor cells and did not damage normal cells in vitro or in human-like mouse models. These findings suggest that targeting beta(2)M or MHC class I by using antibodies or other agents offers a potential therapeutic approach for beta(2)M/MHC class I-expressing malignancies.
Cancer. 2010 Feb 8.
Killing tumor cells through their surface beta(2)-microglobulin or major histocompatibility complex class I molecules.
Yang J, Yi Q.
Department of Lymphoma and Myeloma, Division of Cancer Medicine, Center for Cancer Immunology Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
Wednesday
Levels of beta 2 microglobulin have a prognostic relevance for patients with myelodysplastic syndrome with regard to survival and the risk of trans
We evaluated the relevance of beta 2 microglobulin (B2M) plasma concentration in 109 patients with myelodysplastic syndrome (MDS) from the Duesseldorf registry. Sixty-five patients with B2M level ≥2mg/dl showed a significantly lower overall survival time with a median of 23 in comparison to 61 months for 44 patients with B2M below 2mg/dl. The risk of AML evolution was higher in patients with B2M≥2mg/dl. Using multivariate analysis we found the B2M level at the time of diagnosis to be an independent prognostic parameter for survival and for the risk of developing AML in high-risk MDS patients
Leukemia Research: Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
Volume 33, Issue 2, Pages 232-236 (February 2009)
Leukemia Research: Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
Volume 33, Issue 2, Pages 232-236 (February 2009)
Thursday
Beta2-microglobulin is a better predictor of treatment-free survival in patients with chronic lymphocytic leukaemia if adjusted according to glomerula
ABSTRACT
Even in the era of newer and sophisticated prognostic markers, beta2-microglobulin (B2M) remains a simple but very powerful predictor of treatment-free survival (TFS) and overall survival (OS) in patients with chronic lymphocytic leukaemia (CLL). However, B2M levels are heavily influenced by the patient's glomerular filtration rate (GFR) and this study aimed to evaluate whether GFR-adjusted B2M (GFR-B2M) had improved prognostic value compared to unadjusted B2M in a cohort of over 450 consecutive CLL patients from two separate institutions.
Multivariate analysis identified a significantly shorter TFS in patients who were ZAP-70 + (P < 0·001), with increased GFR-B2M (P < 0·001), and del(11q) or del(17p) as detected by fluorescence in situ hybridization (FISH; P < 0·001). When OS was evaluated by multivariate analysis, age 65 years or older (P < 0·001) and poor risk FISH abnormalities (P < 0·001) had a confirmed adverse prognostic impact, but the predictive value of GFR-B2M was lost in the validation analysis.
In all survival models, B2M did not attain independent significance unless GFR-B2M was eliminated from the analysis. In conclusion, GFR-B2M is a better predictor of TFS than unadjusted B2M in CLL patients.
Servei d'Hematologia, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025 Barcelona, Spain.
Even in the era of newer and sophisticated prognostic markers, beta2-microglobulin (B2M) remains a simple but very powerful predictor of treatment-free survival (TFS) and overall survival (OS) in patients with chronic lymphocytic leukaemia (CLL). However, B2M levels are heavily influenced by the patient's glomerular filtration rate (GFR) and this study aimed to evaluate whether GFR-adjusted B2M (GFR-B2M) had improved prognostic value compared to unadjusted B2M in a cohort of over 450 consecutive CLL patients from two separate institutions.
Multivariate analysis identified a significantly shorter TFS in patients who were ZAP-70 + (P < 0·001), with increased GFR-B2M (P < 0·001), and del(11q) or del(17p) as detected by fluorescence in situ hybridization (FISH; P < 0·001). When OS was evaluated by multivariate analysis, age 65 years or older (P < 0·001) and poor risk FISH abnormalities (P < 0·001) had a confirmed adverse prognostic impact, but the predictive value of GFR-B2M was lost in the validation analysis.
In all survival models, B2M did not attain independent significance unless GFR-B2M was eliminated from the analysis. In conclusion, GFR-B2M is a better predictor of TFS than unadjusted B2M in CLL patients.
Servei d'Hematologia, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025 Barcelona, Spain.
