301
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Acute Promyelocytic Leukemia: A Perspective. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:543-544. [DOI: 10.1016/j.clml.2017.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022]
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302
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Lou Y, Ma Y, Sun J, Suo S, Tong H, Qian W, Mai W, Meng H, Jin J. Effectivity of a modified Sanz risk model for early death prediction in patients with newly diagnosed acute promyelocytic leukemia. Ann Hematol 2017; 96:1793-1800. [PMID: 28823055 DOI: 10.1007/s00277-017-3096-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022]
Abstract
Early death is the main obstacle for the cure of patients with acute promyelocytic leukemia (APL). We have analyzed risk factors of early death from 526 consecutive newly diagnosed APL patients between 2004 and 2016. The overall incidence of early death was 7.2% (38/526). The peak hazard of early death occurred in the first 0-3 days. Multivariate logistic analysis demonstrated white blood cell (WBC) counts [odds ratio (OR) = 1.039; 95% confidence interval (CI): 1.024-1.055; P < 0.001], age (OR = 1.061; 95% CI: 1.025-1.099; P = 0.001) and platelet counts (OR = 0.971; 95% CI: 0.944-0.999; P = 0.038) were independent risk factors for early death. Furthermore, receiver-operator characteristic (ROC) curve analyses revealed a simple WBC/platelet ratio was significantly more accurate in predicting early death [areas under the ROC curve (AUC) = 0.842, 95% CI: 0.807-0.872) than WBC counts (AUC = 0.793; 95% CI: 0.756-0.827) or Sanz score (AUC = 0.746; 95% CI: 0.706-0.783). We stratified APL patients into four risk subgroups: low risk (WBC ≤ 10 × 109/L, platelet >40 × 109/L), intermediate risk (WBC/platelet <0.2 and age ≤ 60, not in low risk), high risk (WBC/platelet ≥0.2 or age > 60, not in low and ultra-high risk) and ultra-high risk (WBC > 50 × 109/L), the early death rates were 0, 0.6, 12.8, and 41.2%, respectively. In conclusion, we proposed a modified Sanz risk model as a useful predictor of early death risk in patients with APL.
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Affiliation(s)
- Yinjun Lou
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Yafang Ma
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Jianai Sun
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Sansan Suo
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Hongyan Tong
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Wenbin Qian
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Wenyuan Mai
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Haitao Meng
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China
| | - Jie Jin
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, China. .,Key Laboratory of Hematopoietic Malignancies, Hangzhou, Zhejiang Province, People's Republic of China.
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303
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Patient-reported outcomes in hematology: is it time to focus more on them in clinical trials and hematology practice? Blood 2017; 130:859-866. [DOI: 10.1182/blood-2017-03-737403] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/23/2017] [Indexed: 12/24/2022] Open
Abstract
Abstract
In less than 2 decades, major clinical advances have been made in various areas of hematologic malignancies. Clinicians and patients now frequently face challenging choices regarding various treatments that are often similar in regard to safety or clinical effectiveness; hence, medical decision making has grown in complexity. For example, several novel drugs have been developed as oral agents, introducing an additional challenge in patient management, such as ensuring an optimal adherence to therapy in order to maximize drug effectiveness. This rapidly changing scenario provides a rationale for a more systematic collection of patient-reported outcomes (PRO) in clinical research and routine care. In the former case, PRO may help to better understand overall treatment effectiveness of a new drug being tested. In the latter case, it may aid in making more informed, individualized treatment decisions in daily practice by obtaining more accurate information on the actual symptom burden experienced by the patient. In any case, evaluating PRO requires making several, and often challenging, decisions depending, for example, on the population being studied and the specific setting. Therefore, if PROs are to fulfill their potential of generating clinically meaningful data that robustly inform patient care, special attention should be given to methodological rigor. We outline the value of a more systematic and rigorous implementation of PRO assessment in the current hematology arena, by providing some real world examples of how PRO data have contributed in better understanding the value of new therapies. We also discuss practical considerations in PRO assessment in clinical research.
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304
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Hecht A, Doll S, Altmann H, Nowak D, Lengfelder E, Röllig C, Ehninger G, Spiekermann K, Hiddemann W, Weiß C, Hofmann WK, Nolte F, Platzbecker U. Validation of a Molecular Risk Score for Prognosis of Patients With Acute Promyelocytic Leukemia Treated With All-trans Retinoic Acid and Chemotherapy-containing Regimens. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:889-896.e5. [PMID: 28923666 DOI: 10.1016/j.clml.2017.08.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Although treatment of acute promyelocytic leukemia (APL) has evolved dramatically during the past decades, especially with the introduction of all-trans retinoic acid, risk stratification remains an important issue. To date, relapse risk can be predicted by leukocyte and platelet counts only. In the present report, we present a validation study on 3 candidate genes and a newly developed molecular risk score for APL in 2 independent patient cohorts. PATIENTS AND METHODS An integrative risk score combining the expression levels of BAALC, ERG, and WT1 was calculated for 79 de novo APL patients from the original cohort and 76 de novo APL patients from a validation cohort. Gene expression analysis was executed the same for both cohorts, and the results regarding the effect on patient outcomes were compared. RESULTS The expression levels of BAALC, ERG, and WT1 were similar in both cohorts compared with the healthy controls. The relapse and survival rates were not different between the low- and high-risk patients according to the Sanz score. However, application of the molecular risk score on the validation cohort distinctly discriminated patients according to their risk of relapse and death just as in the original APL cohort, although single gene analyses could not reproduce the negative prognostic impact. CONCLUSION The analysis clearly validated the prognostic effect of the integrative risk score on the outcome in APL patients. The value was further empowered because the single gene analyses did not show similar results. Whether the integrative risk score retains its prognostic power in the chemotherapy-free setting should be investigated further.
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Affiliation(s)
- Anna Hecht
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany.
| | - Seraphina Doll
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Heidi Altmann
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Daniel Nowak
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Eva Lengfelder
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Gerhard Ehninger
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Wolfgang Hiddemann
- Department of Hematology/Oncology, University of Munich, Munich, Germany
| | - Christel Weiß
- Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Florian Nolte
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Uwe Platzbecker
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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305
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Masciarelli S, Capuano E, Ottone T, Divona M, De Panfilis S, Banella C, Noguera NI, Picardi A, Fontemaggi G, Blandino G, Lo-Coco F, Fazi F. Retinoic acid and arsenic trioxide sensitize acute promyelocytic leukemia cells to ER stress. Leukemia 2017; 32:285-294. [PMID: 28776567 PMCID: PMC5808088 DOI: 10.1038/leu.2017.231] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/10/2017] [Accepted: 06/20/2017] [Indexed: 01/03/2023]
Abstract
Retinoic acid (RA) in association with chemotherapy or with arsenic trioxide (ATO) results in high cure rates of acute promyelocytic leukemia (APL). We show that RA-induced differentiation of human leukemic cell lines and primary blasts dramatically increases their sensitivity to endoplasmic reticulum (ER) stress-inducing drugs at doses that are not toxic in the absence of RA. In addition, we demonstrate that the PERK pathway, triggered in response to ER stress, has a major protective role. Moreover, low amounts of pharmacologically induced ER stress are sufficient to strongly increase ATO toxicity. Indeed, in the presence of ER stress, ATO efficiently induced apoptosis in RA-sensitive and RA-resistant APL cell lines, at doses ineffective in the absence of ER stress. Our findings identify the ER stress-related pathways as potential targets in the search for novel therapeutic strategies in AML.
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Affiliation(s)
- S Masciarelli
- Section of Histology and Medical Embryology, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - E Capuano
- Section of Histology and Medical Embryology, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - T Ottone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - M Divona
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - S De Panfilis
- Centre for Life Nano Science, Istituto Italiano di Tecnologia, Rome, Italy
| | - C Banella
- Laboratory of Neuro-Oncohematology Unit, Santa Lucia Foundation, Rome, Italy
| | - N I Noguera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Laboratory of Neuro-Oncohematology Unit, Santa Lucia Foundation, Rome, Italy
| | - A Picardi
- Stem Cell Transplant Unit, Rome Transplant Network, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - G Fontemaggi
- Oncogenomic and Epigenetic Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - G Blandino
- Oncogenomic and Epigenetic Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - F Lo-Coco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Laboratory of Neuro-Oncohematology Unit, Santa Lucia Foundation, Rome, Italy
| | - F Fazi
- Section of Histology and Medical Embryology, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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306
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Creutzig U, Dworzak MN, Bochennek K, Faber J, Flotho C, Graf N, Kontny U, Rossig C, Schmid I, von Stackelberg A, Mueller JE, von Neuhoff C, Reinhardt D, von Neuhoff N. First experience of the AML-Berlin-Frankfurt-Münster group in pediatric patients with standard-risk acute promyelocytic leukemia treated with arsenic trioxide and all-trans retinoid acid. Pediatr Blood Cancer 2017; 64. [PMID: 28111878 DOI: 10.1002/pbc.26461] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/07/2016] [Accepted: 12/25/2016] [Indexed: 11/10/2022]
Abstract
Recently, studies in adults with acute promyelocytic leukemia (APL) showed high cure rates in low-risk patients treated with all-trans retinoid acid (ATRA) and arsenic trioxide (ATO), while toxicities were significantly reduced compared to the standard treatment with ATRA and chemotherapy. Here we report about first experience with 11 pediatric patients with low-risk APL treated with ATRA and ATO. All patients stayed in molecular remission. All suffered from hyperleukocytosis. Two patients experienced reversible severe side effects. One suffered from osteonecroses at both femurs, seizures, as well as posterior reversible encephalopathy syndrome, the other patient had an abducens paresis.
