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Hu W, Wang X, Yang R, Bi L, Xie Y, Zhang Z, Lu H, Wu L. Expression of CD56 is a risk factor for acute lymphocytic leukemia with central nervous system involvement in adults. ACTA ACUST UNITED AC 2016; 22:81-87. [PMID: 27734763 DOI: 10.1080/10245332.2016.1238183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To gain further insights into the predisposing risk factors for central nervous system (CNS) involvement in patients with acute lymphocytic leukemia (ALL), the impact of CD56 expression in these patients was investigated. METHODS We reviewed the clinical features of CD56 expression in 588 consecutive ALL patients treated with systemic chemotherapy regimens between 2000 and 2014. The categorical data from CD56+ ALL patients were compared with those from CD56- ALL patients. RESULTS Among the 588 patients studied, 18.9% showed CD56 expression. The expression was significantly associated with CD33+, CD10-, CD15+, TdT-, and CD5+ immunophenotypes. After systemic chemotherapy, 8.8% patients showed CNS involvement, of which 3.2% exhibited combined recurrences and 5.6% exhibited isolated CNS involvement. The 5-year event-free survival was significantly lower for patients with CD56+ immunophenotype compared with patients with CD56- immunophenotype (22.5% vs. 32.7%, P = 0.04). Cumulative incidences of CNS involvement were significantly greater in the CD56+ cohort compared with the CD56- cohort (14.4% vs. 7.5%, P = 0.02). Multivariate analysis revealed CD56 expression to be statistically significant risk factors for CNS involvement. CONCLUSION CD56 expression should be regarded as an independent risk factor for ALL with CNS involvement in adults.
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Affiliation(s)
- Wangqiang Hu
- a Department of Laboratory Medicine , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
| | - Xiaoxia Wang
- a Department of Laboratory Medicine , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
| | - Rongrong Yang
- a Department of Laboratory Medicine , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
| | - Laixi Bi
- b Department of Hematology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
| | - Yaosheng Xie
- a Department of Laboratory Medicine , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
| | - Zhuo Zhang
- a Department of Laboratory Medicine , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
| | - Hong Lu
- a Department of Laboratory Medicine , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
| | - Lianfeng Wu
- a Department of Laboratory Medicine , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang Province , China
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202
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Minimal Residual Disease at First Achievement of Complete Remission Predicts Outcome in Adult Patients with Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia. PLoS One 2016; 11:e0163599. [PMID: 27695097 PMCID: PMC5047486 DOI: 10.1371/journal.pone.0163599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022] Open
Abstract
We evaluated the prognostic effect of minimal residual disease at first achievement of complete remission (MRD at CR1) in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL). A total of 97 patients received treatment in our center between 2007 and 2012 were retrospectively reviewed in this study. Patients were divided into two arms according to the post-remission therapy (chemotherapy alone or allogeneic hematopoietic stem cell transplantation (allo-HSCT)) they received. MRD was detected by four-color flow cytometry. We chose 0.02% and 0.2% as the cut-off points of MRD at CR1 for risk stratification using receiver operating characteristic analysis. The 3-year overall survival (OS) and leukemia free survival (LFS) rates for the whole cohort were 46.2% and 40.5%. MRD at CR1 had a significantly negative correlation with survival in both arms. Three-year OS rates in the chemotherapy arm were 70.0%, 25.2%, 0% (P = 0.003) for low, intermediate, and high levels of MRD at CR1, respectively. Three-year OS rates in the transplant arm were 81.8%, 64.3%, 27.3% (P = 0.005) for low, intermediate, and high levels of MRD at CR1, respectively. Multivariate analysis confirmed that higher level of MRD at CR1 was a significant adverse factor for OS and LFS. Compared with chemotherapy alone, allo-HSCT significantly improved LFS rates in patients with intermediate (P = 0.005) and high (P = 0.022) levels of MRD at CR1, but not patients with low level of MRD at CR1 (P = 0.851). These results suggested that MRD at CR1 could strongly predict the outcome of adult ALL. Patients with intermediate and high levels of MRD at CR1 would benefit from allo-HSCT.
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203
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Blinatumomab vs historical standard therapy of adult relapsed/refractory acute lymphoblastic leukemia. Blood Cancer J 2016; 6:e473. [PMID: 27662202 PMCID: PMC5056974 DOI: 10.1038/bcj.2016.84] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/28/2016] [Indexed: 12/19/2022] Open
Abstract
We compared outcomes from a single-arm study of blinatumomab in adult patients with B-precursor Ph-negative relapsed/refractory acute lymphoblastic leukemia (R/R ALL) with a historical data set from Europe and the United States. Estimates of complete remission (CR) and overall survival (OS) were weighted by the frequency distribution of prognostic factors in the blinatumomab trial. Outcomes were also compared between the trial and historical data using propensity score methods. The historical cohort included 694 patients with CR data and 1112 patients with OS data compared with 189 patients with CR and survival data in the blinatumomab trial. The weighted analysis revealed a CR rate of 24% (95% CI: 20–27%) and a median OS of 3.3 months (95% CI: 2.8–3.6) in the historical cohort compared with a CR/CRh rate of 43% (95% CI: 36–50%) and a median OS of 6.1 months (95% CI: 4.2–7.5) in the blinatumomab trial. Propensity score analysis estimated increased odds of CR/CRh (OR=2.68, 95% CI: 1.67–4.31) and improved OS (HR=0.536, 95% CI: 0.394–0.730) with blinatumomab. The analysis demonstrates the application of different study designs and statistical methods to compare novel therapies for R/R ALL with historical data.
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204
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Besbes S, Hamadou WS, Boulland ML, Lefranc MP, Ben Youssef Y, Achour B, Khelif A, Fest T, Soua Z. Combined IKZF1 and IG markers as new tools for diagnosis and minimal residual disease assessment in Tunisian B-ALL. Bull Cancer 2016; 103:822-828. [PMID: 27614734 DOI: 10.1016/j.bulcan.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/21/2016] [Accepted: 07/23/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The monitoring of minimal residual disease (MRD) approach in patients diagnosed with B-acute lymphoblastic leukemia (B-ALL) allows an early detection of residual clones inducing relapses and therefore appropriate therapy strategy. The molecular markers may identify and quantify the residual blasts in B-ALL with normal cytology. In this study, we aimed to use combined IKZF1, IGH and IGK immunoglobulin genes for diagnosis and MRD monitoring in B-ALL sample using MLPA, multiplex PCR and real-time quantitative PCR. MATERIAL We showed that multiplex PCR and MLPA are necessary and complementary to detect IKZF1 deletions. RESULTS We have identified at the diagnosis clonal IGH rearrangement (VH3-JH5) and IKZF1 deletion (Δ4-7), which we have used it for MRD evaluation after induction chemotherapy. Despite the absence of chromosome abnormality, the patient may be classified in high-risk group with a relapse rate of residual blasts>10-4 and sensitivity up to 10-5. This molecular approach enabled the patient's stratification, which was overlooked by classical methods. CONCLUSION The combined IKZF1 and immunoglobulin genes will be used as appropriate molecular tools for diagnosis and MRD assessment of B-lineage leukemias and introduced as a routine tests in Tunisian clinical laboratories. They will be useful to stratify patients into risk groups leading to better treatment strategy.
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Affiliation(s)
- Sawsen Besbes
- Université de Sousse, faculté de médecine, laboratoire de biochimie, unité de recherche 14 ES 19, 4000 Sousse, Tunisia
| | - Walid-Sabri Hamadou
- Université de Sousse, faculté de médecine, laboratoire de biochimie, unité de recherche 14 ES 19, 4000 Sousse, Tunisia
| | | | | | - Yosra Ben Youssef
- Université de Sousse, faculté de médecine, laboratoire de biochimie, unité de recherche 14 ES 19, 4000 Sousse, Tunisia; CHU F. Hached, service d'hématologie clinique, 4000 Sousse, Tunisia
| | - Béchir Achour
- CHU F. Hached, service d'hématologie clinique, 4000 Sousse, Tunisia
| | - Abderrahim Khelif
- Université de Sousse, faculté de médecine, laboratoire de biochimie, unité de recherche 14 ES 19, 4000 Sousse, Tunisia; CHU F. Hached, service d'hématologie clinique, 4000 Sousse, Tunisia
| | - Thierry Fest
- CHU Pontchaillou, service d'hématologie biologique, 35033 Rennes, France
| | - Zohra Soua
- Université de Sousse, faculté de médecine, laboratoire de biochimie, unité de recherche 14 ES 19, 4000 Sousse, Tunisia.
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205
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Ruella M, Barrett DM, Kenderian SS, Shestova O, Hofmann TJ, Perazzelli J, Klichinsky M, Aikawa V, Nazimuddin F, Kozlowski M, Scholler J, Lacey SF, Melenhorst JJ, Morrissette JJD, Christian DA, Hunter CA, Kalos M, Porter DL, June CH, Grupp SA, Gill S. Dual CD19 and CD123 targeting prevents antigen-loss relapses after CD19-directed immunotherapies. J Clin Invest 2016; 126:3814-3826. [PMID: 27571406 DOI: 10.1172/jci87366] [Citation(s) in RCA: 428] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022] Open
Abstract
Potent CD19-directed immunotherapies, such as chimeric antigen receptor T cells (CART) and blinatumomab, have drastically changed the outcome of patients with relapsed/refractory B cell acute lymphoblastic leukemia (B-ALL). However, CD19-negative relapses have emerged as a major problem that is observed in approximately 30% of treated patients. Developing approaches to preventing and treating antigen-loss escapes would therefore represent a vertical advance in the field. Here, we found that in primary patient samples, the IL-3 receptor α chain CD123 was highly expressed on leukemia-initiating cells and CD19-negative blasts in bulk B-ALL at baseline and at relapse after CART19 administration. Using intravital imaging in an antigen-loss CD19-negative relapse xenograft model, we determined that CART123, but not CART19, recognized leukemic blasts, established protracted synapses, and eradicated CD19-negative leukemia, leading to prolonged survival. Furthermore, combining CART19 and CART123 prevented antigen-loss relapses in xenograft models. Finally, we devised a dual CAR-expressing construct that combined CD19- and CD123-mediated T cell activation and demonstrated that it provides superior in vivo activity against B-ALL compared with single-expressing CART or pooled combination CART. In conclusion, these findings indicate that targeting CD19 and CD123 on leukemic blasts represents an effective strategy for treating and preventing antigen-loss relapses occurring after CD19-directed therapies.
