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Frikha R, Kassar O, Elloumi M, Kamoun H. Assessment of molecular response to tyrosine kinase inhibitors in Tunisian Patients with Chronic Myeloid Leukemia. J Oncol Pharm Pract 2021; 28:1826-1831. [PMID: 34846219 DOI: 10.1177/10781552211048232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM This study was carried out to assess the minimal residual disease in Tunisian patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors in routine clinical practice, to recognize potentially eligible carrier for treatment discontinuation, based on a molecular response (MR). PATIENTS AND METHODS A retrospective study was carried out in the Hospital University of Sfax, south of Tunisia from January 2016 to October 2020, including all CML patients in the chronic phase at diagnosis, treated with TKI (tyrosine kinase inhibitors) for a minimum duration of 6 months. Quantitative assessment of the BCR-ABL transcript was performed using the Cepheid Xpert BCR-ABL ultra-assay. Molecular response and outcome were evaluated, according to the European Leukemia Net guidelines. RESULTS A total of 162 CML patients were carried out. The median age was 50 years, the sex ratio M/F was 1.62. The rate of cumulative EMR; MMR and DMR was 80.8%; 73.8% and 55.9% respectively. According to the ELN criteria, 141 CML patients were evaluable. Optimal, suboptimal response and failure were noted in 81 (57.4%), 33(23.4%), and 27(19.1%) patients, respectively. Overall survival (OS) and progression-free survival (PFS) were 96.3% and 85%. Risk factors for an event (death/progression) were lack of EMR, MMR, and DMR (P < 0.05). Among 149 patients with sustained DMR; 14 (8.6%) CML patients have discontinued TKI therapy. CONCLUSION Despite the limit of our study (duration and size), the available real-life molecular responses with TKI therapy should be considered to identify potentially CML patients eligible for discontinuation of TKI therapy.
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Affiliation(s)
- Rim Frikha
- Department of Medical Genetics, Hospital Hédi Chaker of Sfax, Tunisia
| | - Olfa Kassar
- Department of Haematology, Hospital Hédi Chaker of Sfax, Tunisia
| | - Moez Elloumi
- Department of Haematology, Hospital Hédi Chaker of Sfax, Tunisia
| | - Hassen Kamoun
- Department of Medical Genetics, Hospital Hédi Chaker of Sfax, Tunisia
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2
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Karpurmath SV, Seshachalam A, Selvaraj K, Rajamani P, kumar S, Reddy N, Malipatil B, Sirigeri R, Prasad K, Reddy K, Danthala M, Udupa KS, Nandennavar M, Murugesan J, Patil C, Anoop P, Jacob RK, Kalashetty M, Rathnam K, Ganapathy R. Halving Time of BCR-ABL1 in Chronic Myeloid Leukemia: Is It Better Than Day-90 Value—A Multicenter Study From South India. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e205-e211. [DOI: 10.1016/j.clml.2019.09.606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 11/25/2022]
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3
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Molecular biology as a tool for the treatment of cancer. Clin Exp Med 2018; 18:457-464. [PMID: 30006681 DOI: 10.1007/s10238-018-0518-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/08/2018] [Indexed: 12/30/2022]
Abstract
Cancer is a genetic disease characterized by uncontrolled cell growth and metastasis. Cancer can have a number of causes, such the activation of oncogenes, the inactivation of tumor-suppressing genes, mutagenesis provoked by external factors, and epigenetic modifications. The development of diagnostic tools and treatments using a molecular biological approach permits the use of sensitive, low-cost, noninvasive tests for cancer patients. Biomarkers can be used to provide rapid, personalized oncology, in particular the molecular diagnosis of chronic myeloid leukemia, and gastric, colon, and breast cancers. Molecular tests based on DNA methylation can also be used to direct treatments or evaluate the toxic effects of chemotherapy. The adequate diagnosis, prognosis, and prediction of the response of cancer patients to treatment are essential to ensure the most effective therapy, reduce the damaging effects of treatment, and direct the therapy to specific targets, and in this context, molecular biology has become increasingly important in oncology. In this brief review, we will demonstrate the fundamental importance of molecular biology for the treatment of three types of cancer-chronic myeloid leukemia, hereditary diffuse gastric cancer, and astrocytomas (sporadic tumors of the central nervous system). In each of these three models, distinct biological mechanisms are involved in the transformation of the cells, but in all cases, molecular biology is fundamental to the development of personalized analyses for each patient and each type of neoplasia, and to guarantee the success of the treatment.
