51
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Shallis RM, Boddu PC, Bewersdorf JP, Zeidan AM. The golden age for patients in their golden years: The progressive upheaval of age and the treatment of newly-diagnosed acute myeloid leukemia. Blood Rev 2020; 40:100639. [DOI: 10.1016/j.blre.2019.100639] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022]
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52
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Wang Y, Liu Y, Bailey C, Zhang H, He M, Sun D, Zhang P, Parkin B, Baer MR, Zheng P, Malek SN, Liu Y. Therapeutic targeting of TP53-mutated acute myeloid leukemia by inhibiting HIF-1α with echinomycin. Oncogene 2020; 39:3015-3027. [PMID: 32060420 PMCID: PMC7291851 DOI: 10.1038/s41388-020-1201-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 01/02/2023]
Abstract
TP53 mutation in acute myeloid leukemia (AML) is associated with poor prognosis. Since no targeted therapy is available to restore p53 function, it is of great interest to test whether other pathways activated by TP53 mutations can be therapeutically targeted. Here we showed HIF-1α target genes are enriched in TP53-mutated vs TP53-wild type AML. To determine the role of this activation, we tested efficacy of HIF-1α inhibitor echinomycin in TP53-mutated AML samples in vitro and in vivo. Echinomycin was broadly effective against a panel of primary AML blast cells, with low nanomolar IC50s and, based on colony-forming unit assay, was 10-fold more effective in eliminating AML stem cells. Echinomycin selectively eliminated CD34+CD38- AML cells. To test the therapeutic efficacy of echinomycin, we established a xenograft model of TP53-mutated AML. Echinomycin was broadly effective against xenografts from multiple AML samples in vivo, and more effective than cytarabine + daunorubicin chemotherapy. Importantly, while cytarabine + daunorubicin enriched for AML stem cells, echinomycin nearly eliminated this population. Using TP53-mutated AML cell line THP1 and patient-derived AML cells, we tested a new echinomycin formulation with longer half-life and significantly improved therapeutic effect. Our data suggest a novel approach to treat AML with TP53 mutations.
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Affiliation(s)
- Yin Wang
- Division of Immunotherapy, Institute of Human Virology, Department of Surgery and Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Yan Liu
- Division of Immunotherapy, Institute of Human Virology, Department of Surgery and Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Christopher Bailey
- Division of Immunotherapy, Institute of Human Virology, Department of Surgery and Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Graduate Program of Integrated Biomedical Research, George Washington University School of Medicine, Washington, DC, 20052, USA
| | - Huixia Zhang
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Miao He
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Duxin Sun
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Peng Zhang
- Division of Immunotherapy, Institute of Human Virology, Department of Surgery and Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Brian Parkin
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Maria R Baer
- Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 21201, USA
| | - Pan Zheng
- Division of Immunotherapy, Institute of Human Virology, Department of Surgery and Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,OncoImmune, Inc., Rockville, MD, 20853, USA
| | - Sami N Malek
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yang Liu
- Division of Immunotherapy, Institute of Human Virology, Department of Surgery and Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,OncoImmune, Inc., Rockville, MD, 20853, USA.
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53
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Qian T, Cheng Z, Quan L, Zeng T, Cui L, Liu Y, Si C, Huang W, Dai Y, Chen J, Liu L, Jiao Y, Deng C, Pang Y, Ye X, Shi J, Fu L. Prognostic role of SCAMP family in acute myeloid leukemia. THE PHARMACOGENOMICS JOURNAL 2020; 20:595-600. [PMID: 31988488 DOI: 10.1038/s41397-020-0149-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 11/19/2019] [Accepted: 01/15/2020] [Indexed: 01/10/2023]
Abstract
Acute myeloid leukemia (AML) is a malignant disease of myeloid hematopoietic stem or progenitor cells characterized by abnormal proliferation of primary and immature myeloid cells in bone marrow and peripheral blood. Gene mutation and expression profiles can be used as prognosis predictors for different prognostic subgroups. Secretory carrier-associated membrane proteins (SCAMPs) are a multigenic family with five members and act as cell surface vectors in the post-Golgi recycling pathways in mammals. Nevertheless, the prognostic and clinical influence of SCAMP family has hardly ever been illustrated in AML. In our study, expression patterns of SCAMP family (SCAMP1-5) were analyzed in 155 AML patients which were extracted from the Cancer Genome Atlas database. In chemotherapy, only subgroup, higher SCAMP1 level was significantly associated with longer EFS and OS (all P = 0.002), and SCAMP1 was confirmed to be an independent favorable factor in un-transplanted patients by Multivariate analysis (all P < 0.05). Nevertheless, in the allogeneic hematopoietic stem cell transplantation (allo-HSCT) treatment subgroup, none of the SCAMP genes had any effect on the clinical survival. Our study found that high expression level of SCAMP1 is a favorable prognostic factor in AML, but allo-HSCT may neutralize its prognostic effect.
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Affiliation(s)
- Tingting Qian
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China.,Translational Medicine Center, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Zhiheng Cheng
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Liang Quan
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China.,Translational Medicine Center, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Tiansheng Zeng
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Longzhen Cui
- Translational Medicine Center, Huaihe Hospital of Henan University, 475000, Kaifeng, China.,Department of Hematology, Huaihe Hospital of Henan University, 475000, Kaifeng, China
| | - Yan Liu
- Translational Medicine Center, Huaihe Hospital of Henan University, 475000, Kaifeng, China.,Department of Hematology, Huaihe Hospital of Henan University, 475000, Kaifeng, China
| | - Chaozeng Si
- Department of Operations and Information Management, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Wenhui Huang
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China.,Translational Medicine Center, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Yifeng Dai
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jinghong Chen
- Translational Medicine Center, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Ling Liu
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Yang Jiao
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, 310058, Hangzhou, China
| | - Cong Deng
- Translational Medicine Center, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Ying Pang
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Xu Ye
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China
| | - Jinlong Shi
- Department of Biomedical Engineering, Chinese PLA General Hospital, 100853, Beijing, China
| | - Lin Fu
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China. .,Translational Medicine Center, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, 510260, Guangzhou, China. .,Translational Medicine Center, Huaihe Hospital of Henan University, 475000, Kaifeng, China. .,Department of Hematology, Huaihe Hospital of Henan University, 475000, Kaifeng, China.
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54
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Lee BH, Kang KW, Jeon MJ, Yu ES, Kim DS, Choi H, Lee SR, Sung HJ, Kim BS, Choi CW, Park Y. Comparison between 5-day decitabine and 7-day azacitidine for lower-risk myelodysplastic syndromes with poor prognostic features: a retrospective multicentre cohort study. Sci Rep 2020; 10:39. [PMID: 31913293 PMCID: PMC6949213 DOI: 10.1038/s41598-019-56642-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
Numerous studies have analysed the clinical efficacies of hypomethylating agents (HMAs) in patients with myelodysplastic syndromes (MDS). However, reports that compare the two HMAs, decitabine and azacitidine, in patients with lower-risk (low and intermediate-1) MDS are limited. We compared 5-day decitabine and 7-day azacitidine regimens in terms of treatment responses, survival outcomes, and adverse events in patients with lower-risk MDS with poor prognostic features. The overall response rates (ORRs) were 67.2% and 44.0% in the patients treated with decitabine and azacitidine, respectively (P = 0.014). While the median progression-free survival (PFS) was significantly better in the patients treated with decitabine than in those treated with azacitidine (P = 0.019), no significant differences in event-free and overall survival rates were observed between the two groups. Multivariate analysis revealed that compared with azacitidine treatment, decitabine treatment is significantly associated with a higher ORR (P = 0.026) and longer PFS (P = 0.037). No significant differences were observed in the incidence of grade 3 or higher haematologic adverse events in response to the two HMAs. In conclusion, in lower-risk MDS, especially with poor prognostic features, ORR and PFS were significantly better with 5-day decitabine treatment than with 7-day azacitidine treatment, with comparable safety.
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Affiliation(s)
- Byung-Hyun Lee
- Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Ka-Won Kang
- Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Eun Sang Yu
- Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Dae Sik Kim
- Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Hojoon Choi
- Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital, Gyeonggi-do, Korea
| | - Se Ryeon Lee
- Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital, Gyeonggi-do, Korea
| | - Hwa Jung Sung
- Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital, Gyeonggi-do, Korea
| | - Byung Soo Kim
- Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Chul Won Choi
- Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea.
| | - Yong Park
- Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, Korea.
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55
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56
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Daher-Reyes GS, Merchan BM, Yee KWL. Guadecitabine (SGI-110): an investigational drug for the treatment of myelodysplastic syndrome and acute myeloid leukemia. Expert Opin Investig Drugs 2019; 28:835-849. [PMID: 31510809 DOI: 10.1080/13543784.2019.1667331] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: The incidence of acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) is increasing with the aging population. Prognosis and overall survival (OS) remain poor in elderly patients and in those not eligible for intensive treatment. Hypomethylating agents (HMAs) have played an important role in this group of patients but their efficacy is limited. Areas covered: This article reviews the mechanism of action, pharmacology, safety profile and clinical efficacy of subcutaneous guadecitabine, a second-generation DNA methylation inhibitor in development for the treatment of AML and MDS. Expert opinion: Although guadecitabine did not yield improved complete remission (CR) rates and OS compared to the control arm in patients with treatment-naïve AML who were ineligible for intensive chemotherapy, subgroup analysis in patients who received ≥4 cycles of therapy demonstrated superior outcomes in favor of guadecitabine. Given its stability, ease of administration, safety profile and prolonged exposure time, guadecitabine would be the more appropriate HMA, replacing azacitidine and decitabine, to be used combination treatment regimens in patients with myeloid malignancies.
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Affiliation(s)
- Georgina S Daher-Reyes
- Division of Medical Oncology and Hematology, University Health Network - Princess Margaret Cancer Centre , Toronto , Ontario , Canada
| | - Brayan M Merchan
- Division of Medical Oncology and Hematology, University Health Network - Princess Margaret Cancer Centre , Toronto , Ontario , Canada
| | - Karen W L Yee
- Division of Medical Oncology and Hematology, University Health Network - Princess Margaret Cancer Centre , Toronto , Ontario , Canada
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57
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Kobbe G, Schroeder T, Rautenberg C, Kaivers J, Gattermann N, Haas R, Germing U. Molecular genetics in allogeneic blood stem cell transplantation for myelodysplastic syndromes. Expert Rev Hematol 2019; 12:821-831. [DOI: 10.1080/17474086.2019.1645004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Guido Kobbe
- Departments of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Schroeder
- Departments of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christina Rautenberg
- Departments of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jennifer Kaivers
- Departments of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Norbert Gattermann
- Departments of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rainer Haas
- Departments of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ulrich Germing
- Departments of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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58
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Haase D, Stevenson KE, Neuberg D, Maciejewski JP, Nazha A, Sekeres MA, Ebert BL, Garcia-Manero G, Haferlach C, Haferlach T, Kern W, Ogawa S, Nagata Y, Yoshida K, Graubert TA, Walter MJ, List AF, Komrokji RS, Padron E, Sallman D, Papaemmanuil E, Campbell PJ, Savona MR, Seegmiller A, Adès L, Fenaux P, Shih LY, Bowen D, Groves MJ, Tauro S, Fontenay M, Kosmider O, Bar-Natan M, Steensma D, Stone R, Heuser M, Thol F, Cazzola M, Malcovati L, Karsan A, Ganster C, Hellström-Lindberg E, Boultwood J, Pellagatti A, Santini V, Quek L, Vyas P, Tüchler H, Greenberg PL, Bejar R. TP53 mutation status divides myelodysplastic syndromes with complex karyotypes into distinct prognostic subgroups. Leukemia 2019; 33:1747-1758. [PMID: 30635634 PMCID: PMC6609480 DOI: 10.1038/s41375-018-0351-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/15/2023]
Abstract
Risk stratification is critical in the care of patients with myelodysplastic syndromes (MDS). Approximately 10% have a complex karyotype (CK), defined as more than two cytogenetic abnormalities, which is a highly adverse prognostic marker. However, CK-MDS can carry a wide range of chromosomal abnormalities and somatic mutations. To refine risk stratification of CK-MDS patients, we examined data from 359 CK-MDS patients shared by the International Working Group for MDS. Mutations were underrepresented with the exception of TP53 mutations, identified in 55% of patients. TP53 mutated patients had even fewer co-mutated genes but were enriched for the del(5q) chromosomal abnormality (p < 0.005), monosomal karyotype (p < 0.001), and high complexity, defined as more than 4 cytogenetic abnormalities (p < 0.001). Monosomal karyotype, high complexity, and TP53 mutation were individually associated with shorter overall survival, but monosomal status was not significant in a multivariable model. Multivariable survival modeling identified severe anemia (hemoglobin < 8.0 g/dL), NRAS mutation, SF3B1 mutation, TP53 mutation, elevated blast percentage (>10%), abnormal 3q, abnormal 9, and monosomy 7 as having the greatest survival risk. The poor risk associated with CK-MDS is driven by its association with prognostically adverse TP53 mutations and can be refined by considering clinical and karyotype features.