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Affiliation(s)
- Ursula Creutzig
- Department of Pediatric Hematology/Oncology, Hannover Medical School, Children's Hospital, Hannover, Germany
| | - Michael N Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Konrad Bochennek
- Division for Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Flotho
- Division of Pediatric Hematology/Oncology, University Medical Center, Freiburg, Germany
| | - Norbert Graf
- Department of Pediatric Oncology/Hematology, Saarland University, Homburg, Germany
| | - Udo Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, Dr. von Hauner Children`s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Arend von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité University Medical Center Berlin, Berlin, Germany
| | - Jans-Enno Mueller
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Christine von Neuhoff
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Nils von Neuhoff
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
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307
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Luskin MR, Stone RM. Can Minimal Residual Disease Determination in Acute Myeloid Leukemia Be Used in Clinical Practice? J Oncol Pract 2017; 13:471-480. [DOI: 10.1200/jop.2017.021675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In acute myeloid leukemia (AML) that is in complete remission, minimal residual disease (MRD) is presumed to be present, though not morphologically evident. Advances in diagnostics now permit the detection and quantification of MRD in AML by several techniques. The level of MRD after induction and consolidation therapy correlates with disease sensitivity to chemotherapy and has greater power to predict long-term survival than patient and disease characteristics that are available at diagnosis, including genetic information. A unique advantage of MRD is that it is an integrated measure of the impact and interaction of genetics, epigenetics, host immune milieu, bone marrow environment, and drug sensitivity on disease response to treatment. Here, we review the main techniques for MRD assessment in AML, including polymerase chain reaction, multiparameter flow cytometry, and next-generation sequencing, with a focus on method-specific and general limitations to the optimal employment of MRD techniques for the determination of AML prognosis. We also review the data that establish the prognostic and predictive value of MRD assessment in AML. Finally, we provide recommendations for the use of MRD in the care of patients with AML in clinical practice today, including whether it should influence treatment decisions.
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Affiliation(s)
- Marlise R. Luskin
- Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Richard M. Stone
- Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
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308
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Abstract
Acute promyelocytic leukaemia (APML) is a subtype of leukaemia arising from a distinct reciprocal translocation involving chromosomes 15 and 17, which results in the PML-RARA fusion gene. Over the past three decades, APML has been transformed from a highly fatal disease to a highly curable one. This drastic improvement is because of the introduction of a new treatment strategy with all-trans retinoic acid and, more recently, arsenic trioxide. The revolutionary treatment of APML has also paved the way for a new cancer treatment, which is genetically targeted therapy. In this review, we look into this amazing journey of transformation and provide recent advances in the management of APML.
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Affiliation(s)
- Chin-Hin Ng
- National University Cancer Institute, Singapore, Singapore
| | - Wee-Joo Chng
- National University Cancer Institute, Singapore, Singapore
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309
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Gemtuzumab ozogamicin in acute myeloid leukemia. Leukemia 2017; 31:1855-1868. [PMID: 28607471 DOI: 10.1038/leu.2017.187] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022]
Abstract
CD33 is variably expressed on leukemia blasts in almost all patients with acute myeloid leukemia (AML) and possibly leukemia stem cells in some. Efforts to target CD33 therapeutically have focused on gemtuzumab ozogamicin (GO; Mylotarg), an antibody-drug conjugate delivering a DNA-damaging calicheamicin derivative. GO is most effective in acute promyelocytic leukemia but induces remissions in other AML types and received accelerated approval in the US in 2000. However, because a large follow-up study showed no survival improvement and increased early deaths the drug manufacturer voluntarily withdrew the US New Drug Application in 2010. More recently, a meta-analysis of data from several trials reported better survival in adults with favorable- and intermediate-risk cytogenetics but not adverse-risk AML randomized to receive GO along with intensive induction chemotherapy. As a result, GO is being re-evaluated by regulatory agencies. Responses to GO are diverse and predictive biological response markers are needed. Besides cytogenetic risk, ATP-binding cassette transporter activity and possibly CD33 display on AML blasts may predict response, but established clinical assays and prospective validation are lacking. Single-nucleotide polymorphisms in CD33 may also be predictive, most notably rs12459419 where the minor T-allele leads to decreased display of full-length CD33 and preferential translation of a splice variant not recognized by GO. Data from retrospective analyses suggest only patients with the rs12459419 CC genotype may benefit from GO therapy but confirmation is needed. Most important may be markers for AML cell sensitivity to calicheamicin, which varies over 100 000-fold, but useful assays are unavailable. Novel CD33-targeted drugs may overcome some of GO's limitations but it is currently unknown whether such drugs will be more effective in patients benefitting from GO and/or improve outcomes in patients not benefitting from GO, and what the supportive care requirements will be to enable their safe use.
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310
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Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy. Leukemia 2017; 32:21-29. [DOI: 10.1038/leu.2017.178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 12/19/2022]
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311
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Litzow MR, Fielding AK, Luger SM, Paietta E, Ofran Y, Rowe JM, Goldstone AH, Tallman MS, Lazarus HM. The evolving role of chemotherapy and hematopoietic cell transplants in Ph-positive acute lymphoblastic leukemia in adults. Bone Marrow Transplant 2017; 52:1592-1598. [PMID: 28581459 DOI: 10.1038/bmt.2017.110] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/29/2016] [Accepted: 11/02/2016] [Indexed: 01/28/2023]
Abstract
The introduction of the tyrosine kinase inhibitors (TKI) into the treatment of patients with Ph or BCR-ABL1-positive acute lymphoblastic leukemia has revolutionized the treatment of this poor prognosis acute leukemia. The combination of TKI with chemotherapy has improved response rates and allowed more patients to proceed to allogeneic hematopoietic cell transplant (alloHCT). Older patients have excellent responses to TKI and corticosteroids or in combination with minimal chemotherapy. This raises the question as to whether patients require full-intensity chemotherapy with TKI to achieve molecular remissions. The pediatricians have proposed that cure is achievable without alloHCT in children. These results have suggested that many patients may not require traditional chemotherapy in addition to TKI to achieve remission, and that patients who achieve a negative minimal residual disease state may not require alloHCT. The data in support of these questions is presented here and a suggested future clinical trial design based on these data is proposed.
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Affiliation(s)
- M R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - S M Luger
- University of Pennsylvania, Philadelphia, PA, USA
| | - E Paietta
- Montefiore Medical Center, Bronx, NY, USA
| | - Y Ofran
- Rambam Healthcare Campus, Haifa, Israel
| | - J M Rowe
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - M S Tallman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - H M Lazarus
- University Hospitals Cleveland Medical Center Cleveland, OH, USA
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312
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Mo XD, Lv M, Huang XJ. Preventing relapse after haematopoietic stem cell transplantation for acute leukaemia: the role of post-transplantation minimal residual disease (MRD) monitoring and MRD-directed intervention. Br J Haematol 2017; 179:184-197. [PMID: 28542711 DOI: 10.1111/bjh.14778] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Xiao-Dong Mo
- Peking University People's Hospital; Peking University Institute of Haematology; Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation; Beijing China
| | - Meng Lv
- Peking University People's Hospital; Peking University Institute of Haematology; Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation; Beijing China
| | - Xiao-Jun Huang
- Peking University People's Hospital; Peking University Institute of Haematology; Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation; Beijing China
- Peking-Tsinghua Centre for Life Sciences; Beijing China
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313
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Sellar R, Losman JA. Targeting Aberrant Signaling in Myeloid Malignancies: Promise Versus Reality. Hematol Oncol Clin North Am 2017; 31:565-576. [PMID: 28673388 DOI: 10.1016/j.hoc.2017.04.001] [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: 01/01/2023]
Abstract
Clonal myeloid disorders are characterized by genetic alterations that activate cytokine signaling pathways and stimulate cell proliferation. These activated signaling pathways have been extensively studied as potential therapeutic targets, and tyrosine kinase inhibitors have indeed had extraordinary success in treating BCR/ABL-positive chronic myeloiud leukemia. However, although inhibitors of other activated kinases have been developed that perform well in preclinical studies, the therapeutic efficacy of these drugs in patients has been unimpressive. This article discusses potential reasons for these discordant results and outlines recent scientific advances that are informing future efforts to target activated kinases in clonal myeloid disorders.
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Affiliation(s)
- Rob Sellar
- Division of Hematology, Brigham and Women's Hospital, 1 Blackfan Circle, Karp Building, CHRB05.125, Boston, MA 02115, USA
| | - Julie-Aurore Losman
- Department of Medical Oncology, Division of Hematology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
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314
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Li K, Wang F, Cao WB, Lv XX, Hua F, Cui B, Yu JJ, Zhang XW, Shang S, Liu SS, Yu JM, Han MZ, Huang B, Zhang TT, Li X, Jiang JD, Hu ZW. TRIB3 Promotes APL Progression through Stabilization of the Oncoprotein PML-RARα and Inhibition of p53-Mediated Senescence. Cancer Cell 2017; 31:697-710.e7. [PMID: 28486108 DOI: 10.1016/j.ccell.2017.04.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/10/2016] [Accepted: 04/12/2017] [Indexed: 12/19/2022]
Abstract
Acute promyelocytic leukemia (APL) is driven by the oncoprotein PML-RARα, which antagonizes myeloid differentiation and promotes APL-initiating cell self-renewal. Combined all-trans retinoic acid (ATRA) with arsenic trioxide (As2O3) or chemotherapy dramatically improves the prognosis of APL patients. Here we report that expression of pseudokinase Tribble 3 (TRIB3) associates positively with APL progression and therapeutic resistance. The elevated TRIB3 expression promotes APL by interacting with PML-RARα and suppressing its sumoylation, ubiquitylation, and degradation. This represses PML nuclear body assembly, p53-mediated senescence, and cell differentiation, and supports cellular self-renewal. Genetically inhibiting TRIB3 expression or combination of a peptide disturbing TRIB3/PML-RARα interaction with ATRA/As2O3 eradicates APL by accelerating PML-RARα degradation. Our study provides insight into APL pathogenesis and a potential therapeutic option against APL.
