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Wu CH, Weng TF, Li JP, Wu KH. Biology and Therapeutic Properties of Mesenchymal Stem Cells in Leukemia. Int J Mol Sci 2024; 25:2527. [PMID: 38473775 DOI: 10.3390/ijms25052527] [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: 01/07/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
This comprehensive review delves into the multifaceted roles of mesenchymal stem cells (MSCs) in leukemia, focusing on their interactions within the bone marrow microenvironment and their impact on leukemia pathogenesis, progression, and treatment resistance. MSCs, characterized by their ability to differentiate into various cell types and modulate the immune system, are integral to the BM niche, influencing hematopoietic stem cell maintenance and functionality. This review extensively explores the intricate relationship between MSCs and leukemic cells in acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and chronic lymphocytic leukemia. This review also addresses the potential clinical applications of MSCs in leukemia treatment. MSCs' role in hematopoietic stem cell transplantation, their antitumor effects, and strategies to disrupt chemo-resistance are discussed. Despite their therapeutic potential, the dual nature of MSCs in promoting and inhibiting tumor growth poses significant challenges. Further research is needed to understand MSCs' biological mechanisms in hematologic malignancies and develop targeted therapeutic strategies. This in-depth exploration of MSCs in leukemia provides crucial insights for advancing treatment modalities and improving patient outcomes in hematologic malignancies.
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Affiliation(s)
- Cheng-Hsien Wu
- School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Te-Fu Weng
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Ju-Pi Li
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Department of Pathology, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
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Kronick O, Chen X, Mehra N, Varmeziar A, Fisher R, Kartchner D, Kota V, Mitchell CS. Hematological Adverse Events with Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia: A Systematic Review with Meta-Analysis. Cancers (Basel) 2023; 15:4354. [PMID: 37686630 PMCID: PMC10486908 DOI: 10.3390/cancers15174354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic myeloid leukemia (CML) is treated with tyrosine kinase inhibitors (TKI) that target the pathological BCR-ABL1 fusion oncogene. The objective of this statistical meta-analysis was to assess the prevalence of other hematological adverse events (AEs) that occur during or after predominantly first-line treatment with TKIs. Data from seventy peer-reviewed, published studies were included in the analysis. Hematological AEs were assessed as a function of TKI drug type (dasatinib, imatinib, bosutinib, nilotinib) and CML phase (chronic, accelerated, blast). AE prevalence aggregated across all severities and phases was significantly different between each TKI (p < 0.05) for anemia-dasatinib (54.5%), bosutinib (44.0%), imatinib (32.8%), nilotinib (11.2%); neutropenia-dasatinib (51.2%), imatinib (29.8%), bosutinib (14.1%), nilotinib (14.1%); thrombocytopenia-dasatinib (62.2%), imatinib (30.4%), bosutinib (35.3%), nilotinib (22.3%). AE prevalence aggregated across all severities and TKIs was significantly (p < 0.05) different between CML phases for anemia-chronic (28.4%), accelerated (66.9%), blast (55.8%); neutropenia-chronic (26.7%), accelerated (63.8%), blast (36.4%); thrombocytopenia-chronic (33.3%), accelerated (65.6%), blast (37.9%). An odds ratio (OR) with 95% confidence interval was used to compare hematological AE prevalence of each TKI compared to the most common first-line TKI therapy, imatinib. For anemia, dasatinib OR = 1.65, [1.51, 1.83]; bosutinib OR = 1.34, [1.16, 1.54]; nilotinib OR = 0.34, [0.30, 0.39]. For neutropenia, dasatinib OR = 1.72, [1.53, 1.92]; bosutinib OR = 0.47, [0.38, 0.58]; nilotinib OR = 0.47, [0.42, 0.54]. For thrombocytopenia, dasatinib OR = 2.04, [1.82, 2.30]; bosutinib OR = 1.16, [0.97, 1.39]; nilotinib OR = 0.73, [0.65, 0.82]. Nilotinib had the greatest fraction of severe (grade 3/4) hematological AEs (30%). In conclusion, the overall prevalence of hematological AEs by TKI type was: dasatinib > bosutinib > imatinib > nilotinib. Study limitations include inability to normalize for dosage and treatment duration.
