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Hou CX, Chen Y, Liu SH, Jiang YZ, Huang DP, Chen SN. Effective treatment with Gilteritinib-based regimens for FLT3-mutant extramedullary relapse in acute promyelocytic leukemia. Hematology 2024; 29:2293496. [PMID: 38095349 DOI: 10.1080/16078454.2023.2293496] [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: 06/30/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Extramedullary relapse (EMR) is rare in acute promyelocytic leukemia (APL) and, there is a lack of information on its management. Current practices for EMR in APL are always to adopt strategies from other subtypes of Acute lymphoblastic leukemia (ALL) and Acute myeloid leukemia (AML). Gilteritinib, a highly selective FLT3 inhibitor, has demonstrated a remarkable effect on EMR in FLT3-mutant AML. Therefore, it is worthwhile exploring if FLT3 mutation can be a therapeutic target and assessing the efficacy of Gilteritinib on FLT3-mutant EMR in APL. METHODS We described three cases of FLT3-mutant EMR in APL, comprising two isolated EMR cases and one systemic relapse. The patients underwent treatment with Gilteritinib-based regimens based on FLT3 mutation. RESULTS All three patients achieved complete regression of EMR, and no signs of tumor lysis syndrome during Gilteritinib-based therapy, only patient 1 showed mild granulocytopenia. They all maintained molecular complete remission (mCR) during the follow-up period. CONCLUSIONS The Gilteritinib-based regimen shows a high and sustained therapeutic effect with minimal adverse effects, and provides a valuable experience for further evaluation in EMR APL patients.
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Affiliation(s)
- Chun-Xiao Hou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, People's Republic of China
| | - Yu Chen
- Department of Hematology, the Second Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Shan-Hao Liu
- Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Yi-Zhi Jiang
- Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Dong-Ping Huang
- Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Su-Ning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, People's Republic of China
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2
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Snaith O, Poveda-Rogers C, Laczko D, Yang G, Morrissette JJD. Cytogenetics and genomics of acute myeloid leukemia. Best Pract Res Clin Haematol 2024; 37:101533. [PMID: 38490763 DOI: 10.1016/j.beha.2023.101533] [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: 02/28/2023] [Revised: 09/14/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024]
Abstract
The diversity of genetic and genomic abnormalities observed in acute myeloid leukemia (AML) reflects the complexity of these hematologic neoplasms. The detection of cytogenetic and molecular alterations is fundamental to diagnosis, risk stratification and treatment of AML. Chromosome rearrangements are well established in the diagnostic classification of AML, as are some gene mutations, in several international classification systems. Additionally, the detection of new mutational profiles at relapse and identification of mutations in the pre- and post-transplant settings are illuminating in understanding disease evolution and are relevant to the risk assessment of AML patients. In this review, we discuss recurrent cytogenetic abnormalities, as well as the detection of recurrent mutations, within the context of a normal karyotype, and in the setting of chromosome abnormalities. Two new classification schemes from the WHO and ICC are described, comparing these classifications in terms of diagnostic criteria and entity definition in AML. Finally, we discuss ways in which genomic sequencing can condense the detection of gene mutations and chromosome abnormalities into a single assay.
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Affiliation(s)
- Oraine Snaith
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Corey Poveda-Rogers
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Dorottya Laczko
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Guang Yang
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer J D Morrissette
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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3
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Yokoyama Y. Risk factors and remaining challenges in the treatment of acute promyelocytic leukemia. Int J Hematol 2024:10.1007/s12185-023-03696-7. [PMID: 38386203 DOI: 10.1007/s12185-023-03696-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/23/2024]
Abstract
The treatment of acute promyelocytic leukemia (APL) has evolved with the introduction of all-trans retinoic acid (ATRA) and subsequent arsenic trioxide (ATO), particularly in standard-risk APL with an initial white blood cell count (WBC) < 10,000/μL, where a high cure rate can now be achieved. However, for some patients with risk factors, early death or relapse remains a concern. Insights from the analysis of patients treated with ATRA and chemotherapy have identified risk factors such as WBC, surface antigens, complex karyotypes, FLT3 and other genetic mutations, p73 isoforms, variant rearrangements, and drug resistance mutations. However, in the ATRA + ATO era, the significance of these risk factors is changing. This article provides a comprehensive review of APL risk factors, taking into account the treatment approach, and explores the challenges associated with APL treatments.
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Affiliation(s)
- Yasuhisa Yokoyama
- Department of Hematology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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4
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Liu G, Liu L, Bartolo DD, Li KY, Li X. Acute Promyelocytic Leukemia with Rare Genetic Aberrations: A Report of Three Cases. Genes (Basel) 2022; 14:genes14010046. [PMID: 36672788 PMCID: PMC9858271 DOI: 10.3390/genes14010046] [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: 11/30/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a unique subtype of acute myeloid leukemia (AML) that is characterized by the PML::RARA fusion or, more rarely, a variant RARA translocation. While APL can be clinically suspected, diagnosis of APL requires genetic confirmation. Targeted therapy such as all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) has dramatically improved the prognosis of APL patients, but this is dependent on timely genetic testing as different fusions and/or mutations can affect therapeutic outcomes. Here we report three APL cases with various genetic aberrations: cryptic PML::RARA fusion, variant RARA rearrangement, and typical PML::RARA fusion with co-existing FLT3-ITD mutation. They serve to illustrate the utility of integrating genetic testing, using chromosome analysis, fluorescence in situ hybridization (FISH), reverse transcriptase-polymerase chain reaction (RT-PCR), and next-generation sequencing (NGS) in providing a detailed understanding of the genetic alterations underlying each patient's disease.
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Affiliation(s)
- Guang Liu
- Genetics/Genomics Division, Sonora Quest Laboratories, University of Arizona College of Medicine, Phoenix, AZ 85034, USA
- Correspondence: (G.L.); (X.L.)
| | - Lanting Liu
- AmeriPath Indiana, Indianapolis, IN 46219, USA
| | | | - Katie Y. Li
- Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA
| | - Xia Li
- Department of Pathology, University of Arizona College of Medicine, Sonora Quest Laboratories, Phoenix, AZ 85034, USA
- Correspondence: (G.L.); (X.L.)
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5
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Vu MP, Nguyen CN, Vu H, Nguyen TM, Nguyen TT, Pham PT. Association between FLT3-ITD and additional chromosomal abnormalities in the prognosis of acute promyelocytic leukemia. J Int Med Res 2022; 50:3000605221138490. [PMID: 36539954 PMCID: PMC9791292 DOI: 10.1177/03000605221138490] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Internal tandem duplications of the Fms-like tyrosine kinase 3 gene (FLT3-ITD) and additional chromosomal abnormalities (ACA) are prognostic factors in patients with acute promyelocytic leukemia (APL). This study aimed to determine the effect of the association between FLT3-ITD and ACA in the prognosis of APL. METHODS This was a retrospective cohort study including 60 patients with APL treated with all-trans retinoic acid (ATRA) and chemotherapy. Five-year overall survival (OS) and progression-free survival (PFS) were analyzed in patient groups according to the presence of FLT3-ITD and ACA. RESULTS FLT3-ITD was an independent adverse factor for 5-year PFS, and ACA was an independent adverse factor for 5-year OS. There were significant differences in OS and PFS among the groups: FLT3-ITD-negative without ACA, FLT3-ITD-positive without ACA, FLT3-ITD-negative with ACA, and FLT3-ITD-positive with ACA. The OS times were 52.917, 45.813, 25.375, and 23.417 months, and the PFS times were 48.833, 38.563, 23.250, and 17.333 months, respectively. CONCLUSION FLT3-ITD and ACA are associated with the poorest OS and PFS outcomes in patients with APL treated with chemotherapy plus ATRA.
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Affiliation(s)
- Minh Phuong Vu
- Hanoi Medical University, Department of Hematology, Hanoi, Vietnam,Bach Mai Hospital, Center for Hematology and Blood Transfusion, Hanoi, Vietnam,Minh Phuong Vu, Hanoi Medical University, Department of Hematology, 1, Ton That Tung Street, Dong Da district, Hanoi, Vietnam.
| | - Cuc Nhung Nguyen
- Bach Mai Hospital, Center for Hematology and Blood Transfusion, Hanoi, Vietnam
| | - Hoang Vu
- Bach Mai Hospital, Center for Hematology and Blood Transfusion, Hanoi, Vietnam
| | - Tuyet Mai Nguyen
- Hanoi Medical University, Department of Hematology, Hanoi, Vietnam
| | - Tuan Tung Nguyen
- Bach Mai Hospital, Center for Hematology and Blood Transfusion, Hanoi, Vietnam
| | - Phuong Thao Pham
- Hanoi Medical University, Department of Hematology, Hanoi, Vietnam
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Hartzell C, McLaughlin J, Nasibli J, Bains A. Myeloid sarcoma mimicking suprasellar meningioma in acute promyelocytic leukaemia. Pathology 2022; 54:955-957. [PMID: 35249746 DOI: 10.1016/j.pathol.2021.12.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Connor Hartzell
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - John McLaughlin
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Jalil Nasibli
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Ashish Bains
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, USA.
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Evolving of treatment paradigms and challenges in acute promyelocytic leukaemia: A real-world analysis of 1105 patients over the last three decades. Transl Oncol 2022; 25:101522. [PMID: 36075113 PMCID: PMC9465437 DOI: 10.1016/j.tranon.2022.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Although acute promyelocytic leukaemia (APL) is a highly curable disease, challenges of early death (ED) and relapse still exist, and real-world data are scarce in the ATRA plus ATO era. A total of 1105 APL patients from 1990 to 2020 were enrolled and categorized into three treatment periods, namely ATRA, ATRA plus ATO, and risk-adapted therapy. The early death (ED) rate was 20.2%, 10.1%, and 7.0%, respectively, in three periods, while there was no significant decline in the 7-day death rate. Consistently, the overall survival (OS) and disease-free survival (DFS) of APL patients markedly improved over time. Despite the last two periods exhibiting similar DFS, the chemotherapy load was substantially lower in Period 3. Notably, leveraging older age and higher WBC count (especially > 50 × 109/L), we could identify a small group of extremely high-risk patients who had a very high ED rate and poor prognosis, while those with NRAS mutations and higher WBC tended to relapse, both representing obstacles to curing all patients. In conclusion, the evolvement of treatment paradigms can reduce the ED rate, improve clinical outcomes, and spare patients the toxicity of chemotherapy. Special care and innovative agents are warranted for the particularly high-risk APL.