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Affiliation(s)
- Detlef Haase
- University Medical Center, Georg- August-University, Goettingen, Germany
| | | | | | | | - Aziz Nazha
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Alan F List
- H. Lee Moffitt Cancer Center and Research Institute, Tampa Bay, FL, USA
| | - Rami S Komrokji
- H. Lee Moffitt Cancer Center and Research Institute, Tampa Bay, FL, USA
| | - Eric Padron
- H. Lee Moffitt Cancer Center and Research Institute, Tampa Bay, FL, USA
| | - David Sallman
- H. Lee Moffitt Cancer Center and Research Institute, Tampa Bay, FL, USA
| | | | | | | | | | - Lionel Adès
- Hôpital St Louis, Assistance Publique-Hôpitaux de Paris and Paris Diderot University, Paris, France
| | - Pierre Fenaux
- Hôpital St Louis, Assistance Publique-Hôpitaux de Paris and Paris Diderot University, Paris, France
| | - Lee-Yung Shih
- Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
| | | | - Sudhir Tauro
- University of Dundee, Ninewells Hospital, Dundee, UK
| | - Michaela Fontenay
- Université Paris Descartes, Hopital Cochin Assistance Publique-Hopitaux de Paris, Paris, France
| | - Olivier Kosmider
- Université Paris Descartes, Hopital Cochin Assistance Publique-Hopitaux de Paris, Paris, France
| | - Michal Bar-Natan
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Mario Cazzola
- Fondazione IRCCS Policlinico San Matteo & University of Pavia, Pavia, Italy
| | - Luca Malcovati
- Fondazione IRCCS Policlinico San Matteo & University of Pavia, Pavia, Italy
| | - Aly Karsan
- University of British Columbia, Vancouver, BC, Canada
| | - Christina Ganster
- University Medical Center, Georg- August-University, Goettingen, Germany
| | | | | | | | - Valeria Santini
- MDS Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Lynn Quek
- MRC Molecular Hematology Unit, WIMM University of Oxford, Oxford, UK
- Haematology Theme Oxford Biomedical Research Centre and Department of Hematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paresh Vyas
- MRC Molecular Hematology Unit, WIMM University of Oxford, Oxford, UK
- Haematology Theme Oxford Biomedical Research Centre and Department of Hematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Heinz Tüchler
- Ludwig-Boltzmann Institute for Leukemia Research, Vienna, Austria
| | | | - Rafael Bejar
- UC San Diego Moores Cancer Center, La Jolla, CA, USA.
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59
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Valent P, Orazi A, Savona MR, Patnaik MM, Onida F, van de Loosdrecht AA, Haase D, Haferlach T, Elena C, Pleyer L, Kern W, Pemovska T, Vladimer GI, Schanz J, Keller A, Lübbert M, Lion T, Sotlar K, Reiter A, De Witte T, Pfeilstöcker M, Geissler K, Padron E, Deininger M, Orfao A, Horny HP, Greenberg PL, Arber DA, Malcovati L, Bennett JM. Proposed diagnostic criteria for classical chronic myelomonocytic leukemia (CMML), CMML variants and pre-CMML conditions. Haematologica 2019; 104:1935-1949. [PMID: 31048353 PMCID: PMC6886439 DOI: 10.3324/haematol.2019.222059] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is a myeloid neoplasm characterized by dysplasia, abnormal production and accumulation of monocytic cells and an elevated risk of transforming into acute leukemia. Over the past two decades, our knowledge about the pathogenesis and molecular mechanisms in CMML has increased substantially. In parallel, better diagnostic criteria and therapeutic strategies have been developed. However, many questions remain regarding prognostication and optimal therapy. In addition, there is a need to define potential pre-phases of CMML and special CMML variants, and to separate these entities from each other and from conditions mimicking CMML. To address these unmet needs, an international consensus group met in a Working Conference in August 2018 and discussed open questions and issues around CMML, its variants, and pre-CMML conditions. The outcomes of this meeting are summarized herein and include diag nostic criteria and a proposed classification of pre-CMML conditions as well as refined minimal diagnostic criteria for classical CMML and special CMML variants, including oligomonocytic CMML and CMML associated with systemic mastocytosis. Moreover, we propose diagnostic standards and tools to distinguish between 'normal', pre-CMML and CMML entities. These criteria and standards should facilitate diagnostic and prognostic evaluations in daily practice and clinical studies in applied hematology.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria .,Ludwig Boltzmann Institute for Hematology & Oncology, Vienna, Austria
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Michael R Savona
- Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francesco Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam UMC, location VU University Medical Center, Cancer Center Amsterdam, the Netherlands
| | - Detlef Haase
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Chiara Elena
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Lisa Pleyer
- 3 Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria
| | | | - Tea Pemovska
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Gregory I Vladimer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Julie Schanz
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexandra Keller
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Michael Lübbert
- Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lion
- Children's Cancer Research Institute and Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Theo De Witte
- Department of Tumor Immunology-Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael Pfeilstöcker
- Ludwig Boltzmann Institute for Hematology & Oncology, Vienna, Austria.,3 Medical Department, Hanusch Hospital, Vienna, Vienna, Austria
| | | | - Eric Padron
- Malignant Hematology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Michael Deininger
- Huntsman Cancer Institute & Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA
| | - Alberto Orfao
- Servicio Central de Citometría, Centro de Investigación del Cáncer (IBMCC, CSIC-USAL), CIBERONC and IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | | | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Luca Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - John M Bennett
- Department of Pathology, Hematopathology Unit and James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
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Huang HJ, Shi ZX, Li B, Qin TJ, Xu ZF, Zhang HL, Fang LW, Hu NB, Pan LJ, Qu SQ, Liu D, Cai YN, Zhang YD, Xiao ZJ. [Clinical implications and prognostic value of TP53 gene mutation and deletion in patients with myelodysplastic syndromes]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:215-221. [PMID: 30929389 PMCID: PMC7342541 DOI: 10.3760/cma.j.issn.0253-2727.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
目的 探讨伴TP53基因异常骨髓增生异常综合征(MDS)患者的临床特征及预后。 方法 回顾性分析2009年10月至2017年12月中国医学科学院血液病医院新诊断的584例原发性MDS患者临床资料,采用包含112个血液肿瘤相关基因的靶向测序技术进行突变分析,并采用间期荧光原位杂交(FISH)技术检测TP53基因缺失。分析TP53基因突变和(或)缺失与临床特征之间的关系及其对患者总生存(OS)的影响。 结果 42例(7.2%)伴TP53基因异常,其中单纯基因突变31例(5.3%),单纯基因缺失8例(1.4%),同时伴有突变和缺失3例(0.5%)。34例伴TP53基因突变患者中共检测到37个TP53突变,其中35个位于DNA结合结构域(第5~8号外显子),1个位于第10号外显子,1个为剪切位点突变。伴TP53基因异常组的平均基因突变数目(2.52个)显著高于无异常组(1.96个)(z=−2.418,P=0.016)。伴TP53基因异常患者的中位年龄[60(21~78)岁]高于无异常患者[52(14~83)岁](z=−2.188,P=0.029);伴TP53基因异常组中复杂核型比例、IPSS较高危组(中危-2及高危)比例显著高于无异常组(P值均<0.001)。伴TP53基因异常组的中位OS期[13(95%CI 7.57~18.43)个月]较无异常组(未达到)显著缩短(χ2=12.342,P<0.001),但多因素模型纳入复杂核型进行校正后,TP53突变不再是独立预后因素。 结论 伴TP53基因异常MDS患者中基因突变较基因缺失常见,突变位点主要分布于DNA结合结构域。TP53基因异常与复杂核型相关,且常与多个基因突变相伴出现。在多因素模型纳入复杂核型校正后,TP53基因异常则不再是独立的预后因素。
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Affiliation(s)
- H J Huang
- Institute of Hematology and Blood Diseases Hospital CAMS & PUMC, The State Key Laboratory of Experimental Hematology, Tianjin 300020, China
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Stomper J, Lübbert M. Can we predict responsiveness to hypomethylating agents in AML? Semin Hematol 2019; 56:118-124. [PMID: 30926087 DOI: 10.1053/j.seminhematol.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 11/11/2022]
Abstract
DNA-hypomethylating agents (HMAs) were developed as nonintensive treatment alternatives to standard chemotherapy in older, unfit patients with acute myeloid leukemia and myelodysplastic syndrome. Given their distinct effects on the methylome and transcriptome of malignant cells compared to cytarabine (Ara-C) and other cytotoxic drugs not inhibiting DNA methyltransferases, it is of great interest to define their specific clinical ``signature.'' Here, we present and discuss clinical, genetic, and epigenetic predictors of responsiveness to HMAs. Indeed, mounting evidence supports the notion that HMAs are not "just another kind of low-dose Ara-C." Not only patient factors (age, performance status, comorbidities, etc.), blast counts, and early platelet response, but also adverse genetics (monosomal karyotype and/or a TP53 mutation) have predictive potential. Given the surprising-and initially counterintuitive-responses observed in patients with the latter features, these are subject to mechanistic studies to elucidate their as yet unresolved interaction with HMAs. Finally, other potential biomarkers for HMA response such as elevated fetal hemoglobin might also contribute to overcome the present challenges in predicting responsiveness to HMAs.
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Affiliation(s)
- Julia Stomper
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Michael Lübbert
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany; German Cancer Research Consortium (DKTK), Freiburg, Germany.
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de Haas V, Ismaila N, Advani A, Arber DA, Dabney RS, Patel-Donelly D, Kitlas E, Pieters R, Pui CH, Sweet K, Zhang L. Initial Diagnostic Work-Up of Acute Leukemia: ASCO Clinical Practice Guideline Endorsement of the College of American Pathologists and American Society of Hematology Guideline. J Clin Oncol 2019; 37:239-253. [PMID: 30523709 PMCID: PMC6338392 DOI: 10.1200/jco.18.01468] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The College of American Pathologists (CAP) and the American Society of Hematology (ASH) developed an evidence-based guideline on the initial diagnostic work-up of acute leukemia (AL). Because of the relevance of this topic to the ASCO membership, ASCO reviewed the guideline and applied a set of procedures and policies for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS The CAP-ASH guideline on initial diagnostic work-up of AL was reviewed for developmental rigor by methodologists. Then, an ASCO Endorsement Expert Panel updated the literature search and reviewed the content and recommendations. RESULTS The ASCO Expert Panel determined that the recommendations from the guideline, published in 2016, are clear, thorough, and based on the most relevant scientific evidence. ASCO fully endorsed the CAP-ASH guideline on initial diagnostic work-up of AL and included some discussion points according to clinical practice and updated literature. CONCLUSION Twenty-seven guideline statements were reviewed. Some discussion points were included to better assess CNS involvement in leukemia and to provide novel insights into molecular diagnosis and potential markers for risk stratification and target therapy. These discussions are categorized into four sections: (1) initial diagnosis focusing on basic diagnostics and determination of risk parameters, (2) molecular markers and minimal residual disease detection, (3) context of referral to another institution with expertise in the management of AL, and (4) reporting and record keeping for better outlining and follow-up discussion. Additional information is available at: www.asco.org/hematologic-malignancies-guidelines .
