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Shin DY, Park S, Jang E, Kong JH, Won YW, Oh S, Choi Y, Kim JA, Lee SW, Mun YC, Kim H, Kim SH, Rok Do Y, Kwak JY, Kim HJ, Zang DY, Lim SN, Lee WS, Kim DW. Early dose reduction of dasatinib does not compromise clinical outcomes in patients with chronic myeloid leukemia: A comparative analysis of two prospective trials. Leuk Res 2024; 143:107542. [PMID: 38924942 DOI: 10.1016/j.leukres.2024.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Dasatinib is a potent second-generation tyrosine kinase inhibitor (TKI) used as a first-line treatment option for patients with chronic myeloid leukemia (CML). Currently, dose modification due to adverse events (AEs) is common in patients treated with dasatinib. This study compared the outcomes of two sequential prospective trials that enrolled patients with newly diagnosed chronic phase of CML (CP-CML) and initiated dasatinib at a starting dose of 100 mg daily. In the PCR-DEPTH study, CP-CML patients who started dasatinib 100 mg daily were enrolled and followed up, while in the DAS-CHANGE study, when patients achieved early molecular response with any grade of AEs were enrolled and treated with dasatinib 80 mg once daily. A total of 102 patients (PCR-DEPTH) and 90 patients (DAS-CHANGE) were compared. Although the median value of the relative dose intensity (RDI) of dasatinib was significantly higher in PCR-DEPTH than in DAS-CHANGE (99.6 % vs. 80.1 %, p <0.001), the MMR rate at 12months showed a trend toward superiority in DAS-CHANGE compared to PCR-DEPTH (77.1 % vs 65.2 %, p = 0.084). The frequencies of MR4.0 at 24 and 36 months were higher in DAS-CHANGE than in PCR-DEPTH (44.4 % vs 28.8 %, p = 0.052 and 63.6 % vs 40.3 %, p= 0.013, respectively). RDIs were not different according to the MMR, MR4.0 or MR4.5 in analyses using a pooled population. Our results suggest that early dose reduction of dasatinib does not compromise efficacy in patients achieving EMR at 3 months and could be an interventional strategy for improving long term outcomes.
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Affiliation(s)
- Dong-Yeop Shin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sahee Park
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea
| | - Eunjung Jang
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea
| | - Jee Hyun Kong
- Department of Hematology-Oncology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Sukjoong Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yunsuk Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-A Kim
- Department of Hematology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Se Won Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hawk Kim
- Division of Hematology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Rok Do
- Division of Hematology-Oncology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Jae-Yong Kwak
- Division of Hematology-Oncology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyeoung-Joon Kim
- Department of Internal Medicine, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sung-Nam Lim
- Department of Hematology and Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea.
| | - Dong-Wook Kim
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea.
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Bhaskar M, Biraris P, Tisekar O, Kaushal RK, Janu A, Tandon S. Unilateral Interstitial Lung Disease with Contralateral Effusion: Unusual Case Report of Dasatinib Toxicity. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractDasatinib is a second-generation tyrosine kinase inhibitor (TKI) used in chronic myelogenous leukemia (CML). While pleural effusion due to Dasatinib is well described in the literature, interstitial lung disease (ILD) caused by it is rare. A 60-year-old gentleman was on treatment with 100 mg of tablet Dasatinib per day for chronic myeloid leukemia. He presented to the outpatient department with history of progressive breathlessness over 2 months. High-resolution computerized tomography (HRCT) thorax revealed mild right-sided effusion and non-specific interstitial pneumonia (NSIP) pattern of ILD in the left lower lobe. Thoracocentesis of the right-sided pleural effusion showed exudative and lymphocytic rich pleural effusion. The effusion was negative for malignant cells or infection. Biopsy of the left lower lobe was consistent with the diagnosis of ILD. He was started on prednisolone which was gradually tapered and stopped. At 3 months, there was a complete resolution of the ILD and pleural effusion. Clinicians need to be aware about the pleuroparenchymal toxicities of Dasatinib. Early diagnosis and treatment with steroids can lead to complete resolution of the signs and symptoms.
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Affiliation(s)
- Maheema Bhaskar
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pavankumar Biraris
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Owais Tisekar
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiology, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandeep Tandon
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Murai K, Ureshino H, Kumagai T, Tanaka H, Nishiwaki K, Wakita S, Inokuchi K, Fukushima T, Yoshida C, Uoshima N, Kiguchi T, Mita M, Aoki J, Kimura S, Karimata K, Usuki K, Shimono J, Chinen Y, Kuroda J, Matsuda Y, Nakao K, Ono T, Fujimaki K, Shibayama H, Mizumoto C, Takeoka T, Io K, Kondo T, Miura M, Minami Y, Ikezoe T, Imagawa J, Takamori A, Kawaguchi A, Sakamoto J, Kimura S. Low-dose dasatinib in older patients with chronic myeloid leukaemia in chronic phase (DAVLEC): a single-arm, multicentre, phase 2 trial. THE LANCET HAEMATOLOGY 2021; 8:e902-e911. [DOI: 10.1016/s2352-3026(21)00333-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/30/2022]
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Activated naïve γδ T cells accelerate deep molecular response to BCR-ABL inhibitors in patients with chronic myeloid leukemia. Blood Cancer J 2021; 11:182. [PMID: 34785653 PMCID: PMC8595379 DOI: 10.1038/s41408-021-00572-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) that target BCR-ABL are the frontline treatments in chronic myeloid leukemia (CML). Growing evidence has shown that TKIs also enhance immunity. Since gamma-delta T (γδT) cells possess the potent anticancer capability, here we investigated the potential involvement of γδT cells in TKI treatments for CML. We characterized γδT cells isolated from chronic-phase CML patients before and during TKI treatments. γδT expression increased significantly in CML patients who achieved major molecular response (MMR) and deep molecular response (DMR). Their Vδ2 subset of γδT also expanded, and increased expression of activating molecules, namely IFN-γ, perforin, and CD107a, as well as γδT cytotoxicity. Mechanistically, TKIs augmented the efflux of isopentenyl pyrophosphate (IPP) from CML cells, which stimulated IFN-γ production and γδT expansion. Notably, the size of the IFN-γ+ naïve γδT population in TKI-treated CML patients was strongly correlated with their rates to reach DMR and with the duration on DMR. Statistical analysis suggests that a cutoff of 7.5% IFN-γ+ naïve subpopulation of γδT in CML patients could serve as a determinant for MR4.0 sustainability. Our results highlight γδT cells as a positive regulator for TKI responses in CML patients.
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Influence of proton pump inhibitors and H2-receptor antagonists on the efficacy and safety of dasatinib in chronic myeloid leukemia patients. Int J Hematol 2020; 111:826-832. [PMID: 32152877 DOI: 10.1007/s12185-020-02845-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
We evaluated the effect of proton pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs) on the efficacy and safety of dasatinib for chronic-phase chronic myeloid leukemia (CP-CML). Retrospective analyses were performed for patients with CP-CML who received dasatinib at seven hospitals between April 2009 and December 2016. Seventy-three patients were identified, 16 of whom received PPIs or H2RAs concurrently with dasatinib. Major molecular response at 12 months was observed in 13 of 13 patients (100%) with concurrent PPIs or H2RAs (combination group), and in 23 of 51 patients (45.1%) who received only dasatinib (dasatinib-alone group; P < 0.001). Deep molecular response at 12 months was observed in four of six patients (66.7%) in the combination group, and seven of 38 patients (18.4%) in the dasatinib-alone group (P = 0.027). Dasatinib chemotherapy was stopped after 18 months for 25 patients (43.9%) from the dasatinib-alone group, but for none from the combination group. Combination treatment with PPIs or H2RAs did not reduce the efficacy of dasatinib. PPIs and H2RAs reduce the incidence of dasatinib discontinuation due to adverse events and increase the efficacy of dasatinib chemotherapy for patients.
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Mechanisms of Cardiovascular Toxicity of BCR-ABL1 Tyrosine Kinase Inhibitors in Chronic Myelogenous Leukemia. Curr Hematol Malig Rep 2020; 15:20-30. [DOI: 10.1007/s11899-020-00560-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nilotinib treatment induced large granular lymphocyte expansion and maintenance of longitudinal remission in a Philadelphia chromosome-positive acute lymphoblastic leukemia. Int J Hematol 2020; 111:719-723. [PMID: 31894532 DOI: 10.1007/s12185-019-02789-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
It is well known that the second-generation tyrosine kinase inhibitor dasatinib evokes an immunological reaction as an off-target effect and induces large granular lymphocytes (LGLs) expansion in 30% of patients. However, LGLs expansion in nilotinib-treated patients is rare. We report the case of a 65-year-old patient with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) who showed LGLs expansion during nilotinib treatment. The patient achieved complete remission (CR) after multi-agent chemotherapy combined with dasatinib treatment. However, ALL relapsed in the central nervous system and bone marrow when treatment was interrupted due to interstitial pneumonia. Nilotinib treatment was subsequently started and the patient achieved second CR. Marked peripheral blood lymphocytosis emerged after the start of nilotinib treatment. CD8 + CD57 + cytotoxic T cells were predominantly expanded and showed strong cytocidal activity against K562 Ph-positive leukemia cells. These results suggest that similar to dasatinib, nilotinib can induce LGLs expansion, possibly contributing to long-term remission in patients with Ph-ALL.
