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Cui J, Chen X, Li C, Yan Q, Yuan G. Reduced duration and dosage of venetoclax is efficient in newly diagnosed patients with acute myeloid leukemia. Hematology 2024; 29:2293512. [PMID: 38095287 DOI: 10.1080/16078454.2023.2293512] [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: 06/27/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The combination of Venetoclax (VEN) and Azacitidine (AZA) increases survival outcomes and yields excellent responses in patients with acute myeloid leukemia (AML). However, dose reduction (or discontinuation) is commonly encountered due to therapy-related toxicity. Thus, this study aimed to investigate the efficiency and safety of a lower dosage of venetoclax for the treatment of AML. METHODS This observational study analyzed the characteristics and outcomes of newly diagnosed AML patients who received 100 mg VEN combined with AZA for 14 days at our institution. RESULTS A total of 36 patients were enrolled, and the median age at diagnosis was 64 years. After a median follow-up of 15 (range 4-29) months, the median overall survival (OS) and progression-free survival (PFS) for the whole cohort were 17 (4-29) months and 12 (1-28) months, respectively. Meanwhile, the overall response rate (ORR) was 69.4%, and the CRc rate was 66.7% in the whole cohort. Subgroup analysis revealed that NPM1 mutations and FAB-M5 subtype were associated with higher response rates, whereas the adverse ELN risk group was predictive of an inferior response. Moreover, ASXL1, NPM1, and IDH1/2 mutations negatively impacted PFS. DISCUSSION Our study optimized the administration of venetoclax plus azacytidine for the treatment of AML patients. Response rates were favorable, with median survival in agreement with the findings of earlier reports, offering valuable insights for optimizing VEN-based regimens. CONCLUSION In summary, the VEN combination regimen is effective for the treatment of newly diagnosed AML patients in the real world despite VEN dose reductions .
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Affiliation(s)
- Jingying Cui
- School of Medicine, Wuhan University of Science and Technology, Wuhan, People's Republic of China
- Department of Hematology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Xuexing Chen
- Department of Hematology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Chunfang Li
- Department of Hematology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Qiong Yan
- Department of Hematology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
| | - Guolin Yuan
- Department of Hematology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China
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2
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Ucciero A, Traversa G, Pisterna A, Cardinali V, Sciabolacci S, Poloni A, Capelli D, Gaidano G, Patriarca A, Lunghi M. Prescription patterns of venetoclax in acute myeloid leukemia. Hematol Oncol 2024; 42:e3298. [PMID: 38989910 DOI: 10.1002/hon.3298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Andrealuna Ucciero
- University Hospital Maggiore della Carità-Hospital Pharmacy, Novara, Italy
| | | | - Alessia Pisterna
- University Hospital Maggiore della Carità-Hospital Pharmacy, Novara, Italy
| | - Valeria Cardinali
- University of Perugia and AOU Santa Maria della Misericordia-Institute of Hematology and Oncology-Hematology Research Center, Perugia, Italy
| | - Sofia Sciabolacci
- University of Perugia and AOU Santa Maria della Misericordia-Institute of Hematology and Oncology-Hematology Research Center, Perugia, Italy
| | - Antonella Poloni
- Hematology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche and United Hospitals of Ancona, Ancona, Italy
| | - Debora Capelli
- Hematology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche and United Hospitals of Ancona, Ancona, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Monia Lunghi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
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3
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Boisclair S, Zhou E, Naing P, Thakur R, Jou E, Goldberg B, Gladstone DE, Allen SL, Kolitz JE, Chitty DW. Less is more: An analysis of venetoclax and hypomethylating agent post-induction treatment modifications in AML. Leuk Res 2024; 143:107545. [PMID: 38963990 DOI: 10.1016/j.leukres.2024.107545] [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: 05/01/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
