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Benlachgar N, Masrar A, Haidouri S, Harmouche H, Tazi Mezalek Z. Bi-lineage B- and T-lymphoid Extramedullary Blast Crisis at an Initial Presentation of Chronic Myeloid Leukemia: A Case Report and Literature Review of Extramedullary Blast Crisis. Cureus 2023; 15:e49348. [PMID: 38143593 PMCID: PMC10749144 DOI: 10.7759/cureus.49348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Chronic myeloid leukemia (CML) with BCR-ABL1-positive cells is a myeloproliferative neoplasm (MPN) characterized by a chromosomal translocation t(9,22)(q34.1;q11.2), which results in the formation of a Philadelphia (Ph) chromosome containing the BCR-ABL1 fusion gene. Extramedullary blast crisis (EBC) associated with bcr/abl-positive CML is a rare initial presentation. Here, we present and discuss the case of a 51-year-old man who presented with a weight loss history, cervical swelling, and left-sided abdominal pain. He had a white blood cell count of 147,910/mm3. The blood smear study revealed myelemia in 23% and 8% of blast-like cells. The bone marrow aspiration and biopsy showed a richly cellularized sample; the megakaryocytes were present; the granular neutrophil line was at 89% with blasts at 1%. The cytogenetic analysis revealed a complex karyotype with the presence of a Philadelphia chromosome t (9, 22) (q34, q11) associated with additional cytogenetic abnormalities (ACA). Molecular analysis (PCR) detected a BCR::ABL1 (p210) rearrangement. At this point, a diagnosis of CML in the chronic phase was confirmed, but a cervical lymph node biopsy analysis revealed a bi-phenotypic B/T-lymphoblastic lymphoma (LBL) and expressed at fluorescent in situ hybridization (FISH) analysis BCR::ABL1 rearrangement. These findings were consistent with the diagnosis of a bi-phenotypic B/T extramedullary blast crisis associated with CML.
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Affiliation(s)
- Naoufal Benlachgar
- Department of Clinical Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Azlarab Masrar
- Central Laboratory of Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Soukaina Haidouri
- Department of Clinical Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Hicham Harmouche
- Department of Internal Medicine, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
| | - Zoubida Tazi Mezalek
- Department of Clinical Hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rabat, MAR
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2
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Al-Janazreh H, Abuzneid YS, Khamayseh I, Morabito F, Alqam B, Abusabbah RMF, Mustafa FK, Sarahneh S. An unusual case of T-cell acute lymphoblastic leukemia in a patient with BCR-ABL positive chronic myeloid leukemia and Gaucher disease. Ann Med Surg (Lond) 2021; 68:102565. [PMID: 34336196 PMCID: PMC8313842 DOI: 10.1016/j.amsu.2021.102565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Chronic myelogenous leukemia (CML) is a chronic myeloproliferative disease characterized by a massive overproduction of myeloid cells. It is associated with the Philadelphia chromosome [Ph1, t (9; 22) (q34; q11)] or BCR-ABL fusion gene. CML usually undergoes a triphasic clinical course ending in a blast crisis, an accelerated phase of blasts and promyelocyte production. Ten percent of CML patients reach the blast crisis phase, with 20–30% of leukemias belonging to B-cell lymphoid lineage. However, a transformation of CML into T-cell acute lymphoblastic leukemia (T-ALL) is rare. Case presentation We present a 56-year-old male patient, known case of hypertension and Ph1 CML of eight years with a family history of Gaucher disease who developed T-ALL. The patient presented with lymphadenopathy and severe anemia, needing packed RBC transfusion, neutropenia and thrombocytopenia at the admission. However, the monocytes and basophils percentage were high. The patient underwent a cervical lymph node core biopsy, and the immunohistochemistry stains showed an invasion of neoplastic cells positive for CD3, CD5, BCL2, CD34, TdT and focally positive for C-Kit and negative for CD20, CD56 and pan-CK. These histopathology features were consistent with T-cell acute lymphoblastic leukemia (T-ALL). Conclusion Blast crisis remain a challenge in CML management. It's of great importance to do a full proper workup including lymph nodes biopsies. The aim is to reverse blast crisis and restore the chronic phase. Even if CML normally transforms into B-ALL, it can also manifest as T-ALL. Careful history taking, meticulous physical examination, and investigations are necessary. Avoiding the blast crisis is very important in order to prevent its transformation.
