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Wang Y, Liang ZJ, Gale RP, Liao HZ, Ma J, Gong TJ, Shao YQ, Liang Y. Chronic myeloid leukaemia: Biology and therapy. Blood Rev 2024; 65:101196. [PMID: 38604819 DOI: 10.1016/j.blre.2024.101196] [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: 11/30/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Chronic myeloid leukaemia (CML) is caused by BCR::ABL1. Tyrosine kinase-inhibitors (TKIs) are the initial therapy. Several organizations have reported milestones to evaluate response to initial TKI-therapy and suggest when a change of TKI should be considered. Achieving treatment-free remission (TFR) is increasingly recognized as the optimal therapy goal. Which TKI is the best initial therapy for which persons and what depth and duration of molecular remission is needed to achieve TFR are controversial. In this review we discuss these issues and suggest future research directions.
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MESH Headings
- Humans
- Protein Kinase Inhibitors/therapeutic use
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Remission Induction
- Biology
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Affiliation(s)
- Yun Wang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhi-Jian Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Robert Peter Gale
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Hua-Ze Liao
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jun Ma
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China
| | - Tie-Jun Gong
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China.
| | - Ying-Qi Shao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
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Rinaldi I, Mauludi R, Jusman SW, Sinto R, Harimurti K. HIF2-α Expression in CML Patients Receiving Hydroxyurea Prior to Imatinib That Achieved Major Molecular Response (MMR) versus in Those Not Achieving MMR. J Blood Med 2024; 15:61-67. [PMID: 38375065 PMCID: PMC10875243 DOI: 10.2147/jbm.s436015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Currently, Imatinib (IM) which is a Tyrosine Kinase Inhibitor (TKI), is the main treatment for patients with chronic myeloid leukemia (CML). Major molecular response (MMR) is used as therapeutic response. Resistance to IM may be caused by hypoxia which is regulated by hypoxia inducible factor (HIF) 2-α. The role of HIF2-α is currently not researched extensively. This study aimed to analyse the differences in HIF-2α expression between chronic phase CML patients that achieved MMR and those that did not achieve MMR. Methods This study used a cross-sectional method which analysed secondary data from whole blood samples in chronic phase CML patients aged 18-60 years that received hydroxyurea (HU) before IM, aged 18-60 years, received IM therapy for more than 12 months, and were willing to participate in the study. The exclusion criteria for this study were patients who were receiving IM at a dose of more than 400 mg/day. HIF-2α protein expression was examined using the enzyme-linked immunosorbent assay (ELISA) method. Differences between HIF-2α protein expression in groups that achieved MMR versus not achieving MMR was analysed using the Mann-Whitney test. Results A total of 79 subjects were obtained. The median HIF-2α was 90.56 pg/mg protein (3.01-4628.74). There was no statistically significant difference in expression of HIF-2α in the group that reached MMR and did not reach MMR, namely 123.45 pg/mg protein and 89.25 pg/mg protein respectively (p 0.718). Conclusion This study found no statistically significant difference between HIF-2α expression level and MMR achievement of chronic phase CML patients who received HU before IM therapy.
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Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Radinal Mauludi
- Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sri Widia Jusman
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Robert Sinto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Cipto Mangunkusumo National General hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Clinical Epidemiology Unit, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Division of Geriatrics, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Song L, Guo J, Zhou D, Tao S, Ding B, Yu L, Wang C. Assessment of knowledge, attitudes, and practices of CML patients and their families toward TKI therapy in China. Medicine (Baltimore) 2023; 102:e36498. [PMID: 38115374 PMCID: PMC10727673 DOI: 10.1097/md.0000000000036498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/24/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized chronic myeloid leukemia (CML) treatment. The knowledge, attitude, and practice (KAP) of patients and their families play a significant role in treatment adherence and effectiveness. This study aimed to investigate the KAP of CML patients and their families regarding TKI therapy in China. From November 1 to December 31, 2022, a cross-sectional study was conducted at the Affiliated Huai'an No. 1 People's Hospital in China. A total of 313 CML patients and 268 family caregivers were selected using convenience sampling. Participants answered a self-designed questionnaire. The questionnaire contained demographic/clinical data and assessed KAP toward CML and TKI therapy. Participants exhibited mean KAP scores of 8.91 (55.7%), 33.10 (73.6%), and 2.20 (73.3%), respectively. Family members had higher knowledge and practice scores than patients (both P < .05), with factors such as younger age, urban residency, higher education, employment, higher income, and interaction with peers correlating with better knowledge scores (P < .001). Although participants were well-informed about their diagnosis and medication (>80%), understanding of disease causes (<30%) and treatment prognosis and side effects (<50%) was limited, and cost concerns affected 80.55%. Anxiety and depression were reported more among caregivers (46.64% and 13.8%) than patients (29.71% and 11.51%). While 84.85% adhered to the doctor's instructions, only 68.50% actively sought more CML information. Positive correlations were observed among KAP scores, indicating their interdependence (knowledge-attitude: R = 0.397; knowledge-practice: R = 0.598; attitude-practice: R = 0.353; all P < .001). The findings underscore the importance of tailored education to fill knowledge gaps about CML and the need to address financial concerns and provide psychological support. The positive correlations among knowledge, attitudes, and practices emphasize the need for comprehensive interventions. In conclusion, this study highlights the importance of tailored education, addresses financial concerns, and provides emotional support for CML patients and caregivers in China, despite limitations such as convenience sampling and questionnaire design. Future research should evaluate the effectiveness of educational interventions and long-term outcomes to further enhance the overall well-being of this population.
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Affiliation(s)
- Lixiao Song
- Department of Hematology, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, China
| | - Jun Guo
- Department of Hematology, People’s Hospital of Rizhao, Rizhao, China
| | - Dan Zhou
- Department of Hematology, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, China
| | - Shandong Tao
- Department of Hematology, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, China
| | - Banghe Ding
- Department of Hematology, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, China
| | - Liang Yu
- Department of Hematology, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, China
| | - Chunling Wang
- Department of Hematology, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, China
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Lao Z, Tse EWC, Chuncharunee S, Kwong YL, Wei A, Ko BS, Kim JS, Ng SC, Wang J, Goh YT. Asia-Pacific Leukemia Consortium: An innovative and collaborative initiative to improve care of leukemia and related diseases in the Asia-Pacific region. Asia Pac J Clin Oncol 2023; 19:655-663. [PMID: 37259880 DOI: 10.1111/ajco.13970] [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: 01/08/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023]
Abstract
The burden of leukemia and related diseases is rapidly growing in Asia. Currently, there is a paucity of regional collaborative groups/initiatives that focus exclusively on the management of leukemia in the Asia-Pacific (APAC) region. The Asia-Pacific Leukemia Consortium (APLC) was established on the 8 September 2021 to understand the status quo, unmet needs, and ways to improve the management of leukemia and related diseases in the APAC region. The APLC working group set up a group of experts from various countries (Singapore, Malaysia, Thailand, Hong Kong, Japan, South Korea, Taiwan, China, and Australia) to discuss on the status of: (i) clinical trials; (ii) disease registry database; (iii) genetic and tissue repository; (iv) patient advocacy and care; and (v) disease prevention and education in the APAC region. Low levels of awareness about leukemia amongst the public, lack of financial support, and limited access to newly approved therapies were identified as barriers to the implementation of effective leukemia management in low- or mid-income Asian countries. Patients often enroll in clinical trials to gain access to novel/approved therapies. The APLC group aims to address the growing threat of leukemia through a collaborative approach to advance disease prevention, research, clinical trials, and education.
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Affiliation(s)
- Zhentang Lao
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Eric Wai Choi Tse
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | | | - Yok Lam Kwong
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Andrew Wei
- Walter and Eliza Hall Institute and Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Bor Sheng Ko
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Tai-Chen Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Soo Chin Ng
- Department of Hematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Yeow Tee Goh
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
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Agarwal MB, John MJ, Jain P, Vaid AK, Bapna A, Basade M, Dattatreya PS, Chakrapani A, Ramanan V, Varadarajan R, Subramanian M, Shah CA, Warrier N, Sanyal S, Ashwin TS, Ramanjinappa N. The Role of Bosutinib in Chronic Myeloid Leukemia: An Indian Perspective. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1756477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AbstractManagement of chronic myeloid leukemia (CML) has been transformed by the use of tyrosine kinase inhibitors (TKIs). Presently in India, five TKIs are approved for the management of CML with distinct safety profiles. The selection of TKIs for chronic phase (CP)-CML patients is based on treatment goals, underlying comorbidities, and specific TKI toxicity profiles. Bosutinib is one of five TKIs indicated for the first-line treatment of CP-CML and patients with intolerance or resistance to prior TKI therapy. It possesses a distinct safety profile among other TKIs, with less cardiovascular adverse events (AEs), albeit the liver-related and gastrointestinal AEs have higher occurrence. The safety and efficacy of bosutinib have been examined in clinical trials; however, there is a paucity of data from Asia. A virtual expert panel meeting was convened to gather expert opinion from India on the selection of bosutinib as a treatment choice for patients with CP-CML. This is a white paper document drafted with the help of an expert panel of 14 oncologists and hematooncologists from India on bosutinib use in CP-CML. The experts concurred that bosutinib has proven efficacy for CP-CML in global randomized clinical trials and is well suited for CP-CML patients with existing cardiovascular comorbidities. However, it was not recommended for patients with gastrointestinal, pancreatic, or renal abnormalities. This review aims to put forth expert opinion and guidance document on key considerations for CP-CML clinical decision-making in India.
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Affiliation(s)
| | | | - Punit Jain
- Apollo Hospitals, Navi Mumbai, Maharashtra, India
| | | | - Ajay Bapna
- Department of Oncology, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur, Rajasthan, India
| | | | | | | | - Vijay Ramanan
- Clinical Hematology, Bone Marrow and Stem Cell Transplant, Yashoda Hematology Clinic, Pune, Maharashtra, India
| | | | | | | | | | | | | | - Nagendra Ramanjinappa
- Mylan Pharmaceuticals Private Limited (A Viatris Company), Prestige Tech Park, Kadubeesanahalli, Bengaluru, Karnataka
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Asif M, Hussain A, Ali I, Baloch Z, Rasool M, Achakzai NM. Cytogenetical and hematological analysis of chronic myelogenous leukemia patients with a novel case 52XX, t (1;9;22) (q23.3; q34; q11.2), +6, +8, i(9) (q10;q10), +18,+19,+21+der22 t(9;22)(q34;q11). Medicine (Baltimore) 2022; 101:e31670. [PMID: 36397339 PMCID: PMC9666132 DOI: 10.1097/md.0000000000031670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
(9;22) (q34; q11) translocation is appear in above ninety percent of chronic myelogenous leukemia patients while variant/complex translocations were observed in almost 5% to 8% chronic myelogenous leukemia (CML) positive cases. Gleevec (Imatinib Mesylate) is the first choice breakpoint cluster region (BCR)/ABL targeted oral therapy that produced a complete response almost in 71% to 80% of patients affected with CML. A complete blood count (CBC) of 37 patients was done during diagnosis, however only 21 showed abnormal CBC values which were selected for the study. Karyotyping study using bone marrow samples was performed on 21 CML patients for the conformation of 9;22, however, fluorescence in situ hybridisation was performed for the detection of the BCR-ABL fusion gene of 15 patients. Out of 21, 17 patients showed Ph-positive (9;22) (q34; q11) translocation. Sixteen CML patients showed standard translocation however only CML patients showed a three-way variant/complex translocation with six additional chromosomes, 52XX, t(1;9;22) (q23.3;q34;q11),+6,+8, i(9)(q10;q10), +18,+19,+21 + der22 t(9;22)(q34;q11)). Here we report we report a novel case of six additional chromosomes with the three-way translocation of 52XX, t(1;9;22) (q23.3;q34;q11),+6,+8, i(9)(q10;q10), +18,+19,+21 + der22 t(9;22)(q34;q11) in blast phase.