Venetoclax (Ven) combined with a hypomethylating agent (HMA) enhances survival in elderly/unfit acute myeloid leukemia (AML) patients, yet often necessitates regimen modifications due to intolerance. However, it is unclear how these modifications affect patient outcome. This retrospective cohort study evaluates the impact of post-induction HMA/Ven regimen modifications on disease progression and survival. This study reviewed 142 AML patients treated with HMA/Ven within the Northwell Health System from January 2019 to December 2022. To assess the impact of post-induction regimen modifications, patients were grouped according to median days between cycles (≤34 or ≥35 days cycle intervals) and median Ven days per cycle (≤14 or ≥15 days/cycle) based on only cycle 3 and beyond. Kaplan-Meier and Cox proportional hazard regression analyses were employed for univariate and multivariate assessments, respectively. There was no significant difference in median progression-free survival (mPFS)(11.6 vs 11.8 months, p = 0.73) or median overall survival (mOS)(15.1 vs 21.8 months, p = 0.16) between cycle interval groups. However, there was a clinically and statistically significant advantage in mPFS (15.8 vs 8.7 months, p = 0.01) and mOS (24.7 vs 11.3 months, p = 0.006) for patients with a median of ≤14 Ven days/cycle compared to ≥15 Ven days/cycle. Multivariate analysis demonstrated that ≤14 days of Ven for cycle 3 and beyond was an independent predictor of decreased mortality (HR 0.18, CI 0.07-0.48, p = 0.0007). Extended cycle intervals did not adversely affect mortality while reduced Ven duration per cycle post-induction was associated with improved survival in elderly AML patients.
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Affiliation(s)
- Stephanie Boisclair
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States.
| | - Edward Zhou
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - Phyu Naing
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - Richa Thakur
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - Erin Jou
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - Bradley Goldberg
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - Douglas E Gladstone
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - Steven L Allen
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - Jonathan E Kolitz
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
| | - David W Chitty
- Northwell, New Hyde Park, NY, United States; Northwell Health Cancer Institute, Lake Success, NY, United States; Zucker School of Medicine, Hempstead, NY, United States
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4
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Bono R, Sapienza G, Tringali S, Rotolo C, Patti C, Mulè A, Calafiore V, Santoro A, Castagna L. Allogeneic Stem Cell Transplantation in Refractory Acute Myeloid Leukaemia. Cells 2024; 13:755. [PMID: 38727291 PMCID: PMC11083056 DOI: 10.3390/cells13090755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Refractory acute myeloid leukaemia is very difficult to treat and represents an unmet clinical need. In recent years, new drugs and combinations of drugs have been tested in this category, with encouraging results. However, all treated patients relapsed and died from the disease. The only curative option is allogeneic transplantation through a graft from a healthy donor immune system. Using myeloablative conditioning regimens, the median overall survival regimens is 19%. Several so-called sequential induction chemotherapies followed by allogeneic transplantation conditioned by reduced intensity regimens have been developed, improving the overall survival to 25-57%. In the allogeneic transplantation field, continuous improvements in practices, particularly regarding graft versus host disease prevention, infection prevention, and treatment, have allowed us to observe improvements in survival rates. This is true mainly for patients in complete remission before transplantation and less so for refractory patients. However, full myeloablative regimens are toxic and carry a high risk of treatment-related mortality. In this review, we describe the results obtained with the different modalities used in more recent retrospective and prospective studies. Based on these findings, we speculate how allogeneic stem cell transplantation could be modified to maximise its therapeutic effect on refractory acute myeloid leukaemia.
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Affiliation(s)
- Roberto Bono
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Giuseppe Sapienza
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Stefania Tringali
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Cristina Rotolo
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Caterina Patti
- Onco-Hematology Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (C.P.); (A.M.); (V.C.)
| | - Antonino Mulè
- Onco-Hematology Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (C.P.); (A.M.); (V.C.)
| | - Valeria Calafiore
- Onco-Hematology Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (C.P.); (A.M.); (V.C.)