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Colom-Fernández B, Kreutzman A, Marcos-Jiménez A, García-Gutiérrez V, Cuesta-Mateos C, Portero-Sainz I, Pérez-García Y, Casado LF, Sánchez-Guijo F, Martínez-López J, Ayala RM, Boqué C, Xicoy B, Montero I, Soto C, Paz R, Silva G, Vega-Piris L, Steegmann JL, Muñoz-Calleja C. Immediate Effects of Dasatinib on the Migration and Redistribution of Naïve and Memory Lymphocytes Associated With Lymphocytosis in Chronic Myeloid Leukemia Patients. Front Pharmacol 2019; 10:1340. [PMID: 31824308 PMCID: PMC6886582 DOI: 10.3389/fphar.2019.01340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Dasatinib is a dual SRC/ABL tyrosine kinase inhibitor used to treat chronic myeloid leukemia (CML) that is known to have unique immunomodulatory effects. In particular, dasatinib intake typically causes lymphocytosis, which has been linked to better clinical response. Since the underlying mechanisms are unknown and SRC family kinases are involved in many cell motility processes, we hypothesized that the movement and migration of lymphocytes is modulated by dasatinib. Patients, Materials and Methods: Peripheral blood samples from CML patients treated with second-line dasatinib were collected before and 2 h after the first dasatinib intake, and follow-up samples from the same patients 3 and 6 months after the start of therapy. The migratory capacity and phenotype of lymphocytes and differential blood counts before and after drug intake were compared for all study time-points. Results: We report here for the first time that dasatinib intake is associated with inhibition of peripheral blood T-cell migration toward the homeostatic chemokines CCL19 and CCL21, which control the trafficking toward secondary lymphoid organs, mainly the lymph nodes. Accordingly, the proportion of lymphocytes in blood expressing CCR7, the chemokine receptor for both CCL19 and CCL21, decreased after the intake including both naïve CD45RA+ and central memory CD45RO+ T-cells. Similarly, naïve B-cells diminished with dasatinib. Finally, such changes in the migratory patterns did not occur in those patients whose lymphocyte counts remained unchanged after taking the drug. Discussion: We, therefore, conclude that lymphocytosis induced by dasatinib reflects a pronounced redistribution of naïve and memory populations of all lymphocyte subsets including CD4+ and CD8+ T-cells and B-cells.
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Affiliation(s)
- Beatriz Colom-Fernández
- Servicio de Inmunología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Anna Kreutzman
- Servicio de Inmunología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ana Marcos-Jiménez
- Servicio de Inmunología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Carlos Cuesta-Mateos
- Servicio de Inmunología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Itxaso Portero-Sainz
- Servicio de Inmunología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Yaiza Pérez-García
- Servicio de Inmunología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Luis Felipe Casado
- Servicio de Hematología y Hemoterapia, Hospital Virgen de la Salud, Toledo, Spain
| | - Fermín Sánchez-Guijo
- Servicio de Hematología y Hemoterapia, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain
| | - Joaquín Martínez-López
- Servicio de Hematología y Hemoterapia, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid (UCM), CIBERONC, Madrid, Spain
| | - Rosa M Ayala
- Servicio de Hematología y Hemoterapia, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid (UCM), CIBERONC, Madrid, Spain
| | - Concha Boqué
- Servicio de Hematología Clínica, Hospital Duran i Reynals, Institut Català d'Oncologia, Barcelona, Spain
| | - Blanca Xicoy
- Servicio de Hematología, Servicio de Hematología Clínica, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Barcelona, José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Montero
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - César Soto
- Servicio de Hematología, Hospital Povisa, Vigo, Spain
| | - Raquel Paz
- Servicio de Hematología, Hospital Universitario de la Paz, Madrid, Spain
| | - Gabriela Silva
- Servicio de Hematología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Lorena Vega-Piris
- Unidad de Metodología, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Juan Luis Steegmann
- Servicio de Hematología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Cecilia Muñoz-Calleja
- Servicio de Inmunología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Rivera-Torres J, San José E. Src Tyrosine Kinase Inhibitors: New Perspectives on Their Immune, Antiviral, and Senotherapeutic Potential. Front Pharmacol 2019; 10:1011. [PMID: 31619990 PMCID: PMC6759511 DOI: 10.3389/fphar.2019.01011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022] Open
Abstract
Deregulated activity of the Src tyrosine kinases leads to malignant transformation. Since the FDA approval of the tyrosine kinase inhibitor, imatinib, in 2001 for the treatment of chronic myeloid leukemia (CML), the number of these inhibitors together with Src tyrosine kinase inhibitors (STKIs) has increased notably due to their beneficial effects. Dasatinib, a second-generation STKI inhibitor widely studied, proved high efficiency in CML patients resistant to imatinib. In the last decade STKIs have also been implicated and showed therapeutic potential for the treatment of diverse pathologies other than cancer. In this regard, we review the properties of STKIs, dasatinib in particular, including its immunomodulatory role. Similarly, the potential benefits, adverse effects, and safety concerns of these inhibitors regarding viral infections are considered. Moreover, since life expectancy has increased in the last decades accompanied by age-related morbidity, the reduction of undesirable effects associated to aging has become a powerful therapeutic target. Here, we comment on the ability of STKIs to alleviate age-associated physical dysfunction and their potential impact in the clinic.
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Affiliation(s)
- José Rivera-Torres
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid. Madrid, Spain
| | - Esther San José
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid. Madrid, Spain
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Maral S, Bakanay SM, Kucuksahin O, Dilek I. Lupus-like symptoms with anti-RNP/Sm and anti-nuclear antibodies positivity: An extremely rare adverse event of dasatinib. J Oncol Pharm Pract 2019; 26:738-741. [PMID: 31359838 DOI: 10.1177/1078155219863469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dasatinib is a potent tyrosine-kinase inhibitor which is used for chronic myeloid leukemia treatment. Pleural effusion is a frequent side effect in patients during dasatinib treatment. Pulmonary arterial hypertension is a rare and life-threatening adverse event of dasatinib. The relationship between dasatinib and autoimmune disorders is unclear, but there are reports of possible mechanisms that have triggered autoimmunity by dasatinib. CASE REPORT A 53-year-old male was diagnosed with chronic myeloid leukemia and initiated imatinib mesylate as a treatment. Imatinib was changed to dasatinib as the patient was unresponsive in the first year of treatment. In the fourth year of dasatinib when chronic myeloid leukemia was in both hematological and cytogenetical remission, the patient presented with bilateral massive exudative pleural effusion. Echocardiography was consistent with pericardial effusion with right ventricle enlargement and normal left-side cardiac function. Pulmonary arterial hypertension was diagnosed with high systolic pulmonary arterial pressure. When he had fever and arthralgia, further investigation showed positivity of anti-nuclear antibodies (1/160 titer) and anti-RNP/Sm, which have high specificity for the diagnosis of Systemic Lupus Erythematosus (SLE). MANAGEMENT AND OUTCOME Dasatinib was discontinued and nilotinib was initiated. As the pleural effusion persisted despite diuretics and methylprednisolone, mycophenolate mofetil was initiated as a steroid-sparing immune-suppressive agent. The lupus-like symptoms disappeared, and antibodies became undetectable after dasatinib discontinuation. Pericardial effusion improved and pleural effusion did not relapse. DISCUSSION Screening for auto-antibodies may be recommended for patients with a history or symptoms of autoimmune disease before starting dasatinib. All patients who develop pleural effusion while on dasatinib treatment should be investigated for antibodies for lupus.
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Affiliation(s)
- Senem Maral
- Department of Hematology, Dıskapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Sule Mine Bakanay
- Department of Hematology, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Orhan Kucuksahin
- Department of Rheumatology, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Imdat Dilek
- Department of Hematology, Ataturk Research and Training Hospital, Ankara, Turkey
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Skouras VS, Kalomenidis I. Pleurotoxic Drugs—an Update: Someone Else to Blame? CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-0225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chang MC, Cheng HI, Hsu K, Hsu YN, Kao CW, Chang YF, Lim KH, Chen CG. NKG2A Down-Regulation by Dasatinib Enhances Natural Killer Cytotoxicity and Accelerates Effective Treatment Responses in Patients With Chronic Myeloid Leukemia. Front Immunol 2019; 9:3152. [PMID: 30705677 PMCID: PMC6344416 DOI: 10.3389/fimmu.2018.03152] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/20/2018] [Indexed: 12/20/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a hematological malignancy characterized by the presence of t(9;22) chromosomal translocation that results in BCR-ABL fusion gene. ABL tyrosine kinase inhibitors (TKIs), such as imatinib, nilotinib, and dasatinib, are currently the front-line treatment options for CML. Recently, natural killer (NK) cell activation and expansion have been shown to be associated with optimal treatment responses for CML. To investigate the effects and mechanisms of these TKIs on NK cells, here we characterized activating and inhibitory NK receptors in CD3-CD16+CD56dim NK cells isolated from CML patients in chronic phase (CP). The expressions of activating NK receptors, such as NKG2D, natural cytotoxicity receptor (NCR) and DNAM-1, rebounded after successful TKI treatments for CML. In contrast, among the three surveyed inhibitory receptors (NKG2A, KIR2DL1, and KIR3DL1), only the expression of NKG2A was reverted and suppressed to a very low level by dasatinib, and not by imatinib or nilotinib. CML patients treated with dasatinib indeed expressed fewer NKG2A+ NK cells, which send negative signals for induction of NK cytotoxicity. For these dasatinib-treated patients, the duration to reach major molecular response (MMR) was shorter, and significantly correlated with individual's NKG2A+ NK cell number. This clinical relevance to NKG2A was not observed in treatments with imatinib or nilotinib. In line with dasatinib-specific down-regulation of NKG2A, NK cytotoxicity evaluated by the killing assay was also significantly higher in patients treated with dasatinib than in those treated with imatinib or nilotinib. The lower NK cytotoxicity from imatinib or nilotinib treatments could be reverted by NKG2A blockade using anti-NKG2A antibody. Further in vitro experiments revealed mechanistically that dasatinib could inactivate p38 mitogen-activated protein kinase (MAPK), and consequently affect nuclear import of GATA-3 and GATA-3 transcriptional activities for NKG2A. Our results highlight the dual effects of dasatinib in direct inhibition of ABL kinase and in immunomodulation through NKG2A down-regulation, contributing to accelerated molecular responses (MR) in CML.
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Affiliation(s)
- Ming-Chin Chang
- Department of Hematology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Hung-I Cheng
- Department of Hematology, MacKay Memorial Hospital, Hsin-Chu, Taiwan
| | - Kate Hsu
- Department of Medical Research, Transfusion Medicine & Immunogenetics Laboratories, MacKay Memorial Hospital, Tamsui, Taiwan
| | - Yen-Ning Hsu
- Department of Hematology, MacKay Memorial Hospital, Hsin-Chu, Taiwan
| | - Chen-Wei Kao
- GCRC Laboratory, Department of Hematology, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Yi-Fang Chang
- Department of Hematology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,GCRC Laboratory, Department of Hematology, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Ken-Hong Lim
- Department of Hematology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,GCRC Laboratory, Department of Hematology, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Caleb Gonshen Chen
- Department of Hematology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,GCRC Laboratory, Department of Hematology, MacKay Memorial Hospital, New Taipei, Taiwan
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Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Clinical significance of dasatinib-induced pleural effusion in patients with de novo chronic myeloid leukemia. Hematol Rep 2018; 10:7474. [PMID: 30283618 PMCID: PMC6151348 DOI: 10.4081/hr.2018.7474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 06/27/2018] [Indexed: 12/29/2022] Open
Abstract
Dasatinib is currently approved for clinical use as a first-line treatment agent for newly diagnosed chronic myeloid leukemia (CML). However, only a few clinical trials have been performed to evaluate dasatinibinduced PE following first-line therapy. We investigated the incidence and clinical features of dasatinib-induced PE following first-line therapy in Japanese CML patients of real world clinical practice settings. Among 22 patients, the median age of PE-positive patients was higher than that of PE-negative patients. Major molecular response was achieved in 75% of PE-positive patients and 50% of PE-negative patients. Most patients developed PE more than 1 year after treatment. Appearance of PE is associated with better clinical response during dasatinib treatment, however it is developed at any time. Elderly and high-risk patients tend to develop PE. The clinical features of dasatinib-induced PE following first-line therapy might be late onset and might not immediately follow the increasing of large granular lymphocyte.