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Affiliation(s)
- Muhammad Asif
- Department of Biotechnology, BUITEMS, Quetta, Pakistan
- Office of Research Innovation and Commercialization, BUITEMS, Quetta, Pakistan
| | - Abrar Hussain
- Department of Biotechnology, BUITEMS, Quetta, Pakistan
- * Correspondence: Niaz M. Achakzai, Department of Molecular Biology, DNA Section, Legal Medicine Directorate, Ministry of Public Health, Kabul, Afghanistan (e-mail: )
| | - Irfan Ali
- Centre of Agricultural Biochemistry and Biotechnology, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Zarak Baloch
- Faisalabad Medical University, Faisalabad, Pakistan
| | - Mahmood Rasool
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Niaz M. Achakzai
- Department of Molecular Biology, DNA Section, Legal Medicine Directorate, Ministry of Public Health, Kabul, Afghanistan
- * Correspondence: Niaz M. Achakzai, Department of Molecular Biology, DNA Section, Legal Medicine Directorate, Ministry of Public Health, Kabul, Afghanistan (e-mail: )
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Siti Mariam I, Norhidayah R, Zulaikha AB, Nazihah MY, Rosline H, Kausar GA, Sarina S, Azlan H, Ankathil R. Differential prognostic impact of stratified additional chromosome abnormalities on disease progression among Malaysian chronic myeloid leukemia patients undergoing treatment with imatinib mesylate. Front Oncol 2022; 12:720845. [PMID: 36003793 PMCID: PMC9393706 DOI: 10.3389/fonc.2022.720845] [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: 06/05/2021] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
The emergence of additional chromosome abnormalities (ACAs) in chronic myeloid leukemia (CML) patients during treatment with a tyrosine kinase inhibitor (TKI) regime is generally associated with resistance to treatment and a sign of disease progression to accelerated phase or blast phase. We report the type, frequency, and differential prognostic impact of stratified ACAs with treatment response in 251 Malaysian CML patients undergoing TKI therapy. ACAs were observed in 40 patients (15.9%) of which 7 patients (17.5%) showed ACAs at time of initial diagnosis whereas 33 patients (82.5%) showed ACAs during the course of IM treatment. In order to assess the prognostic significance, we stratified the CML patients with ACAs into four groups, group 1 (+8/+Ph), group 2 (hypodiploidy), group 3 (structural/complex abnormalities); group 4 (high-risk complex abnormalities), and followed up the disease outcome of patients. Group 1 and group 2 relatively showed good prognosis while patients in group 3 and group 4 had progressed or transformed to AP or blast phase with a median survival rate of 12 months after progression. Novel ACAs consisting of rearrangements involving chromosome 11 and chromosome 12 were found to lead to myeloid BP while ACAs involving the deletion of 7q or monosomy 7 led toward a lymphoid blast phase. There was no evidence of group 2 abnormalities (hypodiploidy) contributing to disease progression. Compared to group 1 abnormalities, CML patients with group 3 and group 4 abnormalities showed a higher risk for disease progression. We conclude that the stratification based on individual ACAs has a differential prognostic impact and might be a potential novel risk predictive system to prognosticate and guide the treatment of CML patients at diagnosis and during treatment.
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Affiliation(s)
- Ismail Siti Mariam
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ramli Norhidayah
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Abu Bakar Zulaikha
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Yunus Nazihah
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Hassan Rosline
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ghazali Anis Kausar
- Unit of Biostatstics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Sulong Sarina
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Husin Azlan
- Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ravindran Ankathil
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- *Correspondence: Ravindran Ankathil,
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Baccarani M, Bonifazi F, Soverini S, Castagnetti F, Gugliotta G, Saber W, Estrada-Merly N, Rosti G, Gale RP. Questions concerning tyrosine kinase-inhibitor therapy and transplants in chronic phase chronic myeloid leukaemia. Leukemia 2022; 36:1227-1236. [PMID: 35338251 PMCID: PMC9061294 DOI: 10.1038/s41375-022-01522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 01/07/2023]
Abstract
In this provocative commentary, we consider several questions posed by the late chronic myeloid leukaemia (CML) expert Prof. Michele Baccarani, which he challenged us to address after his death. He noted only a small proportion of people with chronic phase CML receiving tyrosine kinase-inhibitor (TKI)-therapy are likely to achieve sustained therapy-free remission (TFR) and even fewer are likely to be cured. Persons most likely to fail TKItherapy can be identified at diagnosis or soon after starting TKI-therapy. These persons are likely to need lifetime TKI-therapy with attendant risks of adverse events, cost and psychological consequences. Allogeneic transplants achieve much higher rates of leukaemia-free survival compared with TKI-therapy but are associated with transplant-related adverse events including an almost 20 percent risk of transplant-related deaths within 1 year post-transplant and a compromised quality-of-life because of complications such as chronic graft-versus-host disease. Subject-, disease- and transplant-related co-variates associated with transplant outcomes are known with reasonable accuracy. Not everyone likely to fail TKI-therapy is a transplant candidate. However, in those who candidates are physicians and patients need to weigh benefits and risks of TKI-therapy versus a transplant. We suggest transplants should be more often considered in the metric when counseling people with chronic phase CML unlikely to achieve TFR with TKI-therapy. We question whether we are discounting a possible important therapy intervention; we think so.
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Affiliation(s)
- Michele Baccarani
- IRCCS Azienda Ospedaliero -Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Hematology 'Lorenzo e Ariosto Seràgnoli', University of Bologna, Bologna, Italy
| | | | - Simona Soverini
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Hematology 'Lorenzo e Ariosto Seràgnoli', University of Bologna, Bologna, Italy
| | - Fausto Castagnetti
- IRCCS Azienda Ospedaliero -Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Hematology 'Lorenzo e Ariosto Seràgnoli', University of Bologna, Bologna, Italy
| | | | - Wael Saber
- Center for International Blood and Marrow Transplant Research), Milwaukee, WI, USA
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Noel Estrada-Merly
- Center for International Blood and Marrow Transplant Research), Milwaukee, WI, USA
| | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
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Daskalakis M, Feller A, Noetzli J, Bonadies N, Arndt V, Baerlocher GM. Potential to Improve Therapy of Chronic Myeloid Leukemia (CML), Especially for Patients with Older Age: Incidence, Mortality, and Survival Rates of Patients with CML in Switzerland from 1995 to 2017. Cancers (Basel) 2021; 13:6269. [PMID: 34944892 PMCID: PMC8699480 DOI: 10.3390/cancers13246269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKI) substantially improved chronic myeloid leukemia (CML) prognosis. We aimed to describe time period- and age-dependent outcomes by reporting real-world data of CML patients from Switzerland. METHODS Population-based incidence, mortality, and survival were assessed for four different study periods and age groups on the basis of aggregated data from Swiss Cantonal Cancer Registries. RESULTS A total of 1552 new CML cases were reported from 1995 to 2017. The age-standardized rate (ASR) for the incidence remained stable, while the ASR for mortality decreased by 50-80%, resulting in a five-year RS from 36% to 74% over all four age groups. Importantly, for patients <60 years (yrs), the five-year RS increased only in earlier time periods up to 92%, whereas for older patients (+80 yrs), the five-year RS continued to increase later, however, reaching only 53% until 2017. CONCLUSIONS This is the first population-based study of CML patients in Switzerland confirming similar data compared to other population-based registries in Europe. The RS increased significantly in all age groups over the last decades after the establishment of TKI therapy. Interestingly, we found a more prominent increase in RS of patients with older age at later observation periods (45%) compared to patients at younger age (10%), implicating a greater benefit from TKI treatment for elderly occurring with delay since the establishment of TKI therapy. Our findings suggest more potential to improve CML therapy, especially for older patients.
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Affiliation(s)
- Michael Daskalakis
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; (J.N.); (N.B.)
- Department of BioMedicalResearch (DMBR), University of Bern, Murtenstrasse 40, 3008 Bern, Switzerland
| | - Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), University of Zurich, Seilergraben 49, 8001 Zurich, Switzerland; (A.F.); (V.A.)
- National Agency for Cancer Registration (NACR) Operated by NICER, University of Zurich, 8001 Zurich, Switzerland
| | - Jasmine Noetzli
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; (J.N.); (N.B.)
- Cabinet Noetzli, Avenue de Rumine 35, 1005 Lausanne, Switzerland
| | - Nicolas Bonadies
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; (J.N.); (N.B.)
- Department of BioMedicalResearch (DMBR), University of Bern, Murtenstrasse 40, 3008 Bern, Switzerland
| | - Volker Arndt
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), University of Zurich, Seilergraben 49, 8001 Zurich, Switzerland; (A.F.); (V.A.)
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Gabriela Maria Baerlocher
- Department of BioMedicalResearch (DMBR), University of Bern, Murtenstrasse 40, 3008 Bern, Switzerland
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10
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Maheshwari VK, Slader C, Dani N, Gkitzia C, Yuan Q, Xiong T, Liu Y, Viana R. Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China. PLoS One 2021; 16:e0259076. [PMID: 34695169 PMCID: PMC8544861 DOI: 10.1371/journal.pone.0259076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the cost effectiveness of molecular monitoring in patients with chronic myeloid leukemia in the chronic phase (CML-CP) compared to no molecular monitoring from a Chinese payer perspective. Methods Analyses were conducted using a semi-Markov model with a 50-year time horizon. Population data from multicenter registry-based studies of Chinese patients with CML-CP informed the model. Transition probabilities were based on time-to-event data from the literature. Utility values were obtained from published studies and were assumed to be the same for patients with and without molecular monitoring. Costs were based on values commonly used in the Chinese healthcare system, including drug acquisition, drug administration, follow-up, treatment for disease progression, molecular monitoring, and terminal care costs, and were in the local currency (2020 Chinese Yuan RMB [¥]). Outcomes were total life-years (LYs) and quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio. Results Molecular monitoring was dominant to no molecular monitoring, with increased LYs (1.52) and QALYs (1.90) and costs savings (¥93,840) over a lifetime compared to no monitoring in discounted analyses. The opportunity of patients that receive molecular monitoring to discontinue treatment during treatment-free remission, an opportunity not afforded to those without molecular monitoring, was the principle driver of this result. Results were similar across multiple clinical scenarios. Particularly, molecular monitoring remained dominant even if the proportion of patients achieving deep molecular response (DMR) was reduced by 10%-30%, or the proportion of patients maintaining DMR for 1 year was reduced by 10%-30% or increased by 10%. Cost savings in these scenarios ranged from ¥62,230 to ¥103,964. Conclusions Overall, this analysis demonstrates that adherence to guideline recommendations of regular molecular monitoring of patients with CML-CP treated with TKIs provides significant clinical benefit that leads to substantial cost savings compared to no molecular monitoring from the perspective of a Chinese payer. In a time where healthcare systems have limited resources to allocate to optimal patient care, investment in molecular monitoring is an ideal choice for improving patient benefits at a reduced cost.