| | - Alessandra Santoro
- Onco-Hematology and Cell Manipulation Laboratory Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy;
| | - Luca Castagna
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
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5
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Angotzi F, Lessi F, Leoncin M, Filì C, Endri M, Lico A, Visentin A, Pravato S, Candoni A, Trentin L, Gurrieri C. Efficacy and safety of venetoclax plus hypomethylating agents in relapsed/refractory acute myeloid leukemia: a multicenter real-life experience. Front Oncol 2024; 14:1370405. [PMID: 38680863 PMCID: PMC11045980 DOI: 10.3389/fonc.2024.1370405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Venetoclax (VEN) has been shown to play a synergistic effect in combination with hypomethylating agents (HMAs) in the frontline treatment of acute myeloid leukemia (AML). However, the potential role of this therapy in the relapsed/refractory (R/R) AML setting, still needs to be further unveiled. The aim of the current study was to retrospectively outline the safety profile, response and survival outcomes of R/R AML patients treated with VEN in association with HMAs. Clinical, biological, and molecular data were collected from 57 patients with R/R AML treated with VEN combined with azacitidine or decitabine between 2018 and 2023. The median age of patients was 63 years, 38 (66.7%) received treatment for relapsed disease while 19 (33.3%) for refractory disease, 5 (8.7%) were treated for molecular relapse. A consistent proportion of the cohort was represented by patients with unfavorable prognostic factors such as complex karyotype (36.8%), secondary AML (29.8%), previous exposure to HMAs (38.6%), and relapse after allogeneic stem cell transplant (22.8%). A total of 14 patients achieved CR (24.6%), 3 (5.3%) CRi, 3 (5.3%) MLFS, and 3 (5.3%) PR, accounting for an ORR of 40.4%. The CR/CRi rate was higher in the group treated with azacitidine than in the group treated with decitabine (37.8% vs. 15%). The median OS was 8.2 months, reaching 20.1 months among responding patients. VEN-HMAs treatment allowed to bridge to allogeneic stem cell transplantation 11 (23.9%) of eligible patients, for which a median OS of 19.8 months was shown. On multivariate analysis, ECOG performance status ≥2, complex karyotype and not proceeding to allogeneic stem cell transplantation after therapy with VEN-HMAs were the factors independently associated with shorter OS. Patients treated with the azacitidine rather than the decitabine containing regimen generally displayed a trend toward superior outcomes. The major toxicities were prolonged neutropenia and infections. In conclusion, this study showed how VEN-HMAs could represent an effective salvage therapy in patients with R/R AML, even among some of those patients harboring dismal prognostic features, with a good toxicity profile. Further prospective studies are thus warranted.
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Affiliation(s)
- Francesco Angotzi
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Federica Lessi
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Matteo Leoncin
- Hematology Unit, Azienda Ulss3 Serenissima, Ospedale dell’Angelo, Venice, Italy
| | - Carla Filì
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Integrata Friuli Centrale (ASUFC), Udine, Italy
| | - Mauro Endri
- Hematology Section, Dipartimento di Medicina Specialistica, Ca’ Foncello Hospital, Treviso, Italy
| | - Albana Lico
- Hematology and Cell Therapy Division, San Bortolo Hospital, Vicenza, Italy
| | - Andrea Visentin
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Stefano Pravato
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Anna Candoni
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Integrata Friuli Centrale (ASUFC), Udine, Italy
| | - Livio Trentin
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Carmela Gurrieri
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
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6
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Zhao J, Wu S, Wang D, Edwards H, Thibodeau J, Kim S, Stemmer P, Wang G, Jin J, Savasan S, Taub JW, Ge Y. Panobinostat sensitizes AraC-resistant AML cells to the combination of azacitidine and venetoclax. Biochem Pharmacol 2024:116065. [PMID: 38373594 DOI: 10.1016/j.bcp.2024.116065] [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: 12/04/2023] [Revised: 01/22/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
The majority of acute myeloid leukemia (AML) patients respond to intensive induction therapy, consisting of cytarabine (AraC) and an anthracycline, though more than half experience relapse. Relapsed/refractory (R/R) AML patients are difficult to treat, and their clinical outcomes remain dismal. Venetoclax (VEN) in combination with azacitidine (AZA) has provided a promising treatment option for R/R AML, though the overall survival (OS) could be improved (OS ranges from 4.3 to 9.1 months). Overexpression of c-Myc is associated with chemoresistance in AML. Histone deacetylase (HDAC) inhibitors have been shown to suppress c-Myc and enhance the antileukemic activity of VEN, as well as AZA, though combination of all three has not been fully explored. In this study, we investigated the HDAC inhibitor, panobinostat, in combination with VEN + AZA against AraC-resistant AML cells. Panobinostat treatment downregulated c-Myc and Bcl-xL and upregulated Bim, which enhanced the antileukemic activity of VEN + AZA against AraC-resistant AML cells. In addition, panobinostat alone and in combination with VEN + AZA suppressed oxidative phosphorylation and/or glycolysis in AraC-resistant AML cells. These findings support further development of panobinostat in combination with VEN + AZA for the treatment of AraC-resistant AML.