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Affiliation(s)
- Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Takahisa Nakanishi
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Yoshiko Azuma
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Yukie Tsubokura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Masaaki Hotta
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Hideaki Yoshimura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kazuyoshi Ishii
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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14
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Dasatinib-induced anti-leukemia cellular immunity through a novel subset of CD57 positive helper/cytotoxic CD4 T cells in chronic myelogenous leukemia patients. Int J Hematol 2018; 108:588-597. [PMID: 30151740 DOI: 10.1007/s12185-018-2517-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
Dasatinib induces lymphocytosis of large granular lymphocytes (LGLs) in a proportion of patients with chronic myelogenous leukemia (CML), and is associated with better clinical outcomes. LGLs consist of cytotoxic T lymphocytes and natural killer cells; however, the context and phenotypic/functional features of each type of LGL are unknown. To better define features of these LGLs, we investigated lymphocytosis in CML patients treated with dasatinib. D57-positive and CD4-positive type I T-helper (Th) cells (CD57+ Th cells) rarely occur in CML patients without lymphocytosis and in healthy individuals; however, a substantial increase in the proportion of CD57+ Th cells was observed in CML patients treated with dasatinib. In addition, these cells showed appreciable levels of cytocidal activity via cytotoxic degranulation. Analysis of T-cell receptor α and β sequences showed a skewed T-cell repertoire in the CD57+ Th cells. Furthermore, patients with LGLs and CD57+ Th lymphocytosis achieved stronger molecular responses than did those without lymphocytosis. While further studies are warranted, our observations suggest that dasatinib induces the expansion of CD57+ Th-LGLs, which may play a crucial role in the dasatinib-induced response against Philadelphia chromosome-positive leukemia.
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15
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Schubert C, Chatain N, Braunschweig T, Schemionek M, Feldberg K, Hoffmann M, Dufva O, Mustjoki S, Brümmendorf TH, Koschmieder S. The SCLtTAxBCR-ABL transgenic mouse model closely reflects the differential effects of dasatinib on normal and malignant hematopoiesis in chronic phase-CML patients. Oncotarget 2018; 8:34736-34749. [PMID: 28423730 PMCID: PMC5471007 DOI: 10.18632/oncotarget.16152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/12/2017] [Indexed: 12/19/2022] Open
Abstract
The second generation tyrosine kinase inhibitor (TKI) dasatinib is a clinically approved drug for chronic myeloid leukemia (CML) as well as Ph+ acute lymphoblastic leukemia. In addition to its antileukemic effects, dasatinib was shown to impact on normal hematopoiesis and cells of the immune system.Due to the fact that the murine in vivo studies so far have not been performed in a chronic-phase CML model under steady-state conditions, our aim was to study the hematopoietic effects of dasatinib (20 mg/kg p.o.) in BCR-ABL expressing SCLtTAxBCR-ABL double transgenic (dtg) mice. Dasatinib robustly antagonized the CML phenotype in vivo in our transgenic mouse model, and this effect included both mature and immature cell populations. However, similar to patients with CML, the fraction of LinnegSca-1+KIT+CD48negCD150+ hematopoietic stem cells was not reduced by dasatinib treatment, suggesting that these cells are not oncogene-addicted. Moreover, we observed differential effects of dasatinib in these animals as compared to wild-type (wt) animals: while granulocytes were significantly reduced in dtg animals, they were increased in wt mice. And Ter119+ erythrocytic and B220+ B cells were increased in dtg mice but decreased in wt mice. Finally, while dasatinib induced a shift from CD49b/NK1.1 positive NK cells from the bone marrow to the spleen in wt animals, there was no change in dtg mice. In conclusion, the present mouse model provides a useful tool to study mechanisms of TKI resistance and dasatinib-associated beneficial effects and adverse events.
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Affiliation(s)
- Claudia Schubert
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Nicolas Chatain
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Mirle Schemionek
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Kristina Feldberg
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Melanie Hoffmann
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Olli Dufva
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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16
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Nakaya A, Azuma Y, Fujita S, Satake A, Nakanishi T, Tsubokura Y, Konishi A, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Dasatinib-induced hemorrhagic colitis complicated with cytomegalovirus infection. Hematol Rep 2017; 9:7415. [PMID: 29333227 PMCID: PMC5757412 DOI: 10.4081/hr.2017.7415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Yoshiko Azuma
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Takahisa Nakanishi
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Yukie Tsubokura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Akiko Konishi
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Masaaki Hotta
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Hideaki Yoshimura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kazuyoshi Ishii
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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17
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Shiseki M, Yoshida C, Takezako N, Ohwada A, Kumagai T, Nishiwaki K, Horikoshi A, Fukuda T, Takano H, Kouzai Y, Tanaka J, Morita S, Sakamoto J, Sakamaki H, Inokuchi K. Dasatinib rapidly induces deep molecular response in chronic-phase chronic myeloid leukemia patients who achieved major molecular response with detectable levels of BCR-ABL1 transcripts by imatinib therapy. Int J Clin Oncol 2017; 22:972-979. [PMID: 28550414 PMCID: PMC5608785 DOI: 10.1007/s10147-017-1141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/14/2017] [Indexed: 01/06/2023]
Abstract
Background With the introduction of imatinib, a first-generation tyrosine kinase inhibitor (TKI) to inhibit BCR-ABL1 kinase, the outcome of chronic-phase chronic myeloid leukemia (CP-CML) has improved dramatically. However, only a small proportion of CP-CML patients subsequently achieve a deep molecular response (DMR) with imatinib. Dasatinib, a second-generation TKI, is more potent than imatinib in the inhibition of BCR-ABL1 tyrosine kinase in vitro and more effective in CP-CML patients who do not achieve an optimal response with imatinib treatment. Methods In the present study, we attempted to investigate whether switching the treatment from imatinib to dasatinib can induce DMR in 16 CP-CML patients treated with imatinib for at least two years who achieved a major molecular response (MMR) with detectable levels of BCR-ABL1 transcripts. Results The rates of achievement of DMR at 1, 3, 6 and 12 months after switching to dasatinib treatment in the 16 patients were 44% (7/16), 56% (9/16), 63% (10/16) and 75% (12/16), respectively. The cumulative rate of achieving DMR at 12 months from initiation of dasatinib therapy was 93.8% (15/16). The proportion of natural killer cells and cytotoxic T cells in peripheral lymphocytes increased after switching to dasatinib. In contrast, the proportion of regulatory T cells decreased during treatment. The safety profile of dasatinib was consistent with previous studies. Conclusion Switching to dasatinib would be a therapeutic option for CP-CML patients who achieved MMR but not DMR by imatinib, especially for patients who wish to discontinue TKI therapy.
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Affiliation(s)
- Masayuki Shiseki
- Department of Hematology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Chikashi Yoshida
- Department of Hematology, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Naoki Takezako
- Department of Hematology, National Disaster Medical Center, Tokyo, Japan
| | - Akira Ohwada
- Department of Hematology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takashi Kumagai
- Department of Hematology, Ohme Municipal General Hospital, Tokyo, Japan
| | - Kaichi Nishiwaki
- Clinical Oncology and Hematology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Akira Horikoshi
- Department of General Internal Medicine, Nerima-Hikarigaoka Hospital, Tokyo, Japan
| | - Tetsuya Fukuda
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hina Takano
- Department of Hematology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yasuji Kouzai
- Hematology Department, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Koiti Inokuchi
- Division of Hematology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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18
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Hughes A, Yong ASM. Immune Effector Recovery in Chronic Myeloid Leukemia and Treatment-Free Remission. Front Immunol 2017; 8:469. [PMID: 28484463 PMCID: PMC5402174 DOI: 10.3389/fimmu.2017.00469] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/05/2017] [Indexed: 01/22/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a hematological cancer, characterized by a reciprocal chromosomal translocation between chromosomes 9 and 22 [t(9;22)], producing the Bcr-Abl oncogene. Tyrosine kinase inhibitors (TKIs) represent the standard of care for CML patients and exert a dual mode of action: direct oncokinase inhibition and restoration of effector-mediated immune surveillance, which is rendered dysfunctional in CML patients at diagnosis, prior to TKI therapy. TKIs such as imatinib, and more potent second-generation nilotinib and dasatinib induce a high rate of deep molecular response (DMR, BCR-ABL1 ≤ 0.01%) in CML patients. As a result, the more recent goal of therapy in CML treatment is to induce a durable DMR as a prelude to successful treatment-free remission (TFR), which occurs in approximately half of all CML patients who cease TKI therapy. The lack of overt relapse in such patients has been attributed to immunological control of CML. In this review, we discuss an immunological timeline to successful TFR, focusing on the immunology of CML during TKI treatment; an initial period of immune suppression, limiting antitumor immune effector responses in newly diagnosed CML patients, linked to an expansion of immature myeloid-derived suppressor cells and regulatory T cells and aberrant expression of immune checkpoint signaling pathways, including programmed death-1/programmed death ligand-1. Commencement of TKI treatment is associated with immune system re-activation and restoration of effector-mediated [natural killer (NK) cell and T cell] immune surveillance in CML patients, albeit with differing frequencies in concert with differing levels of molecular response achieved on TKI. DMR is associated with maximal restoration of immune recovery in CML patients on TKI. Current data suggest a net balance between both the effector and suppressor arms of the immune system, at a minimum involving mature, cytotoxic CD56dim NK cells may be important in mediating TFR success. However, a major goal remains in CML to identify the most effective pathways to target to maximize an advantageous immune response and promote TFR success.
