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Awada G, de Azambuja E, Awada A. Pharmacologic measures in the prevention of left ventricular dysfunction associated with molecular-targeted therapies in the treatment of cancer patients. Expert Opin Drug Metab Toxicol 2017; 13:1205-1215. [PMID: 29088977 DOI: 10.1080/17425255.2017.1398733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Left ventricular dysfunction (LVD) is an infrequent but significant side effect of certain molecular-targeted cancer therapies and may lead to treatment modification and impact on disease prognosis. There may be a role for beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in the prevention of LVD. Areas covered: There are multiple definitions for LVD based on clinical and/or imaging features. Molecular-targeted therapies cause reversible LVD. Therapies with well-reported LVD are inhibitors of human epidermal growth factor 2 (HER2), angiogenesis, Abelson murine leukemia viral oncogene homolog (ABL) and the proteasome. BB, ACEI and ARB seem to have a role in the prevention of LVD associated with anthracyclines. Few trials have investigated the role of BB, ACEI and ARB as primary prevention of LVD in molecular-targeted therapies. Their results are not conclusive but a beneficial role cannot be excluded. Expert opinion: Because of inconclusive data, future interventional studies should not include all treated patients with molecular-targeted therapy, but focus on patients at risk for developing LVD. Another option is to study patients who show early signs of LVD to prevent progression to overt heart failure.
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Affiliation(s)
- Gil Awada
- a Department of Internal Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Evandro de Azambuja
- b Medical Oncology Clinic , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Ahmad Awada
- b Medical Oncology Clinic , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
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202
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Goldberg SL, Cortes JE, Gambacorti‐Passerini C, Hehlmann R, Khoury HJ, Michallet M, Paquette RL, Simonsson B, Zyczynski T, Foreman A, Abruzzese E, Andorsky D, Beeker A, Cony‐Makhoul P, Hansen R, Lomaia E, Olavarria E, Mauro MJ. First-line treatment selection and early monitoring patterns in chronic phase-chronic myeloid leukemia in routine clinical practice: SIMPLICITY. Am J Hematol 2017; 92:1214-1223. [PMID: 28815757 PMCID: PMC5659133 DOI: 10.1002/ajh.24887] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 12/31/2022]
Abstract
Achieving successful outcomes in chronic phase-chronic myeloid leukemia (CP-CML) requires careful monitoring of cytogenetic/molecular responses (CyR/MR). SIMPLICITY (NCT01244750) is an observational study exploring tyrosine kinase inhibitor use and management patterns in patients with CP-CML receiving first-line imatinib (n = 416), dasatinib (n = 418) or nilotinib (n = 408) in the US and 6 European countries in routine clinical practice. Twelve-month follow-up data of 1242 prospective patients (enrolled October 01 2010-September 02 2015) are reported. 81% of patients had baseline comorbidities. Treatment selection was based on perceived efficacy over patient comorbidity profile. There was a predominance of imatinib-treated patients enrolled earlier in the study, with subsequent shift toward dasatinib- and nilotinib-treated patients by 2013/2014. Monitoring for either CyR/MR improved over time and was documented for 36%, 82%, and 95% of patients by 3, 6, and 12 months, respectively; 5% had no documentation of CyR/MR monitoring during the first year of therapy. Documentation of MR/CyR testing was higher in Europe than the US (P < .001) and at academic versus community practices (P = .001). Age <65 years, patients being followed at sites within Europe, those followed at academic centers and patients no longer on first-line therapy were more likely to be monitored by 12 months. SIMPLICITY demonstrates that the NCCN and ELN recommendations on response monitoring have not been consistently translated into routine clinical practice. In the absence of appropriate monitoring practices, clinical response to TKI therapy cannot be established, any needed changes to treatment strategy will thus not be implemented, and long-term patient outcomes are likely to be impacted.
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Affiliation(s)
- Stuart L. Goldberg
- John Theurer Cancer Center, Hackensack University Medical CenterHackensackNew Jersey
| | - Jorge E. Cortes
- The University of Texas, MD Anderson Cancer CenterHoustonTexas
| | | | | | - H. Jean Khoury
- Winship Cancer Institute of Emory UniversityAtlantaGeorgia
| | | | | | | | | | | | | | | | | | | | | | - Elza Lomaia
- Federal Almazov North‐West Medical Research CentreSt PetersburgRussia
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203
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Outcome of Frontline Treatment with "Generic" Imatinib In Adult Patients with Chronic Myeloid Leukemia in Algerian Population: A Multicenter Study. Mediterr J Hematol Infect Dis 2017; 9:e2017062. [PMID: 29181139 PMCID: PMC5667527 DOI: 10.4084/mjhid.2017.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction In a developing country like Algeria, such expensive therapy is not available. Alternative approaches are needed to help these adult. In Algeria 'imatib' (CIPLA-India) was introduced in 2006; but no study has been published yet in the North Africa region regarding response and outcome of this copy in CML patients. The goal of this multicenter study is to characterize newly adult CML in the western region of Algeria and to assess the effectiveness and safety of imatib (IM, copy) as frontline therapy for patients with CML. Patients and Methods The study was carried out in 7 hematology centers in the western Algeria. Patients, who were diagnosed to be suffering from CML between January 1st, 2007 and December 31st, 2014 were selected for data analysis. All patients received a copy preparation, consisting of the alpha crystal form of imatinib, (IM, copy) at an oral dose of 400 mg daily and monitored for tolerance and side effects while on therapy. Results Between January 2007 and December 2014, 355 patients with CML were treated with imatib (Copy). The median follow- up of the study was 46 months (range: 13-107 months). Complete hematological response (CHR) was seen in 83% of patients within 3 months. According to the Sokal score, 72% patients with low, 78% with intermediate and 69% with high risk disease achieved a CHR in 3 months (p=0.26) and according to the EUTOS score, 81% of patients with low and 70% with high risk disease achieved a CHR in 3 months (p=0.08). The major molecular response (MMR) at six months (M6), M9, M12, M18 and M24 was 21%, 38%, 35%, 51% and 67% respectively and 34% of patients achieved a complete molecular response (CMR). The projected 5-year overall survival (OS) rate was 83%. Side effects of imatib (copy) in this study were similar to those reported previously for the entire imatinib mesylate treatment study and only 8% of patients were intolerant to imatib (copy) and treated with a second generation of BCR-ABL inhibitor. Conclusion This study reflects real world experience treating patients with CML in a developing country and thus sheds light on differences in this population compared to Western countries. In conclusion, imatib (copy) is effective and safe in treating patients with CML in chronic phase and proves to have a durable outcome. To our knowledge this is the first study reporting the response to imatib (copy) in an Algerian population.
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204
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Leitch JA, McMullin CL, Paterson AJ, Mahon MF, Bhonoah Y, Frost CG. Ruthenium-Catalyzed para
-Selective C−H Alkylation of Aniline Derivatives. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201708961] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jamie A. Leitch
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Claire L. McMullin
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Andrew J. Paterson
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Mary F. Mahon
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Yunas Bhonoah
- Syngenta; Jealott's Hill International Research Centre; Bracknell Berkshire RG42 6EY UK
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205
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Leitch JA, McMullin CL, Paterson AJ, Mahon MF, Bhonoah Y, Frost CG. Ruthenium-Catalyzed para
-Selective C−H Alkylation of Aniline Derivatives. Angew Chem Int Ed Engl 2017; 56:15131-15135. [DOI: 10.1002/anie.201708961] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Jamie A. Leitch
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Claire L. McMullin
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Andrew J. Paterson
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Mary F. Mahon
- Department of Chemistry; University of Bath; Claverton Down Somerset BA2 7AY UK
| | - Yunas Bhonoah
- Syngenta; Jealott's Hill International Research Centre; Bracknell Berkshire RG42 6EY UK
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206
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Harrington P, Kizilors A, de Lavallade H. The Role of Early Molecular Response in the Management of Chronic Phase CML. Curr Hematol Malig Rep 2017; 12:79-84. [PMID: 28405921 PMCID: PMC5410202 DOI: 10.1007/s11899-017-0375-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose of Review Although tyrosine kinase inhibitors (TKIs) spectacularly improve the disease burden and the overall survival of chronic myeloid leukemia patients, early identification of a subset of poor TKI responders has been recognized as a critical goal to prevent disease progression in these patients. We herein review the past and recent evidence on the impact of early response. Recent Findings In the recent years, the achievement of an early molecular response (EMR, defined as 3-month BCR-ABL1 transcript <10% IS) has emerged as a useful tool to identify poor-risk patients. Although several groups have reported the importance of such milestone, clinical intervention based on it remains controversial partly due to its low specificity to predict progression, which may be partially improved by using the rate of decline in BCR-ABL1 transcript level (halving time or velocity of ratio reduction). Summary Standardization of halving time or velocity of ratio reduction will likely help establishing more stringent recommendation and modify current clinical practices.
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Affiliation(s)
- Patrick Harrington
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,Haematology Department, King's College London, London, UK
| | - Aytug Kizilors
- Haematology Department, King's College London, London, UK.,Laboratory for Molecular Haemato-Oncology, King's College Hospital NHS Foundation Trust/King's College London, London, UK
| | - Hugues de Lavallade
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK. .,Haematology Department, King's College London, London, UK.