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Affiliation(s)
- Olivia Kronick
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Xinyu Chen
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Nidhi Mehra
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Armon Varmeziar
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Rachel Fisher
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - David Kartchner
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Vamsi Kota
- Department of Medicine, Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA 30912, USA;
| | - Cassie S. Mitchell
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
- The Machine Learning Center at Georgia Tech, Georgia Institute of Technology, Atlanta, GA 30332, USA
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3
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Dulucq S, Rigal-Huguet F, Nicolini FE, Cony-Makhoul P, Escoffre-Barbe M, Gardembas M, Legros L, Rousselot P, Liu J, Rea D, De Mas V, Hayette S, Raynaud S, Lacoste-Roussillon C, Robbesyn F, Klein E, Morisset S, Mahon FX, Etienne G. Efficacy and safety of nilotinib in chronic myeloid leukaemia patients who failed to achieve a treatment-free remission period after imatinib discontinuation: Results of the French Nilo post-STIM study. Br J Haematol 2023. [PMID: 37004981 DOI: 10.1111/bjh.18796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
Molecular recurrence (MRec) occurs in about half of all patients with chronic myeloid leukaemia (CML) who discontinue tyrosine kinase inhibitors (TKI) in sustained deep molecular response. A second TKI discontinuation has been attempted in some patients who regain the discontinuation criteria after resuming treatment. Nilotinib treatment affords faster and deeper molecular responses than imatinib as first-line therapy. We prospectively evaluated the efficacy and safety of nilotinib (300 mg twice daily) in chronic-phase CML patients who experienced MRec, after imatinib discontinuation and analysed the probability of TFR after a new attempt in patients treated for 2 years with sustained MR4.5 for at least 1 year. A total of 31 patients were included in the study between 2013 and 2018. Seven (23%) patients experienced serious adverse events after a median of 2 months of nilotinib treatment leading to discontinuation of treatment. One patient was excluded from the study for convenience. Among the 23 patients treated for 2 years with nilotinib, 22 maintained their molecular response for at least 1 year (median: 22 months) and stopped nilotinib. The TFR rates at 24 and 48 months after nilotinib discontinuation were 59.1% (95% confidence interval [CI]: 41.7%-83.7%) and 42.1% (95% CI: 25%-71%) respectively (NCT #01774630).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Franck E Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Léon Bérard, Lyon, France
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU de Pontchaillou, Rennes, France
| | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU, Angers, France
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology & Oncology Department, Centre Hospitalier de Valence, Valence, France
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Adult Hematology Department, Hôpital Saint Louis, Paris, France
| | - Véronique De Mas
- Laboratory of Hematology, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Sandrine Hayette
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Laboratory of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Sophie Raynaud
- Laboratory of Hematology, University Hospital of Nice, Nice, France
| | - Caroline Lacoste-Roussillon
- Clinical Research and Innovation Department, Safety and Vigilance Unit, Bordeaux University Hospital, Bordeaux, France
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
| | - Emilie Klein
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Stéphane Morisset
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
- Hematology Department, CHU Bordeaux, Pessac, France
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
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Mehra N, Varmeziar A, Chen X, Kronick O, Fisher R, Kota V, Mitchell CS. Cross-Domain Text Mining to Predict Adverse Events from Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia. Cancers (Basel) 2022; 14:4686. [PMID: 36230609 PMCID: PMC9563938 DOI: 10.3390/cancers14194686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/04/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) are prescribed for chronic myeloid leukemia (CML) and some other cancers. The objective was to predict and rank TKI-related adverse events (AEs), including under-reported or preclinical AEs, using novel text mining. First, k-means clustering of 2575 clinical CML TKI abstracts separated TKIs by significant (p < 0.05) AE type: gastrointestinal (bosutinib); edema (imatinib); pulmonary (dasatinib); diabetes (nilotinib); cardiovascular (ponatinib). Next, we propose a novel cross-domain text mining method utilizing a knowledge graph, link prediction, and hub node network analysis to predict new relationships. Cross-domain text mining of 30+ million articles via SemNet predicted and ranked known and novel TKI AEs. Three physiology-based tiers were formed using unsupervised rank aggregation feature importance. Tier 1 ranked in the top 1%: hematology (anemia, neutropenia, thrombocytopenia, hypocellular marrow); glucose (diabetes, insulin resistance, metabolic syndrome); iron (deficiency, overload, metabolism), cardiovascular (hypertension, heart failure, vascular dilation); thyroid (hypothyroidism, hyperthyroidism, parathyroid). Tier 2 ranked in the top 5%: inflammation (chronic inflammatory disorder, autoimmune, periodontitis); kidney (glomerulonephritis, glomerulopathy, toxic nephropathy). Tier 3 ranked in the top 10%: gastrointestinal (bowel regulation, hepatitis, pancreatitis); neuromuscular (autonomia, neuropathy, muscle pain); others (secondary cancers, vitamin deficiency, edema). Results suggest proactive TKI patient AE surveillance levels: regular surveillance for tier 1, infrequent surveillance for tier 2, and symptom-based surveillance for tier 3.
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Affiliation(s)
- Nidhi Mehra
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Armon Varmeziar
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Xinyu Chen
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Olivia Kronick
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Rachel Fisher
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Vamsi Kota
- Division of Hematology and Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Cassie S. Mitchell
- Laboratory for Pathology Dynamics, Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA 30332, USA
- Center for Machine Learning, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Chelysheva EY, Petrova AN, Shukhov OA, Bykova AV, Nemchenko IS, Gurianova MA, Tsyba NN, Turkina AG. Withdrawal syndrome after tyrosine kinase inhibitors discontinuation in patients with chronic myeloid leukemia. TERAPEVT ARKH 2022; 94:836-843. [DOI: 10.26442/00403660.2022.07.201747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
Background. Withdrawal syndrome (WS) a musculoskeletal pain after discontinuation of tyrosine kinase inhibitors (TKI) in patients with chronic myeloid leukemia (CML) has been described in the treatment-free remission (TFR) studies. The pathophysiological mechanisms and predisposing factors of WS have not been well established.