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206
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Lee KJ, Chow V, Weissman A, Tulpule S, Aldoss I, Akhtari M. Clinical use of blinatumomab for B-cell acute lymphoblastic leukemia in adults. Ther Clin Risk Manag 2016; 12:1301-10. [PMID: 27601914 PMCID: PMC5003562 DOI: 10.2147/tcrm.s84261] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Adults with relapsed or refractory B-cell acute lymphoblastic leukemia have a dismal prognosis with a short median overall survival that can be measured in months. Because most patients will have chemotherapy-resistant disease, allogeneic hematopoietic stem cell transplantation remains the only potentially curative treatment. Despite advances in current management, patients continue to have poor outcomes and lack of durable responses. Thus, new therapies with alternative modes of actions are currently being investigated. Blinatumomab is a novel bispecific T-cell engager that simultaneously binds CD3-positive cytotoxic T-cells and CD19-positive B-cells, resulting in selective lysis of tumor cells. It has shown promising results in patients with relapsed or refractory acute lymphoblastic leukemia or those achieving hematologic response with persistent minimum residual disease. Future clinical trials will answer questions regarding its optimal place in the treatment paradigm. Dose-limiting toxicities include immunological toxicities and cytokine release syndrome. However, most patients tolerate the therapy relatively well. This review will focus on the pharmacology, clinical efficacy, and safety of blinatumomab in the treatment of adult B-cell acute lymphoblastic leukemia while highlighting its unique drug warnings and toxicity management.
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Affiliation(s)
- Kum Ja Lee
- Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California
| | - Vivian Chow
- Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California
| | - Ashley Weissman
- Department of Pharmacy, University of Southern California Norris Cancer Hospital, Los Angeles, CA
| | - Sunil Tulpule
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, NJ
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Mojtaba Akhtari
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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207
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Achieving Molecular Remission before Allogeneic Stem Cell Transplantation in Adult Patients with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia: Impact on Relapse and Long-Term Outcome. Biol Blood Marrow Transplant 2016; 22:1983-1987. [PMID: 27492792 DOI: 10.1016/j.bbmt.2016.07.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/22/2016] [Indexed: 01/21/2023]
Abstract
Allogeneic stem cell transplantation (alloHSCT) in first complete remission (CR1) remains the consolidation therapy of choice in Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL). The prognostic value of measurable levels of minimal residual disease (MRD) at time of conditioning is a matter of debate. We analyzed the predictive relevance of MRD levels before transplantation on the clinical outcome of Ph+ ALL patients treated with chemotherapy and imatinib in 2 consecutive prospective clinical trials. MRD evaluation before transplantation was available for 65 of the 73 patients who underwent an alloHSCT in CR1. A complete or major molecular response at time of conditioning was achieved in 24 patients (37%), whereas 41 (63%) remained carriers of any other positive MRD level in the bone marrow. MRD negativity at time of conditioning was associated with a significant benefit in terms of risk of relapse at 5 years, with a relapse incidence of 8% compared with 39% for patients with MRD positivity (P = .007). However, thanks to the post-transplantation use of tyrosine kinase inhibitors (TKIs), disease-free survival was 58% versus 41% (P = .17) and overall survival was 58% versus 49% (P = .55) in MRD-negative compared with MRD-positive patients, respectively. The cumulative incidence of nonrelapse mortality was similar in the 2 groups. Achieving a complete molecular remission before transplantation reduces the risk of leukemia relapse even though TKIs may still rescue some patients relapsing after transplantation.
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208
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Bennett AL, Williams LE, Ferguson MW, Hauck ML, Suter SE, Lanier CB, Hess PR. Canine acute leukaemia: 50 cases (1989-2014). Vet Comp Oncol 2016; 15:1101-1114. [PMID: 27402031 DOI: 10.1111/vco.12251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 12/15/2022]
Abstract
Acute leukaemia (AL) is a bone marrow malignancy of hematopoietic progenitors that historically is poorly responsive to treatment. With the widespread adoption of dose-intense chemotherapy, more human patients attain long-term survivals, but whether comparable progress has been made in canine AL is unknown. To investigate this question, medical records from three academic veterinary hospitals were reviewed. Fifty dogs met the criteria for AL, having excess circulating or marrow blasts, a major cytopenia(s), and no substantial lymphadenopathy. Thirty-six dogs received cytotoxic chemotherapy; 23 achieved a complete or partial response for a median of 56 days (range, 9-218). With failure or relapse, 14 dogs were rescued. Median survival with treatment was poor at 55 days (range, 1-300). Untreated (n = 6) and palliatively-treated (n = 8) dogs lived a median of 7.5 days. Most dogs developed chemoresistance within weeks of initiating treatment, and consequently, survival times for AL remain disappointingly short.
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Affiliation(s)
- A L Bennett
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - L E Williams
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - M W Ferguson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - M L Hauck
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - S E Suter
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - C B Lanier
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - P R Hess
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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209
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Blix ES, Husebekk A. Raiders of the lost mark - endothelial cells and their role in transplantation for hematologic malignancies. Leuk Lymphoma 2016; 57:2752-2762. [PMID: 27396981 DOI: 10.1080/10428194.2016.1201566] [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: 01/18/2023]
Abstract
Endothelial cells (EC) are crucial for normal angiogenesis and important for patients with leukemia, myeloma, and lymphoma during and after hematopoietic stem cell transplantation (HSCT). Knowledge of endothelial dysfunction in hematologic malignancies is provided by translational studies analyzing soluble endothelial markers, morphologic and functional changes of EC cultured in patients' sera or enumeration of circulating EC or endothelial progenitor cells (EPC). EC are important for stem cell homing and maintenance. Endothelial activation or damage is a central component in the pathogenesis of several complications after HSCT, like acute and chronic graft-versus-host disease, sinusoidal obstruction syndrome, capillary leak syndrome, engraftment syndrome, diffuse alveolar syndrome, idiopathic pneumonia syndrome, and transplant-associated microangiopathy. Finally, EC or EPC may facilitate tumor cell survival thus representing potential factors for both disease progression and relapse in hematologic malignancies.
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Affiliation(s)
- Egil S Blix
- a Immunology Research Group, Institute of Medical Biology , UiT the Arctic University of Norway , Tromsø , Norway.,b Department of Oncology , University Hospital of North Norway , Tromsø , Norway
| | - Anne Husebekk
- a Immunology Research Group, Institute of Medical Biology , UiT the Arctic University of Norway , Tromsø , Norway
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210
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Outcomes and Predictors of Mortality for Patients with Acute Leukemia Admitted to the Intensive Care Unit. Can Respir J 2016; 2016:3027656. [PMID: 27445524 PMCID: PMC4944052 DOI: 10.1155/2016/3027656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 01/05/2023] Open
Abstract
Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22–33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01–1.38) and invasive ventilation (OR 9.64, 95% CI 3.39–27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission. Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU.
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211
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Dussiau C, Trinquand A, Lhermitte L, Latiri M, Simonin M, Cieslak A, Bedjaoui N, Villarèse P, Verhoeyen E, Dombret H, Ifrah N, Macintyre E, Asnafi V. Targeting IRAK1 in T-cell acute lymphoblastic leukemia. Oncotarget 2016; 6:18956-65. [PMID: 26068967 PMCID: PMC4662467 DOI: 10.18632/oncotarget.4150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/20/2015] [Indexed: 01/28/2023] Open
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) represents expansion of cells arrested at specific stages of thymic development with the underlying genetic abnormality often determining the stage of maturation arrest. Although their outcome has been improved with current therapy, survival rates remain only around 50% at 5 years and patients may therefore benefit from specific targeted therapy. Interleukin receptor associated kinase 1 (IRAK1) is a ubiquitously expressed serine/threonine kinase that mediates signaling downstream to Toll-like (TLR) and Interleukin-1 Receptors (IL1R). Our data demonstrated that IRAK1 is overexpressed in all subtypes of T-ALL, compared to normal human thymic subpopulations, and is functional in T-ALL cell lines. Genetic knock-down of IRAK1 led to apoptosis, cell cycle disruption, diminished proliferation and reversal of corticosteroid resistance in T-ALL cell lines. However, pharmacological inhibition of IRAK1 using a small molecule inhibitor (IRAK1/4-Inh) only partially reproduced the results of the genetic knock-down. Altogether, our data suggest that IRAK1 is a candidate therapeutic target in T-ALL and highlight the requirement of next generation IRAK1 inhibitors.
