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Ramakrishnan R, Munir F, Quesada AE, Hitzler J, Cuglievan B. Low-dose cytarabine and hypomethylating agents for Down syndrome with acute myeloid leukemia. Pediatr Blood Cancer 2024; 71:e30974. [PMID: 38523255 DOI: 10.1002/pbc.30974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Ramya Ramakrishnan
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Faryal Munir
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andres Ernesto Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Johann Hitzler
- Division of Hematology Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Branko Cuglievan
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Barwe SP, Kolb EA, Gopalakrishnapillai A. Down syndrome and leukemia: An insight into the disease biology and current treatment options. Blood Rev 2024; 64:101154. [PMID: 38016838 DOI: 10.1016/j.blre.2023.101154] [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: 09/15/2023] [Revised: 10/31/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
Children with Down syndrome (DS) have a 10- to 20-fold greater predisposition to develop acute leukemia compared to the general population, with a skew towards myeloid leukemia (ML-DS). While ML-DS is known to be a subtype with good outcome, patients who relapse face a dismal prognosis. Acute lymphocytic leukemia in DS (DS-ALL) is considered to have poor prognosis. The relapse rate is high in DS-ALL compared to their non-DS counterparts. We have a better understanding about the mutational spectrum of DS leukemia. Studies using animal, embryonic stem cell- and induced pluripotent stem cell-based models have shed light on the mechanism by which these mutations contribute to disease initiation and progression. In this review, we list the currently available treatment strategies for DS-leukemias along with their outcome with emphasis on challenges with chemotherapy-related toxicities in children with DS. We focus on the mechanisms of initiation and progression of leukemia in children with DS and highlight the novel molecular targets with greater success in preclinical trials that have the potential to progress to the clinic.
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Affiliation(s)
- Sonali P Barwe
- Lisa Dean Moseley Institute for Cancer and Blood Disorders, Nemours Children's Health, Wilmington, Delaware, 19803, USA
| | - E Anders Kolb
- Lisa Dean Moseley Institute for Cancer and Blood Disorders, Nemours Children's Health, Wilmington, Delaware, 19803, USA
| | - Anilkumar Gopalakrishnapillai
- Lisa Dean Moseley Institute for Cancer and Blood Disorders, Nemours Children's Health, Wilmington, Delaware, 19803, USA.
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3
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Songthawee N, Sripornsawan P, Chavananon S, Kittivisuit S, McNeil EB, Chotsampancharoen T. Survival outcomes of myeloid leukemia associated with Down syndrome and de novo acute myeloid leukemia in children: Experience from a single tertiary center in Thailand. Pediatr Hematol Oncol 2024; 41:150-162. [PMID: 38013232 DOI: 10.1080/08880018.2023.2286970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
Few studies have reported the survival outcomes of myeloid leukemia associated with Down syndrome (DS) in resource-limited countries. This study aimed to compare characteristics and survival outcomes of children with acute myeloid leukemia (AML) between those with and without DS in Thailand. The medical records of AML patients aged 0-15 years treated in a major tertiary center in Southern Thailand between October 1978 and December 2019 were reviewed retrospectively. The overall (OS) and event-free survivals (EFS) rates were calculated using the Kaplan-Meier method. A total of 362 AML patients were included, of which 41 (11.3%) had DS. The mean age at diagnosis of the DS patients was 2.5 ± 1.9 years and most of them (90.2%) were under the age of five. The DS patients had lower initial white blood cell counts and peripheral blasts compared to the non-DS patients. The AML-M7 subtype was more common in the DS than in the non-DS patients (80.5% vs. 9.1%, p < 0.01, respectively). The 5-year OS and EFS rates of the DS patients were lower compared to the non-DS patients (12.9% vs. 20.5%, p = 0.05 and 13.7% vs. 18.4%, p = 0.03, respectively). DS patients had a significantly higher rate of early and treatment-related deaths compared to non-DS patients (30.3% vs. 13.5%, p < 0.01 and 39.4% vs. 19.5%, p = 0.02, respectively). Over the study period, there were a decrease in early death rate and an increase in survival rates of DS patients, which suggests that chemotherapy regimens and supportive care have improved over time.
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Affiliation(s)
- Natsaruth Songthawee
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Pornpun Sripornsawan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Shevachut Chavananon
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Sirinthip Kittivisuit
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Thirachit Chotsampancharoen
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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4
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Raghuram N, Hasegawa D, Nakashima K, Rahman S, Antoniou E, Skajaa T, Merli P, Verma A, Rabin KR, Aftandilian C, Kotecha RS, Cheuk D, Jahnukainen K, Kolenova A, Balwierz W, Norton A, O’Brien M, Cellot S, Chopek A, Arad-Cohen N, Goemans B, Rojas-Vasquez M, Ariffin H, Bartram J, Kolb EA, Locatelli F, Klusmann JH, Hasle H, McGuire B, Hasnain A, Sung L, Hitzler J. Survival outcomes of children with relapsed or refractory myeloid leukemia associated with Down syndrome. Blood Adv 2023; 7:6532-6539. [PMID: 36735769 PMCID: PMC10632607 DOI: 10.1182/bloodadvances.2022009381] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Children with Down syndrome (DS) are at a significantly higher risk of developing acute myeloid leukemia, also termed myeloid leukemia associated with DS (ML-DS). In contrast to the highly favorable prognosis of primary ML-DS, the limited data that are available for children who relapse or who have refractory ML-DS (r/r ML-DS) suggest a dismal prognosis. There are few clinical trials and no standardized treatment approach for this population. We conducted a retrospective analysis of international study groups and pediatric oncology centers and identified 62 patients who received treatment with curative intent for r/r ML-DS between year 2000 to 2021. Median time from diagnosis to relapse was 6.8 (range, 1.1-45.5) months. Three-year event-free survival (EFS) and overall survival (OS) were 20.9 ± 5.3% and 22.1 ± 5.4%, respectively. Survival was associated with receipt of hematopoietic stem cell transplantation (HSCT) (hazard ratio [HR], 0.28), duration of first complete remission (CR1) (HR, 0.31 for > 12 months) and attainment of remission after relapse (HR, 4.03). Patients who achieved complete remission (CR) before HSCT, had an improved OS and EFS of 56.0 ± 11.8% and 50.5 ± 11.9%, respectively compared to those who underwent HSCT without CR (3-year OS and EFS of 10.0 ± 9.5%). Treatment failure after HSCT was predominantly because of disease recurrence (52%) followed by treatment-related mortality (10%). The prognosis of r/r ML-DS remains dismal even in the current treatment period and serve as a reference point for current prognostication and future interventional studies. Clinical trials aimed at improving the survival of patients with r/r ML-DS are needed.
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Affiliation(s)
- Nikhil Raghuram
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Kentaro Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Syaza Rahman
- Division of Paediatric Haematology-Oncology and BM Transplantation, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Evangelia Antoniou
- Department of Pediatric Hematology and Oncology, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Torjus Skajaa
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Pietro Merli
- Department of Pediatric Hematology/Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Pediatrico Bambino Gesù, Sapienza University of Rome, Rome, Italy
| | - Anupam Verma
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Karen R. Rabin
- Pediatric Hematology-Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Catherine Aftandilian
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Rishi S. Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of WA, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Daniel Cheuk
- Department of Paediatrics and Adolescent Medicine, the University of Hong Kong and Hong Kong Children's Hospital, Hong Kong, China
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Alice Norton
- Department of Haematology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Maureen O’Brien
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sonia Cellot
- Division of Hematology, Department of Pediatrics, Ste-Justine Hospital, Montréal, Université de Montréal, Montréal, QC, Canada
| | - Ashley Chopek
- Pediatric Blood and Marrow Transplant Program, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Nira Arad-Cohen
- Pediatric Hematology-Oncology Department, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Bianca Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marta Rojas-Vasquez
- Department of Pediatric Hematology-Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Hany Ariffin
- Division of Paediatric Haematology-Oncology and BM Transplantation, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Jack Bartram
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders/Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Pediatrico Bambino Gesù, Sapienza University of Rome, Rome, Italy
| | | | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bryan McGuire
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Afia Hasnain
- Division of Genome Diagnostics, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Johann Hitzler
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
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5
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Verma A, Lupo PJ, Shah NN, Hitzler J, Rabin KR. Management of Down Syndrome-Associated Leukemias: A Review. JAMA Oncol 2023; 9:1283-1290. [PMID: 37440251 DOI: 10.1001/jamaoncol.2023.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Importance Down syndrome (DS), caused by an extra copy of material from chromosome 21, is one of the most common genetic conditions. The increased risk of acute leukemia in DS (DS-AL) has been recognized for decades, consisting of an approximately 150-fold higher risk of acute myeloid leukemia (AML) before age 4 years, and a 10- to 20-fold higher risk of acute lymphoblastic leukemia (ALL), compared with children without DS. Observations A recent National Institutes of Health-sponsored conference, ImpacT21, reviewed research and clinical trials in children, adolescents, and young adults (AYAs) with DS-AL and are presented herein, including presentation and treatment, clinical trial design, and ethical considerations for this unique population. Between 10% to 30% of infants with DS are diagnosed with transient abnormal myelopoiesis (TAM), which spontaneously regresses. After a latency period of up to 4 years, 20% to 30% develop myeloid leukemia associated with DS (ML-DS). Recent studies have characterized somatic mutations associated with progression from TAM to ML-DS, but predicting which patients will progress to ML-DS remains elusive. Clinical trials for DS-AL have aimed to reduce treatment-related mortality (TRM) and improve survival. Children with ML-DS have better outcomes compared with non-DS AML, but outcomes remain dismal in relapse. In contrast, patients with DS-ALL have inferior outcomes compared with those without DS, due to both higher TRM and relapse. Management of relapsed leukemia poses unique challenges owing to disease biology and increased vulnerability to toxic effects. Late effects in survivors of DS-AL are an important area in need of further study because they may demonstrate unique patterns in the setting of chronic medical conditions associated with DS. Conclusions and Relevance Optimal management of DS-AL requires specific molecular testing, meticulous supportive care, and tailored therapy to reduce TRM while optimizing survival. There is no standard approach to treatment of relapsed disease. Future work should include identification of biomarkers predictive of toxic effects; enhanced clinical and scientific collaborations; promotion of access to novel agents through innovative clinical trial design; and dedicated studies of late effects of treatment.
