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Wenge DV, Wethmar K, Klar CA, Kolve H, Sauer T, Angenendt L, Evers G, Call S, Kerkhoff A, Khandanpour C, Kessler T, Mesters R, Schliemann C, Mikesch JH, Reicherts C, Brüggemann M, Berdel WE, Lenz G, Stelljes M. Characteristics and Outcome of Elderly Patients (>55 years) with Acute Lymphoblastic Leukemia. Cancers (Basel) 2022; 14:cancers14030565. [PMID: 35158832 PMCID: PMC8833618 DOI: 10.3390/cancers14030565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Disease-specific mortality of acute lymphoblastic leukemia (ALL) increases with age. So far, only a few analyses have investigated disease characteristics of elderly patients (>55 years) with newly diagnosed ALL. The aim of our retrospective study was to evaluate the treatment results of 93 elderly patients who received intensive chemotherapy between May 2003 and October 2020. We identify poor performance status and older age at the time of diagnosis as risk factors for inferior outcomes, while ALL immunophenotype, BCR::ABL1 status, the complexity of karyotype, and intensity of treatment did not significantly affect overall survival (OS). With 17.3% of patients dying while in complete remission (CR), an event-free survival (EFS) and OS of 32.9% and 47.3% at 3 years, our data suggest that intensive treatment of elderly ALL patients is feasible but associated with significant toxicity. These results underline the need for novel, less toxic treatment approaches for this vulnerable cohort of patients. Abstract Prognosis of elderly ALL patients remains dismal. Here, we retrospectively analyzed the course of 93 patients > 55 years with B-precursor (n = 88) or T-ALL (n = 5), who received age-adapted, pediatric-inspired chemotherapy regimens at our center between May 2003 and October 2020. The median age at diagnosis was 65.7 years, and surviving patients had a median follow-up of 3.7 years. CR after induction therapy was documented in 76.5%, while the rate of treatment-related death within 100 days was 6.4%. The OS of the entire cohort at 1 and 3 year(s) was 75.2% (95% CI: 66.4–84.0%) and 47.3% (95% CI: 36.8–57.7%), respectively, while the EFS at 1 and 3 years(s) was 59.0% (95% CI: 48.9–69.0%) and 32.9% (95% CI: 23.0–42.8%), respectively. At 3 years, the cumulative incidence (CI) of relapse was 48.3% (95% CI: 38.9–59.9%), and the CI rate of death in CR was 17.3% (95% CI: 10.9–27.5%). Older age and an ECOG > 2 represented risk factors for inferior OS, while BCR::ABL1 status, immunophenotype, and intensity of chemotherapy did not significantly affect OS. We conclude that intensive treatment is feasible in selected elderly ALL patients, but high rates of relapse and death in CR underline the need for novel therapeutic strategies.
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Affiliation(s)
- Daniela V. Wenge
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
- Dana-Farber Cancer Institute, Department of Pediatric Oncology, Harvard Medical School, Boston, MA 02215, USA
| | - Klaus Wethmar
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Corinna A. Klar
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Hedwig Kolve
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Tim Sauer
- Department of Medicine V, Hematology, Oncology, Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Linus Angenendt
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
- Department of Biosystems Science and Engineering, ETH Zürich, 4058 Basel, Switzerland
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Simon Call
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Andrea Kerkhoff
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Cyrus Khandanpour
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Rolf Mesters
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Jan-Henrik Mikesch
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Christian Reicherts
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Monika Brüggemann
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig Holstein, 24105 Kiel, Germany;
| | - Wolfgang E. Berdel
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
| | - Matthias Stelljes
- Department of Medicine A, Hematology, Oncology, Hemostaseology, Pneumology, University Hospital Muenster, 48149 Muenster, Germany; (D.V.W.); (K.W.); (C.A.K.); (H.K.); (L.A.); (G.E.); (S.C.); (A.K.); (C.K.); (T.K.); (R.M.); (C.S.); (J.-H.M.); (C.R.); (W.E.B.); (G.L.)