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Affiliation(s)
- Charles Dussiau
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Amélie Trinquand
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Ludovic Lhermitte
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Mehdi Latiri
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Mathieu Simonin
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Agata Cieslak
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Nawel Bedjaoui
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Patrick Villarèse
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Els Verhoeyen
- CIRI, EVIR Team, INSERM, U1111, CNRS, UMR5308, Université de Lyon-1, ENS de Lyon, Lyon, France.,INSERM, U1065, C3M, Equipe "Contrôle Métabolique des Morts Cellulaires", Nice, France
| | - Hervé Dombret
- University Paris 7, Hôpital Saint-Louis, AP-HP, Department of Hematology and Institut Universitaire d'Hématologie, EA, Paris, France
| | - Norbert Ifrah
- PRES LUNAM, CHU Angers Service des Maladies du Sang et INSERM U892, Angers, France
| | - Elizabeth Macintyre
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Vahid Asnafi
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151 and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
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Higuchi Y, Tokunaga K, Watanabe Y, Kawakita T, Harada N, Yamaguchi S, Nosaka K, Mitsuya H, Asou N. Lineage switch with t(6;11)(q27;q23) from T-cell lymphoblastic lymphoma to acute monoblastic leukemia at relapse. Cancer Genet 2016; 209:267-71. [PMID: 27268298 DOI: 10.1016/j.cancergen.2016.05.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/18/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
Abstract
We present a patient with T-cell lymphoblastic lymphoma (T-LBL) harboring t(6;11)(q27;q23) that converted to acute monoblastic leukemia at relapse. A 27-year-old man developed T-LBL with a mediastinal mass. He exhibited several recurrences in the central nervous system and marrow. A fifth relapse occurred in the marrow, with 42.8% blasts with CD4, CD5, CD7, CD10, CD33, CD34, HLA-DR and cytoplasmic (cy) CD3. While achieving complete remission with nelarabine, sixth relapse occurred in the marrow with 6.8% blasts, which had characteristics of monoblastic features, 2 months later. Marrow blasts were positive for myeloperoxidase, CD4, CD33, CD56, CD64, and HLA-DR, but were negative for cyCD3, CD5, CD7, CD10, and CD34. Marrow cells at both the 5th lymphoid and 6th myeloid relapses had t(6;11)(q27;q23) and the same MLL-MLLT4 fusion transcript. In addition, the MLL-MLLT4 fusion sequences documented in the initial mediastinal cells were the same as seen in peripheral blood cells at the 6th relapse. The patient continues 7th remission after one course of gemtuzumab ozogamicin therapy followed by cord blood transplantation for more than 3 years. Sequential phenotypic and cytogenetic studies may yield valuable insights into the mechanism of leukemic recurrence and possible implications for treatment selection.
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Affiliation(s)
- Yusuke Higuchi
- Department of Hematology, Kumamoto University School of Medicine, Kumamoto
| | - Kenji Tokunaga
- Department of Hematology, Kumamoto University School of Medicine, Kumamoto
| | - Yuko Watanabe
- Department of Hematology, Kumamoto University School of Medicine, Kumamoto
| | - Toshiro Kawakita
- Department of Hematology, National Institute of Kumamoto Medical Center, Kumamoto
| | - Naoko Harada
- Department of Hematology, National Institute of Kumamoto Medical Center, Kumamoto
| | | | - Kisato Nosaka
- Cancer Center, Kumamoto University Hospital, Kumamoto
| | - Hiroaki Mitsuya
- Department of Hematology, Kumamoto University School of Medicine, Kumamoto
| | - Norio Asou
- Department of Hematology, Kumamoto University School of Medicine, Kumamoto; Department of Hematology, International Medical Center, Saitama Medical University, Saitama, Japan.
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213
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Genomic Profiling of Adult and Pediatric B-cell Acute Lymphoblastic Leukemia. EBioMedicine 2016; 8:173-183. [PMID: 27428428 PMCID: PMC4919728 DOI: 10.1016/j.ebiom.2016.04.038] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/11/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022] Open
Abstract
Genomic landscapes of 92 adult and 111 pediatric patients with B-cell acute lymphoblastic leukemia (B-ALL) were investigated using next-generation sequencing and copy number alteration analysis. Recurrent gene mutations and fusions were tested in an additional 87 adult and 93 pediatric patients. Among the 29 newly identified in-frame gene fusions, those involving MEF2D and ZNF384 were clinically relevant and were demonstrated to perturb B-cell differentiation, with EP300-ZNF384 inducing leukemia in mice. Eight gene expression subgroups associated with characteristic genetic abnormalities were identified, including leukemia with MEF2D and ZNF384 fusions in two distinct clusters. In subgroup G4 which was characterized by ERG deletion, DUX4-IGH fusion was detected in most cases. This comprehensive dataset allowed us to compare the features of molecular pathogenesis between adult and pediatric B-ALL and to identify signatures possibly related to the inferior outcome of adults to that of children. We found that, besides the known discrepancies in frequencies of prognostic markers, adult patients had more cooperative mutations and greater enrichment for alterations of epigenetic modifiers and genes linked to B-cell development, suggesting difference in the target cells of transformation between adult and pediatric patients and may explain in part the disparity in their responses to treatment. The genomic landscapes of adult and pediatric B-ALL were defined by next-generation sequencing of patient samples. MEF2D and ZNF384 fusions could perturb B-cell differentiation or induce leukemia in mice and exhibited clinical relevance. Adult patients showed greater enrichment for alterations of genes linked to epigenetic modification and B-cell development.
This study comprehensively addressed the genomic signatures of adult versus pediatric B-ALL. The identification of distinct MEF2D and ZNF384 fusions expands the existing knowledge about molecular subtypes of B-ALL in both age groups. RNA-seq data allowed most of the B-ALL cases to be clustered into 8 subgroups related to genetic abnormalities. Notably, adult patients have more cooperative sequence variation mutations than pediatric patients, especially in genes involved in epigenetic regulation and B-cell development. These findings may improve our understanding of leukemogenesis in B-ALL, leading to a more precise genetic classification and the further development of targeted therapy in this disease.
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214
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Adult Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Daily Practice: A Multicenter Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:269-74. [DOI: 10.1016/j.clml.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/08/2016] [Accepted: 01/27/2016] [Indexed: 11/19/2022]
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215
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A six gene expression signature defines aggressive subtypes and predicts outcome in childhood and adult acute lymphoblastic leukemia. Oncotarget 2016; 6:16527-42. [PMID: 26001296 PMCID: PMC4599287 DOI: 10.18632/oncotarget.4113] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/22/2015] [Indexed: 11/25/2022] Open
Abstract
Abnormal gene expression in cancer represents an under-explored source of cancer markers and therapeutic targets. In order to identify gene expression signatures associated with survival in acute lymphoblastic leukemia (ALL), a strategy was designed to search for aberrant gene activity, which consists of applying several filters to transcriptomic datasets from two pediatric ALL studies. Six genes whose expression in leukemic blasts was associated with prognosis were identified:three genes predicting poor prognosis (AK022211, FASTKD1 and STARD4) and three genes associated with a favorable outcome (CAMSAP1, PCGF6 and SH3RF3). Combining the expression of these 6 genes could successfully predict prognosis not only in the two discovery pediatric ALL studies, but also in two independent validation cohorts of adult patients, one from a publicly available study and one consisting of 62 newly recruited Chinese patients. Moreover, our data demonstrate that our six gene based test is particularly efficient in stratifying MLL or BCR.ABL negative patients. Finally, common biological traits characterizing aggressive forms of ALL in both children and adults were found, including features of dormant hematopoietic stem cells, suggesting new therapeutic strategies.
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216
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Sang W, Wang Y, Zhang C, Yan D, Niu M, Yang C, Liu X, Sun C, Zhang Z, Loughran TP, Xu K. Fludarabine, idarubicin, and cytarabine regimen together with TKI followed by haploidentical hematopoietic stem cell transplantation, a success for relapsed Ph+ acute lymphoblastic leukemia. Clin Case Rep 2016; 4:390-5. [PMID: 27099735 PMCID: PMC4831391 DOI: 10.1002/ccr3.438] [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: 02/05/2015] [Revised: 07/07/2015] [Accepted: 10/07/2015] [Indexed: 11/11/2022] Open
Abstract
In this report, a case of relapsed Ph+ ALL was remedied by reinduction, and consolidation regimen of TKI and Flu+ Ara-C+ IDA (FLAI) combination, followed by haploidentical SCT. Results suggest that FLAI together with TKI and subsequently with haploidentical SCT could be applied for relapsed Ph+ ALL.
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Affiliation(s)
- Wei Sang
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Ying Wang
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Cong Zhang
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Dongmei Yan
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Mingshan Niu
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Chun Yang
- Department of Radiology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Xia Liu
- Department of Pathology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Cai Sun
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Zhe Zhang
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
| | - Thomas P Loughran
- Department of Medicine University of Virginia Cancer Center Charlottesville Virginia
| | - Kailin Xu
- Department of Hematology Affiliated Hospital of Xuzhou Medical College Xuzhou China
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217
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Hoelzer D. Monitoring and managing minimal residual disease in acute lymphoblastic leukemia. Am Soc Clin Oncol Educ Book 2016:290-3. [PMID: 23714526 DOI: 10.14694/edbook_am.2013.33.290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In adult acute lymphoblastic leukemia (ALL) the complete remission (CR) rates have improved to 85% to 90%. Despite this high CR rate, 40% to 50% of patients eventually relapse. This occurs because of the limited sensitivity of cytomorphology in assessing complete molecular remission. Thus, more sensitive methods that detect leukemic cells on a molecular level and identify minimal residual disease are needed.
