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Duployez N, Preudhomme C. Monitoring molecular changes in the management of myelodysplastic syndromes. Br J Haematol 2024. [PMID: 38934371 DOI: 10.1111/bjh.19614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
The ongoing or anticipated therapeutic advances as well as previous experience in other malignancies, including acute myeloid leukaemia, have made molecular monitoring a potential interesting tool for predicting outcomes and demonstrating treatment efficacy in patients with myelodysplastic syndromes (MDS). The important genetic heterogeneity in MDS has made challenging the establishment of recommendations. In this context, high-throughput/next-generation sequencing (NGS) has emerged as an attractive tool, especially in patients with high-risk diseases. However, its implementation in clinical practice still suffers from a lack of standardization in terms of sensitivity, bioinformatics and result interpretation. Data from literature, mostly gleaned from retrospective cohorts, show NGS monitoring when used appropriately could help clinicians to guide therapy, detect early relapse and predict disease evolution. Translating these observations into personalized patient management requires a prospective evaluation in clinical research and remains a major challenge for the next years.
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Affiliation(s)
- Nicolas Duployez
- Laboratory of Haematology, CHU Lille, Lille, France
- U1277 CANTHER (Cancer Heterogeneity Plasticity and Resistance to Therapies), University of Lille, INSERM, Lille, France
| | - Claude Preudhomme
- Laboratory of Haematology, CHU Lille, Lille, France
- U1277 CANTHER (Cancer Heterogeneity Plasticity and Resistance to Therapies), University of Lille, INSERM, Lille, France
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2
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Schulz E, Aplan PD, Freeman SD, Pavletic SZ. Moving toward a conceptualization of measurable residual disease in myelodysplastic syndromes. Blood Adv 2023; 7:4381-4394. [PMID: 37267435 PMCID: PMC10432617 DOI: 10.1182/bloodadvances.2023010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023] Open
Abstract
Approximately 90% of patients with myelodysplastic syndromes (MDSs) have somatic mutations that are known or suspected to be oncogenic in the malignant cells. The genetic risk stratification of MDSs has evolved substantially with the introduction of the clinical molecular international prognostic scoring system, which establishes next-generation sequencing at diagnosis as a standard of care. Furthermore, the International Consensus Classification of myeloid neoplasms and acute leukemias has refined the MDS diagnostic criteria with the introduction of a new MDS/acute myeloid leukemia category. Monitoring measurable residual disease (MRD) has historically been used to define remission status, improve relapse prediction, and determine the efficacy of antileukemic drugs in patients with acute and chronic leukemias. However, in contrast to leukemias, assessment of MRD, including tracking of patient-specific mutations, has not yet been formally defined as a biomarker for MDS. This article summarizes current evidence and challenges and provides a conceptual framework for incorporating MRD into the treatment of MDS and future clinical trials.
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Affiliation(s)
- Eduard Schulz
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
- Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD
| | - Peter D. Aplan
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
- Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD
| | - Sylvie D. Freeman
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Steven Z. Pavletic
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
- Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD
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3
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Stempel JM, Xie Z, Bewersdorf JP, Stahl M, Zeidan AM. Evolution of Therapeutic Benefit Measurement Criteria in Myelodysplastic Syndromes/Neoplasms. Cancer J 2023; 29:203-211. [PMID: 37195777 DOI: 10.1097/ppo.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
ABSTRACT Myelodysplastic syndromes/neoplasms (MDS) are heterogeneous, clonal myeloid neoplasms characterized by ineffective hematopoiesis, progressive cytopenias, and an increased risk of progression to acute myeloid leukemia. The diversity in disease severity, morphology, and genetic landscape challenges not only novel drug development but also therapeutic response assessment. The MDS International Working Group (IWG) response criteria were first published in the year 2000 focusing on measures of blast burden reduction and hematologic recovery. Despite revision of the IWG criteria in 2006, correlation between IWG-defined responses and patient-focused outcomes, including long-term benefits, remains limited and has potentially contributed to failures of several phase III clinical trials. Several IWG 2006 criteria also lacked clear definitions leading to problems in practical applications and interobserver and intraobserver consistency of response reporting. Although the 2018 revision addressed lower-risk MDS, the most recent update in 2023 redefined responses for higher-risk MDS and has set out to provide clear definitions to enhance consistency while focusing on clinically meaningful outcomes and patient-centered responses. In this review, we analyze the evolution of the MDS response criteria, limitations, and areas of improvement.