- Correspondence:
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Ribera JM, García O, Chapchap EC, Gil C, González-Campos J, Barba P, Amigo ML, Moreno MJ, Lavilla E, Alonso N, Bergua JM, Tormo M, Ribera J, Sierra M, Martínez-Carballeira D, Mercadal S, Hernández-Rivas JM, Vall-Llovera F, Genescà E, Cladera A, Novo A, Abella E, García-Cadenas I, Monteserín C, Bermúdez A, Piernas S, Montesinos P, López JL, García-Guiñón A, Serrano A, Martínez MP, Olivares M, López A, Serrano J. Treatment of Frail Older Adults and Elderly Patients With Philadelphia Chromosome-negative Acute Lymphoblastic Leukemia: Results of a Prospective Trial With Minimal Chemotherapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e513-e522. [PMID: 32336676 DOI: 10.1016/j.clml.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The treatment of acute lymphoblastic leukemia (ALL) in older adults and elderly patients is a challenge, and modern protocols include targeted therapy and immunotherapy in combination with attenuated or minimal chemotherapy. However, frail patients are excluded from these trials, and reports on the outcome of this subgroup of patients are scarce. Our objective was to analyze the outcome of unfit older adults and elderly patients with Philadelphia chromosome-negative ALL included in a prospective trial (ALL-07FRAIL). PATIENTS AND METHODS Older adults and elderly patients with Charlson Comorbidity Index (CCI) ≥ 4 were included. Induction therapy consisted of vincristine and dexamethasone, and maintenance therapy with mercaptopurine and methotrexate for 2 years. RESULTS Seventy-two patients with a median age of 67 years (range, 57-89 years) and a median CCI of 5 (range, 4-12) were included. The rates of early withdrawal, early death, resistance, and complete response (CR) were 5%, 10%, 31%, and 54%, respectively. Six patients with CR abandoned the study, 5 died in CR, and 23 relapsed (cumulative relapse incidence 75%). The medians of disease-free and overall survival (OS) were 6.9 months (95% confidence interval [CI], 0.3-13.5 months) and 7.6 months (95% CI, 6.3-8.9 months), respectively. The most frequent toxic events were hematologic (neutropenia 77% and thrombocytopenia 54%, of grade III-IV in all cases). Eastern Cooperative Oncology Group score but not the CCI had significant impact on OS. CONCLUSION Complete remission with very attenuated chemotherapy can be attained in one-half of older or elderly infirm patients with ALL. These results suggest that some of these patients could benefit from the concomitant or subsequent use of immunotherapy and/or targeted therapy.
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Affiliation(s)
- Josep-Maria Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain.
| | - Olga García
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Cristina Gil
- Hematology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Pere Barba
- Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María-Luz Amigo
- Hematology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | | | - Natalia Alonso
- Hematology Department, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Mar Tormo
- Hematology Department, Hospital Clínico, Valencia, Spain
| | - Jordi Ribera
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain
| | - Magdalena Sierra
- Hematology Department, Hospital Virgen de la Concha, Zamora, Spain
| | | | - Santiago Mercadal
- Hematology Department, Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Eulàlia Genescà
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain
| | - Antònia Cladera
- Hematology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Andrés Novo
- Hematology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Eugènia Abella
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | | | - Carmen Monteserín
- Hematology Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Arancha Bermúdez
- Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sonia Piernas
- Hematology Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jose-Luis López
- Hematology Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Alfons Serrano
- Hematology Department, Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | | | | | - Aurelio López
- Hematology Department, Hospital Arnau de Vilanova, Valencia, Spain
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Danese MD, Katz A, Cetin K, Chia V, Gleeson ML, Kelsh M, Griffiths RI. Treatment patterns, survival, and hospitalization in adult patients with acute lymphoblastic leukemia: an observational cohort study using SEER Medicare data. Leuk Lymphoma 2019; 60:2015-2024. [DOI: 10.1080/10428194.2018.1555329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Robert I. Griffiths
- Outcomes Insights, Inc, Westlake Village, CA, USA
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ghelli Luserna Di Rorà A, Beeharry N, Imbrogno E, Ferrari A, Robustelli V, Righi S, Sabattini E, Verga Falzacappa MV, Ronchini C, Testoni N, Baldazzi C, Papayannidis C, Abbenante MC, Marconi G, Paolini S, Parisi S, Sartor C, Fontana MC, De Matteis S, Iacobucci I, Pelicci PG, Cavo M, Yen TJ, Martinelli G. Targeting WEE1 to enhance conventional therapies for acute lymphoblastic leukemia. J Hematol Oncol 2018; 11:99. [PMID: 30068368 PMCID: PMC6090987 DOI: 10.1186/s13045-018-0641-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the recent progress that has been made in the understanding and treatment of acute lymphoblastic leukemia (ALL), the outcome is still dismal in adult ALL cases. Several studies in solid tumors identified high expression of WEE1 kinase as a poor prognostic factor and reported its role as a cancer-conserving oncogene that protects cancer cells from DNA damage. Therefore, the targeted inhibition of WEE1 kinase has emerged as a rational strategy to sensitize cancer cells to antineoplastic compounds, which we evaluate in