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MESH Headings
- Animals
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Arsenic Trioxide
- Arsenicals/pharmacology
- Cell Cycle Proteins/deficiency
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cell Differentiation/drug effects
- Cell Line, Tumor
- Cell Proliferation
- Cellular Senescence
- Disease Progression
- Drug Resistance, Neoplasm
- Female
- Gene Expression Regulation
- Gene Fusion
- HEK293 Cells
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Leukemia, Promyelocytic, Acute/pathology
- Male
- Mice, 129 Strain
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, SCID
- Mice, Transgenic
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Oxides/pharmacology
- Peptides/pharmacology
- Protein Serine-Threonine Kinases/antagonists & inhibitors
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/metabolism
- Protein Stability
- Proteolysis
- Repressor Proteins/genetics
- Repressor Proteins/metabolism
- Signal Transduction
- Sumoylation
- Time Factors
- Transfection
- Tretinoin/pharmacology
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
- Ubiquitination
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Ke Li
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Feng Wang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Wen-Bin Cao
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, P.R. China
| | - Xiao-Xi Lv
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Fang Hua
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Bing Cui
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Jiao-Jiao Yu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Xiao-Wei Zhang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Shuang Shang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Shan-Shan Liu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Jin-Mei Yu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Ming-Zhe Han
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, P.R. China
| | - Bo Huang
- Institute of Basic Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, P.R. China
| | - Ting-Ting Zhang
- Department of Pharmacy, Marine College, Shandong University, Weihai 264209, P.R. China
| | - Xia Li
- Department of Pharmacy, Marine College, Shandong University, Weihai 264209, P.R. China
| | - Jian-Dong Jiang
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China; Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China
| | - Zhuo-Wei Hu
- Immunology and Cancer Pharmacology Group, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, P.R. China.
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315
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Cîrstea M, Coliță A, Ionescu B, Ghiaur A, Vasilescu D, Dobrea C, Jardan C, Dragomir M, Gheorghe A, Várady Z, Lupu AR. Therapy-related myelodysplastic syndrome after successful treatment of acute promyelocytic leukemia: case report and literature review. REV ROMANA MED LAB 2017. [DOI: 10.1515/rrlm-2017-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
In the 2016 revision of the World Health Organization classification the term therapy-related myeloid neoplasia (t-MN) defines a subgroup of acute myeloid leukemia (AML) comprising patients who develop myelodysplastic syndrome (MDS-t) or acute myeloid leukemia (AML-t) after treatment with cytotoxic and/or radiation therapy for various malignancies or autoimmune disorders. We report the case of a 36 year old patient with t-MN (t-MDS) after achieving complete remission (CR) of a PML-RARA positive acute promyelocytic leukemia (APL) at 32 months after diagnosis. Initially classified as low risk APL and treated according to the AIDA protocol - induction and 3 consolidation cycles - the patient achieved a complete molecular response in September 2013 and started maintenance therapy. On follow-up PML-RARA transcript remained negative. In January 2016 leukopenia and thrombocytopenia developed and a peripheral blood smear revealed hypogranular and agranular neutrophils. Immunophenotyping in the bone marrow aspirate identified undifferentiated blast cells that did not express cytoplasmic myeloperoxidase. The cytogenetic study showed normal karyotype. The molecular biology tests not identified PMLRARA transcript. A diagnosis of t-MDS (AREB-2 - WHO 2008) was established. Treatment of AML was started with 2 “3+7” regimens and 1 MEC cycle. Two months from diagnosis, while in CR, an allogeneic HSCT from an unrelated HLA compatible donor was performed after myeloablative regimen. An unfavorable clinical evolution was followed by death on day 9 after transplantation. The occurrence of t-MNs during CR of APL represents a particular problem in terms of follow-up and differential diagnosis of relapse and constitutes a dramatic complication for a disease with a favorable prognosis.
This work was supported by the grants PN 41-087 /PN2-099 from the Romanian Ministry of Research and Technology
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Affiliation(s)
- Mihaela Cîrstea
- Department of Onco-hematology, Fundeni Clinical Institute , Bucharest , Romania
| | - Adriana Coliță
- Fundeni Clinical Institute Romania , Bucharest , Romania
| | - Bogdan Ionescu
- Fundeni Clinical Institute Romania , Bucharest , Romania
| | | | | | - Camelia Dobrea
- Fundeni Clinical Institute Romania , Bucharest , Romania
| | | | | | - Anca Gheorghe
- Fundeni Clinical Institute Romania , Bucharest , Romania
| | - Zsofia Várady
- Fundeni Clinical Institute Romania , Bucharest , Romania
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316
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Liang B, Zheng Z, Shi Y, Chen J, Hu X, Qian H, Shen Z, Jiang S, Yu K, Feng J. Maintenance therapy with all-trans retinoic acid and arsenic trioxide improves relapse-free survival in adults with low- to intermediate-risk acute promyelocytic leukemia who have achieved complete remission after consolidation therapy. Onco Targets Ther 2017; 10:2305-2313. [PMID: 28490888 PMCID: PMC5414635 DOI: 10.2147/ott.s135013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Currently, the optimal maintenance therapy for patients with acute promyelocytic leukemia (APL) who have achieved complete remission (CR) after completing consolidation chemotherapy remains controversial. The comparative effectiveness of the all-trans retinoic acid (ATRA) plus arsenic trioxide (As2O3) maintenance strategy with classic ATRA plus chemotherapy has not been evaluated. In this study, we compared the efficacy and toxicity of maintenance therapy with ATRA plus As2O3 and classic ATRA plus chemotherapy in low- to intermediate-risk APL patients reaching the first CR after induction and consolidation therapy. METHODS A retrospective review of 58 adult patients diagnosed with APL was conducted. After receiving consolidation therapy and achieving CR, 30 patients were administered maintenance therapy with an ATRA plus As2O3 regimen (ATRA+As2O3 group), whereas 28 patients were administered 3-monthly cycles of an ATRA plus chemotherapy regimen (ATRA+chemotherapy group). RESULTS Grade 3-4 neutropenia was significantly more frequent in the ATRA+chemotherapy group (N=9, 32.1%) than in the ATRA+As2O3 group (N=0) (P=0.001). At a median follow-up of 49.1 months (range: 9.7-97.4 months) from the completion of consolidation, no relapses were observed in the ATRA+As2O3 group, whereas seven relapses occurred in the ATRA+chemotherapy group. The risk of relapse in the patients administered ATRA+As2O3 maintenance was significantly lower than that in those administered ATRA+chemotherapy maintenance (P=0.004). Based on log-rank analysis, only maintenance therapy with ATRA and As2O3 was associated with a significantly higher relapse-free survival (P=0.0159). CONCLUSION Maintenance therapy with ATRA and As2O3 was beneficial in low- to intermediate-risk APL patients who were effectively treated to achieve CR. Further clinical trials with reliable designs are needed to confirm these observations.
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Affiliation(s)
- Bin Liang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Zhouyi Zheng
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou.,Division of Hematology-Oncology, Traditional Chinese Medical Hospital of Zhuji, Shaoxing
| | - Yifen Shi
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Jingjing Chen
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Xudong Hu
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Honglan Qian
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Zhijian Shen
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Songfu Jiang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Kang Yu
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Jianhua Feng
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou.,Division of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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317
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Venci A, Mazza R, Spinelli O, Di Schiena L, Bettio D. Acute promyelocytic leukemia with a cryptic insertion of RARA into PML on chromosome 15 due to uniparental isodisomy: A case report. Oncol Lett 2017; 13:4180-4184. [PMID: 28599418 PMCID: PMC5453168 DOI: 10.3892/ol.2017.5979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/30/2016] [Indexed: 01/03/2023] Open
Abstract
Acute promyelocytic leukemia is a myeloid disorder that is characterized by the specific t(15;17) variant in ~98% of cases. The typical hypergranular and microgranular or hypogranular types exist, and are frequently associated with disseminated intravascular coagulopathy. Rare cases of promyelocytic leukemia-retinoic acid receptor α (PML-RARA) fusion without the reciprocal RARA-PML have been reported in cytogenetically normal samples. Conversely, fluorescence in situ hybridization (FISH) analysis has revealed a cryptic insertion of the RARA gene into the PML gene on chromosome 15. The current study reports a unique case with a normal karyotype and molecular evidence of the PML-RARA short isoform 3-fusion transcript, with FISH analysis revealing two fusion signals on the two copies of chromosome 15, but absence of the reciprocal on the two copies of chromosome 17. This finding raised the hypothesis of chromosome 15 uniparental isodysomy as consequence of normal chromosome 15 loss and duplication of the rearranged chromosome, as supported by polymorphic loci molecular analysis. The clinical, cytogenetic and molecular characterization of this case are presented and discussed in the present study.