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207
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Murai K, Yamaguchi K, Ito S, Miyagishima T, Shindo M, Wakasa K, Inomata M, Nagashima T, Kondo T, Fujimoto N, Yamamoto S, Yonezumi M, Oyake T, Kowata S, Tsukushi Y, Mine T, Meguro K, Ikeda K, Watanabe R, Saito S, Sato S, Tajima K, Chou T, Kubo K, Oba K, Sakamoto J, Ishida Y. Rapid reduction in BCR-ABL1
transcript predicts deep molecular response in dasatinib-treated chronic-phase chronic myeloid leukaemia patients. Eur J Haematol 2017; 100:27-35. [DOI: 10.1111/ejh.12969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Kazunori Murai
- Division of Hematology and Oncology; Department of Internal Medicine; Iwate Medical University School of Medicine; Morioka Japan
- Department of Hematology; Iwate Prefectural Central Hospital; Morioka Japan
| | - Kohei Yamaguchi
- Department of Hematology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Shigeki Ito
- Department of Clinical Oncology; School of Medicine; Iwate Medical University; Morioka Japan
| | - Takuto Miyagishima
- Department of Internal Medicine; Japan Labour Health and Welfare Organization; Kushiro Rosai Hospital; Kushiro Japan
| | - Motohiro Shindo
- Division of Gastroenterology and Hematology/Oncology; Asahikawa Medical University; Asahikawa Japan
| | - Kentaro Wakasa
- Division of Hematology; Hokkaido P.W.F.A.C. Obihiro-Kosei General Hospital; Obihiro Japan
| | - Mitsue Inomata
- Division of Hematology; National Hospital Organization Sendai Medical Center; Sendai Japan
| | - Takahiro Nagashima
- Department of Internal Medicine; Kitami Red Cross Hospital; Kitami Japan
| | - Takeshi Kondo
- Department of Hematology; Faculty of Medicine and Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | | | - Satoshi Yamamoto
- Department of Hematology; Sapporo City General Hospital; Sapporo Japan
| | | | - Tatsuo Oyake
- Division of Hematology and Oncology; Department of Internal Medicine; Iwate Medical University School of Medicine; Morioka Japan
| | - Shugo Kowata
- Division of Hematology and Oncology; Department of Internal Medicine; Iwate Medical University School of Medicine; Morioka Japan
| | - Yasuhiko Tsukushi
- Division of Hematology and Oncology; Department of Internal Medicine; Iwate Medical University School of Medicine; Morioka Japan
| | - Takahiro Mine
- Division of Hematology and Oncology; Department of Internal Medicine; Iwate Medical University School of Medicine; Morioka Japan
| | - Kuniaki Meguro
- Division of Gastroenterology and Hematology/Oncology; Asahikawa Medical University; Asahikawa Japan
| | - Kazuhiko Ikeda
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Reiko Watanabe
- Department of Hematology; Saitama Medical Center; Saitama Medical University; Kawagoe Japan
| | - Souichi Saito
- Department of Internal Medicine; Nihonkai General Hospital; Sakata Japan
| | - Shinji Sato
- Department of Hematology; Okitama Public General Hospital; Kawanishimachi Higashi Okitama-gun Japan
| | - Katsushi Tajima
- Department of Neurology, Hematology, Metabolism, and Diabetology (DNHMED); Yamagata University Faculty of Medicine; Yamagata Japan
| | - Takaaki Chou
- Department of Internal Medicine; Niigata Cancer Center Hospital; Niigata Japan
| | - Kohmei Kubo
- Department of Hematology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Koji Oba
- Department of Biostatistics; School of Public Health; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Interfaculty Initiative in Information Studies; The University of Tokyo; Tokyo Japan
| | | | - Yoji Ishida
- Division of Hematology and Oncology; Department of Internal Medicine; Iwate Medical University School of Medicine; Morioka Japan
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208
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Ongoren S, Eskazan AE, Suzan V, Savci S, Erdogan Ozunal I, Berk S, Yalniz FF, Elverdi T, Salihoglu A, Erbilgin Y, Iseri SA, Ar MC, Baslar Z, Aydin Y, Tuzuner N, Ozbek U, Soysal T. Third-line treatment with second-generation tyrosine kinase inhibitors (dasatinib or nilotinib) in patients with chronic myeloid leukemia after two prior TKIs: real-life data on a single center experience along with the review of the literature. Hematology 2017; 23:212-220. [DOI: 10.1080/10245332.2017.1385193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Seniz Ongoren
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Veysel Suzan
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sercan Savci
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isil Erdogan Ozunal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selin Berk
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fevzi Fırat Yalniz
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Salihoglu
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yucel Erbilgin
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Sibel Aylin Iseri
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zafer Baslar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yildiz Aydin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nukhet Tuzuner
- Department of Pathology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ugur Ozbek
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Teoman Soysal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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209
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Pleural effusion and molecular response in dasatinib-treated chronic myeloid leukemia patients in a real-life Italian multicenter series. Ann Hematol 2017; 97:95-100. [DOI: 10.1007/s00277-017-3144-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/21/2017] [Indexed: 12/31/2022]
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210
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Hughes TP, Munhoz E, Aurelio Salvino M, Ong TC, Elhaddad A, Shortt J, Quach H, Pavlovsky C, Louw VJ, Shih L, Turkina AG, Meillon L, Jin Y, Acharya S, Dalal D, Lipton JH. Nilotinib dose-optimization in newly diagnosed chronic myeloid leukaemia in chronic phase: final results from ENESTxtnd. Br J Haematol 2017; 179:219-228. [PMID: 28699641 PMCID: PMC5655928 DOI: 10.1111/bjh.14829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/29/2017] [Indexed: 01/20/2023]
Abstract
The Evaluating Nilotinib Efficacy and Safety in Clinical Trials-Extending Molecular Responses (ENESTxtnd) study was conducted to evaluate the kinetics of molecular response to nilotinib in patients with newly diagnosed chronic myeloid leukaemia in chronic phase and the impact of novel dose-optimization strategies on patient outcomes. The ENESTxtnd protocol allowed nilotinib dose escalation (from 300 to 400 mg twice daily) in the case of suboptimal response or treatment failure as well as dose re-escalation for patients with nilotinib dose reductions due to adverse events. Among 421 patients enrolled in ENESTxtnd, 70·8% (95% confidence interval, 66·2-75·1%) achieved major molecular response (BCR-ABL1 ≤ 0·1% on the International Scale) by 12 months (primary endpoint). By 24 months, 81·0% of patients achieved major molecular response, including 63·6% (56 of 88) of those with dose escalations for lack of efficacy and 74·3% (55 of 74) of those with dose reductions due to adverse events (including 43 of 54 patients with successful re-escalation). The safety profile of nilotinib was consistent with prior studies. The most common non-haematological adverse events were headache, rash, and nausea; cardiovascular events were reported in 4·5% of patients (grade 3/4, 3·1%). The study was registered at clinicaltrials.gov (NCT01254188).
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cardiovascular Diseases/chemically induced
- Cardiovascular Diseases/epidemiology
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Male
- Middle Aged
- Prospective Studies
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
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Affiliation(s)
- Timothy P. Hughes
- South Australian Health and Medical Research Institute (SAHMRI)University of AdelaideSA PathologyAdelaideSAAustralia
| | - Eduardo Munhoz
- Hospital Erasto Gaertner – Liga Paranaense Combate ao CâncerCuritibaBrazil
| | - Marco Aurelio Salvino
- Hospital São Rafael‐Monte Tabor & Hospital Universitario Professor Edgard Santos‐Universidade Federal da BahiaSalvadorBrazil
| | | | | | - Jake Shortt
- School of Clinical Sciences at Monash HealthMonash UniversityClaytonVic.Australia
| | - Hang Quach
- St Vincent's HospitalUniversity of MelbourneMelbourneVic.Australia
| | - Carolina Pavlovsky
- FUNDALEUHospitalization and Clinical Research CentreBuenos AiresArgentina
| | | | - Lee‐Yung Shih
- Chang Gung Memorial Hospital‐LinkouChang Gung UniversityTaoyuan CityTaiwan
| | - Anna G. Turkina
- FGB Haematology Research Centre Health Ministry Research FacilityMoscowRussia
| | - Luis Meillon
- Hospital de EspecialidadesCMN Siglo XXIMexico CityMexico
| | - Yu Jin
- Novartis Pharmaceuticals CorporationEast HanoverNJUSA
| | | | - Darshan Dalal
- Novartis Pharmaceuticals CorporationEast HanoverNJUSA
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211
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Ćojbašić I, Mačukanović-Golubović L, Vučić M, Tijanić I. Analyses of Treatment Outcome According to Age in Patients With Chronic Myeloid Leukemia Receiving Front-line Imatinib Therapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:696-702. [DOI: 10.1016/j.clml.2017.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 11/16/2022]
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212
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Molica M, Massaro F, Breccia M. Diagnostic and prognostic cytogenetics of chronic myeloid leukaemia: an update. Expert Rev Mol Diagn 2017; 17:1001-1008. [PMID: 28930482 DOI: 10.1080/14737159.2017.1383156] [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] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Despite the advent of molecular assessment, banding cytogenetics and fluorescence in situ hybridization (FISH) still have a significant role in diagnostic and prognostic approaches to chronic myeloid leukaemia (CML). Area covered: At diagnosis and during treatment with tyrosine kinase inhibitors (TKIs), cytogenetics is used to detect the Philadelphia chromosome, with its typical translocation t(9;22)(q34;q11.2), and any additional or other chromosomal aberrations (ACAs and OCAs) that may arise in 5-10% of cases, the latter associated to transformation of the disease in blast phases. In this review, the potential role of banding cytogenetics and FISH is discussed through a review of published papers on the prognostic impact of these tools in CML treatment and monitoring. Expert commentary: Cytogenetic techniques, including banding cytogenetics and FISH, continue to maintain a crucial role in CML monitoring. At diagnosis and after 3 months of therapy, banding cytogenetics will continue to be an essential test to perform, but it will become redundant after the achievement of a major molecular response (MMR) assessed with molecular techniques. FISH analysis maintains its usefulness in monitoring the response to TKIs only in special situations.
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Affiliation(s)
- Matteo Molica
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Fulvio Massaro
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Massimo Breccia
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
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213
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Maeda Y, Okamoto A, Kawaguchi SI, Konishi A, Yamamoto K, Eguchi G, Kanai Y, Yamaguchi T. Improved Drug Adherence in Patients with Chronic Myeloid Leukemia in the Chronic Phase by Switching to Second-Generation Tyrosine Kinase Inhibitors. Acta Haematol 2017; 138:140-142. [PMID: 28869927 DOI: 10.1159/000477893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/30/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Yasuhiro Maeda
- Department of Hematology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan
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214
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Rostami G, Hamid M, Jalaeikhoo H. Impact of the BCR - ABL1 fusion transcripts on different responses to Imatinib and disease recurrence in Iranian patients with Chronic Myeloid Leukemia. Gene 2017. [DOI: 10.1016/j.gene.2017.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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215
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Geelen IGP, Thielen N, Janssen JJWM, Hoogendoorn M, Roosma TJA, Willemsen SP, Valk PJM, Visser O, Cornelissen JJ, Westerweel PE. Impact of hospital experience on the quality of tyrosine kinase inhibitor response monitoring and consequence for chronic myeloid leukemia patient survival. Haematologica 2017; 102:e486-e489. [PMID: 28860340 DOI: 10.3324/haematol.2017.175265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Inge G P Geelen
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Noortje Thielen
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | - Jeroen J W M Janssen
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, Dordrecht, the Netherlands
| | - Tanja J A Roosma
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Albert Schweitzer Hospital, Dordrecht, the Netherlands.,Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Otto Visser
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter E Westerweel
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
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Sato E, Iriyama N, Tokuhira M, Takaku T, Ishikawa M, Nakazato T, Sugimoto KJ, Fujita H, Fujioka I, Asou N, Komatsu N, Kizaki M, Hatta Y, Kawaguchi T. Introduction of second-generation tyrosine kinase inhibitors may reduce the prognostic impact of high-risk patients, according to the European treatment and outcome study (EUTOS) score. Leuk Lymphoma 2017; 59:1105-1112. [PMID: 28838287 DOI: 10.1080/10428194.2017.1365858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Our study aims to highlight the critical role of the introduction of second generation tyrosine kinase inhibitors (2nd TKIs) on the prognosis of patients with chronic myeloid leukemia (CML) in chronic phase (CML-CP), as determined by European Treatment and Outcome Study (EUTOS) system. Patients who were diagnosed with CML-CP before March 2009 were classified into the imatinib group, and those diagnosed after April 2009 were classified into the 2nd TKI group. EUTOS high-risk patients exhibited significantly worse outcomes in terms of event-free survival (EFS), progression-free survival (PFS), and CML-associated death than those considered to be low-risk. Risk stratification by EUTOS score was predictive of risk-associated clinical outcomes in patients classified into the imatinib group; however, the EUTOS score failed to predict the outcomes of patients classified into the 2nd TKI group. Our data suggest that the introduction of 2nd TKIs might have improved treatment outcomes, particularly in EUTOS high-risk patients.