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Affiliation(s)
| | - Cassandra Slader
- Novartis Pharma AG, Medical Affairs, Basel, Basel Stadt, Switzerland
| | - Nidhi Dani
- Novartis Pharma AG, Value & Access, Basel, Basel Stadt, Switzerland
| | | | - Quan Yuan
- Novartis Oncology, Market Access Strategy, Beijing, China
| | | | - Yu Liu
- Novartis Oncology, Medical Affairs, Beijing, China
| | - Ricardo Viana
- Novartis Pharma AG, Global Value & Access, Oncology, Basel, Basel Stadt, Switzerland
- * E-mail:
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11
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Wan Puteh SE, Aizuddin AN, Tumian NR, Sathar J, Mohamad Selamat E. Health-related quality of life using EQ-5D among chronic myeloid leukaemia patients in health centres in Klang Valley, Malaysia. PLoS One 2021; 16:e0256804. [PMID: 34449814 PMCID: PMC8396714 DOI: 10.1371/journal.pone.0256804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022] Open
Abstract
Chronic Myeloid Leukaemia (CML) responds well with the targeted therapy drugs, Tyrosine Kinase Inhibitors (TKI), that give potentially long-term disease control for the patients. The objective of this study was to determine the disease burden and factors influencing the health-related quality of life (HRQoL) and health status of CML patients in Klang Valley, Malaysia. CML patients were recruited from haematological outpatient clinics in health centres in Klang Valley, Malaysia. A semi-guided self-administered questionnaire was used. HRQoL was measured by EQ-5D utility value and health status was by visual analogue score (VAS). Logistic regression analysis was conducted to determine the factors influencing HRQoL and health status. A total of 221 respondents participated, where more than half were Malay (56.6%), male (53.4%), and an Imatinib user (68.8%). Majority were diagnosed at the chronic phase (89.5%). The mean age of diagnosis was 41 years old. Significant determinant associated with HRQoL was age of diagnosis. These factors had no significant effect on the HRQoL of these patients regardless of types of TKI used and initial phase of CML. The overall HRQoL of CML patients were comparable to, if not higher, than the general population. Any TKI that was good enough to eliminate disease symptoms and erase patient's worries, can possibly make CML patients have a better quality of life than typical cancer patients and even the general population.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Female
- Health Status
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Logistic Models
- Male
- Middle Aged
- Protein Kinase Inhibitors/therapeutic use
- Quality of Life
- Surveys and Questionnaires
- Young Adult
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Affiliation(s)
- Sharifa Ezat Wan Puteh
- Department of Community Health, Faculty of Medicine, Hospital Canselor Tunku Muhriz, Kuala Lumpur, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Hospital Canselor Tunku Muhriz, Kuala Lumpur, Malaysia
| | - Nor Rafeah Tumian
- Haematology Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Jameela Sathar
- Haematology Department, Hospital Ampang, Ministry of Health Malaysia, Ampang, Malaysia
| | - Ellyana Mohamad Selamat
- Department of Community Health, Faculty of Medicine, Hospital Canselor Tunku Muhriz, Kuala Lumpur, Malaysia
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Quality of life among chronic myeloid leukemia patients in the second-line treatment with nilotinib and influential factors. Qual Life Res 2021; 31:733-743. [PMID: 34258697 DOI: 10.1007/s11136-021-02952-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aims to evaluate the quality of life (QoL) of chronic myeloid leukemia (CML) patients prescribed with nilotinib as a second-line therapy and explores the influential factors. METHODS A multicenter retrospective survey was conducted via face-to-face interviews based on the EORTC QLQ-C30 questionnaire. A total of 121 adult CML patients resistant to imatinib and used nilotinib for at least 3 months were enrolled. The influential features were assessed by multiple linear regression models. RESULTS Patients had the mean age of 47.49 (SD = 13.67) years, dominated by middle-aged and male groups. The mean scores of functions ranged from 75 to 83, and those of symptoms were from 5 to 28, with the highest of fatigue (28.28), insomnia (22.87), and pain (21.07). The mean global health status/QoL score was 67.70 (SD = 16.80) with considerable financial difficulties (52.34 (SD = 32.15)). Male patients reported higher functional scores and fewer symptoms compared with female patients. All aspects of QoL became worse with increasing age. Besides age and gender, level of education, duration of nilotinib usage, and comorbidities were also significantly influential factors in many QoL domains. A predicted model for expected mean scores of QoL domains was built based on these factors. CONCLUSIONS The CML patients treated with nilotinib had the above-moderate QoL scores, a light decrease of functional scores, great financial difficulties, and still experienced symptoms. Strategies and more therapeutic considerations to enhance QoL for CML patients targeted toward women, the old, low educational level, and long duration of nilotinib usage, and many comorbidities are needed in the setting.
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13
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Adel A, Abushanab D, Hamad A, Abdulla M, Izham M, Yassin M. Assessment of Dasatinib Versus Nilotinib as Upfront Therapy for Chronic Phase of Chronic Myeloid Leukemia in Qatar: A Cost-Effectiveness Analysis. Cancer Control 2021; 28:10732748211001796. [PMID: 33887995 PMCID: PMC8204580 DOI: 10.1177/10732748211001796] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The economic outcome research of approved tyrosine kinase inhibitors for treating the chronic phase of chronic myeloid leukemia in developing is scarce. The aim of this study was to assess the cost-effectiveness of dasatinib and nilotinib for newly diagnosed chronic myeloid leukemia patients. Methods: A decision tree model was developed linking clinical effectiveness (defined as major molecular response) and/or complete cytogenetic response, utility, and cost data over a 12-month period. Patients are recruited from Qatar Cancer Registry. The probability of primary clinical outcome is calculated from DASISION (dasatinib) and ENESTnd (nilotinib) trials. Direct healthcare costs were derived from the national healthcare payer system, whereas adverse effects data were derived from local incident reporting system. Results: In the first-line treatments of chronic myeloid leukemia patients, nilotinib has greater major molecular response (39% nilotinib vs 12% dasatinib) and complete cytogenetic response (24% nilotinib vs 16% dastinib) response outcomes, and more adverse effects than dasatinib (13.3% vs 4%). Moreover, nilotinib is more cost-effective with annual costs (USD63,589.59) and after 12 months of follow-up. Despite the lower acquisition annual cost of dasatinib (USD59,486.30), the incremental cost-effectiveness ratio of nilotinib (vs dasatinib) per major molecular response/complete cytogenetic response achieved was USD15,481.10 per year. There were no cases in both arms that progressed to accelerated or blast phase. At a threshold of 3 times gross domestic product per capita of Qatar and according to World Health Organization recommendation, the nilotinib use is still cost-effective. Conclusion: Upfront therapy of chronic myeloid leukemia–chronic phase patients by nilotinib plan appears to be more cost-effective than dasatinib.
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Affiliation(s)
- Ahmad Adel
- Pharmacy Department, National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Dina Abushanab
- Pharmacy Department, Women Wellness and Research Center, HMC, Doha, Qatar
| | - Anas Hamad
- Pharmacy Department, National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Mohammad Abdulla
- Hematology Department, National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Mohamed Izham
- College of Pharmacy, QU Health, 61780Qatar University, Doha, Qatar
| | - Mohamed Yassin
- Hematology Department, National Center for Cancer Care and Research, HMC, Doha, Qatar.,College of Medicine, 61780Qatar University, Doha, Qatar
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Amouei A, Daeian N, Khezrnia SS, Mansouri A, Hadjibabaie M. Imatinib Efficacy, Safety and Resistance in Iranian Patients with Chronic Myeloid Leukemia: A Review of Literature. Int J Hematol Oncol Stem Cell Res 2021; 15:114-131. [PMID: 34466210 PMCID: PMC8381106 DOI: 10.18502/ijhoscr.v15i2.6042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Imatinib is the gold standard in the treatment of chronic myeloid leukemia (CML) patients. Resistance to imatinib is interfering with patients’ responses and their survivals. Materials and Methods: We designed a systematic search to find relevant studies by applying appropriate keywords in PubMed, Web of science, Scopus, Ovid, ProQuest, Science direct and Google scholar for English studies. We also investigated the aforementioned terms’ correspondence in Magiran, Scientific information database (SID) and Google scholar for Persian articles. Results: 25 studies were selected for final analysis. Reported hematologic responses from adult studies ranged 86-99% and major molecular responses were estimated in 38.84% of our patients within 12 months of treatment. The most frequent reported adverse drug reactions (ADRs) were edema (n=5 studies, 100%) and fatigue and nausea (n=4 studies, 80%); ADR per capita ratio was 1.46. Only one study informed ADRs in pediatrics demonstrating 93% of patients experienced ADRs after receiving imatinib. Most of the Studies (n=4, 67% from 7 studies) considered BCR/ABL point mutation as main reason of imatinib resistance. Drug-binding site and P-loop regions were two common sites for BCR/ABL point mutation. Conclusion: Imatinib as the first line treatment for CML has been associated with proper and durable responses in Iranian adults and children CML patients. Moreover, Imatinib life-threatening adverse effects were reported uncommon. Various responses to modified regimens have been reported in resistant patients; therefore, individualized treatment based on mutation type could be recommended.
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Affiliation(s)
- Asiyeh Amouei
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Nesa Daeian
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Sana Khezrnia
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Ava Mansouri
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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15
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Anusha, Dalal H, Subramanian S, V P S, Gowda DA, H K, Damodar S, Vyas N. Exovesicular-Shh confers Imatinib resistance by upregulating Bcl2 expression in chronic myeloid leukemia with variant chromosomes. Cell Death Dis 2021; 12:259. [PMID: 33707419 PMCID: PMC7952724 DOI: 10.1038/s41419-021-03542-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 01/29/2023]
Abstract
Chronic myeloid leukemia (CML) patients with complex chromosomal translocations as well as non-compliant CML patients often demonstrate short-lived responses and poor outcomes on the current therapeutic regimes using Imatinib and its variants. It has been derived so far that leukemic stem cells (LSCs) are responsible for Imatinib resistance and CML progression. Sonic hedgehog (Shh) signaling has been implicated in proliferation of this Imatinib-resistant CD34(+) LSCs. Our work here identifies the molecular mechanism of Shh-mediated mutation-independent Imatinib resistance that is most relevant for treating CML-variants and non-compliant patients. Our results elucidate that while Shh can impart stemness, it also upregulates expression of anti-apoptotic protein—Bcl2. It is the upregulation of Bcl2 that is involved in conferring Imatinib resistance to the CD34(+) LSCs. Sub-toxic doses of Bcl2 inhibitor or Shh inhibitor (<<IC50), when used as adjuvants along with Imatinib, can re-sensitize Shh signaling cells to Imatinib. Our work here highlights the need to molecularly stratify CML patients and implement combinatorial therapy to overcome the current limitations and improve outcomes in CML.
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Affiliation(s)
- Anusha
- Manipal Academy of Higher Education (MAHE), Manipal, 576104, India.,St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, 560034, India
| | - Hamza Dalal
- Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, 560099, India
| | - Sitalakshmi Subramanian
- St. John's Medical College and Hosptial, St. John's Academy of Health Sciences, Bangalore, 560034, India
| | - Snijesh V P
- St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, 560034, India
| | - Divya A Gowda
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, UAS-GKVK Campus, Bellary Road, Bangalore, 560065, India
| | - Krishnamurthy H
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, UAS-GKVK Campus, Bellary Road, Bangalore, 560065, India
| | - Sharat Damodar
- Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, 560099, India.
| | - Neha Vyas
- St. John's Research Institute, St. John's Academy of Health Sciences, Bangalore, 560034, India.
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16
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Hino M, Matsumura I, Fujisawa S, Ishizawa K, Ono T, Sakaida E, Sekiguchi N, Tanetsugu Y, Fukuhara K, Ohkura M, Koide Y, Takahashi N. Phase 2 study of bosutinib in Japanese patients with newly diagnosed chronic phase chronic myeloid leukemia. Int J Hematol 2020; 112:24-32. [PMID: 32279228 DOI: 10.1007/s12185-020-02878-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Abstract
This open-label, single-arm, phase 2 study (ClinicalTrials.gov, NCT03128411) evaluated the efficacy, safety, and pharmacokinetics of bosutinib at a starting dose of 400 mg once daily (QD) in Japanese patients with newly diagnosed chronic phase chronic myeloid leukemia (CP CML). The primary endpoint was major molecular response (MMR) at Month 12 in the modified as-treated population (Philadelphia chromosome-positive [Ph+] patients with e13a2/e14a2 transcripts). Sixty Japanese patients with CP CML were treated with bosutinib; median age was 55 years (range 20-83), 60.0% were males, and all were Ph+ and had e13a2/e14a2 transcripts. After median follow-up of 16.6 months (range 11.1-21.9), 41 (68.3%) patients remained on bosutinib. The MMR rate at Month 12 was 55.0% (2-sided 90% confidence interval: 44.4-65.6). There were no on-treatment transformations to accelerated/blast phase, and no patient died on treatment or within 28 days of the last bosutinib dose. The most common treatment-emergent adverse events were diarrhea (86.7%), increased alanine aminotransferase (55.0%), and increased aspartate aminotransferase (46.7%). The primary objective of this phase 2 study was met, and there were no new safety signals for bosutinib. These data suggest bosutinib is an effective first-line treatment option for Japanese patients with newly diagnosed CP CML.
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Affiliation(s)
- Masayuki Hino
- Department of Hematology, Osaka City University Hospital, 1-4-3, Asahi-machi, Abeno-ku, Osaka, Japan.
| | | | - Shin Fujisawa
- Yokohama City University Medical Center, Yokohama, Japan
| | | | - Takaaki Ono
- Hamamatsu University Hospital, Shizuoka, Japan
| | | | - Naohiro Sekiguchi
- National Hospital Organization Disaster Medical Center, Tokyo, Japan
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17
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Algahtani FH, Alqahtany FS. Evaluation and characterisation of Chronic myeloid leukemia and various treatments in Saudi Arabia: A retrospective study. J Infect Public Health 2020; 13:295-298. [PMID: 31953021 DOI: 10.1016/j.jiph.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Chronic myeloid leukemia (CML) is a clonal BCR-ABL1-positive myelo-proliferative disorder resulting from an acquired genetic mutation, characterized by the presence of the Philadelphia (Ph) chromosome. CML is associated with significantly high granulocyte numbers in the bone marrow and peripheral blood. MATERIALS AND METHODS This retrospective study conducted at the Hematology Unit of King Saud University Medical City aimed to evaluate the incidence and characteristics of CML and the various treatments in Saudi Arabia. We have evaluated the demographic, clinical, and hematological data of 56 consecutive patients who visited the hospital from Jan 2012 to Jan 2018. RESULTS The diagnosis and stage of CML were determined based on the World Health Organization criteria, following polymerase chain reaction analysis of bone marrow aspirates. Our study group had equal numbers of genders with a age mean of 43.3+18.1 years. The predominance of younger patients and equal incidence in males and females could be due to the racial and socioeconomic disparities among our patients compared to those in previous studies. While the most predominant symptom was fatigue and bone pain, the most common clinical sign was hepato-splenomegaly, followed by remarkable weight loss, and epistaxis. CONCLUSION A patient with an increased WBC count, abdominal pain, left side distension, and hepato-splenomegaly should clearly be evaluated for CML.