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Affiliation(s)
- Hamdi Al-Janazreh
- Al-Quds University Faculty of Medicine, Jerusalem, Palestine.,Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, Jerusalem, Palestine
| | | | - Iman Khamayseh
- Al-Quds University Faculty of Medicine, Jerusalem, Palestine
| | - Fortunato Morabito
- Hematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, Jerusalem, Palestine
| | - Bilal Alqam
- Al-Quds University Faculty of Medicine, Jerusalem, Palestine
| | | | | | - Shifa Sarahneh
- Al-Quds University Faculty of Medicine, Jerusalem, Palestine
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3
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A Rare Case of Chronic Myelogenous Leukemia Presenting as T-Cell Lymphoblastic Crisis. Case Rep Oncol Med 2018; 2018:7276128. [PMID: 30581639 PMCID: PMC6276408 DOI: 10.1155/2018/7276128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022] Open
Abstract
Chronic Myelogenous Leukemia in blast crisis can manifest as either myeloid (more common) or lymphoid blast crisis. Most lymphoblastic crises are of B-cell lineage. T-cell blast crisis is extremely rare, with only a few reported cases. We present a case of a middle-aged man who was diagnosed with CML on peripheral blood and bone marrow biopsy. Because of a generalized lymphadenopathy noted at the time of diagnosis, a lymph node biopsy was also performed, which revealed a T-cell lymphoblastic leukemia/lymphoma, BCR/ABL1 positive, with clonal evolution. This is a very rare manifestation of CML in blast crisis with no standard treatment and with poor outcomes despite chemotherapy or allogeneic stem cell transplant. Given its rarity, it would be difficult to develop standard chemotherapy protocols. We believe the treatment for this condition should be similar to any lymphoid blast crisis. The patient was treated with induction chemotherapy (hyper-CVAD regimen) plus dasatinib for 3 cycles followed by sibling-donor allogeneic stem cell transplant and is currently on maintenance dasatinib and has minimal residual disease at this time.
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4
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Kadia TM, Gandhi V. Nelarabine in the treatment of pediatric and adult patients with T-cell acute lymphoblastic leukemia and lymphoma. Expert Rev Hematol 2016; 10:1-8. [PMID: 27869523 DOI: 10.1080/17474086.2017.1262757] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION T-cell acute lymphoblastic leukemia (ALL) and lymphoma (LBL) are aggressive hematologic neoplasms that are treated with combination chemotherapy in the frontline, but have limited options in the relapsed or refractory setting. Based on observations in patients with purine nucleoside phosphorylase (PNP) deficiency, a guanosine nucleoside analogue, arabinosylguanine (ara-G) was developed that provided T-cell specificity. Nelarabine was developed as the water-soluble, clinically useful-prodrug of ara-G and based on its activity was approved for the treatment of relapsed or refractory T-ALL/LBL. Areas covered: In this narrative review, we will summarize the preclinical studies, early dose-finding studies, and efficacy studies that led to approval of nelarabine. The review will succinctly cover response rates and safety signals reported during clinical development. We will also cover more recent work with nelarabine, including combination studies, modified dosing schedules, and frontline treatment approaches. Expert commentary: Based on evidence from the literature review and our own experience with nelarabine, we conclude that it is an effective agent in the treatment of T-cell malignancies. Understanding the factors that modulate the risk of dose-limiting neurotoxicity, how to mitigate this toxicity, and how to safely combine it with other active agents will continue to broaden its use.