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Affiliation(s)
- Anupam Verma
- Pediatric Oncology Branch, Center for Cancer Research (CCR), NCI, NIH, Bethesda, Maryland
| | - Philip J Lupo
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), NCI, NIH, Bethesda, Maryland
| | - Johann Hitzler
- Division of Hematology Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Karen R Rabin
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
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6
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Cooper TM, Alonzo TA, Tasian SK, Kutny MA, Hitzler J, Pollard JA, Aplenc R, Meshinchi S, Kolb EA. Children's Oncology Group's 2023 blueprint for research: Myeloid neoplasms. Pediatr Blood Cancer 2023; 70 Suppl 6:e30584. [PMID: 37480164 PMCID: PMC10614720 DOI: 10.1002/pbc.30584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
During the past decade, the outcomes of pediatric patients with acute myeloid leukemia (AML) have plateaued with 5-year event-free survival (EFS) and overall survival (OS) of approximately 46 and 64%, respectively. Outcomes are particularly poor for those children with high-risk disease, who have 5-year OS of 46%. Substantial survival improvements have been observed for a subset of patients treated with targeted therapies. Specifically, children with KMT2A-rearranged AML and/or FLT3 internal tandem duplication (FLT3-ITD) mutations benefitted from the addition of gemtuzumab ozogamicin, an anti-CD33 antibody-drug conjugate, in the AAML0531 clinical trial (NCT00372593). Sorafenib also improved response and survival in children with FLT3-ITD AML in the AAML1031 clinical trial (NCT01371981). Advances in characterization of prognostic cytomolecular events have helped to identify patients at highest risk of relapse and facilitated allocation to consolidative hematopoietic stem cell transplant (HSCT) in first remission. Some patients clearly have improved survival with HSCT, although the benefit is largely unknown for most patients. Finally, data-driven refinements in supportive care recommendations continue to evolve with meaningful and measurable reductions in toxicity and improvements in EFS and OS. As advances in application of targeted therapies, risk stratification, and improved supportive care measures are incorporated into current trials and become standard-of-care, there is every expectation that we will see improved survival with a reduction in toxic morbidity and mortality. The research agenda of the Children's Oncology Group's Myeloid Diseases Committee continues to build upon experience and outcomes with an overarching goal of curing more children with AML.
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Affiliation(s)
- Todd M Cooper
- Seattle Children’s Hospital Cancer and Blood Disorders Service, University of Washington School of Medicine; Seattle, Washington
| | | | - Sarah K Tasian
- Children’s Hospital of Philadelphia Division of Oncology and Center for Childhood Cancer Research and University of Pennsylvania School of Medicine; Philadelphia, Pennsylvania
| | - Matthew A Kutny
- University of Alabama at Birmingham, Department of Pediatrics, Division of Hematology/Oncology, Birmingham, Alabama
| | - Johann Hitzler
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, ON, Canada; Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Jessica A Pollard
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, and Division of Hematology/Oncology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Richard Aplenc
- Children’s Hospital of Philadelphia Division of Oncology and Center for Childhood Cancer Research and University of Pennsylvania School of Medicine; Philadelphia, Pennsylvania
| | - Soheil Meshinchi
- Seattle Children’s Hospital Cancer and Blood Disorders Service, University of Washington School of Medicine; Seattle, Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - E Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Nemours Children’s Health, Wilmington, DE
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7
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Kosmidou A, Tragiannidis A, Gavriilaki E. Myeloid Leukemia of Down Syndrome. Cancers (Basel) 2023; 15:3265. [PMID: 37444375 DOI: 10.3390/cancers15133265] [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: 04/29/2023] [Revised: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Myeloid leukemia of Down syndrome (ML-DS) is characterized by a distinct natural history and is classified by the World Health Organization (WHO) as an independent entity, occurring with unique clinical and molecular features. The presence of a long preleukemic, myelodysplastic phase, called transient abnormal myelopoiesis (TAM), precedes the initiation of ML-DS and is defined by unusual chromosomal findings. Individuals with constitutional trisomy 21 have a profound dosage imbalance in the hematopoiesis-governing genes located on chromosome 21 and thus are subject to impaired fetal as well as to neonatal erythro-megakaryopoiesis. Almost all neonates with DS develop quantitative and morphological hematological abnormalities, yet still only 5-10% of them present with one of the preleukemic or leukemic conditions of DS. The acquired mutations in the key hematopoietic transcription factor gene GATA1, found solely in cells trisomic for chromosome 21, are considered to be the essential step for the selective growth advantage of leukemic cells. While the majority of cases of TAM remain clinically 'silent' or undergo spontaneous remission, the remaining 20% to 30% of them progress into ML-DS until the age of 4 years. The hypersensitivity of ML-DS blasts to chemotherapeutic agents, including but not limited to cytarabine, and drugs' increased infectious and cardiac toxicity have necessitated the development of risk-adapted treatment protocols for children with ML-DS. Recent advances in cytogenetics and specific molecular mechanisms involved in the evolution of TAM and ML-DS are reviewed here, as well as their integration in the improvement of risk stratification and targeted management of ML-DS.
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Affiliation(s)
- Aikaterini Kosmidou
- 2nd Department of Internal Medicine, General Hospital of Kavala, 65500 Kavala, Greece
| | - Athanasios Tragiannidis
- 2nd Department of Pediatrics, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Gavriilaki
- Hematology Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
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8
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Clonal Myeloproliferative Disorders in Patients with Down Syndrome-Treatment and Outcome Results from an Institution in Argentina. Cancers (Basel) 2022; 14:cancers14133286. [PMID: 35805057 PMCID: PMC9265690 DOI: 10.3390/cancers14133286] [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: 09/02/2021] [Revised: 10/27/2021] [Accepted: 12/03/2021] [Indexed: 02/04/2023] Open
Abstract
Children with Down syndrome (DS) are at an increased risk of developing clonal myeloproliferative disorders. The balance between treatment intensity and treatment-related toxicity has not yet been defined. We analyzed this population to identify risk factors and optimal treatment. This single-center retrospective study included 78 DS patients <16 years-old with Transient Abnormal Myelopoiesis (TAM, n = 25), Acute Myeloblastic Leukemia (DS-AML, n = 41) of which 35 had classical Myeloid Leukemia associated with DS (ML-DS) with megakaryoblastic immunophenotype (AMKL) and 6 sporadic DS-AML (non-AMKL). Patients with DS-AML were treated according to four BFM-based protocols. Classical ML-DS vs. non-DS-AMKL were compared and the outcome of ML-DS was analyzed according to treatment intensity. Only four patients with TAM required cytoreduction with a 5-year Event-Free Survival probability (EFSp) of 74.4 (±9.1)%. DS-AML treatment-related deaths were due to infections, with a 5-year EFSp of 60.6 (±8.2)%. Megakaryoblastic immunophenotype was the strongest good-prognostic factor in univariate and multivariate analysis (p = 0.000). When compared ML-DS with non-DS-AMKL, a better outcome was associated with a lower relapse rate (p = 0.0002). Analysis of administered treatment was done on 32/33 ML-DS patients who achieved CR according to receiving or not high-dose ARA-C block (HDARA-C), and no difference in 5-year EFSp was observed (p = 0.172). TAM rarely required treatment and when severe manifestations occurred, early intervention was effective. DS-AML good outcome was associated with AMKL with a low relapse-rate. Even if treatment-related mortality is still high, our data do not support the omission of HDARA-C in ML-DS since we observed a trend to detect a higher relapse rate in the arm without HDARA-C.
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9
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Rosenzweig J, Pillai PM, Prockop S, Benayed R, Eidenschink Brodersen L, Najfeld V, Loken MR, Zhang Y, Shukla N. Acute myeloid leukemia with an MN1-ETV6 fusion in a young child with Down syndrome. Cold Spring Harb Mol Case Stud 2022; 8:a006167. [PMID: 35483876 PMCID: PMC9059786 DOI: 10.1101/mcs.a006167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Myeloid leukemia of Down syndrome (ML-DS) in young children is associated with distinct clinical and biological features and is typically initiated with oncogenic mutations in the X-linked megakaryocytic transcription factor GATA1. Here we present a 3-yr-old child with DS diagnosed with acute myeloid leukemia (AML), which lacks typical immunophenotypic and molecular characteristics of ML-DS, including GATA1 mutations. The leukemic blasts were found to have an MN1-ETV6 gene fusion, a high-risk oncofusion not previously described in DS patients. This report highlights the importance of immunophenotypic, cytogenetic, and molecular characterization of ML-DS for identification of rare cases with unique features that may benefit from treatment protocols that are more intensive than those developed for patients with typical GATA1 mutant ML-DS.
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Affiliation(s)
- Jaclyn Rosenzweig
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Pallavi M Pillai
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Susan Prockop
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | | | - Vesna Najfeld
- Department of Medicine and Pathology, Tumor Cytogenomics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York 10029, USA
| | | | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
| | - Neerav Shukla
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA
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10
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Hitzler J, Alonzo T, Gerbing R, Beckman A, Hirsch B, Raimondi S, Chisholm K, Viola S, Brodersen L, Loken M, Tong S, Druley T, O'Brien M, Hijiya N, Heerema-McKenney A, Wang YC, Schore R, Taub J, Gamis A, Kolb EA, Berman JN. High-dose AraC is essential for the treatment of ML-DS independent of postinduction MRD: results of the COG AAML1531 trial. Blood 2021; 138:2337-2346. [PMID: 34320162 PMCID: PMC8662073 DOI: 10.1182/blood.2021012206] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/18/2021] [Indexed: 11/20/2022] Open
Abstract
Myeloid leukemia in children with Down syndrome (ML-DS) is associated with young age and somatic GATA1 mutations. Because of high event-free survival (EFS) and hypersensitivity of the leukemic blasts to chemotherapy, the prior Children's Oncology Group protocol ML-DS protocol (AAML0431) reduced overall treatment intensity but lacking risk stratification, retained the high-dose cytarabine course (HD-AraC), which was highly associated with infectious morbidity. Despite high EFS of ML-DS, survival for those who relapse is rare. AAML1531 introduced therapeutic risk stratification based on the previously identified prognostic factor, measurable residual disease (MRD) at the end of the first induction course. Standard risk (SR) patients were identified by negative MRD using flow cytometry (<0.05%) and did not receive the historically administered HD-AraC course. Interim analysis of 114 SR patients revealed a 2-year EFS of 85.6% (95% confidence interval [CI], 75.7-95.5), which was significantly lower than for MRD- patients treated with HD-AraC on AAML0431 (P = .0002). Overall survival at 2 years was 91.0% (95% CI, 83.8-95.0). Twelve SR patients relapsed, mostly within 1 year from study entry and had a 1-year OS of 16.7% (95% CI, 2.7-41.3). Complex karyotypes were more frequent in SR patients who relapsed compared with those who did not (36% vs 9%; P = .0248). MRD by error-corrected sequencing of GATA1 mutations was piloted in 18 SR patients and detectable in 60% who relapsed vs 23% who did not (P = .2682). Patients with SR ML-DS had worse outcomes without HD-AraC after risk classification based on flow cytometric MRD.
