Anaplastic lymphoma kinase (ALK)-positive lymphomas respond to chemotherapy, but relapses, which bear a poor prognosis, occur. Crizotinib inhibits ALK in vitro and in vivo and was administered as monotherapy to 11 ALK+ lymphoma patients who were resistant/refractory to cytotoxic therapy. The overall response rate was 10 of 11 (90.9%; 95% confidence interval [CI] = 58.7% to 99.8%). Disease status at the latest follow-up is as follows: four patients are in complete response (CR) (months >21, >30, >35, >40) under continuous crizotinib administration; 4 patients had progression of disease (months 1, 2, 2, 2); 1 patient obtained CR on crizotinib, received an allogeneic bone marrow transplant, and is in CR; 2 patients (treated before and/or after allogeneic bone marrow transplant) obtained and are still in CR but they have stopped crizotinib. Overall and progression-free survival rates at 2 years are 72.7% (95% CI = 39.1% to 94.0%) and 63.7% (95% CI = 30.8% to 89.1%), respectively. ALK mutations conferring resistance to crizotinib in vitro could be identified in relapsed patients. Crizotinib exerted a potent antitumor activity with durable responses in advanced, heavily pretreated ALK+ lymphoma patients, with a benign safety profile.

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ALK is a tyrosine kinase receptor involved in a broad range of solid and hematologic tumors. Among 70% to 80% of ALK þ anaplastic large cell lymphomas (ALCL) are caused by the aberrant oncogenic fusion protein NPM-ALK. Crizotinib was the first clinically relevant ALK inhibitor, now approved for the treatment of late-stage and metastatic cases of lung cancer. However, patients frequently develop drug resistance to Crizotinib, mainly due to the appearance of point mutations located in the ALK kinase domain. Fortunately, other inhibitors are available and in clinical trial, suggesting the potential for second-line therapies to overcome Crizotinib resistance. This study focuses on the ongoing phase I/II trial small-molecule tyrosine kinase inhibitor (TKI) AP26113, by Ariad Pharmaceuticals, which targets both ALK and EGFR. Two NPM-ALK þ human cell lines, KARPAS-299 and SUP-M2, were grown in the presence of increasing concentrations of AP26113, and eight lines were selected that demonstrated resistance. All lines show IC 50 values higher (130 to 1,000-fold) than the parental line. Mechanistically, KARPAS-299 populations resistant to AP26113 show NPM-ALK overexpression, whereas SUP-M2-resistant cells harbor several point mutations spanning the entire ALK kinase domain. In particular, amino acid substitutions: L1196M, S1206C, the double F1174VþL1198F and L1122VþL1196M mutations were identified. The knowledge of the possible appearance of new clinically relevant mechanisms of drug resistance is a useful tool for the management of new TKI-resistant cases.Implications: This work defines reliable ALCL model systems of AP26113 resistance and provides a valuable tool in the management of all cases of relapse upon NPM-ALK-targeted therapy. Mol Cancer Res; 13(4); 775-83. Ó2014 AACR.

Most of Anaplastic Large Cell Lymphoma (ALCL) cases carry the t(2;5; p23;q35) that produces the fusion protein NPM-ALK. NPM-ALK deregulated kinase activity drives several pathways that support malignant transformation of lymphoma cells. We found that in ALK-rearranged ALCL cell lines NPM-ALK was distributed in equal amounts between the cytoplasm and the nucleus. Only the cytoplasmic portion was catalytically active in both cell lines and primary ALCL, whereas the nuclear portion was inactive due to heterodimerization with NPM1. Thus, about 50% of the NPM-ALK is not active and sequestered as NPM-ALK/NPM1 heterodimers in the nucleus. Overexpression or re-localization of NPM-ALK to the cytoplasm by NPM genetic knock-out or knock-down caused ERK1/2 increased phosphorylation and cell death through the engagement of an ATM/Chk2 and γH2AX mediated DNA damage response. Remarkably, human NPM-ALK amplified cell lines resistant to ALK tyrosine kinase inhibitors (TKIs) underwent apoptosis upon drug withdrawal as a consequence of ERK1/2 hyperactivation. Altogether, these findings indicate that an excess of NPM-ALK activation and signaling induces apoptosis via oncogenic stress responses. A “drug holiday” where the ALK TKI treatment is suspended could represent a therapeutic option in cells that become resistant by NPM-ALK amplification.