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Talpaz M, Saglio G, Atallah E, Rousselot P. Dasatinib dose management for the treatment of chronic myeloid leukemia. Cancer 2018; 124:1660-1672. [PMID: 29370463 PMCID: PMC5901015 DOI: 10.1002/cncr.31232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/01/2017] [Accepted: 12/15/2017] [Indexed: 11/09/2022]
Abstract
Chronic myeloid leukemia (CML) has evolved into a chronic disease that is managed with tyrosine kinase inhibitor therapy. Now that long-term survival has been achieved in patients with CML, the focus of treatment has shifted to dose optimization, with the goal of maintaining response while improving quality of life. In this review, the authors discuss optimizing the dose of the second-generation tyrosine kinase inhibitor dasatinib. Once-daily dosing regimens for dasatinib in the first and later lines of treatment were established through long-term (5-year and 7-year) trials. Recently published data have indicated that further dose optimization may maintain efficacy while minimizing adverse events. Results obtained from dose optimization and discontinuation trials currently in progress will help practitioners determine the best dose and duration of dasatinib for patients with CML, because treatment decisions will be made through continued discussions between physicians and patients. Cancer 2018;124:1660-72. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Affiliation(s)
- Moshe Talpaz
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of Michigan Cancer CenterAnn ArborMichigan
| | - Giuseppe Saglio
- Department of Clinical and Biological SciencesUniversity of Turin, San Luigi HospitalOrbassano‐TorinoItaly
| | - Ehab Atallah
- Department of Hematology and OncologyMedical College of WisconsinMilwaukeeWisconsin
| | - Philippe Rousselot
- Department of Hematology and Oncology, Versailles Medical Center, INSERM UMR 1173University of Versailles Saint‐Quenti‐en‐YvelinesParis SaclayLe ChesnayFrance
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5
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A clinical observation of Chinese chronic myelogenous leukemia patients after discontinuation of tyrosine kinase inhibitors. Oncotarget 2018; 7:58234-58243. [PMID: 27533462 PMCID: PMC5295427 DOI: 10.18632/oncotarget.11281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 08/08/2016] [Indexed: 12/15/2022] Open
Abstract
Whether tyrosine kinase inhibitors (TKIs) can be safely discontinued is a key focus of chronic myelogenous leukemia (CML) at present. We report a clinical observation of TKIs cessation in Chinese CML patients and a probable connection between CML leukemia stem cells (LSCs) and relapse. In all, 22 of 1057 patients consented to participate in this observation. The average time of complete molecular response was 12.73 months after TKI withdrawal. LSCs could be flow cytometrically detected in most of the patients. However, the number of LSCs did not differ between the relapsers and non-relapsers. We evaluated the leukemogenetic ability of the LSCs by transplanting bone marrow into irradiated NOD/SCID mice. The results indicated that part of the bone marrow from the relapsers lead to leukemogensis in the mice. Besides, we found that LSCs-derived microvesicles might serve as a novel factor for the stratification of undetectable minimal residual disease and an early warning sign of relapse. In summary, post-TKI cessation relapse seems to show none association with the number of LSCs. A mouse xenograft model would provide a novel and useful method of analyzing LSCs function and predicting relapse. Microvesicles may provide important information about optimal molecular monitoring schedules in TKI discontinuation strategies.
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6
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Carrà G, Torti D, Crivellaro S, Panuzzo C, Taulli R, Cilloni D, Guerrasio A, Saglio G, Morotti A. The BCR-ABL/NF-κB signal transduction network: a long lasting relationship in Philadelphia positive Leukemias. Oncotarget 2018; 7:66287-66298. [PMID: 27563822 PMCID: PMC5323234 DOI: 10.18632/oncotarget.11507] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/10/2016] [Indexed: 12/23/2022] Open
Abstract
The Nuclear Factor-kappa B (NF-κB) family of transcription factors plays a key role in cancer pathogenesis due to the ability to promote cellular proliferation and survival, to induce resistance to chemotherapy and to mediate invasion and metastasis. NF-κB is recruited through different mechanisms involving either canonical (RelA/p50) or non-canonical pathways (RelB/p50 or RelB/p52), which transduce the signals originated from growth-factors, cytokines, oncogenic stress and DNA damage, bacterial and viral products or other stimuli. The pharmacological inhibition of the NF-κB pathway has clearly been associated with significant clinical activity in different cancers. Almost 20 years ago, NF-κB was described as an essential modulator of BCR-ABL signaling in Chronic Myeloid Leukemia and Philadelphia-positive Acute Lymphoblastic Leukemia. This review summarizes the role of NF-κB in BCR-ABL-mediated leukemogenesis and provides new insights on the long lasting BCR-ABL/NF-κB connection.