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MESH Headings
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Child, Preschool
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Cytarabine/therapeutic use
- Dose-Response Relationship, Drug
- Down Syndrome/complications
- Down Syndrome/genetics
- Female
- Humans
- Infant
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Male
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Prognosis
- Treatment Outcome
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Affiliation(s)
- Johann Hitzler
- Division of Hematology/Oncology, Department of Pediatrics, University of Toronto Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Todd Alonzo
- Children's Oncology Group, University of Southern California, Monrovia, CA
| | - Robert Gerbing
- Children's Oncology Group, University of Southern California, Monrovia, CA
| | - Amy Beckman
- Division of Laboratory Medicine, University of Minnesota, Minneapolis, MN
| | - Betsy Hirsch
- Division of Laboratory Medicine, University of Minnesota, Minneapolis, MN
| | | | - Karen Chisholm
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Shelton Viola
- Department of Pediatrics, Naval Medical Center, Portsmouth, VA
| | | | | | - Spencer Tong
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Todd Druley
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Maureen O'Brien
- Pediatric Hematology/Oncology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Nobuko Hijiya
- Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY
| | | | - Yi-Chang Wang
- Children's Oncology Group, University of Southern California, Monrovia, CA
| | - Reuven Schore
- Division of Hematology/Oncology, Children's National Medical Center, Washington, DC
| | - Jeffrey Taub
- Karmanos Cancer Institute-Wayne State University, Detroit, MI
| | - Alan Gamis
- Division of Hematology/Oncology/Bone Marrow Transplantation, Children's Mercy Kansas City, Kansas City, MO
| | - E Anders Kolb
- Blood and Bone Marrow Transplants, Alfred I. DuPont Hospital for Children, Wilmington, DE; and
| | - Jason N Berman
- Department of Pediatrics, University of Ottawa-Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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11
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Boucher AC, Caldwell KJ, Crispino JD, Flerlage JE. Clinical and biological aspects of myeloid leukemia in Down syndrome. Leukemia 2021; 35:3352-3360. [PMID: 34518645 PMCID: PMC8639661 DOI: 10.1038/s41375-021-01414-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/08/2023]
Abstract
Children with Down syndrome are at an elevated risk of leukemia, especially myeloid leukemia (ML-DS). This malignancy is frequently preceded by transient abnormal myelopoiesis (TAM), which is self-limited expansion of fetal liver-derived megakaryocyte progenitors. An array of international studies has led to consensus in treating ML-DS with reduced-intensity chemotherapy, leading to excellent outcomes. In addition, studies performed in the past 20 years have revealed many of the genetic and epigenetic features of the tumors, including GATA1 mutations that are arguably associated with all cases of both TAM and ML-DS. Despite these advances in understanding the clinical and biological aspects of ML-DS, little is known about the mechanisms of relapse. Upon relapse, patients face a poor outcome, and there is no consensus on treatment. Future studies need to be focused on this challenging aspect of leukemia in children with DS.
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Affiliation(s)
- Austin C Boucher
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Kenneth J Caldwell
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - John D Crispino
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
| | - Jamie E Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
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12
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Al-Kershi S, Golnik R, Flasinski M, Waack K, Rasche M, Creutzig U, Dworzak M, Reinhardt D, Klusmann JH. Recommendations for Diagnosis and Treatment of Children with Transient Abnormal Myelopoiesis (TAM) and Myeloid Leukemia in Down Syndrome (ML-DS). KLINISCHE PADIATRIE 2021; 233:267-277. [PMID: 34407551 DOI: 10.1055/a-1532-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Children with Down syndrome are at a high risk of developing transient abnormal myelopoiesis (TAM; synonym: TMD) or myeloid leukemia (ML-DS). While most patients with TAM are asymptomatic and go into spontaneous remission without a need for therapy, around 20% of patients die within the first six months due to TAM-related complications. Another 20-30% of patients progress from TAM to ML-DS. ML-DS patients are particularly vulnerable to therapy-associated toxicity, but the prognosis of relapsed ML-DS is extremely poor - thus, ML-DS therapy schemata must strive for a balance between appropriate efficacy (to avoid relapses) and treatment-related toxicity. This guideline presents diagnostic and therapeutic strategies for TAM and ML-DS based on the experience and results of previous clinical studies from the BFM working group, which have helped reduce the risk of early death in symptomatic TAM patients using low-dose cytarabine, and which have achieved excellent cure rates for ML-DS using intensity-reduced treatment protocols.
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Affiliation(s)
- Sina Al-Kershi
- Clinic for Pediatrics, University Hospital Frankfurt, Frankfurt, Germany.,Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Golnik
- Clinic for Pediatrics, University Hospital Frankfurt, Frankfurt, Germany
| | - Marius Flasinski
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Hospital Tauberbischofsheim, Tauberbischofsheim, Germany
| | - Katharina Waack
- Pediatrics III, Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Mareike Rasche
- Pediatrics III, Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Ursula Creutzig
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Wien, Austria
| | - Dirk Reinhardt
- Pediatrics III, Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
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13
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Wagenblast E, Araújo J, Gan OI, Cutting SK, Murison A, Krivdova G, Azkanaz M, McLeod JL, Smith SA, Gratton BA, Marhon SA, Gabra M, Medeiros JJF, Manteghi S, Chen J, Chan-Seng-Yue M, Garcia-Prat L, Salmena L, De Carvalho DD, Abelson S, Abdelhaleem M, Chong K, Roifman M, Shannon P, Wang JCY, Hitzler JK, Chitayat D, Dick JE, Lechman ER. Mapping the cellular origin and early evolution of leukemia in Down syndrome. Science 2021; 373:eabf6202. [PMID: 34244384 DOI: 10.1126/science.abf6202] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/09/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022]
Abstract
Children with Down syndrome have a 150-fold increased risk of developing myeloid leukemia, but the mechanism of predisposition is unclear. Because Down syndrome leukemogenesis initiates during fetal development, we characterized the cellular and developmental context of preleukemic initiation and leukemic progression using gene editing in human disomic and trisomic fetal hematopoietic cells and xenotransplantation. GATA binding protein 1 (GATA1) mutations caused transient preleukemia when introduced into trisomy 21 long-term hematopoietic stem cells, where a subset of chromosome 21 microRNAs affected predisposition to preleukemia. By contrast, progression to leukemia was independent of trisomy 21 and originated in various stem and progenitor cells through additional mutations in cohesin genes. CD117+/KIT proto-oncogene (KIT) cells mediated the propagation of preleukemia and leukemia, and KIT inhibition targeted preleukemic stem cells.
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MESH Headings
- Animals
- Antigens, CD34/analysis
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cell Lineage
- Cell Proliferation
- Cell Transformation, Neoplastic
- Chromosomal Proteins, Non-Histone/genetics
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 21/metabolism
- Disease Models, Animal
- Disease Progression
- Down Syndrome/complications
- Down Syndrome/genetics
- Female
- GATA1 Transcription Factor/genetics
- GATA1 Transcription Factor/metabolism
- Hematopoiesis
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/physiology
- Heterografts
- Humans
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/metabolism
- Leukemia, Myeloid/pathology
- Liver/embryology
- Male
- Megakaryocytes/physiology
- Mice
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Mutation
- Preleukemia/genetics
- Preleukemia/metabolism
- Preleukemia/pathology
- Protein Kinase Inhibitors/pharmacology
- Proto-Oncogene Mas
- Proto-Oncogene Proteins c-kit/analysis
- Proto-Oncogene Proteins c-kit/antagonists & inhibitors
- Cohesins
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Affiliation(s)
- Elvin Wagenblast
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada.
| | - Joana Araújo
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Department of Hematology, Centro Hospitalar Universitário de São João, Porto, 4200-319, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, 4200-135, Portugal
- Instituto Nacional de Investigação Biomédica, University of Porto, Porto, 4200-135, Portugal
| | - Olga I Gan
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Sarah K Cutting
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Alex Murison
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Gabriela Krivdova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Maria Azkanaz
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Jessica L McLeod
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Sabrina A Smith
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Blaise A Gratton
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Sajid A Marhon
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Martino Gabra
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jessie J F Medeiros
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | - Sanaz Manteghi
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada
| | - Jian Chen
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada
| | - Michelle Chan-Seng-Yue
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | - Laura Garcia-Prat
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Leonardo Salmena
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Daniel D De Carvalho
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Sagi Abelson
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | - Mohamed Abdelhaleem
- Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Karen Chong
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Maian Roifman
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jean C Y Wang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario M5G 2M9, Canada
| | - Johann K Hitzler
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - John E Dick
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Eric R Lechman
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1L7, Canada.
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14
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Shimada A. Profile of down syndrome–associated malignancies: Epidemiology, clinical features and therapeutic aspects. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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15
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Kapoor R, Mohan KR, Roy S, Pramanik SK, Khera S, Simalti AK. Treating acute myeloid leukemia among children with down syndrome. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_175_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Down Syndrome (DS) children with acute myeloid leukemia (AML) have unique differences in clinical features, epidemiologic nature, and biologic patterns of disease compared with AML in children without DS. Aims and Objective: AML in DS children should be considered distinct disorder from AML in Non DS population and treatment needs to be customized for this population. In this retrospective study spanning from 2014 to 2019 we present our experience of managing leukemia in children with DS. Materials and Methods: From 2014 and 2019, 72 children aged below 18 years were managed at our institute with acute myeloid leukemia (AML). Out of these 72 children with AML, 7 children were with DS which was confirmed by karyotyping. Majority of these children had M7 while M2 and M4 subtypes were seen in one child each. On conventional karyotyping in addition to trisomy 21 additional cytogenetic abnormalities were seen in 4 patients. Two children had trisomy 8. One child had deletion of 11 chromosomes and one had translocation between 8 and 21 chromosomes. Results: All 7 children were administered intensive chemotherapy with curative intent after informed parental consent. All 7 children achieved complete remission. Four out of 7 children had complications related to severe neutropenia. Conclusion: All patients of DS with AML should be offered chemotherapy with curative intent. Endeavour should be to give less aggressive chemotherapy protocol to bring down treatment related mortality.
