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Stelljes M, Raffel S, Alakel N, Wäsch R, Kondakci M, Scholl S, Rank A, Hänel M, Spriewald B, Hanoun M, Martin S, Schwab K, Serve H, Reiser L, Knaden J, Pfeifer H, Marx J, Sauer T, Berdel WE, Lenz G, Brüggemann M, Gökbuget N, Wethmar K. Inotuzumab Ozogamicin as Induction Therapy for Patients Older Than 55 Years With Philadelphia Chromosome-Negative B-Precursor ALL. J Clin Oncol 2024; 42:273-282. [PMID: 37883727 DOI: 10.1200/jco.23.00546] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/28/2023] [Accepted: 08/15/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Despite recent advances in adapting the intensity of treatment for older patients with ALL, current protocols are associated with high rates of early deaths, treatment-related toxicity, and dismal prognosis. We evaluated inotuzumab ozogamicin and dexamethasone (Dex) as induction therapy in older patients with ALL within the German Multicenter Study Group for Adult ALL (GMALL). PATIENTS AND METHODS The open-label, multicenter, phase II, INITIAL-1 trial enrolled 45 patients older than 55 years with newly diagnosed, CD22-positive, BCR::ABL-negative B-precursor ALL (B-ALL). Patients received up to three cycles of inotuzumab ozogamicin/Dex and up to six cycles of age-adapted GMALL consolidation and maintenance therapy. RESULTS Forty-three evaluable patients with common/pre-B (n = 38) and pro-B ALL (n = 5), with a median age of 64 years (range, 56-80), received at least two cycles of inotuzumab ozogamicin induction therapy. All patients achieved complete remission (CR/CR with incomplete hematologic recovery). Twenty-three (53%) and 30 (71%) patients had no evidence of molecularly assessed measurable residual disease (minimum 10e-4 threshold) after the second and third inductions, respectively. After a median follow-up of 2.7 years, event-free survival at one (primary end point) and 3 years was 88% (95% CI, 79 to 98) and 55% (95% CI, 40 to 71), while overall survival (OS) was 91% (95% CI, 82 to 99) and 73% (95% CI, 59 to 87), respectively. None of the patients died during 6 months after the start of induction. Most common adverse events having common toxicity criteria grade ≥3 during induction were leukocytopenia, neutropenia, thrombocytopenia, anemia, and elevated liver enzymes. One patient developed nonfatal veno-occlusive disease after induction II. CONCLUSION Inotuzumab ozogamicin-based induction followed by age-adapted chemotherapy was well tolerated and resulted in high rates of remission and OS. These data provide a rationale for integrating inotuzumab ozogamicin into first-line regimens for older patients with B-ALL.
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Affiliation(s)
- Matthias Stelljes
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Simon Raffel
- Department of Medicine, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nael Alakel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ralph Wäsch
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mustafa Kondakci
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Abteilung Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Medical Center Augsburg, Augsburg, Germany
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Bernd Spriewald
- Department of Internal Medicine V, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Maher Hanoun
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Sonja Martin
- Department of Hematology and Oncology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Katjana Schwab
- Department of Medicine III, Hematology, Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Hubert Serve
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Lena Reiser
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Julian Knaden
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Heike Pfeifer
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Julia Marx
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Tim Sauer
- Department of Medicine, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Monika Brüggemann
- Department of Medicine II, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nicola Gökbuget
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Klaus Wethmar
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
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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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3
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Zhao D, Xing Q, Song H, Zhao Y, Guo G. LINC00265/miR-4500 Axis Accelerates Acute Lymphoblastic Leukemia Progression by Enhancing STAT3 Signals. Cancer Manag Res 2021; 13:8147-8156. [PMID: 34737643 PMCID: PMC8560060 DOI: 10.2147/cmar.s274590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background Long noncoding RNA LINC00265 or miR-4500 is involved in the pathogenesis of many cancers. However, their functions in acute lymphoblastic leukemia (ALL) remain unknown. In this study, we investigated how LINC00265 and miR-4500 regulate the malignant characteristics of ALL. Methods Real-time PCR was used in examining the expression of LINC00265 in ALL cell lines and blood of patients with ALL. Cell proliferation, cell migration, and xenograft tumor assays were performed to verify the function of LINC00265 subjected to overexpressing and silencing experiments. The ceRNA mechanism with LINC00265/miR-4500/STAT3 was investigated through luciferase and RNA pull-down assays. Finally, the function of the LINC00265/miR-4500/STAT3 axis subjected to overexpressing and silencing assays was determined through cell proliferation, cell migration, and xenograft tumor assays. Results LINC00265 was highly expressed in ALL cell lines and blood of patients with ALL and facilitated the proliferation, migration, invasion, and growth of xenograft tumors of ALL cells. The silencing of LINC00265 expression with LINC00265 siRNA significantly inhibited the malignancy of the ALL cells. RNA pull-down and luciferase assays demonstrated that LINC00265 competitively targeted miR-4500 and enhanced STAT3 expression. Furthermore, miR-4500 inhibitors or overexpressed LINC00265 up-regulated STAT3 expression, and miR-4500 mimics or STAT3 shRNAs eliminated the LINC00265-induced malignancy of the ALL cells. Conclusion Mechanistically, LncRNA LINC00265 can competitively interact with miR-4500 and thereby up-regulates STAT3 signaling and enhances the malignancy of tumors.