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218
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Yang T, Yao S, Zhang X, Guo Y. Andrographolide inhibits growth of human T-cell acute lymphoblastic leukemia Jurkat cells by downregulation of PI3K/AKT and upregulation of p38 MAPK pathways. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1389-97. [PMID: 27114702 PMCID: PMC4833376 DOI: 10.2147/dddt.s94983] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) as a prevalent hematologic malignancy is one of the most common malignant tumors worldwide in children. Andrographolide (Andro), the major active component from Andrographis paniculata, has been shown to possess antitumor activities in several types of cancer cells. However, whether Andro would inhibit T-ALL cell growth remains unclear. In this study, we investigated the cytotoxic effect of Andro on human T-ALL Jurkat cells and explored the mechanisms of cell death. Cell apoptosis was assayed by flow cytometry, and the signaling transduction for Andro was analyzed by Western blotting. The results indicated 10 μg/mL Andro could significantly induce Jurkat cells’ apoptosis, depending on the inhibition of PI3K/AKT pathway. Moreover, Andro-induced apoptosis is enhanced by AKT-selective inhibitor LY294002. ERK- or JNK-selective inhibitors PD98059 and SP600125 had no effect on Andro-induced apoptosis. In addition, p38 inhibitor SB203580 could reverse Andro-induced apoptosis in Jurkat cells. We also found that the protein expression of p-p53 and p-p38 were increased after Andro treatments. The result of an in vivo study also demonstrated Andro’s dose-dependent inhibition in subcutaneous Jurkat xenografts. In conclusion, our findings explained a novel mechanism of drug action by Andro in Jurkat cells and suggested that Andro might be developed into a new candidate therapy for T-ALL patients in the coming days.
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Affiliation(s)
- Tingfang Yang
- Department of Pediatrics, Jining No 1 People's Hospital, Shandong Province, People's Republic of China
| | - Shuluan Yao
- Department of Respiratory Medicine, Jining Medical University Affiliated Hospital, Shandong Province, People's Republic of China
| | - Xianfeng Zhang
- Department of Psychiatry, Jining Psychiatric Hospital, Shandong Province, People's Republic of China
| | - Yan Guo
- Department of Respiratory Medicine, Jining Medical University Affiliated Hospital, Shandong Province, People's Republic of China
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219
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Hoelzer D, Bassan R, Dombret H, Fielding A, Ribera JM, Buske C. Acute lymphoblastic leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27:v69-v82. [PMID: 27056999 DOI: 10.1093/annonc/mdw025] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- D Hoelzer
- ONKOLOGIKUM Frankfurt am Museumsufer, Frankfurt, Germany
| | - R Bassan
- Hematology Unit, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - H Dombret
- Institut Universitaire d'Hematologie Hopital St Louis, Paris, France
| | - A Fielding
- Cancer Institute, University College London, London, UK
| | - J M Ribera
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - C Buske
- CCC Ulm, Institut für Experimentelle Tumorforschung, Universitätsklinikum Ulm, Ulm, Germany
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220
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Numata A, Fujisawa S, Itabashi M, Ishii Y, Yamamoto W, Motohashi K, Matsumoto K, Hagihara M, Nakajima H. Favorable prognosis in Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia patients following hematopoietic stem cell transplantation. Clin Transplant 2016; 30:485-6. [PMID: 26990549 DOI: 10.1111/ctr.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ayumi Numata
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Shin Fujisawa
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Megumi Itabashi
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshimi Ishii
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Wataru Yamamoto
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenji Motohashi
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenji Matsumoto
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Maki Hagihara
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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221
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Bassan R, Spinelli O. Minimal Residual Disease Monitoring in Adult ALL to Determine Therapy. Curr Hematol Malig Rep 2016; 10:86-95. [PMID: 25929769 DOI: 10.1007/s11899-015-0252-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Almost 90 % of children and 50 % of adults with acute lymphoblastic leukemia (ALL) are cured by modern treatment regimens, with significant variations due to several disease- and host-related characteristics. The attainment of an early remission and the avoidance of relapse and treatment-related mortality are the fundamental therapeutic steps. In remission patients, the assessment of the disease response to early intensive therapy through the detection and monitoring of minimal residual disease (MRD) can accurately refine the individual prognosis and is increasingly used to support a risk-oriented treatment strategy. In this way, only the patients with an unfavorable MRD response are preferably selected for allogeneic stem cell transplantation, irrespective of their clinical risk class. This choice spares transplant-related toxicities to MRD responsive cases. Further advancement is expected by integrating the MRD analysis with improved pediatric-type regimens and novel targeting agents for ALL subsets at higher risk of relapse.
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Affiliation(s)
- Renato Bassan
- UOC Ematologia, Ospedale dell'Angelo, Via Paccagnella 11, 30174, Mestre-Venezia, Italy,
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222
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Affiliation(s)
- Dieter Hoelzer
- Onkologikum Frankfurt am Museumsufer, Frankfurt, Germany
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223
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Tekgündüz E, Kaynar L, Göker H, Kaya AH, Turak EE, Eliaçık E, Kayıkçı Ö, Çetin M, Büyükaşık Y, Eser B, Altuntaş F. Retrospective analysis of adult patients with acute lymphoblastic leukemia undergoing allogeneic hematopoietic cell transplantation: A multicenter experience of daily practice. Transfus Apher Sci 2016; 54:41-7. [PMID: 26810140 DOI: 10.1016/j.transci.2016.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Compared to pediatric age group, the prognosis of adult acute lymphoblastic leukemia (ALL) is still dismal even in patients receiving allogeneic hematopoietic cell transplantation (AHCT). We retrospectively analyzed 205 adults (male: 122; female: 83) with ALL who underwent AHCT. Median age of patients was 28 (18-59). Fifty-two patients had Ph(+) ALL. The estimated relapse-free and overall survival (OS) of the study cohort at 1, 2 and 3 years were 52.3%/63.9%, 42.9%/49.5% and 39.9%/45.6%, respectively. On multivariate analysis, first complete remission at the time of AHCT, TBI-based conditioning and development of chronic graft-versus-host disease were only factors, which were significantly associated with prolonged OS.
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Affiliation(s)
- Emre Tekgündüz
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey.
| | - Leylagül Kaynar
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hakan Göker
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ali Hakan Kaya
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Esra Ermiş Turak
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Eylem Eliaçık
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ömür Kayıkçı
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Mustafa Çetin
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Yahya Büyükaşık
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Bülent Eser
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Fevzi Altuntaş
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey; Division of Hematology, Department of Internal Medicine, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey
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224
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Engert A, Balduini C, Brand A, Coiffier B, Cordonnier C, Döhner H, de Wit TD, Eichinger S, Fibbe W, Green T, de Haas F, Iolascon A, Jaffredo T, Rodeghiero F, Salles G, Schuringa JJ. The European Hematology Association Roadmap for European Hematology Research: a consensus document. Haematologica 2016; 101:115-208. [PMID: 26819058 PMCID: PMC4938336 DOI: 10.3324/haematol.2015.136739] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/27/2016] [Indexed: 01/28/2023] Open
Abstract
The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap.The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders.The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients.
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Affiliation(s)
| | | | - Anneke Brand
- Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | | | | | | | | | | | - Willem Fibbe
- Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - Tony Green
- Cambridge Institute for Medical Research, United Kingdom
| | - Fleur de Haas
- European Hematology Association, The Hague, the Netherlands
| | | | | | | | - Gilles Salles
- Hospices Civils de Lyon/Université de Lyon, Pierre-Bénite, France
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225
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George B, Kantarjian H, Jabbour E, Jain N. Role of inotuzumab ozogamicin in the treatment of relapsed/refractory acute lymphoblastic leukemia. Immunotherapy 2016; 8:135-43. [PMID: 26780449 PMCID: PMC5618942 DOI: 10.2217/imt.15.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/03/2015] [Indexed: 02/07/2023] Open
Abstract
Inotuzumab ozogamicin is a humanized anti-CD22 monoclonal antibody bound to a toxic natural calicheamicin, which is under investigation for the treatment of relapsed/refractory acute lymphoblastic leukemia. CD22 is commonly expressed in 90-100% of malignant mature B-lymphocyte lineage. The first Phase II study with inotuzumab ozogamicin conducted by Kantarjian et al. gave the opportunity for heavily pretreated patients with acute lymphoblastic leukemia to go for allogeneic stem cell transplant. Inotuzumab is well-tolerated with the exception of veno-occlusive disease. Overall inotuzumab ozogamicin is potentially an encouraging and promising therapy for patients.
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Affiliation(s)
- Binsah George
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Elias Jabbour
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Nitin Jain
- Department of Leukemia, MD Anderson Cancer Centre, Houston, TX 77030, USA
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226
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Roboz GJ, Montesinos P, Selleslag D, Wei A, Jang JH, Falantes J, Voso MT, Sayar H, Porkka K, Marlton P, Almeida A, Mohan S, Ravandi F, Garcia-Manero G, Skikne B, Kantarjian H. Design of the randomized, Phase III, QUAZAR AML Maintenance trial of CC-486 (oral azacitidine) maintenance therapy in acute myeloid leukemia. Future Oncol 2016; 12:293-302. [PMID: 26785287 PMCID: PMC5684733 DOI: 10.2217/fon.15.326] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Older patients with acute myeloid leukemia (AML) have worse rates of complete remission and shorter overall survival than younger patients. The epigenetic modifier CC-486 is an oral formulation of azacitidine with promising clinical activity in patients with AML in Phase I studies. The Phase III, randomized, double-blind, placebo-controlled QUAZAR AML Maintenance trial (CC-486-AML-001) examines CC-486 maintenance therapy (300 mg/day for 14 days of 28-day treatment cycles) for patients aged ≥55 years with AML in first complete remission. The primary end point is overall survival. Secondary end points include relapse-free survival, safety, health-related quality of life and healthcare resource utilization. This trial will investigate whether CC-486 maintenance can prolong remission and improve survival for older patients with AML.