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Affiliation(s)
- Amy Hughes
- Department of Haematology, SA Pathology, Adelaide, SA, Australia.,Cancer Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Agnes S M Yong
- Department of Haematology, SA Pathology, Adelaide, SA, Australia.,Cancer Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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19
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Clinical efficacy of fecal occult blood test and colonoscopy for dasatinib-induced hemorrhagic colitis in CML patients. Blood 2016; 129:126-128. [PMID: 27864292 DOI: 10.1182/blood-2016-08-734947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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20
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Keskin D, Sadri S, Eskazan AE. Dasatinib for the treatment of chronic myeloid leukemia: patient selection and special considerations. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:3355-3361. [PMID: 27784993 PMCID: PMC5066856 DOI: 10.2147/dddt.s85050] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dasatinib is one of the second-generation tyrosine kinase inhibitors used in imatinib resistance and/or intolerance, as well as in the frontline setting in patients with chronic myeloid leukemia-chronic phase, and also in patients with advanced disease. It is also utilized in Philadelphia chromosome-positive acute lymphocytic leukemia. While choosing the appropriate tyrosine kinase inhibitor (ie, dasatinib) for each individual patient, comorbidities and BCR-ABL1 kinase domain mutations should always be taken into consideration, among other things. This review mainly focuses on patient selection prior to dasatinib administration in the treatment of chronic myeloid leukemia.
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Affiliation(s)
- Dilek Keskin
- Department of Internal Medicine, Division of Hematology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevil Sadri
- Department of Internal Medicine, Division of Hematology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Department of Internal Medicine, Division of Hematology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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21
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Iriyama N, Hatta Y, Takei M. Direct effect of dasatinib on signal transduction pathways associated with a rapid mobilization of cytotoxic lymphocytes. Cancer Med 2016; 5:3223-3234. [PMID: 27726309 PMCID: PMC5119978 DOI: 10.1002/cam4.925] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/06/2016] [Accepted: 09/04/2016] [Indexed: 01/04/2023] Open
Abstract
It has been shown that an increase in cytotoxic lymphocyte counts in the peripheral blood occurs rapidly after taking dasatinib, but the underlying mechanism is not yet elucidated. To investigate the influence of dasatinib on signal transduction pathways, we investigated the changes in JAK-STAT, mitogen-activated protein kinase (MAPK), and AKT in cytotoxic lymphocytes, including natural killer (NK) cells and cytotoxic T lymphocytes (CTLs), before and after dasatinib treatment in chronic myeloid leukemia patients. Among a total of 30 patients, 18 were treated with dasatinib, nine with imatinib, and three with nilotinib. At constitutive levels, the expression of phosphorylated proteins, pSTAT1, pSTAT3, and pERK in NK cells and pSTAT3 in CTLs, was significantly higher in dasatinib-treated patients. Among the patients evaluated, only dasatinib-treated patients showed inhibition of multiple signaling pathways after taking a tyrosine kinase inhibitor. The magnitude of pERK and pAKT inhibition was closely associated with an increase in NK cells and CTLs, respectively, after taking a tyrosine kinase inhibitor. Those responses were more evident in patients with cytomegalovirus IgG positivity. In this study, we demonstrated for the first time, the influence of dasatinib on cell events in cytotoxic lymphocytes in vivo and explained the possible underlying mechanism that results in lymphocyte mobilization after dasatinib treatment.
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Affiliation(s)
- Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masami Takei
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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22
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Aldoss I, Gaal K, Al Malki MM, Ali H, Nakamura R, Forman SJ, Pullarkat V. Dasatinib-Induced Colitis after Allogeneic Stem Cell Transplantation for Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant 2016; 22:1900-1903. [DOI: 10.1016/j.bbmt.2016.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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23
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Hagihara M, Iriyama N, Yoshida C, Wakita H, Chiba S, Okamoto S, Kawakami K, Takezako N, Kumagai T, Inokuchi K, Ohyashiki K, Taguchi J, Yano S, Igarashi T, Kouzai Y, Morita S, Sakamoto J, Sakamaki H. Association of pleural effusion with an early molecular response in patients with newly diagnosed chronic-phase chronic myeloid leukemia receiving dasatinib: Results of a D-First study. Oncol Rep 2016; 36:2976-2982. [PMID: 27665844 DOI: 10.3892/or.2016.5110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/07/2016] [Indexed: 11/06/2022] Open
Abstract
Despite the efficacy and safety of dasatinib treatment for chronic-phase chronic myeloid leukemia (CML-CP), adverse effects such as pleural effusion (PE) are still a serious concern. We determined the clinical significance of PE incidence using patient data derived from the D-First clinical study. In the present study, chest radiography and quantification of specific lymphocyte subsets were performed routinely after initiation of dasatinib treatment. Among 52 patients with newly diagnosed CML-CP, 17 (33%) developed PE within 18 months after initial dasatinib administration, but all cases were moderate (Grade 1, 10 patients; Grade 2, 7 patients). CD56+ lymphocyte counts at 1 month correlated significantly with the incidence of PE, whereas lymphocytosis did not. The major molecular response (MMR) rate at 3 months (although not at later times) was significantly higher in PE-positive patients than PE-negative patients (59% versus 24%, respectively; P=0.013). Deep molecular response rates did not differ significantly between the PE groups at any time point during the observation period. Our results suggest that an immune-mediated mechanism involving natural killer cells underlies the development of PE in patients receiving dasatinib for 18 months. This mechanism likely promotes transient tumor regression in patients newly diagnosed with CML-CP.
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Affiliation(s)
- Maki Hagihara
- Department of Hematology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Chikashi Yoshida
- Department of Hematology, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Hisashi Wakita
- Division of Hematology and Oncology, Japanese Red Cross Society, Narita Red Cross Hospital, Chiba, Japan
| | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kimihiro Kawakami
- Department of Hematology and Clinical Oncology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Naoki Takezako
- Department of Hematology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Takashi Kumagai
- Department of Hematology, Ohme Municipal General Hospital, Tokyo, Japan
| | - Koiti Inokuchi
- Division of Hematology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuma Ohyashiki
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Jun Taguchi
- Department of Hematology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Tadahiko Igarashi
- Division of Hematology and Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Yasuji Kouzai
- Department of Hematology, Tokyo Metropolitan Tama Synthesis Medical Center, Tokyo, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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24
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Steegmann JL, Baccarani M, Breccia M, Casado LF, García-Gutiérrez V, Hochhaus A, Kim DW, Kim TD, Khoury HJ, Le Coutre P, Mayer J, Milojkovic D, Porkka K, Rea D, Rosti G, Saussele S, Hehlmann R, Clark RE. European LeukemiaNet recommendations for the management and avoidance of adverse events of treatment in chronic myeloid leukaemia. Leukemia 2016; 30:1648-71. [PMID: 27121688 PMCID: PMC4991363 DOI: 10.1038/leu.2016.104] [Citation(s) in RCA: 314] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/18/2016] [Indexed: 12/20/2022]
Abstract
Most reports on chronic myeloid leukaemia (CML) treatment with tyrosine kinase inhibitors (TKIs) focus on efficacy, particularly on molecular response and outcome. In contrast, adverse events (AEs) are often reported as infrequent, minor, tolerable and manageable, but they are increasingly important as therapy is potentially lifelong and multiple TKIs are available. For this reason, the European LeukemiaNet panel for CML management recommendations presents an exhaustive and critical summary of AEs emerging during CML treatment, to assist their understanding, management and prevention. There are five major conclusions. First, the main purpose of CML treatment is the antileukemic effect. Suboptimal management of AEs must not compromise this first objective. Second, most patients will have AEs, usually early, mostly mild to moderate, and which will resolve spontaneously or are easily controlled by simple means. Third, reduction or interruption of treatment must only be done if optimal management of the AE cannot be accomplished in other ways, and frequent monitoring is needed to detect resolution of the AE as early as possible. Fourth, attention must be given to comorbidities and drug interactions, and to new events unrelated to TKIs that are inevitable during such a prolonged treatment. Fifth, some TKI-related AEs have emerged which were not predicted or detected in earlier studies, maybe because of suboptimal attention to or absence from the preclinical data. Overall, imatinib has demonstrated a good long-term safety profile, though recent findings suggest underestimation of symptom severity by physicians. Second and third generation TKIs have shown higher response rates, but have been associated with unexpected problems, some of which could be irreversible. We hope these recommendations will help to minimise adverse events, and we believe that an optimal management of them will be rewarded by better TKI compliance and thus better CML outcomes, together with better quality of life.