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Affiliation(s)
- Jessica M Stempel
- From the Department of Internal Medicine, Hematology Section, Yale School of Medicine, New Haven, CT
| | - Zhuoer Xie
- Department of Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jan Philipp Bewersdorf
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maximilian Stahl
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Harvard University, Boston, MA
| | - Amer M Zeidan
- From the Department of Internal Medicine, Hematology Section, Yale School of Medicine, New Haven, CT
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4
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Braulke F, Schweighöfer A, Schanz J, Shirneshan K, Ganster C, Pollock-Kopp B, Leha A, Haase D. Cytogenetic peripheral blood monitoring in azacitidine treated patients with high-risk MDS/sAML: A monocentric real-world experience. Leuk Res 2023; 124:106996. [PMID: 36538857 DOI: 10.1016/j.leukres.2022.106996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
In this single center retrospective analysis 76 patients with high-risk (HR) myelodysplastic syndrome (MDS) treated with azacitidine (AZA) were reviewed for response, especially cytogenetic response (cyR) using repeated chromosome banding analyses (CBA) of bone marrow (bm) metaphases and frequent sequential Fluorescence-in-situ Hybridization (FISH) analyses of immunomagnetically enriched CD34 + circulating peripheral blood cells (CD34 +pb-FISH). In total, 526 CD34 +pb-FISH analyses and 236 CBA were examined. Median observation time was 8.45 months, median number of AZA cycles applied was 8, median overall survival (OS) was 14.9 months, 42.1 % of patients responded to therapy according to IWG criteria: 5 complete response (CR), 0 partial response (PR), 12 bmCR, 15 stable disease with hematologic improvement (HI). HI was reached in 36.8 % of patients, 31.5 % became transfusion-independent. By CBA or CD34 +pb-FISH 20.4 % and 31.6 % of patients showed cyR, respectively. HI rate was significantly higher in cytogenetic responders than in non-responders, but there was no impact on OS or leukemia-free-survival. Cytogenetic responders showed significantly better OS than non-responders. Patients with ≥ 6 AZA cycles had significantly better OS than patients with < 6 cycles applied. Karyotype evolution (KE) as a manifestation of cytogenetic progression was diagnosed in 29.5 % and 17.1 % of patients by CBA and CD34 +pb-FISH, respectively. KE was associated with significantly poorer OS and leukemia-free-survival.
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Affiliation(s)
- Friederike Braulke
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Georg August University Göttingen, Germany; Comprehensive Cancer Center Göttingen G-CCC, University Medical Center Göttingen, Georg August University, Göttingen, Germany.
| | - Adrian Schweighöfer
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Georg August University Göttingen, Germany; Praxis Scholz, Harsum, Germany
| | - Julie Schanz
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Georg August University Göttingen, Germany; INDIGHO-Laboratories, University Medical Center Göttingen, Georg August University Göttingen, Germany
| | - Katayoon Shirneshan
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Georg August University Göttingen, Germany; INDIGHO-Laboratories, University Medical Center Göttingen, Georg August University Göttingen, Germany
| | - Christina Ganster
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Georg August University Göttingen, Germany; INDIGHO-Laboratories, University Medical Center Göttingen, Georg August University Göttingen, Germany
| | - Beatrix Pollock-Kopp
- Department of Transfusion Medicine, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Detlef Haase
- Clinic of Hematology and Medical Oncology, University Medical Center Göttingen, Georg August University Göttingen, Germany; INDIGHO-Laboratories, University Medical Center Göttingen, Georg August University Göttingen, Germany
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5
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Park S, Park SY, Lee JH, Choi EJ, Lee KH, Yoon SS, Hong J, Shin DY, Kim YJ. Five-day versus 7-day treatment regimen with azacitidine in lower risk myelodysplastic syndrome: A phase 2, multicenter, randomized trial. Cancer 2022; 128:4095-4108. [PMID: 36208097 DOI: 10.1002/cncr.34492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low-dose azacitidine (AZA) regimens, primarily 5-day AZA, have been used in lower risk myelodysplastic syndrome (LrMDS) but they have yet to be directly compared to the standard 7-day, uninterrupted dosing schedule. METHOD In this phase 2, multicenter, randomized trial, 55 patients with adult LrMDS (low and intermediate-1 risk by international prognostic scoring system [IPSS]) were randomly assigned and received either 5-day (n = 26) or 7-day (n = 29) AZA between March 2012 and August 2020. The trial was stopped prematurely because of the slow accrual of patients. The primary end point was the overall response rate (ORR) of the 5-day AZA as compared to that of the 