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Affiliation(s)
- Rajan Kapoor
- Department of Medicine and Hematology, Command Hospital, Kolkata, West Bengal, India
| | - Karthik Ram Mohan
- Department of Pediatrics, Command Hospital, Kolkata, West Bengal, India
| | - Shuvendu Roy
- Department of Pediatrics, Command Hospital, Kolkata, West Bengal, India
| | - Suman Kumar Pramanik
- Department of Medicine and Hematology, Army Hospital (Research and Referral), New Delhi, India
| | - Sanjeev Khera
- Department of Pediatrics, Army Hospital (Research and Referral), New Delhi, India
| | - A K Simalti
- Pediatric Intensivist, Army Hospital (Research and Referral), New Delhi, India
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16
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Laurent AP, Kotecha RS, Malinge S. Gain of chromosome 21 in hematological malignancies: lessons from studying leukemia in children with Down syndrome. Leukemia 2020; 34:1984-1999. [PMID: 32433508 PMCID: PMC7387246 DOI: 10.1038/s41375-020-0854-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 12/31/2022]
Abstract
Structural and numerical alterations of chromosome 21 are extremely common in hematological malignancies. While the functional impact of chimeric transcripts from fused chromosome 21 genes such as TEL-AML1, AML1-ETO, or FUS-ERG have been extensively studied, the role of gain of chromosome 21 remains largely unknown. Gain of chromosome 21 is a frequently occurring aberration in several types of acute leukemia and can be found in up to 35% of cases. Children with Down syndrome (DS), who harbor constitutive trisomy 21, highlight the link between gain of chromosome 21 and leukemogenesis, with an increased risk of developing acute leukemia compared with other children. Clinical outcomes for DS-associated leukemia have improved over the years through the development of uniform treatment protocols facilitated by international cooperative groups. The genetic landscape has also recently been characterized, providing an insight into the molecular pathogenesis underlying DS-associated leukemia. These studies emphasize the key role of trisomy 21 in priming a developmental stage and cellular context susceptible to transformation, and have unveiled its cooperative function with additional genetic events that occur during leukemia progression. Here, using DS-leukemia as a paradigm, we aim to integrate our current understanding of the role of trisomy 21, of critical dosage-sensitive chromosome 21 genes, and of associated mechanisms underlying the development of hematological malignancies. This review will pave the way for future investigations on the broad impact of gain of chromosome 21 in hematological cancer, with a view to discovering new vulnerabilities and develop novel targeted therapies to improve long term outcomes for DS and non-DS patients.
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Affiliation(s)
- Anouchka P Laurent
- INSERM U1170, Gustave Roussy Institute, Université Paris Saclay, Villejuif, France
- Université Paris Diderot, Paris, France
| | - Rishi S Kotecha
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
- Department of Clinical Haematology, Oncology and Bone Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Sébastien Malinge
- INSERM U1170, Gustave Roussy Institute, Université Paris Saclay, Villejuif, France.
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
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17
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Kim H. Treatments for children and adolescents with AML. Blood Res 2020; 55:S5-S13. [PMID: 32719170 PMCID: PMC7386885 DOI: 10.5045/br.2020.s002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/30/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
In recent decades, survival rates for childhood acute myeloid leukemia have remarkably improved, owing to chemotherapy intensification, allogeneic hematopoietic stem cell transplantation, and improved supportive care. Furthermore, treatment protocols have evolved and are currently better matched to prognostic factors and treatment responses. Recently, new molecular prognostic factors were discovered via leukemia genomic studies. Moreover, new tumor subtypes with independent gene expression profiles have been characterized. To broaden the therapeutic options for patients with poor prognoses, therapies that target specific candidate mutations are being identified. Additionally, new drugs are undergoing clinical trials, and immunotherapy is attracting significant interest as a treatment option for recurrent or refractory childhood acute myeloid leukemia.
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Affiliation(s)
- Hyery Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children’s Hospital, Seoul, Korea
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18
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Abstract
Acute megakaryoblastic leukemia (AMKL) is a rare malignancy affecting megakaryocytes, platelet-producing cells that reside in the bone marrow. Children with Down syndrome (DS) are particularly prone to developing the disease and have a different age of onset, distinct genetic mutations, and better prognosis as compared with individuals without DS who develop the disease. Here, we discuss the contributions of chromosome 21 genes and other genetic mutations to AMKL, the clinical features of the disease, and the differing features of DS- and non-DS-AMKL. Further studies elucidating the role of chromosome 21 genes in this disease may aid our understanding of how they function in other types of leukemia, in which they are frequently mutated or differentially expressed. Although researchers have made many insights into understanding AMKL, much more remains to be learned about its underlying molecular mechanisms.
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Affiliation(s)
- Maureen McNulty
- Northwestern University, Division of Hematology/Oncology, Chicago, Illinois 60611, USA
| | - John D Crispino
- Northwestern University, Division of Hematology/Oncology, Chicago, Illinois 60611, USA
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19
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Nakashima K, Hasegawa D, Tomizawa D, Miyamura T, Hama A, Iwamoto S, Terui K, Adachi S, Taga T. Characteristics and outcomes of children with acute myeloid leukemia and Down syndrome who are ineligible for clinical trials due to severe comorbidities. Pediatr Blood Cancer 2019; 66:e27942. [PMID: 31423753 DOI: 10.1002/pbc.27942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND High survival rates of 80-90% have been reported in recent clinical trials of reduced-intensity chemotherapies for children with acute myeloid leukemia and Down syndrome (AML-DS). However, a certain number of children with AML-DS have complicating comorbidities, including congenital heart disease (CHD), and are therefore ineligible for enrolment in clinical trials. METHODS We retrospectively analyzed the clinical characteristics and outcomes of children with AML-DS who were excluded from Japanese clinical trials conducted between 2000 and 2015. RESULTS Twelve children (six males and six females) were identified and were ineligible for CHD (n = 8) and other comorbidities, including hyperleukocytosis complicated with coagulopathy, severe hemophagocytosis, pulmonary fibrosis, and hypoxic-ischemic encephalopathy (n = 1 each). The median age at the diagnosis was 14 months (range, 5 months to 11.5 years). Among all cases, 11 patients were treated with curative intent. Four patients were considered intolerant to intensive chemotherapy and received only low-dose cytarabine-based chemotherapy: three failed to achieve remission and died of disease, while one successfully achieved remission but eventually died of infection. Seven cases underwent regular-intensive chemotherapy for AML-DS: six were alive and in remission; one had relapsed disease. One patient who received the best supportive care died of disease. Finally, six patients remained in continuous complete remission, while six died. The 5-year overall survival rate was 51%. CONCLUSIONS The prognosis of AML-DS patients who received insufficient treatment due to severe complication was poor. The optimal dose intensity of curative chemotherapy for such cases should be explored.
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Affiliation(s)
- Kentaro Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,AML Committee, Japan Children's Cancer Group, Nagoya, Japan
| | - Daisuke Hasegawa
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Tomizawa
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Miyamura
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Department of Pediatrics, Osaka University School of Medicine, Osaka, Japan
| | - Asahito Hama
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Shotaro Iwamoto
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Department of Pediatrics, Mie University School of Medicine, Mie, Japan
| | - Kiminori Terui
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Souichi Adachi
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | - Takashi Taga
- AML Committee, Japan Children's Cancer Group, Nagoya, Japan.,Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
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20
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Affiliation(s)
- Joel A Kaplan
- Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC
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21
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Sas V, Blag C, Zaharie G, Puscas E, Lisencu C, Andronic-Gorcea N, Pasca S, Petrushev B, Chis I, Marian M, Dima D, Teodorescu P, Iluta S, Zdrenghea M, Berindan-Neagoe I, Popa G, Man S, Colita A, Stefan C, Kojima S, Tomuleasa C. Transient leukemia of Down syndrome. Crit Rev Clin Lab Sci 2019; 56:247-259. [PMID: 31043105 DOI: 10.1080/10408363.2019.1613629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Childhood leukemia is mostly a "developmental accident" during fetal hematopoiesis and may require multiple prenatal and postnatal "hits". The World Health Organization defines transient leukemia of Down syndrome (DS) as increased peripheral blood blasts in neonates with DS and classifies this type of leukemia as a separate entity. Although it was shown that DS predisposes children to myeloid leukemia, neither the nature of the predisposition nor the associated genetic lesions have been defined. Acute myeloid leukemia of DS is a unique disease characterized by a long pre-leukemic, myelodysplastic phase, unusual chromosomal findings and a high cure rate. In the present manuscript, we present a comprehensive review of the literature about clinical and biological findings of transient leukemia of DS (TL-DS) and link them with the genetic discoveries in the field. We address the manuscript to the pediatric generalist and especially to the next generation of pediatric hematologists.
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Affiliation(s)
- Valentina Sas
- a Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania.,b Department of Pediatrics , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Cristina Blag
- b Department of Pediatrics , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Gabriela Zaharie
- c Department of Neonatology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Emil Puscas
- d Department of Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Cosmin Lisencu
- d Department of Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Nicolae Andronic-Gorcea
- a Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Sergiu Pasca
- a Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Bobe Petrushev
- a Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Irina Chis
- e Department of Physiology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Mirela Marian
- f Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania
| | - Delia Dima
- f Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania
| | - Patric Teodorescu
- a Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Sabina Iluta
- a Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Mihnea Zdrenghea
- f Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania
| | - Ioana Berindan-Neagoe
- g MedFuture Research Center for Advanced Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Gheorghe Popa
- b Department of Pediatrics , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Sorin Man
- b Department of Pediatrics , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Anca Colita
- h Department of Pediatrics , Carol Davila University of Medicine and Pharmacy , Bucharest , Romania.,i Department of Pediatrics , Fundeni Clinical Institute , Bucharest , Romania
| | - Cristina Stefan
- j African Organization for Research and Training in Cancer , Cape Town , South Africa
| | - Seiji Kojima
- k Department of Pediatrics , Nagoya University Graduate School of Medicine , Nagoya , Japan.,l Center for Advanced Medicine and Clinical Research , Nagoya University Hospital , Nagoya , Japan
| | - Ciprian Tomuleasa
- a Department of Hematology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania.,f Department of Hematology , Ion Chiricuta Clinical Cancer Center , Cluj Napoca , Romania.,m Research Center for Functional Genomics and Translational Medicine , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj Napoca , Romania
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22
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Rabin K, Izraeli S, Hijiya N, Hitzler J. Need for new thinking: Treatment of relapsed leukemia in children with Down syndrome. Pediatr Blood Cancer 2019; 66:e27644. [PMID: 30724029 DOI: 10.1002/pbc.27644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/10/2018] [Accepted: 01/16/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Karen Rabin
- Texas Children's Cancer Center Division of Pediatric Hematology/Oncology, Baylor College of Medicine, Houston, Texas
| | - Shai Izraeli
- Rina Zaizov Pediatric Hematology Oncology Division, Schneider Children's Medical Center of Israel, Petach Tiqva and Dept. of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Israel
| | - Nobuko Hijiya
- Division of Hematology/Oncology/Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Johann Hitzler
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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23
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Moassass F, Wafa A, Liehr T, Al-Ablog A, Al Achkar W. Down syndrome associated childhood myeloid leukemia with yet unreported acquired chromosomal abnormalities and a new potential adverse marker: dup(1)(q25q44). Mol Cytogenet 2018; 11:22. [PMID: 29563973 PMCID: PMC5851247 DOI: 10.1186/s13039-018-0370-8] [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: 01/10/2018] [Accepted: 03/07/2018] [Indexed: 01/17/2023] Open
Abstract
Background Children with constitutional trisomy 21, i.e. Down syndrome (DS, OMIM #190685) have a 10 to 20-fold increased risk for a hematopoietic malignancy. They may suffer from acute lymphoblastic leukemia or acute myeloid leukemia (AML). AML referred to as myeloid leukemia of Down syndrome (ML-DS) is observed especially after birth at an early gestational age and characterized by enhanced white blood cell count, failure of spontaneous remission, liver fibrosis or liver dysfunction, and is significantly associated with early death. There are only few studies yet focusing on the clonal cytogenetic changes during evolution of ML-DS. Case presentation In a 1.4-year-old boy with DS an immunophenotype consistent with AML-M1 according to French-American-British (FAB) classification was diagnoses. Cytogenetic and molecular cytogenetic analyses revealed, besides constitutional free trisomy 21, an unbalanced translocation as der(16)t(1;16)(q25.3;q24), plus a balanced translocation t(3;20)(q25;q13.1). A poor clinical outcome was observed here. Conclusions To the best of our knowledge, an ML-DS case associated with identical acquired chromosomal abnormalities was not previously reported. Our findings suggest that especially partial trisomy 1q25 to 1q44 may be indicative for a poor prognosis in ML-DS.