Friday
The Prognostic Significance of Serum β2 Microglobulin Levels in Acute Myeloid Leukemia and Prognostic Scores Predicting Survival: Analysis of 1,180 Pa
Purpose: Serum B2 microglobulin (B2M) is prognostic in other hematologic malignancies; therefore, we evaluated its prognostic significance in acute myeloid leukemia (AML).
Experimental Design: Multivariate analyses were used to examine the effect of pretreatment Serum B2 microglobulin (b2M) levels on clinical outcomes in patients with AML. beta 2 microglobulin B2M was associated with poorer survival in older but not younger patients. We thus fit separate Cox survival models in patients above and below age 60 years treated with remission induction therapy containing high-dose cytarabine (n = 1,280). In each age group, 50% of the patients were used to develop the model, which was tested in the other 50%. Resampling methods were also used to validate the independent prognostic significance of covariates.
Results: In patients 60 years or older (n = 591), poorer risk cytogenetics; poorer performance status; and higher levels of B2M, uric acid, and lactate dehydrogenase were each found to independently predict shorter survival and formed the basis of a scoring system. A similar approach was used in patients younger than 60 years (n = 589), with poorer risk cytogenetics, poorer performance status, older age, higher hemoglobin level, and higher leukocyte count predicting a shorter survival and forming the basis of the scoring system. Higher β2M levels were an adverse independent factor for response, survival, relapse-free survival, and event-free survival in older but not in younger patients.
Conclusions: Serum β2M levels can help predict outcome in patients 60 years with untreated AML, and their use is strongly encouraged.
Experimental Design: Multivariate analyses were used to examine the effect of pretreatment Serum B2 microglobulin (b2M) levels on clinical outcomes in patients with AML. beta 2 microglobulin B2M was associated with poorer survival in older but not younger patients. We thus fit separate Cox survival models in patients above and below age 60 years treated with remission induction therapy containing high-dose cytarabine (n = 1,280). In each age group, 50% of the patients were used to develop the model, which was tested in the other 50%. Resampling methods were also used to validate the independent prognostic significance of covariates.
Results: In patients 60 years or older (n = 591), poorer risk cytogenetics; poorer performance status; and higher levels of B2M, uric acid, and lactate dehydrogenase were each found to independently predict shorter survival and formed the basis of a scoring system. A similar approach was used in patients younger than 60 years (n = 589), with poorer risk cytogenetics, poorer performance status, older age, higher hemoglobin level, and higher leukocyte count predicting a shorter survival and forming the basis of the scoring system. Higher β2M levels were an adverse independent factor for response, survival, relapse-free survival, and event-free survival in older but not in younger patients.
Conclusions: Serum β2M levels can help predict outcome in patients 60 years with untreated AML, and their use is strongly encouraged.
Thursday
The Prognostic Significance of Serum β2 Microglobulin Levels in Acute Myeloid Leukemia and Prognostic Scores Predicting Survival: Analysis of 1,180 Pa
Purpose:
Serum β2 microglobulin (β2M) is prognostic in other hematologic malignancies; therefore, we evaluated its prognostic significance in acute myeloid leukemia (AML).
Experimental Design:
Multivariate analyses were used to examine the effect of pretreatment serum β2M levels on clinical outcomes in patients with AML. β2 microglobulin (β2M) was associated with poorer survival in older but not younger patients. We thus fit separate Cox survival models in patients above and below age 60 years treated with remission induction therapy containing high-dose cytarabine (n = 1,280). In each age group, 50% of the patients were used to develop the model, which was tested in the other 50%. Resampling methods were also used to validate the independent prognostic significance of covariates.
Results:
In patients 60 years or older (n = 591), poorer risk cytogenetics; poorer performance status; and higher levels of β2 microglobulin (β2M), uric acid, and lactate dehydrogenase were each found to independently predict shorter survival and formed the basis of a scoring system. A similar approach was used in patients younger than 60 years (n = 589), with poorer risk cytogenetics, poorer performance status, older age, higher hemoglobin level, and higher leukocyte count predicting a shorter survival and forming the basis of the scoring system. Higher β2M levels were an adverse independent factor for response, survival, relapse-free survival, and event-free survival in older but not in younger patients.