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Affiliation(s)
- J L Steegmann
- Servicio de Hematologia y Grupo 44
IIS-IP, Hospital Universitario de la Princesa, Madrid,
Spain
| | - M Baccarani
- Department of Hematology and Oncology
‘L. and A. Seràgnoli', St Orsola University Hospital,
Bologna, Italy
| | - M Breccia
- Department of Cellular Biotechnologies
and Hematology, Sapienza University, Rome, Italy
| | - L F Casado
- Servicio de Hematologia, Hospital Virgen
de la Salud, Toledo, Spain
| | - V García-Gutiérrez
- Servicio Hematología y
Hemoterapia, Hospital Universitario Ramón y Cajal,
Madrid, Spain
| | - A Hochhaus
- Hematology/Oncology,
Universitätsklinikum Jena, Jena, Germany
| | - D-W Kim
- Seoul St Mary's Hospital, Leukemia
Research Institute, The Catholic University of Korea, Seoul,
South Korea
| | - T D Kim
- Medizinische Klinik mit Schwerpunkt
Onkologie und Hämatologie, Campus Charité Mitte,
Charité—Universitätsmedizin Berlin, Berlin,
Germany
| | - H J Khoury
- Department of Hematology and Medical
Oncology, Winship Cancer Institute of Emory University,
Atlanta, GA, USA
| | - P Le Coutre
- Medizinische Klinik mit Schwerpunkt
Onkologie und Hämatologie, Campus Charité Mitte,
Charité—Universitätsmedizin Berlin, Berlin,
Germany
| | - J Mayer
- Department of Internal Medicine,
Hematology and Oncology, Masaryk University Hospital Brno,
Brno, Czech Republic
| | - D Milojkovic
- Department of Haematology Imperial
College, Hammersmith Hospital, London, UK
| | - K Porkka
- Department of Hematology, Helsinki
University Hospital Comprehensive Cancer Center, Helsinki,
Finland
- Hematology Research Unit, University of
Helsinki, Helsinki, Finland
| | - D Rea
- Service d'Hématologie
Adulte, Hôpital Saint-Louis, APHP, Paris,
France
| | - G Rosti
- Department of Hematology and Oncology
‘L. and A. Seràgnoli', St Orsola University Hospital,
Bologna, Italy
| | - S Saussele
- III. Med. Klinik Medizinische
Fakultät Mannheim der Universität Heidelberg,
Mannheim, Germany
| | - R Hehlmann
- Medizinische Fakultät Mannheim der
Universität Heidelberg, Mannheim, Germany
| | - R E Clark
- Department of Molecular and Clinical
Cancer Medicine, University of Liverpool, Liverpool,
UK
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25
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Schiffer CA, Cortes JE, Hochhaus A, Saglio G, le Coutre P, Porkka K, Mustjoki S, Mohamed H, Shah NP. Lymphocytosis after treatment with dasatinib in chronic myeloid leukemia: Effects on response and toxicity. Cancer 2016; 122:1398-407. [PMID: 26998677 PMCID: PMC5071708 DOI: 10.1002/cncr.29933] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The proliferation of clonal cytotoxic T‐cells or natural killer cells has been observed after dasatinib treatment in small studies of patients with chronic myeloid leukemia (CML). METHODS The incidence of lymphocytosis and its association with response, survival, and side effects were assessed in patients from 3 large clinical trials. Overall, 1402 dasatinib‐treated patients with newly diagnosed CML in chronic phase (CML‐CP), CML‐CP refractory/intolerant to imatinib, or with CML in accelerated or myeloid‐blast phase were analyzed. RESULTS Lymphocytosis developed in 32% to 35% of patients and persisted for >12 months. This was not observed in the patients who received treatment with imatinib. Dasatinib‐treated patients in all stages of CML who developed lymphocytosis were more likely to achieve a complete cytogenetic response, and patients who had CML‐CP with lymphocytosis were more likely to achieve major and deep molecular responses. Progression‐free and overall survival rates were significantly longer in patients with CML‐CP who were refractory to or intolerant of imatinib and had lymphocytosis. Pleural effusions developed more commonly in patients with lymphocytosis. CONCLUSIONS Overall, lymphocytosis occurred and persisted in many dasatinib‐treated patients in all phases of CML. Its presence was associated with higher response rates, significantly longer response durations, and increased overall survival, suggesting an immunomodulatory effect. Prospective studies are warranted to characterize the functional activity of these cells and to assess whether an immunologic effect against CML is detectable. Cancer 2016;122:1398–1407. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. Lymphocytosis develops frequently after treatment of chronic myeloid leukemia with dasatinib and is associated with higher response rates, significantly longer response durations, and increased overall survival. Prospective studies are warranted to assess whether dasatinib produces an immunomodulatory effect against chronic myeloid leukemia.
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Affiliation(s)
- Charles A Schiffer
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Jorge E Cortes
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Giuseppe Saglio
- San Luigi Gonaga Hospital, University of Turin, Orbassano-Turin, Italy
| | - Philipp le Coutre
- Charite-Campus Virchow Clinic, Berlin Medical University, Berlin, Germany
| | - Kimmo Porkka
- Department of Hematology and Hematology Research Unit, Helsinki University Central Hospital Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
| | - Satu Mustjoki
- Department of Hematology and Hematology Research Unit, Helsinki University Central Hospital Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
| | | | - Neil P Shah
- University of California, San Francisco School of Medicine, San Francisco, California
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26
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Huguet F. Dasatinib for acute lymphoblastic leukemia. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1098530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Iriyama N, Fujisawa S, Yoshida C, Wakita H, Chiba S, Okamoto S, Kawakami K, Takezako N, Kumagai T, Inokuchi K, Ohyashiki K, Taguchi J, Yano S, Igarashi T, Kouzai Y, Morita S, Sakamoto J, Sakamaki H. Early cytotoxic lymphocyte expansion contributes to a deep molecular response to dasatinib in patients with newly diagnosed chronic myeloid leukemia in the chronic phase: results of the D-first study. Am J Hematol 2015; 90:819-24. [PMID: 26103598 DOI: 10.1002/ajh.24096] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 01/24/2023]
Abstract
Dasatinib is one of the key treatment options for chronic myeloid leukemia (CML) patients. Increase in lymphocyte counts has been known to be predictive of a good treatment response under dasatinib treatment as a second line therapy. However, clinical significance of lymphocyte dynamics in the upfront setting has yet to be clarified. To investigate the significance of lymphocyte dynamics in newly diagnosed chronic phase (CP)-CML, patient data of D-First study (ClinicalTrials.gov NCT01464411) were analyzed. Fifty-two CML-CP patients enrolled to this study were treated with dasatinib (100 mg day(-1) ) and all were followed-up for 18 months. The incidence of lymphocyosis was observed in 14 (27%), but it was not associated with deep molecular response achievement. However, natural killer (NK) cell or cytotoxic T lymphocyte (CTL) counts at 1 month were significantly higher in patients with deep molecular response (DMR) by 18 months compared to those without DMR. When the patients were divided into two groups according to those calculated thresholds by receiver operating characteristic curve (407/μL for NK cells and 347/μL for CTLs), the cumulative DMR rates by 18 months were significantly better in higher value group compared to lower value group. In contrast, regulatory T cell counts were significantly lower at 12 and 15 months in patients achieved DMR. These results suggest the presence of dual effects of dasatinib on immune system through the cytotoxic lymphocytes activation and Treg deregulation in different periods in newly diagnosed CML-CP.
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MESH Headings
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antineoplastic Agents/therapeutic use
- Dasatinib
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/immunology
- Gene Expression
- Humans
- Immunophenotyping
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/genetics
- Leukemia, Myeloid, Chronic-Phase/immunology
- Leukemia, Myeloid, Chronic-Phase/pathology
- Lymphocyte Count
- Lymphocytosis/chemically induced
- Lymphocytosis/genetics
- Lymphocytosis/immunology
- Lymphocytosis/pathology
- Prospective Studies
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- ROC Curve
- Remission Induction
- T-Lymphocytes, Cytotoxic/drug effects
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/pathology
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/pathology
- Thiazoles/therapeutic use
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Affiliation(s)
- Noriyoshi Iriyama
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shin Fujisawa
- Department of Hematology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Chikashi Yoshida
- Department of Hematology, National Hospital Organization, Mito Medical Center, Ibaraki, Japan
| | - Hisashi Wakita
- Division of Hematology and Oncology, Japanese Red Cross Society, Narita Red Cross Hospital, Narita, Japan
| | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kimihiro Kawakami
- Department of Hematology and Clinical Oncology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Naoki Takezako
- Department of Hematology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Takashi Kumagai
- Department of Hematology, Ohme Municipal General Hospital, Tokyo, Japan
| | - Koiti Inokuchi
- Division of Hematology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuma Ohyashiki
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Jun Taguchi
- Department of Hematology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Tadahiko Igarashi
- Division of Hematology and Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Yasuji Kouzai
- Department of Hematology, Tokyo Metropolitan Tama Synthesis Medical Center, Tokyo, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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28
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Shimura Y, Horiike S, Tsutsumi Y, Hatsuse M, Okano A, Fuchida SI, Kobayashi T, Matsumoto Y, Kuroda J, Kawata-Iida E, Uchiyama H, Uoshima N, Shimazaki C, Kaneko H, Kobayashi Y, Taniwaki M. The longitudinal analysis of large granular lymphocytosis in patients with Philadelphia chromosome-positive leukemia treated with dasatinib. Int J Hematol 2015; 102:426-33. [PMID: 26267232 DOI: 10.1007/s12185-015-1848-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
Dasatinib, a 2nd-generation tyrosine kinase inhibitor (TKI), can specifically induce large granular lymphocytes (LGL) in some patients with Philadelphia chromosome (Ph)-positive leukemia. To investigate the properties of the induced LGLs, we performed prospective and longitudinal analyses. From Feb 2011 to Jan 2013, a total of 17 patients with Ph-positive leukemia who were previously untreated or refractory to imatinib were enrolled. T cell receptor (TCR)-γ/δ gene rearrangements and phenotypic profiles of lymphocytes were examined before and during administration of dasatinib. LGL lymphocytosis was observed in half of the dasatinib-treated cases (LGL+ group), showing a relation to increased achievement of complete cytogenetic response within 6 months. The phenotypes of the increased lymphocytes were revealed to be mostly natural killer cells. In the LGL+ group, clonal TCR-γ gene rearrangements were frequently detected at diagnosis (six of nine cases) and persisted during therapy, compared with only two of eight in the LGL- group. The proportion of regulatory T cells to CD4+ T cells at diagnosis was lower in the LGL+ compared with the LGL- group (median 4.2 vs. 6.6 %), and this disparity was sustained throughout the therapeutic period. These results demonstrate that immunological condition at diagnosis may affect LGL lymphocytosis in some dasatinib-treated patients.