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Affiliation(s)
- Donglu Zhao
- No. 4 Ward of Hematology Department, Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, Heilongjiang Province, People's Republic of China
| | - Qi Xing
- No. 4 Ward of Hematology Department, Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, Heilongjiang Province, People's Republic of China
| | - Hang Song
- No. 4 Ward of Hematology Department, Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, Heilongjiang Province, People's Republic of China
| | - Yan Zhao
- No. 4 Ward of Hematology Department, Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, Heilongjiang Province, People's Republic of China
| | - Guiying Guo
- No. 4 Ward of Hematology Department, Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, Heilongjiang Province, People's Republic of China
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Short NJ, Kantarjian H, Jabbour E. Optimizing the treatment of acute lymphoblastic leukemia in younger and older adults: new drugs and evolving paradigms. Leukemia 2021; 35:3044-3058. [PMID: 34172894 DOI: 10.1038/s41375-021-01277-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/12/2021] [Accepted: 04/29/2021] [Indexed: 12/18/2022]
Abstract
In the past decade, the available treatments for patients with acute lymphoblastic leukemia (ALL) have rapidly expanded, in parallel with an increased understanding of the genomic features that impact the disease biology and clinical outcomes. With the development of the anti-CD22 antibody-drug conjugate inotuzumab ozogamicin, the CD3-CD19 bispecific T-cell engager antibody blinatumomab, CD19 chimeric antigen receptor T-cell therapy, and the potent BCR-ABL1 tyrosine kinase inhibitor ponatinib, the outlook of ALL in both younger and older adults has substantially improved. The availability of highly effective drugs raised important questions concerning the optimal combination and sequence of these agents, their incorporation into frontline regimens, and the role of hematopoietic stem cell transplantation. In this review, we discuss the rapidly evolving paradigms in the treatment of ALL, highlighting both established and effective regimens, as well as promising new therapies that are being evaluated in ongoing clinical trials. We specifically focus on novel combination regimens in both the frontline and salvage settings that are leading to new standards of care in the treatment of ALL.
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Affiliation(s)
- Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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5
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Sasaki K, Jabbour E, Short NJ, Jain N, Ravandi F, Pui C, Kantarjian H. Acute lymphoblastic leukemia: A population-based study of outcome in the United States based on the surveillance, epidemiology, and end results (SEER) database, 1980-2017. Am J Hematol 2021; 96:650-658. [PMID: 33709456 DOI: 10.1002/ajh.26156] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 12/22/2022]
Abstract
The treatment in acute lymphoblastic Leukemia (ALL) has evolved and improved dramatically over the past four decades. We assessed the outcome of ALL overall, and the two major subsets of Philadelphia chromosome (Ph)-positive and Ph-negative ALL by age, time periods, ethnicity, median household income, and geographic county area. A total of 12 788 patients diagnosed with ALL from 1980 to 2017 were included. We performed an analysis to better evaluate the outcome evolution in ALL according to time period and patient's demographic factors. The overall 5-year survival rates have improved significantly over time, from 51% before 1990 to 72% since 2010. The survival rates for children (age 0 to 14 years) and adolescents (age 15 to 19 years) have improved from 73% and 55% before 1990 to 93% and 74% since 2010, respectively. Similarly, the rates had improved from 33% to 59% for adults 20 to 29 years old, 24% to 59% for 30 to 39 years old, and 14% to 43% for 40 to 59 years old between the two time periods. The rates remained under 30% in older patients (60+ years). Since 2010, patients with Ph-negative ALL had 5-year survival rate of 73% and those with Ph-positive ALL 50%. African Americans, Hispanic ethnicity, and lower household income were associated with inferior survival. The outcome of patients with ALL showed continued improvement across all age groups in the US. The recent introduction of targeted therapies, together with optimized supportive care, will continue to improve outcomes, particularly in older patients.