Conclusions:
Serum β2 microglobulin (β2M) levels can help predict outcome in patients 60 years with untreated AML, and their use is strongly encouraged.
Serum β2 microglobulin (β2M) is prognostic in other hematologic malignancies; therefore, we evaluated its prognostic significance in acute myeloid leukemia (AML).
Experimental Design:
Multivariate analyses were used to examine the effect of pretreatment serum β2M levels on clinical outcomes in patients with AML. β2 microglobulin (β2M) was associated with poorer survival in older but not younger patients. We thus fit separate Cox survival models in patients above and below age 60 years treated with remission induction therapy containing high-dose cytarabine (n = 1,280). In each age group, 50% of the patients were used to develop the model, which was tested in the other 50%. Resampling methods were also used to validate the independent prognostic significance of covariates.
Results:
In patients 60 years or older (n = 591), poorer risk cytogenetics; poorer performance status; and higher levels of β2 microglobulin (β2M), uric acid, and lactate dehydrogenase were each found to independently predict shorter survival and formed the basis of a scoring system. A similar approach was used in patients younger than 60 years (n = 589), with poorer risk cytogenetics, poorer performance status, older age, higher hemoglobin level, and higher leukocyte count predicting a shorter survival and forming the basis of the scoring system. Higher β2M levels were an adverse independent factor for response, survival, relapse-free survival, and event-free survival in older but not in younger patients.
Conclusions:
Serum β2 microglobulin (β2M) levels can help predict outcome in patients 60 years with untreated AML, and their use is strongly encouraged.
Molecular differences b/t divergent responses of ovalbuminspecific CD4 T cells to alumprecipitated ovalbumin compared toovalbumin expressed Salmonella
CD4 T helper (Th) cell differentiation defined by in vitro cytokine-directed culture systems leaves major gaps in our knowledge of the mechanisms driving divergent Th differentiation. This is evident from our analysis of the response of mouse ovalbumin-specific CD4 T cells to different forms of ovalbumin that induce markedly distinct responses in vivo. We show that live attenuated ovalbumin-expressing Salmonella (SalOVA) induce Th1-associated T-bet and IFN-γ. Conversely, alum-precipitated ovalbumin (alumOVA) induces the Th2-associated GATA-3 and IL-4. The early diversity occurring within these CD4 T cells isolated 3 days after immunization was assessed using real-time RT-PCR microfluidic cards designed with 384 selected genes. The technique was validated both at the population and single cell levels at different stages of the responses, showing β2-microglobulin to be a more stably expressed reference mRNA than either β-actin or 18S RNA. SalOVA was then shown selectively to induce the OVA-specific CD4 T cells to produce many chemokines and pro-inflammatory cytokines, contrasting with alumOVA-induced cells that only produced a few Th2-associated cytokines. Several cytokines and features associated with follicular helper functions were induced in the OVA-specific CD4 T cells by both antigens. Finally, IL-17RB is strongly associated with OVA-specific CD4 T cells responding to alumOVA, suggesting that alum may promote Th2 immune response through a role for the IL-25/IL-17RB pathway.
ARTICLE
ARTICLE
Tuesday
Reduction in β2-Microglobulin With Super-flux Versus High-flux Dialysis Membranes: Results of a 6-Week, Randomized, Double-blind, Crossover Trial
Background
Uremic toxicity is a major concern in the dialysis population. There is keen interest in techniques that increase the removal of larger uremic molecules. We examined the short-term impact of a new, more porous, super-flux Helixone membrane (FX-E) versus the conventional high-flux Helixone membrane (FX-60) on β2-microglobulin (Beta 2 Microglobulin) reduction and nutritional and inflammatory parameters.
Study Design
Randomized, double blind, crossover, pilot trial.
Setting & Participants
A single freestanding dialysis center. 30 stable hemodialysis patients.
Intervention
Patients were treated with FX-60 and FX-E membranes for a treatment period of 6 weeks each, with a 2-week washout period in between.