7-day regimen. RESULTS Median patient age was 59 years, and IPSS intermediate-1 risk comprised the majority (81.8%). The median number of cycles in both arms was six. In the ITT subset (n = 53), in each of the 5-day and 7-day arms, the ORR of 48.0% and 39.3%, hematologic improvement of 44.0% and 39.3%, and RBC transfusion independence of 35.3% and 40.0% were observed respectively, and none of these findings were significantly different between the two arms. A cytogenetic response rate was significantly higher in the 7-day arm (8.3% and 53.8%, p = .027). Survival and adverse events were similar between the groups, although gastrointestinal toxicities, grade ≥3 thrombocytopenia, and febrile neutropenia were less frequent in the 5-day arm. CONCLUSION The 5-day AZA in LrMDS showed comparable efficacy to a 7-day regimen in terms of similar overall response and other outcomes, despite significantly higher rates of cytogenetic responses in the 7-day regimen. LAY SUMMARY Azacitidine (75 mg/m2 /day for 7 consecutive days per 28-day cycle) has shown survival benefit in patients with higher risk myelodysplastic syndrome (MDS). Although the use of azacitidine is less-well studied for lower risk MDS, it is generally accepted as a feasible option for lower risk MDS (LrMDS).
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Affiliation(s)
- Silvia Park
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.,Leukemia Research Institute, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - So Yeon Park
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Je-Hwan Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Ji Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoo-Hyung Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Jin Kim
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.,Leukemia Research Institute, College of Medicine, Catholic University of Korea, Seoul, Korea
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6
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Kim N, Pavletic S, Norsworthy KJ. Meaningful response criteria for myelodysplastic syndromes. Br J Haematol 2021; 196:1137-1148. [PMID: 34628648 DOI: 10.1111/bjh.17838] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/13/2021] [Accepted: 09/02/2021] [Indexed: 01/11/2023]
Abstract
Standardizing response criteria for myelodysplastic syndromes (MDS), a clinically and biologically heterogeneous group of disorders, has been historically challenging. The International Working Group (IWG) response criteria, first proposed in 2000 and modified in 2006 and 2018, represent the best effort by a group of international experts to define a set of clinically meaningful end-points in MDS. These criteria have been adopted in many MDS clinical trials, allowing for comparisons of response across trials. However, clinical experience has also revealed some limitations of these criteria, and most of the end-points proposed by the IWG require further validation. In this review, we present a critical analysis of the current MDS response criteria from both a practical standpoint and based on currently available clinical trial data. Potential areas for improvement in the criteria are highlighted, which may be considered in future iterations of the response criteria.
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Affiliation(s)
- Nina Kim
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven Pavletic
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kelly J Norsworthy
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
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He W, Zhao C, Hu H. Prognostic effect of RUNX1 mutations in myelodysplastic syndromes: a meta-analysis. ACTA ACUST UNITED AC 2020; 25:494-501. [PMID: 33317419 DOI: 10.1080/16078454.2020.1858598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES RUNX1 mutations have been widely found in patients with myelodysplastic syndrome (MDS). Majority of reports revealed that RUNX1 mutations are associated with a poor prognosis. However, discrepancies still remain. The results of univariate analysis were not confirmed in multivariate analysis in some cases. Therefore, we performed a meta-analysis to assess the prognostic effect of RUNX1 mutations in MDS. METHODS We extracted data from qualified studies that were searched from PubMed, Embase and the Cochrane Library. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for the overall survival (OS) and leukemia free survival (LFS) were pooled from the multivariate Cox proportional hazard models. RESULTS Sixteen studies containing 5422 patients were included in this meta-analysis. There were 617 patients with mutated RUNX1 and 4805 patients with wide type RUNX1. The total HR for OS was 1.43 (95% CI = 1.21-1.70, P < 0.0001) and the counterpart of LFS was 1.88 (95% CI = 1.42-2.51, P < 0.0001). DISCUSSION AND CONCLUSION These results suggest that the RUNX1 mutations are associated with unfavorable outcomes and shorter survival in patients with MDS. Furthermore, poor prognosis of patients might be alleviated by stem cell transplantation. Patients bearing these mutations should be prioritized for aggressive therapy.