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Affiliation(s)
- Gail J Roboz
- Weill Medical College of Cornell University & New York-Presbyterian Hospital, New York, NY, USA
| | - Pau Montesinos
- Hospital Univeritari I Politecnic La Fe de Valencia, Valencia, Spain
| | | | - Andrew Wei
- The Alfred Hospital & Monash University, Melbourne, Australia
| | | | - Jose Falantes
- Hospital Universitario Virgen del Rocio & Instituto de Biomedicinia de Sevilla, Seville, Spain
| | - Maria T Voso
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Hamid Sayar
- Indiana University Cancer Center, Indianapolis, IN, USA
| | - Kimmo Porkka
- Helsinki University Central Hospital, Helsinki, Finland
| | - Paula Marlton
- Princess Alexandra Hospital, University of Queensland School of Medicine, Brisbane, Australia
| | - Antonio Almeida
- Instituto Portugues de Oncologia Francisco Gentil, Lisbon, Portugal
| | - Sanjay Mohan
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Farhad Ravandi
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Hagop Kantarjian
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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227
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Kapelko-Slowik K, Owczarek TB, Grzymajlo K, Urbaniak-Kujda D, Jazwiec B, Slowik M, Kuliczkowski K, Ugorski M. Elevated PIM2 gene expression is associated with poor survival of patients with acute myeloid leukemia. Leuk Lymphoma 2016; 57:2140-9. [PMID: 26764044 DOI: 10.3109/10428194.2015.1124991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The PIM2 gene encodes the serine/threonine kinase involved in cell survival and apoptosis. The aim of the study was to evaluate the expression of the PIM2 gene in acute myeloid leukemia (AML) and to examine its role in apoptosis of the blastic cells. We analyzed the PIM2 expression in 148 patients: 91 with AML, 57 with acute lymphoblastic leukemia and 24 healthy controls by Real-Time PCR and Western blot. Inhibition of the PIM2 gene in human leukemic HL60 cell line was performed with RNAi and apoptosis rate was analyzed. Our results indicate that overexpression of PIM2 in AML is associated with low complete remission rate, high-risk cytogenetics, shorter leukemia-free survival, and event-free survival. Cytometric analysis of HL60/PAC-GFP and HL60/PAC-GFP-shPIM2 cells revealed an increase in the number of apoptotic cells after inhibition of PIM2 gene. In summary, the elevated expression of PIM2 in blastic cells is associated with poor prognosis of AML patients and their resistance to induction therapy.
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Affiliation(s)
- Katarzyna Kapelko-Slowik
- a Department of Hematology, Neoplastic Blood Disorders and Bone Marrow Transplantation , Wroclaw Medical University , Wroclaw , Poland
| | - Tomasz B Owczarek
- b Ludwik Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences , Wroclaw , Poland ;,c Department of Biochemistry, Pharmacology and Toxicology , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Krzysztof Grzymajlo
- c Department of Biochemistry, Pharmacology and Toxicology , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Donata Urbaniak-Kujda
- a Department of Hematology, Neoplastic Blood Disorders and Bone Marrow Transplantation , Wroclaw Medical University , Wroclaw , Poland
| | - Bozena Jazwiec
- a Department of Hematology, Neoplastic Blood Disorders and Bone Marrow Transplantation , Wroclaw Medical University , Wroclaw , Poland
| | - Miroslaw Slowik
- d Department of Ophthalmology , Wroclaw Medical University , Wroclaw , Poland
| | - Kazimierz Kuliczkowski
- a Department of Hematology, Neoplastic Blood Disorders and Bone Marrow Transplantation , Wroclaw Medical University , Wroclaw , Poland
| | - Maciej Ugorski
- b Ludwik Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences , Wroclaw , Poland ;,c Department of Biochemistry, Pharmacology and Toxicology , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
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Cohen YC, Joffe E, Benyamini N, Dimopoulos MA, Terpos E, Trestman S, Held-Kuznetsov V, Avivi I, Kastritis E. Primary failure of bortezomib in newly diagnosed multiple myeloma – understanding the magnitude, predictors, and significance. Leuk Lymphoma 2016; 57:1382-8. [PMID: 26727104 DOI: 10.3109/10428194.2015.1121258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yael C Cohen
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | - Erel Joffe
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | - Noam Benyamini
- b Department of Hematology , Rambam Medical Center , Technion , Israel
| | - Meletios A Dimopoulos
- c Department of Clinical Therapeutics , National & Kapodistrian University of Athens School of Medicine , Athens , Greece
| | - Evangelos Terpos
- c Department of Clinical Therapeutics , National & Kapodistrian University of Athens School of Medicine , Athens , Greece
| | - Svetlana Trestman
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | | | - Irit Avivi
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | - Efstathios Kastritis
- c Department of Clinical Therapeutics , National & Kapodistrian University of Athens School of Medicine , Athens , Greece
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229
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Hladnik L, Augustin K, DeFrates S. Advancements in Therapy for Acute Lymphoblastic Leukemia: Blinatumomab. J Adv Pract Oncol 2016; 7:76-82. [PMID: 27713846 PMCID: PMC5045280 DOI: 10.6004/jadpro.2016.7.1.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lindsay Hladnik
- 1Washington University Medical School, St. Louis, Missouri; 2Barnes-Jewish Hospital, St. Louis, Missouri; 3Northwestern Memorial Hospital, Chicago, Illinois
| | - Kristan Augustin
- 1Washington University Medical School, St. Louis, Missouri; 2Barnes-Jewish Hospital, St. Louis, Missouri; 3Northwestern Memorial Hospital, Chicago, Illinois
| | - Sean DeFrates
- 1Washington University Medical School, St. Louis, Missouri; 2Barnes-Jewish Hospital, St. Louis, Missouri; 3Northwestern Memorial Hospital, Chicago, Illinois
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230
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Giaccone L, Audisio E, Bruno B, Maffini E, D'Ardia S, Caracciolo D, Ferrando F, Butera S, Brunello L, Frairia C, Aydin S, Nicolino B, Festuccia M, Crisà E, Bruna R, Passera R, Boccadoro M, Vitolo U, Busca A, Falda M, Marmont F. Role of Chemotherapy and Allografting in the Treatment of Acute Lymphoblastic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 16:96-103. [PMID: 26711180 DOI: 10.1016/j.clml.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/26/2015] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Abstract
We report the clinical outcomes of 83 patients with acute lymphoblastic leukemia (median age, 46 years; range, 18-75 years) treated at our institution between 1999 and 2011. Treatment refers to clinical trials open for accrual at the time of diagnosis or to institutional guidelines. Upfront allografting was considered for younger high-risk patients. Seventy-eight of 83 (94%) patients achieved complete remission after induction, although 53% of them eventually relapsed. Forty of 70 patients younger than 61 years underwent allografting. The median follow-up was 7.4 years (range, 0.2-15.0 years). Overall, the 5-year overall survival (OS) and event-free survival (EFS) were 40% and 39%, respectively. In patients undergoing transplantation, OS and EFS at 5 years were both 53%, whereas in a nontransplantation setting, both OS and EFS were 35% at 5 years (P = .044 for both OS and EFS). By multivariate analysis, the independent predictors of OS and EFS were age and leukocytosis in the overall population and allografting in young patients.
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Affiliation(s)
- Luisa Giaccone
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Scuola di Medicina, Torino, Italy.
| | - Ernesta Audisio
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Benedetto Bruno
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Scuola di Medicina, Torino, Italy
| | - Enrico Maffini
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano D'Ardia
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Caracciolo
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Ferrando
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sara Butera
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Brunello
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Frairia
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Semra Aydin
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Barbara Nicolino
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Moreno Festuccia
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Elena Crisà
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Riccardo Bruna
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Scuola di Medicina, Torino, Italy
| | - Roberto Passera
- Divisione di Medicina Nucleare 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Umberto Vitolo
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Busca
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michele Falda
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Filippo Marmont
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
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Abstract
Acute lymphoblastic leukemia (ALL) is the most frequent malignant disease in childhood. In adults ALL comprises approximately 20 % of all forms of acute leukemia. In recent years substantial progress has been made with respect to the characterization and therapy optimization based on consecutive therapy optimization studies with increasingly more individualized, risk-adapted therapy protocols. Approximately 90 % of adult ALL patients under 55-65 years can now achieve complete remission. The chance of cure for adults could be increased over the last 30 years from less than 10 % to more than 50 %. Fundamental for the improvement of therapy results were an optimization of intensive chemotherapy and supportive treatment, integration of stem cell transplantation into the first-line treatment, inclusion of targeted substances in the therapy concept and improved risk stratification in consideration of the course of the minimal residual disease. Due to individualized therapeutic decisions current therapy protocols are very complex and can only be adequately carried out in specialized centers. Future challenges include further optimization of therapy in older patients and treatment of patients refractory to chemotherapy. In Germany the majority of adult patients are treated according to protocols of the German multicenter study group for adult ALL (GMALL).