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Affiliation(s)
- Anna Venci
- Cytogenetic and Medical Genetic Laboratory, Operative Unit of Clinical Investigations, Humanitas Clinical and Research Center, I-20089 Milan, Italy
| | - Rita Mazza
- Operative Unit of Medical Oncology and Hematology, Humanitas Clinical and Research Center, I-20089 Milan, Italy
| | - Orietta Spinelli
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, I-24127 Bergamo, Italy
| | - Luciana Di Schiena
- Cytogenetic and Medical Genetic Laboratory, Operative Unit of Clinical Investigations, Humanitas Clinical and Research Center, I-20089 Milan, Italy
| | - Daniela Bettio
- Cytogenetic and Medical Genetic Laboratory, Operative Unit of Clinical Investigations, Humanitas Clinical and Research Center, I-20089 Milan, Italy
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318
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McCulloch D, Brown C, Iland H. Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives. Onco Targets Ther 2017; 10:1585-1601. [PMID: 28352191 PMCID: PMC5359123 DOI: 10.2147/ott.s100513] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) with a unique morphological appearance, associated coagulopathy and canonical balanced translocation of genetic material between chromosomes 15 and 17. APL was first described as a distinct subtype of AML in 1957 by Dr Leif Hillestad who recognized the pattern of an acute leukemia associated with fibrinolysis, hypofibrinogenemia and catastrophic hemorrhage. In the intervening years, the characteristic morphology of APL has been described fully with both classical hypergranular and variant microgranular forms. Both are characterized by a balanced translocation between the long arms of chromosomes 15 and 17, [t(15;17)(q24;q21)], giving rise to a unique fusion gene PML-RARA and an abnormal chimeric transcription factor (PML-RARA), which disrupts normal myeloid differentiation programs. The success of current treatments for APL is in marked contrast to the vast majority of patients with non-promyelocytic AML. The overall prognosis in non-promyelocytic AML is poor, and although there has been an improvement in overall survival in patients aged <60 years, only 30%-40% of younger patients are still alive 5 years after diagnosis. APL therapy has diverged from standard AML therapy through the empirical discovery of two agents that directly target the molecular basis of the disease. The evolution of treatment over the last 4 decades to include all-trans retinoic acid and arsenic trioxide, with chemotherapy limited to patients with high-risk disease, has led to complete remission in 90%-100% of patients in trials and rates of overall survival between 86% and 97%.
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Affiliation(s)
- Derek McCulloch
- Institute of Hematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Christina Brown
- Institute of Hematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Harry Iland
- Institute of Hematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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319
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From occasional date to civil union in APL. Blood 2017; 129:1235. [DOI: 10.1182/blood-2017-01-759761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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320
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Stein E, Yen K. Targeted Differentiation Therapy with Mutant IDH Inhibitors: Early Experiences and Parallels with Other Differentiation Agents. ANNUAL REVIEW OF CANCER BIOLOGY-SERIES 2017. [DOI: 10.1146/annurev-cancerbio-050216-122051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Somatic mutations in the isocitrate dehydrogenase (IDH) 1 and 2 genes have been described in multiple hematologic and solid tumors, and confer a gain of function, permitting the production of the oncometabolite (R)-2-hydroxyglutarate (2-HG). 2-HG accumulation induces DNA and histone hypermethylation and altered gene expression, ultimately resulting in a block in cellular differentiation. Proof-of-concept preclinical work demonstrated that targeted inhibition of the mutant IDH (mIDH) enzyme is a feasible therapeutic strategy, based on the hypothesis that inhibition of the mIDH enzyme blocks 2-HG production, resulting in an appropriate methylation state and the onset of cellular differentiation. Clinical development programs for targeted inhibitors are underway, and preliminary data in patients with mIDH acute myeloid leukemia suggest that these inhibitors act as differentiation agents. Here we review the use of differentiation agents for the treatment of hematologic and solid tumors and discuss the preclinical and early clinical evidence that mIDH inhibitors mediate antitumor effects through the induction of differentiation.
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Affiliation(s)
- Eytan Stein
- Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Katharine Yen
- Agios Pharmaceuticals, Inc., Cambridge, Massachusetts 02139
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321
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Abstract
With improvements in care over time it becomes harder to improve clinical outcomes in those conditions where cure rates are high. The focus of research can thus turn to the so-called non-inferiority trial: where the main aim is not to improve clinical outcome, but instead to provide evidence of a lack of difference, whilst other issues, such as cost or toxicity, are improved. The interpretation of such trials is not always straightforward. The burden of proof is reversed compared to a traditional superiority trial, and this means that many of the statistical safeguards, such as significance and intention-to-treat, which act as restraints from an overhasty adoption of a new therapy, may actually work in the opposite fashion. The issues regarding non-inferiority and equivalence trials are considered, and their interpretation discussed.
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Affiliation(s)
- Robert K Hills
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4XN, UK
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322
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Lehmann S, Deneberg S, Antunovic P, Rangert-Derolf Å, Garelius H, Lazarevic V, Myhr-Eriksson K, Möllgård L, Uggla B, Wahlin A, Wennström L, Höglund M, Juliusson G. Early death rates remain high in high-risk APL: update from the Swedish Acute Leukemia Registry 1997-2013. Leukemia 2017; 31:1457-1459. [PMID: 28232742 DOI: 10.1038/leu.2017.71] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- S Lehmann
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Unit of Hematology, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - S Deneberg
- Unit of Hematology, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - P Antunovic
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Å Rangert-Derolf
- Department of Hematology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - H Garelius
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - V Lazarevic
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - K Myhr-Eriksson
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - L Möllgård
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - B Uggla
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - A Wahlin
- Department of Medicine, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - L Wennström
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - M Höglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - G Juliusson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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323
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Platzbecker U, Avvisati G, Cicconi L, Thiede C, Paoloni F, Vignetti M, Ferrara F, Divona M, Albano F, Efficace F, Fazi P, Sborgia M, Di Bona E, Breccia M, Borlenghi E, Cairoli R, Rambaldi A, Melillo L, La Nasa G, Fiedler W, Brossart P, Hertenstein B, Salih HR, Wattad M, Lübbert M, Brandts CH, Hänel M, Röllig C, Schmitz N, Link H, Frairia C, Pogliani EM, Fozza C, D’Arco AM, Di Renzo N, Cortelezzi A, Fabbiano F, Döhner K, Ganser A, Döhner H, Amadori S, Mandelli F, Ehninger G, Schlenk RF, Lo-Coco F. Improved Outcomes With Retinoic Acid and Arsenic Trioxide Compared With Retinoic Acid and Chemotherapy in Non–High-Risk Acute Promyelocytic Leukemia: Final Results of the Randomized Italian-German APL0406 Trial. J Clin Oncol 2017; 35:605-612. [DOI: 10.1200/jco.2016.67.1982] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The initial results of the APL0406 trial showed that the combination of all- trans-retinoic acid (ATRA) and arsenic trioxide (ATO) is at least not inferior to standard ATRA and chemotherapy (CHT) in first-line therapy of low- or intermediate-risk acute promyelocytic leukemia (APL). We herein report the final analysis on the complete series of patients enrolled onto this trial. Patients and Methods The APL0406 study was a prospective, randomized, multicenter, open-label, phase III noninferiority trial. Eligible patients were adults between 18 and 71 years of age with newly diagnosed, low- or intermediate-risk APL (WBC at diagnosis ≤ 10 × 109/L). Overall, 276 patients were randomly assigned to receive ATRA-ATO or ATRA-CHT between October 2007 and January 2013. Results Of 263 patients evaluable for response to induction, 127 (100%) of 127 patients and 132 (97%) of 136 patients achieved complete remission (CR) in the ATRA-ATO and ATRA-CHT arms, respectively ( P = .12). After a median follow-up of 40.6 months, the event-free survival, cumulative incidence of relapse, and overall survival at 50 months for patients in the ATRA-ATO versus ATRA-CHT arms were 97.3% v 80%, 1.9% v 13.9%, and 99.2% v 92.6%, respectively ( P < .001, P = .0013, and P = .0073, respectively). Postinduction events included two relapses and one death in CR in the ATRA-ATO arm and two instances of molecular resistance after third consolidation, 15 relapses, and five deaths in CR in the ATRA-CHT arm. Two patients in the ATRA-CHT arm developed a therapy-related myeloid neoplasm. Conclusion These results show that the advantages of ATRA-ATO over ATRA-CHT increase over time and that there is significantly greater and more sustained antileukemic efficacy of ATO-ATRA compared with ATRA-CHT in low- and intermediate-risk APL.