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Affiliation(s)
- Tapan M Kadia
- a Departments of Leukemia , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Varsha Gandhi
- a Departments of Leukemia , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Departments of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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5
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Burger JA, Schmitt-Gräff A, Bürkle A, Seiler L, Finke J. Imatinib mesylate-induced long-term remission in extra-medullary T-cell lymphoid blastic phase of chronic myelogenous leukemia. Leuk Lymphoma 2006; 47:2427-30. [PMID: 17107924 DOI: 10.1080/10428190600879995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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6
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Raanani P, Trakhtenbrot L, Rechavi G, Rosenthal E, Avigdor A, Brok-Simoni F, Leiba M, Amariglio N, Nagler A, Ben-Bassat I. Philadelphia-chromosome-positive T-lymphoblastic leukemia: acute leukemia or chronic myelogenous leukemia blastic crisis. Acta Haematol 2005; 113:181-9. [PMID: 15870488 DOI: 10.1159/000084448] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Accepted: 12/13/2004] [Indexed: 11/19/2022]
Abstract
The Ph1 chromosome has rarely been reported in T-lineage acute lymphoblastic leukemia (T-ALL), and the clinical relevance of this translocation in T-ALL is currently unknown. In chronic myelogenous leukemia (CML) some data indicate derivation of T-cells from the leukemic clone and only a few cases of T-derived blastic crisis have been reported and quite often disputed. Particularly in cases identified initially in blastic crisis it may be difficult to distinguish those from Ph1-positive T-ALL. We herein report 2 patients who presented with a clinical picture of Ph1-positive T-ALL and who raised a differential diagnosis from T-cell blastic crisis of CML. We review the literature and suggest clinical and laboratory features that can help in the diagnosis. According to our literature review, 23 cases of Ph1-positive T-ALL and 44 cases of T-cell blastic crisis of CML, including ours, were reported. Some major differences between the two entities could help in establishing a diagnosis of Ph1-positive T-cell blastic crisis of CML vs. Ph1-positive T-ALL: Male sex and younger age was more predominant in T-ALL. While in most cases of CML blastic crisis there was a history of CML there was no such history in the T-ALL cases. Medullary involvement with lymphoblastic leukemia was present in all cases of T-ALL but only in about half of the cases of CML blastic crisis. None of the CML-blastic crisis cases tested by RT-PCR showed the minor breakpoint transcript, while 2 cases with T-ALL had the minor breakpoint transcript and 1 had both transcripts. Combined morphologic and FISH analysis can help to distinguish between the two entities and was applied in one of our cases. Although both entities carry a severe prognosis, differentiating between them might have clinical relevance, especially in the imatinib era.
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MESH Headings
- Blast Crisis/genetics
- Blast Crisis/pathology
- Cell Lineage/genetics
- Diagnosis, Differential
- Female
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia-Lymphoma, Adult T-Cell/genetics
- Leukemia-Lymphoma, Adult T-Cell/pathology
- Male
- Middle Aged
- Philadelphia Chromosome
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic/genetics
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Affiliation(s)
- Pia Raanani
- Institute of Hematology, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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7
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Van Rompay AR, Johansson M, Karlsson A. Substrate specificity and phosphorylation of antiviral and anticancer nucleoside analogues by human deoxyribonucleoside kinases and ribonucleoside kinases. Pharmacol Ther 2003; 100:119-39. [PMID: 14609716 PMCID: PMC7126524 DOI: 10.1016/j.pharmthera.2003.07.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Structural analogues of nucleosides, nucleoside analogues (NA), are used in the treatment of cancer and viral infections. Antiviral NAs inhibit replication of the viral genome, whereas anticancer NAs inhibit cellular DNA replication and repair. NAs are inactive prodrugs that are dependent on intracellular phosphorylation to their pharmacologically active triphosphate form. The deoxyribonucleoside kinases (dNK) and ribonucleoside kinases (rNK) catalyze the first phosphorylation step, converting deoxyribonucleosides and ribonucleosides to their corresponding monophosphate form. The dNKs have been studied intensively, whereas the rNKs have not been as thoroughly investigated. This overview is focused on the substrate specificity, tissue distribution, and subcellular location of the mammalian dNKs and rNKs and their role in the activation of NAs.