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Affiliation(s)
- Wei He
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China
| | - Caifang Zhao
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China
| | - Huixian Hu
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People's Republic of China
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8
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Iqbal Z, Absar M, Mahmood A, Aleem A, Iqbal M, Jameel A, Akhtar T, Karim S, Rasool M, Mirza Z, Khalid M, Akram AM, Sabar MF, Khalid AM, Aljarrah K, Iqbal J, Khalid M, Shah IH, Alanazi N. Discovery and Protein Modeling Studies of Novel Compound Mutations Causing Resistance to Multiple Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia. Asian Pac J Cancer Prev 2020; 21:3517-3526. [PMID: 33369447 PMCID: PMC8046299 DOI: 10.31557/apjcp.2020.21.12.3517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE BCR-ABL fusion oncogene is the hallmark of chronic myeloid leukemia (CML), causing genomic instability which leads to accumulation of mutations in BCR-ABL as well as other genes. BCR-ABL mutations are the cause of tyrosine kinase inhibitors (TKIs) resistance in CML. Recently, compound BCR-ABL mutations have been reported to resist all FDA approved TKIs. Therefore, finding novel compound BCR-ABL mutations can help and clinically manage CML. Therefore, our objective was to find out novel drug-resistant compound BCR-ABL mutations in CML and carry out their protein modelling studies. METHODOLOGY Peripheral blood samples were collected from ten imatinib resistant CML patients receiving nilotinib treatment. BCR-ABL transcript mutations were investigated by employing capillary sequencing. Patient follow-up was carried out using European LeukemiaNet guidelines. Protein modeling studies were carried out for new compound mutations using PyMol to see the effects of mutations at structural level. RESULTS A novel compound mutation (K245N mutation along with G250W mutation) and previously known T351I utation was detected in two of the nilotinib resistance CML patients respectively while in the rest of 8 nilotinib responders, no resistant mutations were detected. Protein modelling studies indicated changes in BCR-ABL mutant protein which may have negatively impacted its binding with nilotinib leading to drug resistance. CONCLUSION We report a novel nilotinib resistant BCR-ABL compound mutation (K245N along with G250W mutation) which impacts structural modification in BCR-ABL mutant protein leading to drug resistance. As compound mutations pose a new threat by causing resistance to all FDA approved tyrosine kinase inhibitors in BCR-ABL+ leukemias, our study opens a new direction for in vitro characterization of novel BCR-ABL compound mutations and their resistant to second generation and third generation TKIs.
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Affiliation(s)
- Zafar Iqbal
- Hematology Oncology and Pharmacogenetics Engineering Sciences (HOPES) Group, Health Sciences Research Laboratories, Department of Zoology, University of the Punjab, Lahore, & University of Education, Lahore, Pakistan
| | - Muhammad Absar
- Hematology Oncology and Pharmacogenetics Engineering Sciences (HOPES) Group, Health Sciences Research Laboratories, Department of Zoology, University of the Punjab, Lahore, & University of Education, Lahore, Pakistan
| | - Amer Mahmood
- Department of Anatomy, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Aamer Aleem
- Hematology/Oncology Division, Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mudassar Iqbal
- Foreign Faculty, Asian Medical Institute, Kant City, National Surgical Centre, Bishkek, Kyrgyzstan, and Higher Education Commission Program in "Hematology Oncology and Pharmacogenetics Engineering Sciences (HOPES)", Kyrgyzstan
| | - Abid Jameel
- Post-Graduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Tanveer Akhtar
- Hematology Oncology and Pharmacogenetics Engineering Sciences (HOPES) Group, Health Sciences Research Laboratories, Department of Zoology, University of the Punjab, Lahore, & University of Education, Lahore, Pakistan
| | - Sajjad Karim
- Center of Excellence in Genomic Medicine Research & Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmood Rasool
- Center of Excellence in Genomic Medicine Research & Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zeenat Mirza
- Center of Excellence in Genomic Medicine Research & Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Afia Muhammad Akram
- Department of Zoology, Division of Science and Technology, University of Education, Township, Lahore, Pakistan
| | | | - Ahmad M Khalid
- Departments of Biotechnology and Genomic Medicine, University of Sialkot, Pakistan
| | - Khalid Aljarrah
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS)/ KAIMRC/SSBMT, National Guards Health Affairs, Al-Ahsa, Kingdom of Saudi Arabia.,Jordan University of Science and Technology, Irbid, Jordan
| | - Janhangir Iqbal
- National Guard Health Affairs, King Abdullah International Medical Research Centre (KAIMRC), Al-Ahsa, Saudi Arabia
| | - Muhammad Khalid
- Allied Hospital, Punjab Medical College & Sahil Hospital, Faisalabad, Pakistan