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Affiliation(s)
- Uwe Platzbecker
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Giuseppe Avvisati
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Laura Cicconi
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Christian Thiede
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Francesca Paoloni
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Marco Vignetti
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Felicetto Ferrara
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Mariadomenica Divona
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Francesco Albano
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Fabio Efficace
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Paola Fazi
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Marco Sborgia
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Eros Di Bona
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Massimo Breccia
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Erika Borlenghi
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Roberto Cairoli
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Alessandro Rambaldi
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Lorella Melillo
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Giorgio La Nasa
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Walter Fiedler
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Peter Brossart
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Bernd Hertenstein
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Helmut R. Salih
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Mohammed Wattad
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Michael Lübbert
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Christian H. Brandts
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Mathias Hänel
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Christoph Röllig
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Norbert Schmitz
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Hartmut Link
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Chiara Frairia
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Enrico Maria Pogliani
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Claudio Fozza
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Alfonso Maria D’Arco
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Nicola Di Renzo
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Agostino Cortelezzi
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Francesco Fabbiano
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Konstanze Döhner
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Arnold Ganser
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Hartmut Döhner
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Sergio Amadori
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Franco Mandelli
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Gerhard Ehninger
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Richard F. Schlenk
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
| | - Francesco Lo-Coco
- Uwe Platzbecker, Christian Thiede, Christoph Röllig, and Gerhard Ehninger, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden; Uwe Platzbecker and Gerhard Ehninger, Study Alliance Leukemia, Dresden; Walter Fiedler, University Hospital Hamburg-Eppendorf; Norbert Schmitz, Asklepios Klinik St Georg Hamburg, Hamburg; Peter Brossart, Innere Medizin mit deSchwerpunkten Onkologie, Haematollogie un Rheumatologie, Bonn; Bernd Hertenstein, Klinikum Bremen Mitte, Bremen; Helmut R. Salih,
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DeAngelo DJ. Tailored Approaches to Induction Therapy for Acute Promyelocytic Leukemia. J Clin Oncol 2017; 35:583-586. [DOI: 10.1200/jco.2016.68.4761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Daniel J. DeAngelo
- Daniel J. DeAngelo, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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325
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Long-term outcome of acute promyelocytic leukemia treated with all- trans-retinoic acid, arsenic trioxide, and gemtuzumab. Blood 2016; 129:1275-1283. [PMID: 28003274 DOI: 10.1182/blood-2016-09-736686] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/08/2016] [Indexed: 01/13/2023] Open
Abstract
The combination of all-trans-retinoic acid (ATRA) plus arsenic trioxide (ATO) has been shown to be superior to ATRA plus chemotherapy in the treatment of standard-risk patients with newly diagnosed acute promyelocytic leukemia (APL). A recent study demonstrated the efficacy of this regimen with added gemtuzumab ozogamicin (GO) in high-risk patients. We examined the long-term outcome of patients with newly diagnosed APL treated at our institution on 3 consecutive prospective clinical trials, using the combination of ATRA and ATO, with or without GO. For induction, all patients received ATRA (45 mg/m2 daily) and ATO (0.15 mg/kg daily) with a dose of GO (9 mg/m2 on day 1) added to high-risk patients (white blood cell count, >10 × 109/L), as well as low-risk patients who experienced leukocytosis during induction. Once in complete remission, patients received 4 cycles of ATRA plus ATO consolidation. One hundred eighty-seven patients, including 54 with high-risk and 133 with low-risk disease, have been treated. The complete remission rate was 96% (52 of 54 in high-risk and 127 of 133 in low-risk patients). Induction mortality was 4%, with only 7 relapses. Among low-risk patients, 60 patients (45%) required either GO or idarubicin for leukocytosis. Median duration of follow-up was 47.6 months. The 5-year event-free, disease-free, and overall survival rates are 85%, 96%, and 88%, respectively. Late hematological relapses beyond 1 year occurred in 3 patients. Fourteen deaths occurred beyond 1 year; 12 were related to other causes. This study confirms the durability of responses with this regimen.
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Abstract
Therapy-related myeloid neoplasms (t-MN) combine t-MDS and therapy related acute myeloid leukemia (t-AML) patients in one entity because of their similar pathogenesis, rapid progression from t-MDS to t-AML, and their equally poor prognosis. Treatment with epipodophyllotoxins like etoposide has been associated with a short interval between treatment and development of t-AML, with fusion oncogenes like KMT2A/MLL-MLLT3 and a better prognosis. In contrast, treatment with alkylating agents has been associated with a longer latency, an initial MDS phase, adverse cytogenetics, and a poor prognosis. The pathogenesis of t-MN can be explained by direct induction of an oncogene through chromosomal translocations, induction of genetic instability, or selection of a preexisting treatment-resistant hematopoietic stem cell clone. Recent evidence has highlighted the importance of the last mechanism and explains the high frequency of TP53 mutations in patients with t-MN. After previous cytotoxic therapy, patients present with specific vulnerabilities, especially evident from the high nonrelapse mortality in patients with t-MN after allogeneic hematopoietic cell transplantation. Here, the prognostic impact of currently known risk factors and the therapeutic options in different patient subgroups will be discussed.
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327
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Heuser M. Therapy-related myeloid neoplasms: does knowing the origin help to guide treatment? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:24-32. [PMID: 27913458 PMCID: PMC6142514 DOI: 10.1182/asheducation-2016.1.24] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Therapy-related myeloid neoplasms (t-MN) combine t-MDS and therapy related acute myeloid leukemia (t-AML) patients in one entity because of their similar pathogenesis, rapid progression from t-MDS to t-AML, and their equally poor prognosis. Treatment with epipodophyllotoxins like etoposide has been associated with a short interval between treatment and development of t-AML, with fusion oncogenes like KMT2A/MLL-MLLT3 and a better prognosis. In contrast, treatment with alkylating agents has been associated with a longer latency, an initial MDS phase, adverse cytogenetics, and a poor prognosis. The pathogenesis of t-MN can be explained by direct induction of an oncogene through chromosomal translocations, induction of genetic instability, or selection of a preexisting treatment-resistant hematopoietic stem cell clone. Recent evidence has highlighted the importance of the last mechanism and explains the high frequency of TP53 mutations in patients with t-MN. After previous cytotoxic therapy, patients present with specific vulnerabilities, especially evident from the high nonrelapse mortality in patients with t-MN after allogeneic hematopoietic cell transplantation. Here, the prognostic impact of currently known risk factors and the therapeutic options in different patient subgroups will be discussed.
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MESH Headings
- Antineoplastic Agents, Alkylating/adverse effects
- Antineoplastic Agents, Alkylating/therapeutic use
- Disease-Free Survival
- Hematopoietic Stem Cells/metabolism
- Histone-Lysine N-Methyltransferase/genetics
- Histone-Lysine N-Methyltransferase/metabolism
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/mortality
- Myeloid-Lymphoid Leukemia Protein/genetics
- Myeloid-Lymphoid Leukemia Protein/metabolism
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/metabolism
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Survival Rate
- Translocation, Genetic/drug effects
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
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Abedin S, Altman JK. Acute promyelocytic leukemia: preventing early complications and late toxicities. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:10-15. [PMID: 27913456 PMCID: PMC6142484 DOI: 10.1182/asheducation-2016.1.10] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Acute promyelocytic leukemia (APL) is a unique subtype of acute myeloid leukemia (AML), which presents with a distinct coagulopathy. Therapeutic advances have made APL one of the true success stories in oncology, transforming this once lethal disease into the most curable form of AML. For many patients, cure will now be achieved without the use of chemotherapy. It is hoped that limiting chemotherapy will reduce mortality even further, particularly among more vulnerable older adults whose survival lagged behind that of younger patients. It should be noted that early death persists in patients with APL and continues to negatively affect survival. Further, among survivors treated with chemotherapy or even arsenic trioxide (ATO), there remains the potential for long-term toxicities that must be monitored. Understanding the management of these issues is an important complement to ensure maximal survival for patients with APL.
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Affiliation(s)
- Sameem Abedin
- Robert H. Lurie Comprehensive Cancer Center and Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jessica K Altman
- Robert H. Lurie Comprehensive Cancer Center and Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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329
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Wang X, Tan Y, Li Y, Li J, Jin W, Wang K. Repression of CDKN2C caused by PML/RARα binding promotes the proliferation and differentiation block in acute promyelocytic leukemia. Front Med 2016; 10:420-429. [PMID: 27888400 DOI: 10.1007/s11684-016-0478-3] [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: 03/29/2016] [Accepted: 05/06/2016] [Indexed: 12/14/2022]
Abstract
Inappropriate cell proliferation during oncogenesis is often accompanied by inactivation of components involved in the cell cycle machinery. Here, we report that cyclin-dependent kinase inhibitor 2C (CDKN2C) as a member of the cyclin-dependent kinase inhibitors is a target of the PML/RARα oncofusion protein in leukemogenesis of acute promyelocytic leukemia (APL).We found that CDKN2C was markedly downregulated in APL blasts compared with normal promyelocytes. Chromatin immunoprecipitation combined with quantitative polymerase chain reaction demonstrated that PML/RARα directly bound to the CDKN2C promoter in the APL patient-derived cell line NB4. Luciferase assays indicated that PML/RARα inhibited the CDKN2C promoter activity in a dose-dependent manner. Furthermore, all-trans retinoic acid treatment induced CDKN2C expression by releasing the PML/RARα binding on chromatin in NB4 cells. Functional studies showed that ectopic expression of CDKN2C induced a cell cycle arrest at the G0/G1 phase and a partial differentiation in NB4 cells. Finally, the transcriptional regulation of CDKN2C was validated in primary APL patient samples. Collectively, this study highlights the importance of CDKN2C inactivation in the abnormal cell cycle progression and differentiation block of APL cells and may provide new insights into the study of pathogenesis and targeted therapy of APL.
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Affiliation(s)
- Xiaoling Wang
- State Key Laboratory of Medical Genomics and Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yun Tan
- State Key Laboratory of Medical Genomics and Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yizhen Li
- State Key Laboratory of Medical Genomics and Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jingming Li
- State Key Laboratory of Medical Genomics and Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wen Jin
- State Key Laboratory of Medical Genomics and Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200025, China. .,Sino-French Research Center for Life Sciences and Genomics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Kankan Wang
- State Key Laboratory of Medical Genomics and Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200025, China. .,Sino-French Research Center for Life Sciences and Genomics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Lo-Coco F. Trisenox: a paradigm shift in APL therapy, an interview with Francesco Lo-Coco. Int J Hematol Oncol 2016; 5:101-104. [PMID: 30302209 DOI: 10.2217/ijh-2016-0013] [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] [Accepted: 12/05/2016] [Indexed: 11/21/2022] Open
Abstract
Francesco Lo-Coco speaks to Sebastian Dennis-Beron, Commissioning Editor: Francesco Lo-Coco is currently a full professor of hematology and head of the Laboratory of Integrated Diagnosis of Oncohematologic Diseases at the Department of Biomedicine and Prevention of the University Tor Vergata of Roma. He obtained his MD degree from the University of Pisa in 1981, and his specialization in clinical and laboratory hematology is from the University La Sapienza of Rome in 1985. From 1992 to 1994, he has trained on molecular genetics of lymphomas at Columbia University, New York. His main scientific interest and research activities include genetic characterization, monitoring and treatment of hematologic tumors, particularly acute myeloid leukemia and acute promyelocytic leukemia (APL). He has published over 390 internationally peer-reviewed articles, mainly focused on molecular diagnosis and follow-up of leukemia as well as on treatment of APL. He chairs at present the APL subcommittee of the Italian National Cooperative Group, GIMEMA. He served as president of the Italian Society of Experimental Hematology, chairman of the Education Committee of the European Hematology Association, board member of the Italian Foundation for Cancer Research, member of the Committe on Health Research of the Italian Ministry of Health and member of the Editorial Board of the journals Leukemia, Journal of Clinical Oncology and Haematologica.