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Key Words
- antiviral therapy
- anticancer therapy
- chemotherapy
- nucleoside analogue
- deoxyribonucleoside kinase
- ribonucleoside kinase
- adk, adenosine kinase
- aids, aquired immunodeficiency syndrome
- arac, 1-β-d-arabinofuranosylcytosine (cytarabine)
- arag, 9-β-d-arabinofuranosylguanine (nelarabine)
- azt, 3′-azido-2′,3′-dideoxythymidine (zidovudine)
- cafda, 2-chloro-2′-fluoro-9-β-d-arabinofuranosyladenine (clofarabine)
- cda, 2-chloro-2′-deoxyadenosine (cladribine)
- dck, deoxycytidine kinase
- ddc, 2′,3′-dideoxycytidine (zalcitabine)
- ddi, 2′,3′-dideoxyinosine (didanosine)
- dgk, deoxyguanosine kinase
- dfdc, 2′,2′-difluorodeoxycytidine (gemcitabine)
- dnk, deoxyribonucleoside kinase
- d4t, 2′,3′-didehydro-3′-deoxythymidine (stavudine)
- f-araa, 2-fluoro-9-β-d-arabinofuranosyladenine (fludarabine)
- fda, food and drug administration
- fiau, 1-(2′-deoxy-2′-fluoro-β-d-arabinofuranosyl)-5-iodouracil (fialuridine)
- hbv, hepatitis b virus
- mtdna, mitochondrial dna
- hiv, human immunodeficiency virus
- na, nucleoside analogue
- ndpk, nucleoside diphosphate kinase
- nmpk, nucleoside monophosphate kinase
- 5′-nt, 5′-nucleotidase
- rnk, ribonucleoside kinase
- rr, ribonucleotide reductase
- rt, reverse transcriptase
- tk1, thymidine kinase 1
- tk2, thymidine kinase 2
- uck1, uridine-cytidine kinase 1
- uck2, uridine-cytidine kinase 2
- 3tc, 2′-deoxy-3′-thiacytidine (lamivudine)
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Affiliation(s)
- An R Van Rompay
- Department of Nephrology-Hypertension, University of Antwerp, 2610 Antwerp, Belgium
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8
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Curbo S, Zhivotovsky B, Johansson M, Karlsson A. Effects of 9-beta-D-arabinofuranosylguanine on mitochondria in CEM T-lymphoblast leukemia cells. Biochem Biophys Res Commun 2003; 307:942-7. [PMID: 12878202 DOI: 10.1016/s0006-291x(03)01305-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The nucleoside analog 9-beta-D-arabinofuranosylguanine (araG) is presently evaluated in clinical trials for therapy of T-cell lymphoid malignancies. AraG is a substrate for the mitochondrial deoxyguanosine kinase and we have recently shown that araG is predominantly incorporated into mitochondrial DNA (mtDNA). In this study we have investigated the effects of araG on mtDNA content and function. Although araG was incorporated into mtDNA, no decrease in mtDNA levels or effect on the expression of the mtDNA encoded cytochrome c oxidase was detected. Cells depleted of mtDNA were resistant to araG, but the mechanism of resistance was not specific for nucleoside analogs incorporated into mtDNA. Furthermore, the results suggest that the cells need to pass the S-phase in order for araG to induce caspase-dependent apoptosis. In summary, our findings suggest that the incorporation of araG into mtDNA does not cause the acute cytotoxicity of araG.