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Affiliation(s)
- Eriko Sato
- a Department of Medicine, Division of Hematology , Juntendo University Nerima Hospital , Tokyo , Japan
| | - Noriyoshi Iriyama
- b Division of Hematology and Rheumatology, Department of Medicine , Nihon University School of Medicine , Tokyo , Japan
| | - Michihide Tokuhira
- c Department of Hematology , Saitama Medical Center, Saitama Medical University , Saitama , Japan
| | - Tomoiku Takaku
- d Department of Hematology , Juntendo University School of Medicine , Tokyo , Japan
| | - Maho Ishikawa
- e Department of Hemato-Oncology , Saitama Medical University International Medical Center , Saitama , Japan
| | - Tomonori Nakazato
- f Department of Hematology , Yokohama Municipal Citizen's Hospital , Yokohama , Japan
| | - Kei-Ji Sugimoto
- g Department of Hematology , Juntendo University Urayasu Hospital , Urayasu , Japan
| | - Hiroyuki Fujita
- h Department of Hematology , Saiseikai Yokohama Nanbu Hospital , Yokohama , Japan
| | - Isao Fujioka
- d Department of Hematology , Juntendo University School of Medicine , Tokyo , Japan
| | - Norio Asou
- e Department of Hemato-Oncology , Saitama Medical University International Medical Center , Saitama , Japan
| | - Norio Komatsu
- d Department of Hematology , Juntendo University School of Medicine , Tokyo , Japan
| | - Masahiro Kizaki
- c Department of Hematology , Saitama Medical Center, Saitama Medical University , Saitama , Japan
| | - Yoshihiro Hatta
- b Division of Hematology and Rheumatology, Department of Medicine , Nihon University School of Medicine , Tokyo , Japan
| | - Tatsuya Kawaguchi
- i Department of Hematology and Infectious Diseases , Kumamoto University Hospital , Kumamoto , Japan
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217
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Clonal chromosomal abnormalities appearing in Philadelphia chromosome-negative metaphases during CML treatment. Blood 2017; 130:2084-2091. [PMID: 28835440 DOI: 10.1182/blood-2017-07-792143] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 08/15/2017] [Indexed: 12/16/2022] Open
Abstract
Clonal chromosomal abnormalities in Philadelphia chromosome-negative (CCA/Ph-) metaphases emerge as patients with chronic phase chronic myeloid leukemia (CP-CML) are treated with tyrosine kinase inhibitors (TKIs). We assessed the characteristics and prognostic impact of 598 patients with CP-CML treated on clinical trials with various TKIs. CCA/Ph- occurred in 58 patients (10%); the most common were -Y in 25 (43%) and trisomy 8 in 7 patients (12%). Response to TKI therapy was similar for patients with CCA/Ph- and those without additional chromosomal abnormalities (ACAs). We further categorized CCA/Ph- into those in which -Y was the only clonal abnormality, and all others. We found that patients with non -Y CCA/Ph- had worse failure-free survival (FFS), event-free survival (EFS), transformation-free survival (TFS), and overall survival (OS) compared with those without ACAs with the following 5-year rates: FFS (52% vs 70%, P = .02), EFS (68% vs 86%, P = .02), TFS (76% vs 94%, P < .01), and OS (79% vs 94%, P = .03). In a multivariate analysis, non -Y CCA/Ph- increased the risk of transformation or death when baseline characteristics were considered with a hazard ratio of 2.81 (95% confidence interval, 1.15-6.89; P = .02). However, this prognostic impact was not statistically significant when achieving BCR-ABL <10% at 3 months was included in the analysis. In conclusion, non -Y CCA/Ph- are associated with decreased survival when emerging in patients with chronic-phase CML across various TKIs. This trial was registered at www.clinicaltrials.gov as #NCT00048672, #NCT00038649, and #NCT00050531 (imatinib); #NCT00254423 (dasatinib); #NCT00129740 (nilotinib); and NCT01570868 (ponatinib).
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218
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Li Y, Wang CL, Din B, Yu L, Zhu J. Continuing Imatinib Treatment for Chronic Myeloid Leukemia Patients Who Had Serious Adverse Events at the Onset of Therapy. Acta Haematol 2017; 137:158-162. [PMID: 28399540 DOI: 10.1159/000455035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/11/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Yufeng Li
- Department of Hematology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, PR China
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219
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Castagnetti F, Gugliotta G, Breccia M, Iurlo A, Levato L, Albano F, Vigneri P, Abruzzese E, Rossi G, Rupoli S, Cavazzini F, Martino B, Orlandi E, Pregno P, Annunziata M, Usala E, Tiribelli M, Sica S, Bonifacio M, Fava C, Gherlinzoni F, Bocchia M, Soverini S, Bochicchio MT, Cavo M, Giovanni M, Saglio G, Pane F, Baccarani M, Rosti G. The BCR-ABL1 transcript type influences response and outcome in Philadelphia chromosome-positive chronic myeloid leukemia patients treated frontline with imatinib. Am J Hematol 2017; 92:797-805. [PMID: 28466557 DOI: 10.1002/ajh.24774] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 12/25/2022]
Abstract
The most frequent BCR-ABL1 fusion transcripts in chronic myeloid leukemia (CML) are the e13a2 (b2a2) and the e14a2 (b3a2) ones. In the imatinib era few studies addressing the prognostic significance of the BCR-ABL1 transcript type in early chronic phase CML have been published. Overall, these studies suggest that in e14a2 patients the response to imatinib is faster and deeper. To evaluate if the BCR-ABL1 transcript type (e13a2 compared to e14a2) affect the response to imatinib and the clinical outcome in newly diagnosed adult CML patients, 559 patients enrolled in 3 prospective studies (NCT00514488, NCT00510926, observational study CML/023) were analyzed. A qualitative PCR was performed at baseline: 52% patients had a e14a2 transcript, 37% a e13a2 transcript, 11% co-expressed both transcripts and 1% had other rare transcripts. The median follow-up was 76 months (95% of the patients had at least a 5-year observation). The complete cytogenetic response rates were comparable in e14a2 and e13a2 patients. The median time to MR3.0 (6 and 12 months) and MR4.0 (41 and 61 months) was significantly shorter for e14a2 patients compared to e13a2 patients, with a higher cumulative probability of MR3.0 (88% and 83%, P < .001) and MR4.0 (67% and 52%, P = .001). The 7-year overall survival (90% and 83%, P = .017), progression-free survival (89% and 81%, P = .005) and failure-free survival (71% and 54%, P < .001) were significantly better in patients with e14a2 transcript. In conclusion, patients with e13a2 transcript had a slower molecular response with inferior response rates to imatinib and a poorer long-term outcome.
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Affiliation(s)
- Fausto Castagnetti
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Gabriele Gugliotta
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Massimo Breccia
- Hematology Unit, Department of Cellular Biotechnologies and Hematology; “La Sapienza” University; Roma Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano Italy
| | - Luciano Levato
- Hematology Unit, “Pugliese-Ciaccio” Hospital; Catanzaro Italy
| | | | - Paolo Vigneri
- Unit of Medical Oncology, A.O.U. Policlinico “Vittorio Emanuele”, University of Catania; Catania Italy
| | | | - Giuseppe Rossi
- Hematology Unit, Azienda Ospedaliera “Spedali Civili”; Brescia Italy
| | - Serena Rupoli
- Hematology Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti; Ancona Italy
| | - Francesco Cavazzini
- Chair of Hematology, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara; Ferrara Italy
| | - Bruno Martino
- Hematology Unit, Azienda Ospedaliera “Bianchi-Melacrino-Morelli”; Reggio Calabria Italy
| | - Ester Orlandi
- Hematology Unit, “S. Matteo” University Hospital; Pavia Italy
| | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza; Torino Italy
| | | | - Emilio Usala
- Hematology Unit, “A. Businco” Hospital; Cagliari Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences; Azienda Ospedaliero-Universitaria di Udine; Udine Italy
| | - Simona Sica
- Chair of Hematology, “A. Gemelli” University Hospital; Roma Italy
| | | | - Carmen Fava
- Hematology Unit, “Ordine Mauriziano” Hospital, University of Torino; Torino Italy
| | - Filippo Gherlinzoni
- Hematology Unit, “Ca' Foncello” Hospital, ULSS2 Marca Trevigiana; Treviso Italy
| | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena; Siena Italy
| | - Simona Soverini
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Maria Teresa Bochicchio
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Michele Cavo
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Martinelli Giovanni
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Giuseppe Saglio
- Hematology Unit, “Ordine Mauriziano” Hospital, University of Torino; Torino Italy
| | - Fabrizio Pane
- Chair of Hematology, Department of Biochemistry and Medical Biotechnologies; “Federico II” University; Naples Italy
| | - Michele Baccarani
- Department of Hematology and Oncology “L. and A. Seràgnoli”; University of Bologna; Bologna Italy
| | - Gianantonio Rosti
- Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
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220
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Kassem N, Ismail OM, Elomri H, Yassin MA. Nilotinib Induced Recurrent Gastric Polyps: Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:794-798. [PMID: 28706179 PMCID: PMC5523728 DOI: 10.12659/ajcr.903485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient: Male, 62 Final Diagnosis: Chronic myeloid leukemia Symptoms: Gastric polyps Medication: Nilotinib Clinical Procedure: — Specialty: Hematology
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Affiliation(s)
- Nancy Kassem
- Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Omar M Ismail
- Department of Hematology and Bone Marrow Transplantation (BMT), National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Halima Elomri
- Department of Hematology and Bone Marrow Transplantation (BMT), National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad A Yassin
- Department of Hematology and Bone Marrow Transplantation (BMT), National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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221
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Dasgupta S, Ray UK, Mitra AG, Bhattacharyya DM, Mukhopadhyay A, Das P, Gangopadhyay S, Roy S, Mukhopadhyay S. Evaluation of a new flow cytometry based method for detection of BCR-ABL1 fusion protein in chronic myeloid leukemia. Blood Res 2017; 52:112-118. [PMID: 28698847 PMCID: PMC5503888 DOI: 10.5045/br.2017.52.2.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/17/2016] [Accepted: 01/06/2017] [Indexed: 11/29/2022] Open
Abstract
Background Philadelphia chromosome, a hallmark of chronic myeloid leukemia (CML), plays a key role in disease pathogenesis. It reflects a balanced reciprocal translocation between long arms of chromosomes 9 and 22 involving BCR and ABL1 genes, respectively. An accurate and reliable detection of BCR-ABL fusion gene is necessary for the diagnosis and monitoring of CML. Previously, many technologies, most of which are laborious and time consuming, have been developed to detect BCR-ABL chimeric gene or chromosome. Methods A new flow cytometric immunobead assay was used for detection of BCR-ABL fusion proteins and applicability, sensitivity, reliability, efficacy and rapidity of this method was evaluated. Results From February 2009 to January 2014, a total 648 CML patients were investigated for the status of BCR-ABL1 protein. Among them, 83 patients were enrolled for comparative study of BCR-ABL1 positivity by three routinely used procedures like karyotyping, and quantitative real time PCR (RT-PCR) as well as immunobead flow cytometry assay. BCR-ABL protein analysis was found consistent, more sensitive (17% greater sensitivity) and reliable than the conventional cytogenetics, as flow cytometry showed 95% concordance rate to RT-PCR. Conclusion BCR-ABL fusion protein assay using a new flow cytometric immunobead might be useful in the diagnosis and monitoring CML patients.