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232
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CRLF2 overexpression identifies an unfavourable subgroup of adult B-cell precursor acute lymphoblastic leukemia lacking recurrent genetic abnormalities. Leuk Res 2015; 41:36-42. [PMID: 26754556 DOI: 10.1016/j.leukres.2015.11.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/28/2015] [Accepted: 11/30/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND A deregulated CRLF2 (d-CRLF2) expression was described in B-cell acute lymphoblastic leukemia without recurrent fusion genes (B-NEG ALL). While the role of d-CRLF2 in children has been extensively described, little is known about its role and impact in adult ALL. METHODS Expression levels of CRLF2 were evaluated by quantitative real-time PCR in 102 newly-diagnosed adult B-NEG ALL and correlated with the clinico-biological characteristics and outcome. Incidence and clinical impact of the P2RY8/CRLF2 transcript was also assessed. RESULTS High CRLF2 levels, as continuous variable, were significantly associated with hyperleucocytosis (p=0.0002) and thrombocytopenia (p=0.005); when a cut-point at ΔCt≤8 was applied, 35 cases (34.3%), mostly males (80%), proved positive for CRLF2 expression. High CRLF2 levels, as continuous or categorical variable, were associated with a worse disease-free (p=0.003 and p=0.015) and overall survival (p=0.017 and 0.0038). Furthermore, when CRLF2 was analyzed as a categorical variable, a high statistical association was found with IKZF1 deletion and mutations in the JAK/STAT pathway (p=0.001 and p<0.0001, respectively). Finally, the P2RY8/CRLF2 transcript, identified in 8/102 patients (7.8%), was associated with a poor outcome. CONCLUSIONS In adult B-NEG ALL, high CRLF2 expression is associated with distinct clinico-biological features and an unfavourable prognosis in both univariate and multivariate analysis; similarly, P2RY8/CRLF2 positivity correlates with a poor outcome. The quantification of CRLF2 is an important prognostic marker in adult B-lineage ALL without known genetic lesions.
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233
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López-Martínez B, Vilchis Ordoñez A, Salazar Garcia M, Klünder-Klünder M, Parra-Ortega I, Dorantes-Acosta E, Angeles-Floriano T. Thymidine Kinase: A Biomarker for Recently Diagnosed Acute Leukemia in Pediatric Patients According to the Cell Line Involved. Arch Med Res 2015; 46:630-4. [PMID: 26656666 DOI: 10.1016/j.arcmed.2015.11.005] [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] [Received: 05/25/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Acute leukemia (AL) is a heterogeneous group of diseases characterized by a disorganized clone proliferation of hematopoietic cells. Thymidine kinase (TK) is a cell enzyme involved in DNA synthesis and is considered a cellular proliferation marker in some solid tumors. METHODS A cross-sectional prospective and comparative study was performed in the Federico Gomez Children's Hospital in Mexico (HIMFG, in Spanish) in 125 samples of patients of the HIMFG with AL and 138 samples of children without leukemia. Serum TK levels were determined for both groups. RESULTS Of the children with AL, 90 presented B-cell acute lymphoblastic leukemia (B-ALL); 13, T-cell acute lymphoblastic leukemia (T-ALL); and 22, acute myeloid leukemia (AML). A median (m) TK level of 23.7 IU (IQR 17-35.7) was observed in the group without AL and 91 IU (IQR 98-392) in the AL group. This difference was statistically significant (p <0.0001). When analyzing TK levels according to the type of leukemia, the m was as follows: 68 IU (IQR 35-118) for B-ALL, 470 IU (IQR 88-750) for AML, and 1678 IU (IQR 288-2108) for T- ALL. CONCLUSION TK is an enzyme showing heterogeneous levels in B-ALL although it is significantly increased in 90% of patients with T-ALL and AML.
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Affiliation(s)
- Briceida López-Martínez
- Division of Auxiliary Diagnostic Services, Hospital Infantil de México Federico Gómez, México, D.F., México
| | - Armando Vilchis Ordoñez
- Department of Clinical Laboratory, Hospital Infantil de México Federico Gómez, México, D.F., México
| | - Marcela Salazar Garcia
- Research Laboratory in Developmental Biology and Experimental Teratogenesis, Hospital Infantil de México Federico Gómez, México, D.F., México
| | - Miguel Klünder-Klünder
- Research Department in Community Health, Hospital Infantil de México Federico Gómez, México, D.F., México
| | - Israel Parra-Ortega
- Department of Clinical Laboratory, Hospital Infantil de México Federico Gómez, México, D.F., México
| | - Elisa Dorantes-Acosta
- Hematology-Oncology Department, Hospital Infantil de México Federico Gómez, México, D.F., México
| | - Tania Angeles-Floriano
- Department of Clinical Laboratory, Hospital Infantil de México Federico Gómez, México, D.F., México.
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234
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Bassan R. Using Minimal Residual Disease to Improve Treatment Response Definitions and Hematopoietic Cell Transplantation Strategy in Acute Leukemia. J Clin Oncol 2015; 34:300-2. [PMID: 26668347 DOI: 10.1200/jco.2015.64.8907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Renato Bassan
- UOC Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy.
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235
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Tosello V, Bordin F, Yu J, Agnusdei V, Indraccolo S, Basso G, Amadori A, Piovan E. Calcineurin and GSK-3 inhibition sensitizes T-cell acute lymphoblastic leukemia cells to apoptosis through X-linked inhibitor of apoptosis protein degradation. Leukemia 2015; 30:812-22. [PMID: 26648536 DOI: 10.1038/leu.2015.335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/20/2015] [Accepted: 11/24/2015] [Indexed: 12/26/2022]
Abstract
The calcineurin (Cn)-nuclear factor of activated T cells signaling pathway is critically involved in many aspects of normal T-cell physiology; however, its direct implication in leukemogenesis is still ill-defined. Glycogen synthase kinase-3β (GSK-3β) has recently been reported to interact with Cn in neuronal cells and is implicated in MLL leukemia. Our biochemical studies clearly demonstrated that Cn was able to interact with GSK-3β in T-cell acute lymphoblastic leukemia (T-ALL) cells, and that this interaction was direct, leading to an increased catalytic activity of GSK-3β, possibly through autophosphorylation of Y216. Sensitivity to GSK-3 inhibitor treatment correlated with altered GSK-3β phosphorylation and was more prominent in T-ALL with Pre/Pro immunophenotype. In addition, dual Cn and GSK-3 inhibitor treatment in T-ALL cells promoted sensitization to apoptosis through proteasomal degradation of X-linked inhibitor of apoptosis protein (XIAP). Consistently, resistance to drug treatments in primary samples was strongly associated with higher XIAP protein levels. Finally, we showed that dual Cn and GSK-3 inhibitor treatment in vitro and in vivo is effective against available models of T-ALL, indicating an insofar untapped therapeutic opportunity.
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Affiliation(s)
- V Tosello
- UOC Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - F Bordin
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Universita' di Padova, Padova, Italy
| | - J Yu
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,Department of Systems Biology, Columbia University, New York, NY, USA
| | - V Agnusdei
- UOC Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - S Indraccolo
- UOC Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - G Basso
- Dipartimento di Salute della Donna e del Bambino, Università di Padova, Padova, Italy
| | - A Amadori
- UOC Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy.,Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Universita' di Padova, Padova, Italy
| | - E Piovan
- UOC Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy.,Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Universita' di Padova, Padova, Italy
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236
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Feasibility and results of subtype-oriented protocols in older adults and fit elderly patients with acute lymphoblastic leukemia: Results of three prospective parallel trials from the PETHEMA group. Leuk Res 2015; 41:12-20. [PMID: 26686475 DOI: 10.1016/j.leukres.2015.11.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 10/27/2015] [Accepted: 11/19/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The prognosis of acute lymphoblastic leukemia (ALL) is poor in older adults and elderly patients, and subtype-oriented prospective trials are scarce in these patients. We present the results of three prospective parallel subtype-oriented protocols in fit patients older than 55 years. PATIENTS AND METHODS In 2008, three prospective phase II trials in patients older than 55 years were activated: ALLOLD07 for Philadephia (Ph) chromosome-negative ALL, ALLOPH07 for Ph-positive ALL, and BURKIMAB08 for mature B-ALL. Early death (ED), complete remission (CR), disease-free survival (DFS), overall survival (OS) and toxicity were analyzed. RESULTS 56, 53 and 21 patients from the ALLOLD07, ALLOPH07 and BURKIMAB08 trials, respectively, were evaluable. CR was 74%, 87% and 70%, with an ED rate of 13%, 11% and 15%, respectively. The medians of DFS were 8 and 38 months for ALLOLD07 and ALLOPH07 protocols, not being achieved in the BURKIMAB08 trial (p=0.001), and the median OS was 12, 37 and 25 months, respectively (p=0.030). Neutropenia, thrombocytopenia and infections were less frequent in the ALLOPH07 trial vs. ALLOLD07 and BURKIMAB trials, and renal toxicity and mucositis were more frequent in the BURKIMAB08 trial vs. the ALLOLD07 and ALLOPH07 trials. ECOG score and WBC count had prognostic significance for OS in ALLOPH07 and BURKIMAB08 trials, whereas no prognostic factors were identified in ALLOLD07 protocol. CONCLUSION Subtype-oriented treatment had an impact in the outcome of older adults with ALL. The poorest outcome was observed in Ph-negative non-Mature B-cell ALL patients, for whom improvements in therapy are clearly needed.