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Affiliation(s)
- Sophie Curbo
- Division of Clinical Virology F-68, Karolinska Institutet, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
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9
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Rodríguez-Pinilla SM, Gonzalez MAM, Sanchez PM. Pathologic quiz case: systemic lymphadenopathy in a patient with chronic myelogenous leukemia. Arch Pathol Lab Med 2003; 127:e249-50. [PMID: 12708924 DOI: 10.5858/2003-127-e249-pqcsli] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Atallah E, Talpaz M, O'brien S, Rios MB, Guo JQ, Arlinghaus R, Fernandes-Reese S, Kantarjian H. Chronic myelogenous leukemia in T cell lymphoid blastic phase achieving durable complete cytogenetic and molecular remission with imatinib mesylate (STI571; Gleevec) therapy. Cancer 2002; 94:2996-9. [PMID: 12115389 DOI: 10.1002/cncr.10576] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A T cell lymphoid blastic phase of chronic myelogenous leukemia (CML) is a rare occurrence, with only a few reported cases worldwide. Standard therapy for such patients is undetermined. Imatinib mesylate, a Bcr-Abl tyrosine kinase inhibitor, has shown activity in CML. METHODS The authors report on a patient with CML and marrow as well as extramedullary nodal T cell lymphoid blastic phase who was treated with imatinib mesylate. RESULTS The patient achieved complete morphologic and cytogenetic remission within two months of therapy. Competitive quantitative polymerase chain reaction analysis of marrow cells was negative after 15 months. Response had lasted for 26+ months at the time of writing. CONCLUSIONS The current data suggest that imatinib mesylate may produce long-term event free survival in patients with T-cell lymphoid blastic phase CML. Its potential role alone or in combinations should be further explored in this condition.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Benzamides
- Blood Cell Count
- Disease-Free Survival
- Female
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Lymphocyte Activation/immunology
- Middle Aged
- Philadelphia Chromosome
- Piperazines/therapeutic use
- Polymerase Chain Reaction
- Prognosis
- Pyrimidines/therapeutic use
- Remission Induction
- T-Lymphocytes/immunology
- Treatment Outcome
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Affiliation(s)
- Ehab Atallah
- Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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11
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Lotfi K, Månsson E, Peterson C, Eriksson S, Albertioni F. Low level of mitochondrial deoxyguanosine kinase is the dominant factor in acquired resistance to 9-beta-D-arabinofuranosylguanine cytotoxicity. Biochem Biophys Res Commun 2002; 293:1489-96. [PMID: 12054684 DOI: 10.1016/s0006-291x(02)00415-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
9-beta-D-arabinofuranosylguanine (Ara-G) is an important and relatively new guanosiue analog with activity in patients with T-cell malignancies. The biochemical and molecular events leading to resistance to Ara-G are not fully understood. Therefore we generated two Ara-G-resistant human MOLT-4 leukemic cell lines with different levels of resistance. The mitochondrial enzyme deoxyguanosine kinase (dGK) and the nuclear/cytosol enzyme deoxycytidine kinase (dCK) are key enzymes in the activation of Ara-G. Decreased levels of dGK protein and mRNA were found in both resistant cell sublines. The activity of dCK was decreased in the subline with higher resistance to Ara-G and these cells were highly cross-resistant to other nucleosides activated by dCK. Increased activity of the mitochondrial enzyme thymidine kinase 2 was observed in both resistant sublines and this could be related to the dGK deficiency. In search for other resistance mechanisms it was found that the resistant cells overexpress the mdr1 gene, while no changes were detected in the levels of multidrug resistance-associated protein 1 through 6, lung resistance-associated protein or topoisomerase IIalpha or IIbeta. Taken together, our findings demonstrate that multiple mechanisms are involved in the acquired resistance to Ara-G. However, low expression of dGK is the most apparent alteration in both resistant cell lines. Partial deficiency of dCK was found in the subline cells with higher resistance to Ara-G. Furthermore, Ara-G may select for high expression of the multidrug resistance (mdr1) which could be a specific resistance mechanism but more likely part of an overall cellular stress response.