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Affiliation(s)
- Swati Dasgupta
- Department of Molecular Biology and Hematology, Netaji Subhas Chandra Bose Cancer Research Institute, West Bengal, India
| | - Ujjal K Ray
- Department of Pathology, Netaji Subhas Chandra Bose Cancer Research Institute, West Bengal, India
| | - Arpita Ghosh Mitra
- Department of HLA & Molecular Lab, Medica Superspeciality Hospital, West Bengal, India
| | - Deboshree M Bhattacharyya
- Department of Molecular Biology and Hematology, Netaji Subhas Chandra Bose Cancer Research Institute, West Bengal, India
| | - Ashis Mukhopadhyay
- Department of Hemato-Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, West Bengal, India
| | - Priyabrata Das
- Department of Molecular Biology and Hematology, Netaji Subhas Chandra Bose Cancer Research Institute, West Bengal, India
| | - Sudeshna Gangopadhyay
- Department of Molecular Biology and Hematology, Netaji Subhas Chandra Bose Cancer Research Institute, West Bengal, India
| | - Sudip Roy
- Department of HLA & Molecular Lab, Medica Superspeciality Hospital, West Bengal, India
| | - Soma Mukhopadhyay
- Department of Molecular Biology and Hematology, Netaji Subhas Chandra Bose Cancer Research Institute, West Bengal, India
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222
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Alonso-Dominguez JM, Casado LF, Anguita E, Gomez-Casares MT, Buño I, Ferrer-Marín F, Arenas A, Del Orbe R, Ayala R, Llamas P, Salgado RN, Osorio S, Sanchez-Godoy P, Burgaleta C, Mahíllo-Fernández I, Garcia-Gutierrez V, Steegmann JL, Martinez-Lopez J. PTCH1 is a reliable marker for predicting imatinib response in chronic myeloid leukemia patients in chronic phase. PLoS One 2017; 12:e0181366. [PMID: 28704552 PMCID: PMC5509313 DOI: 10.1371/journal.pone.0181366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022] Open
Abstract
Patched homolog 1 gene (PTCH1) expression and the ratio of PTCH1 to Smoothened (SMO) expression have been proposed as prognostic markers of the response of chronic myeloid leukemia (CML) patients to imatinib. We compared these measurements in a realistic cohort of 101 patients with CML in chronic phase (CP) using a simplified qPCR method, and confirmed the prognostic power of each in a competing risk analysis. Gene expression levels were measured in peripheral blood samples at diagnosis. The PTCH1/SMO ratio did not improve PTCH1 prognostic power (area under the receiver operating characteristic curve 0.71 vs. 0.72). In order to reduce the number of genes to be analyzed, PTCH1 was the selected measurement. High and low PTCH1 expression groups had significantly different cumulative incidences of imatinib failure (IF), which was defined as discontinuation of imatinib due to lack of efficacy (5% vs. 25% at 4 years, P = 0.013), probabilities of achieving a major molecular response (81% vs. 53% at first year, P = 0.02), and proportions of early molecular failure (14% vs. 43%, P = 0.015). Every progression to an advanced phase (n = 3) and CML-related death (n = 2) occurred in the low PTCH1 group (P<0.001 for both comparisons). PTCH1 was an independent prognostic factor for the prediction of IF. We also validated previously published thresholds for PTCH1 expression. Therefore, we confirmed that PTCH1 expression can predict the imatinib response in CML patients in CP by applying a more rigorous statistical analysis. Thus, PTCH1 expression is a promising molecular marker for predicting the imatinib response in CML patients in CP.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Biomarkers, Pharmacological
- Biomarkers, Tumor/physiology
- Female
- Gene Expression Regulation, Leukemic/drug effects
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myeloid, Chronic-Phase/diagnosis
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/genetics
- Male
- Middle Aged
- Patched-1 Receptor/physiology
- Prognosis
- Retrospective Studies
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Juan M. Alonso-Dominguez
- Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), UAM, Madrid, Spain
| | | | | | | | - Ismael Buño
- Hospital General Universitario Gregorio Marañon. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Alicia Arenas
- Fundación Investigación Biomédica Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Del Orbe
- Biocruces Health Research Institute,Barakaldo (Bilbao), Spain
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pilar Llamas
- Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), UAM, Madrid, Spain
| | - Rocio N. Salgado
- Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), UAM, Madrid, Spain
| | - Santiago Osorio
- Hospital General Universitario Gregorio Marañon. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Carmen Burgaleta
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), Spain
| | - Ignacio Mahíllo-Fernández
- Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), UAM, Madrid, Spain
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Reduced-intensity allogeneic hematopoietic stem cell transplantation combined with imatinib has comparable event-free survival and overall survival to long-term imatinib treatment in young patients with chronic myeloid leukemia. Ann Hematol 2017. [PMID: 28624905 DOI: 10.1007/s00277-017-3021-y] [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: 12/27/2022]
Abstract
The relative merits of reduced intensity hematopoietic stem cell transplantation (RIST) for chronic myeloid leukemia (CML) in the first chronic phase (CP) in imatinib era have not been evaluated. The study was designed to compare the outcomes of combination therapy of RIST plus imatinib (RIST + IM) vs. imatinib (IM) alone for young patients with early CP (ECP) and late CP (LCP). Of the patients, 130 were non-randomly assigned to treatment with IM alone (n = 88) or RIST + IM (n = 42). The 10-year overall survival (OS) and event-free survival (EFS) were comparable between RIST + IM and IM groups. LCP, high Sokal score, and no complete cytogenetic response at 3 months were adverse prognostic factors for survival, but only the time from diagnosis to IM was an independent predictor after multivariate analysis. For ECP, IM was similar to RIST + IM, with 10-year EFS rates of 77.2 vs. 81.6% (p = 0.876) and OS rates of 93.8 vs. 87.9% (p = 0.102), respectively. For LCP, both treatments resulted in similar survival, but more patients in the imatinib group experienced events (10-year EFS 40.8 vs. 66.7%, p = 0.047). The patients with higher EBMT risk scores had an inferior survival than those with lower scores (69.2 vs. 92.9%, p = 0.04). We concluded that RIST + IM was comparable to IM in terms of OS and EFS. However, RIST + IM was more affordable than IM alone in a 10-year scale. Thus, RIST + IM could be considered as an alternative treatment option, especially when the patients have low EBMT risk scores and demand a definite cure for CML.
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Gutiérrez LG, Noriega MF, Laudicina A, Quatrin M, Bengió RM, Larripa I. An unusual translocation, t(1;11)(q21;q23), in a case of chronic myeloid leukemia with a cryptic Philadelphia chromosome. Oncol Lett 2017; 13:3159-3162. [PMID: 28521421 DOI: 10.3892/ol.2017.5845] [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] [Received: 05/05/2016] [Accepted: 11/10/2016] [Indexed: 12/29/2022] Open
Abstract
Chronic myeloid leukemia (CML) is characterized by the translocation t(9;22)(q34;q11) [Philadelphia (Ph) chromosome). Although not frequently occurring, additional chromosome abnormalities (ACAs) can be detected at diagnosis and a number have been associated with an adverse cytogenetic and molecular outcome. The present study reports a case of CML presenting with the translocation t(1;11)(q21;q23) and a cryptic Ph chromosome. The presence of ACAs could generate greater genetic instability, promoting the emergence of further alterations. The present findings suggest that t(1;11)(q21;q23) can prevent a good response to tyrosine kinase inhibitor (TKI) therapy developing a primary resistance. In the present patient, at a recent follow-up, the T315I mutation was detected. This mutation confers full resistance to all available TKI, except ponatinib, which was not a therapeutic option due to comorbidities.
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Affiliation(s)
- Leandro Germán Gutiérrez
- Laboratory of Hematological Genetics, Institute of Experimental Medicine, National Council of Scientific and Technical Research-National Academy of Medicine, C1425AUM Buenos Aires, Argentina
| | - María Fernanda Noriega
- Genetics Division, Hematology Research Institute 'Mariano R. Castex', National Academy of Medicine, C1425AUM Buenos Aires, Argentina
| | | | - Mariana Quatrin
- Laboratory of Genetics, 'Sor María Ludovica' Hospital, La Plata, B1904CSI Buenos Aires, Argentina
| | - Raquel María Bengió
- Clinical-Hematological Division, Hematology Research Institute 'Mariano R. Castex', National Academy of Medicine, C1425AUM Buenos Aires, Argentina
| | - Irene Larripa
- Laboratory of Hematological Genetics, Institute of Experimental Medicine, National Council of Scientific and Technical Research-National Academy of Medicine, C1425AUM Buenos Aires, Argentina
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225
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Clonal chromosomal aberrations in Philadelphia negative cells such as monosomy 7 and trisomy 8 may persist for years with no impact on the long term outcome in patients with chronic myeloid leukemia. Cancer Genet 2017; 216-217:1-9. [PMID: 29025581 DOI: 10.1016/j.cancergen.2017.04.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/04/2017] [Accepted: 04/25/2017] [Indexed: 01/06/2023]
Abstract
The appearance of clonal chromosomal aberrations in Philadelphia negative cells (CCA/Ph-) during the treatment of chronic myeloid leukemia (CML) was recently confirmed. Importance of these findings has not been clearly defined. We present data on the time of appearance, persistence, size of the CCA/Ph- clone in terms of drugs used and hematological, cytogenetic and molecular response rates. The focus was on the peripheral blood cytopenias and myelodysplastic changes in the bone marrow microscopic evaluation. In 5 out of 155 (3,2%) CML patients, the persistent presence (up to nine years) of CCA/Ph- was found (monosomy 7 and trisomy 8 in unrelated clones in two patients treated with tyrosine kinase inhibitors; trisomy 8 in two patients on imatinib; trisomy 21 in one patient on interferon alfa treatment). Aberrations were present in median 24% Ph- cells in 3-15 subsequent analyses at different cytogenetic and molecular response time points. No evident myelodysplastic changes nor transformation to MDS/AML occurred in patients with CCA/Ph-. All the patients achieved major molecular response (MMR). It seems that CCA/Ph- presence does not affect the long term outcome in patients with chronic myeloid leukemia. Further complex monitoring of the CML patients with CCA/Ph- is still needed.
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226
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Donor type, in addition to transplantation in chronic phase and myeloablative conditioning, influence transplant survival for patients with advanced chronic myeloid leukemia in the era of tyrosine kinase inhibitors. Leukemia 2017; 31:1654-1657. [PMID: 28400618 DOI: 10.1038/leu.2017.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Oellerich M, Schütz E, Beck J, Kanzow P, Plowman PN, Weiss GJ, Walson PD. Using circulating cell-free DNA to monitor personalized cancer therapy. Crit Rev Clin Lab Sci 2017; 54:205-218. [PMID: 28393575 DOI: 10.1080/10408363.2017.1299683] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Michael Oellerich
- Department of Clinical Pharmacology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Julia Beck
- Chronix Biomedical GmbH, Göttingen, Germany
| | - Philipp Kanzow
- Department of Clinical Pharmacology, University Medical Center Göttingen, Göttingen, Germany
| | - Piers N. Plowman
- Department of Clinical Oncology, St. Bartholomew’s Hospital, West Smithfield, London, UK
| | - Glen J. Weiss
- Cancer Treatment Centers of America, Goodyear, AZ, USA
| | - Philip D. Walson
- Department of Clinical Pharmacology, University Medical Center Göttingen, Göttingen, Germany
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228
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Suh KJ, Lee JY, Shin DY, Koh Y, Bang SM, Yoon SS, Park S, Kim I, Lee JO. Analysis of adverse events associated with dasatinib and nilotinib treatments in chronic-phase chronic myeloid leukemia patients outside clinical trials. Int J Hematol 2017; 106:229-239. [PMID: 28378056 DOI: 10.1007/s12185-017-2225-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 01/29/2023]
Abstract
We analyzed adverse events (AEs) in 201 chronic phase CML patients treated with nilotinib (n = 120) or dasatinib (n = 81) as first- or second-line therapy. The dasatinib group had significantly higher grade 3-4 AEs compared to the nilotinib group (22 vs. 54%, p < 0.001), and had more frequent dose reduction, interruption, and discontinuation (p < 0.001, p = 0.004, and p = 0.006, respectively). Of 59 patients who discontinued treatment, 47 (80%) discontinued treatment due to AEs; 50% of the AEs causing drug discontinuation were of grade 2 severity. Compared to the second-line setting, discontinuation occurred more rapidly in the first-line setting (2.9 vs. 15.6 months, p = 0.015). Pleural effusion occurred in 35% (28/81) of the patients with dasatinib and led to dasatinib discontinuation in 14 patients (grade 2 of 79%). Pulmonary artery hypertension occurred in one patient with dasatinib. Stroke, acute coronary syndrome, and peripheral artery occlusive disease occurred in 5% (6/120) of the patients treated with nilotinib. The dasatinib group had shorter event-free survival than nilotinib group (first-line, p = 0.051; second-line, p = 0.025). In the clinical practice setting, nilotinib or dasatinib use was more frequently interrupted than recommended by guidelines in association with less severe AEs. We believe this phenomenon is attributable to the availability of other TKIs.