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Affiliation(s)
- Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Shigeo Horiike
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.,Department of Blood Transfusion and Cell Therapy, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuhiko Tsutsumi
- Division of Hematology, Department of Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Mayumi Hatsuse
- Division of Hematology, Department of Medicine, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Akira Okano
- Division of Hematology, Department of Medicine, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Shin-Ichi Fuchida
- Division of Hematology, Department of Medicine, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yosuke Matsumoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Eri Kawata-Iida
- Division of Hematology, Department of Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Hitoji Uchiyama
- Division of Hematology, Department of Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Nobuhiko Uoshima
- Division of Hematology, Department of Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Chihiro Shimazaki
- Division of Hematology, Department of Medicine, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Hiroto Kaneko
- Division of Hematology, Department of Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Yutaka Kobayashi
- Division of Hematology, Department of Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Masafumi Taniwaki
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
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29
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Iriyama N, Fujisawa S, Yoshida C, Wakita H, Chiba S, Okamoto S, Kawakami K, Takezako N, Kumagai T, Inokuchi K, Ohyashiki K, Taguchi J, Yano S, Igarashi T, Kouzai Y, Morita S, Sakamoto J, Sakamaki H. Shorter halving time of BCR-ABL1 transcripts is a novel predictor for achievement of molecular responses in newly diagnosed chronic-phase chronic myeloid leukemia treated with dasatinib: Results of the D-first study of Kanto CML study group. Am J Hematol 2015; 90:282-7. [PMID: 25530131 DOI: 10.1002/ajh.23923] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 01/28/2023]
Abstract
To investigate the factors that affect molecular responses on dasatinib treatment in patients with chronic-phase chronic myeloid leukemia (CML-CP), we performed a clinical trial named the "D-First study." Fifty-two patients with newly diagnosed CML-CP were enrolled in this study and received 100 mg dasatinib once daily. A deep molecular response (DMR) was defined as <50 copies/μg RNA of BCR-ABL1 transcript value corrected by GAPDH, which ensures <0.01% of BCR-ABL1 transcript value according to International Scale (BCR-ABL1(IS)). The halving time for BCR-ABL1 transcripts was calculated using transcript levels before dasatinib treatment, transcript levels after 3 months of treatment, and the treatment time between these two points. In terms of molecular response, 38 of 51 (75%) patients reached major molecular response (MMR) by 12 months, and the rate of DMR by 18 months was 59% (30/51). While both BCR-ABL1 transcript levels before treatment and a shorter halving time of BCR-ABL1 transcripts (≤14 days) were significant factors affecting achievement of MMR by 12 months, the Sokal score at diagnosis was not associated with MMR. Importantly, the halving time was the only factor that predicted achievement of DMR by 18 months. We showed that patients with CML-CP treated with dasatinib can be stratified according to the early treatment response as determined by the halving time of BCR-ABL1 transcripts. These data emphasize the significance of the early response from dasatinib treatment in achieving a DMR. (ClinicalTrials.gov; NCT01464411).
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Affiliation(s)
- Noriyoshi Iriyama
- Division of Hematology and Rheumatology; Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - Shin Fujisawa
- Department of Hematology; Yokohama City University Medical Center; Kanagawa Japan
| | - Chikashi Yoshida
- Department of Hematology; National Hospital Organization Mito Medical Center; Ibaraki Japan
| | - Hisashi Wakita
- Division of Hematology and Oncology; Japanese Red Cross Society, Narita Red Cross Hospital; Narita Japan
| | - Shigeru Chiba
- Department of Hematology; Faculty of Medicine; University of Tsukuba; Ibaraki Japan
| | - Shinichiro Okamoto
- Division of Hematology; Department of Internal Medicine; Keio University School of Medicine; Tokyo Japan
| | - Kimihiro Kawakami
- Department of Hematology and Clinical Oncology; Kagawa Prefectural Central Hospital; Kagawa Japan
| | - Naoki Takezako
- Department of Hematology; National Hospital Organization Disaster Medical Center; Tokyo Japan
| | - Takashi Kumagai
- Department of Hematology; Ohme Municipal General Hospital; Tokyo Japan
| | - Koiti Inokuchi
- Division of Hematology; Department of Internal Medicine; Nippon Medical School; Tokyo Japan
| | | | - Jun Taguchi
- Department of Hematology; Japanese Red Cross Shizuoka Hospital; Shizuoka Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology; Department of Internal Medicine; Jikei University School of Medicine; Tokyo Japan
| | - Tadahiko Igarashi
- Division of Hematology and Oncology; Gunma Prefectural Cancer Center; Gunma Japan
| | - Yasuji Kouzai
- Department of Hematology; Tokyo Metropolitan Tama Synthesis Medical Center; Tokyo Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics; Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | - Hisashi Sakamaki
- Hematology Division; Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital; Tokyo Japan
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30
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Ito Y, Miyamoto T, Kamimura T, Aoki K, Henzan H, Aoki T, Shiratsuchi M, Kato K, Nagafuji K, Ogawa R, Eto T, Iwasaki H, Akashi K. Characteristics of Patients With Development of Large Granular Lymphocyte Expansion Among Dasatinib-Treated Patients With Relapsed Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia After Allogeneic Stem Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:e47-54. [DOI: 10.1016/j.clml.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/06/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
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31
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Ureshino H, Kadota C, Kurogi K, Miyahara M, Kimura S. Spontaneous Regression of Methotrexate-related Lymphoproliferative Disorder with T-cell Large Granular Lymphocytosis. Intern Med 2015; 54:2235-9. [PMID: 26328653 DOI: 10.2169/internalmedicine.54.4207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Spontaneous regression of methotrexate-related lymphoproliferative disorders (MTX-LPDs) occurs in some patients after withdrawal of MTX. However, the mechanisms by which MTX withdrawal contributes to the spontaneous regression of MTX-LPDs have not been fully elucidated. We herein show that spontaneous regression of MTX-LPDs is associated with the development of significant and transient T-cell large granular lymphocyte (T-LGL) lymphocytosis induced by MTX withdrawal. Since T-LGLs show strong cytotoxicity, their expansion may contribute to the spontaneous regression of lymphoma. Therefore, the development of T-LGL lymphocytosis maybe associated with a favorable prognosis in MTX-LPD patients.
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Affiliation(s)
- Hiroshi Ureshino
- Department of Internal Medicine, Karatsu Red Cross Hospital, Japan
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32
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Abstract
PURPOSE OF REVIEW Large granular lymphocyte (LGL) syndrome comprises a clonal spectrum of T-cell and natural killer (NK)-cell LGL lymphoproliferative disorders associated with neutropenia. This review presents advances in diagnosis and therapy of LGL syndrome. RECENT FINDINGS Due to the lack of a single unique genetic or phenotypic feature and clinicopathological overlap between reactive and neoplastic entities, accurate LGL syndrome diagnosis should be based on the combination of morphologic, immunophenotypic, and molecular studies as well as clinical features. For diagnosis and monitoring of LGL proliferations, it is essential to perform flow cytometric blood and/or bone marrow analysis using a panel of monoclonal antibodies to conventional and novel T-cell and NK-cell antigens such as NK-cell receptors and T-cell receptor β-chain variable region families together with TCR gene rearrangement studies. Treatment of symptomatic cytopenias in patients with indolent LGL leukemia is still based on immunosuppressive therapy. Treatment with purine analogs and alemtuzumab may be considered as an alternative option. SUMMARY Progress in understanding the pathogenetic mechanisms of these entities, especially resistance of clonal LGLs to apoptosis, due to constitutive activation of survival signaling pathways, has its impact on identification of potential molecular therapeutic targets.
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33
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Jasielec JK, Larson RA. Dasatinib-Related Pulmonary Toxicity Mimicking an Atypical Infection. J Clin Oncol 2014; 34:e46-8. [PMID: 24958829 DOI: 10.1200/jco.2013.50.1981] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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34
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Kreutzman A, Ilander M, Porkka K, Vakkila J, Mustjoki S. Dasatinib promotes Th1-type responses in granzyme B expressing T-cells. Oncoimmunology 2014; 3:e28925. [PMID: 25083322 PMCID: PMC4106168 DOI: 10.4161/onci.28925] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/10/2014] [Accepted: 04/16/2014] [Indexed: 02/08/2023] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have dramatically improved the outcome of chronic myeloid leukemia (CML). Besides inhibiting target kinases in leukemic cells, 2nd generation TKI dasatinib also inhibits off-targets in immune effector cells resulting in atypical immune responses in some patients. Dasatinib has been described to increase the proportion of late effector memory T-cells, however, to date no follow-up studies have been performed in first-line patients. In this study, we explored the functional properties of T-cells using primary samples from CML patients (n = 28) on TKI therapy. Granzyme B (GrB) was used as a marker for late phase antigen experienced CD4+ and CD8+ T-cells. Dasatinib treatment increased the numbers of both GrB expressing memory CD4+ and CD8+ T-cells when compared with healthy controls. Functionally, the GrB+CD4+ T-cells were highly active and differentiated into Th1-type T-cells capable of producing IFN-γ, which is important for tumor control. Similar kind of increase was not observed during imatinib or nilotinib therapy. These data support the dual mode of action of dasatinib: potent BCR-ABL1 inhibition in leukemic cells is accompanied by the enhancement of cellular immunity, which may have implications in the long-term control of leukemia.
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Affiliation(s)
- Anna Kreutzman
- Hematology Research Unit Helsinki; University of Helsinki; Helsinki, Finland ; Department of Hematology; Helsinki University Central Hospital Cancer Center; Helsinki, Finland
| | - Mette Ilander
- Hematology Research Unit Helsinki; University of Helsinki; Helsinki, Finland ; Department of Hematology; Helsinki University Central Hospital Cancer Center; Helsinki, Finland
| | - Kimmo Porkka
- Hematology Research Unit Helsinki; University of Helsinki; Helsinki, Finland ; Department of Hematology; Helsinki University Central Hospital Cancer Center; Helsinki, Finland
| | - Jukka Vakkila
- Hematology Research Unit Helsinki; University of Helsinki; Helsinki, Finland ; Department of Hematology; Helsinki University Central Hospital Cancer Center; Helsinki, Finland
| | - Satu Mustjoki
- Hematology Research Unit Helsinki; University of Helsinki; Helsinki, Finland ; Department of Hematology; Helsinki University Central Hospital Cancer Center; Helsinki, Finland
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35
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Chronic myeloid leukemia patients who develop grade I/II pleural effusion under second-line dasatinib have better responses and outcomes than patients without pleural effusion. Leuk Res 2014; 38:781-7. [PMID: 24832371 DOI: 10.1016/j.leukres.2014.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/05/2014] [Accepted: 04/08/2014] [Indexed: 12/30/2022]
Abstract
Dasatinib is a potent second generation TKI, and it is widely used in patients with CML, both in the up-front setting and failure after imatinib. Lymphocytosis in cases receiving dasatinib therapy has been shown to be associated with pleural effusion (PE) and better outcome. Although patients who gather lymphocytosis during dasatinib have superior responses, there is only little data about the correlation between PE, response rates, and survival. In order to answer this question, the aim of our study was to determine the frequency of PE and lymphocytosis among our CML patients receiving second-line dasatinib, and to compare the responses and outcomes between patients with or without PE. There were 18 patients (44%) who developed PE, in a total of 41 patients, with a median time of 15 months. Lymphocytosis was observed in nine patients (9/41, 22%) with a median duration of 6.5 months of dasatinib treatment. There were fourteen patients with at least one comorbidity that may play a role in the generation of PE. The cumulative MMR and CCyR rates were greater in PE+ patients (p<0.05). The PFS was significantly higher in PE+ group than PE- patients (p=0.013), also the OS was higher among PE+ patients than PE- group (p=0.042). In patients with a grade I/II PE, and durable responses under dasatinib, performing the management strategies for the recovery of effusion, together with continuing dasatinib can be a reasonable choice mainly in countries where third generation TKIs are not available. But alternative treatment strategies such as nilotinib or third generation TKIs can be chosen in patients with grade III/IV PE especially if the quality of life is severely affected.