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Affiliation(s)
- Faten Moassass
- 1Molecular Biology and Biotechnology Department, Human Genetics Division, Chromosomes Laboratory, Atomic Energy Commission of Syria, P.O. Box 6091, Damascus, Syria
| | - Abdulsamad Wafa
- 1Molecular Biology and Biotechnology Department, Human Genetics Division, Chromosomes Laboratory, Atomic Energy Commission of Syria, P.O. Box 6091, Damascus, Syria
| | - Thomas Liehr
- 2Jena University Hospital, Institute of Human Genetics, Am Klinikum 1, 07747 Jena, Germany
| | - Ayman Al-Ablog
- 1Molecular Biology and Biotechnology Department, Human Genetics Division, Chromosomes Laboratory, Atomic Energy Commission of Syria, P.O. Box 6091, Damascus, Syria
| | - Walid Al Achkar
- 1Molecular Biology and Biotechnology Department, Human Genetics Division, Chromosomes Laboratory, Atomic Energy Commission of Syria, P.O. Box 6091, Damascus, Syria
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24
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Klein K, de Haas V, Kaspers GJL. Clinical challenges in de novo pediatric acute myeloid leukemia. Expert Rev Anticancer Ther 2018; 18:277-293. [DOI: 10.1080/14737140.2018.1428091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Klein
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Valérie de Haas
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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25
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Miyake Y, Adachi JI, Suzuki T, Mishima K, Sasaki A, Nishikawa R. Craniospinal Germinomas in Patient with Down Syndrome Successfully Treated with Standard-Dose Chemotherapy and Craniospinal Irradiation: Case Report and Literature Review. World Neurosurg 2017; 108:995.e9-995.e15. [PMID: 28919233 DOI: 10.1016/j.wneu.2017.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with Down syndrome (DS) are more likely to develop chemotherapy-related complications. The standard treatment for these patients with cancer has not yet been established, and the risks of standard chemotherapy are unclear. In this paper, a rare case of multiple craniospinal germinomas in a patient with DS, which was successfully treated with standard-dose chemotherapy combined with craniospinal irradiation, is reported. CASE DESCRIPTION The authors report a case of multiple craniospinal germinomas in a DS patient who presented with bilateral oculomotor and facial nerve palsy and hearing loss. The patient underwent 3 courses of combination chemotherapy using a standard dose of carboplatin and etoposide and 23.4 Gy of concurrent craniospinal irradiation. Posttreatment magnetic resonance imaging showed reduction of the tumors. Both fluorodeoxyglucose- and methionine-positron emission tomography demonstrated no uptake in the residual tumors. Follow-up magnetic resonance imaging and positron emission tomography did not reveal tumor recurrence for 18 months. CONCLUSIONS As far as we know, this is the first case of multiple craniospinal germinomas in a patient with DS who achieved a successful treatment result without fatal adverse events. The literature review indicated that disseminated germinomas may need intensive treatment to reduce recurrence risk. However, intensive chemotherapy using a combination of 3 or more anticancer drugs can increase the rate of treatment-related death during the early stage. Our case indicated that multiple craniospinal germinoma of DS patients could be treated with a standard dose of carboplatin and etoposide regimen with concurrent craniospinal irradiation along with appropriate supportive therapy and careful observation.
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Affiliation(s)
- Yohei Miyake
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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26
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Therapy reduction in patients with Down syndrome and myeloid leukemia: the international ML-DS 2006 trial. Blood 2017; 129:3314-3321. [DOI: 10.1182/blood-2017-01-765057] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/29/2017] [Indexed: 11/20/2022] Open
Abstract
Key Points
Reducing therapy intensity in the ML-DS 2006 trial did not impair the excellent prognosis in ML-DS compared with the historical control. Early treatment response and gain of chromosome 8 are independent prognostic factors.
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27
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Jastaniah W, Alsultan A, Al Daama S, Ballourah W, Bayoumy M, Al-Anzi F, Al Shareef O, Abrar MB, Al Sudairy R, Al Ghemlas I. Treatment results in children with myeloid leukemia of Down syndrome in Saudi Arabia: A multicenter SAPHOS leukemia group study. Leuk Res 2017; 58:48-54. [PMID: 28445808 DOI: 10.1016/j.leukres.2017.04.004] [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: 11/16/2016] [Revised: 03/19/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
Despite the high incidence of Down syndrome (DS) in Arab countires, the incidence and outcomes of myeloid leukemia of DS (ML-DS) have not been studied. We evaluated 206 pediatric acute myeloid leukemia (AML) patients diagnosed between 2005 and 2012 and identified 31 (15%) ML-DS. The incidence of ML-DS was 48 per 100,000 compared to 0.6 per 100,000 for AML in non-DS children. Thus, patients with DS had 80-fold increased risk of ML-DS compared to AML in non-DS children. The median age at diagnosis was 1.8 years, male/female ratio was 1.2, majority (84%) of patients had FAB-M7 subtype, and the cytogenetic abnormalities were normal karyotype (constitutional trisomy 21) in 48%, additional trisomy in 23%, and other aberrations in 29%. Complete remission, cumulative incidences of relapse (CIR), toxic-death, and 5-year event-free survival (EFS) rates were 96.8%, 19.4%, 13.1%, and 67.7±8.4%; respectively. In the present study, multivariate analysis revealed favorable outcome (5-year EFS 86.7±8.8%) for patients with normal karyotype. The incidence and clinical characteristics of ML-DS in Saudi patients were comparable to other reports. However, there is a need to optimize risk stratification and treatment intensity to reduce CIR and toxic death rates to further improve outcomes of patients with ML-DS.
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Affiliation(s)
- Wasil Jastaniah
- Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia; Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Al Daama
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | - Mohammad Bayoumy
- King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Faisal Al-Anzi
- Prince Faisal Bin Bandar Cancer Center, Qaseem, Saudi Arabia
| | | | - Mohammed Burhan Abrar
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Reem Al Sudairy
- Department of Pediatric Hematology/Oncology, King Abdullah specialized Children's Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Al Ghemlas
- Faculty of Medicine, Alfaisal University, Riyadh, Saudi Arabia; King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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28
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Improved outcomes for myeloid leukemia of Down syndrome: a report from the Children's Oncology Group AAML0431 trial. Blood 2017; 129:3304-3313. [PMID: 28389462 DOI: 10.1182/blood-2017-01-764324] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/27/2017] [Indexed: 02/01/2023] Open
Abstract
Patients with myeloid leukemia of Down syndrome (ML-DS) have favorable event-free survival (EFS), but experience significant treatment-related morbidity and mortality. ML-DS blast cells ex vivo have increased sensitivity to cytarabine (araC) and daunorubicin, suggesting that optimizing drug dosing may improve outcomes while reducing toxicity. The Children's Oncology Group (COG) AAML0431 trial consisted of 4 cycles of induction and 2 cycles of intensification therapy based on the treatment schema of the previous COG A2971 trial with several modifications. High-dose araC (HD-araC) was used in the second induction cycle instead of the intensification cycle, and 1 of 4 daunorubicin-containing induction cycles was eliminated. For 204 eligible patients, 5-year EFS was 89.9% and overall survival (OS) was 93.0%. The 5-year OS for 17 patients with refractory/relapsed leukemia was 34.3%. We determined the clinical significance of minimal residual disease (MRD) levels as measured by flow cytometry on day 28 of induction I. MRD measurements, available for 146 of the 204 patients, were highly predictive of treatment outcome; 5-year disease-free survival for MRD-negative patients (n = 125) was 92.7% vs 76.2% for MRD-positive patients (n = 21) (log-rank P = .011). Our results indicated that earlier use of HD-araC led to better EFS and OS in AAML0431 than in past COG studies. A 25% reduction in the cumulative daunorubicin dose did not impact outcome. MRD, identified as a new prognostic factor for ML-DS patients, can be used for risk stratification in future clinical trials. This trial was registered at www.clinicaltrials.gov as #NCT00369317.
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29
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Gallagher-Lacey C, Afify Z, Yaish HM, Yoder BA, Christensen RD. An Instructive Case of Transient Myeloproliferative Disorder. Clin Pediatr (Phila) 2017; 56:288-289. [PMID: 27530503 DOI: 10.1177/0009922816662460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Caitlin Gallagher-Lacey
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Zeinab Afify
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Hassan M Yaish
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Bradley A Yoder
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Robert D Christensen
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
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30
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Abstract
The outcome for children with acute myeloid leukemia (AML) has improved significantly over the past 30 years, with complete remission and overall survival rates exceeding 90 and 60%, respectively, in recent clinical trials. However, these improvements have not been achieved by the introduction of new agents. Instead, intensification of standard chemotherapy, more precise risk classification, improvements in supportive care, and the use of minimal residual disease to monitor response to therapy have all contributed to this success. Nevertheless, novel therapies are needed, as the cure rates for many subtypes of childhood AML remain unacceptably low. Here, we briefly review advances in our understanding of the biology and genetics of AML, the results of recent clinical trials, and current recommendations for the treatment of children with AML.
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Affiliation(s)
- Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA. .,Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA.