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Deka RR, Naseem S, Bhatia P, Binota J, Sonam P, Rana P, Malhotra P, Varma N. 'FLT3-ITD Mutation Does Not Influence Survival Outcome in Adult Acute Promyelocytic Leukemia Patients Treated With ATO and ATRA-Based Therapeutic Regimen: Experience From a North Indian Tertiary Care Centre'. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:416-423. [PMID: 34987015 DOI: 10.1016/j.clml.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION NPM1 and FLT3-ITD are frequently mutated genes in acute myeloid leukemia. We studied clinico-hematological profile and survival outcome of adult acute promyelocytic leukemia (APL) patients harboring these mutations. MATERIALS AND METHODS De novo APL cases (> 12 years), enrolled between January 2019 and June 2020, were evaluated for FLT3-ITD and NPM1 mutations (A, B, D mutations) by conventional and real-time qualitative PCR respectively. RESULTS FLT3-ITD mutation was detected in 12 of 36 (33.3%) de novo APLs cases while NPM1 mutation was not detected. FLT3-ITD was more frequently associated with Sanz high-risk category as compared to the intermediate-risk category (75% vs. 29%, P = .02), with BCR3 transcript type (P = .08) and higher median WBC count [22.7 × 109/L)(range 1.3-184), P = .018]. One and half-years overall survival (OS) and event-free survival (EFS) were not significantly altered by the presence/absence of FLT3-ITD mutation (OS 86% vs. 70%, P = .32; EFS 86% vs. 70%, P = .33), between genders (OS, EFS both 89% in males vs. 69% in females, P = .15) and between adolescent and younger adults (AYA) (≤ 30 years) and older adult APL cases (> 30 years) (OS 86% vs. 78%, P = .55; EFS 85% vs. 77%, P = .55), however were significantly lower with BCR3 transcript as compared to BCR1 transcript (OS 56% vs. 91%, P = .019; EFS 56% vs. 91%, P = .016) in univariate analysis, although not in multivariate analysis. One and half-year OS and EFS was 57% (6/14, P = .009 for each) in high-risk APL. CONCLUSION FLT3-ITD mutation did not influence survival outcome in adult APL treated with ATO and ATRA-based therapeutic regimen.
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Affiliation(s)
- Riju Rani Deka
- Department of Pathology, Tezpur Medical College, Tezpur, Sonitpur, Assam, India; Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prateek Bhatia
- Department of Pediatrics (Pediatric Hematology-Oncology Unit), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jogeshwar Binota
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preeti Sonam
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Palak Rana
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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9
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Shu X, Wu Q, Guo T, Yin H, Liu J. Acute Promyelocytic Leukemia Presenting With a Myeloid Sarcoma of the Spine: A Case Report and Literature Review. Front Oncol 2022; 12:851406. [PMID: 35311073 PMCID: PMC8931201 DOI: 10.3389/fonc.2022.851406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells. Certain known acute myeloid leukemia cytogenetic abnormalities, in particular t(8,21), has been associated with a higher incidence. Myeloid sarcoma, which rarely happens in acute promyelocytic leukemias, is more common in recurrent patients after the advent of all-trans retinoic acid (ATRA) and are rare in untreated acute promyelocytic leukemia. We described a case of, to our knowledge, de novo myeloid sarcoma of the spine confirmed as acute promyelocytic leukemia. Myeloid sarcoma is diagnosed by spinal tumor biopsy, and microscopic examination of a bone marrow smear and cytogenetic analysis led to a confirmed diagnosis of acute promyelocytic leukemia.
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Im D, Jun J, Baek J, Kim H, Kang D, Bae H, Cho H, Hah JM. Rational design and synthesis of 2-(1H-indazol-6-yl)-1H-benzo[d]imidazole derivatives as inhibitors targeting FMS-like tyrosine kinase 3 (FLT3) and its mutants. J Enzyme Inhib Med Chem 2022; 37:472-486. [PMID: 35067150 PMCID: PMC8788362 DOI: 10.1080/14756366.2021.2020772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fms-like tyrosine kinase 3 (FLT3) has been verified as a therapeutic target for acute myeloid leukaemia (AML). In this study, we report a series of 2-(1H-indazol-6-yl)-1H-benzo[d]imidazol-5-yl benzamide and phenyl urea derivatives as potent FLT3 inhibitors based on the structural optimisation of previous FLT3 inhibitors. Derivatives were synthesised as benzamide 8a–k, 8n–z, and phenyl urea 8l–m, with various substituents. The most potent inhibitor, 8r, demonstrated strong inhibitory activity against FLT3 and FLT3 mutants with a nanomolar IC50 and high selectivity profiles over 42 protein kinases. In addition, these type II FLT3 inhibitors were more potent against FLT3 mutants correlated with drug resistance. Overall, we provide a theoretical basis for the structural optimisation of novel benzimidazole analogues to develop strong inhibitors against FLT3 mutants for AML therapeutics.
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Affiliation(s)
- Daseul Im
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
| | - Joonhong Jun
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
| | - Jihyun Baek
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
| | - Haejin Kim
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
| | - Dahyun Kang
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
| | - Hyunah Bae
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
| | - Hyunwook Cho
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
| | - Jung-Mi Hah
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmaceutical Science and Technology, Center for Proteinopathy, Hanyang University, Ansan, Korea
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11
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Kayser S, Kramer M, Martínez-Cuadrón D, Grenet J, Metzeler KH, Sustkova Z, Luskin MR, Brunner AM, Elliott MA, Gil C, Marini SC, Ráčil Z, Cetkovsky P, Novak J, Perl AE, Platzbecker U, Stölzel F, Ho AD, Thiede C, Stone RM, Röllig C, Montesinos P, Schlenk RF, Levis MJ. Characteristics and outcome of patients with core-binding factor acute myeloid leukemia and FLT3-ITD: results from an international collaborative study. Haematologica 2021; 107:836-843. [PMID: 34348451 PMCID: PMC8968900 DOI: 10.3324/haematol.2021.278645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 02/02/2023] Open
Abstract
The aim of this study was to evaluate the prognostic impact of FLT3-ITD in core-binding factor acute myeloid leukemia (CBFAML) in an international, multicenter survey of 97 patients of whom 52% had t(8;21)(q22;q22) and 48% had inv(16)(p13q22)/t(16;16)(p13;q22). The median age of the patients was 53 years (range, 19-81). Complete remission after anthracycline-based induction (n=86) and non-intensive therapy (n=11) was achieved in 97% and 36% of the patients, respectively. The median follow-up was 4.43 years (95% confidence interval [95% CI]: 3.35-7.39 years). The median survival after intensive and non-intensive treatment was not reached and 0.96 years, respectively. Among intensively treated patients, inv(16) with trisomy 22 (n=11) was associated with a favorable 4-year relapse-free survival rate of 80% (95% CI: 59-100%) as compared to 38% (95% CI: 27-54%; P=0.02) in all other patients with CBFAML/ FLT3-ITD (n=75). Overall, 24 patients underwent allogeneic hematopoietic cell transplantation (HCT), 12 in first complete remission and 12 after relapse. Allogeneic HCT in first complete remission was not beneficial (P=0.60); however, allogeneic HCT seemed to improve median survival in relapsed patients compared to that of patients treated with chemotherapy (not reached vs. 0.6 years, respectively; P=0.002). Excluding patients with inv(16) with trisomy 22, our data indicate that compathe outcome of CBF-AML patients with FLT3-ITD may be inferior to that of patients without FLT3-ITD (based on previously published data), suggesting that prognostically CBF-AML patients with FLT3-ITD should not be classified as favorable-risk. FLT3-inhibitors may improve the outcome of these patients.
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Affiliation(s)
- Sabine Kayser
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany,NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany,SABINE KAYSER
| | - Michael Kramer
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Justin Grenet
- Division of Hematology & Oncology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Klaus H. Metzeler
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany,Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Zuzana Sustkova
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Marlise R. Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Michelle A. Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Sandra Casal Marini
- Department of Clinical Haematology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Zdeněk Ráčil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic,Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Petr Cetkovsky
- Department of Internal Medicine and Haematology, 3 Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Novak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Alexander E. Perl
- Division of Hematology & Oncology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Friedrich Stölzel
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Anthony D. Ho
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Richard M. Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Richard F. Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany,Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany,RFS and MJL contributed equally as co-senior authors
| | - Mark J. Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA,RFS and MJL contributed equally as co-senior authors
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12
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Xu LW, Su YZ, Tao HF. All-trans Retinoic Acid, Arsenic Trioxide, and Anthracycline-based Chemotherapy Improves Outcome in Newly Diagnosed Acute Promyelocytic Leukemia Regardless of FLT3-ITD Mutation Status. Curr Med Sci 2021; 41:491-497. [PMID: 34169421 DOI: 10.1007/s11596-021-2377-3] [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: 12/02/2020] [Accepted: 02/26/2021] [Indexed: 02/05/2023]
Abstract
All-trans retinoic acid (ATRA) and pre-upfront arsenic trioxide (ATO) have revolutionized the therapy of acute promyelocytic leukemia (APL). However, internal tandem duplication of FMS-like tyrosine kinase 3 (FLT3-ITD) mutations is associated with increased risk of relapse. The aim of this study was to analyze the prognostic impact of FLT3-ITD on APL patients who received remission induction with ATRA, idarubicin (IDA) and/or ATO, followed by ATRA plus ATO along with anthracycline, as consolidation therapy. A total of 72 patients newly diagnosed with APL were included in this study. 83.3% of the patients achieved complete remission (CR) after induction therapy. FLT3-ITD mutations were detected in 16 (22.2%) patients and closely related to bcr-3 PML-RARa transcript (P<0.001). The 5-year overall survival (OS) rate was 100% in both FLT3-ITDpositive and FLT3-ITDnegative groups, and there was no significant difference in 5-year event-free survival (EFS) between the two groups (78.3% vs. 83.3%, P=0.85). ATRA plus ATO and anthracycline-based chemotherapy achieved great outcome in newly diagnosed APL regardless of the FLT3-ITD mutation status.
