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Monogenic early-onset lymphoproliferation and autoimmunity: Natural history of STAT3 gain-of-function syndrome

Leiding, Jennifer W.; Vogel, Tiphanie P.; Santarlas, Valentine G. J.; Mhaskar, Rahul; Smith, Madison R.; Carisey, Alexandre; Vargas-Hernandez, Alexander; Silva-Carmona, Manuel; Heeg, Maximilian; Rensing-Ehl, Anne; Neven, Benedicte; Hadjadj, Jerome; Hambleton, Sophie; Leahy, Timothy Ronan; Meesilpavikai, Kornvalee; Cunningham-Rundles, Charlotte; Dutmer, Cullen M.; Sharapova, Svetlana O.; Taskinen, Mervi; Chua, Ignatius


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    "creators": [
      {
        "name": "Leiding, Jennifer W."
      }, 
      {
        "name": "Vogel, Tiphanie P."
      }, 
      {
        "affiliation": "Lake Erie Coll Osteopath Med, Erie, PA USA", 
        "name": "Santarlas, Valentine G. J."
      }, 
      {
        "affiliation": "Univ S Florida, Dept Internal Med, Morsani Coll Med, Tampa, FL USA", 
        "name": "Mhaskar, Rahul"
      }, 
      {
        "name": "Smith, Madison R."
      }, 
      {
        "affiliation": "St Jude Childrens Res Hosp, Dept Cell & Mol Biol, Memphis, TN USA", 
        "name": "Carisey, Alexandre"
      }, 
      {
        "name": "Vargas-Hernandez, Alexander"
      }, 
      {
        "affiliation": "Texas Childrens Hosp, Baylor Coll Med, Dept Pediat, Houston, TX USA", 
        "name": "Silva-Carmona, Manuel"
      }, 
      {
        "affiliation": "Univ Freiburg, Med Ctr, Fac Med, Inst Immunodeficiency,Ctr Chron Immunodeficiency, Freiburg, Germany", 
        "name": "Heeg, Maximilian"
      }, 
      {
        "affiliation": "Univ Freiburg, Med Ctr, Fac Med, Inst Immunodeficiency,Ctr Chron Immunodeficiency, Freiburg, Germany", 
        "name": "Rensing-Ehl, Anne"
      }, 
      {
        "affiliation": "Inst Imagine, INSERM, UMR 1163, Lab Immunogenet Pediat Autoimmune Dis, Paris, France", 
        "name": "Neven, Benedicte"
      }, 
      {
        "affiliation": "Inst Imagine, INSERM, UMR 1163, Lab Immunogenet Pediat Autoimmune Dis, Paris, France", 
        "name": "Hadjadj, Jerome"
      }, 
      {
        "affiliation": "Newcastle Univ, Translat & Clin Res Inst, Newcastle Upon Tyne, Tyne & Wear, England", 
        "name": "Hambleton, Sophie"
      }, 
      {
        "affiliation": "Childrens Hlth Ireland Crumlin, Dublin, Ireland", 
        "name": "Leahy, Timothy Ronan"
      }, 
      {
        "name": "Meesilpavikai, Kornvalee"
      }, 
      {
        "affiliation": "Mt Sinai Sch Med, Dept Med, New York, NY USA", 
        "name": "Cunningham-Rundles, Charlotte"
      }, 
      {
        "affiliation": "Univ Colorado, Sch Med, Childrens Hosp Colorado, Aurora, CO USA", 
        "name": "Dutmer, Cullen M."
      }, 
      {
        "affiliation": "Belarusian Res Ctr Pediat Oncol Hematol & Immunol, Minsk, BELARUS", 
        "name": "Sharapova, Svetlana O."
      }, 
      {
        "name": "Taskinen, Mervi"
      }, 
      {
        "name": "Chua, Ignatius"
      }
    ], 
    "description": "<p>Background: In 2014, germline signal transducer and activator of transcription (STAT) 3 gain-of-function (GOF) mutations were first described to cause a novel multisystem disease of early-onset lymphoproliferation and autoimmunity. Objective: This pivotal cohort study defines the scope, natural history, treatment, and overall survival of a large global cohort of patients with pathogenic STAT3 GOF variants. Methods: We identified 191 patients from 33 countries with 72 unique mutations. Inclusion criteria included symptoms of immune dysregulation and a biochemically confirmed germline heterozygous GOF variant in STAT3. Results: Overall survival was 88%, median age at onset of symptoms was 2.3 years, and median age at diagnosis was 12 years. Immune dysregulatory features were present in all patients: lymphoproliferation was the most common manifestation (73%); increased frequencies of double-negative (CD4-CD8-) T cells were found in 83% of patients tested. Autoimmune cytopenias were the second most common clinical manifestation (67%), followed by growth delay, enteropathy, skin disease, pulmonary disease, endocrinopathy, arthritis, autoimmune hepatitis, neurologic disease, vasculopathy, renal disease, and malignancy. Infections were reported in 72% of the cohort. A cellular and humoral immunodeficiency was observed in 37% and 51% of patients, respectively. Clinical symptoms dramatically improved in patients treated with JAK inhibitors, while a variety of other immunomodulatory treatment modalities were less efficacious. Thus far, 23 patients have undergone bone marrow transplantation, with a 62% survival rate. Conclusion: : STAT3 GOF patients present with a wide array of immune-mediated disease including lymphoproliferation, autoimmune cytopenias, and multisystem autoimmunity. Patient care tends to be siloed, without a clear treatment strategy. Thus, early identification and prompt treatment implementation are lifesaving for STAT3 GOF syndrome. (J Allergy Clin Immunol 2023;151:1081-95.)</p>", 
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      "title": "JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY", 
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    "publication_date": "2023-01-01", 
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      "title": "Dergi makalesi", 
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      "Di\u011fer"
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    "title": "Monogenic early-onset lymphoproliferation and autoimmunity: Natural history of STAT3 gain-of-function syndrome"
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