| | - Ijaz H Shah
- Allied Hospital, Punjab Medical College & Sahil Hospital, Faisalabad, Pakistan
| | - Nawaf Alanazi
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS)/ KAIMRC/SSBMT, National Guards Health Affairs, Al-Ahsa, Kingdom of Saudi Arabia
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9
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Short NJ, Jabbour E, Naqvi K, Patel A, Ning J, Sasaki K, Nogueras-Gonzalez GM, Bose P, Kornblau SM, Takahashi K, Andreeff M, Sanchez-Petitto G, Estrov Z, Dinardo CD, Montalban-Bravo G, Konopleva M, Alvarado Y, Bhalla KN, Fiskus W, Khouri M, Islam R, Kantarjian H, Garcia-Manero G. A phase II study of omacetaxine mepesuccinate for patients with higher-risk myelodysplastic syndrome and chronic myelomonocytic leukemia after failure of hypomethylating agents. Am J Hematol 2019; 94:74-79. [PMID: 30328139 DOI: 10.1002/ajh.25318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 11/09/2022]
Abstract
The outcome of patients with myelodysplastic syndromes (MDSs) after failure of hypomethylating agents (HMAs) failure is poor with a median overall survival (OS) of only 4-6 months. Omacetaxine mepesuccinate (OM) is safe and effective in myeloid malignancies but has not been studied in MDS with HMA failure. We conducted a phase II study of OM in patients with MDS or chronic myelomonocytic leukemia (CMML) who had previously failed or been intolerant to HMAs. Patients received OM at a dose of 1.25 mg/m2 subcutaneously every 12 hours for 3 consecutive days on a 4- to 7-week schedule. The primary endpoints were the overall response rate (ORR) and OS. A total of 42 patients were enrolled with a median age of 76 years. The ORR was 33%. Patients with diploid cytogenetics were more likely to respond to OM than were those with cytogenetic abnormalities (58% vs 23%, respectively; P = .03). Overall, the median OS was 7.5 months and 1-year OS rate was 25%. Patients with diploid cytogenetics had superior OS to those with cytogenetic abnormalities (median OS 14.8 vs 6.8 months, respectively; P = .01). Two patients had ongoing response to OM of 2 years or longer (both MDS with diploid cytogenetics and RUNX1 mutation). The most common grade ≥ 3 adverse events were infections in 11 patients (26%), febrile neutropenia in 4 (10%), and hemorrhage in 3 (7%). Overall, OM was safe and active in patients with MDS or CMML who experienced HMA failure. These results support the further development of OM in this setting.
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Affiliation(s)
- Nicholas J. Short
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Elias Jabbour
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Kiran Naqvi
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Ami Patel
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jing Ning
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Koji Sasaki
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Prithviraj Bose
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Steven M. Kornblau
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Koichi Takahashi
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michael Andreeff
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Gabriela Sanchez-Petitto
- Department of Internal Medicine; The University of Texas Health Science Center at Houston; Houston Texas
| | - Zeev Estrov
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Courtney D. Dinardo
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Marina Konopleva
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Yesid Alvarado
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Kapil N. Bhalla
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Warren Fiskus
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Maria Khouri
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rubiul Islam
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hagop Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
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10
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Tefferi A, Gangat N, Mudireddy M, Lasho TL, Finke C, Begna KH, Elliott MA, Al-Kali A, Litzow MR, Hook CC, Wolanskyj AP, Hogan WJ, Patnaik MM, Pardanani A, Zblewski DL, He R, Viswanatha D, Hanson CA, Ketterling RP, Tang JL, Chou WC, Lin CC, Tsai CH, Tien HF, Hou HA. Mayo Alliance Prognostic Model for Myelodysplastic Syndromes: Integration of Genetic and Clinical Information. Mayo Clin Proc 2018; 93:1363-1374. [PMID: 29866419 DOI: 10.1016/j.mayocp.2018.