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Affiliation(s)
- Lin-Wei Xu
- Department of Hematology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Yong-Zhong Su
- Department of Hematology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Hong-Fang Tao
- Department of Hematology, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
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13
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Esnault C, Rahmé R, de Thé H. [Arsenic: The gold standard for acute promyelocytic leukaemia with FLT3-ITD mutation]. Med Sci (Paris) 2021; 37:544-546. [PMID: 34003103 DOI: 10.1051/medsci/2021048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Cécile Esnault
- Inserm U944, CNRS UMR7212, IRSL, Université de Paris, Hôpital Saint-Louis, 16, rue de la Grange aux Belles, Paris, France
| | - Ramy Rahmé
- Department of oncological sciences, Icahn school of medicine, Mount Sinai, 1425 Madison Avenue, New York, États-Unis
| | - Hugues de Thé
- Inserm U944, CNRS UMR7212, IRSL, Université de Paris, Hôpital Saint-Louis, 16, rue de la Grange aux Belles, Paris, France. - Collège de France, Université Paris sciences et lettres, Inserm U1050, CNRS UMR7241, 11 place Marcelin Berthelot, 75005 Paris, France. - Service de biochimie, AP-HP, Hôpital Saint-Louis, Paris, France
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14
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FLT3-ITD Allelic Burden and Acute Promyelocytic Leukemia Risk Stratification. BIOLOGY 2021; 10:biology10030243. [PMID: 33800974 PMCID: PMC8003857 DOI: 10.3390/biology10030243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
Abstract
The significance of FLT3-ITD in acute promyelocytic leukemia (APL) is not well-established. We performed a bi-center retrospective study of 138 APL patients, 59 (42.8%) of whom had FLT3-ITD. APL patients with FLT3-ITD had higher baseline white blood cell counts (WBCs) (p < 0.001), higher hemoglobin, (p = 0.03), higher aspartate aminotransferase (p = 0.001), lower platelets (p = 0.004), lower fibrinogen (p = 0.003), and higher incidences of disseminated intravascular coagulation (p = 0.005), M3v variant morphology (p < 0.001), and the bcr3 isoform (p < 0.001). FLT3-ITD was associated with inferior post-consolidation complete remission (CR) (p = 0.02) and 5-year overall survival (OS) of 79.7%, compared to 94.4% for FLT3-WT (wild-type) (p = 0.02). FLT3-ITD was strongly associated with baseline WBCs ≥ 25 × 109/L (odds ratio (OR): 54.4; 95% CI: 10.4-286.1; p < 0.001). High FLT3-ITD allelic burdens correlated with high-risk (HR) Sanz scores and high WBCs, with every 1% increase in allelic burden corresponding to a 0.6 × 109/L increase in WBC. HR APL was associated with a 38.5% increase in allelic burden compared with low-risk (LR) APL (95% CI: 19.8-57.2; p < 0.001). Our results provide additional evidence that FLT3-ITD APL is a distinct subtype of APL that warrants further study to delineate potential differences in therapeutic approach.
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Andrade FG, Feliciano SVM, Sardou-Cezar I, Brisson GD, dos Santos-Bueno FV, Vianna DT, Marques LVC, Terra-Granado E, Zalcberg I, Santos MDO, Costa JT, Noronha EP, Thuler LCS, Wiemels JL, Pombo-de-Oliveira MS. Pediatric Acute Promyelocytic Leukemia: Epidemiology, Molecular Features, and Importance of GST-Theta 1 in Chemotherapy Response and Outcome. Front Oncol 2021; 11:642744. [PMID: 33816294 PMCID: PMC8017304 DOI: 10.3389/fonc.2021.642744] [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: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Previous studies have suggested a variation in the incidence of acute promyelocytic leukemia (APL) among the geographic regions with relatively higher percentages in the Latin American population. We aimed to explore the population burden of pediatric APL, gathering information from the population-based cancer registry (PBCR) and the diagnosis of APL obtained through incident cases from a hospital-based cohort. The homozygous deletion in glutathione S-transferases (GSTs) leads to a loss of enzyme detoxification activity, possibly affecting the treatment response. Mutations in the RAS pathway genes are also considered to be a key component of the disease both in the pathogenesis and in the outcomes. We have assessed mutations in a RAS-MAP kinase pathway (FLT3, PTPN11, and K-/NRAS) and GST variant predisposition risk in the outcome. Out of the 805 children and adolescents with acute myeloid leukemia (AML) who are registered in the PBCR, 35 (4.3%) were APL cases. The age-adjusted incidence rate (AAIR) was 0.03 per 100,000 person-years. One-hundred and sixty-three patients with APL were studied out of 931 AML cases (17.5%) from a hospital-based cohort. Mutations in FLT3, KRAS, and NRAS accounted for 52.1% of the cases. Patients with APL presented a 5-year probability of the overall survival (OS) of 67.3 ± 5.8%. A GST-theta 1 (GSTT1) null genotype conferred adverse prognosis, with an estimated hazard ratio of 2.8, 95% confidence interval (CI) 1.2-6.9. We speculate that the GSTT1 polymorphism is associated with therapeutics and would allow better OS of patients with APL with a GSTT1 null genotype.
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Affiliation(s)
- Francianne G. Andrade
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Suellen V. M. Feliciano
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Ingrid Sardou-Cezar
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Gisele D. Brisson
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Filipe V. dos Santos-Bueno
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Danielle T. Vianna
- Laboratory of Molecular Biology, Bone Marrow Transplantation Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Luísa V. C. Marques
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Eugênia Terra-Granado
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Ilana Zalcberg
- Laboratory of Molecular Biology, Bone Marrow Transplantation Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marceli de O. Santos
- Surveillance and Prevention, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Juliana T. Costa
- Department of Pediatric Hematology-Oncology, Hospital Martagão Gesteira, Salvador, Brazil
| | - Elda P. Noronha
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Luiz C. S. Thuler
- Clinical Research Department, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Joseph L. Wiemels
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Maria S. Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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16
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Song YH, Peng P, Qiao C, Li JY, Long QQ, Lu H. Potential Effects of the FLT3-ITD Mutation on Chemotherapy Response and Prognosis of Acute Promyelocytic Leukemia. Cancer Manag Res 2021; 13:2371-2378. [PMID: 33737834 PMCID: PMC7965687 DOI: 10.2147/cmar.s297421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/24/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the influence of FLT3-ITD mutations on the treatment response and long-term survival of newly-diagnosed patients with acute promyelocytic leukemia (APL) treated with all-trans retinoic acid and arsenic trioxide. METHODS The long-term survival of 90 newly-diagnosed APL patients (age range 12-75 years) was retrospectively analyzed.The FLT3-ITD mutation rate was assayed by polymerase chain reaction (PCR) amplification and sequencing analysis. Its impact on the treatment response, event-free survival(EFS), or overall survival(OS) was investigated in patients with and without the mutations. RESULTS The FLT3-ITD mutation rate in newly-diagnosed APL patients was 20% (18/90). The white blood cell (WBC) count at diagnosis in patients with mutations was significantly higher than that in patients without mutations while the FLT3-ITD mutation rate was higher in the high-risk group than in the low/intermediate-risk group. Patients with mutations had a significantly higher early death (ED) rate (16.67% vs 1.39%) for those lacking the mutation (P =0.024). However, the complete remission (CR) and differentiation syndrome (DS) rates in the two groups were similar. Kaplan Meier analysis for EFS and OS at five years showed a significant difference between the patients stratified by FLT3-ITD mutation status (log-rank P =0.010 and P =0.009, respectively). CONCLUSION FLT3-ITD mutations can be related to high peripheral WBC counts in APL patients. APL patients with mutations displayed a higher ED rate compared to those without mutations. Patients carrying mutations had reduced five-year EFS and OS rates. Thus, reducing the overall death rate during induction treatment might be an effective way to improve the prognosis of patients with FLT3-ITD mutations.
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Affiliation(s)
- Yu-hua Song
- Department of Haematology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China
| | - Peng Peng
- Department of Haematology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China
| | - Chun Qiao
- Department of Haematology, First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, People’s Republic of China
| | - Jian-yong Li
- Department of Haematology, First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, People’s Republic of China
| | - Qi-qiang Long
- Department of Haematology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China
| | - Hua Lu
- Department of Haematology, First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, People’s Republic of China
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17
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NTAL is associated with treatment outcome, cell proliferation and differentiation in acute promyelocytic leukemia. Sci Rep 2020; 10:10315. [PMID: 32587277 PMCID: PMC7316767 DOI: 10.1038/s41598-020-66223-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/15/2020] [Indexed: 01/04/2023] Open
Abstract
Non-T cell activation linker (NTAL) is a lipid raft-membrane protein expressed by normal and leukemic cells and involved in cell signaling. In acute promyelocytic leukemia (APL), NTAL depletion from lipid rafts decreases cell viability through regulation of the Akt/PI3K pathway. The role of NTAL in APL cell processes, and its association with clinical outcome, has not, however, been established. Here, we show that reduced levels of NTAL were associated with increased all-trans retinoic acid (ATRA)-induced differentiation, generation of reactive oxygen species, and mitochondrial dysfunction. Additionally, NTAL-knockdown (NTAL-KD) in APL cell lines led to activation of Ras, inhibition of Akt/mTOR pathways, and increased expression of autophagy markers, leading to an increased apoptosis rate following arsenic trioxide treatment. Furthermore, NTAL-KD in NB4 cells decreased the tumor burden in (NOD scid gamma) NSG mice, suggesting its implication in tumor growth. A retrospective analysis of NTAL expression in a cohort of patients treated with ATRA and anthracyclines, revealed that NTAL overexpression was associated with a high leukocyte count (P = 0.007) and was independently associated with shorter overall survival (Hazard Ratio: 3.6; 95% Confidence Interval: 1.17-11.28; P = 0.026). Taken together, our data highlights the importance of NTAL in APL cell survival and response to treatment.