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Affiliation(s)
- Giovanna Carrà
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Davide Torti
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Sabrina Crivellaro
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Cristina Panuzzo
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Riccardo Taulli
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Angelo Guerrasio
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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7
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Morotti A, Crivellaro S, Panuzzo C, Carrà G, Guerrasio A, Saglio G. IκB-α: At the crossroad between oncogenic and tumor-suppressive signals. Oncol Lett 2016; 13:531-534. [PMID: 28356925 PMCID: PMC5351326 DOI: 10.3892/ol.2016.5465] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/19/2016] [Indexed: 01/13/2023] Open
Abstract
Nuclear factor κB (NF-κB) is an essential component of tumorigenesis and resistance to cancer treatments. NFKB inhibitor α (IκB-α) acts as a negative regulator of the classical NF-κB pathway through its ability to maintain the presence of NF-κB in the cytoplasm. However, IκB-α is also able to form a complex with tumor protein p53, promoting its inactivation. Recently, we demonstrated that IκB-α is able to mediate p53 nuclear exclusion and inactivation in chronic myeloid leukemia, indicating that IκB-α can modulate either oncogenic or tumor-suppressive functions, with important implications for cancer treatment. The present review describes the role of IκB-α in cancer pathogenesis, with particular attention to hematological cancers, and highlights the involvement of IκB-α in the regulation of p53 tumor-suppressive functions.
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Affiliation(s)
- Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Orbassano, Turin, Italy
| | - Sabrina Crivellaro
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Orbassano, Turin, Italy
| | - Cristina Panuzzo
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Orbassano, Turin, Italy
| | - Giovanna Carrà
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Orbassano, Turin, Italy
| | - Angelo Guerrasio
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Orbassano, Turin, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, I-10043 Orbassano, Turin, Italy
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8
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Carrà G, Crivellaro S, Taulli R, Guerrasio A, Saglio G, Morotti A. Mechanisms of p53 Functional De-Regulation: Role of the IκB-α/p53 Complex. Int J Mol Sci 2016; 17:ijms17121997. [PMID: 27916821 PMCID: PMC5187797 DOI: 10.3390/ijms17121997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 02/06/2023] Open
Abstract
TP53 is one of the most frequently-mutated and deleted tumor suppressors in cancer, with a dramatic correlation with dismal prognoses. In addition to genetic inactivation, the p53 protein can be functionally inactivated in cancer, through post-transductional modifications, changes in cellular compartmentalization, and interactions with other proteins. Here, we review the mechanisms of p53 functional inactivation, with a particular emphasis on the interaction between p53 and IκB-α, the NFKBIA gene product.
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Affiliation(s)
- Giovanna Carrà
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Turin, Italy.
| | - Sabrina Crivellaro
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Turin, Italy.
| | - Riccardo Taulli
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Turin, Italy.
| | - Angelo Guerrasio
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Turin, Italy.
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Turin, Italy.
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Turin, Italy.
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9
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Efficace F, Breccia M, Cottone F, Okumura I, Doro M, Riccardi F, Rosti G, Baccarani M. Psychological well-being and social support in chronic myeloid leukemia patients receiving lifelong targeted therapies. Support Care Cancer 2016; 24:4887-4894. [PMID: 27448405 DOI: 10.1007/s00520-016-3344-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/10/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE The main objective of this study was to investigate whether social support is independently associated with psychological well-being in chronic myeloid leukemia (CML) patients. Secondary objectives were to compare the psychological well-being profile of CML patients with that of their peers in general population and to examine possible age- and sex-related differences. PATIENTS AND METHODS Analysis was performed on 417 patients in treatment with lifelong molecularly targeted therapies. Mean age of patients analyzed was 56 years (range 19-87 years) and 247 (59 %) were male and 170 (41 %) were female. Social support was assessed with the Multidimensional Scale of Perceived Social Support and psychological well-being was evaluated with the short version of the Psychological General Well-Being Index. Descriptive statistics and multivariate logistic regression analyses were used. RESULTS Multivariate logistic regression analysis revealed that a greater social support was independently associated with lower anxiety and depression, as well as with higher positive well-being, self-control, and vitality (p < 0.001). Female patients reported statistically significant worse outcomes in all dimensions of psychological well-being. Age- and sex-adjusted comparisons with population norms revealed that depression (ES = -0.42, p < 0.001) and self-control (ES = -0.48, p < 0.001) were the two main impaired psychological dimensions. CONCLUSION This study indicates that social support is a critical factor associated with psychological well-being of CML patients treated with modern lifelong targeted therapies.