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Affiliation(s)
- Valérie de Haas
- 1 Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | | | | | | | | | - Rob Pieters
- 1 Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Short NJ, Kantarjian HM, Loghavi S, Huang X, Qiao W, Borthakur G, Kadia TM, Daver N, Ohanian M, Dinardo CD, Estrov Z, Kanagal-Shamanna R, Maiti A, Benton CB, Bose P, Alvarado Y, Jabbour E, Kornblau SM, Pemmaraju N, Jain N, Gasior Y, Richie MA, Pierce S, Cortes J, Konopleva M, Garcia-Manero G, Ravandi F. Treatment with a 5-day versus a 10-day schedule of decitabine in older patients with newly diagnosed acute myeloid leukaemia: a randomised phase 2 trial. LANCET HAEMATOLOGY 2018; 6:e29-e37. [PMID: 30545576 DOI: 10.1016/s2352-3026(18)30182-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hypomethylating agents, such as decitabine, are the standard of care for older patients with newly diagnosed acute myeloid leukaemia. Single-arm studies have suggested that a 10-day schedule of decitabine cycles leads to better outcomes than the usual 5-day schedule. We compared the efficacy and safety of these two schedules. METHODS Eligible patients were aged 60 years or older with acute myeloid leukaemia but unsuitable for intensive chemotherapy (or <60 years if unsuitable for intensive chemotherapy with an anthracycline plus cytarabine). The first 40 patients were allocated equally to the two treatment groups by computer-generated block randomisation (block size 40), after which a response-adaptive randomisation algorithm used all previous patients' treatment and response data to decide the allocation of each following patient favouring the group with superior response. Patients were assigned to receive 20 mg/m2 decitabine intravenously for 5 or 10 consecutive days as induction therapy, every 4-8 weeks for up to three cycles. Responding patients received decitabine as consolidation therapy on a 5-day schedule for up to 24 cycles. We assessed a composite primary endpoint of complete remission, complete remission with incomplete platelet recovery (CRp), and complete remission with incomplete haematological recovery (CRi) achieved at any time and assessed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01786343. FINDINGS Between Feb 28, 2013, and April 12, 2018, 71 patients were enrolled. 28 received decitabine for 5 days and 43 for 10 days, and all were assessable for efficacy and safety. The primary endpoint was achieved in similar proportions of patients in the two treatment groups (12 [43%] of 28 in the 5-day schedule group, 95% credible interval 26-60, and 17 [40%] of 43 in the 10-day schedule group, 26-54, p=0·78; difference 3%, -21 to 27). Total follow-up was 38·2 months, during which the median duration of overall survival was 5·5 months (IQR 2·1-11·7) in the 5-day group and 6·0 months (1·9-11·7) in the 10-day group. 1-year overall survival was 25% in both groups. Complete remission, CRp, CRi, and overall survival did not differ between groups when stratified by cytogenetics, de-novo versus secondary or therapy-related acute myeloid leukaemia, or TP53mut status. The most common grade 3-4 adverse events were neutropenic fever (seven patients [25%] in the 5-day group and 14 [33%] in the 10-day group) and infection (five [18%] and 16 [37%], respectively). One patient (4%) died from sepsis in the context of neutropenic fever, infection, and haemorrhage in the 5-day group, and in the 10-day group six patients (14%) died from infection. Early mortality was similar in the two groups. INTERPRETATION In older patients with newly diagnosed acute myeloid leukaemia, efficacy and safety did not differ by the 5-day or the 10-day decitabine schedule. FUNDING University of Texas MD Anderson Cancer Center and National Cancer Institute Specialized Programs of Research Excellence.
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Affiliation(s)
- Nicholas J Short
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop M Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanam Loghavi
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuelin Huang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Qiao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan M Kadia
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maro Ohanian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney D Dinardo
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeev Estrov
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abhishek Maiti
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher B Benton
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prithviraj Bose
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yesid Alvarado
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Kornblau
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naveen Pemmaraju
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nitin Jain
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yvonne Gasior
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Ann Richie
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherry Pierce
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge Cortes
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ren Y, Mei C, Ye L, Luo Y, Zhou X, Yang H, Lin P, Xu W, Ma L, Jin J, Tong H. Analysis of clinical and molecular features of MDS patients with complex karyotype in China. Blood Cells Mol Dis 2018; 75:13-19. [PMID: 30530101 DOI: 10.1016/j.bcmd.2018.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 01/21/2023]
Abstract
We retrospectively analyzed 101 primary MDS patients with complex karyotype during January 2010 and April 2017.The median overall survival (OS) time was 13 (95% CI 9.98-16.02) months, and there was no significant difference in OS for different treatment. Chromosome 5/7 involvement was common (78.22%, 79/101) and associated with shorter OS (12 months vs. 28 months, P < 0.01) Monosomal karyotype (MK) is overlapped with CK in 79 patients, but was not statistically associated with shorter OS. While in 59 cases with genes sequenced, 57 (96.61%) patients were found to have at least one mutation of known significance, and TP53 was the most frequent (74.58%, 44/59), the median OS of patients with TP53 mutation was shorter than those without (10 vs. 27 months, P < 0.01). Multivariate analysis demonstrated that only TP53 mutation was the strongest independent prognostic factor for OS. Moreover, high variant allele frequency (VAF) of TP53 mutation (median VAF was 70.00%) was seen and associated with adverse survival (9 months vs. 13 months, p = 0.04). In conclusion, MDS patients with CK implied an unfavorable outcome regardless of any treatment, TP53 mutation occurs at a high frequency and has a higher VAF, both were associated with worse survival.
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Affiliation(s)
- Yanling Ren
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Chen Mei
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Li Ye
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Yingwan Luo
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Xinping Zhou
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Haiyang Yang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Peipei Lin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Weilai Xu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Liya Ma
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China.
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Marchal C, de Dieuleveult M, Saint-Ruf C, Guinot N, Ferry L, Olalla Saad ST, Lazarini M, Defossez PA, Miotto B. Depletion of ZBTB38 potentiates the effects of DNA demethylating agents in cancer cells via CDKN1C mRNA up-regulation. Oncogenesis 2018; 7:82. [PMID: 30310057 PMCID: PMC6182000 DOI: 10.1038/s41389-018-0092-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 08/22/2018] [Indexed: 11/09/2022] Open
Abstract
DNA methyltransferase inhibitor (DNMTi) treatments have been used for patients with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML), and have shown promising beneficial effects in some other types of cancers. Here, we demonstrate that the transcriptional repressor ZBTB38 is a critical regulator of the cellular response to DNMTi. Treatments with 5-azacytidine, or its derivatives decitabine and zebularine, lead to down-regulation of ZBTB38 protein expression in cancer cells, in parallel with cellular damage. The depletion of ZBTB38 by RNA interference enhances the toxicity of DNMTi in cell lines from leukemia and from various solid tumor types. Further we observed that inactivation of ZBTB38 causes the up-regulation of CDKN1C mRNA, a previously described indirect target of DNMTi. We show that CDKN1C is a key actor of DNMTi toxicity in cells lacking ZBTB38. Finally, in patients with MDS a high level of CDKN1C mRNA expression before treatment correlates with a better clinical response to a drug regimen combining 5-azacytidine and histone deacetylase inhibitors. Collectively, our results suggest that the ZBTB38 protein is a target of DNMTi and that its depletion potentiates the toxicity of DNMT inhibitors in cancer cells, providing new opportunities to enhance the response to DNMT inhibitor therapies in patients with MDS and other cancers.
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Affiliation(s)
- Claire Marchal
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Biological Science, Florida State University, Tallahassee, FL, 32306-4295, USA
| | - Maud de Dieuleveult
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Claude Saint-Ruf
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nadège Guinot
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Laure Ferry
- Université Paris Diderot, Sorbonne Paris Cité, Epigenetics and Cell Fate, UMR 7216 CNRS, 75013, Paris, France
| | - Sara T Olalla Saad
- Hematology and Blood Transfusion Center-University of Campinas/Hemocentro-Unicamp, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas, Brazil
| | - Mariana Lazarini
- Department of Biological Sciences, Federal University of São Paulo, Diadema, Brazil
| | - Pierre-Antoine Defossez
- Université Paris Diderot, Sorbonne Paris Cité, Epigenetics and Cell Fate, UMR 7216 CNRS, 75013, Paris, France
| | - Benoit Miotto
- INSERM, U1016, Institut Cochin, Paris, France. .,CNRS, UMR8104, Paris, France. .,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
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SOHO State of the Art and Next Questions: Management of Myelodysplastic Syndromes With Deletion 5q. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:629-635. [DOI: 10.1016/j.clml.2018.07.293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 12/17/2022]
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Wargasetia TL, Permana S, Widodo N. Potential use of compounds from sea cucumbers as MDM2 and CXCR4 inhibitors to control cancer cell growth. Exp Ther Med 2018; 16:2985-2991. [PMID: 30250516 PMCID: PMC6144067 DOI: 10.3892/etm.2018.6588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/11/2018] [Indexed: 11/06/2022] Open
Abstract
Ineffectiveness of cancer therapy may originate in the incompatibility of the treatment with various mutations in the cancer cells. Finding novel anticancer treatments that work efficiently for varying types of cancer cells remains challenging. Previous studies have identified that compounds in sea cucumbers are capable of inhibiting the growth of cancer cells and inducing apoptosis. However, information on the underlying mechanisms controlling cancer cell growth at a molecular level remains limited. The current study analyzed the potential of colochiroside A, ds-echinoside A, philinopside E, sphingosine and stichoposide C as inhibitors for anticancer target proteins, including mouse double minute 2 homolog (MDM2) and C-X-C chemokine receptor type 4 (CXCR4). Inhibition of MDM2 triggers apoptosis through regulation of tumor protein 53 and CXCR4 inhibition may prevent cancer cell proliferation and growth by affecting the Janus kinase 2/3 signal transducer and activator of transcription signaling pathway and protein tyrosine kinase 2. The results of a binding affinity analysis using molecular docking revealed that philinopside E and ds-echinoside A may inhibit MDM2 and CXCR4. The data suggested that these active compounds may be promising inhibitors of cell growth by binding to two targets simultaneously. Furthermore, stichoposide C and colochiroside A were predicted to inhibit CXCR4. Additional research is needed to validate the in vitro activity of the aforementioned compounds.
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Affiliation(s)
| | - Sofy Permana
- Biology Department, Faculty of Mathematics and Natural Sciences, The University of Brawijaya, Malang, East Java 65145, Indonesia
| | - Nashi Widodo
- Biology Department, Faculty of Mathematics and Natural Sciences, The University of Brawijaya, Malang, East Java 65145, Indonesia
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Predictors of clinical responses to hypomethylating agents in acute myeloid leukemia or myelodysplastic syndromes. Ann Hematol 2018; 97:2025-2038. [DOI: 10.1007/s00277-018-3464-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 07/27/2018] [Indexed: 12/18/2022]
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Shallis RM, Ahmad R, Zeidan AM. The genetic and molecular pathogenesis of myelodysplastic syndromes. Eur J Haematol 2018; 101:260-271. [PMID: 29742289 DOI: 10.1111/ejh.13092] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 12/14/2022]
Abstract
Myelodysplastic syndromes (MDS) comprise a diverse group of clonal and malignant myeloid disorders characterized by ineffective hematopoiesis, resultant peripheral cytopenias, and a meaningful increased risk of progression to acute myeloid leukemia. A wide array of recurring genetic mutations involved in RNA splicing, histone manipulation, DNA methylation, transcription factors, kinase signaling, DNA repair, cohesin proteins, and other signal transduction elements has been identified as important substrates for the development of MDS. Cytogenetic abnormalities, namely those characterized by loss of genetic material (including 5q- and 7q-), have also been strongly implicated and may influence the clonal architecture which predicts such mutations and may provoke an inflammatory bone marrow microenvironment as the substrate for clonal expansion. Other aspects of the molecular pathogenesis of MDS continue to be further elucidated, predicated upon advances in gene expression profiling and the development of new, and improved high-throughput techniques. More accurate understanding of the genetic and molecular basis for the development of MDS directly provides additional opportunity for treatment, which to date remains limited. In this comprehensive review, we examine the current understanding of the molecular pathogenesis and pathophysiology of MDS, as well as review future prospects which may enhance this understanding, treatment strategies, and hopefully outcomes.