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Affiliation(s)
- Farjah H Algahtani
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University, Kind Saud University Medical City, Riyadh, Saudi Arabia.
| | - Fatmah S Alqahtany
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University, Kind Saud University Medical City, Riyadh, Saudi Arabia
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Malhotra H, Radich J, Garcia-Gonzalez P. Meeting the needs of CML patients in resource-poor countries. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:433-442. [PMID: 31808889 PMCID: PMC6913442 DOI: 10.1182/hematology.2019000050] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Subsequent to the development and global availability of BCR/ABL-targeted tyrosine kinase inhibitors (TKIs), the prognosis of patients with chronic myeloid leukemia (CML), at least those in the chronic phase, has markedly improved, and in the developed world, the average lifespan of these patients is now close to that of age- and sex-matched subjects without the disease. However, the situation in low- and middle-income countries (LMICs) may not be so rosy. Many important differences in hematological cancers, including CML, have been highlighted in various publications in LMICs vs developed countries. These include differences in incidence and prevalence rates, age and stage of disease at diagnosis, response rates, and survival. Some of the possible reasons proposed for these are varying socioeconomic milieu (impacting availability of effective drugs and essential monitoring), environmental factors (mainly exposure to viral infections and pesticides), nutritional factors with interplay of malnutrition and diet on drug absorption and blood levels, and possible unknown genetic factors. Although generic first-generation TKIs (imatinib) are available in many parts of the world, several challenges remain in providing optimal treatment to patients with CML in resource-poor countries. Some of these include availability of optimal and high-quality BCR/ABL testing, availability and expense related to use of second- and third-generation TKIs (nilotinib, dasatinib, bosutinib, and ponatinib) and hematopoietic stem cell transplantation, issues with compliance and toxicities of drugs, and ensuring a minimal standard-of-care treatment and monitoring for every patient diagnosed with CML. For the purpose of this article, the more objective country label-LMIC-coined by the World Bank will be used (gross national income per capita between $1026 and $3995; World Bank, June 2019). Some of these issues will be discussed in this article in greater detail by experts in the field in 3 different but interconnected sections.
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MESH Headings
- Adult
- Developing Countries
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Hematopoietic Stem Cell Transplantation/economics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Protein Kinase Inhibitors/economics
- Protein Kinase Inhibitors/therapeutic use
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Affiliation(s)
- Hemant Malhotra
- Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
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Rinaldi I, Reksodiputro AH, Jusman SW, Harahap A, Setiabudy R, Wanandi SI, Tambunan K, Suharti C. Longer Hydroxyurea Administration Prior to Imatinib Mesylate is Risk Factor for Unsuccessful Major Molecular Response in Chronic-Phase Chronic Myeloid Leukemia: Possibility of P-Glycoprotein Role. Asian Pac J Cancer Prev 2019; 20:3689-3695. [PMID: 31870110 PMCID: PMC7173389 DOI: 10.31557/apjcp.2019.20.12.3689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to identify the association between duration of HU administration prior to IM treatment and MMR achievement in chronic-phase CML while evaluating the role of MDA, HIF-1α and P-gp. Methods: The study was conducted at Dr. Cipto Mangunkusumo National General Hospital and Dharmais Cancer Hospital, Jakarta using retrospective cohort design to analyse the association between the duration of HU before IM and its MMR achievement and cross-sectional design to analyse the association between MDA, HIF-1α and P-gp expressions with MMR achievement. Main subjects were chronic-phase CML patients treated by HU prior to IM for ≥ 12 months and HU only. The subjects were divided into four main groups: (1) chronic-phase CML patients treated with HU ≤ 6 months + IM ≥ 12 months and (2) HU > 6 months + IM ≥ 12 months (3) HU only (≤ 6 months), (4) HU only ( >6 months). Subjects were obtained from January 2015 to May 2016. Data were gathered through history taking, physical examination, medical record evaluation, and blood sample analysis. Bivariate analysis was conducted using chi square, independent T-test, and Mann-Whitney according to the variables. Results: Administration of HU for more than 6 months prior to IM was associated with unsuccessful MMR achievement (RR 1.60; 95%CI 1.29-2.00). MDA level, HIF-1α, P-glycoprotein expression were not associated with MMR achievement but the mean MDA level (0.63±0.31 vs 0.75±0.41 p=0.461) and median P-glycoprotein expressions {16,92 (0,04 – 43,86) vs. 5,15 (0,02–39,64); p=0.311} were found to be higher in patients receiving HU for > 6 months group than in HU ≤ 6 months group consecutively. Conclusion: Administration of HU for more than 6 months prior to IM was associated with unsuccessful MMR achievement in chronic-phase CML. The study suggested that P-glycoprotein overexpression as the predictor for unsuccessful MMR achievement.
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Affiliation(s)
- Ikhwan Rinaldi
- Department of Internal Medicine Division of Hematology and Medical Oncology, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ary Harryanto Reksodiputro
- Department of Internal Medicine Division of Hematology and Medical Oncology, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sri Widia Jusman
- Department of Biochemistry, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Alida Harahap
- Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rianto Setiabudy
- Department of Clinical Pharmacology, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Karmel Tambunan
- Department of Internal Medicine Division of Hematology and Medical Oncology, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Catharina Suharti
- Department of Internal Medicine Division of Hematology and Medical Oncology, Faculty of Medicine Universitas Diponegoro-Dr. Karyadi Hospital, Semarang, Indonesia
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20
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Yu L, Liu J, Huang X, Jiang Q. Adverse effects of dasatinib on glucose-lipid metabolism in patients with chronic myeloid leukaemia in the chronic phase. Sci Rep 2019; 9:17601. [PMID: 31772301 PMCID: PMC6879732 DOI: 10.1038/s41598-019-54033-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023] Open
Abstract
To explore the differences in glucose-lipid metabolism profiles among the 3 TKIs, we designed a retrospective study to compare the onset of hyperglycaemia, hypertriglyceridemia, hypercholesterolemia and hyper-low density lipoprotein (LDL)-cholesterolemia in the patients with normal baseline glucose-lipid profiles and had no medical record of cardio- or cerebro-vascular diseases and/or metabolic syndrome diseases, and identify variables associated with them. 370 chronic myeloid leukaemia patients receiving dasatinib, nilotinib or imatinib therapy ≥3 months were retrospectively reviewed. During TKI-therapy, the mean fasting glucose, triglyceride, cholesterol, and LDL-cholesterol levels increased significantly in both dasatinib and nilotinib cohorts compared with the imatinib cohort. In multivariate analyses, dasatinib was the factor significantly associated with both poor hyperglycaemia- and hypertriglyceridemia-free survival. In addition, nilotinib was significantly associated with more occurrences of hyperglycaemia and hypercholesterolemia; increasing age was significantly associated with more occurrences of hyperglycaemia and hypertriglyceridemia. We concluded that dasatinib, similar to nilotinib, has the adverse impact on glucose-lipid metabolism compared with imatinib.
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Affiliation(s)
- Lu Yu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Jing Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China.
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Yu L, Huang X, Gale RP, Wang H, Jiang Q. Variables associated with patient-reported symptoms in persons with chronic phase chronic myeloid leukemia receiving tyrosine kinase inhibitor therapy. Medicine (Baltimore) 2019; 98:e18079. [PMID: 31770225 PMCID: PMC6890299 DOI: 10.1097/md.0000000000018079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the variables associated with patient-reported symptoms and the impact of symptoms on health-related quality-of-life (HRQoL) in patients with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs). METHODS Anonymous Chinese-language questionnaires were distributed to adults with chronic-phase CML (CML-CP) receiving TKIs therapy >3 months regarding symptoms' incidence, severity, and HRQoL. The multivariate cumulative logistic regression model was built to identify variables associated with the symptoms. General Linear Model was used to model the relationship between symptoms and HRQoL using stepwise-forward algorithm. RESULTS A total of 1142 respondents were included in this study. The top 10 common TKI-related symptoms were fatigue, periorbital and lower limb edema, chest distress and shortness of breath, memory deterioration, skin color change, alopecia, muscle cramp, weight gain and musculoskeletal pain, and itchy skin. One hundred forty-one (50%) females ≤50 years reported menstrual disorders. Female, married, therapy duration 1 to 3 years, and foreign generic TKIs were associated with increased symptoms' frequency and severity. In contrast, receiving nilotinib or dasatinib, and achieving a complete cytogenetic response but not complete molecular response were associated with fewer and milder symptoms. Chest distress and shortness of breath and loss of appetite were associated with both lower physical component summary (PCS) and mental component summary (MCS) scores; fatigue, musculoskeletal pain, dizziness and abdominal pain, were associated with lower PCS score; anxiety-depression, was associated with lower MCS score in multivariate analyses. CONCLUSIONS Demographic and social variables, type of TKI-therapy, therapy duration, and depth of response were associated with patient-reported symptoms in persons with chronic phase CML. Certain symptoms have adverse impact on HRQoL.
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Affiliation(s)
- Lu Yu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - Haibo Wang
- Peking University Clinical Research Institute, Beijing
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing, China
- Collaborative Innovation Center of Haematology, Soochow University, Suzhou, China
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22
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Dou X, Qin Y, Huang X, Jiang Q. Planned Pregnancy in Female Patients with Chronic Myeloid Leukemia Receiving Tyrosine Kinase Inhibitor Therapy. Oncologist 2019; 24:e1141-e1147. [PMID: 31186377 PMCID: PMC6853119 DOI: 10.1634/theoncologist.2019-0109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/08/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The aim of this study was to explore outcomes of planned pregnancy in female patients with chronic myeloid leukemia (CML) on tyrosine kinase inhibitors (TKIs). MATERIALS AND METHODS Data of female patients proceeding with a planned pregnancy were retrospectively reviewed. RESULTS A total of 17 patients with CML who achieved at least a major molecular response (MMR) during imatinib (n = 13) or nilotinib (n = 4) therapy prior to a planned pregnancy were enrolled. At the time of TKI interruption, six were in MMR, two in molecular response 4 (MR4), and nine in molecular response 4.5 (MR4.5). TKI therapy was discontinued 6 weeks (range, 2-15 weeks) before conception in 4 patients and at gestational age of 4 weeks (range, 2-5 weeks) after determination of pregnancy in 13 patients. Apart from 1 patient who suffered a spontaneous abortion, 16 patients delivered uneventfully. A total of 10 patients lost MMR after stopping TKIs; 8 lost molecular response 2, and 3 lost complete hematological response. Log-rank analyses showed achieving MR4 (p = .030) or MR4.5 (p = .031), complete cytogenetic response duration ≥3.5 years (p = .049), and MMR duration ≥3.5 years (p = .040) were significantly associated with longer MMR-failure-free survival during TKI interruption. CONCLUSION Planned pregnancy might be pragmatic in female patients with CML on TKIs. Achieving deep molecular response and, importantly, MMR duration ≥3.5 years were significantly associated with maintaining MMR during pregnancy. IMPLICATIONS FOR PRACTICE Female patients with chronic myeloid leukemia on tyrosine kinase inhibitors (TKIs) wishing to conceive are currently advised to discontinue TKIs before conception. However, the ideal degree and duration of response before stopping TKI, in addition to whether there will be any adverse effect caused by a short exposure of TKI, is unknown. Data of 17 female patients, who achieved at least a major molecular response (MMR) before TKI interruption, was revised, and it was found that achieving deep molecular response and MMR duration ≥3.5 years was significantly associated with maintaining MMR during pregnancy. This provides direct evidence for a planned pregnancy strategy, and stopping TKI immediately after determination of pregnancy in female patients might be pragmatic.