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31
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Surgery as a Recurrent Trigger for Immune Thrombocytopenia (ITP) in a Patient Cured of M7 Acute Myelogenous Leukemia. J Pediatr Hematol Oncol 2016; 38:e257-9. [PMID: 26907654 DOI: 10.1097/mph.0000000000000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We report the case of a 10-year-old boy, 8 years post-M7 acute myeloid leukemia with a history of significant thrombocytopenia and bleeding, requiring treatment, after 2 surgical procedures performed under general anesthesia. In both instances, the thrombocytopenia and bleeding responded to intravenous immunoglobulin treatment. Between surgeries, the platelet counts were normal. Before a third surgical procedure, he was successfully pretreated with dexamethasone and experienced no bleeding or thrombocytopenia after the operation. This case highlights the potential utility of corticosteroid pretreatment in patients with a history of immune thrombocytopenia before surgical procedures under general anesthesia.
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32
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Bhatnagar N, Nizery L, Tunstall O, Vyas P, Roberts I. Transient Abnormal Myelopoiesis and AML in Down Syndrome: an Update. Curr Hematol Malig Rep 2016; 11:333-41. [PMID: 27510823 PMCID: PMC5031718 DOI: 10.1007/s11899-016-0338-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Children with constitutional trisomy 21 (Down syndrome (DS)) have a unique predisposition to develop myeloid leukaemia of Down syndrome (ML-DS). This disorder is preceded by a transient neonatal preleukaemic syndrome, transient abnormal myelopoiesis (TAM). TAM and ML-DS are caused by co-operation between trisomy 21, which itself perturbs fetal haematopoiesis and acquired mutations in the key haematopoietic transcription factor gene GATA1. These mutations are found in almost one third of DS neonates and are frequently clinically and haematologcially 'silent'. While the majority of cases of TAM undergo spontaneous remission, ∼10 % will progress to ML-DS by acquiring transforming mutations in additional oncogenes. Recent advances in the unique biological, cytogenetic and molecular characteristics of TAM and ML-DS are reviewed here.
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Affiliation(s)
- Neha Bhatnagar
- Children’s Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU UK
| | - Laure Nizery
- Paediatric Intensive Care Unit, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France
| | - Oliver Tunstall
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin St, Bristol, BS2 8B UK
| | - Paresh Vyas
- Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DS UK
| | - Irene Roberts
- Department of Paediatrics, Children’s Hospital, University of Oxford, John Radcliffe Hospital, OX3 9DU Oxford, UK
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33
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Scheer C, Kratz C, Witt O, Creutzig U, Reinhardt D, Klusmann JH. Hematologic Response to Vorinostat Treatment in Relapsed Myeloid Leukemia of Down Syndrome. Pediatr Blood Cancer 2016; 63:1677-9. [PMID: 27191354 DOI: 10.1002/pbc.26062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/14/2016] [Accepted: 04/21/2016] [Indexed: 01/21/2023]
Abstract
Children with Down syndrome are at high risk to develop myeloid leukemia (ML-DS). Despite their excellent prognosis, children with ML-DS particularly suffer from severe therapy-related toxicities and for relapsed ML-DS the cure rates are very poor. Here we report the clinical course of one child with ML-DS treated with the histone deacetylase (HDAC) inhibitor vorinostat (suberoylanilide hydroxamic acid) after second relapse. The child had previously received conventional chemotherapy and stem cell transplantation, yet showed a remarkable clinical and hematologic response. Thus, HDAC inhibitor may represent an effective class of drugs for the treatment of ML-DS.
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Affiliation(s)
- Carina Scheer
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Christian Kratz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Olaf Witt
- Pediatric Oncology, German Cancer Research Center (DKFZ), University Hospital and National Center for Tumor Diseases, Heidelberg, Germany
| | - Ursula Creutzig
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Dirk Reinhardt
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - Jan-Henning Klusmann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
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34
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Abstract
BACKGROUND Children with Down syndrome (DS) are at higher risk of developing acute leukemia. Treatment continues to evolve as we accumulate better understanding of the distinctive clinical and biological features of acute leukemia in DS patients. PROCEDURE A retrospective review of the clinical features, treatment outcomes, and survival of DS children with acute leukemia in Hong Kong from 1993 to 2013 was conducted. Patients were identified from the registry of the Hong Kong Pediatric Hematology and Oncology study group. RESULTS This cohort included a total of 29 patients with DS. Ten were diagnosed with acute lymphoblastic leukemia and 19 had acute myeloid leukemia (AML). The mean follow-up duration was 8.3 years (range, 0.6 mo to 18.1 y). The 5-year overall survival and event-free survival for DS-acute lymphoblastic leukemia and DS-AML were 65.6%, 54.9%, 89.5%, and 89.5%, respectively. CONCLUSIONS The clinical characteristics and treatment outcomes of DS patients with acute leukemia in Hong Kong were comparable with results from other international study groups. Patients with DS-AML had a better prognosis.
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35
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Taga T, Watanabe T, Tomizawa D, Kudo K, Terui K, Moritake H, Kinoshita A, Iwamoto S, Nakayama H, Takahashi H, Shimada A, Taki T, Toki T, Ito E, Goto H, Koh K, Saito AM, Horibe K, Nakahata T, Tawa A, Adachi S. Preserved High Probability of Overall Survival with Significant Reduction of Chemotherapy for Myeloid Leukemia in Down Syndrome: A Nationwide Prospective Study in Japan. Pediatr Blood Cancer 2016; 63:248-54. [PMID: 26481183 DOI: 10.1002/pbc.25789] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND On the basis of results of previous Japanese trials for myeloid leukemia in Down syndrome (ML-DS), the efficacy of risk-oriented therapy was evaluated in the Japanese Pediatric Leukemia/Lymphoma Study Group AML-D05 study. PROCEDURE All patients received induction chemotherapy that consisted of pirarubicin, intermediate-dose cytarabine, and etoposide. Patients who achieved complete remission (CR) after initial induction therapy were stratified to the standard risk (SR) group and received four courses of reduced-dose intensification therapy. Patients who did not achieve CR were stratified to the high risk (HR) group and received intensified therapy that consisted of continuous or high-dose cytarabine. RESULTS A total of 72 patients were eligible and evaluated. One patient died of sepsis during initial induction therapy. Sixty-nine patients were stratified to SR and two patients to HR. No therapy-related deaths were observed during intensification therapy. The 3-year event-free and overall survival rates were 83.3% ± 4.4% and 87.5% ± 3.9%, respectively. Age at diagnosis less than 2 years was a significant favorable prognostic factor for risk of relapse (P = 0.009). CONCLUSIONS The attempt of risk-oriented prospective study for ML-DS was unsuccessful, but despite the dose reduction of chemotherapeutic agents, the overall outcome was good, and further dose reduction might be possible for specific subgroups.
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Affiliation(s)
- Takashi Taga
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Tomoyuki Watanabe
- Department of Nutritional Science, Faculty of Psychological and Physical Science, Aichi Gakuin University, Nisshin, Japan
| | - Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Kiminori Terui
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroshi Moritake
- Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akitoshi Kinoshita
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shotaro Iwamoto
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideki Nakayama
- Department of Pediatrics, National Hospital Organization, Fukuoka-Higashi Medical Center, Fukuoka, Japan
| | | | - Akira Shimada
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Tomohiko Taki
- Department of Molecular Diagnostics and Therapeutics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Toki
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Etsuro Ito
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroaki Goto
- Division of Hemato-Oncology and Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Akiko M Saito
- Laboratory of Clinical, Epidemiological and Health Services Research, Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Aichi, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Tatsutoshi Nakahata
- Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - Akio Tawa
- Department of Pediatrics, National Hospital Organization, Osaka Medical Center, Osaka, Japan
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36
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Long-term outcome for Down syndrome patients with hematopoietic disorders. J Formos Med Assoc 2016; 115:94-9. [DOI: 10.1016/j.jfma.2015.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/04/2015] [Accepted: 01/22/2015] [Indexed: 11/22/2022] Open
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Taga T, Tomizawa D, Takahashi H, Adachi S. Acute myeloid leukemia in children: Current status and future directions. Pediatr Int 2016; 58:71-80. [PMID: 26645706 DOI: 10.1111/ped.12865] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/05/2015] [Accepted: 10/22/2015] [Indexed: 01/17/2023]
Abstract
Acute myeloid leukemia (AML) accounts for 25% of pediatric leukemia and affects approximately 180 patients annually in Japan. The treatment outcome for pediatric AML has improved through advances in chemotherapy, hematopoietic stem cell transplantation (HSCT), supportive care, and optimal risk stratification. Currently, clinical pediatric AML studies are conducted separately according to the AML subtypes: de novo AML, acute promyelocytic leukemia (APL), and myeloid leukemia with Down syndrome (ML-DS). Children with de novo AML are treated mainly with anthracyclines and cytarabine, in some cases with HSCT, and the overall survival (OS) rate now approaches 70%. Children with APL are treated with an all-trans retinoic acid (ATRA)-combined regimen with an 80-90% OS. Children with ML-DS are treated with a less intensive regimen compared with non-DS patients, and the OS is approximately 80%. HSCT in first remission is restricted to children with high-risk de novo AML only. To further improve outcomes, it will be necessary to combine more accurate risk stratification strategies using molecular genetic analysis with assessment of minimum residual disease, and the introduction of new drugs in international collaborative clinical trials.
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Affiliation(s)
- Takashi Taga
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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38
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Hefti E, Blanco JG. Anthracycline-Related Cardiotoxicity in Patients with Acute Myeloid Leukemia and Down Syndrome: A Literature Review. Cardiovasc Toxicol 2016; 16:5-13. [PMID: 25616318 PMCID: PMC4514565 DOI: 10.1007/s12012-015-9307-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric patients with Down syndrome (DS) are at an increased risk of developing certain cancers. Specifically, patients with DS have a reported 10-20-fold increased risk of developing acute myeloid leukemia (AML). Anthracycline-based treatment regimens achieve good results in patients with DS and AML. It has been proposed that DS status constitutes a risk factor for the cardiotoxicity associated with the use of anthracyclines in the pediatric setting. However, published evidence pointing toward an increased risk of cardiotoxicity in patients with DS is relatively scarce and conflictive. This concise review compiles literature relating to the incidence of anthracycline-related cardiotoxicity in pediatric patients with DS. In general, reports from trials using anthracyclines at the maximum recommended dose showed increases in the incidence of anthracycline-related cardiotoxicity in patients with DS in comparison with trials that used anthracyclines at reduced doses. Evidence from the literature suggests that patients with DS can achieve favorable therapeutic outcomes after receiving treatment with reduced doses of anthracyclines to minimize the potential for cardiotoxicity. Further prospective trials, along with the available evidence, would assist the design of treatment protocols for patients with pediatric leukemias and DS.
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Affiliation(s)
- Erik Hefti
- Department of Pharmaceutical Sciences, The School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, 470 Kapoor Hall, Buffalo, NY, 14214, USA
| | - Javier G Blanco
- Department of Pharmaceutical Sciences, The School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, 470 Kapoor Hall, Buffalo, NY, 14214, USA.