Aim. Our aim was to evaluate clinical features and factors associated with WS in the Russian cohort of CML patients who discontinued TKI therapy.
Materials and methods. WS was evaluated in total of 183 CML patients with chronic phase and sustained deep molecular response (DMR). WS was defined as a musculoskeletal pain newly observed after TKI cessation or as a worsening of previously observed symptoms.
Results. DMR loss free survival at 36 months was 49% and 43% in prospective and retrospective groups respectively (p=0.96) with mеdian (Me) time of observation 33 months (range 1136). WS was observed in 49 (27%) patients: grade 12 was in 45 (92%) patients, grade 3 in 4 (8%) patients. Me time to WS occurrence was 2 months (range 17), Ме duration of WS was 5 months (range 135). WS was resolved in 14 of 15 patients with molecular relapse after 13 months of TKI re-initiation and was decreased in 1 patient. WS was completely resolved in 31 of 34 patients who continued remained in TFR and decreased in 3 patients. WS was resolved spontaneously or with nonsteroidal anti-inflammatory drugs in 14 (45%) and 17 (55%) patients accordingly. Older age (p0.0001), longer duration of TKI therapy (p0.0001) and presence of locomotion system diseases (p=0.022) were observed in patients with WS. No WS was observed in pregnant patients (р0.001). Survival without DMR loss at 12 months after TKI stop was 66 and 42% in patients with and without WS accordingly (р=0.095).
Conclusion. The rate of WS was 27% that is in a good concordance with the data of the other TFR studies. A longer period of TKI exposure, older age and the history of locomotion system diseases were associated with the development of the WS. We found for the first time that WS was not observed in patients with pregnancy. There was no association of WS development and the rate of molecular relapses.
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Dulucq S, Nicolini FE, Rea D, Cony-Makhoul P, Charbonnier A, Escoffre-Barbe M, Coiteux V, Lenain P, Rigal-Huguet F, Liu J, Guerci-Bresler A, Legros L, Ianotto JC, Gardembas M, Turlure P, Dubruille V, Rousselot P, Martiniuc J, Jardel H, Johnson-Ansah H, Joly B, Henni T, Cayssials E, Zunic P, Berger MG, Villemagne B, Robbesyn F, Morisset S, Mahon FX, Etienne G. Kinetics of early and late molecular recurrences after first-line imatinib cessation in chronic myeloid leukemia: updated results from the STIM2 trial. Haematologica 2022; 107:2859-2869. [PMID: 35615931 PMCID: PMC9713567 DOI: 10.3324/haematol.2022.280811] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Discontinuation of tyrosine kinase inhibitors in chronic phase chronic myeloid leukemia is feasible in clinical practice based on recently published international recommendations. Nevertheless, factors predictive of molecular recurrence have not been fully elucidated and long-term follow-up of patients enrolled in clinical studies are required in order to update knowledge on discontinuation attempts particularly in terms of the safety and durability of treatment-free remission (TFR). In the current study, we updated results from the STIM2 study in the light of the consensual criterion of molecular recurrence reported in different international recommendations. Among the 199 patients included in the perprotocol study, 108 patients lost a major molecular response. With a median follow-up of 40.8 months (5.5-111 months), the probability of treatment-free remission was 43.4% [36.3-50.4] at 5 years, 40.9% [32.8-47.3] at 7 years and 34.5% [25.6- 43.3] at 9 years. Molecular recurrence occurred between 0 to 6 months, 6 to 24 months and after 24 months in 75 patients (69%), 15 patients (14%) and 18 patients (17%), respectively. Notably, the kinetics of molecular recurrence differed significantly between these three subgroups with a median time from loss of MR4 (BCR::ABL1 IS≤0.01%) to loss of major molecular response of 1, 7 and 22 months, respectively. Predictive factors of molecular recurrence differed according to the time of occurrence of the molecular recurrence. Durations of imatinib treatment and deep molecular response as well as BCR::ABL1/ABL1 levels at cessation of tyrosine kinase inhibitor treatment, as quantified by reverse transcriptase droplet digital polymerase chain reaction, are involved in molecular recurrence occurring up to 24 months but not beyond. (ClinicalTrial. gov Identifier NCT#0134373).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac,Groupe Fi-LMC, Centre Léon Bérard, Lyon,S. Dulucq
| | - Franck E. Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon,Hematology Department, Centre Léon Bérard, Lyon
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Adult Hematology Department, Hôpital Saint Louis, Paris
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department & Clinical Investigation Center, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy
| | - Aude Charbonnier
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Paoli-Calmettes, Marseilles
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Pontchaillou, Rennes