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Affiliation(s)
- Francesco Lo-Coco
- Department of Biomedicine & Prevention, University Tor Vergata, Rome, Italy
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331
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Massaro F, Molica M, Breccia M. Current first- and second-line treatment options in acute promyelocytic leukemia. Int J Hematol Oncol 2016; 5:105-118. [PMID: 30302210 PMCID: PMC6171971 DOI: 10.2217/ijh-2016-0010] [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: 09/07/2016] [Accepted: 01/05/2017] [Indexed: 02/07/2023] Open
Abstract
Outcome of acute promyelocytic leukemia (APL) has remarkably improved during the last 30 years, especially after the identification of PML-RARA oncogene as a key in the pathogenesis of APL and all-trans retinoic acid as therapeutic agent. Arsenic trioxide has been recently demonstrated to be the most effective single antileukemic agent and it has also showed synergistic action when combined with all-trans retinoic acid, decreasing relapse rate especially in low/intermediate-risk settings. Therapeutic advances led to complete remission rates of more than 90%, modifying disease history. In relapse setting, arsenic trioxide-based regimens showed efficacy for the achievement of second molecular complete remission. The most challenging issue in APL management remains the significant early deaths rate, nowadays the principal reason for treatment failure.
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Affiliation(s)
- Fulvio Massaro
- Hematology, Department of Cellular Biotechnologies & Hematology, Sapienza University, Via Benevento 6, 00161 Rome, Italy
| | - Matteo Molica
- Hematology, Department of Cellular Biotechnologies & Hematology, Sapienza University, Via Benevento 6, 00161 Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies & Hematology, Sapienza University, Via Benevento 6, 00161 Rome, Italy
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332
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Lou Y, Suo S, Tong H, Qian W, Mai W, Meng H, Yu W, Wei J, Jin J. Hypofibrinogenemia as a clue in the presumptive diagnosis of acute promyelocytic leukemia. Leuk Res 2016; 50:11-16. [DOI: 10.1016/j.leukres.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/20/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
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333
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Baljevic M, Dumitriu B, Lee JW, Paietta EM, Wiernik PH, Racevskis J, Chen C, Stein EM, Gallagher RE, Rowe JM, Appelbaum FR, Powell BL, Larson RA, Coutré SE, Lancet J, Litzow MR, Luger SM, Young NS, Tallman MS. Telomere Length Recovery: A Strong Predictor of Overall Survival in Acute Promyelocytic Leukemia. Acta Haematol 2016; 136:210-218. [PMID: 27632567 DOI: 10.1159/000448160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022]
Abstract
Telomeres are the capping ends of chromosomes that protect the loss of genetic material and prevent chromosomal instability. In human tissue-specific stem/progenitor cells, telomere length (TL) is maintained by the telomerase complex, which consists of a reverse transcriptase catalytic subunit (TERT) and an RNA template (TERC). Very short telomeres and loss-of-function mutations in the TERT and TERC genes have been reported in acute myeloid leukemia, but the role of telomeres in acute promyelocytic leukemia (APL) has not been well established. We report the results for a large cohort of 187 PML/RARα-positive APL patients. No germline mutations in the TERT or TERC genes were identified. Codon 279 and 1062 TERT polymorphisms were present at a frequency similar to that in the general population. TL measured in blood or marrow mononuclear cells at diagnosis was significantly shorter in the APL patients than in healthy volunteers, and shorter telomeres at diagnosis were significantly associated with high-risk disease. For patients who achieved complete remission, the median increase in TL from diagnosis to remission (delta TL) was 2.0 kilobase (kb), and we found delta TL to be the most powerful predictor of overall survival when compared with well-established risk factors for poor outcomes in APL.
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Affiliation(s)
- Muhamed Baljevic
- Oncology/Hematology Division, The University of Nebraska Medical Center, Omaha, Nebr., USA
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334
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Norsworthy KJ, Cho E, Arora J, Kowalski J, Tsai HL, Warlick E, Showel M, Pratz KW, Sutherland LA, Gore SD, Ferguson A, Sakoian S, Greer J, Espinoza-Delgado I, Jones RJ, Matsui WH, Smith BD. Differentiation therapy in poor risk myeloid malignancies: Results of companion phase II studies. Leuk Res 2016; 49:90-7. [PMID: 27619199 DOI: 10.1016/j.leukres.2016.09.003] [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] [Received: 05/25/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 12/28/2022]
Abstract
Pre-clinical data in non-M3 AML supports the use of differentiation therapy, but clinical activity has been limited. Myeloid growth factors can enhance anti-leukemic activity of differentiating agents in vitro. We conducted companion phase II trials investigating sargramostim (GM-CSF) 125μg/m(2)/day plus 1) bexarotene (BEX) 300mg/m(2)/day or 2) entinostat (ENT) 4-8mg/m(2)/week in patients with MDS or relapsed/refractory AML. Primary endpoints were response after at least two treatment cycles and toxicity. 26 patients enrolled on the BEX trial had a median of 2 prior treatments and 24 enrolled on the ENT trial had a median of 1. Of 13 response-evaluable patients treated with BEX, the best response noted was hematologic improvement in neutrophils (HI-N) seen in 4 (31%) patients; none achieved complete (CR) or partial remission (PR). Of 10 treated with ENT, there was 1 (10%) partial remission (PR) and 2 (20%) with HI-N. The secondary endpoint responses of HI-N with each combination were accompanied by a numerical increase in ANC (BEX: 524 to 931 cells/mm(3), p=0.096; ENT: 578 to 1 137 cells/mm(3), p=0.15) without increasing marrow blasts. Shared grade 3-4 non-hematologic toxicities included febrile neutropenia, bone pain, fatigue, and dyspnea. GM-CSF plus either BEX or ENT are well tolerated in resistant and refractory MDS and AML and showed modest clinical and biologic activity, most commonly HI-N.
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Affiliation(s)
- Kelly J Norsworthy
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Eunpi Cho
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Jyoti Arora
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Jeanne Kowalski
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Hua-Ling Tsai
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Erica Warlick
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Margaret Showel
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Keith W Pratz
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Lesley A Sutherland
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Steven D Gore
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Anna Ferguson
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Sarah Sakoian
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Jackie Greer
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Igor Espinoza-Delgado
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD, United States
| | - Richard J Jones
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - William H Matsui
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - B Douglas Smith
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States.
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335
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Damery E, Solimando DA, Waddell JA. Arsenic Trioxide and Tretinoin (AsO/ATRA) for Acute Promyelocytic Leukemia (APL). Hosp Pharm 2016; 51:628-632. [PMID: 27698500 PMCID: PMC5030872 DOI: 10.1310/hpj5108-628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net.
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336
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Huang S, Yang H, Li Y, Feng C, Gao L, Chen GF, Gao HH, Huang Z, Li YH, Yu L. Prognostic Significance of Mixed-Lineage Leukemia (MLL) Gene Detected by Real-Time Fluorescence Quantitative PCR Assay in Acute Myeloid Leukemia. Med Sci Monit 2016; 22:3009-17. [PMID: 27561414 PMCID: PMC5012461 DOI: 10.12659/msm.900429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background The overall prognosis of acute myeloid leukemia (AML) patients with mixed-lineage leukemia (MLL) gene-positivity is unfavorable. In this study, we evaluated the expression levels of the MLL gene in AML patients. Material/Methods We enrolled 68 MLL gene-positive patients out of 433 newly diagnosed AML patients, and 216 bone marrow samples were collected. Real-time fluorescence quantitative PCR (RQ-PCR) was used to precisely detect the expression levels of the MLL gene. Results We divided 41 patients into 2 groups according to the variation of MRD (minimal residual disease) level of the MLL gene. Group 1 (n=22) had a rapid reduction of MRD level to ≤10−4 in all samples collected in the first 3 chemotherapy cycles, while group 2 (n=19) had MRD levels constantly >10−4 in all samples collected in the first 3 chemotherapy cycles. Group 1 had a significantly better overall survival (p=0.001) and event-free survival (p=0.001) compared to group 2. Moreover, the patients with >10−4 MRD level before the start of HSCT (hematopoietic stem cell transplantation) had worse prognosis and higher risk of relapse compared to patients with ≤10−4 before the start of HSCT. Conclusions We found that a rapid reduction of MRD level to ≤10−4 appears to be a prerequisite for better overall survival and event-free survival during the treatment of AML. The MRD levels detected by RQ-PCR were basically in line with the clinical outcome and may be of great importance in guiding early allogeneic HSCT (allo-HSCT) treatment.
