Publications by authors named "Alan G Ramsay"

Article Synopsis
  • The REFRACT trial is a UK-based clinical trial aimed at improving treatments for relapsed or refractory follicular lymphoma (rrFL) by testing a new combination therapy of epcoritamab and lenalidomide against standard treatment options.
  • Eligible participants are adults with specific types of follicular lymphoma, and the trial's main goal is to assess the effectiveness of the new therapy based on complete metabolic response as measured by PET-CT after 24 weeks.
  • The study aims to fill the gap in understanding the safety and efficacy of novel therapies in comparison to existing standards, using a unique design to streamline the process and reduce the number of patients needed for reliable results.
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  • BTK inhibitors (BTKis) represent a major advancement in treating chronic lymphocytic leukemia (CLL) by targeting B-cell signaling and improving immune response.
  • A study compared the effects of ibrutinib-rituximab versus another treatment (FCR) and found that while T-cell counts were reduced with BTKi therapy, the quality of T-cell function and anti-CLL activity actually improved, leading to better patient outcomes.
  • The research suggests combining BTKi treatment with other immunotherapies, like glofitamab, to further enhance T-cell activity against CLL.
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  • Chronic lymphocytic leukemia (CLL) cells rely heavily on their surrounding tumor microenvironment for growth, making it crucial to explore new treatment options that can boost the immune response.
  • The study focused on interleukin 27 (IL-27), revealing that a lack of IL-27 leads to worse CLL outcomes and creates a more immunosuppressive environment in mouse models.
  • IL-27 not only enhances the activation and effectiveness of CD8+ T cells against CLL in both mice and human samples, but its levels decrease during CLL progression, suggesting it could be an effective treatment option for patients.
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Recent transcriptomic-based analysis of diffuse large B cell lymphoma (DLBCL) has highlighted the clinical relevance of LN fibroblast and tumor-infiltrating lymphocyte (TIL) signatures within the tumor microenvironment (TME). However, the immunomodulatory role of fibroblasts in lymphoma remains unclear. Here, by studying human and mouse DLBCL-LNs, we identified the presence of an aberrantly remodeled fibroblastic reticular cell (FRC) network expressing elevated fibroblast-activated protein (FAP).

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  • TIGIT is an inhibitory receptor that regulates T-cell responses, and in a study of 115 chronic lymphocytic leukemia (CLL) patients, researchers analyzed the expression of TIGIT and the competing receptor CD226 in leukemic cells.
  • * The study found that a higher TIGIT to CD226 ratio indicated a more indolent form of CLL, while a preference for CD226 correlated with quicker treatment initiation and shorter survival times.
  • * It was also discovered that TIGIT expression inversely affects B-cell receptor (BCR) signaling, with implications for treatment responses, especially in patients undergoing ibrutinib therapy.
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  • This study explores the role of small extracellular vesicles (sEVs or exosomes) in the tumor microenvironment of chronic lymphocytic leukemia (CLL) using mouse models, highlighting their impact on immune cell function.
  • The research found that sEVs contain specific miRNAs and proteins that alter CD8+ T-cell activity and contribute to immune cell exhaustion, which can worsen cancer progression.
  • Elevated levels of sEV-related genes are linked to poor survival outcomes in CLL patients, suggesting that analyzing these vesicles could be a valuable prognostic tool for assessing cancer severity.
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Chemokine receptors and their ligands have been identified as playing an important role in the development of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and Richter syndrome (RS). Our aim was to investigate the different expression profiles in de novo DLBCL, transformed follicular lymphoma (tFL), and RS. Here, we profiled the mRNA expression levels of 18 chemokine receptors (-, -, and ) using RQ-PCR, as well as immunohistochemistry of seven chemokine receptors (CCR1, CCR4-CCR8 and CXCR2) in RS, de novo DLBCL, and tFL biopsy-derived tissues.