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18
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Nie L, Ma R, Yuan X, Jiang L, Yang S, Xu H, Liu X, Liu Y, Zhang L, Zhu Z. The prognostic value of CD2, CD4, and HLA-DR expression and FLT3-ITD mutation in adult acute promyelocytic leukemia. Leuk Lymphoma 2020; 61:2482-2487. [PMID: 32476519 DOI: 10.1080/10428194.2020.1768386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In order to explore the prognostic value of CD2, CD4, and human leucocyte antigen-DR (HLA-DR) expression and Fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutation in leukemia cells in the bone marrow of patients with acute promyelocytic leukemia (APL), we retrospectively collected and analyzed the immunophenotype, molecular features and clinical characteristics of 219 newly diagnosed adult patients with APL in Henan Provincial People's Hospital from January 2010 to December 2019. It turned out that the relapse rates of patients with CD2, CD4, or HLA-DR expression and the early mortality rates of patients with CD2 expression, HLA-DR expression, or FLT3-ITD mutation were higher than those of their counterparts. Moreover, reduced overall survival was found for patients who showed CD2 expression, HLA-DR expression or FLT3-ITD mutation. Therefore, CD2 expression, HLA-DR expression and FLT3-ITD mutation were adverse prognostic factors in adults with APL.
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Affiliation(s)
- Lu Nie
- Zhengzhou University, Zhengzhou, China.,Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China.,Institute of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Rongjun Ma
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaoli Yuan
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Li Jiang
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shiwei Yang
- Institute of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hui Xu
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaoyin Liu
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yuanbo Liu
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lin Zhang
- Institute of Hematology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zunmin Zhu
- Zhengzhou University, Zhengzhou, China.,Department of Hematology, Henan Provincial People's Hospital, Zhengzhou, China.,Institute of Hematology, Henan Provincial People's Hospital, Zhengzhou, China.,Henan Key Laboratory of Stem Cell Differentiation and Modification, Zhengzhou, China
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Impact of CD56 Continuously Recognizable as Prognostic Value of Acute Promyelocytic Leukemia: Results of Multivariate Analyses in the Japan Adult Leukemia Study Group (JALSG)-APL204 Study and a Review of the Literature. Cancers (Basel) 2020; 12:cancers12061444. [PMID: 32492981 PMCID: PMC7352829 DOI: 10.3390/cancers12061444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND After long-term analysis of the JALSG-APL204 study we recently reported that maintenance therapy with tamibarotene was more effective than all-trans retinoic acid (ATRA) by reducing relapse in APL patients. Here, the clinical significance of other important prognostic factors was evaluated with multivariate analyses. PATIENTS AND METHODS Newly diagnosed acute promyelocytic leukemia (APL) patients were registered with the study. Induction was composed of ATRA and chemotherapy. Patients who achieved molecular remission after consolidation were randomly assigned to maintenance with tamibarotene or ATRA. RESULTS Of the 344 eligible patients, 319 (93%) achieved complete remission (CR). After completing consolidation, 269 patients underwent maintenance random assignment-135 to ATRA, and 134 to tamibarotene. By multivariate analysis, overexpression of CD56 in blast was an independent unfavorable prognostic factor for relapse-free survival (RFS) (p = 0.006) together with more than 10.0 × 109/L WBC counts (p = 0.001) and the ATRA arm in maintenance (p = 0.028). Of all phenotypes, CD56 was related most clearly to an unfavorable prognosis. The CR rate, mortality rate during induction and overall survival of CD56+ APL were not significantly different compared with CD56- APL. CD56 is continuously an independent unfavorable prognostic factor for RFS in APL patients treated with ATRA and chemotherapy followed by ATRA or tamibarotene maintenance therapy.
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20
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Gill HS, Yim R, Kumana CR, Tse E, Kwong YL. Oral arsenic trioxide, all-trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long-term results and unique prognostic indicators. Cancer 2020; 126:3244-3254. [PMID: 32365228 DOI: 10.1002/cncr.32937] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of arsenic trioxide (As2 O3 ) in the maintenance of first complete remission (CR1) in acute promyelocytic leukemia (APL) is unclear. METHODS A total of 129 consecutive adult patients with APL of all risk categories who achieved CR1 with conventional induction (all-trans retinoic acid [ATRA]/daunorubicin) and consolidation (daunorubicin/cytarabine [induction daunorubicin and consolidation omitted for age ≥70 years]) underwent maintenance comprising ATRA (45 mg/m2 /day), oral As2 O3 (10 mg/day), and ascorbic acid (1 g/day) (AAA) for 2 weeks every 2 months for 2 years. RESULTS Over a 17-year period from August 1, 2002, to July 31, 2019, 63 men and 66 women (median age, 46 years [range, 18-82 years]) received AAA maintenance, which was already completed in 117 patients. At a median follow-up of 100 months (range, 8-215 months), 17 patients (13%) developed first relapse (R1) (hematologic, n = 14; molecular, n = 3) after a median of 19 months (range, 7-96 months) from CR1. Two R1 patients had concomitant central nervous system (CNS) involvement. All patients achieved CR2 with oral As2 O3 -based salvage. Five patients had a subsequent relapse and died. Eight patients died of unrelated causes while still in CR1. The 5-year and 10-year rates of relapse-free survival (RFS) were 89% and 85%, respectively. The 5-year and 10-year rates of overall survival (OS) were 94% and 87%, respectively. Multivariate analysis showed that inferior RFS was associated with FLT3-ITD (P = .005) and CNS involvement on presentation (P = .004), and inferior OS was associated with therapy-related APL (P = .03), FLT3-ITD (P = .03), and relapse (P = .03). The safety profile was favorable, with no grade 3/4 organ toxicities. CONCLUSION CR1 maintenance with AAA is safe and results in favorable long-term survival in patients with APL.
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Affiliation(s)
- Harinder S Gill
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Rita Yim
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Cyrus R Kumana
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Eric Tse
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Yok-Lam Kwong
- Department of Medicine, University of Hong Kong, Hong Kong, China
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21
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Kayser S, Rahmé R, Martínez-Cuadrón D, Ghiaur G, Thomas X, Sobas M, Guerci-Bresler A, Garrido A, Pigneux A, Gil C, Raffoux E, Tormo M, Vey N, de la Serna J, Salamero O, Lengfelder E, Levis MJ, Fenaux P, Sanz MA, Platzbecker U, Schlenk RF, Adès L, Montesinos P. Outcome of older (≥70 years) APL patients frontline treated with or without arsenic trioxide-an International Collaborative Study. Leukemia 2020; 34:2333-2341. [PMID: 32076120 PMCID: PMC8318880 DOI: 10.1038/s41375-020-0758-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/10/2020] [Indexed: 01/21/2023]
Abstract
Data on outcome in older (≥70 years) patients with acute promyelocytic leukemia after treatment with arsenic trioxide (ATO) compared with standard chemotherapy (CTX) is scarce. We evaluated 433 patients (median age, 73.4 years) treated either with ATO+ all-trans retinoic acid (ATO/ATRA; n = 26), CTX/ATRA + ATO during consolidation (CTX/ATRA/ATO; n = 148), or with CTX/ATRA (n = 259). Median follow-up for overall survival (OS) was 4.8 years. Complete remissions (CR) were achieved in 92% with ATO/ATRA and 82% with CTX/ATRA; induction death rates were 8% and 18%, respectively. For analysis of postremission outcomes we combined the ATO/ATRA and CTX/ATRA/ATO groups (ATO/ATRA ± CTX). Cumulative incidence of relapse (CIR) was significantly lower after ATO/ATRA ± CTX compared with CTX/ATRA (P < 0.001). The same held true when restricting the analysis according to the treatment period after the year 2000. OS of patients in CR1 was not different between ATO/ATRA ± CTX compared with CTX/ATRA (P = 0.20). High (>10 × 109/l) white blood cell (WBC) counts at diagnosis were associated with higher CIR (P < 0.001) compared with lower WBC in the CTX/ATRA group, but not in the ATO/ATRA ± CTX group (P = 0.48). ATO, when added to ATRA or CTX/ATRA is feasible and effective in elderly patients for remission induction and consolidation, particularly in patients with high WBC at diagnosis.
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Affiliation(s)
- Sabine Kayser
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.
| | - Ramy Rahmé
- Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Gabriel Ghiaur
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Xavier Thomas
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, Lyon, France
| | - Marta Sobas
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ana Garrido
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnaud Pigneux
- Department of Hematology, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | | | | | - Olga Salamero
- Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Eva Lengfelder
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Pierre Fenaux
- Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,NCT Trial Center, National Center for Tumor Diseases, German Cancer Research Center and Heidelberg University Hospital, Heidelberg, Germany
| | - Lionel Adès
- Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic, La Fe, Avinguda Fernando Abril Martorell, 106, 46026, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
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22
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The prognosis predictive value of FMS-like tyrosine kinase 3-internal tandem duplications mutant allelic ratio (FLT3-ITD MR) in patients with acute myeloid leukemia detected by GeneScan. Gene 2020; 726:144195. [DOI: 10.1016/j.gene.2019.144195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 01/04/2023]
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Czogała M, Pawińska-Wa Sikowska K, Ksia Żek T, Sikorska-Fic B, Matysiak M, Rodziewicz-Konarska A, Chybicka A, Skalska-Sadowska J, Wachowiak J, Muszyńska-Rosłan K, Krawczuk-Rybak M, Grabowski D, Kowalczyk J, Zielezińska K, Urasiński T, Tomaszewska R, Szczepański T, Karpińska-Derda I, Woszczyk M, Pohorecka J, Karolczyk G, Młynarski W, Mycko K, Badowska W, Skoczeń S, Balwierz W. Treatment Outcome and the Genetic Characteristics of Acute Promyelocytic Leukemia in Children in Poland From 2005 to 2018. Front Pediatr 2020; 8:86. [PMID: 32266181 PMCID: PMC7100382 DOI: 10.3389/fped.2020.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of the study was to analyze the treatment outcome and genetic characteristics of acute promyelocytic leukemia (APL) in children in Poland from 2005 to 2018. Methods: All 41 patients diagnosed with APL in Poland during the analysis period were eligible for the study. In period I (2005-2015), 33 patients were treated with chemotherapy and all-trans retinoic acid (ATRA), and in period II (2015-2018), 3 patients (high risk) received induction chemotherapy with ATRA and arsenic trioxide (ATO), and 5 patients (standard risk) received ATRA and ATO without chemotherapy. Results: Probability of 5-years overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS) was 0.819 ± 0.069, 0.831 ± 0.063, and 0.961 ± 0.037, respectively, in the whole cohort. Four (11%) early deaths were observed. One patient died of severe infection in the course of disease progression. Relapse occurred in one patient, who died finally because of disease progression. All events occurred in the patients from period I. Variant APL was identified in one patient (successfully treated with chemotherapy with ATRA) and complex translocation in one patient (the only patient with relapse). Additional chromosomal aberrations were found in 26% of patients and FLT3-ITD mutation was detected in 44% of patients; none of those changes influenced clinical outcome. Conclusion: Treatment outcome in the analyzed group is similar to the results reported by other study groups. The main cause of death was coagulation disorders in the early stage of disease. Early, accurate diagnosis followed by specific treatment enables the reduction in the number of early deaths.