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Affiliation(s)
- Sai Huang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Hua Yang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Yan Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Cong Feng
- Department of Emergency Medicine, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Li Gao
- Department of Hematology, China-Japan Friendship Hospital, Hepingli, Beijing, China (mainland)
| | - Guo-Feng Chen
- Department of Hematology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Hong-Hao Gao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Zhi Huang
- Department of Electrical and Computer Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Yong-Hui Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Li Yu
- Department of Hematology, Chinese PLA General Hospital, Beijing, China (mainland)
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337
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Wu F, Wu D, Ren Y, Duan C, Chen S, Xu A. Bayesian network meta-analysis comparing five contemporary treatment strategies for newly diagnosed acute promyelocytic leukaemia. Oncotarget 2016; 7:47319-47331. [PMID: 27322078 PMCID: PMC5216944 DOI: 10.18632/oncotarget.10118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a curable subtype of acute myeloid leukemia. The optimum regimen for newly diagnosed APL remains inconclusive. In this Bayesian network meta-analysis, we compared the effectiveness of five regimens-arsenic trioxide (ATO) + all-trans retinoic acid (ATRA), realgar-indigo naturalis formula (RIF) which contains arsenic tetrasulfide + ATRA, ATRA + anthracycline-based chemotherapy (CT), ATO alone and ATRA alone, based on fourteen randomized controlled trials (RCTs), which included 1407 newly diagnosed APL patients. According to the results, the ranking efficacy of the treatment, including early death and complete remission in the induction stage, was the following: 1. ATO/RIF + ATRA; 2. ATRA + CT; 3. ATO, and 4. ATRA. For long-term benefit, ATO/RIF + ATRA significantly improved overall survival (OS) (hazard ratio = 0.35, 95%CI 0.15-0.82, p = 0.02) and event-free survival (EFS) (hazard ratio = 0.32, 95%CI 0.16-0.61, p = 0.001) over ATRA + CT regimen for the low-to-intermediate-risk patients. Thus, ATO + ATRA and RIF + ATRA might be considered the optimum treatments for the newly diagnosed APL and should be recommended as the standard care for frontline therapy.
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Affiliation(s)
- Fenfang Wu
- Guangdong Province Key Laboratory for Pharmaceutical Functional Genes, College of Life Sciences, Sun Yat-Sen University, Guangzhou, Guangdong, 510006, People's Republic of China
| | - Di Wu
- Guangdong Province Key Laboratory for Pharmaceutical Functional Genes, College of Life Sciences, Sun Yat-Sen University, Guangzhou, Guangdong, 510006, People's Republic of China
| | - Yong Ren
- Guangdong Province Key Laboratory for Pharmaceutical Functional Genes, College of Life Sciences, Sun Yat-Sen University, Guangzhou, Guangdong, 510006, People's Republic of China
| | - Chongyang Duan
- Department of Biostatistics, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Shangwu Chen
- Guangdong Province Key Laboratory for Pharmaceutical Functional Genes, College of Life Sciences, Sun Yat-Sen University, Guangzhou, Guangdong, 510006, People's Republic of China
| | - Anlong Xu
- Guangdong Province Key Laboratory for Pharmaceutical Functional Genes, College of Life Sciences, Sun Yat-Sen University, Guangzhou, Guangdong, 510006, People's Republic of China
- Beijing University of Chinese Medicine, Beijing, 100029, People's Republic of China
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338
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Ma Y, Liu L, Jin J, Lou Y. All-Trans Retinoic Acid plus Arsenic Trioxide versus All-Trans Retinoic Acid plus Chemotherapy for Newly Diagnosed Acute Promyelocytic Leukemia: A Meta-Analysis. PLoS One 2016; 11:e0158760. [PMID: 27391027 PMCID: PMC4938459 DOI: 10.1371/journal.pone.0158760] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/21/2016] [Indexed: 12/14/2022] Open
Abstract
Background Recently, the all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) protocol has become a promising first-line therapeutic approach in patients with newly diagnosed acute promyelocytic leukemia (APL), but its benefits compared with standard ATRA plus chemotherapy regimen needs to be proven. Herein, we conducted a meta-analysis comparing the efficacy of ATRA plus ATO with ATRA plus chemotherapy for adult patients with newly diagnosed APL. Methods We systematically searched biomedical electronic databases and conference proceedings through February 2016. Two reviewers independently assessed all studies for relevance and validity. Results Overall, three studies were eligible for inclusion in this meta-analysis, which included a total of 585 patients, with 317 in ATRA plus ATO group and 268 in ATRA plus chemotherapy group. Compared with patients who received ATRA and chemotherapy, patients who received ATRA plus ATO had a significantly better event-free survival (hazard ratio [HR] = 0.38, 95% confidence interval [CI]: 0.22–0.67, p = 0.009), overall survival (HR = 0.44, 95% CI: 0.24–0.82, p = 0.009), complete remission rate (relative risk [RR] = 1.05; 95% CI: 1.01–1.10; p = 0.03). There were no significant differences in early mortality (RR = 0.48; 95% CI: 0.22–1.05; p = 0.07). Conclusion Thus, this analysis indicated that ATRA plus ATO protocol may be preferred to standard ATRA plus chemotherapy protocol, particularly in low-to-intermediate risk APL patients. Further larger trials were needed to provide more evidence in high-risk APL patients.
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Affiliation(s)
- Yafang Ma
- Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lu Liu
- Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jie Jin
- Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Hematopoietic Malignancies Zhejiang Province, Hangzhou, China
| | - Yinjun Lou
- Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Hematopoietic Malignancies Zhejiang Province, Hangzhou, China
- * E-mail:
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339
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Massive Pulmonary Embolism at the Onset of Acute Promyelocytic Leukemia. Mediterr J Hematol Infect Dis 2016; 8:e2016027. [PMID: 27413520 PMCID: PMC4928521 DOI: 10.4084/mjhid.2016.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/15/2016] [Indexed: 11/10/2022] Open
Abstract
Life-threatening bleeding is a major and early complication of acute promyelocytic leukemia (APL), but in the last years there is a growing evidence of thromboses in APL. We report the first case of a young woman with dyspnea as the first symptom of APL due to massive pulmonary embolism (PE) successfully treated with thrombolysis for PE and heparin. APL has been processed with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) obtaining complete remission.
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340
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Li X, Guan X, Li F, Chen Y, Li N. Chemosensitivity enhancement toward arsenic trioxide by inhibition of histone deacetylase in NB4 cell line. J Int Med Res 2016; 44:882-92. [PMID: 27189198 PMCID: PMC5536622 DOI: 10.1177/0300060516646238] [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: 11/24/2015] [Accepted: 04/04/2016] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate the cytotoxic effects of suberanilohydroxamic acid (vorinostat) in combination with arsenic trioxide (ATO) on the human NB4 cell line in vitro. Methods The rates of cell proliferation following treatment with vorinostat with or without ATO were measured. Flow cytometry of Annexin-V/propidium iodide double-stained cells was used to measure apoptosis. Acridine Orange and ethidium bromide staining was used to observe morphological changes characteristic of apoptosis. Western blot analysis was used to measure protein levels. Results Vorinostat and ATO, alone and in combination, inhibited the proliferation of NB4 cells in a time- and dose-dependent manner and the effect was additive. NB4 cells treated with vorinostat + ATO demonstrated greater levels of apoptosis compared with cells treated with either drug alone. Both vorinostat and ATO alone and in combination resulted in lower levels of promyelocytic leukaemia/retinoic acid receptor alpha fusion protein and increased levels of acetyl-histone H3 and acetyl-histone H4 proteins compared with controls. Vorinostat + ATO resulted in lower levels of Akt protein compared with either drug alone. Conclusion The combination of vorinostat and ATO inhibited cell proliferation, induced apoptosis, and enhanced the chemosensitivity of NB4 cells. The mechanism might be associated with increasing histone acetylation levels as well as downregulation of the Akt signalling pathway.
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Affiliation(s)
- Xiaofan Li
- Fujian Provincial Key Laboratory on Haematology, Department of Haematology, Fujian Institute of Haematology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Xiaoyan Guan
- Department of Internal Medicine, Fujian Provincial Hospital, Fuzhou, Fujian Province, China
| | - Fang Li
- Fujian Provincial Key Laboratory on Haematology, Department of Haematology, Fujian Institute of Haematology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Yuanzhong Chen
- Fujian Provincial Key Laboratory on Haematology, Department of Haematology, Fujian Institute of Haematology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Nainong Li
- Fujian Provincial Key Laboratory on Haematology, Department of Haematology, Fujian Institute of Haematology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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341
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Cicconi L, Lo-Coco F. Current management of newly diagnosed acute promyelocytic leukemia. Ann Oncol 2016; 27:1474-81. [PMID: 27084953 DOI: 10.1093/annonc/mdw171] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/04/2016] [Indexed: 01/28/2023] Open
Abstract
The management of acute promyelocytic leukemia (APL) has considerably evolved during the past two decades. The advent of all-trans retinoic acid (ATRA) and its inclusion in combinatorial regimens with anthracycline chemotherapy has provided cure rates exceeding 80%; however, this widely adopted approach also conveys significant toxicity including severe myelosuppression and rare occurrence of secondary leukemias. More recently, the advent of arsenic trioxide (ATO) and its use in association with ATRA with or without chemotherapy has further improved patient outcome by allowing to minimize the intensity of chemotherapy, thus reducing serious toxicity while maintaining high anti-leukemic efficacy. The advantage of ATRA-ATO over ATRA chemotherapy has been recently demonstrated in two large randomized trials and this option has now become the new standard of care in low-risk (i.e. non-hyperleukocytic) patients. In light of its rarity, abrupt onset and high risk of early death and due to specific treatment requirements, APL remains a challenging condition that needs to be managed in highly experienced centers. We review here the results of large clinical studies conducted in newly diagnosed APL as well as the recommendations for appropriate diagnosis, prevention and management of the main complications associated with modern treatment of the disease.