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Affiliation(s)
- Fabio Efficace
- GIMEMA Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Via Benevento, 6, 00161, Rome, Italy.
| | - Massimo Breccia
- Department of Biotechnologies and Hematology, University of Rome Sapienza, Rome, Italy
| | - Francesco Cottone
- GIMEMA Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Via Benevento, 6, 00161, Rome, Italy
| | - Iris Okumura
- Unidade de Hematologia, Hemoterapia e Oncologia (UHHO), Serviço de Transplante de Medula Óssea (STMO), Complexo Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Maribel Doro
- Unidade de Hematologia, Hemoterapia e Oncologia (UHHO), Serviço de Transplante de Medula Óssea (STMO), Complexo Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Gianantonio Rosti
- Department of Hematology-Oncology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Michele Baccarani
- Department of Hematology-Oncology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Protein Kinase CK2: A Targetable BCR-ABL Partner in Philadelphia Positive Leukemias. Adv Hematol 2015; 2015:612567. [PMID: 26843864 PMCID: PMC4710905 DOI: 10.1155/2015/612567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/20/2015] [Indexed: 12/23/2022] Open
Abstract
BCR-ABL-mediated leukemias, either Chronic Myeloid Leukemia (CML) or Philadelphia positive Acute Lymphoblastic Leukemia (ALL), are the paradigm of targeted molecular therapy of cancer due to the impressive clinical responses obtained with BCR-ABL specific tyrosine kinase inhibitors (TKIs). However, BCR-ABL TKIs do not allow completely eradicating both CML and ALL. Furthermore, ALL therapy is associated with much worse responses to TKIs than those observed in CML. The identification of additional pathways that mediate BCR-ABL leukemogenesis is indeed mandatory to achieve synthetic lethality together with TKI. Here, we review the role of BCR-ABL/protein kinase CK2 interaction in BCR-ABL leukemias, with potentially relevant implications for therapy.
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11
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Morotti A, Panuzzo C, Crivellaro S, Carrà G, Torti D, Guerrasio A, Saglio G. The Role of PTEN in Myeloid Malignancies. Hematol Rep 2015; 7:5844. [PMID: 26734127 PMCID: PMC4691678 DOI: 10.4081/hr.2015.6027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/20/2015] [Indexed: 12/31/2022] Open
Abstract
PTEN deletion in the mouse and in the zebrafish highlights the essential role of this tumor suppressor in the development of myeloid malignancies, in particular acute myeloid leukemia and myeloproliferative disorders. In humans, extensive genetic sequences of myeloid malignancies did not reveal recurrent PTEN mutations and deletions. However, PTEN was shown to be functionally inactivated in several acute myeloid leukemia and chronic myeloid leukemia samples, through both post-trasductional modifications, changes in protein levels and cellular compartmentalization. Notably, non genomic inactivation of PTEN in myeloid malignancies could represent a challenging therapeutic opportunity for these diseases. Targeting those mechanisms that affect PTEN function could indeed promote PTEN reactivation with consequent cancer selective apoptosis induction. In this review we will describe the role of PTEN in the development of myeloid malignancies.
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Affiliation(s)
- Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin , Orbassano, Italy
| | - Cristina Panuzzo
- Department of Clinical and Biological Sciences, University of Turin , Orbassano, Italy
| | - Sabrina Crivellaro
- Department of Clinical and Biological Sciences, University of Turin , Orbassano, Italy
| | - Giovanna Carrà
- Department of Clinical and Biological Sciences, University of Turin , Orbassano, Italy
| | - Davide Torti
- Department of Clinical and Biological Sciences, University of Turin , Orbassano, Italy
| | - Angelo Guerrasio
- Department of Clinical and Biological Sciences, University of Turin , Orbassano, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin , Orbassano, Italy
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