In our experience, for unknown reasons, M3v may occur in childhood more than generally was considered. The clinical course and prognosis seem worse in M3v than in typical APL cases.

Rio San Giorgio (Iglesiente, Sardinia, Italy), a stream affected by abandoned mine wastes, is characterized by dense vegetation in the streambed, mainly comprised of Phragmites australis and Juncus acutus. This vegetation creates natural biogeochemical barriers that drive mineralization processes and attenuate metals load in the stream. Several techniques, covering scales from micrometres to kilometres, were applied to investigate the biogeochemical processes: water chemistry, injected hydrologic tracer, mineralogy, microscopic investigation and X-ray spectroscopy. From this multiscale and multimethod approach, we recognized two predominant sets of biogeochemical processes: microbially driven metal sulphide precipitation, mainly resulting in pyrite formation; and plant uptake of metals that leads to formation of iron oxide-hydroxide and incorporation of Zn within the roots and aerial part (stem and leaves). The dense vegetation in the Rio San Giorgio streambed controls its morphology, velocity of streamflow, and, as reflected by observed bromide-tracer loss, enhanced water exchange between the streambed and the hyporheic zone. The combined effect of these vegetative controls is to establish biogeochemical barriers that greatly retard trace-metal mobility in the hyporheic zone. We estimated this effect can lead to an apparent decrease in Zn load up to 60%

The microscopic properties of biomineral hydrozincite [Zn(5)(CO(3))(2)(OH)(6)] from Naracauli Creek (SW Sardinia) were investigated by using X-ray diffraction (XRD), nuclear magnetic resonance spectroscopy (NMR), scanning electron microscopy (SEM), and high-resolution transmission electron microscopy (HRTEM). Because the biomineral hydrozincite turned out to significantly deviate from the ideal structure of hydrozincite, synthetic and geologic hydrozincite samples were also investigated for comparison.\ud \ud SEM imaging shows that biomineral hydrozincite is made of small platelet-shaped crystallites having a 20-50 nm long side at the shortest and other sides measuring hundreds of nanometers long. These are interlaced to form sheaths several micrometers long. HRTEM analysis of the biomineral samples shows an imperfectly oriented aggregation of the nanocrystals that is discussed in terms of mesocrystals. Transmission electron microscopy (TEM) and XRD analysis indicate a progressive decrease in the size of the particles in the biomineral compared to the synthetic and geologic hydrozincite samples, with coherent diffraction domains in the biomineral hydrozincite that are smaller by 30-50% than in the other samples investigated in this study. (13)C magic angle spinning (MAS) and cross polarization magic angle spinning (CPMAS) NMR spectra show more than one peak for all the investigated samples, despite the fact that carbon atoms have a unique crystallographic position in the hydrozincite structure. The additional peaks can reflect the presence of lattice defects typical of nanocrystals as indicated by the HRTEM images, where high concentration of lattice defects, such as grain boundaries and stacking modes, can be observed both in the biomineral and in the synthetic samples. Further additional peaks in the NMR spectra of biomineral samples are attributed to organic molecules, relicts of the biomineralization process, in agreement with the filaments observed in SEM images of biomineral samples

The 'promiscuous' E2A gene, at 19p13.3, is fused with two different molecular partners, PBX1 and HLF, following two chromosome translocations recurrent in childhood pre-B ALL. We have identified a novel gene, FB1, by virtue of its fusion with E2A and by a combination of molecular techniques. FB1 was localized on 19q13.4, suggesting that the novel chimera originated by a cryptic rearrangement of chromosome 19. Two FB1 transcripts, of 1.2 kb and 1.1 kb, are differentially expressed at low level in a variety of human tissues, including hemopoietic cell lines from different lineages. Accordingly, FB1 cDNA displays high homology with a number of cDNA clones from different human tissues. High homology was found also with cDNA clones from mouse and rat, suggesting that the sequence might be conserved at least among mammals. The function of the putative FB1 protein, however, is currently unknown as database sequence comparisons have failed to reveal strong homology with known proteins. The E2A/FB1 fusion appears to be a recurrent feature of pre-B ALLs, suggesting that it might have a role in the development and/or progression of leukemogenesis.