Outcome & Measurements
Primary outcome was change in β2-microglobulin (Beta 2 Microglobulin) concentrations from baseline to end of treatment. Serum samples were obtained predialysis and postdialysis at 0, 2, and 6 weeks, and dialysate albumin samples were collected continuously throughout dialysis sessions.
Results
Mean postdialysis β2M concentrations at the end of 6 weeks of treatment were 6.73 mg/L for FX-E versus 8.22 mg/L for FX-60, which was significantly lower overall by 0.69 mg/L (95% confidence interval [CI], −1.09 to −0.29; P = 0.001). β2M reduction ratios were greater overall with FX-E by 4.83% (95% CI, 2.78 to 6.89; P < 0.001), with mean values of 57% for FX-60 versus 66% for FX-E at the end of treatment. Median dialysate albumin loss with FX-E was 1.23 g (range, 0.22 to 4.83 g) compared with 0.17 g (range, 0.0017 to 2.69 g) with FX-60, which was greater by 1.52 g (95% CI, 1.11 to 1.93; P < 0.001). Serum albumin concentrations were slightly lower with FX-E by 0.1 g/dL (0.55 g/L; 95% CI, −1.04 to −0.07; P = 0.03), but prealbumin concentrations were not significantly different at 8.53 mg/L (95% CI, −23.76 to 6.71; P = 0.3). There were no differences in inflammatory cytokine concentrations or small-solute removal.
Limitations
Short-term pilot study.
Conclusion
In this stable dialysis population, removal of β2-microglobulin (Beta 2 Microglobulin) was more efficient with the Helixone super-flux FX-E membrane, with only a small decrease in albumin concentrations despite increased albumin loss. Large trials with longer treatment periods are required to evaluate the impact of the FX-E membrane on clinical outcomes.
ARTICLE
Uremic toxicity is a major concern in the dialysis population. There is keen interest in techniques that increase the removal of larger uremic molecules. We examined the short-term impact of a new, more porous, super-flux Helixone membrane (FX-E) versus the conventional high-flux Helixone membrane (FX-60) on β2-microglobulin (Beta 2 Microglobulin) reduction and nutritional and inflammatory parameters.
Study Design
Randomized, double blind, crossover, pilot trial.
Setting & Participants
A single freestanding dialysis center. 30 stable hemodialysis patients.
Intervention
Patients were treated with FX-60 and FX-E membranes for a treatment period of 6 weeks each, with a 2-week washout period in between.
Outcome & Measurements
Primary outcome was change in β2-microglobulin (Beta 2 Microglobulin) concentrations from baseline to end of treatment. Serum samples were obtained predialysis and postdialysis at 0, 2, and 6 weeks, and dialysate albumin samples were collected continuously throughout dialysis sessions.
Results
Mean postdialysis β2M concentrations at the end of 6 weeks of treatment were 6.73 mg/L for FX-E versus 8.22 mg/L for FX-60, which was significantly lower overall by 0.69 mg/L (95% confidence interval [CI], −1.09 to −0.29; P = 0.001). β2M reduction ratios were greater overall with FX-E by 4.83% (95% CI, 2.78 to 6.89; P < 0.001), with mean values of 57% for FX-60 versus 66% for FX-E at the end of treatment. Median dialysate albumin loss with FX-E was 1.23 g (range, 0.22 to 4.83 g) compared with 0.17 g (range, 0.0017 to 2.69 g) with FX-60, which was greater by 1.52 g (95% CI, 1.11 to 1.93; P < 0.001). Serum albumin concentrations were slightly lower with FX-E by 0.1 g/dL (0.55 g/L; 95% CI, −1.04 to −0.07; P = 0.03), but prealbumin concentrations were not significantly different at 8.53 mg/L (95% CI, −23.76 to 6.71; P = 0.3). There were no differences in inflammatory cytokine concentrations or small-solute removal.
Limitations
Short-term pilot study.
Conclusion
In this stable dialysis population, removal of β2-microglobulin (Beta 2 Microglobulin) was more efficient with the Helixone super-flux FX-E membrane, with only a small decrease in albumin concentrations despite increased albumin loss. Large trials with longer treatment periods are required to evaluate the impact of the FX-E membrane on clinical outcomes.
ARTICLE
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