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Affiliation(s)
- Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
| | - Katarzyna Pawińska-Wa Sikowska
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
| | - Teofila Ksia Żek
- Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland.,Department of Medical Genetics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Sikorska-Fic
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Matysiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Rodziewicz-Konarska
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, Wroclaw, Poland
| | - Alicja Chybicka
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, Wroclaw, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Dominik Grabowski
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Karolina Zielezińska
- Department of Pediatrics, Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Renata Tomaszewska
- Department of Pediatrics Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Szczepański
- Department of Pediatrics Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | | | - Mariola Woszczyk
- Department of Pediatrics, Hematology and Oncology, City Hospital, Chorzów, Poland
| | - Joanna Pohorecka
- Paediatric Department of Hematology and Oncology, Regional Polyclinic Hospital in Kielce, Kielce, Poland
| | - Grażyna Karolczyk
- Paediatric Department of Hematology and Oncology, Regional Polyclinic Hospital in Kielce, Kielce, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Mycko
- Department of Pediatrics and Hematology and Oncology, Province Children's Hospital, Olsztyn, Poland
| | - Wanda Badowska
- Department of Pediatrics and Hematology and Oncology, Province Children's Hospital, Olsztyn, Poland
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
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24
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Mitrovic M, Kostic T, Virijevic M, Karan‐Djurasevic T, Suvajdzic Vukovic N, Pavlovic S, Tosic N. The influence of Wilms' tumor 1 gene expression level on prognosis and risk stratification of acute promyelocytic leukemia patients. Int J Lab Hematol 2019; 42:82-87. [DOI: 10.1111/ijlh.13144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/05/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Mirjana Mitrovic
- Clinic of Hematology Clinical Center of Serbia Belgrade Serbia
- School of Medicine University of Belgrade Belgrade Serbia
| | - Tatjana Kostic
- Institute for Molecular Genetics and Genetic Engineering University of Belgrade Belgrade Serbia
| | - Marijana Virijevic
- Clinic of Hematology Clinical Center of Serbia Belgrade Serbia
- School of Medicine University of Belgrade Belgrade Serbia
| | | | - Nada Suvajdzic Vukovic
- Clinic of Hematology Clinical Center of Serbia Belgrade Serbia
- School of Medicine University of Belgrade Belgrade Serbia
| | - Sonja Pavlovic
- Institute for Molecular Genetics and Genetic Engineering University of Belgrade Belgrade Serbia
| | - Natasa Tosic
- Institute for Molecular Genetics and Genetic Engineering University of Belgrade Belgrade Serbia
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25
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Rasekh EO, Elsayed GM, Madney Y, El Gammal MM. Prognostic Significance of bcr-1 and bcr-3 Isoforms of PML-RARA and FLT3-ITD in Patients With Acute Promyelocytic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:156-167. [PMID: 32033928 DOI: 10.1016/j.clml.2019.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/19/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) has a characteristic peculiar morphologic and genetic features as well as a more favorable outcome. We studied the differential effect of bcr-1 and bcr-3 isoforms of the promyelocytic leukemia/retinoic acid receptor alpha (PML-RARA) transcript together with FLT3 internal tandem duplication (FLT3-ITD) mutation status on the outcome of newly diagnosed de novo APL patients. PATIENTS AND METHODS This cohort study included all patients diagnosed with APL at outpatient medical and pediatric oncology clinics of the National Cancer Institute, Cairo University, Cairo, Egypt, from May 2012 to January 2018. RESULTS The study included 118 patients with APL, 71 adults (60.2%) and 47 children (39.8%). Median (range) age was 25 (1.5-70) years. Children had significantly higher total leukocyte count (≥10 × 109/L), disseminated intravascular coagulation (DIC), and thrombocytopenia (< 40 × 109/L) than adults (P = .04, .03, and .04, respectively), while the latter group had significantly higher hemorrhage than children (P = .04). FLT3-ITD mutation was detected in the whole group, children, and adults in 23.7%, 30.6%, and 24.6%, respectively. FLT3-ITD mutation was significantly associated with leukocytosis in the whole group (P = .039). bcr-3 was significantly associated with FLT3-ITD mutation in the whole APL cohort and in adults (P = .011, P = .022). All children (both bcr-1 and bcr-3) and all adult patients with bcr-3 experienced CR, while 22 (78.5%) of 28 patients with bcr-1 experienced CR (P = .04). APL patients with DIC and hemorrhage had significantly lower overall survival (P = .002 and < .001, respectively). Overall survival for APL in children was significantly better than in adults (P = .005). Multivariate analysis indicated that age was an independent prognostic variable affecting survival (hazard ratio = 2.6; 95% confidence interval, 1.3-5.3; P = .007) (adults had hazard ratio of death 2.6 times higher than children). DIC and FLT3-ITD were independent prognostic variables affecting survival in children with APL (hazard ratio = 12.3; 95% confidence interval, 1.46-104.61; P = .021; and hazard ratio = 5.2; 95% confidence interval, 1.01-26.95; P = .048, respectively). CONCLUSION Age is an independent prognostic factor for APL. bcr-3 is significantly associated with FLT3-ITD in adults with APL. DIC and FLT3-ITD are adverse prognostic factors in children with APL. Despite children being at higher risk, outcome is better than in adults.
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Affiliation(s)
- Eman O Rasekh
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ghada M Elsayed
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Youssef Madney
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mosaad M El Gammal
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
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26
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Picharski GL, Andrade DP, Fabro ALMR, Lenzi L, Tonin FS, Ribeiro RC, Figueiredo BC. The Impact of Flt3 Gene Mutations in Acute Promyelocytic Leukemia: A Meta-Analysis. Cancers (Basel) 2019; 11:E1311. [PMID: 31492033 PMCID: PMC6770268 DOI: 10.3390/cancers11091311] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 12/21/2022] Open
Abstract
The association of FLT3 mutations with white blood cell (WBC) counts at diagnosis and early death was studied in patients with acute promyelocytic leukemia (APL). Publications indexed in databases of biomedical literature were analyzed. Potential publication bias was evaluated by analyzing the standard error in funnel plots using the estimated relative risk (RR). Mixed-effect models were used to obtain the consolidated RR. All analyses were conducted using the R statistical software package. We used 24 publications in the final meta-analysis. Of 1005 males and 1376 females included in these 24 publications, 645 had FLT3-ITD (internal tandem duplication) mutations. Information on FLT3-D835 mutations was available in 10 publications for 175 patients. Concurrent occurrence of the two mutations was rare. WBC count at diagnosis was ≥10 × 109/L in 351 patients. For patients with the FLT3-ITD mutation, RR was 0.59 for overall survival (OS) and 1.62 for death during induction. For those with FLT3-D835 mutations, the RR was 0.50 for OS and 1.77 for death during induction. RR for WBC count ≥10 × 109/L was 3.29 and 1.48 for patients with FLT3-ITD and FLT3-D835, respectively. APL patients with FLT3-ITD or FLT3-D835 are more likely to present with elevated WBC counts and poorer prognosis than those without these mutations.
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Affiliation(s)
- Gledson L Picharski
- Instituto de Pesquisa Pelé Pequeno Príncipe, 1532 Silva Jardim, AV., Curitiba, Paraná 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, Paraná 80230-902, Brazil
| | - Diancarlos P Andrade
- Instituto de Pesquisa Pelé Pequeno Príncipe, 1532 Silva Jardim, AV., Curitiba, Paraná 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, Paraná 80230-902, Brazil
| | - Ana Luiza M R Fabro
- Instituto de Pesquisa Pelé Pequeno Príncipe, 1532 Silva Jardim, AV., Curitiba, Paraná 80250-200, Brazil
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, Paraná 80230-902, Brazil
- Unidade de Hematologia e Oncologia Pequeno Príncipe Hospital, 1070 Dsembargador Motta Av., Curitiba, Paraná 80250-060, Brazil
| | - Luana Lenzi
- Instituto de Pesquisa Pelé Pequeno Príncipe, 1532 Silva Jardim, AV., Curitiba, Paraná 80250-200, Brazil
- Universidade Federal do Paraná, 632 Pref Lothário Meissner Av., Curitiba, Paraná 80210-170, Brazil
| | - Fernanda S Tonin
- Universidade Federal do Paraná, 632 Pref Lothário Meissner Av., Curitiba, Paraná 80210-170, Brazil
| | - Raul C Ribeiro
- Department of Oncology, Leukemia and Lymphoma Division, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.
| | - Bonald C Figueiredo
- Instituto de Pesquisa Pelé Pequeno Príncipe, 1532 Silva Jardim, AV., Curitiba, Paraná 80250-200, Brazil.
- Faculdades Pequeno Príncipe, 333 Iguaçu Av., Rebouças, Curitiba, Paraná 80230-902, Brazil.
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), 400 Agostinho Leão Jr. Av., Curitiba, Paraná 80030-110, Brazil.