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Affiliation(s)
- Kourosh Lotfi
- Department of Medicine and Care, Division of Clinical Pharmacology, Faculty of Health Sciences, Linköping, SE-581 85, Sweden
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12
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Rodriguez V, Kuehnle I, Heslop HE, Khan S, Krance RA. Guillain-Barré syndrome after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29:515-7. [PMID: 11960272 DOI: 10.1038/sj.bmt.1703412] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2001] [Accepted: 12/14/2001] [Indexed: 11/09/2022]
Abstract
Guillain-Barré syndrome is a rare complication in the setting of hematopoietic stem cell transplantation. We report three children with T cell lymphoma/leukemia in whom this syndrome developed soon after they received unrelated donor transplants. The rapid onset of symptoms raises the concern that the bone marrow transplant conditioning regimen (ie, total body irradiation, cyclophosphamide and cytosine arabinoside) might have precipitated the clinical syndrome of ascending polyneuropathy. Although central nervous system toxicity has been well described with high-dose cytosine arabinoside therapy, peripheral neuropathy of the Guillain-Barré type has been reported only infrequently. We review possible factors contributing to the development of this syndrome in these three patients.
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MESH Headings
- Adolescent
- Cyclophosphamide/adverse effects
- Cyclophosphamide/therapeutic use
- Cytarabine/adverse effects
- Cytarabine/therapeutic use
- Fatal Outcome
- Guillain-Barre Syndrome/chemically induced
- Guillain-Barre Syndrome/drug therapy
- Guillain-Barre Syndrome/etiology
- Guillain-Barre Syndrome/virology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Leukemia, T-Cell/drug therapy
- Leukemia, T-Cell/radiotherapy
- Leukemia, T-Cell/surgery
- Leukemia, T-Cell/virology
- Lymphoma, T-Cell/drug therapy
- Lymphoma, T-Cell/radiotherapy
- Lymphoma, T-Cell/surgery
- Male
- Parainfluenza Virus 1, Human/immunology
- Parainfluenza Virus 1, Human/isolation & purification
- Respirovirus Infections/complications
- Respirovirus Infections/diagnosis
- Respirovirus Infections/drug therapy
- Transplantation Conditioning/adverse effects
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Whole-Body Irradiation/adverse effects
- Whole-Body Irradiation/methods
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Affiliation(s)
- V Rodriguez
- Center for Cell and Gene Therapy, Texas Children's Hospital, Houston, TX, USA
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13
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Okazuka K, Toba K, Kawai K, Nikkuni K, Tsuchiyama J, Momoi A, Kanazawa N, Nagai K, Suzuki N, Aizawa Y. Extramedullary T lymphoid blast crisis representing an additional translocation, t(6;8)(q25;q22) in a patient with Philadelphia-positive chronic myelogenous leukemia after allogeneic bone marrow transplantation. Leuk Res 2001; 25:1089-94. [PMID: 11684281 DOI: 10.1016/s0145-2126(01)00078-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A patient with extramedullary crisis from chronic myelogenous leukemia after allogeneic bone marrow transplantation is reported. A pathological neck lymph node observed after transplantation revealed pre-T lymphoblastic phenotype, and the fluorescence in situ hybridization (FISH) analysis showed recipient type sex chromosomes and bcr/abl fusion gene. The cells represented an additional translocation, t(6;8)(q25;q22). No rearrangements of the T-cell receptor (TCR) beta, gamma or delta chain genes were observed. The absence of TCR rearrangement indicated the clonogenic involvement of pluripotent hematopoietic stem cells by Philadelphia chromosome. Bone marrow specimens at that time showed donor type sex chromosomes and no bcr/abl-positive cells by FISH.