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Affiliation(s)
- Xuelin Dou
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Yazhen Qin
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
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A unique case of complex variant translocation of t(6;9;22)(p22;q34;q11.2), der(19) in a newly diagnosed patient with chronic myeloid leukemia. Cancer Genet 2019; 237:78-81. [PMID: 31447069 DOI: 10.1016/j.cancergen.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/11/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022]
Abstract
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder characterized by the dysregulated production and uncontrolled proliferation of myeloid neoplastic cells. CML is associated with the fusion of BCR (on chromosome 22) and ABL1 (on chromosome 9) resulting in the BCR-ABL1 fusion gene. The translocation of chromosomes (9;22)(q34;p15) is present in almost 90-95% of patients with CML and only 5-8% CML patients have established variant complex translocation due to the participation of one or more chromosomes other than 9 and 22 chromosome. In the present study, a unique case of a pH chromosome-positive CML is reported with a new variant pH translocation involving three chromosomal aberrations 6p22, 9q34, 22q11.2 and derivation 19 which has not been described previously. The complex variant translocation with pH chromosome was 46,XY,t(6;9;22)(p22:q34;q11.2), der(19)[48]/46,XY[2] in this newly diagnosed CML patient. Additional cytogenetic anomalies may be seen in patients which are not controlled by the tyrosine kinase inhibitor in CML patients or in accelerated/blastic phase. In this case, the patient' treatment was switched to dasatinib because the IS-NCN could not be controlled with imatinib. In conclusion, complex translocations in unusual locations of the BCR / ABL gene appear to indicate a poor prognosis.
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García-Gutiérrez V, Hernández-Boluda JC. Tyrosine Kinase Inhibitors Available for Chronic Myeloid Leukemia: Efficacy and Safety. Front Oncol 2019; 9:603. [PMID: 31334123 PMCID: PMC6617580 DOI: 10.3389/fonc.2019.00603] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022] Open
Abstract
Chronic myeloid leukemia (CML) is currently a disease in which patients can enjoy a near normal life-expectancy. However, since the majority of patients will need to remain on treatment indefinitely, physicians in care of CML patients need be familiar with the indications and toxicities of all approved tyrosine kinase inhibitors (TKI). In clinical practice, there are five TKI (imatinib, nilotinib, dasatinib, bosutinib, and ponatinib) that are available in different scenarios and have distinct safety profiles. Decisions regarding first line treatment must be based on CML risk, comorbidities, and patients expectations. Despite the excellent outcome, half of the patients will eventually fail (due to intolerance or resistance) to first line treatment, with many of them requiring a third or even further lines of therapy. When selecting for such patients, it is essential to distinguish between failure and intolerance to previous TKIs. In the present review, we will address all these issues from a practical point of view.
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Affiliation(s)
- Valentín García-Gutiérrez
- Servicio de Hematología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Juan Carlos Hernández-Boluda
- Servicio de Hematología, Hospital Clínico Universitario, Institute of Health Research (INCLIVA), Valencia, Spain
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Gorre M, Sashidhar RB, Annamaneni S, Digumarti R, Satti V. Demographic and Clinical Characteristics of Chronic Myeloid Leukemia Patients: A Study on Confined Populations of Southern India. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_141_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Context: Chronic myeloid leukemia (CML) is one of the most common hematological malignancies in all populations throughout the world. Even though the pathophysiology of CML was well explained in majority of the studies, the incidence of CML was shown to exhibit population diversity, and hence, the demographic factors underlying CML origin remain to be understood. Further, the introduction of tyrosine kinase inhibitors had revolutionized the treatment of CML over the years; however, there is a need for developing tailoring therapy to individual risk since the patient clinical heterogeneity poses a major problem during drug response. Therefore, the study of basic clinical picture may aid in planning treatment strategies for CML patients. Aim: The aim of this article is to study the epidemiological and clinical variables associated with the prognosis of CML. Subjects and Methods: We have considered the distribution of various demographic and clinical variables among 476 CML patients diagnosed at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. Statistical Analysis Used: All the analyses were performed through SPSS software (version 21.0). Correlation and Cox regression analyses were also performed. Results: Apart from the elevated male sex ratio in CML incidence, high frequency of males was observed to be nonresponders to imatinib mesylate (IM). IM response was shown to be dependent on phase of diagnosis, whereas overall survival of CML patients depends on the age at onset and response to IM. Conclusions: The study of epidemiology and clinical picture of CML patients may help in planning better treatment strategies at diagnosis to achieve long-term progression-free survival.
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Affiliation(s)
- Manjula Gorre
- Departments of Biochemistry, University College of Science, Osmania University, Hyderabad, Telangana, India
| | - RB Sashidhar
- Departments of Biochemistry, University College of Science, Osmania University, Hyderabad, Telangana, India
| | - Sandhya Annamaneni
- Departments of Genetics, University College of Science, Osmania University, Hyderabad, Telangana, India
| | - Raghunadharao Digumarti
- Departments of Department of Medical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vishnupriya Satti
- Departments of Genetics, University College of Science, Osmania University, Hyderabad, Telangana, India
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Krishna Chandran R, Geetha N, Sakthivel KM, Suresh Kumar R, Jagathnath Krishna KMN, Sreedharan H. Impact of Additional Chromosomal Aberrations on the Disease Progression of Chronic Myelogenous Leukemia. Front Oncol 2019; 9:88. [PMID: 30891424 PMCID: PMC6411713 DOI: 10.3389/fonc.2019.00088] [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: 12/12/2018] [Accepted: 01/30/2019] [Indexed: 12/20/2022] Open
Abstract
The emergence of additional chromosomal abnormalities (ACAs) in Philadelphia chromosome/BCR-ABL1 positive chronic myeloid leukemia (CML), is considered to be a feature of disease evolution. However, their frequency of incidence, impact on prognosis and treatment response effect in CML is not conclusive. In the present study, we performed a chromosome analysis of 489 patients in different clinical stages of CML, using conventional GTG-banding, Fluorescent in situ Hybridization and Spectral Karyotyping. Among the de novo CP cases, ACAs were observed in 30 patients (10.20%) with lowest incidence, followed by IM resistant CP (16.66%) whereas in AP and BC, the occurrence of ACAs were higher, and was about 40.63 and 50.98%, respectively. The frequency of occurrence of ACAs were compared between the study groups and it was found that the incidence of ACAs was higher in BC compared to de novo and IM resistant CP cases. Likewise, it was higher in AP patients when compared between de novo and IM resistant CP cases, mirroring the fact of cytogenetic evolution with disease progression in CML. In addition, we observed 10 novel and 10 rare chromosomal aberrations among the study subjects. This study pinpoints the fact that the genome of advanced phase patients was highly unstable, and this environment of genomic instability is responsible for the high occurrence of ACAs. Treatment response analysis revealed that compared to initial phases, ACAs were associated with an adverse prognostic effect during the progressive stages of CML. This study further portrayed the cytogenetic mechanism of disease evolution in CML.
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Affiliation(s)
- Ramachandran Krishna Chandran
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, Trivandrum, India
| | - Narayanan Geetha
- Division of Medical Oncology, Regional Cancer Centre, Trivandrum, India
| | - Kunnathur Murugesan Sakthivel
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, Trivandrum, India.,Department of Biochemistry, PSG College of Arts and Science, Coimbatore, India
| | - Raveendran Suresh Kumar
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, Trivandrum, India
| | | | - Hariharan Sreedharan
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, Trivandrum, India
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Kim N, Choi S, Kim SM, Lee AC, Im K, Park HS, Kim JA, Kim K, Kim I, Chang YH, Lee DS. Monozygotic twins with shared de novo GATA2 mutation but dissimilar phenotypes due to differential promoter methylation. Leuk Lymphoma 2019; 60:1053-1061. [PMID: 30714451 DOI: 10.1080/10428194.2018.1516039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A revised WHO classification of hematopoietic neoplasm introduced the new category 'Myeloid Neoplasms with Germline Predisposition', reflecting the growing importance of genetic testing for myeloid neoplasms. Here, we investigated monozygotic twins with the same de novo mutation in GATA2 but different phenotypes. The patient suffering a bleeding tendency was diagnosed with myelodysplastic syndrome (MDS), and her monozygotic twin showed dysmegakaryopoietic features in the bone marrow. Targeted sequencing revealed the same germline mutation in GATA2, c.1192C > T, in both sisters and different somatic mutations in 14 genes between the sisters. The GATA2 mutation was absent in both parents, and their hemograms were normal. The methylation profile of the GATA2 promoter region was different between the twins, showing denser promoter methylation in the patient, correlated with MDS. Thus, we concluded that the twins had acquired a de novo GATA2 mutation but showed different phenotypes, possibly due to the critical role of epigenetic changes.
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Affiliation(s)
- Namhee Kim
- a Department of Laboratory Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Seongmin Choi
- b Division of Clinical Bioinformatics Biomedical Research Institute , Seoul National University Hospital , Seoul , Republic of Korea
| | - Sung-Min Kim
- c Cancer Research Institute, Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Amos Chungwon Lee
- d Interdisciplinary program of Bioengineering , Seoul National University , Seoul , Republic of Korea
| | - Kyongok Im
- c Cancer Research Institute, Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Hee Sue Park
- a Department of Laboratory Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Jung-Ah Kim
- a Department of Laboratory Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Kwangsoo Kim
- b Division of Clinical Bioinformatics Biomedical Research Institute , Seoul National University Hospital , Seoul , Republic of Korea
| | - Inho Kim
- e Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Yoon Hwan Chang
- f Department of Laboratory Medicine , Korea Cancer Center Hospital , Seoul , Republic of Korea
| | - Dong Soon Lee
- a Department of Laboratory Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea.,c Cancer Research Institute, Seoul National University College of Medicine , Seoul , Republic of Korea
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Kang KH, Kim SH, Choi SY, Yoo HL, Lee MY, Song HY, Kee KM, Suh JH, Yang SY, Jang EJ, Lee SE, Kim DW. Compound mutations involving T315I and P-loop mutations are the major components of multiple mutations detected in tyrosine kinase inhibitor resistant chronic myeloid leukemia. Leuk Res 2018; 76:87-93. [PMID: 30503643 DOI: 10.1016/j.leukres.2018.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 12/22/2022]
Abstract
To analyze the pattern of multiple mutations detected by Sanger sequencing (SS), we performed subcloning sequencing using 218 samples from 45 patients with tyrosine kinase inhibitor resistant chronic myeloid leukemia. At the first time of multiple mutation detection by SS (baseline), a total of 19 major mutations from 45 samples were detected; these mutations were found in the following order: T315I (68.9%), E255 K (33.3%), Y253H (13.3%), G250E (13.3%), and F317 L (11.1%). Subcloning sequencing of 900 baseline colonies identified 556 different mutant types, and 791 among the 900 were colonies with major mutations (87.9%). The mutations were found in the following order: T315I (36.4%), E255 K (16.2%), Y253H (7.0%), G250E (6.7%), M351 T (6.6%), and E255 V (5.3%). In subcloning sequencing with 4357 colonies of 218 serial samples, 2506 colonies (57.5%) had compound mutations, among which 2238 colonies (89.3%) had at least one major mutation. The median number of mutations in compound mutant colonies was 2 (range, 2-7), and most were double (52.9%) or triple (28.7%) mutations. Additionally, some mutations in allosteric binding sites were detected as low level mutation in 13 patients. With the available retrospective samples before baseline, subcloning sequencing identified low-level mutations of various frequencies (median, 10%) to be major mutations in 20 patients. Thus, compound mutations involving T315I and P-loop mutations were the major components of multiple mutations, and some low-level mutations with potential clinical significance were detected by subcloning sequencing. Hence, more sensitive sequencing assays are needed in patients with multiple mutations.
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Affiliation(s)
- Ki-Hoon Kang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Hyun Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Young Choi
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae-Lyun Yoo
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Young Lee
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye-Young Song
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Mi Kee
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Hyung Suh
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seon-Young Yang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Jung Jang
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Catholic Hematology Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Wook Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Hematology Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Yanamandra U, Sahu KK, Karunakaran P, Katoch D, Jain N, Khadwal A, Prakash G, Lad D, Naseem S, Varma N, Varma S, Malhotra P. Adolescent and Young Adult Chronic Myeloid Leukemia in Real-World Settings: Experience from a Tertiary Care Institute in Northern India. J Adolesc Young Adult Oncol 2018; 8:94-97. [PMID: 30383979 DOI: 10.1089/jayao.2018.0007] [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: 11/13/2022] Open
Abstract
The data on adolescent and young adult chronic myeloid leukemia (AYA-CML) from the Indian subcontinent are scarce. We studied characteristics of AYA-CML through a retrospective analysis of 1950 CML patients registered to a tertiary care hospital in Northern India. AYA-CML represented 22.1% of all CML patients, with cumulative overall survival (OS) of 84%, and 1 and 8 years OS of 94.2% and 74.2%, respectively. Of all cases, 8.91% patients had advanced disease at the time of diagnosis, and 13.95% had myelofibrosis in the diagnostic marrow, 79.6% had complete cytogenetic response (CCyR), and 84.5% had major molecular response (MMR). Loss of CCyR and MMR was noted in 37.2% and 28.4%, respectively. The cumulative OS was significantly better in patients on patient assistance program, and they were initiated on therapy within 3 months of symptom onset.