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Affiliation(s)
- Rory M Shallis
- Division of Hematology/Medical Oncology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Rami Ahmad
- Division of Hematology/Medical Oncology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Amer M Zeidan
- Division of Hematology/Medical Oncology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
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Walker BA, Mavrommatis K, Wardell CP, Ashby TC, Bauer M, Davies F, Rosenthal A, Wang H, Qu P, Hoering A, Samur M, Towfic F, Ortiz M, Flynt E, Yu Z, Yang Z, Rozelle D, Obenauer J, Trotter M, Auclair D, Keats J, Bolli N, Fulciniti M, Szalat R, Moreau P, Durie B, Stewart AK, Goldschmidt H, Raab MS, Einsele H, Sonneveld P, San Miguel J, Lonial S, Jackson GH, Anderson KC, Avet-Loiseau H, Munshi N, Thakurta A, Morgan G. A high-risk, Double-Hit, group of newly diagnosed myeloma identified by genomic analysis. Leukemia 2018; 33:159-170. [PMID: 29967379 PMCID: PMC6326953 DOI: 10.1038/s41375-018-0196-8] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/26/2022]
Abstract
Patients with newly diagnosed multiple myeloma (NDMM) with high-risk disease are in need of new treatment strategies to improve the outcomes. Multiple clinical, cytogenetic, or gene expression features have been used to identify high-risk patients, each of which has significant weaknesses. Inclusion of molecular features into risk stratification could resolve the current challenges. In a genome-wide analysis of the largest set of molecular and clinical data established to date from NDMM, as part of the Myeloma Genome Project, we have defined DNA drivers of aggressive clinical behavior. Whole-genome and exome data from 1273 NDMM patients identified genetic factors that contribute significantly to progression free survival (PFS) and overall survival (OS) (cumulative R2 = 18.4% and 25.2%, respectively). Integrating DNA drivers and clinical data into a Cox model using 784 patients with ISS, age, PFS, OS, and genomic data, the model has a cumlative R2 of 34.3% for PFS and 46.5% for OS. A high-risk subgroup was defined by recursive partitioning using either a) bi-allelic TP53 inactivation or b) amplification (≥4 copies) of CKS1B (1q21) on the background of International Staging System III, comprising 6.1% of the population (median PFS = 15.4 months; OS = 20.7 months) that was validated in an independent dataset. Double-Hit patients have a dire prognosis despite modern therapies and should be considered for novel therapeutic approaches.
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Affiliation(s)
- Brian A Walker
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Christopher P Wardell
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - T Cody Ashby
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael Bauer
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Faith Davies
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Hongwei Wang
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - Pingping Qu
- Cancer Research and Biostatistics, Seattle, WA, USA
| | | | - Mehmet Samur
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Maria Ortiz
- Celgene Institute of Translational Research Europe, Sevilla, Spain
| | | | | | | | | | | | - Matthew Trotter
- Celgene Institute of Translational Research Europe, Sevilla, Spain
| | | | - Jonathan Keats
- Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | | | - Raphael Szalat
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Brian Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA
| | | | - Hartmut Goldschmidt
- Department of Medicine V, Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Marc S Raab
- Department of Medicine V, Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Heidelberg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, Wurzburg University, Wurzburg, Germany
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jesus San Miguel
- Clinica Universidad de Navarra, Centro Investigacion Medica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | | | - Herve Avet-Loiseau
- Centre de Recherche en Cancérologie de Toulouse Institut National de la Santé et de la Recherche Médicale, U1037, Toulouse, France.,L'Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Nikhil Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Gareth Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Efficacy of azacitidine is independent of molecular and clinical characteristics - an analysis of 128 patients with myelodysplastic syndromes or acute myeloid leukemia and a review of the literature. Oncotarget 2018; 9:27882-27894. [PMID: 29963245 PMCID: PMC6021252 DOI: 10.18632/oncotarget.25328] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/24/2018] [Indexed: 12/16/2022] Open
Abstract
Azacitidine is the first drug to demonstrate a survival benefit for patients with MDS. However, only half of patients respond and almost all patients eventually relapse. Limited and conflicting data are available on predictive factors influencing response. We analyzed 128 patients from two institutions with MDS or AML treated with azacitidine to identify prognostic indicators. Genetic mutations in ASXL1, RUNX1, DNMT3A, IDH1, IDH2, TET2, TP53, NRAS, KRAS, FLT3, KMT2A-PTD, EZH2, SF3B1, and SRSF2 were assessed by next-generation sequencing. With a median follow up of 5.6 years median survival was 1.3 years with a response rate of 49%. The only variable with significant influence on response was del(20q). All 6 patients responded (p = 0.012) but survival was not improved. No other clinical, cytogenetic or molecular marker for response or survival was identified. Interestingly, patients from poor-risk groups as high-risk cytogenetics (55%), t-MDS/AML (54%), TP53 mutated (48%) or relapsed after chemotherapy (60%) showed a high response rate. Factors associated with shorter survival were low platelets, AML vs. MDS, therapy-related disease, TP53 and KMT2A-PTD. In multivariate analysis anemia, platelets, FLT3-ITD, and therapy-related disease remained in the model. Poor-risk factors such as del(7q)/-7, complex karyotype, ASXL1, RUNX1, EZH2, and TP53 did not show an independent impact. Thus, no clear biomarker for response and survival can be identified. Although a number of publications on predictive markers for response to AZA exist, results are inconsistent and improved response rates did not translate to improved survival. Here, we provide a comprehensive overview comparing the studies published to date.
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72
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Kubasch AS, Platzbecker U. Beyond the Edge of Hypomethylating Agents: Novel Combination Strategies for Older Adults with Advanced MDS and AML. Cancers (Basel) 2018; 10:E158. [PMID: 29795051 PMCID: PMC6025349 DOI: 10.3390/cancers10060158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022] Open
Abstract
Higher-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) of the elderly exhibit several commonalities, including first line treatment with hypomethylating agents (HMA) like azacitidine (AZA) or decitabine (DAC). Until today, response to treatment occurs in less than 50 percent of patients, and is often short-lived. Moreover, patients failing HMA have a dismal prognosis. Current developments include combinations of HMA with novel drugs targeting epigenetic or immunomodulatory pathways. Other efforts focus on the prevention of resistance to HMA using checkpoint inhibitors to enhance immune attack. This review focuses on recent advances in the field of HMA-based front-line therapies in elderly patients with myeloid diseases.
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Affiliation(s)
- Anne Sophie Kubasch
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany.
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany.
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany.
- German Cancer Consortium (DKTK), 01307 Dresden, Germany.
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
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73
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DNA Methyltransferase Inhibitors in Myeloid Cancer: Clonal Eradication or Clonal Differentiation? ACTA ACUST UNITED AC 2018; 23:277-285. [PMID: 28926428 DOI: 10.1097/ppo.0000000000000282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
DNA methyltransferase inhibitors, so-called hypomethylating agents (HMAs), are the only drugs approved for the treatment of higher-risk myelodysplastic syndromes and are widely used in this context. However, it is still unclear why some patients respond to HMAs, whereas others do not. Recent sequencing efforts have identified molecular disease entities that may be specifically sensitive to these drugs, and many attempts are being made to clarify how HMAs affect the malignant clone during treatment. Here, we review the most recent data on the clinical effects of HMAs in myeloid malignancies.
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74
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Vidal V, Robert G, Goursaud L, Durand L, Ginet C, Karsenti JM, Luciano F, Gastaud L, Garnier G, Braun T, Hirsch P, Raffoux E, Nloga AM, Padua RA, Dombret H, Rohrlich P, Ades L, Chomienne C, Auberger P, Fenaux P, Cluzeau T. BCL2L10 positive cells in bone marrow are an independent prognostic factor of azacitidine outcome in myelodysplastic syndrome and acute myeloid leukemia. Oncotarget 2018; 8:47103-47109. [PMID: 28514758 PMCID: PMC5564547 DOI: 10.18632/oncotarget.17482] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/14/2017] [Indexed: 12/12/2022] Open
Abstract
Azacitidine (AZA), the reference treatment for most higher-risk myelodysplastic (MDS) patients can also improve overall survival (OS) in elderly acute myeloid leukemia (AML) patients ineligible for intensive chemotherapy, but reliable biological markers predicting response and OS in patients treated with AZA are lacking. In a preliminary study, we found that an increase of the percentage of BCL2L10, an anti-apoptotic member of the bcl-2 family, was correlated with AZA resistance. In this study, we assessed prospectively by flow cytometry the prognostic value of BCL2L10 positive bone marrow mononuclear cells in 70 patients (42 MDS and 28 AML), prior to AZA treatment. In patients with baseline marrow blasts below 30%, the baseline percentage of bone marrow BCL2L10 positive cells inversely correlated with response to AZA and OS independently of the International Prognostic Scoring System (IPSS) and IPSS-revised (IPSS-R). Specifically, OS was significantly lower in patients with more than 10% BCL2L10 positive cells (median 8.3 vs 22.9 months in patients with less than 10% positivity, p = 0,001). In summary, marrow BCL2L10 positive cells may be a biomarker for azacitidine response and OS, with a potential impact in clinical practice.