this study. METHODS The effectiveness of the selective WEE1 inhibitor AZD-1775 as a single agent and in combination with different antineoplastic agents in B and T cell precursor ALL (B/T-ALL) was evaluated in vitro and ex vivo studies. The efficacy of the compound in terms of cytotoxicity, induction of apoptosis, and changes in gene and protein expression was assessed using different B/T-ALL cell lines and confirmed in primary ALL blasts. RESULTS We showed that WEE1 was highly expressed in adult primary ALL bone marrow and peripheral blood blasts (n = 58) compared to normal mononuclear cells isolated from the peripheral blood of healthy donors (p = 0.004). Thus, we hypothesized that WEE1 could be a rational target in ALL, and its inhibition could enhance the cytotoxicity of conventional therapies used for ALL. We evaluated the efficacy of AZD-1775 as a single agent and in combination with several antineoplastic agents, and we elucidated its mechanisms of action. AZD-1775 reduced cell viability in B/T-ALL cell lines by disrupting the G2/M checkpoint and inducing apoptosis. These findings were confirmed in human primary ALL bone marrow and peripheral blood blasts (n = 15). In both cell lines and primary leukemic cells, AZD-1775 significantly enhanced the efficacy of several tyrosine kinase inhibitors (TKIs) such as bosutinib, imatinib, and ponatinib, and of chemotherapeutic agents (clofarabine and doxorubicin) in terms of the reduction of cell viability, apoptosis induction, and inhibition of proliferation. CONCLUSIONS Our data suggest that WEE1 plays a role in ALL blast's survival and is a bona fide target for therapeutic intervention. These data support the evaluation of the therapeutic potential of AZD-1775 as chemo-sensitizer agent for the treatment of B/T-ALL.
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Affiliation(s)
- Andrea Ghelli Luserna Di Rorà
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Neil Beeharry
- Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, PA, USA.,LAM Therapeutics, Guilford, CT, USA
| | - Enrica Imbrogno
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Anna Ferrari
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Valentina Robustelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Simona Righi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Elena Sabattini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | | | - Chiara Ronchini
- Laboratory of Clinical Genomics, European Institute of Oncology, Milan, Italy
| | - Nicoletta Testoni
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Carmen Baldazzi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Cristina Papayannidis
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Maria Chiara Abbenante
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Giovanni Marconi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Stefania Paolini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Sarah Parisi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Chiara Sartor
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Maria Chiara Fontana
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Serena De Matteis
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ilaria Iacobucci
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Michele Cavo
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Timothy J Yen
- Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Trino S, De Luca L, Laurenzana I, Caivano A, Del Vecchio L, Martinelli G, Musto P. P53-MDM2 Pathway: Evidences for A New Targeted Therapeutic Approach in B-Acute Lymphoblastic Leukemia. Front Pharmacol 2016; 7:491. [PMID: 28018226 PMCID: PMC5159974 DOI: 10.3389/fphar.2016.00491] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/30/2016] [Indexed: 11/13/2022] Open
Abstract
The tumor suppressor p53 is a canonical regulator of different biological functions, like apoptosis, cell cycle arrest, DNA repair, and genomic stability. This gene is frequently altered in human tumors generally by point mutations or deletions. Conversely, in acute lymphoblastic leukemia (ALL) genomic alterations of TP53 are rather uncommon, and prevalently occur in patients at relapse or with poor prognosis. On the other hand, p53 pathway is often compromised by the inactivation of its regulatory proteins, as MDM2 and ARF. MDM2 inhibitor molecules are able to antagonize p53-MDM2 interaction allowing p53 to exert tumor suppressor transcriptional regulation and to induce apoptotic pathways. Recent preclinical and clinical studies propose that MDM2 targeted therapy represents a promising anticancer strategy restoring p53 dependent mechanisms in ALL disease. Here, we discussed the use of new small molecule targeting p53 pathways as a promising drug target therapy in ALL.
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Affiliation(s)
- Stefania Trino
- Laboratory of Pre-Clinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata Rionero in Vulture (PZ), Italy
| | - Luciana De Luca
- Laboratory of Pre-Clinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata Rionero in Vulture (PZ), Italy
| | - Ilaria Laurenzana
- Laboratory of Pre-Clinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata Rionero in Vulture (PZ), Italy
| | - Antonella Caivano
- Laboratory of Pre-Clinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata Rionero in Vulture (PZ), Italy
| | - Luigi Del Vecchio
- CEINGE - Biotecnologie Avanzate S.C.a R.L.Naples, Italy; Department of Molecular Medicine and Medical Biotechnologies, Universita' degli Studi di Napoli Federico IINaples, Italy
| | - Giovanni Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. and A. Seràgnoli," University of Bologna Bologna, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS - Referral Cancer Center of Basilicata Rionero in Vulture (PZ), Italy
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