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Affiliation(s)
- Jianlei Zhao
- National Engineering Laboratory for AIDS Vaccine, Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, PR China; Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Shuangshuang Wu
- Department of Pediatric Hematology, The First Hospital of Jilin University, Changchun 130012, PR China
| | - Deying Wang
- The Tumor Center of the First Hospital of Jilin University, Changchun 130021, PR China
| | - Holly Edwards
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Jenna Thibodeau
- Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Seongho Kim
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Paul Stemmer
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Detroit, MI 48201, USA
| | - Guan Wang
- National Engineering Laboratory for AIDS Vaccine, Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, PR China
| | - Jingji Jin
- National Engineering Laboratory for AIDS Vaccine, Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, PR China
| | - Süreyya Savasan
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, USA; Division of Pediatric Hematology and Oncology, Children's Hospital of Michigan, Detroit, MI 48202, USA; Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI 48859, USA
| | - Jeffrey W Taub
- Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA; Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, USA; Division of Pediatric Hematology and Oncology, Children's Hospital of Michigan, Detroit, MI 48202, USA; Department of Pediatrics, Central Michigan University College of Medicine, Mt. Pleasant, MI 48859, USA.
| | - Yubin Ge
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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7
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Chatzilygeroudi T, Darmani I, El Gkotmi N, Vryttia P, Douna S, Bouchla A, Labropoulou V, Kotsopoulou M, Symeonidis A, Pagoni M, Pappa V, Papageorgiou SG. Real-Life Multicenter Experience of Venetoclax in Combination with Hypomethylating Agents in Previously Untreated Adult Patients with Acute Myeloid Leukemia in Greece. J Clin Med 2024; 13:584. [PMID: 38276092 PMCID: PMC10816211 DOI: 10.3390/jcm13020584] [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: 12/29/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The landscape of first-line treatment for acute myeloid leukemia (AML) patients ineligible for intensive chemotherapy has changed remarkably after venetoclax approval. Accumulating real-world data further apprises us with more knowledgeable use. To assess the efficacy and safety challenges in the real-life setting of the combination of hypomethylated agent (HMA) and venetoclax, we conducted a multi-center retrospective study. METHODS Forty adult AML patients treated with the combination of HMA and venetoclax as a first-line treatment after full approval (2020) were included. To confirm VIALE-A results, this group was compared to a historical cohort of 17 chemotherapy-ineligible AML patients treated with HMA monotherapy before 2020. RESULTS The combination of HMA-venetoclax achieved a composite complete response rate of 86.8% (p < 0.001), median overall survival, and event-free survival of 33.8 and 19.7 months, respectively, in a median follow-up of 17.8 months (pos < 0.001, HR = 0.276, CI: 0.132-0.575, pEFS = 0.004, HR = 0.367, CI: 0.174-0.773). High rates of neutropenia (90%) and consequent infection rates (57.5%) were noted. Only 55% of our patients received antifungal prophylaxis, as its use remains controversial, and invasive fungal infections were presented in 7.5%. CONCLUSIONS Evidently, venetoclax-HMA yields high response rates and profound survival benefits in real life and has changed our approach to alternative chemotherapy options.