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Affiliation(s)
- Valérie Vidal
- INSERM U1131, Institut Universitaire d'hématologie, Paris, France
| | - Guillaume Robert
- INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Nice, France
| | - Laure Goursaud
- INSERM U1131, Institut Universitaire d'hématologie, Paris, France
| | - Laetitia Durand
- INSERM U1131, Institut Universitaire d'hématologie, Paris, France
| | - Clemence Ginet
- INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Nice, France
| | - Jean Michel Karsenti
- Cote d'azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
| | - Frederic Luciano
- INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Nice, France
| | - Lauris Gastaud
- Centre Antoine Lacassagne, Service d'oncologie, Nice, France
| | - Georges Garnier
- CH Princesse Grace, Service de Médecine Interne, Monaco, Monaco
| | - Thorsten Braun
- Hôpital Avicenne, Paris 13 University, APHP, Bobigny, France
| | - Pierre Hirsch
- Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie Cellulaire, Paris, France.,Sorbonne Universités, UPMC Univ Paris 6, UMRS 938, CDR Saint-Antoine, Paris, France
| | - Emmanuel Raffoux
- Hôpital Saint Louis, Paris 7 University, Service d'Hématologie Adulte, APHP, Paris, France
| | - Anne Marie Nloga
- Hôpital Saint Louis, Paris 7 University, Service d'Hématologie Sénior, APHP, Paris, France
| | - Rose Ann Padua
- INSERM U1131, Institut Universitaire d'hématologie, Paris, France
| | - Hervé Dombret
- Hôpital Saint Louis, Paris 7 University, Service d'Hématologie Adulte, APHP, Paris, France
| | - Pierre Rohrlich
- Cote d'azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
| | - Lionel Ades
- INSERM U1131, Institut Universitaire d'hématologie, Paris, France.,Hôpital Saint Louis, Paris 7 University, Service d'Hématologie Sénior, APHP, Paris, France
| | | | - Patrick Auberger
- INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Nice, France.,Cote d'azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
| | - Pierre Fenaux
- INSERM U1131, Institut Universitaire d'hématologie, Paris, France.,Hôpital Saint Louis, Paris 7 University, Service d'Hématologie Sénior, APHP, Paris, France
| | - Thomas Cluzeau
- INSERM U1131, Institut Universitaire d'hématologie, Paris, France.,INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Nice, France.,Cote d'azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
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75
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Somatic mutations predict outcomes of hypomethylating therapy in patients with myelodysplastic syndrome. Oncotarget 2018; 7:55264-55275. [PMID: 27419369 PMCID: PMC5342416 DOI: 10.18632/oncotarget.10526] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/28/2016] [Indexed: 12/21/2022] Open
Abstract
Although hypomethylating therapy (HMT) is the first line therapy in higher-risk myelodysplastic syndromes (MDS), predicting response to HMT remains an unresolved issue. We aimed to identify mutations associated with response to HMT and survival in MDS. A total of 107 Korean patients with MDS who underwent HMT (57 responders and 50 non-responders) were enrolled. Targeted deep sequencing (median depth of coverage 1,623X) was performed for 26 candidate MDS genes. In multivariate analysis, no mutation was significantly associated with response to HMT, but a lower hemoglobin level (<10g/dL, OR 3.56, 95% CI 1.22-10.33) and low platelet count (<50,000/μL, OR 2.49, 95% CI 1.05-5.93) were independent markers of poor response to HMT. In the subgroup analysis by type of HMT agents, U2AF1 mutation was significantly associated with non-response to azacitidine, which was consistent in multivariate analysis (OR 14.96, 95% CI 1.67-134.18). Regarding overall survival, mutations in DNMT1 (P=0.031), DNMT3A (P=0.006), RAS (P=0.043), and TP53 (P=0.008), and two clinical variables (male-gender, P=0.002; IPSS-R H/VH, P=0.026) were independent predicting factors of poor prognosis. For AML-free survival, mutations in DNMT3A (P<0.001), RAS (P=0.001), and TP53 (P=0.047), and two clinical variables (male-gender, P=0.024; IPSS-R H/VH, P=0.005) were independent predicting factors of poor prognosis. By combining these mutations and clinical predictors, we developed a quantitative scoring model for response to azacitidine, overall- and AML-free survival. Response to azacitidine and survival rates became worse significantly with increasing risk-scores. This scoring model can make prognosis prediction more reliable and clinically applicable.
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76
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Utx loss causes myeloid transformation. Leukemia 2018; 32:1458-1465. [PMID: 29479066 DOI: 10.1038/s41375-018-0011-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
Abstract
Recurrent somatic loss-of-function mutations in histone demethylases are frequently detected in cancer. However, whether loss of a histone demethylase can cause cancer has not been determined. Here, we report that knockout of the histone demethylase Utx in mice causes a chronic myelomonocytic leukemia (CMML)-like disease with splenomegaly, monocytosis, and extramedullary hematopoiesis. Mutational analysis of patient data indicated that UTX mutations occur simultaneously with TP53 mutations in myeloid malignancies, and combined inactivation of Utx and Trp53 accelerated the development of CMML in a cell-autonomous manner. Utx loss caused increased self-renewal of hematopoietic stem cells and predisposed hematopoietic stem cells to differentiate into myeloid-derived lineages. Transcriptome and chromatin immunoprecipitation analyses revealed that Utx activates key transcriptional factors required for erythroid differentiation by modulating histone H3 lysine 27 and lysine 4 trimethylation. Our results suggest that Utx suppresses CMML formation by controlling hematopoietic stem cell self-renewal and differentiation.
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77
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Komrokji R, Swern AS, Grinblatt D, Lyons RM, Tobiasson M, Silverman LR, Sayar H, Vij R, Fliss A, Tu N, Sugrue MM. Azacitidine in Lower-Risk Myelodysplastic Syndromes: A Meta-Analysis of Data from Prospective Studies. Oncologist 2018; 23:159-170. [PMID: 29118268 PMCID: PMC5813747 DOI: 10.1634/theoncologist.2017-0215] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/06/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND After erythropoiesis-stimulating agent (ESA) failure, lenalidomide and hypomethylating agents are the only remaining treatment options for most patients with lower-risk myelodysplastic syndromes (LR-MDS). Optimal choice of these agents as front-line therapy in non-del(5q) LR-MDS is unclear. Because azacitidine clinical data mainly describe experience in higher-risk MDS, we performed a meta-analysis of patient-level data to evaluate azacitidine in patients with red blood cell (RBC) transfusion-dependent LR-MDS. MATERIALS AND METHODS We searched English-language articles for prospective phase II and III azacitidine clinical trials and patient registries published between 2000 and 2015, and Embase abstracts from 2015 conferences. Patient-level data from identified relevant studies were provided by investigators. Meta-analyses followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Efficacy endpoints were RBC transfusion independence (TI) and Clinical Benefit (RBC-TI, erythroid response, and complete or partial remission, per International Working Group 2006 criteria for MDS). RESULTS Data for 233 patients from 6 clinical studies and 1 registry study met criteria for inclusion in analyses. Overall, 90.3% of patients had non-del(5q) LR-MDS. Pooled estimates from random-effects models of RBC-TI and Clinical Benefit were 38.9% and 81.1%, respectively; for the ESA-refractory subgroup, they were 40.5% and 77.3%; and for patients with isolated anemia, they were 41.9% and 82.5%. In multivariate analyses, planned use of ≥6 azacitidine treatment cycles was significantly predictive of response. CONCLUSION Azacitidine effects in these patients, most with non-del(5q) LR-MDS, were promising and generally similar to those reported for lenalidomide in similar patients. The choice of initial therapy is important because most patients eventually stop responding to front-line therapy and alternatives are limited. IMPLICATIONS FOR PRACTICE Lower-risk myelodysplastic syndromes (LR-MDS) are primarily characterized by anemia. After erythropoiesis-stimulating agent (ESA) failure, lenalidomide and hypomethylating agents are the only remaining treatment options for most patients. This meta-analysis of 233 azacitidine-treated red blood cell (RBC) transfusion-dependent patients with LR-MDS (92.3% non-del[5q]) from 7 studies showed 38.9% became RBC transfusion-independent. There is no clear guidance regarding the optimal choice of lenalidomide or hypomethylating agents for patients with non-del(5q) LR-MDS following ESA failure. Clinical presentation (e.g., number of cytopenias) and potential outcomes after hypomethylating agent failure are factors to consider when making initial treatment decisions for LR-MDS patients.
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Affiliation(s)
- Rami Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Arlene S Swern
- Biostatistics, Celgene Corporation, Summit, New Jersey, USA
| | - David Grinblatt
- Hematology, Northshore University Health System, Evanston, Illinois, USA
| | - Roger M Lyons
- Department of Hematology, US Oncology-Texas Oncology, San Antonio, Texas, USA
| | - Magnus Tobiasson
- Division of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Lewis R Silverman
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hamid Sayar
- Simon Cancer Center, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Ravi Vij
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Albert Fliss
- Medical Affairs, Celgene Corporation, Summit, New Jersey, USA
| | - Nora Tu
- Biostatistics, Celgene Corporation, Summit, New Jersey, USA
| | - Mary M Sugrue
- Medical Affairs, Celgene Corporation, Summit, New Jersey, USA
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78
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Shapiro RM, Lazo-Langner A. Systematic review of azacitidine regimens in myelodysplastic syndrome and acute myeloid leukemia. BMC HEMATOLOGY 2018; 18:3. [PMID: 29435331 PMCID: PMC5793426 DOI: 10.1186/s12878-017-0094-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 12/18/2017] [Indexed: 01/10/2023]
Abstract
Background 5-Azacitidine administered as a 7-day dosing regimen (7–0-0) is approved in high risk IPSS myelodysplastic syndrome (MDS) patients. Alternative regimens such as a 5-day (5–0-0) or 7-day with a weekend break (5–2-2) are commonly used. No randomized controlled trial has been done directly comparing all three dosing regimens. The objective of this study was to compare the efficacies of the 5–0-0, 5–2-2, and 7–0-0 regimens in MDS and AML. Methods A systematic review was conducted using MEDLINE, EMBASE and CENTRAL. Eligible studies were randomized controlled trials (RCTs), observational prospective and retrospective studies. The primary clinical outcomes were Objective Response Rate (ORR) defined as the sum of complete response (CR), partial response (PR), and hematological improvement (HI) as defined by the IWG 2006 criteria. A meta-analysis of simple proportions was conducted using a random effects model with weights defined according to Laird and Mosteller. Comparisons between groups were not attempted due to the heterogeneity of study designs. Results The only RCT directly comparing alternative azacitidine regimens showed no difference in ORR between the 5–0-0 and 5–2-2 regimens. All other RCTs compared a dosing regimen to conventional care. The pooled proportion of ORR was 44.8% with 95% CI (42.8%, 45.5%) for 7–0-0, 41.2% with 95% CI (39.2%, 41.9%) for 5–0-0, and 45.8% with 95% CI (42.6%, 46.4%) for 5–2-2. Conclusions Indirect comparison of alternative azacitidine dosing regimens in MDS and AML shows a benefit for the 7-day regimen in attaining ORR. Additional RCTs are required to definitively address this comparison. Electronic supplementary material The online version of this article (10.1186/s12878-017-0094-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roman M Shapiro
- 1Department of Medicine, Western University, London, ON Canada
| | - Alejandro Lazo-Langner
- 2Department of Medicine, Division of Hematology, Western University, London, ON Canada.,3Department of Epidemiology & Biostatistics, Western University, London, ON Canada.,4Hematology Division, London Health Sciences Centre, 800 Commissioners Rd E, Rm E6-216A, London, ON N6A 5W9 Canada
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79
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Montalban-Bravo G, Garcia-Manero G. Myelodysplastic syndromes: 2018 update on diagnosis, risk-stratification and management. Am J Hematol 2018; 93:129-147. [PMID: 29214694 DOI: 10.1002/ajh.24930] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW The myelodysplastic syndromes (MDS) are a very heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myelogenous leukemia (AML). MDS occurs more frequently in older males and in individuals with prior exposure to cytotoxic therapy. DIAGNOSIS Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry or molecular genetics is usually complementary and may help refine diagnosis. RISK-STRATIFICATION Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow and cytogenetic characteristics. The most commonly used system is probably the International Prognostic Scoring System (IPSS). IPSS is now replaced by the revised IPSS-R score. Although not systematically incorporated into new validated prognostic systems, somatic mutations can help define prognosis and should be considered as new prognostic factors. RISK-ADAPTED THERAPY Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts and cytogenetic and mutational profiles. Goals of therapy are different in lower risk patients than in higher risk. In lower risk, the goal is to decrease transfusion needs and transformation to higher risk disease or AML, as well as to improve survival. In higher risk, the goal is to prolong survival. Current available therapies include growth factor support, lenalidomide, hypomethylating agents, intensive chemotherapy and allogeneic stem cell transplantation. The use of lenalidomide has significant clinical activity in patients with lower risk disease, anemia and a chromosome 5 alteration. 5-azacitidine and decitabine have activity in both lower and higher-risk MDS. 5-azacitidine has been shown to improve survival in higher risk MDS. A number of new molecular lesions have been described in MDS that may serve as new therapeutic targets or aid in the selection of currently available agents. Additional supportive care measures may include the use of prophylactic antibiotics and iron chelation. MANAGEMENT OF PROGRESSIVE OR REFRACTORY DISEASE At the present time there are no approved interventions for patients with progressive or refractory disease particularly after hypomethylating based therapy. Options include participation in a clinical trial or cytarabine based therapy and stem cell transplantation.