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Abstract
Dasatinib is a second generation tyrosine kinase inhibitor (TKI) approved for clinical use in patients with imatinib-resistant chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL). Large granular lymphocytes (LGLs) are medium to large cells with eccentric nuclei and abundant cytoplasm with coarse azurophilic granules. LGL lymphocytosis is caused by a proliferation of cytotoxic (CD8+) T cells and/or NK cells. In a proportion of CML and Ph(+) ALL patients, there is a significant expansion of LGLs during dasatinib therapy. LGL lymphocytosis is seen in some cases with fevers, colitis, and pleural effusions (PE), suggesting an aberrant immune response mediated by these LGLs. LGLs may participate in the elimination of the residual leukemic cells, and LGL clonal expansion is associated with excellent, long-lasting therapy responses in dasatinib-treated patients. For a more comprehensive analysis, we analyzed the morphologic, phenotypic, clinical, and functional features of the LGL subsets amplified in vivo during dasatinib therapy.
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Affiliation(s)
- Zhi-Yuan Qiu
- Department of Hematology; the First Affiliated Hospital of Nanjing Medical University; Jiangsu Province Hospital; Nanjing, PR China
| | - Wei Xu
- Department of Hematology; the First Affiliated Hospital of Nanjing Medical University; Jiangsu Province Hospital; Nanjing, PR China
| | - Jian-Yong Li
- Department of Hematology; the First Affiliated Hospital of Nanjing Medical University; Jiangsu Province Hospital; Nanjing, PR China
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37
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Relative increase in lymphocytes from as early as 1 month predicts improved response to dasatinib in chronic-phase chronic myelogenous leukemia. Int J Hematol 2013; 99:41-52. [PMID: 24297450 DOI: 10.1007/s12185-013-1483-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 10/26/2022]
Abstract
Lymphocytosis in response to dasatinib for chronic myelogenous leukemia (CML) may be associated with favorable response. However, it occurs at varying times and in a limited subset of patients. To identify early clinical markers for favorable responses applicable to all patients with or without lymphocytosis, we prospectively analyzed lymphocyte profiles of 50 Japanese CML patients treated with dasatinib after intolerance/resistance to imatinib. Although absolute lymphocyte counts did not differ significantly until 3 months between patients with complete molecular response (CMR) at 12 months and those without it, relative increases in lymphocyte compared with baselines differed significantly from 1 month. Patients with relative lymphocyte counts >150 % at 1 month or >200 % at 3 months had higher CMR rates at 12 months than others (57.9 vs. 23.3 %, P = 0.015, and 76.5 vs. 16.1 %, P < 0.0001, respectively). A relative increase in lymphocyte subset of CD57(+)CD14(-), CD8(+)T, or NK cells >200 % at 1 month was also significantly associated with a higher CMR rate. There were significant negative correlations between relative lymphocyte increases and BCR/ABL transcript levels. CD57(+)CD14(-) cells were a highly specific focus of proliferation. Relative increases in lymphocyte count and its subsets from 1 month are reliable early markers of favorable responses to dasatinib.
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38
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Paydas S. Dasatinib, large granular lymphocytosis, and pleural effusion: useful or adverse effect? Crit Rev Oncol Hematol 2013; 89:242-7. [PMID: 24210599 DOI: 10.1016/j.critrevonc.2013.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 09/20/2013] [Accepted: 10/02/2013] [Indexed: 12/16/2022] Open
Abstract
Dasatinib is a second generation tyrosine kinase inhibitor approved for clinical use in first line and imatinib-resistant chronic myeloid leukemia and Philadelphia positive (Ph+) acute lymphoblastic leukemia. In addition to BCR-ABL1, dasatinib inhibits TEC kinases and SRC family kinases and is more potent than imatinib in the treatment of Ph+ leukemias. In the last 3 years, increases in cytotoxic T and natural-killer cells in peripheral blood samples have been reported in cases treated by dasatinib. The awareness of the clonal expansion of large granular lymphocytes and beneficial effect of these clonal cells increased the interest to dasatinib in cases receiving this drug. Clonal expansion of large granular lymphocytes is an important effect of dasatinib therapy, shown to be an off-target phenomenon associated with pleural effusion and better clinical response. The benefit of dasatinib-induced lymphocytosis and its underlying mechanism of this are important points for clinicians working in hematology and oncology.
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Affiliation(s)
- Semra Paydas
- Cukurova University, Faculty of Medicine, Department of Oncology, Adana, Turkey.
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39
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Mustjoki S, Auvinen K, Kreutzman A, Rousselot P, Hernesniemi S, Melo T, Lahesmaa-Korpinen AM, Hautaniemi S, Bouchet S, Molimard M, Smykla R, Lee FY, Vakkila J, Jalkanen S, Salmi M, Porkka K. Rapid mobilization of cytotoxic lymphocytes induced by dasatinib therapy. Leukemia 2012. [PMID: 23192016 DOI: 10.1038/leu.2012.348] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) have potent effects on malignant cells, and they also target kinases in normal cells, which may have therapeutic implications. Using a collection of 55 leukemia patients treated with TKI therapy (chronic myeloid leukemia, n=47; acute lymphoblastic leukemia, n=8), we found that dasatinib, a second-generation broad-spectrum TKI, induced a rapid, dose-dependent and substantial mobilization of non-leukemic lymphocytes and monocytes in blood peaking 1-2 h after an oral intake and the blood counts closely mirrored drug plasma concentration. A preferential mobilization was observed for natural killer (NK), NK T, B and γδ+ T cells. Mobilization was coupled with a more effective transmigration of leukocytes through an endothelial cell layer and improved cytotoxicity of NK cells. Platelet numbers decreased markedly after the drug intake in a proportion of patients. Similar effects on blood cell dynamics and function were not observed with any other TKI (imatinib, nilotinib and bosutinib). Thus, dasatinib induces a unique, rapid mobilization and activation of cytotoxic, extravasation-competent lymphocytes, which may not only enhance antileukemia immune responses but can also be causally related to the side-effect profile of the drug (pleural effusions, thrombocytopenia).
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Affiliation(s)
- S Mustjoki
- Hematology Research Unit Helsinki, Department of Medicine, Division of Hematology, University of Helsinki and Helsinki University Central Hospital (HUCH), Helsinki, Finland
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40
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Latagliata R, Breccia M, Fava C, Stagno F, Tiribelli M, Luciano L, Gozzini A, Gugliotta G, Annunziata M, Cavazzini F, Ferrero D, Musto P, Capodanno I, Iurlo A, Visani G, Crugnola M, Calistri E, Castagnetti F, Vigneri P, Alimena G. Incidence, risk factors and management of pleural effusions during dasatinib treatment in unselected elderly patients with chronic myelogenous leukaemia. Hematol Oncol 2012; 31:103-9. [PMID: 22815278 DOI: 10.1002/hon.2020] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/03/2012] [Accepted: 06/05/2012] [Indexed: 11/10/2022]
Abstract
To assess the most important features and clinical impact of pleural effusions, which are a common toxicity during dasatinib treatment and often impair its high efficacy, 172 unselected consecutive patients with chronic myelogenous leukaemia in chronic phase treated in 27 Italian centres, with dasatinib when aged >60 years for resistance/intolerance to imatinib, were examined. During treatment, 52/172 patients (30.2%) presented pleural effusion, which was grades 1-2 in 38 patients and grades 3-4 in 14 patients (8.1% of the entire cohort of patients), according to the WHO scale; in 14/52 patients (26.9%), there was a concomitant pericardial effusion. Pleural effusion was recurrent in 25/52 patients (48.0%). Median time from dasatinib to first pleural effusion was 11.0 months (interquartile range 3.6-18.6). Eleven patients (6.4%) required permanent dasatinib discontinuation. Only presence of concomitant pulmonary disease ( p = 0.035) and initial daily dose of dasatinib (140 mg vs 100 mg, p = 0.014) were significantly associated with pleural effusions. There were no differences among patients with or without pleural effusions as concerns response rates and overall survival. Pleural effusions were common in our unselected 'real-life' population of elderly patients but were clinically manageable and did not seem to affect treatment results.
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Affiliation(s)
- Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology, University La Sapienza, Rome, Italy.
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41
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Imagawa J, Tanaka H, Matsumoto K, Morita K, Harada Y, Harada H. A sharp fluctuation in peripheral blood cells shortly after dasatinib administration. Int J Hematol 2012; 96:194-9. [PMID: 22797901 DOI: 10.1007/s12185-012-1138-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 06/25/2012] [Accepted: 06/27/2012] [Indexed: 01/09/2023]
Abstract
Dasatinib, a tyrosine kinase inhibitor, has a reduced plasma half-life and a more extensive inhibition profile, including targeting of Src family kinases. We monitored the peripheral blood count and the serum concentration of dasatinib over time. Interestingly, we found a transient fluctuation of blood cells, which correlated with the dasatinib level. The peripheral blood count before intake of dasatinib was compared with counts measured 2 h later in blood samples from 23 patients. Total white blood cells (WBCs) increased by 2,186 ± 1,960/μL from baseline (P = 0.00002), whereas platelets decreased from a baseline of 185 ± 47 × 10(3)/μL to 164 ± 52 × 10(3)/μL (P = 0.0007). Similar phenomena were not observed in patients treated with imatinib or nilotinib. In addition, in contrast to imatinib, dasatinib strongly attenuated the expression of CD18, CD62P and CD63 by blood cells both in vivo and in vitro. These results suggest that this drug may influence the distribution of blood cells in vivo by regulating its specific adhesion molecule expression on blood cells.