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Affiliation(s)
- L Cicconi
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - F Lo-Coco
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
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342
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Gocek E, Studzinski GP. DNA Repair in Despair-Vitamin D Is Not Fair. J Cell Biochem 2016; 117:1733-44. [PMID: 27122067 DOI: 10.1002/jcb.25552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 02/06/2023]
Abstract
The role of vitamin D as a treatment option for neoplastic diseases, once considered to have a bright future, remains controversial. The preclinical studies discussed herein show compelling evidence that Vitamin D Derivatives (VDDs) can convert some cancer and leukemia cells to a benign phenotype, by differentiation/maturation, cell cycle arrest, or induction of apoptosis. Furthermore, there is considerable, though still evolving, knowledge of the molecular mechanisms underlying these changes. However, the attempts to clearly document that the treatment outcomes of human neoplastic diseases can be positively influenced by VDDs have been, so far, disappointing. The clinical trials to date of VDDs, alone or combined with other agents, have not shown consistent results. It is our contention, shared by others, that there were limitations in the design or execution of these trials which have not yet been fully addressed. Based on the connection between upregulation of JNK by VDDs and DNA repair, we propose a new avenue of attack on cancer cells by increasing the toxicity of the current, only partially effective, cancer chemotherapeutic drugs by combining them with VDDs. This can impair DNA repair and thus kill the malignant cells, warranting a comprehensive study of this novel concept. J. Cell. Biochem. 117: 1733-1744, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elżbieta Gocek
- Faculty of Biotechnology, Department of Proteins Biotechnology, University of Wrocław, Joliot-Curie 14A Street, Wrocław 50-383, Poland
| | - George P Studzinski
- Department of Pathology and Laboratory Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, 07103, New Jersey, USA
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343
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Prasad S, Gupta SC, Aggarwal BB. Serendipity in Cancer Drug Discovery: Rational or Coincidence? Trends Pharmacol Sci 2016; 37:435-450. [PMID: 27083322 DOI: 10.1016/j.tips.2016.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 01/13/2023]
Abstract
Novel drug development leading to final approval by the US FDA can cost as much as two billion dollars. Why the cost of novel drug discovery is so expensive is unclear, but high failure rates at the preclinical and clinical stages are major reasons. Although therapies targeting a given cell signaling pathway or a protein have become prominent in drug discovery, such treatments have done little in preventing or treating any disease alone because most chronic diseases have been found to be multigenic. A review of the discovery of numerous drugs currently being used for various diseases including cancer, diabetes, cardiovascular, pulmonary, and autoimmune diseases indicates that serendipity has played a major role in the discovery. In this review we provide evidence that rational drug discovery and targeted therapies have minimal roles in drug discovery, and that serendipity and coincidence have played and continue to play major roles. The primary focus in this review is on cancer-related drug discovery.
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Affiliation(s)
- Sahdeo Prasad
- Cytokine Research Laboratory, Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Subash C Gupta
- Department of Biochemistry, Institute of Science, Banaras Hindu University, 221005 India
| | - Bharat B Aggarwal
- Cytokine Research Laboratory, Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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344
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Ali AM, Mirrakhimov AE, Abboud CN, Cashen AF. Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest. Hematol Oncol 2016; 34:69-78. [PMID: 27018197 DOI: 10.1002/hon.2292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/25/2016] [Accepted: 02/15/2016] [Indexed: 11/08/2022]
Abstract
Leukostasis is a poorly understood and life-threatening complication of acute hyperleukocytic leukemia. The incidence of hyperleukocytosis and leukostasis differs among various subtypes of leukemias. While the pathophysiology of leukostasis is not fully understood, recent research has elucidated many novel pathways that may have therapeutic implications in the future. Respiratory and neurological compromise represents the classical clinical manifestations of leukostasis. If it is not diagnosed and treated rapidly, the one-week mortality rate is approximately 40%. Targeted induction chemotherapy is an important component of the successful treatment of leukostasis, although other modalities of cytoreduction are being used and investigated. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alaa M Ali
- Washington University School of Medicine, Department of Medicine, St. Louis, MO, USA
| | - Aibek E Mirrakhimov
- University of Kentucky College of Medicine, Department of Medicine, Lexington, KY, USA
| | - Camille N Abboud
- Washington University School of Medicine, Department of Medicine, St. Louis, MO, USA
| | - Amanda F Cashen
- Washington University School of Medicine, Department of Medicine, St. Louis, MO, USA
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345
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Affiliation(s)
| | - Laura Di Donato
- Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) Foundation, Rome, Italy
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346
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LG-362B targets PML-RARα and blocks ATRA resistance of acute promyelocytic leukemia. Leukemia 2016; 30:1465-74. [PMID: 27012866 DOI: 10.1038/leu.2016.50] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/11/2016] [Accepted: 02/23/2016] [Indexed: 12/25/2022]
Abstract
Acute promyelocytic leukemia (APL) is a M3 subtype of acute myeloid leukemia (AML). Promyelocytic leukemia (PML)-retinoic acid receptor α (RARα) translocation generally occurs in APL patients and makes APL unique both for diagnosis and treatment. However, some conventional drugs like all-transretinoic acid (ATRA) and arsenic trioxide (ATO), as the preferred ones for APL therapy, induce irreversible resistance and responsible for clinical failure of complete remission. Herein, we screened a library of novel chemical compounds with structural diversity and discovered a novel synthetic small compound, named LG-362B, specifically inhibited the proliferation of APL and induced apoptosis. Notably, the differentiation arrest was also relieved by LG-362B in cultured APL cells and APL mouse models. Moreover, LG-362B overcame the ATRA resistance on cellular differentiation and transplantable APL mice. These positive effects were driven by caspases-mediated degradation of PML-RARα when treated with LG-362B, making it specific to APL and reasonable for ATRA resistance relief. We propose that LG-362B would be a potential candidate agent for the treatment of the relapsed APL with ATRA resistance in the future.
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347
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348
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Grimwade D, Ivey A, Huntly BJP. Molecular landscape of acute myeloid leukemia in younger adults and its clinical relevance. Blood 2016; 127:29-41. [PMID: 26660431 PMCID: PMC4705608 DOI: 10.1182/blood-2015-07-604496] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/04/2015] [Indexed: 01/13/2023] Open
Abstract
Recent major advances in understanding the molecular basis of acute myeloid leukemia (AML) provide a double-edged sword. Although defining the topology and key features of the molecular landscape are fundamental to development of novel treatment approaches and provide opportunities for greater individualization of therapy, confirmation of the genetic complexity presents a huge challenge to successful translation into routine clinical practice. It is now clear that many genes are recurrently mutated in AML; moreover, individual leukemias harbor multiple mutations and are potentially composed of subclones with differing mutational composition, rendering each patient's AML genetically unique. In order to make sense of the overwhelming mutational data and capitalize on this clinically, it is important to identify (1) critical AML-defining molecular abnormalities that distinguish biological disease entities; (2) mutations, typically arising in subclones, that may influence prognosis but are unlikely to be ideal therapeutic targets; (3) mutations associated with preleukemic clones; and (4) mutations that have been robustly shown to confer independent prognostic information or are therapeutically relevant. The reward of identifying AML-defining molecular lesions present in all leukemic populations (including subclones) has been exemplified by acute promyelocytic leukemia, where successful targeting of the underlying PML-RARα oncoprotein has eliminated the need for chemotherapy for disease cure. Despite the molecular heterogeneity and recognizing that treatment options for other forms of AML are limited, this review will consider the scope for using novel molecular information to improve diagnosis, identify subsets of patients eligible for targeted therapies, refine outcome prediction, and track treatment response.
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Affiliation(s)
- David Grimwade
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Adam Ivey
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Brian J P Huntly
- Department of Haematology, Cambridge Institute for Medical Research and Addenbrookes Hospital, University of Cambridge, and Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, Cambridge, United Kingdom
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349
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Kantarjian H. Acute myeloid leukemia--major progress over four decades and glimpses into the future. Am J Hematol 2016; 91:131-45. [PMID: 26598393 DOI: 10.1002/ajh.24246] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 12/17/2022]
Abstract
In this Review, the progress in research and therapy of acute myeloid leukemia is detailed.
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Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia; MD Anderson Cancer Center; Houston Texas
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350
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Lo-Coco F, Cicconi L, Breccia M. Current standard treatment of adult acute promyelocytic leukaemia. Br J Haematol 2015; 172:841-54. [PMID: 26687281 DOI: 10.1111/bjh.13890] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/24/2015] [Indexed: 11/28/2022]
Abstract
The outcome of patients with acute promyelocytic leukaemia (APL) has dramatically improved over the last two decades, due to the introduction of combined all-trans retinoic acid (ATRA) and chemotherapy regimens and, more recently, to the advent of arsenic trioxide (ATO). ATRA and anthracycline-based chemotherapy remains a widely used strategy, providing cure rates above 80%, but it is associated with risk of severe infections and occurrence of secondary leukaemias. ATO is the most effective single agent in APL and, used alone or in combination with ATRA or ATRA and reduced-intensity chemotherapy, results in greater efficacy with considerably less haematological toxicity. The toxic profile of ATO includes frequent, but manageable, QTc prolongation and increase of liver enzymes. Two large randomized studies have shown that ATRA + ATO is superior to ATRA + chemotherapy for newly diagnosed low-risk APL resulting in 2-4 year event-free survival rates above 90% and very few relapses. According to real world data, the spectacular progress in APL outcomes reported in clinical trials has not been paralleled by a significant improvement in early death rates, this remains the most challenging issue for the final cure of the disease.
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Affiliation(s)
- Francesco Lo-Coco
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.,Laboratory of Neuro-Oncohaematology, Santa Lucia Foundation, Rome, Italy
| | - Laura Cicconi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.,Laboratory of Neuro-Oncohaematology, Santa Lucia Foundation, Rome, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
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