| | - Valérie Coiteux
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Huriez, Lille
| | - Pascal Lenain
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Henri Becquerel, Rouen
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology & Oncology Department, Centre Hospitalier de Valence, Valence
| | - Agnès Guerci-Bresler
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHRU Brabois, Nancy
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | | | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU, Angers
| | - Pascal Turlure
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Dupuytren, Limoges
| | - Viviane Dubruille
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôtel Dieu, Nantes
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Versailles, Le Chesnay
| | - Juliana Martiniuc
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc
| | - Henry Jardel
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Bretagne, Vannes
| | - Hyacinthe Johnson-Ansah
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Institute of Normandy, CHU de la Côte de Nacre, Caën
| | - Bertrand Joly
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CH Sud Francilien, Corbeil-Essonne
| | - Tawfiq Henni
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHR La Réunion
| | - Emilie Cayssials
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Poitiers, Poitiers
| | - Patricia Zunic
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier, Saint Pierre de La Réunion
| | - Marc G. Berger
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology (Biology) Department, CHU Estaing, Clermont-Ferrand
| | - Bruno Villemagne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Internal Medicine and Onco-hematology Department, La Roche sur Yon and
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac
| | - Stephane Morisset
- INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
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Borghi L, Rosti G, Maggi A, Breccia M, Di Bona E, Iurlo A, La Barba G, Sportoletti P, Albano F, Galimberti S, Rivellini F, Cambrin GR, Capodanno I, Cuneo A, Bonifacio M, Sica S, Arcaini L, Capochiani E, Minotto C, Ciceri F, Crugnola M, Di Caprio L, Supekar S, Elena C, Baccarani M, Vegni E. Perspectives and Emotional Experiences of Patients With Chronic Myeloid Leukemia During ENESTPath Clinical Trial and Treatment-Free Remission: Rationale and Protocol of the Italian Substudy. Front Oncol 2021; 11:638689. [PMID: 34123791 PMCID: PMC8189147 DOI: 10.3389/fonc.2021.638689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
Achievement of deep molecular response following treatment with a tyrosine kinase inhibitor (TKI) allows for treatment-free remission (TFR) in many patients with chronic myeloid leukemia (CML). Successful TFR is defined as the achievement of a sustained molecular response after cessation of ongoing TKI therapy. The phase 3 ENESTPath study was designed to determine the required optimal duration of consolidation treatment with the second-generation TKI, nilotinib 300 mg twice-daily, to remain in successful TFR without relapse after entering TFR for 12 months. The purpose of this Italian 'patient's voice CML' substudy was to evaluate patients' psycho-emotional characteristics and quality of life through their experiences of stopping treatment with nilotinib and entering TFR. The purpose of the present contribution is to early present the study protocol of an ongoing study to the scientific community, in order to describe the study rationale and to extensively present the study methodology. Patients aged ≥18 years with a confirmed diagnosis of Philadelphia chromosome positive BCR-ABL1+ CML in chronic phase and treated with front-line imatinib for a minimum of 24 months from the enrollment were eligible. Patients consenting to participate the substudy will have quality of life questionnaires and in-depth qualitative interviews conducted. The substudy will include both qualitative and quantitative design aspects to evaluate the psychological outcomes as assessed via patients' emotional experience during and after stopping nilotinib therapy. Randomization is hypothesized to be a timepoint of higher psychological alert or distress when compared to consolidation and additionally any improvement in health-related quality of life (HRQoL) due to nilotinib treatment is expected across the timepoints (from consolidation, to randomization, and TFR). An association is also expected between dysfunctional coping strategies, such as detachments and certain personality traits, and psychological distress and HRQoL impairments. Better HRQoL outcomes are expected in TFR compared to the end of consolidation. This substudy is designed for in-depth assessment of all potential psycho-emotional variables and aims to determine the need for personalized patient care and counselling, and also guide clinicians to consider the psychological well-being of patients who are considering treatment termination. NCT number: NCT01743989, EudraCT number: 2012-005124-15.