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80
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Belickova M, Vesela J, Jonasova A, Pejsova B, Votavova H, Merkerova MD, Zemanova Z, Brezinova J, Mikulenkova D, Lauermannova M, Valka J, Michalova K, Neuwirtova R, Cermak J. TP53 mutation variant allele frequency is a potential predictor for clinical outcome of patients with lower-risk myelodysplastic syndromes. Oncotarget 2017; 7:36266-36279. [PMID: 27167113 PMCID: PMC5094999 DOI: 10.18632/oncotarget.9200] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/16/2016] [Indexed: 12/31/2022] Open
Abstract
TP53 mutations are frequently detected in patients with higher-risk myelodysplastic syndromes (MDS); however, the clinical impact of these mutations on the disease course of patients with lower-risk MDS is unclear. In this study of 154 lower-risk MDS patients, TP53 mutations were identified in 13% of patients, with prevalence in patients with del(5q) (23.6%) compared to non-del(5q) (3.8%). Two-thirds of the mutations were detected at the time of diagnosis, and one-third were detected during the course of the disease. Multivariate analysis demonstrated that a TP53 mutation was the strongest independent prognostic factor for overall survival (OS) (HR: 4.39) and progression-free survival (PFS) (HR: 3.74). Evaluation of OS determined a TP53 variant allele frequency (VAF) threshold of 6% as an optimal cut-off for patient stratification. The median OS was 43.5 months in patients with mutations detected at the time of diagnosis and a mutational burden of > 6% VAF compared to 138 months (HR 12.2; p = 0.003) in patients without mutations; similarly, the median PFS was 20.2 months versus 116.6 months (HR 79.5; p < 0.0001). In contrast, patients with a mutational burden of < 6% VAF were stable for long periods without progression and had no significant impact on PFS or OS. Additionally, we found a high correlation in the mutational data from cells of the peripheral blood and those of the bone marrow, indicating that peripheral blood is a reliable source for mutation monitoring. Our results indicate that the clinical impact of TP53 mutations in lower-risk MDS patients depends on the level of mutational burden.
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Affiliation(s)
- Monika Belickova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jitka Vesela
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Anna Jonasova
- First Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Barbora Pejsova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Hana Votavova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Zuzana Zemanova
- Center of Oncocytogenetics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Brezinova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Dana Mikulenkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Jan Valka
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Kyra Michalova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic.,Center of Oncocytogenetics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radana Neuwirtova
- First Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
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81
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Clinical implications of TP53 mutations in myelodysplastic syndromes treated with hypomethylating agents. Oncotarget 2017; 7:14172-87. [PMID: 26871476 PMCID: PMC4924706 DOI: 10.18632/oncotarget.7290] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 01/09/2016] [Indexed: 01/15/2023] Open
Abstract
We screened TP53 mutations in 168 MDS patients who were treated with HMA and evaluated predictive and prognostic value of TP53 mutations. Overall response to HMA was not different based on TP53 mutation status (45% vs. 32% in TP53-mutated and wild type [WT], respectively, P = 0.13). However, response duration was significantly shorter in TP53-mutated patients compared to WT patients (5.7 months vs. 28.5 months, P = 0.003). Longitudinal analysis of TP53 mutations after HMA showed that TP53 mutations almost always persisted at times of disease progression. TP53-mutated patients showed significantly worse overall survival (OS) compared to WT patients (9.4 months vs. 20.7 months, P <0.001). Further, TP53 mutations distinguished prognosis in the subgroup of patients with complex karyotype and Revised International Prognostic Scoring System (IPSS-R) defined very high-risk disease. Multivariate analysis showed that TP53 mutation status is significantly prognostic for OS after adjusting prognostic effect from other factors. The current study provides evidence that TP53 mutations are independently prognostic in MDS patients treated with HMA. While TP53-mutated MDS patients initially respond well to HMA, their duration of response is significantly shorter than WT patients. Novel strategies to improve duration of response in TP53-mutated MDS are urgently needed.
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82
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Sébert M, Komrokji RS, Sekeres MA, Prebet T, Cluzeau T, Santini V, Gyan E, Sanna A, Ali NHA, Hobson S, Eclache V, List A, Fenaux P, Adès L. Impact of baseline cytogenetic findings and cytogenetic response on outcome of high-risk myelodysplastic syndromes and low blast count AML treated with azacitidine. Leuk Res 2017; 63:72-77. [DOI: 10.1016/j.leukres.2017.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/06/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
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83
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Mutations in the DNA methylation pathway and number of driver mutations predict response to azacitidine in myelodysplastic syndromes. Oncotarget 2017; 8:106948-106961. [PMID: 29291002 PMCID: PMC5739787 DOI: 10.18632/oncotarget.22157] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
We evaluated the association of mutations in 34 candidate genes and response to azacitidine in 84 patients with myelodysplastic syndrome (MDS), with 217 somatic mutations identified by next-generation sequencing. Most patients (93%) had ≥1 mutation (mean=2.6/patient). The overall response rate to azacitidine was 42%. No clinical characteristic was associated with response to azacitidine. However, total number of mutations/patient was negatively associated with overall drug response (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.33–0.94; p=0.028), and a positive association was found for having ≥1 mutation in a DNA methylation-related gene: TET2, DNMT3A, IDH1 and/or IDH2 (OR: 4.76, 95%CI: 1.31–17.27; p=0.017). Mutations in TP53 (hazard ratio [HR]: 3.88; 95%CI: 1.94–7.75) and EZH2 (HR: 2.50; 95%CI: 1.23–5.09) were associated with shorter overall survival. Meta-analysis of 6 studies plus present data (n=815 patients) allowed assessment of the association of drug response with mutations in 9 candidate genes: ASXL1, CBL, EZH2, SF3B1, SRSF2, TET2, DNMT3A, IDH1/2 and TP53. TET2 mutations predicted a more favorable drug response compared with ‘wild-type’ peers (pooled OR: 1.67, 95%CI: 1.14–2.44; p=0.01). In conclusion, mutations in the DNA methylation pathway, especially TET2 mutations, and low number of total mutations are associated with a better response to azacitidine.
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84
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Wang W, Routbort MJ, Tang Z, Ok CY, Patel KP, Daver N, Garcia-Manero G, Medeiros LJ, Wang SA. Characterization of TP53 mutations in low-grade myelodysplastic syndromes and myelodysplastic syndromes with a non-complex karyotype. Eur J Haematol 2017; 99:536-543. [PMID: 28926144 DOI: 10.1111/ejh.12971] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Although commonly associated with high-grade myelodysplastic syndrome (MDS) and MDS with a complex karyotype, TP53 mutations also occur in low-grade MDS and MDS with a non-complex karyotype. In latter cases, their clinicopathological features and the characteristics of TP53 mutations remain poorly characterized. METHODS 176 MDS cases with TP53 mutations were stratified and characterized based on their karyotype and histologic subtype. RESULTS Among 176 cases, 17% had a non-complex karyotype and 24% were low-grade MDS. TP53 mutations often occurred in DNA-binding domains and the majority of cases had only one mutation, irrespective of their karyotype and MDS subtype. The variant allele frequency (VAF), however, was associated with karyotype complexity and the types of MDS with a lower VAF found in cases with a non-complex karyotype and low-grade MDS. A low (<20%) VAF was associated with a better survival, as well as low-grade subtype. CONCLUSIONS In low-grade MDS and MDS with a non-complex karyotype, TP53 mutations showed a lower VAF. Patients with a lower VAF had a better survival. TP53 mutations are not the only prognostic factor in MDS patients with TP53 mutations as the VAF, blast counts and history of prior therapy also play important roles in prognosis.
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Affiliation(s)
- Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark J Routbort
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhenya Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chi Young Ok
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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85
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Putri JF, Widodo N, Sakamoto K, Kaul SC, Wadhwa R. Induction of senescence in cancer cells by 5′-Aza-2′-deoxycytidine: Bioinformatics and experimental insights to its targets. Comput Biol Chem 2017; 70:49-55. [DOI: 10.1016/j.compbiolchem.2017.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/27/2017] [Accepted: 08/02/2017] [Indexed: 12/13/2022]
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86
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Aldoss I, Pham A, Li SM, Gendzekhadze K, Afkhami M, Telatar M, Hong H, Padeganeh A, Bedell V, Cao T, Khaled SK, Malki MMA, Salhotra A, Ali H, Aribi A, Palmer J, Aoun P, Spielberger R, Stein AS, Snyder D, O'Donnell MR, Murata-Collins J, Senitzer D, Weisenburger D, Forman SJ, Pullarkat V, Marcucci G, Pillai R, Nakamura R. Favorable impact of allogeneic stem cell transplantation in patients with therapy-related myelodysplasia regardless of TP53 mutational status. Haematologica 2017; 102:2030-2038. [PMID: 28971906 PMCID: PMC5709102 DOI: 10.3324/haematol.2017.172544] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/20/2017] [Indexed: 01/04/2023] Open
Abstract
Therapy-related myelodysplastic syndrome is a long-term complication of cancer treatment in patients receiving cytotoxic therapy, characterized by high-risk genetics and poor outcomes. Allogeneic hematopoietic cell transplantation is the only potential cure for this disease, but the prognostic impact of pre-transplant genetics and clinical features has not yet been fully characterized. We report here the genetic and clinical characteristics and outcomes of a relatively large cohort of patients with therapy-related myelodysplastic syndrome (n=67) who underwent allogeneic transplantation, comparing these patients to similarly treated patients with de novo disease (n=199). The 5-year overall survival was not different between patients with therapy-related and de novo disease (49.9% versus 53.9%; P=0.61) despite a higher proportion of individuals with an Intermediate-2/High International Prognostic Scoring System classification (59.7% versus 43.7%; P=0.003) and high-risk karyotypes (61.2% versus 30.7%; P<0.01) among the patients with therapy-related disease. In mutational analysis, TP53 alteration was the most common abnormality in patients with therapy-related disease (n=18: 30%). Interestingly, the presence of mutations in TP53 or in any other of the high-risk genes (EZH2, ETV6, RUNX1, ASXL1: n=29: 48%) did not significantly affect either overall survival or relapse-free survival. Allogeneic stem-cell transplantation is, therefore, a curative treatment for patients with therapy-related myelodysplastic syndrome, conferring a similar long-term survival to that of patients with de novo disease despite higher-risk features. While TP53 alteration was the most common mutation in therapy-related myelodysplastic syndrome, the finding was not detrimental in our case-series.
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Affiliation(s)
- Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anh Pham
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Sierra Min Li
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, CA, USA
| | | | | | | | - Hao Hong
- Department of Pathology, City of Hope, Duarte, CA, USA
| | | | | | - Thai Cao
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Samer K Khaled
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Joycelynne Palmer
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, CA, USA
| | - Patricia Aoun
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Ricardo Spielberger
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Anthony S Stein
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - David Snyder
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Margaret R O'Donnell
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | | | | | | | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA
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87
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Moyo TK, Savona MR. Molecular Testing in Patients with Suspected Myelodysplastic Syndromes. Curr Hematol Malig Rep 2017; 11:441-448. [PMID: 27734261 DOI: 10.1007/s11899-016-0356-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Myelodysplastic syndromes (MDS) comprise a heterogeneous group of clonal hematologic malignancies characterized by a hypercellular bone marrow and morphologic dysplasia in one or more lineage (i.e., myeloid, erythroid, or megakaryocytic), presenting clinically with leukopenia, anemia, and/or thrombocytopenia and with a propensity to transform to acute myelogenous leukemia. Newer technologies such as next-generation sequencing have allowed better understanding of the genetic landscape in MDS. Nearly 80 % of MDS patients have at least one mutation, and approximately 40 recurrent somatic mutations have been identified to occur in >1 % of cases. Many of these mutations are relevant for prognosis, help with selection of therapy, and/or have specific targeted treatment options. In this article, we will explore the impact of molecular testing on diagnosis, prognosis, and treatment decisions in patients with suspected MDS.
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Affiliation(s)
- Tamara K Moyo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA
| | - Michael R Savona
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA.