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Affiliation(s)
- Jun Imagawa
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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42
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Tanaka H, Nakashima S, Usuda M. Rapid and sustained increase of large granular lymphocytes and rare cytomegalovirus reactivation during dasatinib treatment in chronic myelogenous leukemia patients. Int J Hematol 2012; 96:308-19. [PMID: 22767140 DOI: 10.1007/s12185-012-1132-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
We retrospectively investigated increases in large granular lymphocytes (LGL) in peripheral blood during dasatinib treatment in 25 chronic myelogenous leukemia patients. Fifteen of 25 patients (60 %) showed an increase in LGL. All 15 of these patients also showed an increase in NK cells, and 11 showed an increase in CD8(+) T cells. High frequencies of clonal rearrangements of TCR-β, -γ, and -δ genes were observed in LGL (+) patients, and at lower frequencies in LGL (-) patients as well. Clinical responses were favorable for all. With respect to their newly obtained complete molecular response after dasatinib treatment, LGL (+) patients showed higher response rates than did LGL (-) patients. In contrast, pleural effusions were more commonly observed in LGL (+) patients (60 %) than in LGL (-) patients (20 %). LGL counts significantly increased at 2 h after oral intake of dasatinib in all 25 patients. This was not observed in treatment with imatinib or nilotinib. Cytomegalovirus (CMV) C7-HRP tests were negative in all patients. Serum CMV-IgM antibodies were positive in only 2 of 25 patients without symptom of infection. Thus, LGL lymphocytosis during dasatinib treatment may be correlated with favorable molecular response, and with increased incidence of pleural effusions. In the clinical setting, CMV reactivation appears uncommon.
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Affiliation(s)
- Hideo Tanaka
- Department of Hematology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan.
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Rohon P. Biological therapy and the immune system in patients with chronic myeloid leukemia. Int J Hematol 2012; 96:1-9. [PMID: 22661045 DOI: 10.1007/s12185-012-1116-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 05/22/2012] [Accepted: 05/23/2012] [Indexed: 02/01/2023]
Abstract
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of hematopoietic stem cells that has been recognized as a disease responsive to immunotherapy. Despite the huge success of the tyrosine kinase inhibitors (TKIs), CML remains for the most part incurable, probably due to treatment resistance of leukemic stem cells, which are responsible for rapid disease relapse after discontinuation of therapy. Only allogeneic stem cell transplantation enables disease eradication. In addition to the Bcr-Abl1 oncoprotein, TKIs also inhibit off-target kinases (e.g. c-kit, Src, Tec), some of them having physiological functions in immune responses. In vitro studies have implied immunomodulatory effects of TKIs and interferon-alpha (IFN-α), but comprehensive information from in vivo analyses is missing. This review summarizes the recent advances in the field of immunology of CML, including basic information about leukemia-associated antigens and peptide vaccines, that could lead to the incorporation of TKIs and IFN-α in future therapeutic, potentially curative, interventions for CML.
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Affiliation(s)
- Peter Rohon
- University Hospital, Olomouc, Czech Republic.
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44
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Aoki J, Ohashi K, Kobayashi T, Kakihana K, Hirashima Y, Sakamaki H. Sustained complete molecular response of chronic myeloid leukemia after discontinuation of second-generation tyrosine kinase inhibitors. Leuk Lymphoma 2012; 53:1412-4. [DOI: 10.3109/10428194.2011.649753] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Hayashi Y, Nakamae H, Katayama T, Nakane T, Koh H, Nakamae M, Hirose A, Hagihara K, Terada Y, Nakao Y, Hino M. Different immunoprofiles in patients with chronic myeloid leukemia treated with imatinib, nilotinib or dasatinib. Leuk Lymphoma 2012; 53:1084-9. [PMID: 22211798 DOI: 10.3109/10428194.2011.647017] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Immunomodulation induced by dasatinib is reportedly related to better prognosis in chronic myeloid leukemia (CML). However, the underlying mechanism has not yet been fully elucidated. The immunoprofiles of 63 patients in the chronic phase of CML were evaluated during treatment with a tyrosine kinase inhibitor (imatinib, n = 36; nilotinib, n = 9; dasatinib, n = 18). The numbers of CD56 + CD57 + and CD3 + CD57 + cells increased significantly in the dasatinib group. The numbers of regulatory T-cells were comparable among the three groups. Dasatinib markedly enhanced natural killer (NK)-cell reactivity. Only one patient treated with dasatinib showed a slight cytomegalovirus (CMV) reactivation. In contrast, nilotinib suppressed NK-cell reactivity. Plasma levels of interleukin-8 (IL-8), interferon-γ inducible protein-10 (IP-10) and monocyte chemoattractant protein-1 (MCP-1) were significantly elevated in all three groups, and plasma levels of granulocyte macrophage-colony stimulating factor (GM-CSF) were significantly elevated in the imatinib and dasatinib groups. Our results suggest the presence of a mechanism for dasatinib-associated immunomodulatory effects that is distinct from CMV reactivation and a decreased number of regulatory T-cells.
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Affiliation(s)
- Yoshiki Hayashi
- Graduate School of Medicine, Osaka City University, Osaka, Japan
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46
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Deininger MW, Manley P. What do kinase inhibition profiles tell us about tyrosine kinase inhibitors used for the treatment of CML? Leuk Res 2011; 36:253-61. [PMID: 21996558 DOI: 10.1016/j.leukres.2011.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/12/2011] [Accepted: 09/19/2011] [Indexed: 11/17/2022]
Abstract
Cancer treatment has long been based upon cytotoxic therapies that affect all rapidly dividing cells, and as such, is necessarily associated with significant toxicity. More recently, drugs targeted toward pathways critical for tumor cell survival have been developed. With limited off-target activity, such therapies are expected to be better tolerated than broad-acting cytotoxic chemotherapies. BCR-ABL inhibitors in chronic myeloid leukemia are reviewed as a model to investigate the concept of targeted cancer therapies and evaluate how the kinase inhibition profiles of these agents may contribute to their toxicity profiles.
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Affiliation(s)
- Michael W Deininger
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112-5550, USA.
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47
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Shami PJ, Deininger M. Evolving treatment strategies for patients newly diagnosed with chronic myeloid leukemia: the role of second-generation BCR-ABL inhibitors as first-line therapy. Leukemia 2011; 26:214-24. [PMID: 21844872 DOI: 10.1038/leu.2011.217] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In patients with chronic myeloid leukemia (CML), disease in the initial chronic phase (CP) and subsequent progression are driven by the oncogenic activity of the BCR-ABL fusion kinase. Imatinib, a tyrosine kinase inhibitor of BCR-ABL, has been the mainstay of first-line therapy for CML for 10 years. Although patients with CML-CP respond well to imatinib, those who have delayed reductions in leukemic burden during imatinib therapy, such as not achieving a complete cytogenetic response (CCyR) by 12 months, have an increased risk of disease progression. It has been recognized, with 8 years of observation, that patients who achieve an early major molecular response (MMR) on imatinib have a very low probability of disease progression. Recent randomized phase 3 trials have shown that first-line treatment with dasatinib or nilotinib-more potent BCR-ABL inhibitors-results in significantly higher rates and more rapid achievement of CCyR and MMR in comparison with standard-dose imatinib. These trials suggest that CML treatment can be improved with more potent BCR-ABL inhibition during initial therapy, but further follow-up is needed to confirm that the improved response rates with dasatinib and nilotinib are maintained long term.
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Affiliation(s)
- P J Shami
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112-5550, USA
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48
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Lee SJ, Jung CW, Kim DY, Lee KH, Sohn SK, Kwak JY, Kim HJ, Kim IH, Park S, Kim DHD. Retrospective multicenter study on the development of peripheral lymphocytosis following second-line dasatinib therapy for chronic myeloid leukemia. Am J Hematol 2011; 86:346-50. [PMID: 21442637 DOI: 10.1002/ajh.21980] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The current retrospective study investigated the incidence of lymphocytosis following second-line dasatinib therapy in chronic myeloid leukemia (CML) and analyzed the clinical factors predictive of the development of lymphocytosis, as well as association with treatment outcomes. Fifty CML patients who failed imatinib treatment and received dasatinib were included from nine centers in the Republic of Korea. The cumulative incidence of lymphocytosis was assessed, and cytogenetic and molecular response, treatment failure, loss of response, progression to advanced disease, and survival were evaluated and analyzed according to the development of lymphocytosis. After a median of 17 months of dasatinib therapy, 23 patients (46%) developed lymphocytosis (median onset 4 months). No clinical predictive factor for the development of lymphocytosis was found. The group presenting lymphocytosis showed a higher complete cytogenetic response (CCyR; 78.3 vs. 29.6%, P = 0.001) and major molecular response (MMR; 52.2 vs. 14.8%, P = 0.005), in comparison to the group without presenting lymphocytosis. The development of lymphocytosis after dasatinib was identified as a favorable independent marker for predicting a CCyR (P = 0.002) or MMR (P = 0.003). Further study is necessary to identify which subset of lymphocytes was expanded and to reveal the exact mechanism by which dasatinib induces lymphocyte expansion.
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Affiliation(s)
- Su Jin Lee
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, Korea
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49
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Cervantes F, Mauro M. Practical management of patients with chronic myeloid leukemia. Cancer 2011; 117:4343-54. [PMID: 21413002 DOI: 10.1002/cncr.26062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 12/13/2010] [Accepted: 01/26/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Francisco Cervantes
- Hematology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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50
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Powers JJ, Dubovsky JA, Epling-Burnette PK, Moscinski L, Zhang L, Mustjoki S, Sotomayor EM, Pinilla-Ibarz JA. A molecular and functional analysis of large granular lymphocyte expansions in patients with chronic myelogenous leukemia treated with tyrosine kinase inhibitors. Leuk Lymphoma 2011; 52:668-79. [PMID: 21271862 DOI: 10.3109/10428194.2010.550074] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Tyrosine kinase inhibitor (TKI) therapy has become the standard treatment for chronic myelogenous leukemia (CML). Off-target kinase inhibition has been implicated in the appearance of unique adverse effects, such as colitis and pleural effusions. In addition, some patients present oligoclonal expansions of large granular lymphocytes (LGLs). We sought to further investigate this phenomenon in 64 patients treated with five different TKIs. Clonal expansions of cytotoxic T lymphocytes (CTLs) were identified in all TKI-treated patient groups, but only in dasatinib-treated patients were these expansions characterized as LGLs. Survival factors known to be important in LGL leukemia (interleukin-15 [IL-15] transpresentation, plasma platelet-derived growth factor [PDGF]-BB levels, nuclear factor-κB [NF-κB] and T-bet activation) were found to be associated with TKI-induced LGL expansions. Interestingly, patients with LGL expansions had increased cytotoxicity against non-transformed endothelial cells, which may play a role in observed autoimmune-like side effects. Our results indicate that patients with CML treated with TKIs can develop T cell expansions, which can in certain cases be related to some adverse effects.
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Affiliation(s)
- John J Powers
- Department of Immunology and Experimental Therapeutics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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