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  • Chronic lymphocytic leukemia (CLL) involves complex interactions between CLL cells and various T-cell subsets, particularly in the lymph node microenvironment where these interactions are important for disease development.
  • In co-cultures of CLL nurselike cells (NLC) from 28 patients, researchers observed significant expansion of T-follicular helper (Tfh) cells characterized by specific protein expressions, alongside an increase in regulatory T cells (Treg) that help maintain immune tolerance.
  • Using advanced microscopy, the study revealed that Tfh cells closely interact with proliferating CLL cells in lymph nodes, highlighting potential targets for new therapies aimed at disrupting this harmful interaction.
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  • - The study investigates how T cell exhaustion (a state where T cells lose effectiveness against tumors) affects immunity and responses to immunotherapy in chronic lymphocytic leukemia (CLL).
  • - Researchers identified different subsets of CD8 T cells, noting that specific signaling pathways (IL-10R and STAT3) influence the balance between exhausted and functional T cells, impacting tumor progression.
  • - Findings suggest that low levels of IL-10 or disruptions in IL-10R-STAT3 signaling lead to increased exhausted T cells, which correlate with worse patient outcomes in CLL and breast cancer, highlighting potential targets for improving immunotherapy.
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  • The tumor microenvironment (TME) plays a significant role in the progression of B cell malignancies by supporting tumor growth and helping malignant cells evade immune detection.
  • Immunomodulatory drugs (IMiDs) like lenalidomide not only have direct anti-tumor effects but also target immune cells and the TME, promoting anti-tumor responses while inhibiting pro-tumor signaling.
  • Newer drugs, such as avadomide, show strong anti-tumor activity and promising results in clinical settings, especially when combined with existing treatments like lenalidomide and rituximab for relapsed/refractory follicular lymphoma.
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  • - High-dimensional cytometry is a cutting-edge method for monitoring the immune system in both healthy and diseased states, helping researchers discover new biological insights and disease biomarkers.
  • - An R package called ImmunoCluster is introduced, which simplifies the analysis of complex cytometry data, enabling those without specialized computational skills to conduct immune profiling efficiently.
  • - The ImmunoCluster package features a scalable framework for analyzing millions of cells, offering a structured protocol that includes data import, dimensionality reduction, clustering, and annotation, all within an accessible open-source environment.
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  • The tumor microenvironment (TME) is crucial for the development and survival of malignant B-cells in chronic lymphocytic leukemia (CLL), involving various immune cells and signals that influence disease progression.
  • Traditional CLL treatments primarily target leukemic cells, but new findings suggest that altering TME interactions can enhance treatment effectiveness.
  • This review highlights the importance of understanding TME dynamics and encourages further research into innovative drug combinations and therapeutic targets for improving CLL treatment outcomes.
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  • Cancers, particularly lymphomas, create a tumor microenvironment (TME) that hinders effective anti-tumor T cell responses, with significant differences between types such as Hodgkin lymphoma and chronic lymphocytic leukemia.
  • The interaction between T cells, inflammatory signals, and the TME is vital for understanding how to improve responses to immunotherapies like anti-PD-1 treatments.
  • The review emphasizes the importance of examining both tumor and non-tumor cells in the TME to develop more effective immunotherapy strategies and overcome immune suppression.
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Patient-derived xenograft models of chronic lymphocytic leukemia (CLL) can be created using highly immunodeficient animals, allowing analysis of primary tumor cells in an setting. However, unlike many other tumors, CLL B lymphocytes do not reproducibly grow in xenografts without manipulation, proliferating only when there is concomitant expansion of T cells. Here we show that pre-activation of CLL-derived T lymphocytes allows for a reliable and robust system for primary CLL cell growth within a fully autologous system that uses small numbers of cells and does not require pre-conditioning.