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88
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Abstract
Acute myeloid leukemia (AML) is predominantly a disease of older adults associated with poor long-term outcomes with available therapies. Used as single agents, hypomethylating agents (HMAs) induce only 15 to 25% complete remissions, but current data suggest that median OS observed after HMAs is comparable to that observed after more intensive therapies. Whether long-term cure may be obtained in some patients treated with HMAs is unknown. Combinations of HMAs to novel agents are now extensively investigated and attractive response rates have been reported when combining HMAs to different drug classes. The absence of reliable predictive biomarkers of efficacy of HMAs in AML and the uncertainties regarding their most relevant mechanisms of action hinder the rational design of the combinations to be tested in priority, usually in untreated older AML patients.
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89
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Yang B, Yu R, Cai L, Chi X, Liu C, Yang L, Wang X, He P, Lu X. A comparison of therapeutic dosages of decitabine in treating myelodysplastic syndrome: a meta-analysis. Ann Hematol 2017; 96:1811-1823. [PMID: 28842789 DOI: 10.1007/s00277-017-3102-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/11/2017] [Indexed: 01/15/2023]
Abstract
Decitabine is used to treat myelodysplastic syndrome (MDS). This meta-analysis evaluated the efficacy and safety of different dosing regimens of decitabine in treating intermediate and/or high-risk MDS. Medline, Cochrane, EMBASE, and Google Scholar databases were searched up to October 23, 2015. Randomized controlled trials, prospective, cohort, and case series studies were included. Fifteen studies were included with a total of 1378 patients. The decitabine 100 mg/m2/course dosing regimen had a greater overall response rate than the 60-75 mg/m2/course (51 vs. 25%; P = 0.003). It also had higher complete response rate compared with the 135 mg/m2/course regimen (24.2 vs.13.7%; P = 0.016). The three dosing regimens were similar with respect to bone marrow complete response and partial response and hematologic improvement (P values > 0.05). Decitabine 135 mg/m2/course regimen had similar hematologic improvement as best supportive care (P = 0.066). The incidence of neutropenia, thrombocytopenia, infections, and anemia was similar across treatment groups (range, 31 to 38%; P values ≥ 0.899). The 100 mg/m2/course decitabine regimen showed benefit with respect to overall response rate compared with the 60-75 mg/m2/course regimen, as well as greater improvement in complete response rate compared with the 135 mg/m2/course regimen. All three dosing regimens had similar frequency of adverse events.
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Affiliation(s)
- Bo Yang
- Department of Geriatric Hematology, Nanlou Clinic, Chinese PLA General Hospital, Fuxing Road 28, Handian District, Beijing, 100853, China
| | - Ruili Yu
- Department of Allergy, Beijing Shijitan Hospital, Affiliated to Capital Medical University, Beijing, 100038, China
| | - Lili Cai
- Department of Geriatric Laboratory Medicine, Nanlou Clinic, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaohua Chi
- Department of Pharmacy, Chinese PLA Rocket Force General Hospital, Beijing, 100800, China
| | - Cui Liu
- Department of Geriatric Ultrasound, Nanlou Clinic, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lei Yang
- Medical Department, Nanlou Clinic, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xueyan Wang
- Department of Allergy, Beijing Shijitan Hospital, Affiliated to Capital Medical University, Beijing, 100038, China
| | - Peifeng He
- Medical Information Management Major, Shanxi Medical University, Taiyuan, 30001, China
| | - Xuechun Lu
- Department of Geriatric Hematology, Nanlou Clinic, Chinese PLA General Hospital, Fuxing Road 28, Handian District, Beijing, 100853, China.
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90
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Talati C, Sallman D, List A. Lenalidomide: Myelodysplastic syndromes with del(5q) and beyond. Semin Hematol 2017; 54:159-166. [PMID: 28958290 DOI: 10.1053/j.seminhematol.2017.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 01/18/2023]
Abstract
Myelodysplastic syndrome (MDS) with deletion 5q (del(5q)) is a distinct clinical and pathological disease subset that is exquisitely sensitive to lenalidomide for the treatment of red blood cell transfusion-dependent anemia. Although lenalidomide has erythropoeitic promoting activity in MDS without del(5q) (non-del(5q) MDS), the frequency of response to treatment is lower and relates to biologically separate drug effects. In del(5q) MDS, lenalidomide suppresses the malignant clone to restore effective erythropoiesis by virtue of synthetic lethality, arising from cereblon-dependent degradation of haplodeficient proteins encoded within the commonly deleted region of the chromosome 5q deletion. In contrast, in non-del(5q) MDS, lenalidomide restores effective erythropoiesis via enhancement of erythropoietin (EPO) receptor-initiated transcriptional response arising from the assembly of signaling-competent receptor complexes within membrane lipid raft domains. Recently, large phase III clinical studies have explored the role of lenalidomide, alone and in combination with, erythropoiesis-stimulating agents showing additive improvement in erythroid responses. Herein, we will describe the mechanisms of lenalidomide action in MDS and pivotal clinical studies testing the benefit of lenalidomide in both del(5q) and non-del(5q) MDS. Furthermore, we discuss evidence-based strategies to incorporate lenalidomide into the treatment algorithm for patients with MDS.
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Affiliation(s)
- Chetasi Talati
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - David Sallman
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
| | - Alan List
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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91
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Schuh AC, Döhner H, Pleyer L, Seymour JF, Fenaux P, Dombret H. Azacitidine in adult patients with acute myeloid leukemia. Crit Rev Oncol Hematol 2017; 116:159-177. [PMID: 28693797 DOI: 10.1016/j.critrevonc.2017.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 01/13/2023] Open
Abstract
Azacitidine is recommended front-line treatment for older patients with acute myeloid leukemia (AML) who are not candidates for intensive treatment regimens, and was recently granted approval in the European Union for treatment of adult AML. Reviewed here is azacitidine experience in AML, including: mechanistic and pharmacokinetic data; safety and efficacy in controlled trials; treatment effects in AML subpopulations defined by disease characteristics; experience in unselected patients treated in the community setting; clinical outcomes relative to other approved AML therapies; and experience with azacitidine-based combination treatment regimens. Collectively, these data suggest that (a) azacitidine may prolong overall survival to a similar or greater extent than do other approved AML treatments, but with less toxicity, (b) azacitidine may be the preferred treatment option for older patients with unfavorable cytogenetics, and (c) experience and outcomes with azacitidine in the clinic are similar to those seen in clinical trials. Continued investigation of combination regimens on an azacitidine backbone is warranted.
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Affiliation(s)
- Andre C Schuh
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | | | - Lisa Pleyer
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Austria
| | - John F Seymour
- Peter MacCallum Cancer Centre, Melbourne, Australia; University of Melbourne, Parkville, Australia
| | - Pierre Fenaux
- Hôpital Saint Louis, Institut Universitaire d'Hématologie, Paris, France
| | - Hervé Dombret
- Hôpital Saint Louis, Institut Universitaire d'Hématologie, Paris, France
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92
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Garcia-Manero G, Montalban-Bravo G, Berdeja JG, Abaza Y, Jabbour E, Essell J, Lyons RM, Ravandi F, Maris M, Heller B, DeZern AE, Babu S, Wright D, Anz B, Boccia R, Komrokji RS, Kuriakose P, Reeves J, Sekeres MA, Kantarjian H, Ghalie R, Roboz GJ. Phase 2, randomized, double-blind study of pracinostat in combination with azacitidine in patients with untreated, higher-risk myelodysplastic syndromes. Cancer 2017; 123:994-1002. [PMID: 28094841 PMCID: PMC5432122 DOI: 10.1002/cncr.30533] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The prognosis of patients with higher-risk myelodysplastic syndromes (MDS) remains poor despite available therapies. Histone deacetylase inhibitors have demonstrated activity in patients with MDS and in vitro synergy with azacitidine. METHODS A phase 2 randomized, placebo-controlled clinical trial of azacitidine and pracinostat was conducted in patients who had International Prognostic Scoring System intermediate-2-risk or high-risk MDS. The primary endpoint was the complete response (CR) rate by cycle 6 of therapy. RESULTS Of 102 randomized patients, there were 51 in the pracinostat group and 51 in the placebo group. The median age was 69 years. The CR rate by cycle 6 of therapy was 18% and 33% (P = .07) in the pracinostat and placebo groups, respectively. No significant differences in overall survival (median, 16 vs 19 months, respectively; hazard ratio, 1.21; 95% confidence interval, 0.66-2.23) or progression-free survival (11 vs 9 months, respectively; hazard ratio, 0.82; 95% confidence interval, 0.546-1.46) were observed between groups. Grade ≥3 adverse events occurred more frequently in the pracinostat group (98% vs 74%), leading to more treatment discontinuations (20% vs 10%). CONCLUSIONS The combination of azacitidine with pracinostat did not improve outcomes in patients with higher-risk MDS. Higher rates of treatment discontinuation may partially explain these results, suggesting alternative dosing and schedules to improve tolerability may be required to determine the potential of the combination. Cancer 2017;123:994-1002. © 2016 American Cancer Society.
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Affiliation(s)
- Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Houston, TX
| | - Guillermo Montalban-Bravo
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Houston, TX
| | | | - Yasmin Abaza
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Houston, TX
| | | | | | - Farhad Ravandi
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Houston, TX
| | | | | | - Amy E. DeZern
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wain, IN
| | - David Wright
- Florida Cancer Specialists-North, Jacksonville, FL
| | | | - Ralph Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD
| | | | | | - James Reeves
- Florida Cancer Specialists-South, Cape Coral, FL
| | | | - Hagop Kantarjian
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Houston, TX
| | | | - Gail J Roboz
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical
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Epigenetic drug combination induces remission in mouse xenograft models of pediatric acute myeloid leukemia. Leuk Res 2017; 58:91-97. [PMID: 28505595 DOI: 10.1016/j.leukres.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 01/06/2023]
Abstract
Aberrations in epigenetic modifications contribute to leukemogenesis in childhood acute myeloid leukemia (AML). We combined DNA hypomethylating agent azacitidine with histone deacetylase inhibitor panobinostat in preclinical models of childhood AML. Synergistic cytotoxic effect upon treatment with azacitidine and panobinostat with combination indices <1.0 was observed. Azacitidine and panobinostat increased median survival by 26 and 6days respectively in MV4;11 xenografted mice. Mice treated with both drugs showed a drastic reduction in leukemic burden leading to complete remission sustained for the duration of the experimental period lasting more than 519days. Reduced leukemic burden and prolonged survival was also observed in AML-193 xenografted mice treated with azacitidine-panobinostat combination. Differential gene expression profiling was performed on AML cells treated with azacitidine, panobinostat or azacitidine-panobinostat combination. Functional mapping of transcripts uniquely regulated by the azacitidine-panobinostat combination in MV4;11 cells identified p53 as an upstream regulator. A comparison of the uniquely modulated transcripts by azacitidine-panobinostat combination in MV4;11 cells versus AML-193 and THP-1 cells, bearing mutated p53, also revealed p53 as the topmost upstream regulator. Finally, expression of mutant p53 in MV4;11 cells reduced sensitivity to azacitidine-panobinostat combination, suggesting that p53 may be a predictor of response to epigenetic therapy in pediatric AML.