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a new risk model for primary myelodysplastic syndromes (MDS) that integrates information on mutations, karyotype, and clinical variables. PATIENTS AND METHODS Patients with World Health Organization-defined primary MDS seen at Mayo Clinic (MC) from December 28, 1994, through December 19, 2017, constituted the core study group. The National Taiwan University Hospital (NTUH) provided the validation cohort. Model performance, compared with the revised International Prognostic Scoring System, was assessed by Akaike information criterion and area under the curve estimates. RESULTS The study group consisted of 685 molecularly annotated patients from MC (357) and NTUH (328). Multivariate analysis of the MC cohort identified monosomal karyotype (hazard ratio [HR], 5.2; 95% CI, 3.1-8.6), "non-MK abnormalities other than single/double del(5q)" (HR, 1.8; 95% CI, 1.3-2.6), RUNX1 (HR, 2.0; 95% CI, 1.2-3.1) and ASXL1 (HR, 1.7; 95% CI, 1.2-2.3) mutations, absence of SF3B1 mutations (HR, 1.6; 95% CI, 1.1-2.4), age greater than 70 years (HR, 2.2; 95% CI, 1.6-3.1), hemoglobin level less than 8 g/dL in women or less than 9 g/dL in men (HR, 2.3; 95% CI, 1.7-3.1), platelet count less than 75 × 109/L (HR, 1.5; 95% CI, 1.1-2.1), and 10% or more bone marrow blasts (HR, 1.7; 95% CI, 1.1-2.8) as predictors of inferior overall survival. Based on HR-weighted risk scores, a 4-tiered Mayo alliance prognostic model for MDS was devised: low (89 patients), intermediate-1 (104), intermediate-2 (95), and high (69); respective median survivals (5-year overall survival rates) were 85 (73%), 42 (34%), 22 (7%), and 9 months (0%). The Mayo alliance model was subsequently validated by using the external NTUH cohort and, compared with the revised International Prognostic Scoring System, displayed favorable Akaike information criterion (1865 vs 1943) and area under the curve (0.87 vs 0.76) values. CONCLUSION We propose a simple and contemporary risk model for MDS that is based on a limited set of genetic and clinical variables.
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Affiliation(s)
| | | | | | | | | | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN
| | | | | | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN
| | - Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Tai-Cheng Stem Cell Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chien Chou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chin Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Hong Tsai
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Tai-Cheng Stem Cell Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-An Hou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Bell JA, Galaznik A, Blazer M, Farrelly E, Ogbonnaya A, Raju A, Eaddy M, Fram RJ, Faller DV. Transfusion-free interval is associated with improved survival in patients with higher-risk myelodysplastic syndromes engaged in routine care. Leuk Lymphoma 2018; 60:49-59. [DOI: 10.1080/10428194.2018.1464155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jill A. Bell
- Millennium Pharmaceuticals, Inc, (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Aaron Galaznik
- Millennium Pharmaceuticals, Inc, (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | | | | | | | | | | | - Robert J. Fram
- Millennium Pharmaceuticals, Inc, (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Douglas V. Faller
- Millennium Pharmaceuticals, Inc, (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
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12
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Gangat N, Mudireddy M, Lasho TL, Finke CM, Nicolosi M, Szuber N, Patnaik MM, Pardanani A, Hanson CA, Ketterling RP, Tefferi A. Mutations and prognosis in myelodysplastic syndromes: karyotype-adjusted analysis of targeted sequencing in 300 consecutive cases and development of a genetic risk model. Am J Hematol 2018; 93:691-697. [PMID: 29417633 DOI: 10.1002/ajh.25064] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 01/02/2023]
Abstract
To develop a genetic risk model for primary myelodysplastic syndromes (MDS), we queried the prognostic significance of next-generation sequencing (NGS)-derived mutations, in the context of the Mayo cytogenetic risk stratification, which includes high-risk (monosomal karyotype; MK), intermediate-risk (non-MK, classified as intermediate/poor/very poor, per the revised international prognostic scoring system; IPSS-R), and low-risk (classified as good/very good, per IPSS-R). Univariate analysis in 300 consecutive patients with primary MDS identified TP53, RUNX1, U2AF1, ASXL1, EZH2, and SRSF2 mutations as "unfavorable" and SF3B1 as "favorable" risk factors for survival; for the purposes of the current study, the absence of SF3B1 mutation was accordingly dubbed as an "adverse" mutation. Analysis adjusted for age and MK, based on our previous observation of significant clustering between MK and TP53 mutations, confirmed independent prognostic contribution from RUNX1, ASXL1, and SF3B1 mutations. Multivariable analysis that included age, the Mayo cytogenetics risk model and the number of adverse mutations resulted in HRs (95% CI) of 5.3 (2.5-10.3) for presence of three adverse mutations, 2.4 (1.6-3.7) for presence of two adverse mutations, 1.5 (1.02-2.2) for presence of one adverse mutation, 5.6 (3.4-9.1) for high-risk karyotype, 1.5 (1.1-2.2) for intermediate-risk karyotype and 2.4 (1.8-3.3) for age >70 years; HR-weighted risk point assignment generated a three-tiered genetic risk model: high (N = 65; 5-year survival 2%), intermediate (N = 100; 5-year survival 18%), and low (N = 135; 5-year survival 56%). The current study provides a practically simple risk model in MDS that is based on age, karyotype, and mutations only.