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Affiliation(s)
- Lidia Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianantonio Rosti
- Department of Hematology-Oncology, L. and A. Seràgnoli, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Massimo Breccia
- Department of Translational and Precision Medicine, University Sapienza Rome - Azienda Policlinico Umberto I, Rome, Italy
| | - Eros Di Bona
- Department of Hematology, Vicenza Hospital, Vicenza, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaetano La Barba
- Department of Hematology, Spirito Santo Hospital, Pescara, Italy
| | - Paolo Sportoletti
- Institute of Hematology-Centro di Ricerche Emato-Oncologiche, Department of Medicine, University of Perugia, Perugia, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation, Hematology Section, University of Bari, Bari, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Flavia Rivellini
- Hematology Unit, Nocera Inferiore Hospital, Nocera Inferiore, Italy
| | - Giovanna Rege Cambrin
- Division of Hematology and Internal Medicine, San Luigi Gonzaga University Hospital, Orbassano, University of Turin, Turin, Italy
| | | | - Antonio Cuneo
- Institute of Hematology, University of Ferrara, Ferrara, Italy
| | | | - Simona Sica
- Fondazione Policlinico Universitario Agostino Gemelli – IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Arcaini
- Department of Hematology Oncology, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | | | - Claudia Minotto
- Department of Oncology and Hematology, Aulss 3 Serenissima, Venice, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Monica Crugnola
- Division of Hematology and BMT Center AOU Parma, Parma, Italy
| | | | - Sharon Supekar
- Oncology Region Europe, Novartis Farma SpA, Origgio, Italy
| | - Chiara Elena
- Department of Hematology Oncology, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - Michele Baccarani
- Department of Hematology and Oncology “L. and A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
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8
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Abruzzese E, Mauro M, Apperley J, Chelysheva E. Tyrosine kinase inhibitors and pregnancy in chronic myeloid leukemia: opinion, evidence, and recommendations. Ther Adv Hematol 2020; 11:2040620720966120. [PMID: 33194164 PMCID: PMC7607785 DOI: 10.1177/2040620720966120] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
With survival expectation that of age-matched controls and given excellent response and worldwide access to tyrosine kinase inhibitors (TKI), family planning is increasingly important for a considerable fraction of patients with chronic myeloid leukemia (CML). The potential for therapy discontinuation ("treatment free remission") can afford the opportunity for a CML patient in deep response to plan and carry a pregnancy to full term without any therapeutic interventions. However, the reality of pregnancy desired or occurring when patients are not eligible for treatment-free remission raises the discussion of therapy choices during pregnancy. To date there are no official guidelines available to assist patients and clinicians with these decisions. This first position paper aims to analyze information published and presented surrounding this challenging area, with focus on different scenarios of disease burden and time from CML diagnosis, including CML discovered during pregnancy and pregnancy during CML treatment. An updated review, supported by data and presented together with authors' joint recommendations, is aimed to counsel the practical management of CML patients and pregnancy.
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Affiliation(s)
- Elisabetta Abruzzese
- S. Eugenio Hospital, Tor Vergata University, Piazzale dell’Umanesimo 10, Roma, Roma 00144, Italy
| | - Michael Mauro
- Memorial Sloan-Kettering Cancer Center, New York, USA
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9
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Molica M, Noguera NI, Trawinska MM, Martinelli G, Cerchione C, Abruzzese E. Treatment free remission in chronic myeloid leukemia: Lights and shadows. Hematol Rep 2020; 12:8950. [PMID: 33042501 PMCID: PMC7520857 DOI: 10.4081/hr.2020.8950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 01/03/2023] Open
Abstract
In addition to the best possible overall survival, discontinuation of the tyrosine kinase-inhibitor (TKI) treatment [treatment free remission (TFR)] without observing a recurrence of the disease has become a standard part of chronic myeloid leukemia (CML) care. Worldwide, more than 2000 patients with CML have attempted TFR, and very rare instances of disease transformation have been reported. Several studies in the last decade have demonstrated the feasibility and safety of TKI discontinuation in selected patients with CML who achieve deep and sustained molecular response with TKI. This has moved prime-time into clinical practice although open questions remain in terms of understanding the disease biology that leads to successful TKI cessation in some patients while not in others. Despite the remaining questions regarding which factors may be considered predictive for TFR, treatment interruption is a safe option provided that adequate molecular monitoring is available, with prompt re-initiation of TKIs as soon as major molecular response has been lost. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation, frequency of a safe monitoring, optimal strategies to sustain ongoing TFR and increase the number of patients who can access to discontinuation programs.
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Affiliation(s)
| | - Nelida I Noguera
- Department of Biomedicine and Prevention, Tor Vergata University of Rome
| | | | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
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10
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Morimoto A, Kudo K. Hematopoietic stem cell transplantation for Langerhans cell histiocytosis: clinical findings and long-term outcomes. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1778462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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11
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Annunziata M, Bonifacio M, Breccia M, Castagnetti F, Gozzini A, Iurlo A, Pregno P, Stagno F, Specchia G. Current Strategies and Future Directions to Achieve Deep Molecular Response and Treatment-Free Remission in Chronic Myeloid Leukemia. Front Oncol 2020; 10:883. [PMID: 32582549 PMCID: PMC7280484 DOI: 10.3389/fonc.2020.00883] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/05/2020] [Indexed: 12/21/2022] Open
Abstract
The treatment of chronic myeloid leukemia (CML) has been radically changed by the approval of tyrosine kinase inhibitors (TKIs), which target BCR-ABL1 kinase activity. CML is now managed as a chronic disease requiring long-term treatment and close molecular monitoring. It has been shown that in a substantial number of patients who have achieved a stable deep molecular response (DMR), TKI treatment can be safely discontinued without loss of response. Therefore, treatment-free remission (TFR), through the achievement of a DMR, is increasingly regarded as a feasible treatment goal in many CML patients. However, only nilotinib has approval in this setting and a number of controversial aspects remain regarding treatment choices and timings, predictive factors, patient communication, and optimal strategies to achieve successful TFR. This narrative review aims to provide a comprehensive overview on how to optimize the path to DMR and TFR in patients with CML, and discusses recent data and future directions.