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237
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Saltman D, Barlev A, Seshagiri D, Katsoulis I, Lin V, Barber B. Management and treatment of relapsed or refractory Ph(-) B-precursor ALL: a web-based, double-blind survey of EU clinicians. BMC Cancer 2015; 15:771. [PMID: 26498125 PMCID: PMC4619337 DOI: 10.1186/s12885-015-1745-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 10/09/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The prognosis for adult patients with Ph(-) B-precursor acute lymphoblastic leukaemia (ALL) who are refractory to treatment or experience relapse (R/R), is poor; over 90% of these patients die from the disease, typically within a few months. While there are some national guidelines published for the treatment of adult patients with ALL, and local working group recommendations do exist, there is very little detail and no preferred treatment regimens for adult patients with R/R Ph(-) B-precursor ALL. The aim of this study was to describe current real-world clinical practice in Europe for the management and treatment of adult R/R Ph(-) B-precursor ALL. METHODS A web-based, double-blind survey was conducted in November/December 2013 in France, Germany, Italy, Spain, and the UK. The survey was developed following consultation with specialist clinicians and a critical review of published literature. Eligible clinicians (15 per country) were board-certified in haemato-oncology or haematology; had at least 4 years of experience in their current role and had treated at least five patients with adult ALL in the 36 months before the survey, including at least one with R/R Ph(-) B-precursor ALL. RESULTS Clinicians across the five countries consulted 16 guidelines and local working group recommendations for the diagnosis and treatment of R/R Ph(-) B-precursor ALL. Thirty three regimens for salvage therapy were reported; the most frequently cited was augmented hyper-CVAD (15%), with vincristine the most commonly used agent. Salvage therapy regimens involved a range of agents, and most respondents reported using at least one cytotoxic agent; across respondents 10 different cytotoxic agents were cited. All respondents reported that toxicity was common for the regimens they used to treat R/R Ph(-) B-precursor ALL. CONCLUSIONS This study provides evidence of current management and treatment patterns of R/R Ph(-) B-precursor ALL in the real-world clinical practice in Europe. The approach to the treatment of R/R Ph(-) B-precursor ALL is heterogeneous, reflecting the lack of any clearly superior chemotherapeutic option, thus it appears that clinicians are trying a wide variety of therapies. These findings show a clear need for effective, tolerable treatments for R/R Ph(-) B-precursor ALL.
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Affiliation(s)
- Deborah Saltman
- PRMA Consulting, Fleet, UK.
- School of Public Health, Imperial College, London, UK.
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238
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Ravandi F, Jorgensen JL, O'Brien SM, Jabbour E, Thomas DA, Borthakur G, Garris R, Huang X, Garcia-Manero G, Burger JA, Ferrajoli A, Wierda W, Kadia T, Jain N, Wang SA, Konoplev S, Kebriaei P, Champlin RE, McCue D, Estrov Z, Cortes JE, Kantarjian HM. Minimal residual disease assessed by multi-parameter flow cytometry is highly prognostic in adult patients with acute lymphoblastic leukaemia. Br J Haematol 2015; 172:392-400. [PMID: 26492205 DOI: 10.1111/bjh.13834] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Abstract
The prognostic value of minimal residual disease (MRD) assessed by multi-parameter flow cytometry (MFC) was investigated among 340 adult patients with B-cell acute lymphoblastic leukaemia (B-ALL) treated between 2004 and 2014 using regimens including the hyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) backbone. Among them, 323 (95%) achieved complete remission (CR) and were included in this study. Median age was 52 years (range, 15-84). Median white blood cell count (WBC) was 9·35 × 10(9) /l (range, 0·4-658·1 ×1 0(9) /l). MRD by MFC was initially assessed with a sensitivity of 0·01%, using a 15-marker, 4-colour panel and subsequently a 6-colour panel on bone marrow specimens obtained at CR achievement and at approximately 3 month intervals thereafter. MRD negative status at CR was associated with improved disease-free survival (DFS) and overall survival (OS) (P = 0·004 and P = 0·03, respectively). Similarly, achieving MRD negative status at approximately 3 and 6 months was associated with improved DFS (P = 0·004 and P < 0·0001, respectively) and OS (P = 0·004 and P < 0·0001, respectively). Multivariate analysis including age, WBC at presentation, cytogenetics (standard versus high risk) and MRD status at CR, 3 and 6 months, indicated that MRD negative status at CR was an independent predictor of DFS (P < 0·05). Achievement of an MRD negative state assessed by MFC is an important predictor of DFS and OS in adult patients with ALL.
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Affiliation(s)
- Farhad Ravandi
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey L Jorgensen
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan M O'Brien
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah A Thomas
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Garris
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuelin Huang
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guillermo Garcia-Manero
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan A Burger
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Wierda
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan Kadia
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nitin Jain
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sergei Konoplev
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Departments of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Champlin
- Departments of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah McCue
- Departments of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeev Estrov
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Cortes
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop M Kantarjian
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fan D, Li W, Yang Y, Zhang X, Zhang Q, Yan Y, Yang M, Wang J, Xiong D. Redirection of CD4+ and CD8+ T lymphocytes via an anti-CD3 × anti-CD19 bi-specific antibody combined with cytosine arabinoside and the efficient lysis of patient-derived B-ALL cells. J Hematol Oncol 2015; 8:108. [PMID: 26444983 PMCID: PMC4596481 DOI: 10.1186/s13045-015-0205-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/28/2015] [Indexed: 01/07/2023] Open
Abstract
Background B-acute lymphoblastic leukemia (B-ALL) is derived from B cell progenitors. Recently, the development of appropriate combinations of chemotherapy and immunotherapy represents a promising approach for eliminating cancer. We previously constructed an anti-CD3 × anti-CD19 bi-specific antibody in a diabody configuration and its disulfide-stabilized format (ds-diabody). The combination of the diabody or ds-diabody and Ara-C was highly effective in enhancing the cytotoxicity of T cells against the CD19+ human leukemia cell-line, Nalm-6, both in vitro and in vivo. This study verified whether B-ALL patient-derived cells were sensitive to the diabody or ds-diabody and low-dosage Ara-C combination. Methods This study aimed to detect the B7 family members B7.1 (CD80) and B7.2 (CD86) that were expressed in B-ALL patient-derived cells pre-treated by Ara-C (0.25 μM) and to determine the targeted killing ability of T cell subtypes induced by the diabody or ds-diabody combination with Ara-C both in vitro and in vivo. We also determined the levels of the cytokines that were released by activated CD4+ or CD8+ T cells during therapy. Result Low-dose Ara-C enhanced CD80 and CD86 expression in nearly 50 % of specimens of B-ALL patient-derived cells. A combination of diabody or ds-diabody and Ara-C enhanced T cell against B-ALL cells in vitro and in vivo. Both CD8+ and CD4+ T cells were potently activated. Expression of CD25 and CD69 was augmented equally by CD4+ or CD8+ T cells. However, CD8+ T cells made the major contribution by redirecting target cell lysis in a granzyme B and perforin-dependent mechanism. CD4+ T cells played an important immunomodulatory role by secreting IL2. Consequently, IL3, IL6, TNFα, and IFNγ were also released by CD4+ or CD8+ T cells following diabody-mediated T cell activation. Conclusion T cell therapy induced by diabody or ds-diabody combined with low dose of Ara-C was effective against cancer cell-lines and in clinical trials. In vivo, the ds-diabody was more efficient than its parent diabody due to its enhanced stability.
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Affiliation(s)
- Dongmei Fan
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Wei Li
- Department of Maxillofacial and E.N.T. Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.
| | - Yuqi Yang
- School of Pharmacy, Tianjin Medical University, Tianjin, 300070, People's Republic of China.
| | - Xiaolong Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Qing Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Yan Yan
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Ming Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
| | - Dongsheng Xiong
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, People's Republic of China.
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240
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Allogeneic stem cell transplantation after conditioning with treosulfan, etoposide and cyclophosphamide for patients with ALL: a phase II-study on behalf of the German Cooperative Transplant Study Group and ALL Study Group (GMALL). Bone Marrow Transplant 2015; 50:1503-7. [PMID: 26367236 DOI: 10.1038/bmt.2015.202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 01/27/2023]
Abstract
TBI-based preparative regimens are considered as standard conditioning therapy for allogeneic stem cell transplantation (AHSC) in patients with ALL. We investigated toxicity and efficacy of a non-TBI-based regimen consisting of treosulfan, etoposide and cyclophosphamide for ALL within a prospective study. Major inclusion criteria were CR and non-eligibility for TBI. Fifty patients with a median age of 46.5 years (range, 18-64) were included. Donors were HLA-identical sibling (n=8), matched (n=42) or mismatched (n=10) unrelated. The toxicity was moderate, resulting in a cumulative incidence of non-relapse mortality (NRM) at 1 year of 8% (90% confidence interval: 2-15%). Acute GvHD grade II-IV and grade III/IV was noted in 53% and 14%, respectively. Chronic GvHD at one year was seen in 41%. After a median follow-up of 24 months the cumulative incidence of relapse was 36% (90% confidence interval: 24-48) and 51% (90% confidence interval: 37-65) at 1 and 2 years, respectively. The estimated 2-year disease-free and overall survivals were 36 and 48%, respectively. Treosulfan, etoposide and cyclophosphamide followed by AHSC has a favorable toxicity profile with low NRM and therefore represents a potential alternative regimen for ALL in 1. CR (NCT00682305).
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241
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Eigendorff E, Hochhaus A. Akute Leukämien des Erwachsenen. DER PATHOLOGE 2015; 36:503-17; quiz 518-9. [DOI: 10.1007/s00292-015-0087-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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242
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Peirs S, Van der Meulen J, Van de Walle I, Taghon T, Speleman F, Poppe B, Van Vlierberghe P. Epigenetics in T-cell acute lymphoblastic leukemia. Immunol Rev 2015; 263:50-67. [PMID: 25510271 DOI: 10.1111/imr.12237] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Normal T-cell development is a strictly regulated process in which hematopoietic progenitor cells migrate from the bone marrow to the thymus and differentiate from early T-cell progenitors toward mature and functional T cells. During this maturation process, cooperation between a variety of oncogenes and tumor suppressors can drive immature thymocytes into uncontrolled clonal expansion and cause T-cell acute lymphoblastic leukemia (T-ALL). Despite improved insights in T-ALL disease biology and comprehensive characterization of its genetic landscape, clinical care remained largely similar over the past decades and still consists of high-dose multi-agent chemotherapy potentially followed by hematopoietic stem cell transplantation. Even with such aggressive treatment regimens, which are often associated with considerable side effects, clinical outcome is still extremely poor in a significant subset of T-ALL patients as a result of therapy resistance or hematological relapses. Recent genetic studies have identified recurrent somatic alterations in genes involved in DNA methylation and post-translational histone modifications in T-ALL, suggesting that epigenetic homeostasis is critically required in restraining tumor development in the T-cell lineage. In this review, we provide an overview of the epigenetic regulators that could be implicated in T-ALL disease biology and speculate how the epigenetic landscape of T-ALL could trigger the development of epigenetic-based therapies to further improve the treatment of human T-ALL.