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Affiliation(s)
- Naseema Gangat
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Terra L. Lasho
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Maura Nicolosi
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | - Natasha Szuber
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | - Rhett P. Ketterling
- Divisions of Laboratory Genetics and Genomics, Departments of Internal and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Ayalew Tefferi
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
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13
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Sébert M, Komrokji RS, Sekeres MA, Prebet T, Cluzeau T, Santini V, Gyan E, Sanna A, Ali NHA, Hobson S, Eclache V, List A, Fenaux P, Adès L. Impact of baseline cytogenetic findings and cytogenetic response on outcome of high-risk myelodysplastic syndromes and low blast count AML treated with azacitidine. Leuk Res 2017; 63:72-77. [DOI: 10.1016/j.leukres.2017.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/06/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
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14
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Alfonso A, Montalban-Bravo G, Takahashi K, Jabbour EJ, Kadia T, Ravandi F, Cortes J, Estrov Z, Borthakur G, Pemmaraju N, Konopleva M, Bueso-Ramos C, Pierce S, Kantarjian H, Garcia-Manero G. Natural history of chronic myelomonocytic leukemia treated with hypomethylating agents. Am J Hematol 2017; 92:599-606. [PMID: 28370097 DOI: 10.1002/ajh.24735] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 01/22/2023]
Abstract
Hypomethylating agents (HMA) are the most commonly used therapeutic intervention in chronic myelomonocytic leukemia (CMML). Due to the lack of CMML-specific clinical trials, the impact of these agents in the natural history of CMML is not fully understood. We present the largest retrospective series of CMML (n = 151) treated with HMA. Mean age at diagnosis was 69 years (range 50-88). According to the CMML-specific prognostic scoring system (CPSS): 17 (15%) were low-risk, 45 (39%) intermediate-1 risk, 42 (36%) intermediate-2, and 12 (10%) high-risk. 35 (23%) patients received single agent azacitidine, 73 (48%) single agent decitabine, and 43 (29%) combinations. With a median follow-up of 17 months, overall response rate (ORR) was 75%, with 41% achieving complete response (CR). Median overall survival (OS) was 24 months (95%CI: 20-28) and event-free survival 14 months (95%CI: 11-17). By multivariate analysis, age < 70 years, higher levels of hemoglobin, absence of blast in peripheral blood and lower CPSS cytogenetic risk predicted for better OS. CR was significantly higher in those patients treated with decitabine (58.3%) when compared with azacitidine (20.6%) (P < .001). 13 patients (9%) received allo-SCT after a median of 4 cycles of HMA. 66 patients (50%) had HMA failure: 26 primary (34%) and 50 secondary (66%), including 35 (46%) that transformed to AML. Outcomes after HMA failure were poor with OS of 7 months (95%CI: 3-12). In conclusion, HMA are effective in CMML but new agents and combinations are needed. This data could be a benchmark for further drug development in CMML.
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Affiliation(s)
- Ana Alfonso
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | | | - Koichi Takahashi
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Elias J. Jabbour
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Tapan Kadia
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Farhad Ravandi
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Jorge Cortes
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Zeev Estrov
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Gautam Borthakur
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Naveen Pemmaraju
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Marina Konopleva
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Carlos Bueso-Ramos
- Departments of Hematopathology; The University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Sherry Pierce
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Hagop Kantarjian
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
| | - Guillermo Garcia-Manero
- Departments of Leukemia; University of Texas, MD Anderson Cancer Center; Houston TX 77015 USA
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