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Affiliation(s)
- Theodora Chatzilygeroudi
- Hematology Division, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Patras, 30100 Patras, Greece; (T.C.); (V.L.); (A.S.)
| | - Ismini Darmani
- Hematology Department, Evaggelismos General Hospital, 10676 Athens, Greece; (I.D.); (N.E.G.); (M.P.)
| | - Natali El Gkotmi
- Hematology Department, Evaggelismos General Hospital, 10676 Athens, Greece; (I.D.); (N.E.G.); (M.P.)
| | - Pinelopi Vryttia
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
| | - Stavroula Douna
- Hematology Department, Metaxa General Hospital, 18537 Peiraeus, Greece; (S.D.); (M.K.)
| | - Anthi Bouchla
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
| | - Vasiliki Labropoulou
- Hematology Division, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Patras, 30100 Patras, Greece; (T.C.); (V.L.); (A.S.)
| | - Maria Kotsopoulou
- Hematology Department, Metaxa General Hospital, 18537 Peiraeus, Greece; (S.D.); (M.K.)
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Patras, 30100 Patras, Greece; (T.C.); (V.L.); (A.S.)
| | - Maria Pagoni
- Hematology Department, Evaggelismos General Hospital, 10676 Athens, Greece; (I.D.); (N.E.G.); (M.P.)
| | - Vasiliki Pappa
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
| | - Sotirios G. Papageorgiou
- Hematology Unit, Second Department of Internal Medicine, and Research Institute, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (P.V.); (A.B.); (V.P.)
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8
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Hu M, Li W, Zhang Y, Liang C, Tan J, Wang Y. Venetoclax in adult acute myeloid leukemia. Biomed Pharmacother 2023; 168:115820. [PMID: 37925935 DOI: 10.1016/j.biopha.2023.115820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023] Open
Abstract
Venetoclax is a potent inhibitor that specifically targets B-cell lymphoma-2 (BCL-2), which has been demonstrated to be effective in preclinical studies utilizing acute myeloid leukemia (AML) cell lines and xenograft models. Significant antileukemic activity was also observed in clinical trials, both as a monotherapy and in combination with other drugs. This novel therapeutic approach has revolutionized the treatment prospects for AML patients with unfavorable prognoses and those who are unable to tolerate intensive chemotherapy. Nevertheless, further investigations are required to establish the optimal dosing, sequencing, and combinational strategies of venetoclax for AML treatments. Additionally, identifying biomarkers is crucial for predicting response and resistance to this targeted intervention. In this review, we provide an overview of venetoclax-based therapy for AML and explore potential avenues for future research.
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Affiliation(s)
- Mengci Hu
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Wenzhe Li
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Youshan Zhang
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Caixia Liang
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Jie Tan
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
| | - Ya Wang
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China; Department of Hubei Provincial Clinical Research Center for Personalized Diagnosis and Treatment of Cancer, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
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Apolito V, Arrigo G, Vasseur L, Olivi M, Perrone S, Giai V, Secreto C, Di Biase F, De Simone MC, Copia C, Gravetti A, Freilone R, Bruno B, Lanzarone G, Beggiato E, Frairia C, Audisio E, D'Ardia S, Ferrero D, Cerrano M, Ferrara F. Validation of SIE/SIES/GITMO consensus criteria for unfitness to predict early mortality and survival in acute myeloid leukaemia patients treated with hypomethylating agents and venetoclax. Br J Haematol 2023; 203:e98-e101. [PMID: 37533098 DOI: 10.1111/bjh.19022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Vincenzo Apolito
- Division of Haematology, University of Turin, Turin, Italy
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Giulia Arrigo
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Loic Vasseur
- Hôpital Saint-Louis, Assistance, Publique-Hôpitaux de Paris, Paris, France
| | - Matteo Olivi
- Division of Haematology, University of Turin, Turin, Italy
| | - Silvia Perrone
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Valentina Giai
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carolina Secreto
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Roberto Freilone
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Chiara Frairia
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ernesta Audisio
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano D'Ardia
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Dario Ferrero
- Division of Haematology, University of Turin, Turin, Italy
| | - Marco Cerrano
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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10