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  • Checkpoint blockade therapies, particularly anti-PD-1 antibodies, show high effectiveness in Hodgkin lymphoma but low response rates in non-Hodgkin lymphomas like chronic lymphocytic leukemia (CLL).
  • Combining anti-PD-1 or PD-L1 therapies with avadomide, a cereblon E3 ligase modulator, enhances anti-CLL effects by stimulating immune responses and T-cell activation.
  • Clinical findings indicate that avadomide treatment leads to increased PD-L1 expression on T cells and better immune signaling in B-cell cancer patients, highlighting the need to boost T-cell inflammation for effective therapy.
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Purpose: Using next-generation sequencing (NGS), we recently documented T-cell oligoclonality in treatment-naïve chronic lymphocytic leukemia (CLL), with evidence indicating T-cell selection by restricted antigens.

Experimental Design: Here, we sought to comprehensively assess T-cell repertoire changes during treatment in relation to (i) treatment type [fludarabine-cyclophosphamide-rituximab (FCR) versus ibrutinib (IB) versus rituximab-idelalisib (R-ID)], and (ii) clinical response, by combining NGS immunoprofiling, flow cytometry, and functional bioassays.

Results: T-cell clonality significantly increased at (i) 3 months in the FCR and R-ID treatment groups, and (ii) over deepening clinical response in the R-ID group, with a similar trend detected in the IB group.

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Chemotherapy plus rituximab has been the mainstay of treatment for follicular lymphoma (FL) for two decades but is associated with immunosuppression and relapse. In phase 2 studies, lenalidomide combined with rituximab (R ) has shown clinical synergy in front-line and relapsed/refractory FL. Here, we show that lenalidomide reactivated dysfunctional T and Natural Killer (NK) cells ex vivo from FL patients by enhancing proliferative capacity and T-helper cell type 1 (Th1) cytokine release.

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MicroRNAs are short endogenous noncoding RNAs that play pivotal roles in a diverse range of cellular processes. The miR-181 family is important in T cell development, proliferation, and activation. In this study, we have identified BRK1 as a potential target of miR-181c using a dual selection functional assay and have showed that miR-181c regulates BRK1 by translational inhibition.

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Lenalidomide is an immunomodulatory agent that has demonstrated clinical benefit for patients with relapsed or refractory mantle cell lymphoma (MCL); however, despite this observed clinical activity, the mechanism of action (MOA) of lenalidomide has not been characterized in this setting. We investigated the MOA of lenalidomide in clinical samples from patients enrolled in the CC-5013-MCL-002 trial (NCT00875667) comparing single-agent lenalidomide versus investigator's choice single-agent therapy and validated our findings in pre-clinical models of MCL. Our results revealed a significant increase in natural killer (NK) cells relative to total lymphocytes in lenalidomide responders compared to non-responders that was associated with a trend towards prolonged progression-free survival and overall survival.

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Several lines of evidence suggest that homing of tumor cells to lymphoid tissue contributes to disease progression in chronic lymphocytic leukemia (CLL). Here, we demonstrate that lymph node (LN)-derived CLL cells possess a distinct phenotype, and exhibit enhanced capacity for T-cell activation and superior immune synapse formation when compared with paired peripheral blood (PB) samples. LN-derived CLL cells manifest a proliferative, CXCR4(dim)CD5(bright) phenotype compared with those in the PB and higher expression of T-cell activation molecules including CD80, CD86, and HLA-D-related (DR).

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The complex interplay between cancer cells, stromal cells, and immune cells in the tumor microenvironment (TME) regulates tumorigenesis and provides emerging targets for immunotherapies. Crosstalk between CD4(+) T cells and proliferating chronic lymphocytic leukemia (CLL) tumor B cells occurs within lymphoid tissue pseudofollicles, and investigating these interactions is essential to understand both disease pathogenesis and the effects of immunotherapy. Tumor-derived extracellular vesicle (EV) shedding is emerging as an important mode of intercellular communication in the TME.

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Immune checkpoint blockade antibodies and immunomodulatory drugs can unleash anti-tumor T cell immunity and mediate durable cancer regressions. However, only a fraction of patients currently respond to immunotherapy. Lymphoid malignancies are known to have clinically exploitable immune sensitivity and their intrinsic lymphoid tumor-microenvironment (TME) should make them natural targets for immunotherapy.

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