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Affiliation(s)
- Koung Jin Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-di, 13620, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ji Yun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-di, 13620, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-di, 13620, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seonyang Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-di, 13620, Korea.
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229
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Xin P, Li C, Zheng Y, Peng Q, Xiao H, Huang Y, Zhu X. Efficacy of the dual PI3K and mTOR inhibitor NVP-BEZ235 in combination with imatinib mesylate against chronic myelogenous leukemia cell lines. Drug Des Devel Ther 2017; 11:1115-1126. [PMID: 28435223 PMCID: PMC5388256 DOI: 10.2147/dddt.s132092] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin (PI3K/Akt/mTOR) pathway is a therapy target of cancer. We aimed to confirm the effect of dual PI3K/mTOR inhibitor NVP-BEZ235 on proliferation, apoptosis, and autophagy of chronic myelogenous leukemia (CML) cells and sensitivity of tyrosine kinase inhibitor in vitro. METHODS Two human CML cell lines, K562 and KBM7R (T315I mutant strain), were used. The proliferation of CML cells was detected by MTS (Owen's reagent) assay. Cell cycle and apoptosis assay were examined by flow cytometric analysis. The phosphorylation levels and the expression levels were both evaluated by Western blot analysis. NVP-BEZ235 in combination with imatinib was also used to reveal the effect on proliferation and apoptosis. RESULTS NVP-BEZ235 significantly inhibited the proliferation in a time- and dose-dependent manner, and the half-maximal inhibitory concentration values of NVP-BEZ235 inhibiting the proliferation of K562 and KBM7R were 0.37±0.21 and 0.43±0.27 μmol/L, respectively, after 48 h. Cell apoptosis assay showed that NVP-BEZ235 significantly increased the late apoptotic cells. Cell cycle analysis indicated that the cells were mostly arrested in G1/G0 phase after treatment by NVP-BEZ235. In addition, results also found that, after treatment by NVP-BEZ235, phosphorylation levels of Akt kinase and S6K kinase significantly reduced, and the expression levels of cleaved caspase-3 significantly increased; meanwhile, the expression levels of caspase-3, B-cell lymphoma-2, cyclin D1, and cyclin D2 significantly decreased, and the ratio of LC3II/LC3I was significantly increased with increased LC3II expression level. Moreover, imatinib in combination with NVP-BEZ235 induced a more pronounced colony growth inhibition than imatinib alone. CONCLUSION NVP-BEZ235 effectively inhibited cell proliferation by G0/G1 cell cycle arrest and induced apoptosis through deregulating PI3K/Akt/mTOR pathway in CML cells; in addition, NVP-BEZ235 can enhance cell autophagy, and is conducive to raising CML cell sensitivity to imatinib to inhibit the growth of imatinib-resistant cells.
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Affiliation(s)
- Pengliang Xin
- Department of Haematology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Licheng, Quanzhou, Fujian Province, China
| | - Chuntuan Li
- Department of Haematology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Licheng, Quanzhou, Fujian Province, China
| | - Yan Zheng
- Department of Haematology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Licheng, Quanzhou, Fujian Province, China
| | - Qunyi Peng
- Department of Haematology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Licheng, Quanzhou, Fujian Province, China
| | - Huifang Xiao
- Department of Haematology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Licheng, Quanzhou, Fujian Province, China
| | - Yuanling Huang
- Department of Haematology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Licheng, Quanzhou, Fujian Province, China
| | - Xiongpeng Zhu
- Department of Haematology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Licheng, Quanzhou, Fujian Province, China
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Harivenkatesh N, Kumar L, Bakhshi S, Sharma A, Kabra M, Velpandian T, Gogia A, Shastri SS, Gupta YK. Do polymorphisms inMDR1andCYP3A5genes influence the risk of cytogenetic relapse in patients with chronic myeloid leukemia on imatinib therapy? Leuk Lymphoma 2017; 58:1-9. [DOI: 10.1080/10428194.2017.1287359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Lalit Kumar
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Pediatrics (Genetics Unit), All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Gogia
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivaram S. Shastri
- Pediatrics (Genetics Unit), All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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231
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Li N, Yang X, Fan L, Totev T, Guerin A, Chen L, Bhattacharyya S, Joseph G. Nilotinib versus dasatinib as second-line therapy in patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase who are resistant or intolerant to imatinib: a cost-effectiveness analysis based on real-world data. J Med Econ 2017; 20:328-336. [PMID: 27841717 DOI: 10.1080/13696998.2016.1261032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of second-line nilotinib vs dasatinib among patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase (Ph+ CML-CP) who are resistant or intolerant to imatinib, from a US third-party perspective. METHODS A lifetime partitioned survival model was developed to compare the costs and effectiveness of nilotinib vs dasatinib, which included four health states: CP on treatment, CP post-discontinuation, progressive disease (accelerated phase [AP] or blast crisis [BC]), and death. Time on treatment, progression-free survival, and overall survival of nilotinib and dasatinib were estimated using real-world comparative effectiveness data. Parametric survival models were used to extrapolate outcomes beyond the study period. Drug treatment costs, medical costs, and adverse event costs were obtained from the literature and publicly available databases. Utilities of health states were derived from the literature. Incremental cost-effectiveness ratios, including incremental cost per life-year (LY) gained and incremental cost per quality-adjusted life-year (QALY) gained, were estimated comparing nilotinib and dasatinib. Deterministic sensitivity analyses were performed by varying patient characteristics, cost, and utility inputs. RESULTS Over a lifetime horizon, nilotinib-treated patients were associated with 11.7 LYs, 9.1 QALYs, and a total cost of $1,409,466, while dasatinib-treated patients were associated with 9.5 LYs, 7.3 QALYs, and a total cost of $1,422,122. In comparison with dasatinib, nilotinib was associated with better health outcomes (by 2.2 LYs and 1.9 QALYs) and lower total costs (by $12,655). Deterministic sensitivity analysis results showed consistent findings in most scenarios. LIMITATIONS In the absence of long-term real-world data, the lifetime projection could not be validated. CONCLUSIONS Compared with dasatinib, second-line nilotinib was associated with better life expectancy, better quality-of-life, and lower costs among patients with Ph+ CML-CP who were resistant or intolerant to imatinib.
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Affiliation(s)
- Nanxin Li
- a Analysis Group , Boston , MA , USA
| | - Xi Yang
- a Analysis Group , Boston , MA , USA
| | | | | | | | - Lei Chen
- c Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | - George Joseph
- c Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
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232
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Nakamae H, Fujisawa S, Ogura M, Uchida T, Onishi Y, Taniwaki M, Utsunomiya A, Matsue K, Takamatsu Y, Usuki K, Tanimoto M, Ishida Y, Ohashi K, Li L, Miyoshi M. Dasatinib versus imatinib in Japanese patients with newly diagnosed chronic phase chronic myeloid leukemia: a subanalysis of the DASISION 5-year final report. Int J Hematol 2017; 105:792-804. [PMID: 28341918 DOI: 10.1007/s12185-017-2208-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 01/07/2023]
Abstract
The international phase III DASISION trial demonstrated improved efficacy of dasatinib versus imatinib in treatment-naive patients with chronic myeloid leukemia in the chronic phase (CML-CP). We report efficacy and safety outcomes in a Japanese population from the final, 5-year follow-up of DASISION. At the end of the study, 77% (20/26) of dasatinib-treated and 61% (14/23) of imatinib-treated patients remained on initial therapy. Improved responses were observed in Japanese patients who received dasatinib versus imatinib (complete cytogenetic response: 96 vs 87%; major molecular response: 88 vs 74%; BCR-ABL1 ≤0.0032% International Scale [MR4.5]: 58 vs 52%). In patients who achieved BCR-ABL1 ≤10% at 3 months, 5-year progression-free survival and overall survival rates were high with dasatinib (96 and 96%) and imatinib (88 and 100%). The majority of adverse events were grade 1/2 in Japanese patients. Pleural effusion occurred more frequently in dasatinib-treated Japanese patients versus all patients (42 vs 28%), with no treatment discontinuations. Overall, in Japanese patients, dasatinib maintained its safety profile and had higher or comparable response and survival outcomes compared with imatinib or with all patients in DASISION. These findings demonstrate the long-term efficacy and tolerability of dasatinib and support frontline treatment of Japanese patients with CML-CP with dasatinib.
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Affiliation(s)
- Hirohisa Nakamae
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Shin Fujisawa
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Michinori Ogura
- Department of Hematology and Oncology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.,Department of Hematology, Tokai Central Hospital, Gifu, Japan
| | - Toshiki Uchida
- Department of Hematology and Oncology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Masafumi Taniwaki
- Department of Hematology, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
| | - Kosei Matsue
- Department of Internal Medicine, Kameda Medical Center, Chiba, Japan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infectious Diseases, Department of Internal Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Mitsune Tanimoto
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yoji Ishida
- Department of Hematology and Oncology, Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan
| | - Kazuteru Ohashi
- Cancer and Infectious Diseases Center, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Li Li
- Bristol-Myers Squibb, Princeton, NJ, USA
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233
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Huang J, Wang L, Chen L, Qun H, Yajing X, Fangping C, Xielan Z. Changing Treatment May Affect the Predictive Ability of European Treatment Outcome Study Scoring for the Prognosis of Patients with Chronic Myeloid Leukemia. Turk J Haematol 2017; 34:10-15. [PMID: 27751981 PMCID: PMC5451668 DOI: 10.4274/tjh.2016.0156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Previous studies compared the predictive ability of the European Treatment Outcome Study (EUTOS), Sokal, and Hasford scoring systems and demonstrated inconsistent findings with unknown reasons. This study was conducted to determine a useful scoring system to predict the prognosis of patients with chronic myeloid leukemia (CML) and identify the probable factors that affect the scoring. Materials and Methods: This is a retrospective cohort study. The predictive ability of EUTOS and the factors that affect scoring were analyzed in 234 Chinese chronic-phase CML patients treated with frontline imatinib, including a few patients temporarily administered hydroxyurea for cytoreduction before imatinib. Patients were stratified into different risk groups according to each scoring system to assess the treatment outcomes and the predictive ability of EUTOS scores between patients who received imatinib during the entire follow-up period and patients who received altered treatment because of intolerance, progression, and treatment failure. Results: Sixty-one (26.0%) patients received altered treatments during the follow-up. In the EUTOS low- and high-risk groups, the 5-year overall survival was 94.6% and 84.7% (p=0.011), 5-year event-free survival was 92.6% and 77.6% (p=0.001), and 5-year progression-free survival (PFS) was 95.3% and 82.4% (p=0.001), respectively. The predictive ability of EUTOS was better than that of the Sokal and Hasford scores (p=0.256, p=0.062, p=0.073) without statistical significance. All three scoring systems were valid in predicting early optimal response. Kaplan-Meier analysis showed a high association between overall PFS and the EUTOS scores in the standard-dose imatinib group (p<0.001). Conclusion: This study suggests that the EUTOS scoring system could predict the outcome of chronic-phase CML patients treated with standard-dose imatinib. Altered treatment is a crucial factor that affects the prognostic impact of EUTOS scoring. Achieving complete cytogenetic response at 18 months is an essential factor in predicting the prognosis of patients with CML.