- Departamento de Saúde Coletiva, Universidade Federal do Paraná, 260 Padre Camargo St., Centro, Curitiba, Paraná 80060-240, Brazil.
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27
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Combining gene mutation with gene expression analysis improves outcome prediction in acute promyelocytic leukemia. Blood 2019; 134:951-959. [PMID: 31292112 DOI: 10.1182/blood.2019000239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022] Open
Abstract
By combining the analysis of mutations with aberrant expression of genes previously related to poorer prognosis in both acute promyelocytic leukemia (APL) and acute myeloid leukemia, we arrived at an integrative score in APL (ISAPL) and demonstrated its relationship with clinical outcomes of patients treated with all-trans retinoic acid (ATRA) in combination with anthracycline-based chemotherapy. Based on fms-like tyrosine kinase-3-internal tandem duplication mutational status; the ΔNp73/TAp73 expression ratio; and ID1, BAALC, ERG, and KMT2E gene expression levels, we modeled ISAPL in 159 patients (median ISAPL score, 3; range, 0-10). ISAPL modeling identified 2 distinct groups of patients, with significant differences in early mortality (P < .001), remission (P = .004), overall survival (P < .001), cumulative incidence of relapse (P = .028), disease-free survival (P = .03), and event-free survival (P < .001). These data were internally validated by using a bootstrap resampling procedure. At least for patients treated with ATRA and anthracycline-based chemotherapy, ISAPL modeling may identify those who need to be treated differently to maximize their chances for a cure.
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28
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Thomas X. Acute Promyelocytic Leukemia: A History over 60 Years-From the Most Malignant to the most Curable Form of Acute Leukemia. Oncol Ther 2019; 7:33-65. [PMID: 32700196 PMCID: PMC7360001 DOI: 10.1007/s40487-018-0091-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 02/07/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) that is cytogenetically characterized by a balanced reciprocal translocation between chromosomes 15 and 17, which results in the fusion of the promyelocytic leukemia (PML) and retinoic acid receptor alpha (RARα) genes. Because patients with APL present a tendency for severe bleeding, often resulting in an early fatal course, APL was historically considered to be one of the most fatal forms of acute leukemia. However, therapeutic advances, including anthracycline- and cytarabine-based chemotherapy, have significantly improved the outcomes of APL patients. Due to the further introduction of all-trans retinoic acid (ATRA) and-more recently-the development of arsenic trioxide (ATO)-containing regimens, APL is currently the most curable form of AML in adults. Treatment with these new agents has introduced the concept of cure through targeted therapy. With the advent of revolutionary ATRA-ATO combination therapies, chemotherapy can now be safely omitted from the treatment of low-risk APL patients. In this article, we review the six-decade history of APL, from its initial characterization to the era of chemotherapy-free ATRA-ATO, a model of cancer-targeted therapy.
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Affiliation(s)
- Xavier Thomas
- Hospices Civils de Lyon, Hematology Department, Lyon-Sud University Hospital, Pierre Bénite, France.
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29
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Arsenic and old FLT3. Blood 2019; 133:1392-1393. [DOI: 10.1182/blood-2019-02-899286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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FLT3-ITD impedes retinoic acid, but not arsenic, responses in murine acute promyelocytic leukemias. Blood 2019; 133:1495-1506. [PMID: 30674471 DOI: 10.1182/blood-2018-07-866095] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/16/2019] [Indexed: 12/21/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is often associated with activating FLT3 signaling mutations. These are highly related to hyperleukocytosis, a major adverse risk factor with chemotherapy-based regimens. APL is a model for oncogene-targeted therapies: all-trans retinoic acid (ATRA) and arsenic both target and degrade its ProMyelocytic Leukemia/Retinoic Acid Receptor α (PML/RARA) driver. The combined ATRA/arsenic regimen now cures virtually all patients with standard-risk APL. Although FLT3-internal tandem duplication (ITD) was an adverse risk factor for historical ATRA/chemotherapy regimens, the molecular bases for this effect remain unknown. Using mouse APL models, we unexpectedly demonstrate that FLT3-ITD severely blunts ATRA response. Remarkably, although the transcriptional output of initial ATRA response is unaffected, ATRA-induced PML/RARA degradation is blunted, as is PML nuclear body reformation and activation of P53 signaling. Critically, the combination of ATRA and arsenic fully rescues therapeutic response in FLT3-ITD APLs, restoring PML/RARA degradation, PML nuclear body reformation, P53 activation, and APL eradication. Moreover, arsenic targeting of normal PML also contributes to APL response in vivo. These unexpected results explain the less favorable outcome of FLT3-ITD APLs with ATRA-based regimens, and stress the key role of PML nuclear bodies in APL eradication by the ATRA/arsenic combination.
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31
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Lv L, Yang L, Cui H, Ma T. A complex translocation (1;17;15) with spliced short-type PML-RARA fusion transcripts in acute promyelocytic leukemia: A case report. Exp Ther Med 2018; 17:1360-1366. [PMID: 30680014 PMCID: PMC6327484 DOI: 10.3892/etm.2018.7091] [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: 07/03/2018] [Accepted: 10/26/2018] [Indexed: 11/08/2022] Open
Abstract
The promyelocytic leukemia (PML)-retinoic acid receptor α (RARA) fusion is hypothesized to serve a vital role in the pathogenesis of acute promyelocytic leukemia (APL), which results from a reciprocal translocation between chromosomes 15 and 17, t(15;17)(q24;q21). A minority of APL cases lack the classical t(15;17) and have been identified to have cryptic or masked t(15;17) or complex translocations. The present study reports on a case of a 37-year-old male with APL harboring a complex three-way translocation t(1;17;15)(q21;q21;q24). This karyotypic interpretation was further confirmed by fluorescence in situ hybridization, and 98% of the bone marrow cells analyzed were positive for the PML-RARA fusion gene. After combined treatment with all-trans retinoic acid and arsenic trioxide, the patient achieved complete remission with no recurrence for 3 years to date. To the best of our knowledge, the present study is the first to report on the novel variant of t(15;17) involving the breakpoint 1q21.
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Affiliation(s)
- Lili Lv
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Honghua Cui
- Department of Oncology and Hematology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Tonghui Ma
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
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32
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Sun J, Zhu J, Zhou D, Zhu L, Yang X, Xie M, Li L, Huang X, Zhu M, Zheng Y, Xie W, Ye X. Factors Affecting Early Death and Survival of Patients With Acute Promyelocytic Leukemia Treated With ATRA-Based Therapy Regimens. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:e63-e70. [PMID: 30661514 DOI: 10.1016/j.clml.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To perform a retrospective analysis of the prognostic relevance of clinicopathologic parameters in a well-documented cohort of patients treated with all-trans-retinoic acid (ATRA)-based induction regimens in order to discover which indicators can predict a high risk of early death (ED) and patient survival. PATIENTS AND METHODS We analyzed data of 288 newly diagnosed adult acute promyelocytic leukemia patients in Hangzhou, China. The median follow-up time was 32 months (range, 6-78 months). RESULTS The 3-year disease-free and overall survival rates were 90.83% and 91.69%, respectively. In the multivariable analysis, older age (≥ 60 years) was the only independent risk factor for ED (hazard ratio [HR] = 15.057; P = .004). High white blood cell count was not a risk factor for ED (P = .055), but it was for relapse (HR = 2.7; P = .009). FLT3 mutation (HR = 3.9; 95% confidence interval, 1.4 to 10; P = .007) and older age (≥ 60 years) (HR = 5.3; 95% confidence interval, 2.4 to 11; P < .001) were prognostic factors for poorer disease-free and overall survival. Interestingly, CD15 negativity (HR = 0.23; P = .049) was a prognostic factor for relapse. The ED rate was 5.9% (17/288 patients). CONCLUSION The perceived impact of the identification of these high-risk factors should be described in order to decide whether any modifications to treatment strategy should be entertained.
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Affiliation(s)
- Jianai Sun
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jingjing Zhu
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - De Zhou
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lixia Zhu
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiudi Yang
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mixue Xie
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Li Li
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xianbo Huang
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mingyu Zhu
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yanlong Zheng
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Wanzhuo Xie
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiujin Ye
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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33
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Singh ZN, Duong VH, Koka R, Zou Y, Sawhney S, Tang L, Baer MR, Ambulos N, El Chaer F, Emadi A. High-Risk Acute Promyelocytic Leukemia with Unusual T/Myeloid Immunophenotype Successfully Treated with ATRA and Arsenic Trioxide-Based Regimen. J Hematop 2018; 11:67-74. [PMID: 30294391 DOI: 10.1007/s12308-018-0329-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We describe two patients with acute promyelocytic leukemia (APL) with an unusual immunophenotype with co-expression of myeloperoxidase (MPO) with cytoplasmic CD3 (cCD3) representing myeloid and T-lineage differentiation. Both harbored FLT3-ITD mutations. One additionally had a deletion in the PML gene affecting the primer binding site, thus limiting measurable residual disease (MRD) analysis during follow-up. Both patients achieved durable remission with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO)-based therapy, thus mitigating the need for repetitive conventional chemotherapy cycles and allogeneic stem cell transplantation. Our report highlights the complexity and challenge of diagnosis and management of APL due to the variant immunophenotype and genetics, and underscores the importance of synthesizing information from all testing modalities. The association of the unusual immunophenotype and FLT3-ITD mutation illustrates the plasticity of the hematopoietic stem cell and the pathobiology of leukemia with mixed lineage or lineage infidelity.