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Affiliation(s)
- Uday Yanamandra
- 1 Department of Hematology and Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Kamal Kant Sahu
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Parathan Karunakaran
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Deeksha Katoch
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Nidhi Jain
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Alka Khadwal
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Gaurav Prakash
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Deepesh Lad
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Shano Naseem
- 3 Department of Hematology, PGIMER, Chandigarh, India
| | - Neelam Varma
- 3 Department of Hematology, PGIMER, Chandigarh, India
| | - Subhash Varma
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- 2 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
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30
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Nguyen LT, Guo M, Naugler C, Rashid-Kolvear F. Incidence of chronic myeloid leukemia in Calgary, Alberta, Canada. BMC Res Notes 2018; 11:780. [PMID: 30382890 PMCID: PMC6211485 DOI: 10.1186/s13104-018-3890-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/26/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The epidemiology of chronic myeloid leukemia is shifting due to the aging global population and the recent discovery and availability of targeted treatment options. This study provides recent data regarding the incidence of CML in Calgary, a major Canadian city. Data from patients diagnosed with CML by bone marrow sample analysis from 2011 to 2015 were collected from the database of the sole centralized cytogenetics facility in service of Calgary and its surrounding area. RESULTS With an average of 10.2 newly diagnosed cases per year in Calgary from 2011 to 2015, the incidence rate was calculated to be 0.75 cases per 100,000 person-years (95% CI 0.57-0.99). With age standardization, the incidence was 0.87 cases per 100,000 person-years (95% CI 0.82-0.91) for the Canadian population, which was low compared to other developed Western nations. The highest incidence rates were observed in the older patient categories, however there was a broad age distribution for incident cases and the median age at diagnosis was 48. There was a general male bias for CML most pronounced at the younger ages. Our description of CML incidence will help to inform healthcare planners amidst the dramatically altered treatment of this hematological neoplasm.
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Affiliation(s)
- Leonard Tu Nguyen
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maggie Guo
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Departments of Family Medicine and Community Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fariborz Rashid-Kolvear
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Diagnostic and Scientific Centre, 2E-415, 9 3535 Research Road NW, Calgary, AB, T2L2K8, Canada.
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Yanamandra U, Malhotra P, Sahu K, Sushma Y, Saini N, Chauhan P, Gill J, Rikhi D, Khadwal A, Prakash G, Lad D, Suri V, Kumari S, Varma N, Varma S. Variation in Adherence Measures to Imatinib Therapy. J Glob Oncol 2018; 4:1-10. [PMID: 30241224 PMCID: PMC6223484 DOI: 10.1200/jgo.2016.007906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The introduction of tyrosine kinase inhibitors has transformed the care of patients with chronic myeloid leukemia, with survival approaching that of healthy individuals. Current-day challenges in chronic myeloid leukemia care include adherence to tyrosine kinase inhibitor therapy. We studied adherence from resource-constrained settings and tried to analyze the factors responsible for nonadherence in these individuals. We also correlated adherence to current molecular status. PATIENTS AND METHODS This was a single-center, cross-sectional, observational study from north India. It consisted of a questionnaire-based survey in which a one-to-one interview technique was used by trained nursing staff administering the Modified Morisky Adherence Scale (MMAS-9) questionnaire. Adherence was also measured on the basis of physician's assessment. JMP 13.0.0 was used for statistical analysis. RESULTS A total of 333 patients with a median age of 42 years were included in the study. The median BCR-ABL/ABL ratio (IS) was 0.175 (0.0 to 98.0). The mean MMAS-9 score was 11 ± 2. Adherence was seen in 54.95% on the basis of MMAS-9, whereas physician's assessment reported adherence in 90.39% of patients. Using the χ2 test, no relationship was found between the two assessment techniques. There was a significant relationship between major molecular response status and adherence by physician's assessment and MMAS-9 ( P < .001). Bivariate analysis by logistic fit showed a good relation between the MMAS-9 score and the BCR-ABL/ABL ratio (IS), χ2 (1,220) = 135.45 ( P < .001). On multivariate analysis, enrolment in the Novartis Oncology Access program (a patient assistance program) was significantly associated with adherence ( P = .012). CONCLUSION This study highlights the lack of adherence in real-world settings and the various factors responsible. Such studies are important from a public health services perspective in various settings around the world because they may lead to corrective action being taken at the institutional level.
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Affiliation(s)
- Uday Yanamandra
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Pankaj Malhotra
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - K.K. Sahu
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Yanamandra Sushma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Neha Saini
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Pooja Chauhan
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Jasmeen Gill
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Deepika Rikhi
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Alka Khadwal
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Gaurav Prakash
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Deepesh Lad
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Vikas Suri
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Savita Kumari
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Neelam Varma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
| | - Subhash Varma
- Uday Yanamandra, Pankaj Malhotra,
K.K. Sahu, Neha Saini, Pooja Chauhan,
Jasmeen Gill, Deepika Rikhi, Alka
Khadwal, Gaurav Prakash, Deepesh Lad,
Vikas Suri, Savita Kumari, Neelam
Varma, and Subhash Varma, Postgraduate Institute of
Medical Education and Research, Chandigarh; and Yanamandra Sushma,
Max Hospital, Mohali, Punjab, India
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Yu L, Jiang Q. [Comorbidity profile and its impact on reported outcome in Chinese patients with chronic myeloid leukemia in chronic phase receiving tyrosine kinase-inhibitor therapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:533-539. [PMID: 30122010 PMCID: PMC7342205 DOI: 10.3760/cma.j.issn.0253-2727.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 01/22/2023]
Abstract
Objectives: To explore the comorbidity profile and its impact on reported outcome of patients with chronic myeloid leukemia in chronic phase (CML-CP) receiving tyrosine kinase-inhibitor (TKI) therapy in China. Methods: From September 2015 to March 2016, anonymous questionnaires were distributed to adult CML patients who were receiving TKI treatment in China. The questionnaires included demographics, comorbidity(ies), TKI(s) therapy, annual out-of-pocket expense for TKIs, treatment responses, health-related quality of life (HRQoL) measured by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), satisfaction with therapy, impact of TKI therapy on work and daily life. Results: Data from 1 108 respondents in CML-CP were analyzed, 701 (63.6%) were male, median age was 42 years (range, 18-88 years), 76.4% were currently on imatinib, median TKI-therapy-duration was 29 months (range, 3-178 months). Of them, 300 (27.1%) had ≥1 comorbidity(ies), including hypertension(30.3%), diabetes (21.0%), coronary heart disease (12.3%), gastro-intestinal disease (12.3%), liver disease (11.7%), kidney disease (8.3%), cerebrovascular disease (6.7%) and lung diseases (5.7%), thrombosis (1.3%), other benign diseases (15.3%) and other cancer (8.0%), and 74 (24.7%) had ≥2 comorbidities. Multivariate analyses showed the comorbidity profile of other benign diseases was significantly associated with lower HRQoL score and TKI therapy affecting work and daily life, but it did not significantly affect patients' satisfaction with TKI treatment. Female and no complete cytogenetic response (CCyR) were associated with lower HRQoL score, education level ≥bachelor degree and TKI-therapy duration ≥3 years were associated with higher HRQoL score. Switching between first and second generation TKIs and no CCyR were associated with dis-satisfaction or extreme dis-satisfaction with TKI therapy, free out-of-pocket expense for TKI was associated with better satisfaction. Age<60 years and no CCyR were associated with TKI therapy affecting work and daily life. Conclusions: The survey showed that 27.1% Chinese adult patients with CML-CP receiving TKI-therapy had comorbidity(ies). Different comorbidity profile had different impact on patients' HRQoL and different impact of TKI therapy on work and daily life.
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Affiliation(s)
- L Yu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China
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Shin J, Koh Y, Yoon SH, Cho JY, Kim DY, Lee KH, Kim HJ, Ahn JS, Kim YK, Park J, Sohn SK, Moon JH, Lee YJ, Yoon S, Lee JO, Cheong JW, Kim KH, Kim SH, Kim HG, Kim H, Nam SH, Do YR, Park SG, Park SK, Bae SH, Song HH, Shin DY, Oh D, Kim MK, Jung CW, Park S, Kim I. A phase 4 study of nilotinib in Korean patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase: ENESTKorea. Cancer Med 2018; 7:1814-1823. [PMID: 29577674 PMCID: PMC5943463 DOI: 10.1002/cam4.1450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 11/12/2022] Open
Abstract
Although nilotinib has improved efficacy compared to imatinib, suboptimal response and intolerable adverse events (AEs) limit its effectiveness in many patients with chronic myeloid leukemia in chronic phase (CML-CP). We investigated the 2-year efficacy and safety of nilotinib and their relationships with plasma nilotinib concentrations (PNCs). In this open-label, multi-institutional phase 4 study, 110 Philadelphia chromosome-positive CML-CP patients were treated with nilotinib at a starting dose of 300 mg twice daily. Molecular responses (MRs) and AEs were monitored for up to 24 months. The 24-month cumulative MR4.5 rate was evaluated as the primary endpoint. Plasma samples were collected from 94 patients to determine PNCs, and the per-patient mean was used to categorize them into four mean PNC (MPNC) groups. Cumulative MR rates and safety were compared between groups. With a median follow-up of 22.2 months, the 24-month cumulative MR4.5 rate was 56.2% (95% confidence interval, 44.0%-8.3%), and the median time to MR4.5 was 23.3 months. There were no significant differences in the cumulative rates of major molecular response, MR4 , and MR4.5 between MPNC groups. One patient died due to acute viral hepatitis, and two developed hematological or cytogenetic relapse, while no progression to accelerated or blast phase was observed. Safety results were consistent with previous studies with no new safety signal identified. Across the MPNC groups, there was no significant linear trend in the frequency of AEs. Nilotinib is highly effective for the treatment of CML-CP with manageable AEs. The measurement of PNC has no predictive value for patient outcomes and is thus not found to be clinically useful. This study is registered with clinicaltrials.gov, Number NCT03332511.
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Affiliation(s)
- Junghoon Shin
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seo Hyun Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, Seoul, Korea
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, Seoul, Korea
| | - Dae-Young Kim
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoo-Hyung Lee
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Hyeong-Joon Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae-Sook Ahn
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yeo-Kyeoung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jinny Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang-Kyun Sohn
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seonghae Yoon
- Clinical Trials Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - June-Won Cheong
- Department of Internal Medicine, Severance Hospital, Seoul, Korea
| | - Kyoung Ha Kim
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Hoon-Gu Kim
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Hawk Kim
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Seung-Hyun Nam
- Department of Internal Medicine, VHS Medical Center, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Seong Kyu Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung Hwa Bae
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Hun Ho Song
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Doyeun Oh
- Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Chul Won Jung
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Seonyang Park
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW A large number of chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitors (TKIs) can now enjoy a deep molecular control of the disease and the life span could be approaching that of normal population. The purpose of the review is to evaluate current evidence and if we can talk of a cure. RECENT FINDINGS The revolution in the treatment of CML was apparent since the exquisite efficacy of imatinib mesylate, a tyrosine kinase inhibitor, was proven and received approval for newly diagnosed cases in 2001. Subsequent development of second-generation TKIs, nilotinib and dasatinib, has increased our armamentarium. These TKIs, because of their safety and efficacy, are now offered as first-line therapy, thus relegating use of allogeneic transplant to the second line or beyond. It has also been possible to stop TKIs in selected subsets in whom leukemia burden became undetectable and ~ 40% of them remain drug-free for a number of years-treatment-free remission (TFR). Nevertheless, much work needs to be done to eradicate leukemia stem cells as current TKIs appear unable to eradicate leukemia stem cells (LSC). Effective treatment of more advanced phase CML remains elusive. Further efforts to develop newer molecules targeting BCR-ABL and beyond must be continued. Although TKIs have revolutionized treatment of chronic phase CML, longer follow-up is necessary to realize their curative potential. Equally important is to explore newer targets and development of more potent small molecules for eradication of leukemia clone in all patients.