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Affiliation(s)
| | | | | | | | | | | | - Zhao Xielan
- Xiangya Hospital, Central South University, Department of Hematology, Changsha, China Phone: +8673184896157 E-mail:
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234
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Özen M, Üstün C, Öztürk B, Topçuoğlu P, Arat M, Gündüz M, Atilla E, Bolat G, Arslan Ö, Demirer T, Akan H, İlhan O, Beksaç M, Gürman G, Özcan M. Allogeneic Transplantation in Chronic Myeloid Leukemia and the Effect of Tyrosine Kinase Inhibitors on Survival: A Quasi-Experimental Study. Turk J Haematol 2017; 34:16-26. [PMID: 27094579 PMCID: PMC5451684 DOI: 10.4274/tjh.2015.0346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: Tyrosine kinase inhibitors (TKIs) have changed the indications for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in chronic myeloid leukemia (CML). Therefore, we aimed to evaluate the effect of TKIs on allo-HSCT in CML. Materials and Methods: In this quasi-experimental study, we compared patient, disease, and transplantation characteristics as well as allo-HSCT outcomes between the pre-TKI era (before 2002) and the post-TKI era (2002 and later) in patients with CML. A total of 193 allo-HSCTs were performed between 1989 and 2012. Results: Patients in the post-TKI era had more advanced disease (>chronic phase 1) at the time of transplant and more frequently received reduced-intensity conditioning compared to patients in the pre-TKI era. Relapse/progression occurred more frequently in the year ≥2002 group than in the year <2002 group (48% vs. 32% at 5 years, p=0.01); however, overall survival (OS) was similar in these two groups (5-year survival was 50.8% vs. 59.5%, respectively; p=0.3). TKIs (with donor lymphocyte infusions or alone) for treatment of relapse after allo-HSCT were available in the post-TKI era and were associated with improved OS. While the rates of hematologic remission at 3 months after allo-HSCT were similar between TKI eras, patients having remission had better disease-free survival (DFS) [relative risk (RR): 0.15, confidence interval (CI) 95%: 0.09-0.24, p<0.001] and OS (RR: 0.14, CI 95%: 0.09-0.23, p<0.001). Male allo-HSCT recipients had worse DFS (RR: 1.7, CI 95%: 1.2-2.5, p=0.007) and OS (RR: 1.7, CI 95%: 1.1-2.6, p=0.02) than females. Conclusion: TKIs are an effective option for the treatment of relapse after allo-HSCT in CML. Hematologic remission after allo-HSCT is also an important factor for survival in CML patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Muhit Özcan
- Ankara University Faculty of Medicine, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey Phone: +90-312-466 3550 E-mail: ,
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235
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Kong JH, Winton EF, Heffner LT, Chen Z, Langston AA, Hill B, Arellano M, El-Rassi F, Kim A, Jillella A, Kota VK, Bodó I, Khoury HJ. Does the frequency of molecular monitoring after tyrosine kinase inhibitor discontinuation affect outcomes of patients with chronic myeloid leukemia? Cancer 2017; 123:2482-2488. [PMID: 28241101 DOI: 10.1002/cncr.30608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND To the authors' knowledge, the optimal frequency of monitoring after tyrosine kinase inhibitor (TKI) discontinuation in patients with chronic myeloid leukemia (CML) has not been established. Data regarding the discontinuation of second-generation TKIs used in first-line treatment or after the failure of first-line treatment with TKIs are limited. Herein, the authors report real-world experience with "reduced frequency" molecular monitoring in patients with CML in all phases who discontinued treatment with imatinib, dasatinib, or bosutinib. METHODS The records of patients who discontinued TKIs were reviewed. Patients who discontinued TKIs were monitored prospectively on an intended schedule of monthly blood quantitative reverse transcriptase-polymerase chain reaction for BCR-ABL1 for 3 months, quarterly for 12 months, and every 6 months thereafter until loss of major molecular response (MMR). After loss of MMR, the TKI that previously was discontinued was reinitiated. RESULTS Between January 2010 and September 2015, a total of 24 patients in chronic (21 patients), accelerated (2 patients), and lymphoid blast (1 patient) phase discontinued imatinib (16 patients), dasatinib (5 patients), or bosutinib (3 patients) used in the front-line treatment or beyond. Blood quantitative reverse transcriptase-polymerase chain reaction for BCR-ABL1 was performed 1.3 ± 0.7 times within the first 3 months (24 patients) and 2.7 ± 1.4 times in the following 12 months (18 patients). With a median follow-up of 36.5 months (range, 3.2-67.4 months), the probabilities of treatment-free remission at 1 year and 2 years were 65.7% (95% confidence interval, 55.8%-75.6%) and 59.7% (95% confidence interval, 49.1%-70.3%), respectively. Loss of MMR was observed in 9 patients at a median of 2.8 months (range, 1.8-14.2 months) after discontinuation of TKIs. CONCLUSIONS With the limitations of a small sample size, the results of the current study demonstrate that less frequent monitoring of BCR-ABL1 does not appear to affect outcomes, and that discontinuation of TKIs used as first-line treatment or beyond after resistance or intolerance to first-line treatment appears feasible. Cancer 2017;123:2482-88. © 2017 American Cancer Society.
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Affiliation(s)
- Jee Hyun Kong
- Division of Hematology-Oncology, Department of Internal Medicine, Wonju Severance Hospital, Yonsei College of Medicine, Wonju, Korea.,Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Elliott F Winton
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Leonard T Heffner
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Zhengjia Chen
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Amelia A Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Brittany Hill
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Martha Arellano
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Fuad El-Rassi
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Audrey Kim
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Anand Jillella
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Vamsi K Kota
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Imre Bodó
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Hanna Jean Khoury
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Alikian M, Gale RP, Apperley JF, Foroni L. Molecular techniques for the personalised management of patients with chronic myeloid leukaemia. BIOMOLECULAR DETECTION AND QUANTIFICATION 2017; 11:4-20. [PMID: 28331814 PMCID: PMC5348117 DOI: 10.1016/j.bdq.2017.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 12/28/2016] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
Chronic myeloid leukemia (CML) is the paradigm for targeted cancer therapy. RT-qPCR is the gold standard for monitoring response to tyrosine kinase-inhibitor (TKI) therapy based on the reduction of blood or bone marrow BCR-ABL1. Some patients with CML and very low or undetectable levels of BCR-ABL1 transcripts can stop TKI-therapy without CML recurrence. However, about 60 percent of patients discontinuing TKI-therapy have rapid leukaemia recurrence. This has increased the need for more sensitive and specific techniques to measure residual CML cells. The clinical challenge is to determine when it is safe to stop TKI-therapy. In this review we describe and critically evaluate the current state of CML clinical management, different technologies used to monitor measurable residual disease (MRD) focus on comparingRT-qPCR and new methods entering clinical practice. We discuss advantages and disadvantages of new methods.
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Key Words
- ABL1, Abelson murine leukaemia virus
- ALL, acute lymphoblastic leukaemia
- AP, accelerated phase
- ARQ, armored RNA Quant
- ATP, adenosine triphosphate
- BC, blast crisis
- BCR, breakpoint cluster region
- BM, bone marrow
- BMT, bone marrow transplantation
- Bp, base pair
- CAP, College of American Pathology
- CES, capillary electrophoresis sequencing
- CML
- CML, chronic myeloid leukaemia
- CMR, complete molecular response/remission
- CP, chronic phase
- DESTINY, De-Escalation and Stopping Treatment of Imatinib, Nilotinib or sprYcel in Chronic Myeloid Leukaemia
- DNA, deoxyribonucleic acid
- EAC, Europe Against Cancer
- ELN, European Leukaemia Net
- EURO-SKI, European Stop Tyrosine Kinase Inhibitor Study
- GUSB, glucuronidase beta gene
- IC, inhibotory concentration
- IRIS, interferon and cytarabine versus STI571
- IS, International Scale
- InDels, insertions and deletions
- KDa, Kilo Dalton
- Kbp, Kilo Base Pairs
- LPC, leukemic progenitor cells
- LSC, leukemic stem cell
- LoD, limit of detection
- LoQ, limit of quantification
- M-bcr, major-breakpoint cluster region
- MMR, major molecular response/remission
- MR, deep molecular response/remission
- MRD
- MRD, minimal residual disease
- Mbp, mega base pair
- Molecular monitoring
- NCCN, National Comprehensive Cancer Network
- NEQAS, National External Quality Assessement Service
- NGS
- NGS, next generation sequencing
- NTC, No Template Control
- PB, Peripheral Blood
- PCR, Polymerase Chain Reaction
- PFS, Progression Free Survival
- Ph, Philadelpia
- Q-PCR, quantitative polymerase chain reaction
- QC, Quality Control
- RT, reverse transcription
- RT-dPCR, reverse transcription-digital polymerase chain reaction
- RT-qPCR, reverse transcription-quantitative polymerase chain reaction
- SCT, stem cell transplant
- SMRT, single-molecule real-time sequencing
- STIM, stop imatinib
- TKD, tyrosine kinase domain
- TKI, tyrosine kinase inhibitor
- WHO, World Health Organisation
- ZMW, zero-mode wave-guided
- allo-SCT, Allogeneic Stem Cell Transplantation
- cDNA, coding or complimentary DNA
- dMIQE, Minimum Information for Publication of Quantitative Digital PCR Experiments
- dPCR
- dPCR, digital polymerase chain reaction
- emPCR, emulsion PCR
- gDNA, genomic deoxyribonucleic acid
- m-bcr, minor-breakpoint cluster region
- mRNA, messenger RNA
- nM, manomolar
- μ-bcr, micro-breakpoint cluster region
- μg, microgram
- μl, microliter
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Affiliation(s)
- Mary Alikian
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK; Imperial Molecular Pathology, Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Robert Peter Gale
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK
| | - Jane F Apperley
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK
| | - Letizia Foroni
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK
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Soyer N, Uysal A, Tombuloglu M, Sahin F, Saydam G, Vural F. Allogeneic stem cell transplantation in chronic myeloid leukemia patients: Single center experience. World J Hematol 2017; 6:1-10. [DOI: 10.5315/wjh.v6.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/21/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative disease which leads the unregulated growth of myeloid cells in the bone marrow. It is characterized by the presence of Philadelphia chromosome. Reciprocal translocation of the ABL gene from chromosome 9 to 22 t (9; 22) (q34; q11.2) generate a fusion gene (BCR-ABL). BCR-ABL protein had constitutive tyrosine kinase activity that is a primary cause of chronic phase of CML. Tyrosine kinase inhibitors (TKIs) are now considered standard therapy for patients with CML. Even though, successful treatment with the TKIs, allogeneic stem cell transplantation (ASCT) is still an important option for the treatment of CML, especially for patients who are resistant or intolerant to at least one second generation TKI or for patients with blastic phase. Today, we know that there is no evidence for increased transplant-related toxicity and negative impact of survival with pre-transplant TKIs. However, there are some controversies about timing of ASCT, the optimal conditioning regimens and donor source. Another important issue is that BCR-ABL signaling is not necessary for survival of CML stem cell and TKIs were not effective on these cells. So, ASCT may play a role to eliminate CML stem cells. In this article, we review the diagnosis, management and treatment of CML. Later, we present our center’s outcomes of ASCT for patients with CML and then, we discuss the place of ASCT in CML treatment in the TKIs era.