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Affiliation(s)
- Koji Sasaki
- Department of Leukemia U.T. M.D. Anderson Cancer Center Houston Texas
| | - Elias Jabbour
- Department of Leukemia U.T. M.D. Anderson Cancer Center Houston Texas
| | - Nicholas J. Short
- Department of Leukemia U.T. M.D. Anderson Cancer Center Houston Texas
| | - Nitin Jain
- Department of Leukemia U.T. M.D. Anderson Cancer Center Houston Texas
| | - Farhad Ravandi
- Department of Leukemia U.T. M.D. Anderson Cancer Center Houston Texas
| | - Ching‐Hon Pui
- Departments of Oncology and Pathology St. Jude Children's Research Hospital Memphis Tennessee
| | - Hagop Kantarjian
- Department of Leukemia U.T. M.D. Anderson Cancer Center Houston Texas
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DeAngelo DJ, Jabbour E, Advani A. Recent Advances in Managing Acute Lymphoblastic Leukemia. Am Soc Clin Oncol Educ Book 2021; 40:330-342. [PMID: 32421447 DOI: 10.1200/edbk_280175] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is characterized by chromosomal translocations and somatic mutations that lead to leukemogenesis. The incorporation of pediatric-type regimens has improved survival in young adults, and the incorporation of tyrosine kinase inhibitors for patients with Philadelphia chromosome-positive disease has led to further improvements in outcomes. However, older patients often have poor-risk biology and reduced tolerance to chemotherapy, leading to lower remission rates and overall survival. Regardless of age, patients with relapsed or refractory ALL have extremely poor outcomes. The advent of next-generation sequencing has facilitated the revolution in understanding the genetics of ALL. New genetic risk stratification together with the ability to measure minimal residual disease, leukemic blasts left behind after cytotoxic chemotherapy, has led to better tools to guide postremission approaches-that is, consolidation chemotherapy or allogeneic stem cell transplantation. In this article, we discuss the evolving and complex genetic landscape of ALL and the emerging therapeutic options for patients with relapsed/refractory ALL and older patients with ALL.
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Affiliation(s)
- Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elias Jabbour
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anjali Advani
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
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Khalife R, Montroy J, Grigor EJM, Fergusson DA, Atkins H, Seftel M, Presseau J, Thavorn K, Holt RA, Hay K, Lalu MM, Kekre N. Building Canadian capacity for CAR-T cells in relapsed/refractory acute lymphoblastic leukaemia: a retrospective cohort study. Br J Haematol 2020; 191:e14-e19. [PMID: 32688454 DOI: 10.1111/bjh.16940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Roy Khalife
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Montroy
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada
| | - Emma J M Grigor
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Pubic Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Harold Atkins
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ontario, Ottawa, Canada
| | - Matthew Seftel
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,School of Epidemiology and Pubic Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,School of Epidemiology and Pubic Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert A Holt
- Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kevin Hay
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ontario, Ottawa, Canada
| | - Natasha Kekre
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Samra B, Jabbour E, Ravandi F, Kantarjian H, Short NJ. Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions. J Hematol Oncol 2020; 13:70. [PMID: 32503572 PMCID: PMC7275444 DOI: 10.1186/s13045-020-00905-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
Recent years have witnessed major advances that have improved outcome of adults with acute lymphoblastic leukemia (ALL). The emergence of the concept of measurable residual disease has fine-tuned our prognostic models and guided our treatment decisions. The treatment paradigms of ALL have been revolutionized with the advent of tyrosine kinase inhibitors targeting BCR-ABL1, monoclonal antibodies targeting CD20 (rituximab), antibody-drug conjugates targeting CD22 (inotuzumab ozogamicin), bispecific antibodies (blinatumomab), and CD19 chimeric antigen receptor T cell therapy (tisagenlecleucel). These highly effective new agents are allowing for novel approaches that reduce reliance on intensive cytotoxic chemotherapy and hematopoietic stem cell transplantation in first remission. This comprehensive review will focus on the recent advances and future directions in novel therapeutic strategies in adult ALL.