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Affiliation(s)
| | | | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology “L. and A. Seràgnoli”, “S. Orsola-Malpighi” Univeristy Hospital, University of Bologna, Bologna, Italy
| | - Antonella Gozzini
- Department of Cellular Therapy and Transfusional Medicine, AUO Careggi, Florence, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Pregno
- Hematology Division, Oncology and Hematology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico—V. Emanuele, Catania, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Bari, Italy
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12
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Yamazaki K, Inagaki N, Moldaver D, Viana R, Kimura S. Budget impact analysis of treatment-free remission in nilotinib-treated Japanese chronic myeloid leukemia patients. Cancer Sci 2020; 111:2526-2535. [PMID: 32324296 PMCID: PMC7385357 DOI: 10.1111/cas.14430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 01/05/2023] Open
Abstract
Treatment‐free remission (TFR), in which patients discontinue pharmacotherapy and remain in molecular remission, is an emerging treatment goal for patients with chronic myeloid leukemia (CML). Attainment of TFR requires an increased frequency of molecular monitoring, to ensure that patients maintain a deep molecular response. The objective of this analysis was to assess the economic impact of stopping nilotinib among Japanese TFR‐eligible patients. A Markov model evaluated the economic impact of TFR among the study population, TFR‐eligible CML patients diagnosed since 2012. The model compared patients who had discontinued tyrosine kinase inhibitor (TKI) treatment (ie, attempted TFR) with patients that continued TKI treatment. A 3‐y time horizon was modeled from a Japanese public payer perspective. Costs associated with drug treatment, hospital/physician visits, and molecular monitoring were considered. TFR‐eligible patients were calculated from Japanese CML incidence rates and efficacy was derived from nilotinib trials. Japanese co‐payment maximums were utilized to assess the patient perspective. An estimated 761 and 140 patients were eligible for first‐ and second‐line nilotinib, respectively, in 2019. Assuming that 100% of eligible patients complied, TFR was associated with cost savings of ¥7 625 174 640 (US$66 567 775) over 3 y. In scenarios with reduced willingness to attempt TFR, cost savings persisted. Achievement of TFR was estimated to markedly reduce out‐of‐pocket expenses for CML patients, regardless of the timing of relapse. Stopping nilotinib for TFR‐eligible patients in Japan may result in significant cost savings to both payers and patients. Monitoring costs contributed little to overall annual costs and decreased over time.
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Affiliation(s)
| | | | | | | | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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13
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Herrmann AB, Müller ML, Orth MF, Müller JP, Zernecke A, Hochhaus A, Ernst T, Butt E, Frietsch JJ. Knockout of LASP1 in CXCR4 expressing CML cells promotes cell persistence, proliferation and TKI resistance. J Cell Mol Med 2020; 24:2942-2955. [PMID: 31957290 PMCID: PMC7077607 DOI: 10.1111/jcmm.14910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/30/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic myeloid leukaemia (CML) is a clonal myeloproliferative stem cell disorder characterized by the constitutively active BCR-ABL tyrosine kinase. The LIM and SH3 domain protein 1 (LASP1) has recently been identified as a novel BCR-ABL substrate and is associated with proliferation, migration, tumorigenesis and chemoresistance in several cancers. Furthermore, LASP1 was shown to bind to the chemokine receptor 4 (CXCR4), thought to be involved in mechanisms of relapse. In order to identify potential LASP1-mediated pathways and related factors that may help to further eradicate minimal residual disease (MRD), the effect of LASP1 on processes involved in progression and maintenance of CML was investigated. The present data indicate that not only overexpression of CXCR4, but also knockout of LASP1 contributes to proliferation, reduced apoptosis and migration as well as increased adhesive potential of K562 CML cells. Furthermore, LASP1 depletion in K562 CML cells leads to decreased cytokine release and reduced NK cell-mediated cytotoxicity towards CML cells. Taken together, these results indicate that in CML, reduced levels of LASP1 alone and in combination with high CXCR4 expression may contribute to TKI resistance.