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Kristensen DT, Brøndum RF, Ørskov AD, Marcher CW, Schöllkopf C, Sørensen ALT, Severinsen MT, Bøgsted M, Roug AS. Venetoclax-based therapy for relapsed or refractory acute myeloid leukaemia following intensive induction chemotherapy. Eur J Haematol 2023; 111:573-582. [PMID: 37489268 DOI: 10.1111/ejh.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The treatment of relapsed or refractory (R/R) acute myeloid leukaemia (AML) remains challenging and outcomes extremely poor. The introduction of venetoclax has transformed the treatment of AML and emerging data suggest that venetoclax-based therapy may enforce salvage treatment. MATERIALS AND METHODS In this nationwide Danish retrospective study, we analysed treatment outcomes of venetoclax-based salvage treatment for R/R AML between 2019 and 2022. Only venetoclax-naive patients who had previously received treatment with intensive chemotherapy therapy were included. RESULTS The cohort consisted of 43 R/R patients with a median age of 57 years. Nine (20.9%) were primary refractory and 34 (79.1%) patients had relapsed, including 21 after previous allogeneic stem cell transplantation. The overall response rate was 76.2% including 61.9% with composite complete remission (CRc: CR + CRi). Among CRc-responders with information on measurable residual disease (MRD), 8/13 (61.5%) obtained an MRD-negativity response. The overall survival was 9.3 months for all patients with an estimated 1-year overall survival of 34%. For CRc-responders the median overall survival was 13.3 months, and the median relapse-free survival was 12.8 months. CONCLUSION Venetoclax-based salvage treatment for R/R AML produced high response rates; however, for most patients the response was of limited duration. This study is limited by an observational design and prone to selection bias.
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Affiliation(s)
- Daniel Tuyet Kristensen
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Froberg Brøndum
- Center for Clinical Data Science, Department of Clinical Medicine, Aalborg University and Research, Education, and Innovation, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas Due Ørskov
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Claudia Schöllkopf
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Marianne Tang Severinsen
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin Bøgsted
- Center for Clinical Data Science, Department of Clinical Medicine, Aalborg University and Research, Education, and Innovation, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Stidsholt Roug
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
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11
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Zong L, Yin M, Kong J, Zhang J, Song B, Zhu J, Xue S, Wu X, Wu D, Bao X, Qiu H. Development of a scoring system for predicting primary resistance to venetoclax plus hypomethylating agents (HMAs) in acute myeloid leukemia patients. Mol Carcinog 2023; 62:1572-1584. [PMID: 37555764 DOI: 10.1002/mc.23600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/15/2023] [Accepted: 06/13/2023] [Indexed: 08/10/2023]
Abstract
In recent years, one of the most promising advances in the treatment of acute myeloid leukemia (AML) is the combination of a hypomethylating agent (HMA) with the BCL2 inhibitor venetoclax (VEN). To better understand the key factors associated with the response of VEN plus HMA, 212 consecutive AML patients were retrospectively recruited to establish and validate a scoring system for predicting the primary resistance to VEN-based induced therapy. All AML patients were divided randomly into a training set (n = 155) and a validation set (n = 57). Factors were selected using a multivariate logistic regression model, including FAB-M5, myelodysplastic syndrome-secondary acute myeloid leukemia (MDS-sAML), RUNX1-RUNX1T1 and FLT3-ITD mutation (FLT3-ITDm). A nomogram was then constructed including all these four predictors. The nomogram both presented a good performance of discrimination and calibration, with a C-index of 0.770 and 0.733 in the training and validation set. Decision curve analysis also indicated that the nomogram was feasible to make beneficial decisions. Eventually a total scoring system of 8 points was developed, which was divided into three risk groups: low-risk (score 0-2), medium-risk (score 3-4), and high-risk (score 5-8). There was a significant difference in the nonremission (NR) rate of these three risk groups (22.8% vs. 60.0% vs. 77.8%, p < 0.001). After adjustment of the other variables, patients in medium- or high-risk groups also presented a worse event-free survival (EFS) than that in the low-risk group (hazard ratio [HR] = 1.62, p = 0.03). In conclusion, we highlighted the response determinants of AML patients receiving a combination therapy of VEN plus HMAs. The scoring system can be used to predict the resistance of VEN, providing better guidance for clinical treatment.