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MESH Headings
- Blast Crisis
- Bone Marrow Transplantation
- Chromosomes, Human, Pair 6
- Chromosomes, Human, Pair 8
- Gene Rearrangement, T-Lymphocyte
- Humans
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Lymph Nodes/immunology
- Male
- Middle Aged
- Translocation, Genetic
- Transplantation, Homologous
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Affiliation(s)
- K Okazuka
- First Department of Internal Medicine, Niigata University School of Medicine, Asahimachi-dori 1, Niigata City 951-8520, Japan
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14
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Galmarini CM, Mackey JR, Dumontet C. Nucleoside analogues: mechanisms of drug resistance and reversal strategies. Leukemia 2001; 15:875-90. [PMID: 11417472 DOI: 10.1038/sj.leu.2402114] [Citation(s) in RCA: 354] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nucleoside analogues (NA) are essential components of AML induction therapy (cytosine arabinoside), effective treatments of lymphoproliferative disorders (fludarabine, cladribine) and are also used in the treatment of some solid tumors (gemcitabine). These important compounds share some general common characteristics, namely in terms of requiring transport by specific membrane transporters, metabolism and interaction with intracellular targets. However, these compounds differ in regard to the types of transporters that most efficiently transport a given compound, and their preferential interaction with certain targets which may explain why some compounds are more effective against rapidly proliferating tumors and others on neoplasia with a more protracted evolution. In this review, we analyze the available data concerning mechanisms of action of and resistance to NA, with particular emphasis on recent advances in the characterization of nucleoside transporters and on the potential role of activating or inactivating enzymes in the induction of clinical resistance to these compounds. We performed an extensive search of published in vitro and clinical data in which the levels of expression of nucleoside-activating or inactivating enzymes have been correlated with tumor response or patient outcome. Strategies aiming to increase the intracellular concentrations of active compounds are presented.
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Affiliation(s)
- C M Galmarini
- Unité INSERM 453, Laboratoire de Cytologie Analytique, Faculté de Médécine Rockefeller, Lyon, France
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15
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Apfelbeck U, Hoefler G, Neumeister P, Fonatsch C, Linkesch W, Sill H. Extramedullary T cell lymphoblastic transformation of chronic myeloid leukaemia successfully treated with matched unrelated donor bone marrow transplantation. Bone Marrow Transplant 2000; 26:1111-2. [PMID: 11108312 DOI: 10.1038/sj.bmt.1702665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic myeloid leukaemia (CML) inevitably terminates in blast crisis (BC) which is of myeloid phenotype in approximately two-thirds and B-lymphoid in one-third of patients. T cell BC is rare and associated with poor prognosis. We describe the case of a 48-year-old woman with extramedullary T cell lymphoblastic transformation. After treatment with combination chemotherapy she achieved a second chronic phase and underwent an allogeneic BMT from an HLA-matched unrelated donor. At 30 months follow-up she is still in complete molecular remission and in good clinical condition. We conclude that unrelated donor BMT should be considered as a therapeutic option for patients with extramedullary BC.
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Affiliation(s)
- U Apfelbeck
- Department of Medicine, Karl-Franzens University, Graz, Austria
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16
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Zhu C, Johansson M, Karlsson A. Differential incorporation of 1-beta-D-arabinofuranosylcytosine and 9-beta-D-arabinofuranosylguanine into nuclear and mitochondrial DNA. FEBS Lett 2000; 474:129-32. [PMID: 10838071 DOI: 10.1016/s0014-5793(00)01569-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The anti-leukemic nucleoside analogs 1-beta-D-arabinofuranosylcytosine (araC) and 9-beta-D-arabinofuranosylguanine (araG) are dependent on intracellular phosphorylation for pharmacological activity. AraC is efficiently phosphorylated by deoxycytidine kinase (dCK). Although araG is phosphorylated by dCK in vitro, it is a preferred substrate of mitochondrial deoxyguanosine kinase. We have used autoradiography to show that araC was incorporated into nuclear DNA in Molt-4 and CEM T-lymphoblastoid cells as well as in Chinese hamster ovary cells. In contrast, araG was predominantly incorporated into mitochondrial DNA in the investigated cell lines, without detectable incorporation into nuclear DNA. These data suggest that the molecular targets of araG and araC may differ.
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Affiliation(s)
- C Zhu
- Division of Clinical Virology, Karolinska Institute, Huddinge University Hospital, S-141 86, Stockholm, Sweden
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17
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