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Xu J, Gu J, Zhao Y, Meng H, Du L, Zhang R, Jiang H, Luo J. The BCL2L11 deletion polymorphism is not associated with imatinib resistance in chronic myeloid leukemia patients: meta-analysis. Oncotarget 2017; 8:99041-99048. [PMID: 29228749 PMCID: PMC5716789 DOI: 10.18632/oncotarget.21154] [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: 08/01/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022] Open
Abstract
A common deletion polymorphism of the gene Bcl-2 like protein 11 (BCL2L11, BIM) has been reported to cause tyrosine kinase inhibitors (TKIs) resistance in several malignant tumors. However, the conclusions were not consistent in chronic myeloid leukemia (CML) individuals. In order to obtain a reliable conclusion, we systematically searched PubMed, Embase, Web of Science, Chinese Biomedical Database, and China National Knowledge Infrastructure and performed the meta-analysis. Six published articles contain 760 East Asian patients were identified from these electronic databases. The methodological quality of one included trial was high, and the others were moderate. Meta-analysis showed that the rate of TKI resistance between the BIM deletion and wild-type group were no statistical significance (OR = 1.24, 95% CI 0.79-1.95). In conclusion, BIM deletion may not a predictor of TKI resistance in CML individuals in East Asia.
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Affiliation(s)
- Jinyun Xu
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jiaowei Gu
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yan Zhao
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Huihua Meng
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Li’an Du
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ruibo Zhang
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hao Jiang
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jianming Luo
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Asif M, Hussain A, Wali A, Ahmad N, Sajjad N, Amir M, Ali I, Pushparaj PN, Rasool M. A rare case of three-way complex variant translocation in chronic myeloid leukemia t(6;9;22)(p21;q34;q11): A case report. Biomed Rep 2017; 7:377-379. [PMID: 29085635 DOI: 10.3892/br.2017.967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/20/2017] [Indexed: 11/05/2022] Open
Abstract
Philadelphia (Ph)-positive chromosome or Ph translocation has been recognized in 90-95 chronic myeloid leukemia (CML) cases worldwide. However, only 5-8% CML patients show complex variant translocations. In the present study, hematological tests for a 47-year-old female CML patient were performed to determine the hemoglobin, platelets and total leukocyte values. A FISH test was carried out to recognize the BCR/ABL gene fusion, and a cytogenetic analysis was performed. The hematological results showed an increase in WBC (414000/mm3) and a decrease in hemoglobin (8.9 mg/dl), indicating the anemic condition in the CML patient. Furthermore, cytogenetic karyotyping results showed 46,XX,t(6;9;22)(p21;q34;q11) and positive for Ph chromosome. In conclusion, in the present study, we report a rare three-way complex variant translocation in a CML patient.
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Affiliation(s)
- Muhammad Asif
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta 87300, Pakistan
| | - Abrar Hussain
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta 87300, Pakistan
| | - Abdul Wali
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta 87300, Pakistan
| | - Nazeer Ahmad
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta 87300, Pakistan
| | - Naheed Sajjad
- Department of Biotechnology, Sardar Bahadur Khan Women's University, Quetta 87500, Pakistan
| | - Muhammad Amir
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta 87300, Pakistan
| | - Irfan Ali
- Akhuwat Faisalabad Institute of Research Science and Technology, Faisalabad 38000, Pakistan
| | - Peter Natesan Pushparaj
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Mahmood Rasool
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
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Lee JY, Lee SM, Yoon HK, Kim KH, Choi MY, Lee WS. A case of synchronous multiple myeloma and chronic myeloid leukemia. Blood Res 2017; 52:219-221. [PMID: 29043239 PMCID: PMC5641516 DOI: 10.5045/br.2017.52.3.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/29/2017] [Accepted: 03/13/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji-Young Lee
- Department of Internal Medicine, Hemato-Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Sang-Min Lee
- Department of Internal Medicine, Hemato-Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Hye-Kyoung Yoon
- Department of Pathology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Ki-Hyang Kim
- Department of Internal Medicine, Hemato-Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Moon-Young Choi
- Department of Internal Medicine, Hemato-Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Won-Sik Lee
- Department of Internal Medicine, Hemato-Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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Ko PS, Yu YB, Liu YC, Wu YT, Hung MH, Gau JP, Liu CJ, Hsiao LT, Chen PM, Chiou TJ, Liu CY, Liu JH. Moderate anemia at diagnosis is an independent prognostic marker of the EUTOS, Sokal, and Hasford scores for survival and treatment response in chronic-phase, chronic myeloid leukemia patients with frontline imatinib. Curr Med Res Opin 2017; 33:1737-1744. [PMID: 28715941 DOI: 10.1080/03007995.2017.1356708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aimed to examine the prognostic value of anemia for the diagnosis of chronic myeloid leukemia in the chronic phase (CML-CP) receiving imatinib. METHODS One hundred and fifty-four CML-CP patients were enrolled. The influences of moderate anemia with hemoglobin (Hb) < 10 g/dl, four scoring systems, and the early molecular response at 3 months (BCR-ABL ≤10%; 3M-EMR) on the achievement of a deep molecular response (DMR, MR4.5), progression-free survival (PFS), event-free survival (EFS), and overall survival (OS) were compared. RESULTS Moderate anemia was identified in 44 (28.6%) patients. These patients had more aggressive baseline features and higher risks, as assessed by scoring systems, and less favorable treatment responses vs those without anemia, including 3M-EMR (50.0% vs 69.1%), a complete cytogenetic response at 6 months (20.5% vs 50.9%), and a major molecular response at 12 months (22.5% vs 45.2%), with a median follow-up of 54.0 months. Furthermore, an Hb of 10 g/dl better distinguished DMR, EFS, PFS, and OS than the EUTOS, Sokal, and Hasford scores, and better predicted the responses and survivals in combination with 3M-EMR than 3M-EMR alone. CONCLUSIONS This finding highlights the significance of anemia in CML-CP, and suggests that patients with anemia at diagnosis should be carefully monitored and might benefit from more potent TKIs if not achieving 3M-EMR.
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Affiliation(s)
- Po-Shen Ko
- a Division of Hematology and Oncology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Yuan-Bin Yu
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
- c Division of Oncology and Hematology, Department of Internal Medicine , Far Eastern Memorial Hospital , Taipei , Taiwan
| | - Yao-Chung Liu
- a Division of Hematology and Oncology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Yi-Tsui Wu
- d Department of Nursing , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Man-Hsin Hung
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
- e Division of Medical Oncology, Department of Oncology , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Jyh-Pyng Gau
- a Division of Hematology and Oncology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Chia-Jen Liu
- a Division of Hematology and Oncology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
- f Institute of Public Health, National Yang-Ming University , Taipei , Taiwan
| | - Liang-Tsai Hsiao
- a Division of Hematology and Oncology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Po-Min Chen
- a Division of Hematology and Oncology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Tzeon-Jye Chiou
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
- g Division of Transfusion Medicine, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Chun-Yu Liu
- b School of Medicine , National Yang-Ming University , Taipei , Taiwan
- e Division of Medical Oncology, Department of Oncology , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Jin-Hwang Liu
- a Division of Hematology and Oncology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- h Institute of Biopharmaceutical Sciences, National Yang-Ming University , Taipei , Taiwan
- i Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University , Taipei , Taiwan
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Kwak JY, Kim SH, Oh SJ, Zang DY, Kim H, Kim JA, Do YR, Kim HJ, Park JS, Choi CW, Lee WS, Mun YC, Kong JH, Chung JS, Shin HJ, Kim DY, Park J, Jung CW, Bunworasate U, Comia NS, Jootar S, Reksodiputro AH, Caguioa PB, Lee SE, Kim DW. Phase III Clinical Trial (RERISE study) Results of Efficacy and Safety of Radotinib Compared with Imatinib in Newly Diagnosed Chronic Phase Chronic Myeloid Leukemia. Clin Cancer Res 2017; 23:7180-7188. [PMID: 28939746 DOI: 10.1158/1078-0432.ccr-17-0957] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/27/2017] [Accepted: 09/15/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Radotinib is a second-generation BCR-ABL1 tyrosine kinase inhibitor (TKI) approved in Korea for chronic phase chronic myeloid leukemia (CML-CP) in patients newly diagnosed or with insufficient response to other TKIs. This study was conducted to evaluate the efficacy and safety of radotinib as first-line therapy for CML-CP.Experimental Design: This multinational, open-label study assigned patients (1:1:1) to one of two twice-daily radotinib doses, or imatinib daily. The primary endpoint was major molecular response (MMR) by 12 months.Results: Two hundred forty-one patients were randomized to receive radotinib 300 mg (n = 79) or 400 mg twice-daily (n = 81), or imatinib 400 mg daily (n = 81). MMR rates by 12 months were higher in patients receiving radotinib 300 mg (52%) or radotinib 400 mg twice-daily (46%) versus imatinib (30%; P = 0.0044 and P = 0.0342, respectively). Complete cytogenetic response (CCyR) rates by 12 months were higher for radotinib 300 mg (91%) versus imatinib (77%; P = 0.0120). Early molecular response at 3 months occurred in 86% and 87% of patients receiving radotinib 300 mg and radotinib 400 mg, respectively, and 71% of those receiving imatinib. By 12 months, no patients had progression to accelerated phase or blast crisis. Most adverse events were manageable with dose reduction.Conclusions: Radotinib demonstrated superiority over imatinib in CCyR and MMR in patients newly diagnosed with Philadelphia chromosome-positive CML-CP. This trial was registered at www.clinicaltrials.gov as NCT01511289 Clin Cancer Res; 23(23); 7180-8. ©2017 AACR.
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Affiliation(s)
- Jae-Yong Kwak
- Chonbuk National University Medical School & Hospital, Jeonju, South Korea
| | - Sung-Hyun Kim
- Dong-A University Medical Center, Busan, South Korea
| | - Suk Joong Oh
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae Young Zang
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Hawk Kim
- Ulsan University Hospital, Ulsan, South Korea
| | - Jeong-A Kim
- St. Vincent Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Young Rok Do
- Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Hyeoung Joon Kim
- Chonnam National University, Hwasun Hospital, Hwasun, South Korea
| | | | | | - Won Sik Lee
- Inje University Busan Paik Hospital, Busan, South Korea
| | - Yeung-Chul Mun
- Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Jee Hyun Kong
- Wonju Severance Christian Hospital, Wonju, South Korea
| | | | - Ho-Jin Shin
- Pusan National University Hospital, Busan, South Korea
| | - Dae-Young Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinny Park
- Gachon University Gil Medical Center, Seoul, South Korea
| | - Chul Won Jung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Udomsak Bunworasate
- King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | | | - Saengsuree Jootar
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Sung-Eun Lee
- Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Wook Kim
- Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.
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Abstract
Background In the last decade, the use of imatinib has brought a paradigm shift in the management of chronic myeloid leukemia (CML). In India, imatinib has been available for more than a decade and has been made accessible to all segments of the population because of patient assistance programs and cheaper generic versions. Despite improvements in survival, there are unique challenges in the Indian context. Methods We reviewed published data pertaining to CML in India for the period of 1990 to 2016, using PubMed advanced search with the terms chronic myeloid leukemia and India, and included studies that reported on epidemiology, monitoring for therapy, treatment outcomes, and resistance. Additionally, the references in retrieved articles were also reviewed. Results Thirty-seven studies were identified. The incidence of CML may be slightly lower in India than in the West, but there was only a single article reporting population-based data. Indian patients presented with more advanced disease. Most centers have access to imatinib as first-line therapy, but there is limited availability of molecular monitoring and second-line therapy. Most of the outcome data were retrospective but seemed comparable with that reported in Western centers. Drug adherence was impaired in at least one third of patients and contributed to poor survival. Conclusion Focused prospective studies and cooperative studies might improve the quality of data available. Future studies should focus on adherence, its effects on outcomes, and methods to address this problem.