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Affiliation(s)
- Lihong Zong
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Minyue Yin
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jinyu Kong
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jian Zhang
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Baoquan Song
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shengli Xue
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaojin Wu
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiebing Bao
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Huiying Qiu
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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12
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Ucciero A, Pagnoni F, Scotti L, Pisterna A, Barone-Adesi F, Gaidano G, Patriarca A, Lunghi M. Venetoclax with Hypomethylating Agents in Newly Diagnosed Acute Myeloid Leukemia: A Systematic Review and Meta-Analysis of Survival Data from Real-World Studies. Cancers (Basel) 2023; 15:4618. [PMID: 37760587 PMCID: PMC10526951 DOI: 10.3390/cancers15184618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/26/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
In recent years, the association of venetoclax (VEN) with hypomethylating agents (HMAs) significantly improved the outcome of patients with newly diagnosed acute myeloid leukemia (AML) who were unfit for intensive chemotherapy and became the standard of care after the publication of the pivotal RCT VIALE-A. However, it is still not clear to what extent the results observed in the VIALE-A apply to a real-world setting. For this reason, we carried out a systematic review and meta-analysis of real-world studies on newly diagnosed patients with AML, ineligible for intensive induction chemotherapy, receiving first-line VEN+HMA. We then compared their results in term of survival with those from the VIALE-A. Kaplan-Meier curves were extracted from all included studies and individual survival data was reconstructed. We then estimated a pooled survival curve and compared it with the results of the VIALE-A using the log-rank test. We also conducted a secondary analysis including only studies considering VEN plus azacytidine (AZA) as treatment, as this was the schedule originally used in the VIALE-A. Nineteen real-world studies met the inclusion criteria and were included in the systematic review. Most of them reported a worse survival than the VIALE-A. The pooled survival curve was similar to that reported in the VIALE-A during the first three months of treatment but diverged thereafter (p-value = 0.0001). The pooled median survival among the real-world studies was 9.37 months (95%CI 8.81-10.5), substantially lower than that reported in the VIALE-A (14.7 months; 95%CI 11.9-18.7). Results slightly increased when the analysis was restricted to the studies using VEN+AZA as treatment (median survival: 11.5 months; 95%CI 10.2-14.8). Survival of newly diagnosed AML patients treated with VEN+HMAs in a real-world setting seems to be lower than previously reported in the VIALE-A, while the effect of VEN+AZA is more in line with expected results. Future studies are needed to evaluate whether this apparent discrepancy is due to the different characteristics of enrolled patients or to a non-optimal adherence to therapy, and whether alternative regimens can provide better results in terms of safety and effectiveness.
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Affiliation(s)
| | - Federico Pagnoni
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Alessia Pisterna
- Hospital Pharmacy AOU Maggiore della Carità, 28100 Novara, Italy
| | - Francesco Barone-Adesi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, 28100 Novara, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, 28100 Novara, Italy
| | - Monia Lunghi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, 28100 Novara, Italy
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13
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Maffeo B, Panuzzo C, Moraca A, Cilloni D. A Leukemic Target with a Thousand Faces: The Mitochondria. Int J Mol Sci 2023; 24:13069. [PMID: 37685874 PMCID: PMC10487524 DOI: 10.3390/ijms241713069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
In the era of personalized medicine greatly improved by molecular diagnosis and tailor-made therapies, the survival rate of acute myeloid leukemia (AML) at 5 years remains unfortunately low. Indeed, the high heterogeneity of AML clones with distinct metabolic and molecular profiles allows them to survive the chemotherapy-induced changes, thus leading to resistance, clonal evolution, and relapse. Moreover, leukemic stem cells (LSCs), the quiescent reservoir of residual disease, can persist for a long time and activate the recurrence of disease, supported by significant metabolic differences compared to AML blasts. All these points highlight the relevance to develop combination therapies, including metabolism inhibitors to improve treatment efficacy. In this review, we summarized the metabolic differences in AML blasts and LSCs, the molecular pathways related to mitochondria and metabolism are druggable and targeted in leukemia therapies, with a distinct interest for Venetoclax, which has revolutionized the therapeutic paradigms of several leukemia subtype, unfit for intensive treatment regimens.
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Affiliation(s)
| | - Cristina Panuzzo
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (B.M.); (A.M.); (D.C.)
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