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Affiliation(s)
- Zeba N Singh
- Department of Pathology, University of Maryland School of Medicine
| | - Vu H Duong
- Department of Medicine, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Rima Koka
- Department of Pathology, University of Maryland School of Medicine
| | - Ying Zou
- Department of Pathology, University of Maryland School of Medicine
| | - Sameer Sawhney
- Department of Pathology, University of Maryland School of Medicine
| | - Li Tang
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Maria R Baer
- Department of Medicine, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Nicholas Ambulos
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Firas El Chaer
- Department of Medicine, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Ashkan Emadi
- Department of Medicine, University of Maryland School of Medicine.,Department of Pharmacology, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
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Chen C, Huang X, Wang K, Chen K, Gao D, Qian S. Early mortality in acute promyelocytic leukemia: Potential predictors. Oncol Lett 2018; 15:4061-4069. [PMID: 29541170 PMCID: PMC5835847 DOI: 10.3892/ol.2018.7854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/08/2017] [Indexed: 01/18/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is a rare leukemia characterized by the balanced reciprocal translocation between the promyelocytic leukemia gene on chromosome 15 and the retinoic acid receptor α (RARα) gene on chromosome 17, and accounts for 10-15% of newly diagnosed acute myeloid leukemia each year. The combined use of all-trans retinoic acid and arsenic trioxide (ATO) as primary therapy has markedly improved the survival rate of patients with APL. Mortality in the first 30 days following therapy remains a major contribution to treatment failure. In the present study, published data was reviewed with a focus on the factors associated with early mortality. When treated with ATO as a primary treatment, the fms-like tyrosine kinase-internal tandem deletion has no impact on early mortality. Low lymphoid enhancer binding factor-1 expression may be a reliable marker for early mortality and the target of therapy if it could be proven by further studies. Cluster of differentiation (CD)56+ and CD34+/CD2+ may be candidates to select high-risk patients. The risk of early mortality in APL still cannot be predicted via the cell surface makers, despite multiple studies on their prognostic significance. Typically, a complex translocation did not alter the survival rate in patients with APL; however, if an abnormal karyotype [e.g., Ide(17), ZBTB16/RARα and STAT5B/RARα] appeared singularly or as part of a complex mutation, there is a high possibility of early mortality if clinicians are unable to identify or monitor it.
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Affiliation(s)
- Can Chen
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Xilian Huang
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Kaile Wang
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Kuang Chen
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Danquan Gao
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Shenxian Qian
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
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35
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Lucena-Araujo AR, Pereira-Martins DA, Koury LC, Franca-Neto PL, Coelho-Silva JL, de Deus Wagatsuma VM, Melo RAM, Bittencourt R, Pagnano K, Pasquini R, Chiattone CS, Fagundes EM, Chauffaille MDL, Schrier SL, Tallman MS, Ribeiro RC, Grimwade D, Ganser A, Löwenberg B, Lo-Coco F, Sanz MA, Berliner N, Rego EM. Clinical impact of BAALC expression in high-risk acute promyelocytic leukemia. Blood Adv 2017; 1:1807-1814. [PMID: 29296827 PMCID: PMC5728094 DOI: 10.1182/bloodadvances.2017005926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/13/2017] [Indexed: 01/08/2023] Open
Abstract
Although overexpression of the brain and acute leukemia, cytoplasmic (BAALC) gene is associated with primary resistant disease and shorter relapse-free, disease-free, and overall survival in different subsets of acute myeloid leukemia (AML), little is known about its clinical impact in acute promyelocytic leukemia (APL). Using real-time reverse transcriptase polymerase chain reaction, we showed that BAALC expression is significantly lower in APL compared with other subsets of AML (P < .001). We also demonstrated that BAALC overexpression was associated with shorter disease-free survival (DFS) (hazard ratio [HR], 4.43; 95% confidence interval [CI], 1.29-15.2; P = .018) in 221 consecutive patients (median age, 35 years; range, 18-82 years) with newly diagnosed APL homogeneously treated with all-trans retinoic acid and anthracycline-based chemotherapy. Cox proportional hazard modeling showed that BAALC overexpression was independently associated with shorter DFS in the total cohort (HR, 5.26; 95% CI, 1.52-18.2; P = .009) and in patients with high-risk disease (ie, those with initial leukocyte counts >10 × 109/L) (HR, 5.3; 95% CI, 1.14-24.5; P = .033). We conclude that BAALC expression could be useful for refining risk stratification in APL, although this needs to be confirmed in independent cohorts.
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Affiliation(s)
- Antonio R Lucena-Araujo
- Department of Genetics, Federal University of Pernambuco, Recife, Brazil
- Department of Internal Medicine, Medical School of Ribeirao Preto and
- Center for Cell Based Therapy, University of São Paulo, Ribeirao Preto, Brazil
| | - Diego A Pereira-Martins
- Department of Genetics, Federal University of Pernambuco, Recife, Brazil
- Department of Internal Medicine, Medical School of Ribeirao Preto and
- Center for Cell Based Therapy, University of São Paulo, Ribeirao Preto, Brazil
| | - Luisa C Koury
- Center for Cell Based Therapy, University of São Paulo, Ribeirao Preto, Brazil
| | | | - Juan L Coelho-Silva
- Department of Genetics, Federal University of Pernambuco, Recife, Brazil
- Department of Internal Medicine, Medical School of Ribeirao Preto and
- Center for Cell Based Therapy, University of São Paulo, Ribeirao Preto, Brazil
| | - Virginia M de Deus Wagatsuma
- Department of Internal Medicine, Medical School of Ribeirao Preto and
- Center for Cell Based Therapy, University of São Paulo, Ribeirao Preto, Brazil
| | - Raul A M Melo
- Department of Internal Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Rosane Bittencourt
- Hematology Division, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Katia Pagnano
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | - Ricardo Pasquini
- Hematology Division, Federal University of Paraná, Curitiba, Brazil
| | | | - Evandro M Fagundes
- Hematology Division, Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Martin S Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York, NY
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - David Grimwade
- Department of Medical and Molecular Genetics, School of Medicine, King's College London, London, United Kingdom
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Francesco Lo-Coco
- Department of Biopathology, University Tor Vergata, Rome, Italy
- Santa Lucia Foundation, Rome, Italy
| | - Miguel A Sanz
- Department of Hematology, Valencia University Medical School, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain; and
| | - Nancy Berliner
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eduardo M Rego
- Department of Internal Medicine, Medical School of Ribeirao Preto and
- Center for Cell Based Therapy, University of São Paulo, Ribeirao Preto, Brazil
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36
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Abstract
Acute promyelocytic leukaemia (APML) is a subtype of leukaemia arising from a distinct reciprocal translocation involving chromosomes 15 and 17, which results in the PML-RARA fusion gene. Over the past three decades, APML has been transformed from a highly fatal disease to a highly curable one. This drastic improvement is because of the introduction of a new treatment strategy with all-trans retinoic acid and, more recently, arsenic trioxide. The revolutionary treatment of APML has also paved the way for a new cancer treatment, which is genetically targeted therapy. In this review, we look into this amazing journey of transformation and provide recent advances in the management of APML.
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Affiliation(s)
- Chin-Hin Ng
- National University Cancer Institute, Singapore, Singapore
| | - Wee-Joo Chng
- National University Cancer Institute, Singapore, Singapore
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37
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Ma RJ, Zhu ZM, Yuan XL, Jiang L, Yang SW, Yang J, Guo JM, Shi J, Lei PC, Zhang L, Shang BJ, Sun K, Zhai YP, Li W, Zhang Y. [The analysis of prognosis-associated factors in adults with acute promyelocytic leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:592-596. [PMID: 28810326 PMCID: PMC7342290 DOI: 10.3760/cma.j.issn.0253-2727.2017.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 11/12/2022]
Abstract
Objective: To explore the prognostic value of CD34, CD2, CD56 expressions and FLT3-ITD mutation in adults with acute promyelocytic leukemia (APL) . Methods: The immuno-phenotypic and molecular characteristics of 137 adult patients with APL (from January 2010 to March 2016, in Henan Provincial People's Hospital) were investigated. And the relationships between CD34, CD2, CD56 expressions, FLT3-ITD mutation and the outcomes of high WBC counts at onset, complete remission (CR) rate, early mortality, relapse rate (RR) , overall survival (OS) , disease free survival (DFS) were explored. Results: ①Among the 137 patients, the positive ratios of CD34, CD2, CD56 expressions and mutation rate of FLT3-ITD were 26.3%, 25.5%, 10.2% and 17.5%, respectively. The morbidities of positive CD34, CD2, CD56 expressions and FLT3-ITD mutation in the high-risk group were 43.2%, 47.7%, 18.2% and 27.3% respectively, while those in the low-/intermediate-risk groups were 18.3%, 15.1%, 6.5% and 12.9%, respectively (P<0.05) . ②At a median follow-up of 41 months, the total CR rate of the 137 adults APL patients was 96.9%, early mortality 6.6% and relapse rate 7.3% respectively. And RR of positive CD34 or CD2 expression patients was higher than negative CD34/CD2 expression ones (18.8% vs 3.3%, χ(2)=8.462, P=0.004; 16.1% vs 4.3%, χ(2)=4.382, P=0.028, respectively) . In addition, the early mortality of patients with positive CD56 expression or FLT3-ITD mutation was extremely higher than in negative ones (21.4% vs 4.9%, χ(2)=5.610, P=0.018; 16.7% vs 4.4%, χ(2)=4.833, P=0.028, respectively) . ③The whole OS and DFS were 88.3% and 84.7%, respectively. Wherein, OS and DFS in patients with CD34(+), CD56(+) or FLT3-ITD mutation were worse (P<0.05) . Conclusions: Positive CD34, CD2, CD56 expression and FLT3-ITD mutation were latent poor prognostic factors in adults with APL.
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Affiliation(s)
- R J Ma
- Department of Hematology, Henan Provincial People's Hospital, Henan University, Zhengzhou 450003, China
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38
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Wang LN, Tang YL, Zhang YC, Zhang ZH, Liu XJ, Ke ZY, Li Y, Tan HZ, Huang LB, Luo XQ. Arsenic trioxide and all-trans-retinoic acid selectively exert synergistic cytotoxicity against FLT3-ITD AML cells via co-inhibition of FLT3 signaling pathways. Leuk Lymphoma 2017; 58:2426-2438. [PMID: 28276286 DOI: 10.1080/10428194.2017.1289522] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
FLT3-ITD mutations occur in approximately 30% of acute myeloid leukemia (AML) and are associated with a poor outcome. Currently available FLT3 inhibitors have in vitro but limited clinical activity in FLT3-ITD AML. Reports have shown that an arsenic trioxide (ATO)/all-trans-retinoic acid (ATRA) combination improves prognosis in acute promyelocytic leukemia, especially with FLT3-ITD, and ATO or ATRA alone enhances apoptosis in FLT3-ITD AML cells treated with FLT3 inhibitors, providing a rationale to investigate the role of ATO/ATRA in FLT3-ITD AML. Here, we demonstrate that an ATO/ATRA combination selectively exerts synergistic cytotoxicity against FLT3-ITD AML cell lines (MV4;11/MOLM-13). The signaling pathways affected by ATO/ATRA include FLT3/STAT5/MYC, FLT3/STAT5/E2F1, FLT3/ERK/ATF5 and FLT3/AKT/ATF5.ATF5 may function as an oncogene in FLT3-ITD AML. Our findings provide experimental evidence that supports further exploration of ATO/ATRA in FLT3-ITD AML in vivo and warrants a clinical evaluation of regimens comprising an ATO/ATRA combination.