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Affiliation(s)
- Sofie Peirs
- Center for Medical Genetics, Ghent University, Ghent, Belgium
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243
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Rational combination therapies targeting survival signaling in aggressive B-cell leukemia/lymphoma. Curr Opin Hematol 2015; 21:297-308. [PMID: 24811162 DOI: 10.1097/moh.0000000000000045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The identification of oncogenic 'driver' mutations and activated survival pathways in selected aggressive B-cell malignancies directs the development of novel adjunctive therapies using targeted small molecule inhibitors. With a focus on diffuse large B-cell lymphoma 'not otherwise specified', Hodgkin lymphoma and childhood B-cell precursor acute lymphoblastic leukemia, this review will provide an up-to-date account of the current literature on the development of new molecularly targeted treatment modalities for aggressive B-cell malignancies. RECENT FINDINGS Subclassification of B-cell malignancies depending on their particular genetic 'driver' lesions and transcriptional and/or signaling signatures has led to the development of targeted therapeutic approaches using small molecule inhibitors to amend current combination chemotherapy. SUMMARY Treatment outcome with current combination chemotherapy is still poor for subsets of aggressive B-cell malignancies, and demands development of targeted therapeutic approaches. Advanced gene expression profiling and genomic sequencing have revealed a more detailed landscape of recurrent alterations, allowing a better subclassification of B-cell lymphomas and leukemias. Many alterations directly or indirectly lead to activation of survival signaling pathways and expression of key oncoproteins and prosurvival molecules, including Janus kinase-signal transducer and activator of transcription (JAK-STAT), phosphatidylinositol-3 kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR), avian myelocytomatosis viral oncogene homolog (MYC) and B-cell lymphoma 2 (BCLl-2). Small molecule inhibitors targeting these proteins and pathways are currently being tested in clinical trials and preclinically to improve chemotherapeutic regimes and treatment outcomes.
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244
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Lang F, Wojcik B, Rieger MA. Stem Cell Hierarchy and Clonal Evolution in Acute Lymphoblastic Leukemia. Stem Cells Int 2015; 2015:137164. [PMID: 26236346 PMCID: PMC4506911 DOI: 10.1155/2015/137164] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 01/15/2023] Open
Abstract
Cancer is characterized by a remarkable intertumoral, intratumoral, and cellular heterogeneity that might be explained by the cancer stem cell (CSC) and/or the clonal evolution models. CSCs have the ability to generate all different cells of a tumor and to reinitiate the disease after remission. In the clonal evolution model, a consecutive accumulation of mutations starting in a single cell results in competitive growth of subclones with divergent fitness in either a linear or a branching succession. Acute lymphoblastic leukemia (ALL) is a highly malignant cancer of the lymphoid system in the bone marrow with a dismal prognosis after relapse. However, stabile phenotypes and functional data of CSCs in ALL, the so-called leukemia-initiating cells (LICs), are highly controversial and the question remains whether there is evidence for their existence. This review discusses the concepts of CSCs and clonal evolution in respect to LICs mainly in B-ALL and sheds light onto the technical controversies in LIC isolation and evaluation. These aspects are important for the development of strategies to eradicate cells with LIC capacity. Common properties of LICs within different subclones need to be defined for future ALL diagnostics, treatment, and disease monitoring to improve the patients' outcome in ALL.
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Affiliation(s)
- Fabian Lang
- Department of Hematology/Oncology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Bartosch Wojcik
- Department of Hematology/Oncology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- LOEWE Center for Cell and Gene Therapy Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Michael A. Rieger
- Department of Hematology/Oncology, Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- LOEWE Center for Cell and Gene Therapy Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
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Bumma N, Papadantonakis N, Advani AS. Structure, development, preclinical and clinical efficacy of blinatumomab in acute lymphoblastic leukemia. Future Oncol 2015; 11:1729-39. [DOI: 10.2217/fon.15.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
ABSTRACT The treatment of acute lymphoblastic leukemia (ALL) in adults remains challenging and novel therapies are needed. The antigen, CD19, is expressed by >90% of pre-B ALLs and represents an attractive therapeutic target. The bispecific T-cell-engaging antibody, blinatumomab, targets CD19 and has demonstrated encouraging results in minimal residual disease positive and relapsed/refractory pre-B ALL. In this review, we discuss in detail the mechanism of action and key pharmacologic aspects of blinatumomab. In addition, the preclinical studies, clinical studies and toxicities are summarized.
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Affiliation(s)
- Naresh Bumma
- Department of Internal Medicine, The Cleveland Clinic, Desk R35, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Nikolaos Papadantonakis
- Department of Hematology/Oncology, Cleveland Clinic Lerner College of Medicine, The Cleveland Clinic, Desk R35, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Anjali S Advani
- Department of Hematology/Oncology, Cleveland Clinic Lerner College of Medicine, The Cleveland Clinic, Desk R35, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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246
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He YZ, Liang Z, Wu MR, Wen Q, Deng L, Song CY, Wu BY, Tu SF, Huang R, Li YH. Overexpression of EPS8 is associated with poor prognosis in patients with acute lymphoblastic leukemia. Leuk Res 2015; 39:575-81. [DOI: 10.1016/j.leukres.2015.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/29/2015] [Accepted: 03/10/2015] [Indexed: 12/23/2022]
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How I treat adults with relapsed or refractory Philadelphia chromosome-negative acute lymphoblastic leukemia. Blood 2015; 126:589-96. [PMID: 25966988 DOI: 10.1182/blood-2014-09-551937] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 04/02/2015] [Indexed: 12/17/2022] Open
Abstract
The long-term prognosis of adult patients with relapsed Philadelphia chromosome-negative acute lymphoblastic lymphoma (ALL) is poor. Allogeneic stem cell transplant in second remission is the only curative approach and is the goal when feasible. There is no standard chemotherapy regimen for relapsed disease, although a few agents are approved for use in this setting. The bispecific CD19-directed CD3 T-cell engager, blinatumomab, has recently been granted accelerated approval by the US Food and Drug Administration for relapsed or refractory disease of B-cell lineage. For patients with relapsed T-cell ALL, nelarabine is available. Liposomal vincristine is also approved for relapsed disease. When selecting combination chemotherapy salvage options, evaluation of the prior treatment and timing of relapse informs treatment decisions. Monoclonal and cellular investigational therapies are quite promising and should be explored in the appropriate patient.
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248
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Saab AM, Guerrini A, Zeino M, Wiench B, Rossi D, Gambari R, Sacchetti G, Greten HJ, Efferth T. Laurus nobilisL. Seed Extract Reveals Collateral Sensitivity in Multidrug-Resistant P-Glycoprotein-Expressing Tumor Cells. Nutr Cancer 2015; 67:664-75. [DOI: 10.1080/01635581.2015.1019632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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249
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Ohanian M, Kantarjian H, Guy D, Thomas D, Jabbour E, O'Brien S. Inotuzumab ozogamicin in B-cell acute lymphoblastic leukemias and non-Hodgkin's lymphomas. Expert Opin Biol Ther 2015; 15:601-11. [PMID: 25775418 DOI: 10.1517/14712598.2015.1024652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The expression profile of the CD22 antigen and its role in B-cell function make it an important target in B-cell leukemias and lymphomas. Inotuzumab ozogamicin (IO), a humanized monoclonal antibody targeting CD22, is one of the most promising monoclonal antibodies for the treatment of relapsed/refractory B-cell acute lymphoblastic leukemia (ALL). AREAS COVERED This article reviews the current literature of IO in adult leukemias and lymphomas. EXPERT OPINION Single-agent IO has demonstrated activity in patients with relapsed B-cell ALL and non-Hodgkin lymphoma (NHL). It has also demonstrated favorable early results when combined with chemotherapy in older patients with ALL. There is potential for IO to be combined with other targeted therapies under development for these diseases; data are still early and further studies of IO are warranted. While the pivotal randomized study of IO for relapsed NHL versus physician's choice did not show a statistically significant advantage in response rate, the results of the pivotal study in ALL are not yet available.
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Affiliation(s)
- Maro Ohanian
- University of Texas, MD Anderson Cancer Center , Houston, TX , USA
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250
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A Safety and Efficacy Study of Medium-Dose Etoposide, Cyclophosphamide and Total Body Irradiation Conditioning Before Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukemia. Transplant Direct 2015; 1:e8. [PMID: 27500214 PMCID: PMC4946459 DOI: 10.1097/txd.0000000000000514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/29/2014] [Indexed: 11/29/2022] Open
Abstract
Prognosis for adult patients with acute lymphoblastic leukemia (ALL) has been reported to be approximately 35% to 50%, even after allogeneic stem cell transplantation (allo-SCT). We previously reported retrospective analyses of a conditioning regimen of medium-dose etoposide, cyclophosphamide (CY), and total body irradiation (TBI) before allo-SCT for ALL. To prospectively analyze the efficacy of this conditioning regimen, we conducted a trial prospectively.
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