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39
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Acute myeloid leukemia in children and adolescents: identification of new molecular targets brings promise of new therapies. Hematology 2015; 2015:507-13. [DOI: 10.1182/asheducation-2015.1.507] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Recent reports of recurrent mutations in childhood acute myeloid leukemia (AML) have identified potential targets for new therapeutic strategies. Acute promyelocytic leukemia (APL) is characterized commonly by a fusion between the PML gene and the RARA gene, genes targetable by arsenic (ATO) and retinoic acid (ATRA), respectively. A mutation in GATA1, common in AML of Down syndrome (ML-DS), renders cells more susceptible to cytarabine and anthracyclines, thus permitting targeted dose reductions to preserve high survival rates while reducing toxicity. In all other patients, Ras pathway mutations, KMT2A and other methyltransferase mutations, FLT3 mutations, and KIT mutations are all relatively common in childhood AML and all are potentially “druggable”. The focus of this review is on those therapies likely to be clinically available in the near future. The preclinical and clinical data providing a rationale for testing in children of specific agents in children is discussed. Whether the expression of a potential target is sufficient to predict response to a targeted therapy is an open question in childhood AML. Development of clinical trials to evaluate targeted therapies in small molecularly defined subsets of AML will be the next great challenge for all cooperative groups in North America and Europe.
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40
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Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, De Bont ESJM, De Moerloose B, Dworzak M, Gibson BES, Hasle H, Leverger G, Locatelli F, Ragu C, Ribeiro RC, Rizzari C, Rubnitz JE, Smith OP, Sung L, Tomizawa D, van den Heuvel-Eibrink MM, Creutzig U, Kaspers GJL. Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia. J Clin Oncol 2015; 33:2949-62. [PMID: 26304895 DOI: 10.1200/jco.2015.62.8289] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Diagnosis, treatment, response monitoring, and outcome of pediatric acute myeloid leukemia (AML) have made enormous progress during the past decades. Because AML is a rare type of childhood cancer, with an incidence of approximately seven occurrences per 1 million children annually, national and international collaborative efforts have evolved. This overview describes these efforts and includes a summary of the history and contributions of each of the main collaborative pediatric AML groups worldwide. The focus is on translational and clinical research, which includes past, current, and future clinical trials. Separate sections concern acute promyelocytic leukemia, myeloid leukemia of Down syndrome, and relapsed AML. A plethora of novel antileukemic agents that have emerged, including new classes of drugs, are summarized as well. Finally, an important aspect of the treatment of pediatric AML--supportive care--and late effects are discussed. The future is bright, with a wide range of emerging innovative therapies and with more and more international collaboration that ultimately aim to cure all children with AML, with fewer adverse effects and without late effects.
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Affiliation(s)
- C Michel Zwaan
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Edward A Kolb
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Dirk Reinhardt
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jonas Abrahamsson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Souichi Adachi
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Richard Aplenc
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Eveline S J M De Bont
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Barbara De Moerloose
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Michael Dworzak
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Brenda E S Gibson
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Henrik Hasle
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Guy Leverger
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Franco Locatelli
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Christine Ragu
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Raul C Ribeiro
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Carmelo Rizzari
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Jeffrey E Rubnitz
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Owen P Smith
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Lillian Sung
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Daisuke Tomizawa
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Marry M van den Heuvel-Eibrink
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Ursula Creutzig
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
| | - Gertjan J L Kaspers
- C. Michel Zwaan, Marry M. van den Heuvel-Eibrink, Sophia Children's Hospital/Erasmus MC, Rotterdam; C. Michel Zwaan, International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) New Agents Committee; C. Michel Zwaan, Innovative Therapies for Children With Cancer Consortium; C. Michel Zwaan, Eveline S.J.M. De Bont, Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Dutch Childhood Oncology Group, Den Haag; Eveline S.J.M. De Bont, University of Groningen, University Medical Center Groningen, Groningen; Marry M. van den Heuvel-Eibrink, Gertjan J.L. Kaspers, Princess Máxima Center for Pediatric Oncology, Utrecht; Gertjan J.L. Kaspers, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Edward A. Kolb, Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE; Edward A. Kolb, Richard Aplenc, Lilian Sung, Children's Oncology Group, Monrovia, CA; Dirk Reinhardt, Universitäts-Klinikum, Essen; Ursula Creutzig, Hannover Medical School, Hannover; Dirk Reinhardt, Michael Dworzak, Henrik Hasle, Ursula Creutzig, Gertjan J.L. Kaspers, I-BFM Acute Myeloid Leukemia (AML) Study Group, Kiel, Germany; Jonas Abrahamsson, Sahlgrenska University Hospital, Goteborg; Jonas Abrahamsson and Henrik Hasle, Nordic Society for Pediatric Hematology and Oncology, Stockholm, Sweden; Souichi Adachi, Kyoto University, Kyoto; Souichi Adachi, Daisuke Tomizawa, The Japanese Pediatric Leukemia/Lymphoma Study Group, Nagoya; Daisuke Tomizawa, National Center for Child Health and Development, Tokyo, Japan; Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PA; Barbara De Moerloose, Ghent University Hospital and Belgian Society of Paediatric Haematology Oncology, Ghent, Belgium; Michael Dworzak, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria; Brenda E.S. Gibson, Royal Hospital for Sick Children, Glasgow; Brenda E.S. Gibson and Owen Smith, Children's Cancer and Leukemia Study Group, London, United King
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Mateos MK, Barbaric D, Byatt SA, Sutton R, Marshall GM. Down syndrome and leukemia: insights into leukemogenesis and translational targets. Transl Pediatr 2015; 4:76-92. [PMID: 26835364 PMCID: PMC4729084 DOI: 10.3978/j.issn.2224-4336.2015.03.03] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Children with Down syndrome (DS) have a significantly increased risk of childhood leukemia, in particular acute megakaryoblastic leukemia (AMKL) and acute lymphoblastic leukemia (DS-ALL). A pre-leukemia, called transient myeloproliferative disorder (TMD), characterised by a GATA binding protein 1 (GATA1) mutation, affects up to 30% of newborns with DS. In most cases, the pre-leukemia regresses spontaneously, however one-quarter of these children will go on to develop AMKL or myelodysplastic syndrome (MDS) . AMKL and MDS occurring in young children with DS and a GATA1 somatic mutation are collectively termed myeloid leukemia of Down syndrome (ML-DS). This model represents an important multi-step process of leukemogenesis, and further study is required to identify therapeutic targets to potentially prevent development of leukemia. DS-ALL is a high-risk leukemia and mutations in the JAK-STAT pathway are frequently observed. JAK inhibitors may improve outcome for this type of leukemia. Genetic and epigenetic studies have revealed likely candidate drivers involved in development of ML-DS and DS-ALL. Overall this review aims to identify potential impacts of new research on how we manage children with DS, pre-leukemia and leukemia.
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Affiliation(s)
- Marion K Mateos
- 1 Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia ; 2 School of Women's and Children's Health, University of New South Wales, Kensington, Australia ; 3 Children's Cancer Institute Australia, University of New South Wales, Lowy Cancer Centre, Randwick, Australia
| | - Draga Barbaric
- 1 Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia ; 2 School of Women's and Children's Health, University of New South Wales, Kensington, Australia ; 3 Children's Cancer Institute Australia, University of New South Wales, Lowy Cancer Centre, Randwick, Australia
| | - Sally-Anne Byatt
- 1 Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia ; 2 School of Women's and Children's Health, University of New South Wales, Kensington, Australia ; 3 Children's Cancer Institute Australia, University of New South Wales, Lowy Cancer Centre, Randwick, Australia
| | - Rosemary Sutton
- 1 Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia ; 2 School of Women's and Children's Health, University of New South Wales, Kensington, Australia ; 3 Children's Cancer Institute Australia, University of New South Wales, Lowy Cancer Centre, Randwick, Australia
| | - Glenn M Marshall
- 1 Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia ; 2 School of Women's and Children's Health, University of New South Wales, Kensington, Australia ; 3 Children's Cancer Institute Australia, University of New South Wales, Lowy Cancer Centre, Randwick, Australia
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Abstract
Children with Down syndrome (DS) and acute leukemias acute have unique biological, cytogenetic, and intrinsic factors that affect their treatment and outcome. Myeloid leukemia of Down syndrome (ML-DS) is associated with high event-free survival (EFS) rates and frequently preceded by a preleukemia condition, the transient abnormal hematopoiesis (TAM) present at birth. For acute lymphoblastic leukemia (ALL), their EFS and overall survival are poorer than non-DS ALL, it is important to enroll them on therapeutic trials, including relapse trials; investigate new agents that could potentially improve their leukemia-free survival; and strive to maximize the supportive care these patients need.
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Affiliation(s)
- Kelly W Maloney
- Center for Cancer & Blood Disorders, Children's Hospital Colorado, 13123 East 16th Avenue, B115, Aurora, CO 80045, USA
| | - Jeffrey W Taub
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
| | - Yaddanapudi Ravindranath
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Irene Roberts
- Department of Paediatrics and Molecular Haematology Unit, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, OX3 9DS, UK
| | - Paresh Vyas
- MRC Molecular Haematology Unit, Department of Haematology, Weatherall Institute of Molecular Medicine, Oxford University Hospitals NHS Trust, University of Oxford, Oxford OX3 9DS, UK
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43
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Goto H, Kaneko T, Shioda Y, Kajiwara M, Sakashita K, Kitoh T, Hayakawa A, Miki M, Kato K, Ogawa A, Hashii Y, Inukai T, Kato C, Sakamaki H, Yabe H, Suzuki R, Kato K. Hematopoietic stem cell transplantation for patients with acute lymphoblastic leukemia and Down syndrome. Pediatr Blood Cancer 2015; 62:148-52. [PMID: 25262825 DOI: 10.1002/pbc.25245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/11/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is one curable option for high-risk acute lymphoblastic leukemia (ALL); however, transplant-related toxicities might be severe in patients with Down syndrome and ALL (DS-ALL). PROCEDURE HSCTs performed in patients with DS-ALL were identified in the Japan Society for Hematopoietic Cell Transplantation registry. RESULTS In the registry data, 11 patients with DS-ALL were identified. The median age at HSCT was 9 years (range: 6-22 years). Six patients underwent HSCT at non-remission status. Allogeneic grafts were utilized in all patients, including eight patients who received HSCT from unrelated donors. Reduced intensity conditioning regimens were used in three patients. All patients achieved neutrophil engraftment by a median of day 18 (range: day 11-61). Ten patients experienced grade 3 or more infectious episodes. Six patients experienced complications of the respiratory system. The incidences of II-IV or III-IV acute GVHD were nine (81.8%) or seven patients (63.6%), respectively. Chronic GVHD was observed in five (55.6%) out of nine evaluable patients. Seven patients died at a median of 6 months (range: 0-24 months) after HSCT. Two-year relapse-free and overall survival were 33.3% (95% CI: 2.5-64.1%) or 37.5% (95% CI: 5.9-69.1%), respectively. The causes of death were relapse (n = 2), infection (n = 2), bleeding (n = 1), thrombotic microangiopathy (n = 1), and chronic GVHD (n = 1). CONCLUSIONS Therapy-related mortality accounted for five out of seven deceased patients in this case series. Attempts to reduce toxicities should be considered in HSCT for patients with DS-ALL.