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Affiliation(s)
- Andreas B Herrmann
- Institut für Experimentelle Biomedizin II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Martha-Lena Müller
- Rudolf-Virchow-Zentrum für Experimentelle Biomedizin I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Martin F Orth
- Labor für Pädiatrische Sarkombiologie, Medizinische Fakultät, Pathologisches Institut, LMU München, München, Germany
| | - Jörg P Müller
- Center for Molecular Biomedicine, Institut für Molekulare Zellbiologie, Universitätsklinikum Jena, Jena, Germany
| | - Alma Zernecke
- Institut für Experimentelle Biomedizin II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Hochhaus
- Abteilung für Hämatologie und internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Ernst
- Abteilung für Hämatologie und internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Elke Butt
- Institut für Experimentelle Biomedizin II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jochen J Frietsch
- Abteilung für Hämatologie und internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
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14
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Petrova A, Chelysheva E, Shukhov O, Bykova A, Nemchenko I, Gusarova G, Tsyba N, Julhakyan H, Shuvaev V, Fominykh M, Martynkevich I, Ionova T, Turkina A. Withdrawal Syndrome After Tyrosine Kinase Inhibitor Discontinuation in Patients With Chronic Myeloid Leukemia in the Russian Prospective Study RU-SKI. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:267-271. [PMID: 32146103 DOI: 10.1016/j.clml.2019.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/26/2019] [Accepted: 12/30/2019] [Indexed: 01/01/2023]
Abstract
We aimed to characterize withdrawal syndrome (WS) and evaluate factors associated with its development in the prospective clinical study RU-SKI in patients with chronic myeloid leukemia with deep molecular response who discontinued tyrosine kinase inhibitor (TKI) therapy. In total, 98 adult patients with chronic myeloid leukemia chronic phase, TKI therapy ≥ 3 years, and deep molecular response (BCR-ABL ≤ 0.01%) ≥ 2 years were enrolled and observed without treatment. WS was defined as newly observed or worsening musculoskeletal pain after TKI cessation. WS symptoms were found in 41 (42%) of 98 patients with a median time of observation of 25 months (range, 12-42 months). WS grades 1 to 2 and grade 3 were observed in 39 (95%) and in 2 (5%) patients, respectively. The median duration of WS was 5 months (range, 1-25 months). WS was resolved in 37 (90%) patients. Anti-inflammatory therapy was used in 21 (51%) patients. Older age (P = .039) and longer TKI therapy (P = .001) were associated with WS. The 2-month landmark analysis found no association of WS development and the rate of molecular relapses. In total, 42% of the patients experienced WS after TKI therapy discontinuation in the RU-SKI study. Physicians should be warned about the possibility of WS development, and patients of older age and with longer TKI treatment need special attention.
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Affiliation(s)
- Anna Petrova
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Ekaterina Chelysheva
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Oleg Shukhov
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Anastasiya Bykova
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Irina Nemchenko
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Galina Gusarova
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Nikolay Tsyba
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
| | - Hunan Julhakyan
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation.
| | - Vasiliy Shuvaev
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint-Petersburg, Russian Federation; City Clinical Hospital n.a. V.V. Veresaev of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Mikhail Fominykh
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint-Petersburg, Russian Federation; Academic Chair of Hospital Therapy, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Irina Martynkevich
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint-Petersburg, Russian Federation
| | - Tatyana Ionova
- Chair of Quality of Life Unit, Saint-Petersburg State University Hospital, Saint Petersburg, Russian Federation; Quality of Life Monitoring Department, Multinational Center for Quality of Life Research, Saint Petersburg, Russian Federation
| | - Anna Turkina
- Scientific and Advisory Department of Chemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russian Federation
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15
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Abstract
PURPOSE OF REVIEW Treatment goals and ambitions have even been upwardly revised since demonstration was made that under certain conditions, treatment-free remission was possible. Herein, we will discuss on how to try tailoring treatment choices to the unique characteristics of each patient. RECENT FINDINGS Since the first-generation ATP-competitive TKI imatinib was made available in the clinic in 2001, second-generation drugs such as dasatinib, nilotinib and bosutinib and the third-generation TKI ponatinib have broadened the therapeutic armamentarium, providing effective salvage against intolerance and different types of resistance, or as frontline options. Management and outcomes of patients with chronic myeloid leukemia have been revolutionized by the discovery, development, and approval of BCR-ABL tyrosine kinase inhibitors (TKIs). Most patients can now expect a near-to normal life expectancy and acceptable quality of life on life-long treatment, providing awareness and avoidance of harmful adverse events, which depend on each TKI safety profile and patient personal background.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Clinical Decision-Making
- Disease Management
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Molecular Targeted Therapy/methods
- Precision Medicine/methods
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Retreatment
- Treatment Outcome
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Affiliation(s)
- Florence Rabian
- Service Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, Avenue Claude Vellefaux, 75010, Paris, France.