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238
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Nair D, Dhangar S, Shanmukhaiah C, Vundinti BR. Association of genetic polymorphisms of the ABCG2, ABCB1, SLCO1B3 genes and the response to Imatinib in chronic myeloid leukemia patients with chronic phase. Meta Gene 2017. [DOI: 10.1016/j.mgene.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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239
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Kaygusuz Atagunduz I, Toptas T, Deniz R, Kara O, Eser A, Sezgin A, Ozgumus T, Gecgel F, Firatli Tuglular T. Effects of Deeper Molecular Responses on Outcomes in Chronic Myeloid Leukemia Patients in Chronic Phase Treated With Imatinib Mesylate. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:120-125. [DOI: 10.1016/j.clml.2016.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/03/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
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Tantiworawit A, Kongjarern S, Rattarittamrong E, Lekawanvijit S, Bumroongkit K, Boonma N, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Norasetthada L. Diagnosis and Monitoring of Chronic Myeloid Leukemia: Chiang Mai University Experience. Asian Pac J Cancer Prev 2017; 17:2159-64. [PMID: 27221912 DOI: 10.7314/apjcp.2016.17.4.2159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A diagnosis of chronic myeloid leukemia (CML) is made on discovery of the presence of a Philadelphia (Ph) chromosome. The success of the treatment of this form of leukemia with tyrosine kinase inhibitor (TKI) is monitored by reduction of the Ph chromosome. OBJECTIVE To compare the role of conventional cytogenetic (CC) methods with a real time quantitative polymerase chain reaction (RQ-PCR) and fluorescence in situ hybridization (FISH) for diagnosis and treatment monitoring of CML patients. The secondary outcome was to analyze the treatment responses to TKI in CML patients. MATERIALS AND METHODS This was a retrospective study of CML patients who attended the Hematology clinic at Chiang Mai University Hospital from 2005-2010. Medical records were reviewed for demographic data, risk score, treatment response and the results of CC methods, FISH and RQ-PCR. RESULTS One hundred and twenty three cases were included in the study, 57.7% of whom were male with a mean age of 46.9 years. Most of the patients registered as intermediate to high risk on the Sokal score. At diagnosis, 121 patients were tested using the CC method and 118 (95.9%) were identified as positive. Five patients failed to be diagnosed by CC methods but were positive for BCR-ABL1 using the FISH method. Imatinib was the first-line treatment used in 120 patients (97.6%). In most patients (108 out of 122, 88.5%), a complete cytogenetic response (CCyR) was achieved after TKI therapy and in 86 patients (70.5%) CCyR was achieved long term by the CC method. Five out of the 35 analyzed patients in which CCyR was achieved by the CC method had a positive FISH result. Out of the 76 patients in which CCyR was achieved, RQ-PCR classified patients to only CCyR in 17 patients (22.4%) with a deeper major molecular response (MMR) in 4 patients (5.3%) and complete molecular response (CMR) in 55 patients (72.4%). In the case of initial therapy, CCyR was achieved in 95 patients (79.1%) who received imatinib and in both patients who received dasatinib (100%). For the second line treatment, nilotinib were used in 30 patients and in 19 of them (63.3%) CCyR was achieved. In half of the 6 patients (50%) who received dasatinib as second line or third line treatment CCyR was also achieved. CONCLUSIONS CML patients had a good response to TKI treatment. FISH could be useful for diagnosis in cases where CC analysis failed to detect the Ph chromosome. RQ-PCR was helpful in detecting any residual disease and determining the depth of the treatment response at levels greater than the CC methods.
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Affiliation(s)
- Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Chiang Mai University, Thailand E-mail :
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Ramachandran SS, Muiwo P, Ahmad HM, Pandey RM, Singh S, Bakhshi S, Kumar L, Bhattacharya A, Gupta YK. miR-505-5p and miR-193b-3p: potential biomarkers of imatinib response in patients with chronic myeloid leukemia. Leuk Lymphoma 2017; 58:1981-1984. [DOI: 10.1080/10428194.2016.1272681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Pamchui Muiwo
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Hafiz M. Ahmad
- Department of Cancer Cell and Molecular Biology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Surender Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr. BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Bhattacharya
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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242
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Ganta RR, Nasaka S, Linga VG, Gundeti S, Maddali LS, Digumarti RR. Effectiveness of Three Prognostic Scoring Systems in Predicting the Response and Outcome in Pediatric Chronic Myeloid Leukemia Chronic Phase on Frontline Imatinib. Indian J Med Paediatr Oncol 2017; 38:282-286. [PMID: 29200674 PMCID: PMC5686967 DOI: 10.4103/ijmpo.ijmpo_104_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction: The Sokal and Hasford (Euro) scores were developed in the chemotherapy and interferon eras and are widely used as prognostic indicators in patients with chronic myeloid leukemia (CML). Recently, European Treatment and Outcome Study (EUTOS) scoring system was introduced. Data on risk stratification in pediatric CML population was lacking due to its rarity (<3%). Objective: To study the effectiveness in predicting the response and outcome with three prognostic scores in pediatric CML-chronic phase patients on front line Imatinib. Materials and Methods: We retrospectively analyzed the hospital records of newly diagnosed CML CP patients (aged ≤18 years) from 2006 to 2010 for their risk score, cytogenetic response at 18 months and event free survival (EFS) at the end of 4 years. Events include loss of hematological response, loss of cytological response, progression to accelerated/blast phase (AP/BC). All received free Imatinib under Gleevac international patient assistance program. Results: Data of 106 children was analyzed with median age of 13.5 (ranged 5-18 years) and male preponderance (M:F = 1.14:1). The distribution of children was 63%, 32% and 5% in Sokal low, intermediate and high risk respectively, 50%, 43% and 5% in Hasford/Euro low, intermediate and high risk respectively, 71% and 29% in EUTOS low and high risk respectively. The overall cumulative complete hematological response at the end of 3 month was 94%, and complete cytogenetic response at 12 months was 75%. The CCyR at 18 month was seen in 90%,74% and 83% among Sokal low, intermediate and high risk groups respectively, 83%, 86% and 83% among Hasford/Euro low, intermediate and high risk groups respectively, 84% and 86% EUTOS low and high risk groups respectively. The EFS at the end of 48 months was seen in 87%,79% and 83% among Sokal low, intermediate and high risk groups respectively, 83%, 86% and 83% among Hasford/Euro low, intermediate and high risk groups respectively, 86% and 80% EUTOS low and high risk groups respectively. Conclusion: None of the scoring systems predicted the response and outcome effectively in children with CML CP on front line Imatinib.
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Affiliation(s)
- Ranga Raman Ganta
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Srividya Nasaka
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vijay Gandhi Linga
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Lakshmi Srinivas Maddali
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Raghunadha Rao Digumarti
- Department of Medical Oncology, Tata Memorial Cancer Hospital, Visakhapatnam, Andhra Pradesh, India
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Chaitanya PK, Kumar KA, Stalin B, Sadashivudu G, Srinivas ML. The Role of Mutation Testing in Patients with Chronic Myeloid Leukemia in Chronic Phase after Imatinib Failure and Their Outcomes after Treatment Modification: Single-institutional Experience Over 13 Years. Indian J Med Paediatr Oncol 2017; 38:328-333. [PMID: 29200684 PMCID: PMC5686977 DOI: 10.4103/ijmpo.ijmpo_115_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: BCR-ABL1 kinase domain mutations represent the most frequent mechanism of resistance to tyrosine kinase inhibitor (TKI) therapy, being detected in 40%–50% of imatinib-resistant patients with chronic myeloid leukemia in chronic phase (CML-CP). Over 100 BCR-ABL1 single-point mutations have been reported in patients with imatinib-resistant CML. There were few studies reported from India on BCR-ABL kinase mutations in imatinib failure patients. We present our data on imatinib resistance mutation analysis (IRMA) and use of imatinib dose hike and 2nd-generation TKI at our institute. Materials and Methods: All patients with a diagnosis of CML in a university hospital from June 2003 to July 2016 and who were tested for IRMA in view of imatinib failure, those in CP, and age <18 years were included in the study. Results: A total of 2110 cases of CML reviewed and 269 cases of CML with imatinib failure were analyzed. The male to female ratio was 1.7:1. The median age at presentation was 36 years (range: 18–66 years). Among these, 26% were primary failures and 74% were secondary failures. The treatment was modified either as imatinib dose hike or nilotinib/dasatinib. Molecular response at 12 months was achieved in 25.7% in imatinib dose hike, 46.6% in nilotinib, and 53.8% in dasatinib arms. The 4-year overall survival in mutation detected group was 37.5% and in nonmutated group was 87.7%. Conclusion: Imatinib-resistant mutations were more common in the cases with secondary failure though not statistically significant. T315I mutation was the common mutation found in the study. Imatinib dose hike to the failure cases resulted in optimal hematological response rates.
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Affiliation(s)
| | - Karnam Ashok Kumar
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Bala Stalin
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gundeti Sadashivudu
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Maddali Lakshmi Srinivas
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Characterization of Patients with Chronic Myeloid Leukemia Unresponsive to Tyrosine Kinase Inhibitors Who Underwent Allogeneic Hematopoietic Stem Cell Transplantation. Int J Hematol Oncol Stem Cell Res 2017; 11:30-36. [PMID: 28286612 PMCID: PMC5338279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Tyrosine kinase inhibitors (TKIs) were the first drugs to use an intracellular signaling molecule as a therapeutic target. Unresponsiveness to TKIs limits therapeutic options, making allogeneic hematopoietic stem cell transplantation (HSCT) the only option leading to molecular remission. The aim of this study is to characterize CML patients unresponsive to first- and/or second-generation TKI therapy who underwent HSCT and to describe the main factors associated with treatment failure. Subjects and Methods: Twenty one CML patients who underwent allogeneic HSCT and had previously used first- and/or second-generation TKIs from January 2005 to May 2014. Results: Of the 21 patients, 52.4% were male, with a median age of 49 years (23-65 years) and 85.7% had chronic phase CML at the time of diagnosis; 28.6% showed inadequate treatment adherence to TKI therapy. Thirteen patients were resistant and eight were intolerant to TKIs; additionally, nine did not have T315I mutation. Ten transplantations involved related donors, and more than a half of patients (11) died, three of which due to graft failure. Most patients who survived transplantation were in the chronic phase of disease at the time of HSCT. Conclusion: The population was composed mainly of young age patients at diagnosis, male, white, and coming from areas in the state of Rio Grande do Sul other than Porto Alegre and metropolitan region. Low adherence to TKI therapy may be related to unresponsiveness to treatment, especially in patients with acquired resistance, or this low adherence, together with the presence of molecular changes, may have led to the need for HSCT.