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Affiliation(s)
- Li-Na Wang
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Yan-Lai Tang
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Yin-Chuan Zhang
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zu-Han Zhang
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Xiao-Jian Liu
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zhi-Yong Ke
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Yu Li
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Hui-Zhen Tan
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Li-Bin Huang
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Xue-Qun Luo
- a Department of Pediatrics , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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39
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Gao N, Wang XX, Sun JR, Yu WZ, Li XZ. Clinical impact of galectin-3 in newly diagnosed t (15;17)(q22;q21)/PML-RARa acute promyelocytic leukemia treated with all-trans retinoic acid and arsenic trioxide-based regimens. Ann Hematol 2017; 96:711-718. [DOI: 10.1007/s00277-017-2948-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 02/04/2017] [Indexed: 11/30/2022]
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40
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Abstract
Molecular genetic and molecular biology methods enable one to reveal pathogenetic basis of oncohematological diseases, they are particular useful for diagnostic purpouses, to control and evaluate treatment efficiency. In leukemia patients there are two different types of chromosomal anomalities: some of them give rise for chimeric oncogenes, others activate hyperexpression of regulatory genes. It is necessary to take into account this difference in order to proparely develop molecular genetic tests. Molecular tests are more sensitive to compare with other approaches, due to this fact they are especially useful to monitor residual leukemia cells and for early detection of relapse.
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41
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Crespo-Solis E, Contreras-Cisneros J, Demichelis-Gómez R, Rosas-López A, Vera-Zertuche JM, Aguayo A, López-Karpovitch X. Survival and treatment response in adults with acute promyelocytic leukemia treated with a modified International Consortium on Acute Promyelocytic Leukemia protocol. Rev Bras Hematol Hemoter 2016; 38:285-290. [PMID: 27863754 PMCID: PMC5119665 DOI: 10.1016/j.bjhh.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/29/2016] [Accepted: 08/24/2016] [Indexed: 11/03/2022] Open
Abstract
Acute promyelocytic leukemia has good prognosis in view of the high complete remission and survival rates achieved with therapies containing all-trans retinoic acid or arsenic trioxide. However, there is a significant risk of death during induction due to hemorrhage secondary to disseminated intravascular coagulation. This has contributed to a gap in the prognosis of patients between developed and developing countries. The International Consortium on Acute Promyelocytic Leukemia was created in 2005 and proposed a treatment protocol based on daunorubicin and all-trans retinoic acid stratified by risk geared toward developing countries. Herein are presented the results from the first patient cohort treated in a single developing country hospital employing a slightly modified version of the International Consortium protocol in a real life setting. Twenty patients with acute promyelocytic leukemia were enrolled: 27.8% had low-risk, 55.6% intermediate risk and 16.7% high-risk. The complete remission rate was 94.4% after a median of 42 days. Both relapse rates and death rates were one patient (5.5%) each. No deaths were observed during consolidation. After a median follow-up of 29 months, the overall survival rate was 89.1%. Efficacy and safety of the International Consortium on Acute Promyelocytic Leukemia protocol has been reproduced in acute promyelocytic leukemia patients from a developing country.
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Affiliation(s)
- Erick Crespo-Solis
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico.
| | - Jorge Contreras-Cisneros
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico
| | - Roberta Demichelis-Gómez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico
| | - Adriana Rosas-López
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico
| | | | - Alvaro Aguayo
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico
| | - Xavier López-Karpovitch
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico
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42
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High ΔNp73/TAp73 ratio is associated with poor prognosis in acute promyelocytic leukemia. Blood 2015; 126:2302-6. [PMID: 26429976 DOI: 10.1182/blood-2015-01-623330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/11/2015] [Indexed: 12/14/2022] Open
Abstract
The TP73 gene transcript is alternatively spliced and translated into the transcriptionally active (TAp73) or inactive (ΔNp73) isoforms, with opposite effects on the expression of p53 target genes and on apoptosis induction. The imbalance between ΔNp73 and TAp73 may contribute to tumorigenesis and resistance to chemotherapy in human cancers, including hematologic malignancies. In acute promyelocytic leukemia (APL), both isoforms are expressed, but their relevance in determining response to therapy and contribution to leukemogenesis remains unknown. Here, we provide the first evidence that a higher ΔNp73/TAp73 RNA expression ratio is associated with lower survival, lower disease-free survival, and higher risk of relapse in patients with APL homogeneously treated with all-trans retinoic acid and anthracycline-based chemotherapy, according to the International Consortium on Acute Promyelocytic Leukemia (IC-APL) study. Cox proportional hazards modeling showed that a high ΔNp73/TAp73 ratio was independently associated with shorter overall survival (hazard ratio, 4.47; 95% confidence interval, 1.64-12.2; P = .0035). Our data support the hypothesis that the ΔNp73/TAp73 ratio is an important determinant of clinical response in APL and may offer a therapeutic target for enhancing chemosensitivity in blast cells.
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43
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Giri S, Pathak R, Martin MG, Bhatt VR. Survival of de novo and secondary acute promyelocytic leukemia: a propensity-matched analysis of the SEER database. Leuk Lymphoma 2015; 57:385-391. [PMID: 26084205 DOI: 10.3109/10428194.2015.1063142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prior studies demonstrated that secondary acute promyelocytic leukemia (sAPL) and de novo APL may but not consistently have similar overall survival (OS). We used the Surveillance, Epidemiology, and End Results (SEER) 13 database to compare their OS. Patients with sAPL (n = 90), compared to de novo APL (n = 1600), were more likely to be older, White and diagnosed after year 2005. Mortality rate at 1 month (28.9% vs. 23.0%, p = 0.20) and 5-year OS (42% vs. 50%, p = 0.24) was similar between sAPL and de novo APL. In a multivariate analysis, sAPL was associated with similar OS as de novo APL (hazard ratio, HR 1.11; 95% confidence interval, CI 0.78-1.58; p = 0.546). This population-based study demonstrated no difference in OS or early mortality rate between sAPL and de novo APL. sAPL can be managed very similarly to de novo APL and does not need to be excluded from clinical trials of APL.
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Affiliation(s)
- Smith Giri
- a Department of Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Ranjan Pathak
- b Department of Medicine , Reading Health System , Reading , PA , USA
| | - Mike G Martin
- a Department of Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Vijaya Raj Bhatt
- c University of Nebraska Medical Center , Department of Internal Medicine, Division of Hematology-Oncology , Omaha, Nebraska , USA
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44
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FLT3-ITD in acute promyelocytic leukemia: Clinical distinct profile but still controversial prognosis. Leuk Res 2015; 39:397-9. [DOI: 10.1016/j.leukres.2015.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 01/07/2015] [Accepted: 01/11/2015] [Indexed: 11/22/2022]
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45
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Souza Melo CP, Campos CB, Dutra ÁP, Neto JCA, Fenelon AJS, Neto AH, Carbone EK, Pianovski MAD, Ferreira ACDS, Assumpcão JG. Correlation between FLT3-ITD status and clinical, cellular and molecular profiles in promyelocytic acute leukemias. Leuk Res 2014; 39:131-7. [PMID: 25530565 DOI: 10.1016/j.leukres.2014.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
Internal tandem duplications (ITD) of FLT3 gene occur in about a third of acute promyelocytic leukemias (APL). We investigated the patterns of blood count, surface antigen, expression, chromosome aberrations, PML-RARa isoform, gene expression profile (GEP) and survival in 34 APL patients according to FLT3-ITD status. 97% had a t(15;17) and all of them carried PML-RARa gene fusion, 8 (23.5%) had a FLT3-ITD mutation. Presence of ITD was associated with higher Hb and WBC levels, bcr3 isoform, CD34 expression, CD2 or CD2/CD34 expression. In a multivariate analysis, Hb>9.6g/dL and WBC≥20 × 10(9)/L were important factors for predicting ITD presence. GEP showed that FLT3-ITD carriers clustered separately, even when as few as 5 genes were considered. This study provides further evidence that FLT3-ITDs carriers constitute a biologically distinct group of APL patients.
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Affiliation(s)
- Carolina Pereira Souza Melo
- Laboratório BIOCOD Biotecnologia Ltda., Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil.
| | - Catharina Brant Campos
- Laboratório BIOCOD Biotecnologia Ltda., Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil.
| | - Álvaro Pimenta Dutra
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales 1111, Belo Horizonte CEP 30150-221, MG, Brazil.
| | - Joaquim Caetano Aguirre Neto
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales 1111, Belo Horizonte CEP 30150-221, MG, Brazil.
| | - Alexandre José Silva Fenelon
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales 1111, Belo Horizonte CEP 30150-221, MG, Brazil.
| | - Abrahão Hallack Neto
- Hospital Universitário da Universidade Federal de Juiz de Fora, Rua Catulo Breviglieri s/n, Juiz de Fora CEP 36036-110, MG, Brazil.
| | - Edna Kakitani Carbone
- Hospital Pequeno Príncipe, Rua Desembargador Motta 1070, Curitiba CEP 80250-060, PR, Brazil.
| | | | | | - Juliana Godoy Assumpcão
- Laboratório BIOCOD Biotecnologia Ltda., Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil; Setor de Pesquisa e Desenvolvimento-Instituto Hermes Pardini, Av. das Nações 2448, Portaria A, Vespasiano CEP 33200-000, MG, Brazil.
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