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Affiliation(s)
- Prasanth Ganesan
- , Cancer Institute (WIA), Chennai; and , All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- , Cancer Institute (WIA), Chennai; and , All India Institute of Medical Sciences, New Delhi, India
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Sholikah TA, Hutajulu SH, Sulistyawati D, Aning S, Fatmawati S, Syifarahmah A, Widayati K, Kurnianda J, Paramita DK. New Genetic Variation in BCR gene of Major B3a2 Breakpoint BCR-ABL Fusion Gene in Patients with Chronic Myelogenous Leukemia in Yogyakarta, Indonesia. Asian Pac J Cancer Prev 2017; 18:1343-1348. [PMID: 28612580 PMCID: PMC5555545 DOI: 10.22034/apjcp.2017.18.5.1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Polymorphic bases in several exons of the BCR gene have been found in several studies of the BCR-ABL fusion gene . Most of the polymorphisms do not have any implications for the primary structure of the BCR-ABL protein. Nucleotide changes are often located in the area close to the fusion region, and therefore may influence primer annealing. Our previous work failed to amplify 15 of 200 samples from BCR-ABL positive chronic myelogenous leukemia (CML) patients using multiplex PCR, the standard method to detect BCR-ABL transcripts used in our institution. The failure was considered due to problems in primer annealing caused by sequence variations. Sequence analysis of BCR-ABL fusion gene breakpoint types in CML patients has never been hitherto performed in Indonesia. Therefore, the aim of this study was to perform sequence analysis of several samples that did not show amplification using the standard method. Methods: Fifteen samples were qualitatively amplified by two-step PCR using inner primers in the 2nd PCR to determine the breakpoint type of the BCR-ABL fusion gene. The 2nd PCR products were used as templates to perform sequence analysis, and the results were compared to those in genbank. Result: Seven and 5 of 15 samples were confirmed as major b3a2 and major b2a2, respectively. One sample featured a combination of b3a2 and b2a2, and 2 samples a combination of b3a2 and b2a2 with an additional fragment at 500bp. Sequence analysis showed 3 sequence variations in the major b3a2 breakpoint. One had been reported earlier (c.3296T>C) but the others (c.3245C>T and c.3359T>C) were novel. Fragments at 500bp were confirmed as b3a2 and similar sequence b3a2 in genbank. Conclusion: This study found two new genetic variations in the BCR gene in BCR-ABL fusion cases.
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Affiliation(s)
- Tri Agusti Sholikah
- Biomedical Science Study Program, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Departement of Histology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.
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Ponatinib in Japanese patients with Philadelphia chromosome-positive leukemia, a phase 1/2 study. Int J Hematol 2017; 106:385-397. [PMID: 28444644 DOI: 10.1007/s12185-017-2238-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 12/22/2022]
Abstract
In this ongoing Phase 1/2 study (NCT01667133), we evaluated ponatinib and assessed its recommended dose in Japanese patients with chronic myeloid leukemia (CML) resistant/intolerant to dasatinib or nilotinib, or with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) resistant/intolerant to ≥1 tyrosine kinase inhibitor (TKI). The primary endpoints were safety of the recommended dose (Phase 1) and major cytogenetic response (MCyR) by 12 months in chronic-phase CML (CP-CML) patients or major hematologic response (MaHR) by 6 months in patients with advanced phase disease (Phase 2). MCyR was achieved/maintained by 12 months in 65% of CP-CML patients; MaHR was achieved by 6 months in 61% of patients with advanced phase disease. The most common nonhematologic grade 3/4 treatment-emergent adverse event (AE) was hypertension (37%); common hematologic grade 3/4 AEs were thrombocytopenia (57%), neutropenia (34%), and leukopenia (26%). Overall, five (14%) patients experienced arterial occlusive events (AOEs); no grade 5 AOEs were reported. The steady-state accumulation ratio of ponatinib (based on area under the curve) ranged from 2.6 (15 mg/day) to 1.3 (45 mg/day). In summary, ponatinib demonstrated efficacy in Japanese patients with CML and Ph+ALL resistant/intolerant to prior TKI treatment; safety data support a recommended starting dose of 45 mg/day in these patients.
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Levine PH, Ajmera K, O’Neill B, Venkatesh V, Garcia-Gonzalez P, Hoffman HJ. Demographic factors related to young age at diagnosis of chronic myeloid leukemia in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lakkireddy S, Aula S, Kapley A, Swamy AVN, Digumarti RR, Kutala VK, Jamil K. Association of Vascular Endothelial Growth Factor A (VEGFA) and its Receptor (VEGFR2) Gene Polymorphisms with Risk of Chronic Myeloid Leukemia and Influence on Clinical Outcome. Mol Diagn Ther 2016; 20:33-44. [PMID: 26476544 DOI: 10.1007/s40291-015-0173-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Vascular endothelial growth factor A (VEGFA) and its kinase insert domain receptor (VEGFR2/KDR) were reported to be upregulated in chronic myeloid leukemia (CML); however, the influence of polymorphisms in VEGFA and VEGFR2 in CML pathogenesis and therapeutic response, have not yet been elucidated. METHODS We aimed to analyze these polymorphisms in 212 CML patients and 212 healthy controls by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach. RESULTS The VEGFA+936C>T polymorphism did not differ significantly between the CML patients and controls. The frequency of CT genotype was higher in CML patients than in controls (25 vs. 18%), higher in males than in females (29 vs. 18%), was more prevalent in the patients with splenomegaly (p = 0.03), and was negatively associated with lactate dehydrogenase (LDH) levels (p = 0.01). The frequency of VEGFR2 mutant T-allele was higher in CML patients than controls (p < 0.0001). In the dominant model, patients having the combined AT and TT genotypes were associated with 2.6-fold higher risk of CML [odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.71–3.97, p < 0.0001]. VEGFR2 AT genotype was significantly associated with high blast count (p = 0.006), minor hematological response (p = 0.03) and poor cytogenetic response (p = 0.003), indicating its role in therapeutic resistance. In contrast, poor molecular response was observed in patients with TT genotype (p = 0.02). VEGFA+936C>T polymorphism was found to have synergistic interaction with VEGFR2+1416A>T in inflating the risk for CML further (P(interaction) = 0.0002). CONCLUSION Our results indicate that VEGFR2+1416A>T polymorphism may be a useful marker in assessing the disease progression in CML patients. In addition, VEGFA+936C>T was observed to have additive effect in inflating the risk further.
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Asif M, Hussain A, Rasool M. A rare case of a three way complex variant positive Philadelphia translocation involving chromosome (9;11;22)(q34;p15;q11) in chronic myeloid leukemia: A case report. Oncol Lett 2016; 12:1986-1988. [PMID: 27602125 DOI: 10.3892/ol.2016.4821] [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] [Received: 01/31/2015] [Accepted: 12/02/2015] [Indexed: 11/05/2022] Open
Abstract
The t(9;22)(q34;q11) translocation is present in 90-95% of patients with chronic myeloid leukemia (CML). Variant complex translocations have been observed in 5-8% of CML patients, in which a third chromosome other than (9;22) is involved. Imatinib mesylate is the first line breakpoint cluster region-Abelson gene (BCR/ABL)-targeted oral therapy for CML, and may produce a complete response in 70-80% of CML patients in the chronic phase. In the present study, a bone marrow sample was used for conventional cytogenetic analysis, and the fluorescence in situ hybridization (FISH) test was used for BCR/ABL gene detection. A hematological analysis was also performed to determine the white blood cell (WBC) count, red blood cell count, hemoglobin levels, packed and mean cell volumes, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and platelet values of the patient. The hematological analysis of the patient indicated the increased WBC of 186.5×103 cells/µl, and decreased hemoglobin levels of 11.1 g/dl. The FISH test revealed that 67% cells demonstrated BCR/ABL gene translocation. The patient was treated with 400 mg imatinib mesylate daily, and was monitored at various intervals over a 6-month period. The present study reports the rare case of a patient that demonstrates a three-way Philadelphia chromosome-positive translocation involving 46XY,t(9;11;22)(q34;p15;q11)[10], alongside CML in the chronic phase. The translocation was analyzed using cytogenetic and FISH tests.
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Affiliation(s)
- Muhammad Asif
- Department of Biotechnology and Informatics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Balochistan 87300, Pakistan; Office of Research Innovation and Commercialization, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Balochistan 87300, Pakistan
| | - Abrar Hussain
- Department of Biotechnology and Informatics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Balochistan 87300, Pakistan
| | - Mahmood Rasool
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Makkah 21589, Saudi Arabia
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Yun S, Vincelette ND, Segar JM, Dong Y, Shen Y, Kim DW, Abraham I. Comparative Effectiveness of Newer Tyrosine Kinase Inhibitors Versus Imatinib in the First-Line Treatment of Chronic-Phase Chronic Myeloid Leukemia Across Risk Groups: A Systematic Review and Meta-Analysis of Eight Randomized Trials. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e85-94. [DOI: 10.1016/j.clml.2016.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/06/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
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Daroudi R, Mirzania M, Nikravanfard N, Sadighi S, Sedighi Z, Zendehdel K. Estimation of the prevalence and direct medical costs of chronic myeloid leukemia in the I.R. of Iran in the era of tyrosine kinase inhibitors. Asia Pac J Clin Oncol 2016; 13:e416-e422. [PMID: 26990676 DOI: 10.1111/ajco.12470] [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] [Received: 04/08/2015] [Revised: 11/01/2015] [Accepted: 01/13/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND After the introduction of tyrosine kinase inhibitors for chronic myeloid leukemia (CML), the survival of these patients has increased significantly. However, these new drugs are expensive and impose considerable expense to patients and governments. Epidemiologic and economic evaluation studies provide good information for resource allocation and decision making. We estimated the incidence, prevalence and direct medical cost of CML in Iran. METHODS We used the National Cancer Registry (NCR) data from 2006 to 2009 to estimate the incidence rate of CML (ICD-10 code C92.1). After adjustment for the underestimation of incidence rates, we used survival rates of CML and estimated the 5-year prevalence for these patients. In addition, we used clinical practice guideline, expert opinions and medical tariffs to estimate the direct medical costs through the prevalence approach. RESULTS After an adjustment for the underestimation, the incidence rate of CML was 0.5 per 100 000 in the I.R. of Iran. The 5-year prevalence was about 2263 cases (2.98 per 100 000). The total direct medical cost of CML was $23 089 323 and the majority of the cost (97%) was related to drug costs. The total cost will increase considerably to $40 728 869 if all patients use the new drug nilotinib (800 mg/day) as a second-line treatment. CONCLUSIONS The increased survival of CML patients and a possible increase in incidence of CML in Iran will most likely lead to a considerable rise in its prevalence and economic burden.
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Affiliation(s)
- Rajabali Daroudi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran.,Department of Health Economics and Management, School of Public Health, TUMS, Tehran, I.R of Iran
| | - Mehrzad Mirzania
- Hematology and Medical Oncology Group, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, TUMS, Tehran, I.R of Iran
| | - Nazila Nikravanfard
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran.,National Research Ethics Committee, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, I.R of Iran
| | - Sanambar Sadighi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran
| | - Zahra Sedighi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran.,Cancer Models Research Center, Cancer Institute of Iran, TUMS, Tehran, I.R of Iran
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Noh H, Park MS, Kim SH, Oh SJ, Zang DY, Park HL, Cho DJ, Kim DW, Lee JI. Optimization of radotinib doses for the treatment of Asian patients with chronic myelogenous leukemia based on dose-response relationship analyses. Leuk Lymphoma 2015; 57:1856-64. [DOI: 10.3109/10428194.2015.1113278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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49
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Geographic and income variations in age at diagnosis and incidence of chronic myeloid leukemia. Int J Hematol 2015; 103:70-8. [DOI: 10.1007/s12185-015-1893-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/30/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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50
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Tahira B, Asif M, Khan S, Hussain A, Shahwani MN, Malik A, Inayatullah S, Iqbal Z, Rasool M. Detection of BCR/ABL Fusion Gene by Hematological and Cytogenetical Analysis in Chronic Myeloid Leukemia Patients in Quetta, Pakistan. Asian Pac J Cancer Prev 2015; 16:3793-7. [PMID: 25987039 DOI: 10.7314/apjcp.2015.16.9.3793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic myeloid leukemia (CML) is a myeloproliferative disorder of pluripotent stem cells, caused by reciprocal translocation between the long arms of chromosomes 9 and 22, t(9;22)(q34;q11), known as the Philadelphia chromosome. MATERIALS AND METHODS A total of 51 CML patients were recruited in this study. Complete blood counts of all CML patients were performed to find out their total leukocytes, hemoglobin and platelets. FISH was performed for the detection of BCR-ABL fusion and cryptogenic tests using bone marrow samples were performed for the conformation of Ph (9;22)(q34;q11) and variant translocation mechanisms. RESULTS In cytogenetic analysis we observed that out of 51 CML patients 40 (88.9%) were Ph positive and 4 (8.88%) had Ph negative chromosomes. Mean values of WBC 134.5 103/μl, hemoglobin 10.44 mg/dl, and platelets 288.6 103/μl were observed in this study. CONCLUSIONS In this study, Ph positive translocation between chromosome (9:22)(q34;q11) were observed in 40 (88.9%) CML patients.
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Affiliation(s)
- Bibi Tahira
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan E-mail :
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