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245
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Castagnetti F, Di Raimondo F, De Vivo A, Spitaleri A, Gugliotta G, Fabbiano F, Capodanno I, Mannina D, Salvucci M, Antolino A, Marasca R, Musso M, Crugnola M, Impera S, Trabacchi E, Musolino C, Cavazzini F, Mineo G, Tosi P, Tomaselli C, Rizzo M, Siragusa S, Fogli M, Ragionieri R, Zironi A, Soverini S, Martinelli G, Cavo M, Vigneri P, Stagno F, Rosti G, Baccarani M. A population-based study of chronic myeloid leukemia patients treated with imatinib in first line. Am J Hematol 2017; 92:82-87. [PMID: 27770583 DOI: 10.1002/ajh.24591] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 01/14/2023]
Abstract
Chronic myeloid leukemia (CML) treatment is based on company-sponsored and academic trials testing different tyrosine kinase inhibitors (TKIs) as first-line therapy. These studies included patients selected according to many inclusion-exclusion criteria, particularly age and comorbidities, with specific treatment obligations. In daily clinical practice (real-life), inclusion-exclusion criteria do not exist, and the treatment outcome does not only depend on the choice of first-line TKI but also on second- and third-line TKIs. To investigate in a real-life setting the response and the outcome on first-line imatinib, with switch to second generation TKIs in case of unsatisfying response or intolerance, we analyzed all newly diagnosed patients (N = 236), living in two Italian regions, registered in a prospective study according to population-based criteria and treated front-line with imatinib. A switch from imatinib to second-generation TKIs was reported in 14% of patients for side effects and in 24% for failure or suboptimal response, with an improvement of molecular response in 57% of them. The 5-year overall survival (OS) and leukemia-related survival (LRS) were 85% and 93%, respectively; the 4-year rates of MR3.0 and MR4.0 were 75% and 48%, respectively. Cardiovascular complications were reported in 4% of patients treated with imatinib alone and in 6% of patients receiving nilotinib as second-line. Older age (≥70 years) affected OS, but not LRS. These data provide an unbiased reference on the CML management and on the results of TKI treatment in real-life, according to ELN recommendations, using imatinib as first-line treatment and second-generation TKIs as second-line therapy. Am. J. Hematol. 92:82-87, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Fausto Castagnetti
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Francesco Di Raimondo
- Division of Hematology, A.O.U. Policlinico “Vittorio Emanuele,”; University of Catania; Catania Italy
| | - Antonio De Vivo
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Antonio Spitaleri
- Division of Hematology, A.O.U. Policlinico “Vittorio Emanuele,”; University of Catania; Catania Italy
| | - Gabriele Gugliotta
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Francesco Fabbiano
- Division of Hematology and Bone Marrow Transplantation; Ospedali Riuniti Villa Sofia - Cervello; Palermo Italy
| | - Isabella Capodanno
- Division of Hematology; Arcispedale Santa Maria Nuova, IRCCS; Reggio Emilia Italy
| | | | - Marzia Salvucci
- Division of Hematology; “Santa Maria delle Croci” Hospital; Ravenna Italy
| | - Agostino Antolino
- Service of Immunohematology and Transfusion Medicine; Azienda Ospedaliera Provinciale; Ragusa Italy
| | - Roberto Marasca
- Division of Hematology; Modena University Hospital, University of Modena and Reggio Emilia; Modena Italy
| | - Maurizio Musso
- Division of Hematology; Clinica La Maddalena; Palermo Italy
| | - Monica Crugnola
- Division of Hematology and Bone Marrow Transplantation; University Hospital; Parma Italy
| | | | - Elena Trabacchi
- Division of Hematology and Bone Marrow Transplantation; “Guglielmo da Saliceto” Hospital; Piacenza Italy
| | - Caterina Musolino
- Division of Hematology; “G. Martino” University Hospital, University of Messina; Italy
| | - Francesco Cavazzini
- Division of Hematology; “Sant'Anna” University Hospital, University of Ferrara; Ferrara Italy
| | - Giuseppe Mineo
- Division of Hematology; “S.Vincenzo” Hospital; Taormina ME Italy
| | - Patrizia Tosi
- Division of Hematology; Ospedale degli Infermi; Rimini Italy
| | - Carmela Tomaselli
- Department of Oncology/Division of Hematology; Ospedale Civico; Palermo Italy
| | - Michele Rizzo
- Division of Hematology; Ospedale S. Elia; Caltanissetta Italy
| | - Sergio Siragusa
- Division of Hematology and Bone Marrow Transplantation; Azienda Ospedaliera Universitaria Policlinico “P. Giaccone,”; Palermo Italy
| | - Miriam Fogli
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Riccardo Ragionieri
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Alessandro Zironi
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Simona Soverini
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Giovanni Martinelli
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Michele Cavo
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Paolo Vigneri
- Unit of Medical Oncology, A.O.U. Policlinico “Vittorio Emanuele,” University of Catania; Catania Italy
| | - Fabio Stagno
- Division of Hematology, A.O.U. Policlinico “Vittorio Emanuele,”; University of Catania; Catania Italy
| | - Gianantonio Rosti
- Department of Oncology and Hematology; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
- Department of Experimental, Diagnostic and Specialty Medicine; “S.Orsola-Malpighi” University Hospital, University of Bologna; Bologna Italy
| | - Michele Baccarani
- Department of Hematology and Oncology “L. and A. Seràgnoli,”; University of Bologna; Bologna Italy
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The clinical relevance of imatinib plasma trough concentrations in chronic myeloid leukemia. A Belgian study. Clin Biochem 2016; 50:452-454. [PMID: 28017570 DOI: 10.1016/j.clinbiochem.2016.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/21/2022]
Abstract
This retrospective multicenter study in patients with chronic myeloid leukemia in chronic phase was undertaken to confirm the clinical relevance of imatinib plasma concentrations monitoring in daily practice. Forty-one patients, with 47 imatinib plasma measurements, were analyzed during treatment with imatinib given at a fixed 400mg daily dose. A significant inverse relationship of imatinib concentration with the patients' weight was observed (Pearson's test: p=0.02, R2=0.1). More interestingly, patients with poor response (switched to another tyrosine kinase inhibitor because of imatinib failure, or because of disease progression after an initial response) displayed a significantly lower mean imatinib concentration as compared to patients maintained on imatinib (822ng/mL vs 1099ng/mL; Student's t-test, p=0.04). Failure or disease progression occurred more often in patients in the lowest quartile of imatinib concentrations compared to patients in the highest quartile (p=0.02, logrank test). No correlation could be established with other biological or clinical parameter, including complete cytogenic response and major molecular response. IN CONCLUSION in patients treated with imatinib at a fixed daily dose of 400mg, imatinib plasma concentrations decreased with increasing body weight and were lower in patients switched to another tyrosine kinase inhibitor due to imatinib failure. Systematic determination of imatinib plasma trough levels should be encouraged in such patients.
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247
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Giona F, Saglio G, Santopietro M, Menna G, Putti MC, Micalizzi C, Iaria G, Santoro N, Ladogana S, Mura R, Burnelli R, Consarino C, Cosmi C, Moleti ML, Leszl A, Tucci F, Nanni M, Diverio D, Biondi A, Locatelli F, Foà R. Early response does not predict outcome in children and adolescents with chronic myeloid leukaemia treated with high-dose imatinib. Br J Haematol 2016; 180:895-898. [PMID: 27984633 DOI: 10.1111/bjh.14458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Fiorina Giona
- Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin at Orbassano, Turin, Italy
| | - Michelina Santopietro
- Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Giuseppe Menna
- Paediatric Haematology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - Maria Caterina Putti
- Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Concetta Micalizzi
- Clinical Experimental Haematology Unit, Gaslini Research Institute, Genoa, Italy
| | - Grazia Iaria
- Division of Haematology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Nicola Santoro
- U.O. di Oncologia ed Ematologia Oncologica Pediatrica, Policlinico, Bari, Italy
| | - Saverio Ladogana
- Department of Paediatrics, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Rosamaria Mura
- Paediatric Haemato-Oncology Unit, Ospedale Regionale per le Microcitemie, Cagliari, Italy
| | - Roberta Burnelli
- Department of Reproduction and Growth, University Hospital Sant'Anna in Ferrara, Ferrara, Italy
| | - Caterina Consarino
- Haemato-Oncology Unit, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - Carlo Cosmi
- Paediatric Unit, Ospedale di Sassari, Sassari, Italy
| | - Maria Luisa Moleti
- Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Anna Leszl
- Clinical Experimental Haematology Unit, Gaslini Research Institute, Genoa, Italy
| | - Francesca Tucci
- Paediatric Haematology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - Mauro Nanni
- Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Daniela Diverio
- Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Andrea Biondi
- Department of Paediatrics, University of Milano-Bicocca, Monza, Italy
| | - Franco Locatelli
- Dipartimento di Oncoematologia Pediatrica, IRCCS Ospedale Bambino Gesù, Rome, Italy.,Dipartimento di Scienze Pediatriche Università di Pavia, Italy
| | - Robin Foà
- Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
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Abstract
PURPOSE OF REVIEW This article aims to describe the ocular manifestations of leukemia, resulting both from direct infiltration of neoplastic cells and from the more common secondary effects of leukemia and its treatment. The prevalence of these findings is also discussed, along with their clinical significance, association with hematologic markers and the ophthalmologist's role caring for these patients. RECENT FINDINGS Recent studies have included a large case series examining the prevalence of ocular manifestations in newly diagnosed leukemic patients as well as case reports of ocular manifestations of leukemia. SUMMARY Patients with leukemia often have ocular manifestations. These occur either from direct infiltration of neoplastic cells or from indirect or secondary causes, including hematologic abnormalities, central nervous system involvement, opportunistic infections, or from treatment. Although nearly all ocular structures can be affected, leukemic retinopathy is often the most clinically apparent manifestation. Awareness of the ophthalmic manifestations of leukemia is important as they may precede systemic diagnosis or may be a sign of leukemia recurrence.
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249
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Discontinuation of dasatinib or nilotinib in chronic myeloid leukemia: interim analysis of the STOP 2G-TKI study. Blood 2016; 129:846-854. [PMID: 27932374 DOI: 10.1182/blood-2016-09-742205] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022] Open
Abstract
STOP second generation (2G)-tyrosine kinase inhibitor (TKI) is a multicenter observational study designed to evaluate 2G-TKI discontinuation in chronic myeloid leukemia (CML). Patients receiving first-line or subsequent dasatinib or nilotinib who stopped therapy after at least 3 years of TKI treatment and in molecular response 4.5 (MR4.5) with undetectable BCR-ABL1 transcripts for the 2 preceding years at least were eligible for inclusion. This interim analysis reports outcomes of 60 patients with a minimum follow-up of 12 months (median 47, range: 12-65). Twenty-six patients (43.3%) experienced a molecular relapse defined as the loss of a major molecular response (MMR). Relapses occurred after a median time of 4 months (range: 1-38). Cumulative incidences of molecular relapse by 12 and 48 months were 35% (95% confidence interval [CI], 24.79% to 49.41%) and 44.76% (95% CI, 33.35% to 59.91%), respectively. Treatment-free remission (TFR) rates at 12 and 48 months were 63.33% (95% CI, 51.14% to 75.53%) and 53.57% (95% CI, 40.49% to 66.65%), respectively. In univariate analysis, prior suboptimal response or TKI resistance was the only baseline factor associated with significantly worse outcome. A landmark analysis demonstrated that loss of MR4.5 3 months after stopping TKI was predictive of failure to maintain MMR later on. During the treatment-free phase, no progression toward advanced phase CML occurred, and all relapsing patients regained MMR and MR4.5 after restarting therapy. In conclusion, discontinuation of first-line or subsequent 2G-TKI yields promising TFR rates without safety concerns. Further research is encouraged to better define conditions that will offer patients the highest chance to remain free from 2G-TKI therapy.
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250
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Vinhas R, Cordeiro M, Pedrosa P, Fernandes AR, Baptista PV. Current trends in molecular diagnostics of chronic myeloid leukemia. Leuk Lymphoma 2016; 58:1791-1804. [PMID: 27919203 DOI: 10.1080/10428194.2016.1265116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nearly 1.5 million people worldwide suffer from chronic myeloid leukemia (CML), characterized by the genetic translocation t(9;22)(q34;q11.2), involving the fusion of the Abelson oncogene (ABL1) with the breakpoint cluster region (BCR) gene. Early onset diagnosis coupled to current therapeutics allow for a treatment success rate of 90, which has focused research on the development of novel diagnostics approaches. In this review, we present a critical perspective on current strategies for CML diagnostics, comparing to gold standard methodologies and with an eye on the future trends on nanotheranostics.
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Affiliation(s)
- Raquel Vinhas
- a Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, UCIBIO , Universidade Nova de Lisboa , Caparica , Portugal
| | - Milton Cordeiro
- a Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, UCIBIO , Universidade Nova de Lisboa , Caparica , Portugal
| | - Pedro Pedrosa
- a Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, UCIBIO , Universidade Nova de Lisboa , Caparica , Portugal
| | - Alexandra R Fernandes
- a Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, UCIBIO , Universidade Nova de Lisboa , Caparica , Portugal
| | - Pedro V Baptista
- a Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, UCIBIO , Universidade Nova de Lisboa , Caparica , Portugal
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