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Affiliation(s)
- John S Welch
- Washington University School of Medicine, St. Louis, MO
| | | | - Timothy J Ley
- Washington University School of Medicine, St. Louis, MO
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Lindsley RC, Saber W, Mar BG, Redd R, Wang T, Haagenson MD, Grauman PV, Hu ZH, Spellman SR, Lee SJ, Verneris MR, Hsu K, Fleischhauer K, Cutler C, Antin JH, Neuberg D, Ebert BL. Prognostic Mutations in Myelodysplastic Syndrome after Stem-Cell Transplantation. N Engl J Med 2017; 376:536-547. [PMID: 28177873 PMCID: PMC5438571 DOI: 10.1056/nejmoa1611604] [Citation(s) in RCA: 517] [Impact Index Per Article: 73.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Genetic mutations drive the pathogenesis of the myelodysplastic syndrome (MDS) and are closely associated with clinical phenotype. Therefore, genetic mutations may predict clinical outcomes after allogeneic hematopoietic stem-cell transplantation. METHODS We performed targeted mutational analysis on samples obtained before transplantation from 1514 patients with MDS who were enrolled in the Center for International Blood and Marrow Transplant Research Repository between 2005 and 2014. We evaluated the association of mutations with transplantation outcomes, including overall survival, relapse, and death without relapse. RESULTS TP53 mutations were present in 19% of the patients and were associated with shorter survival and a shorter time to relapse than was the absence of TP53 mutations, after adjustment for significant clinical variables (P<0.001 for both comparisons). Among patients 40 years of age or older who did not have TP53 mutations, the presence of RAS pathway mutations was associated with shorter survival than was the absence of RAS pathway mutations (P=0.004), owing to a high risk of relapse, and the presence of JAK2 mutations was associated with shorter survival than was the absence of JAK2 mutations (P=0.001), owing to a high risk of death without relapse. The adverse prognostic effect of TP53 mutations was similar in patients who received reduced-intensity conditioning regimens and those who received myeloablative conditioning regimens. By contrast, the adverse effect of RAS pathway mutations on the risk of relapse, as compared with the absence of RAS pathway mutations, was evident only with reduced-intensity conditioning (P<0.001). In young adults, 4% of the patients had compound heterozygous mutations in the Shwachman-Diamond syndrome-associated SBDS gene with concurrent TP53 mutations and a poor prognosis. Mutations in the p53 regulator PPM1D were more common among patients with therapy-related MDS than those with primary MDS (15% vs. 3%, P<0.001). CONCLUSIONS Genetic profiling revealed that molecular subgroups of patients undergoing allogeneic hematopoietic stem-cell transplantation for MDS may inform prognostic stratification and the selection of conditioning regimen. (Funded by the Edward P. Evans Foundation and others.).
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Affiliation(s)
- R Coleman Lindsley
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Wael Saber
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Brenton G Mar
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Robert Redd
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Tao Wang
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Michael D Haagenson
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Peter V Grauman
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Zhen-Huan Hu
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Stephen R Spellman
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Stephanie J Lee
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Michael R Verneris
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Katharine Hsu
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Katharina Fleischhauer
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Corey Cutler
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Joseph H Antin
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Donna Neuberg
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
| | - Benjamin L Ebert
- From the Department of Medical Oncology, Division of Hematological Malignancies (R.C.L., C.C., J.H.A.), and the Departments of Pediatric Oncology (B.G.M.) and Biostatistics and Computational Biology (R.R., D.N.), Dana-Farber Cancer Institute, and the Division of Hematology, Brigham and Women's Hospital, Harvard Medical School (P.V.G., B.L.E.) - all in Boston; the Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee (W.S., T.W., Z.-H.H., S.J.L.); the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program-Be the Match (M.D.H., S.R.S.), and the Pediatric Blood and Marrow Transplantation Center, University of Minnesota (M.R.V.) - both in Minneapolis; the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle (S.J.L.); Memorial Sloan Kettering Cancer Center, New York (K.H.); and the Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany (K.F.)
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Poiré X, Labopin M, Maertens J, Yakoub-Agha I, Blaise D, Ifrah N, Socié G, Gedde-Dhal T, Schaap N, Cornelissen JJ, Vigouroux S, Sanz J, Michaux L, Esteve J, Mohty M, Nagler A. Allogeneic stem cell transplantation in adult patients with acute myeloid leukaemia and 17p abnormalities in first complete remission: a study from the Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT). J Hematol Oncol 2017; 10:20. [PMID: 28100265 PMCID: PMC5241968 DOI: 10.1186/s13045-017-0393-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Acute myeloid leukaemia (AML) with 17p abnormalities (abn(17p)) carries a very poor prognosis due to high refractoriness to conventional chemotherapy, and allogeneic stem cell transplantation (allo-SCT) appears as the only potential curative option. METHODS To address outcomes after allo-SCT in patients with abn(17p), we retrospectively analysed de novo or secondary AML undergoing SCT between 2000 and 2013 from the EBMT registry. RESULTS One hundred thirty-nine patients with confirmed abn(17p) have been selected. At the time of transplant, one hundred twenty-five were in first remission (CR1). Median age was 54 years old. Abn(17p) was associated with a monosomal karyotype in 83% of patients, complex karyotype in 91%, monosomy 5 or 5q deletion (-5/5q-) in 55%, monosomy 7 (-7) in 39% and both -5/5q and -7 in 27%. Seventy-three patients (59%) had a reduced-intensity conditioning regimen. The 2-year overall survival (OS) and leukaemia-free survival (LFS) were 28 and 24%, respectively. The 2-year non-relapse mortality (NRM) was 15%, and 2-year relapse incidence (RI) was 61%. The cumulative incidence of grade II to IV acute graft-versus-host disease (GvHD) was 24% and that of chronic GvHD was 21%. In multivariate analysis, the presence of a -5/5q- in addition to abn(17p) was significantly and independently associated with worse OS, LFS and higher RI. Age and donor types did not correlate with outcome. Conditioning intensity was not statistically associated with OS, LFS and NRM when adjusted for patients' age. CONCLUSIONS In contrast to the dismal prognosis reported for AML patients harbouring abn(17p) undergoing conventional chemotherapy, allogeneic SCT provides responses in about 25% of those patients transplanted in CR1.
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Affiliation(s)
- Xavier Poiré
- Section of Hematology, Department of Medicine, Cliniques Universitaires Saint-Luc, 10, avenue Hippocrate, 1200, Brussels, Belgium.
| | - Myriam Labopin
- Acute Leukemia Working Party of the EBMT office, Paris, France.,Service d'Hématologie clinique, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie, INSERM UMRs U938, Paris, France
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Didier Blaise
- Programme de Transplantation et Thérapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | | | - Gérard Socié
- Department of Hematology, Hôpital Saint-Louis, Paris, France
| | | | - Nicolaas Schaap
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan J Cornelissen
- Daniel den Hoed Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Jaime Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - Lucienne Michaux
- Center for Human Genetics, KU Leuven and University Hospitals, Leuven, Belgium
| | - Jordi Esteve
- Hematology department, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Mohamad Mohty
- Acute Leukemia Working Party of the EBMT office, Paris, France.,Service d'Hématologie clinique, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie, INSERM UMRs U938, Paris, France
| | - Arnon Nagler
- Acute Leukemia Working Party of the EBMT office, Paris, France.,Chaim Sheba Medical Center, Tel-Hashomer, Israel
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97
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Solly F, Koering C, Mohamed AM, Maucort-Boulch D, Robert G, Auberger P, Flandrin-Gresta P, Adès L, Fenaux P, Kosmider O, Tavernier-Tardy E, Cornillon J, Guyotat D, Campos L, Mortreux F, Wattel E. An miRNA–DNMT1 Axis Is Involved in Azacitidine Resistance and Predicts Survival in Higher-Risk Myelodysplastic Syndrome and Low Blast Count Acute Myeloid Leukemia. Clin Cancer Res 2016; 23:3025-3034. [DOI: 10.1158/1078-0432.ccr-16-2304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 11/16/2022]
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98
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Tenti E, Papayannidis C, Marconi G, Parisi S, Simonetti G, Paolini S, Sartor C, Ottaviani E, Testoni N, Martinelli G. Efficacy of Azacitidine in the treatment of adult patients aged 65 years or older with AML. Expert Opin Pharmacother 2016; 17:2479-2486. [PMID: 27829292 DOI: 10.1080/14656566.2016.1258056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Therapy for acute myeloid leukemia (AML) in elderly populations (>65 years) is still a challenge for scientists and hematologists worldwide, and represents an urgent medical need. Notably, the identification and the recognition of molecular and epigenetic mechanisms involved in the pathogenesis of such a heterogeneous disease, are providing new tools for a more successful and 'targeted' approach. Azacitidine is a hypomethylating agent (HMA) with relevant activity in patients affected by myelodysplastic syndrome (MDS) and AML with low blast cells percentage (>30%), in terms of reduction of transfusion dependence, and improvement of quality of life. Areas covered: This review summarizes the mechanism of action, safety profile and efficacy of azacitidine in the field of elderly AML populations, providing up-to-date references on this subset of high-risk patients. Expert opinion: HMAs are the first successful treatment for elderly patients with high-risk MDS and are effective for some AML subtypes. Translational studies based on gene expression profiling and molecular sequencing, would be able to identify, in the near future, patients with a favorable profile of response to these compounds suggesting new potential treatment combinations also.
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Affiliation(s)
- Elena Tenti
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Cristina Papayannidis
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Giovanni Marconi
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Sarah Parisi
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Giorgia Simonetti
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Stefania Paolini
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Chiara Sartor
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Emanuela Ottaviani
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
| | - Nicoletta Testoni
- b Dept Hematol & Oncol Sci, St Orsola Malpighi Hospital , Univ Bologna , Bologna , Italy
| | - Giovanni Martinelli
- a Institute of Hematology L. e A. Seràgnoli , Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi Ringgold standard institution , Bologna , Italy
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99
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Integrating mutation variant allele frequency into clinical practice in myeloid malignancies. Hematol Oncol Stem Cell Ther 2016; 9:89-95. [DOI: 10.1016/j.hemonc.2016.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/29/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023] Open
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100
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McGraw KL, Cluzeau T, Sallman DA, Basiorka AA, Irvine BA, Zhang L, Epling-Burnette PK, Rollison DE, Mallo M, Sokol L, Solé F, Maciejewski J, List AF. TP53 and MDM2 single nucleotide polymorphisms influence survival in non-del(5q) myelodysplastic syndromes. Oncotarget 2016; 6:34437-45. [PMID: 26416416 PMCID: PMC4741464 DOI: 10.18632/oncotarget.5255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/14/2015] [Indexed: 11/25/2022] Open
Abstract
P53 is a key regulator of many cellular processes and is negatively regulated by the human homolog of murine double minute-2 (MDM2) E3 ubiquitin ligase. Single nucleotide polymorphisms (SNPs) of either gene alone, and in combination, are linked to cancer susceptibility, disease progression, and therapy response. We analyzed the interaction of TP53 R72P and MDM2 SNP309 SNPs in relationship to outcome in patients with myelodysplastic syndromes (MDS). Sanger sequencing was performed on DNA isolated from 208 MDS cases. Utilizing a novel functional SNP scoring system ranging from +2 to −2 based on predicted p53 activity, we found statistically significant differences in overall survival (OS) (p = 0.02) and progression-free survival (PFS) (p = 0.02) in non-del(5q) MDS patients with low functional scores. In univariate analysis, only IPSS and the functional SNP score predicted OS and PFS in non-del(5q) patients. In multivariate analysis, the functional SNP score was independent of IPSS for OS and PFS. These data underscore the importance of TP53 R72P and MDM2 SNP309 SNPs in MDS, and provide a novel scoring system independent of IPSS that is predictive for disease outcome.
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Affiliation(s)
- Kathy L McGraw
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Thomas Cluzeau
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Hematology Department, CHU of Nice, Nice, France.,University Nice Sophia Antipolis, Faculty of Medicine, Nice, France.,Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France.,French Group of Myelodysplasia, France
| | - David A Sallman
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ashley A Basiorka
- Moffitt Cancer Center and Research Institute and The Cancer Biology Ph.D. Program, University of South Florida, Tampa, FL, USA
| | - Brittany A Irvine
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ling Zhang
- Department of Pathology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - P K Epling-Burnette
- Department of Immunology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mar Mallo
- Institut de Recerca Contra la Leucèmia Josep Carreras (IJC) Badalona, Barcelona, Spain
| | - Lubomir Sokol
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Francesc Solé
- Institut de Recerca Contra la Leucèmia Josep Carreras (IJC) Badalona, Barcelona, Spain
| | | | - Alan F List
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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