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Affiliation(s)
- Hiroaki Goto
- Division of Hemato-Oncology and Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
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Caldwell JT, Ge Y, Taub JW. Prognosis and management of acute myeloid leukemia in patients with Down syndrome. Expert Rev Hematol 2014; 7:831-40. [PMID: 25231553 DOI: 10.1586/17474086.2014.959923] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Children with Down syndrome (DS) are at a substantially increased risk to develop acute myeloid leukemia (AML). This increase in incidence is tempered, however, by favorable overall survival rates of approximately 80%, whereas survival for non-DS children with similar leukemic subtypes is <35%. In this review, the clinical studies that have contributed to this overall high survival will be presented and their individual successes will be discussed. Important issues including intensity of treatment regimens, the role of bone marrow transplants and prognostic indicators will be reviewed. In particular, the roles of high- vs low- vs very low-dose cytarabine will be discussed, as well as potential therapeutic options in the future and the direction of the field over the next 5 years. In summary, children with DS and AML should be treated with a moderate-intensity cytarabine-based regimen with curative intent.
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Affiliation(s)
- J Timothy Caldwell
- MD/PhD Program, Wayne State University School of Medicine, 110 East Warren Ave, Detroit, MI 48201, USA
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45
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Schifferli A, Hitzler J, Bartholdi D, Heinimann K, Hoeller S, Diesch T, Kühne T. Transient myeloproliferative disorder in neonates without Down syndrome: case report and review. Eur J Haematol 2014; 94:456-62. [DOI: 10.1111/ejh.12382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Alexandra Schifferli
- Department of haematology/oncology; University Children's Hospital Basel; Basel Switzerland
| | - Johann Hitzler
- Department of haematology/oncology; The Hospital for Sick Children; Toronto Canada
| | | | - Karl Heinimann
- Department of genetic; University Hospital Basel; Basel Switzerland
| | - Sylvia Hoeller
- Department of pathology; University Hospital Basel; Basel Switzerland
| | - Tamara Diesch
- Department of haematology/oncology; University Children's Hospital Basel; Basel Switzerland
| | - Thomas Kühne
- Department of haematology/oncology; University Children's Hospital Basel; Basel Switzerland
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Faulk K, Gore L, Cooper T. Overview of therapy and strategies for optimizing outcomes in de novo pediatric acute myeloid leukemia. Paediatr Drugs 2014; 16:213-27. [PMID: 24639021 DOI: 10.1007/s40272-014-0067-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although acute myelogenous leukemia (AML) accounts for <20 % of leukemia in children, it is responsible for over half of all pediatric leukemia deaths. Improvement in event-free survival rates, now over 50 %, are due largely to intensification of chemotherapy, aggressive supportive care, development of risk stratification based on cytogenetic and molecular markers, and improved salvage regimens. Despite this improvement over the past few decades, the survival rates have recently plateaued, and further improvement will need to take into account advances in molecular characterization of AML, development of novel agents, and better understanding of host factors influencing toxicity and response to chemotherapy. This article reviews the epidemiology and biology trends in diagnosis and treatment of pediatric acute myelogenous leukemia.
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Affiliation(s)
- Kelly Faulk
- Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora, CO, USA
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47
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Abstract
Four out of five children diagnosed with cancer can be cured with contemporary cancer therapy. This represents a dramatic improvement since 50 years ago when the cure rate of childhood cancer was <25% in the pre-chemotherapy era. Over the past ten years, while improvement in overall survival (OS) has been marginal, progress in pediatric oncology lies with adopting risk-adapted therapeutic approach. This has been made possible through identifying clinical and biologic prognostic factors with rigorous research and stratifying patients using these risk factors, and subsequently modifying therapy according to risk group assignment. This review provides a perspective for eight distinct pediatric malignancies, in which significant advances in treatment were made in the last decade and are leading to changes in standard of care. This includes four hematologic malignancies [acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL)] and four solid tumors [medulloblastoma (MB), low grade glioma (LGG), neuroblastoma (NB) and Ewing sarcoma (ES)]. Together, they comprise 60% of childhood cancer. Improved patient outcome is not limited to better survival, but encompasses reducing both short and long-term treatment-related complications which is as important as cure, given the majority of childhood cancer patients will become long-term survivors. Risk-adapted approach allows treatment intensification in the high-risk cohort while therapy can be de-escalated in the low-risk to minimize toxicity and late sequelae without compromising survival. Advances in medical research technology have also led to a rapid increase in the understanding of the genetics of childhood cancer in the last decade, facilitating identification of molecular targets that can potentially be exploited for therapeutic benefits. As we move into the era of targeted therapeutics, searching for novel agents that target specific genetic lesions becomes a major research focus. We provide an overview of seven novel agents (bevacizumab, bortezomib, vorinostat, sorafenib, tipifarnib, erlotinib and mTOR inhibitors), which have been most frequently pursued in childhood cancers in the last decade, as well as reporting the progress of clinical trials involving these agents.
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Affiliation(s)
- Federica Saletta
- 1 Children's Cancer Research Unit, Kid's Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michaela S Seng
- 1 Children's Cancer Research Unit, Kid's Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Loretta M S Lau
- 1 Children's Cancer Research Unit, Kid's Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 2 Oncology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia ; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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48
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Development of acute megakaryoblastic leukemia in Down syndrome is associated with sequential epigenetic changes. Blood 2013; 122:e33-43. [PMID: 23980066 DOI: 10.1182/blood-2013-05-503011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acute megakaryoblastic leukemia (AMKL) is more frequently observed in Down syndrome (DS) patients, in whom it is often preceded by a transient myeloproliferative disorder (TMD). The development of DS-TMD and DS-AMKL requires not only the presence of the trisomy 21 but also that of GATA1 mutations. Despite extensive studies into the genetics of DS-AMKL, the importance of epigenetic deregulation in this disease has been unexplored. We performed DNA methylation profiling at different stages of development of DS-AMKL and analyzed the dynamics of the epigenetic program. Early genome-wide DNA methylation changes can be detected in trisomy 21 fetal liver mononuclear cells, prior to the acquisition of GATA1 mutations. These early changes are characterized by marked loss of DNA methylation at genes associated with developmental disorders, including those affecting the cardiovascular, neurological, and endocrine systems. This is followed by a second wave of changes detected in DS-TMD and DS-AMKL, characterized by gains of methylation. This new wave of hypermethylation targets a distinct set of genes involved in hematopoiesis and regulation of cell growth and proliferation. These findings indicate that the final epigenetic landscape of DS-AMKL is the result of sequential and opposing changes in DNA methylation occurring at specific times in the disease development.
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49
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Krause DS, Crispino JD. Molecular pathways: induction of polyploidy as a novel differentiation therapy for leukemia. Clin Cancer Res 2013; 19:6084-8. [PMID: 23963861 DOI: 10.1158/1078-0432.ccr-12-2604] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Differentiation therapy has emerged as a powerful way to target specific hematologic malignancies. One of the best examples is the use of all-trans retinoic acid (ATRA) in acute promyelocytic leukemia (APL), which has significantly improved the outcome for patients with this specific form of acute myeloid leukemia (AML). In considering how differentiation therapy could be used in other forms of AML, we predicted that compounds that induce terminal differentiation of megakaryocytes would be effective therapies for the megakaryocytic form of AML, named acute megakaryocytic leukemia (AMKL). We also speculated that such agents would reduce the burden of abnormal hematopoietic cells in primary myelofibrosis and alter the differentiation of megakaryocytes in myelodysplastic syndromes. Using a high-throughput chemical screening approach, we identified small molecules that promoted many features of terminal megakaryocyte differentiation, including the induction of polyploidization, the process by which cells accumulate DNA to 32N or greater. As the induction of polyploidization is an irreversible process, cells that enter this form of the cell cycle do not divide again. Thus, this would be an effective way to reduce the tumor burden. Clinical studies with polyploidy inducers, such as aurora kinase A inhibitors, are under way for a wide variety of malignancies, whereas trials specifically for AMKL and PMF are in development. This novel form of differentiation therapy may be clinically available in the not-too-distant future. Clin Cancer Res; 19(22); 6084-8. ©2013 AACR.
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Affiliation(s)
- Diane S Krause
- Authors' Affiliations: Department of Laboratory Medicine, Yale Stem Cell Center, Yale University, New Haven, Connecticut; and Division of Hematology/Oncology, Northwestern University, Chicago, Illinois
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50
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Gamis AS, Alonzo TA, Perentesis JP, Meshinchi S. Children's Oncology Group's 2013 blueprint for research: acute myeloid leukemia. Pediatr Blood Cancer 2013; 60:964-71. [PMID: 23255301 PMCID: PMC4605815 DOI: 10.1002/pbc.24432] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/11/2012] [Indexed: 01/23/2023]
Abstract
For the 365 children diagnosed with acute myeloid leukemia in the US annually, 5-year survival for patients on COG trials with low, intermediate, and high risk disease is 83%, 62%, and 23%, respectively. Recent advances include improved therapeutic stratification, improved survival with dose intensification, and further elucidation of the heterogeneity specific to childhood AML. These discoveries now guide current strategy incorporating targeted agents to pathways specific to childhood AML as well as evaluating methods to increase the sensitivity of the leukemic stem cell, first in Phase II feasibility trials followed by Phase III efficacy trials of the most promising agents. Acute myeloid leukemia in children, though with similar subgroups to adults, remains uniquely different based upon quite different prevalence of subtypes as well as overall response to therapy. The Children's Oncology Group's research agenda builds upon earlier efforts to better elucidate the leukemogenic steps distinct to childhood AML in order to more scientifically develop and test novel therapeutic approaches to the treatment and ultimate cure for children with this disorder. Pediatr Blood Cancer 2013; 60: 964-971. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Alan S. Gamis
- Children's Mercy Hospitals & Clinics, Kansas City, Missouri,Correspondence to: Dr. Alan S. Gamis, MD, MPH, Division of Hematology/Oncology/Bone Marrow Transplantation, Children's Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO 64108.
| | - Todd A. Alonzo
- University of Southern California, Los Angeles, California
| | | | - Soheil Meshinchi
- Fred Hutchinson Comprehensive Cancer Research Center, Seattle, Washington
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