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Affiliation(s)
- Bachar Samra
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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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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Abou Dalle I, Jabbour E, Short NJ. Evaluation and management of measurable residual disease in acute lymphoblastic leukemia. Ther Adv Hematol 2020; 11:2040620720910023. [PMID: 32215194 PMCID: PMC7065280 DOI: 10.1177/2040620720910023] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
With standard chemotherapy regimens for adults with acute lymphoblastic leukemia, approximately 90% of patients achieve complete remission. However, up to half of patients have persistent minimal/measurable residual disease (MRD) not recognized by routine microscopy, which constitutes the leading determinant of relapse. Many studies in pediatric and adult populations have demonstrated that achievement of MRD negativity after induction chemotherapy or during consolidation is associated with significantly better long-term outcomes, and MRD status constitutes an independently prognostic marker, often superseding other conventional risk factors. Persistence of MRD after intensive chemotherapy is indicative of treatment refractoriness and warrants alternative therapeutic approaches including allogeneic stem cell transplantation, blinatumomab, or investigational therapies such as inotuzumab ozogamicin or chimeric antigen receptor T cells. Furthermore, the incorporation of novel monoclonal antibodies or potent BCR-ABL1 tyrosine kinase inhibitors, such as ponatinib into frontline treatment may have the advantage of achieving higher rates of MRD negativity while minimizing chemotherapy-related toxicities. Many studies are therefore ongoing to determine whether this strategy can improve cure rates without the need for allogeneic stem cell transplantation.
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Affiliation(s)
- Iman Abou Dalle
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Hematology and Oncology, American University of Beirut, Beirut, Lebanon
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas J. Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 428, Houston, TX 77030, USA
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Franquiz MJ, Short NJ. Blinatumomab for the Treatment of Adult B-Cell Acute Lymphoblastic Leukemia: Toward a New Era of Targeted Immunotherapy. Biologics 2020; 14:23-34. [PMID: 32103893 PMCID: PMC7027838 DOI: 10.2147/btt.s202746] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/31/2020] [Indexed: 12/20/2022]
Abstract
Several therapeutic advancements in the treatment of B-cell acute lymphoblastic leukemia (ALL) have surfaced in the past decade, primarily driven by an increased understanding of the immunopathobiology of this disease. The clinical use of blinatumomab, a bispecific antibody that coordinates cytotoxic CD3+ T lymphocytes and CD19+ lymphoblasts, has resulted in improved outcomes in both relapsed/refractory and minimal residual disease-positive B-cell ALL. Promising emerging data also demonstrate the efficacy of this agent in the frontline setting and in combination regimens. Uncertainty remains regarding the optimal sequencing and combination of blinatumomab with cytotoxic chemotherapy and other emerging agents. The pharmacology and clinical data on blinatumomab for adult B-cell ALL, both as monotherapy and in combinations, will be reviewed herein.
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Affiliation(s)
- Miguel J Franquiz
- Baylor College of Medicine, Houston, TX, USA
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Outcomes of the cyclophosphamide, vincristine, prednisone (CVP) +/- rituximab (R-CVP) regimen in older patients with newly diagnosed Ph- acute lymphoblastic leukemia. Leuk Res 2020; 89:106297. [PMID: 31935625 DOI: 10.1016/j.leukres.2020.106297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 11/22/2022]
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Guerra VA, Jabbour EJ, Ravandi F, Kantarjian H, Short NJ. Novel monoclonal antibody-based treatment strategies in adults with acute lymphoblastic leukemia. Ther Adv Hematol 2019; 10:2040620719849496. [PMID: 31205644 PMCID: PMC6535741 DOI: 10.1177/2040620719849496] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/18/2019] [Indexed: 12/21/2022] Open
Abstract
Adult acute lymphoblastic leukemia (ALL) has a poor overall survival compared with pediatric ALL where cure rates are observed in more than 90% of patients. The recent development of novel monoclonal antibodies targeting CD20, CD19, and CD22 has changed the long-term outcome of this disease, both in the frontline setting (e.g. rituximab) and for patients with relapsed/refractory disease (e.g. inotuzumab ozogamicin and blinatumomab). The CD3-CD19 bispecific T-cell-engaging antibody blinatumomab is also the first drug approved in ALL for patients with persistent or recurrent measurable residual disease, providing a new treatment paradigm for these patients. Several new agents are also in development that use novel constructs or target alternative surface epitopes such as CD123, CD25, and CD38. Herein, we review the role of monoclonal antibodies in adult ALL and summarize the current and future approaches in ALL, including novel combination therapies and the possibility of early incorporation of these agents into treatment regimens.
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Affiliation(s)
- Veronica A Guerra
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias J Jabbour
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas J Short
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Short NJ, Kantarjian H, Pui CH, Goldstone A, Jabbour E. SOHO State of the Art Update and Next Questions: Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:439-446. [DOI: 10.1016/j.clml.2018.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
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