| | - Etienne Lengline
- Service d'Hématologie Adultes, Hôpital Saint-Louis, APHP, Paris, France
| | - Delphine Rea
- Service d'Hématologie Adultes, Hôpital Saint-Louis, APHP, Paris, France
- INSERM UMR 1160, Hôpital Saint-Louis, APHP, Paris, France
- France Intergroupe des Leucémies Myéloïdes chroniques (FI-LMC), Institut Bergonié, Bordeaux, France
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16
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Cessation of nilotinib in patients with chronic myelogenous leukemia who have maintained deep molecular responses for 2 years: a multicenter phase 2 trial, stop nilotinib (NILSt). Int J Hematol 2019; 110:675-682. [PMID: 31538327 DOI: 10.1007/s12185-019-02736-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
The aim of this multicenter phase 2 trial, Stop Nilotinib (NILSt), was to examine the safety and efficacy of discontinuation of nilotinib in patients with chronic phase (CP)-chronic myelogenous leukemia (CML). Patients with CP-CML who had achieved molecular response (MR4.5) after initiation of imatinib or nilotinib therapy received consolidation therapy with nilotinib 300-400 mg twice daily for up to 24 months. Patients who maintained MR4.5 at 24 months of consolidation therapy proceeded to discontinuation of nilotinib. The study enrolled 149 patients; 112 patients proceeded to consolidation therapy with nilotinib; 90 patients maintained MR4.5 with consolidation therapy, and 87 proceeded to discontinuation of nilotinib. The treatment-free remission (TFR) (MR4.5) rate at both 1 and 3 years after discontinuation of nilotinib was the same, at 60.9% (90% CI 51.6-69.7). Among 34 patients with molecular relapse, nilotinib was resumed in 33 patients; all of them attained MR4.5. There was no significant association between molecular relapse and age, sex, Sokal score, previous interferon-α exposure, duration of tyrosine kinase inhibitors treatment, or trough concentration of nilotinib. With nilotinib, it might be possible to avoid prognostic factors for TFR that exist with imatinib discontinuation. Cessation of nilotinib after two years of consolidation was safe and feasible.Trial registration UMIN000007141.
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17
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Tarantini F, Anelli L, Ingravallo G, Attolico I, Zagaria A, Russo Rossi A, Lospalluti L, Bufano T, Zanframundo G, Maiorano E, Specchia G, Albano F. Skin lesions in chronic myeloid leukemia patients during dasatinib treatment. Cancer Manag Res 2019; 11:7991-7996. [PMID: 31692557 PMCID: PMC6717053 DOI: 10.2147/cmar.s217872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/26/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose In our work we sought to define the prevalence rates of cutaneous events during dasatinib therapy in chronic myeloid leukemia (CML) patients and to investigate the clinical and pathological characteristics of these reactions. Patients and methods In our institution, 67 CML patients were treated with dasatinib. it was given as first line treatment in 26 (39%) and subsequent treatment in 41 (61%) CML patients. Flow cytometry analysis of peripheral blood and cutaneous biopsy was done on all CML patients with dermatological lesions appearing during dasatinib treatment. Results Among 67 CML patients, 4 (5.9%) showed skin lesions during dasatinib treatment. The cutaneous manifestations were not generalized but mainly located on the back, abdomen, thorax or leg regions. The patients did not show peripheral lymphocytosis at the time when skin lesions appeared. Overall, histological analysis showed that the skin lesions were characterized by a mild perivascular small CD8+ T lymphocytes infiltrate with minimal epidermotropism. Conclusion The unusual T cytotoxic cutaneous infiltrate demonstrated in our CML cases could be the expression of a dasatinib-promoted lymphocyte expansion. However, the heterogeneity of the dermatologic manifestations reported in our CML patients could also be related to unknown factors specific to each CML patient. Our work highlights the finding that skin lesions may be associated with dasatinib treatment and that they should not be confused with viral or bacterial infections but rather interpreted as the clinical expression of lymphocytosis promoted by this TKI.
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Affiliation(s)
- Francesco Tarantini
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Luisa Anelli
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Immacolata Attolico
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Antonella Zagaria
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Antonella Russo Rossi
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Lospalluti
- Department of Biomedical Sciences and Clinical Oncology, Dermatology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Tamara Bufano
- Department of Biomedical Sciences and Clinical Oncology, Dermatology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Zanframundo
- Department of Biomedical Sciences and Clinical Oncology, Dermatology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Eugenio Maiorano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Giorgina Specchia
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari, Italy
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18
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Sakurai M, Kikuchi T, Karigane D, Kasahara H, Matsuki E, Hashida R, Yamane Y, Abe R, Koda Y, Toyama T, Kato J, Shimizu T, Yokoyama Y, Suzuki S, Nakamura T, Okamoto S, Mori T. Renal dysfunction and anemia associated with long-term imatinib treatment in patients with chronic myelogenous leukemia. Int J Hematol 2019; 109:292-298. [PMID: 30680668 DOI: 10.1007/s12185-019-02596-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/28/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022]
Abstract
Knowledge of the toxicity profile of long-term treatment with imatinib is limited. In the present study, we sought to evaluate renal function and hemoglobin levels during long-term imatinib treatment. Eighty-two patients with chronic myelogenous leukemia in chronic phase who had been on imatinib for over 5 years were retrospectively analyzed. The mean estimated glomerular filtration rate (eGFR) was significantly decreased over 5 years (77 ± 17 to 62 ± 14 ml/min/1.73m², P < 0.001). Higher age and lower eGFR value at initiation of imatinib were significantly associated with development of renal dysfunction by multivariate analyses. Mean hemoglobin levels also significantly decreased over the 5-year period (12.9 ± 1.7 to 12.4 ± 1.3 g/dl, P < 0.01). The rate of decrease in eGFR correlated significantly with hemoglobin levels (correlation coefficient = - 0.249, P < 0.05). Serum erythropoietin (EPO) levels did not increase in 16 patients with both renal dysfunction and anemia (median, 31.9 mIU/ml). In patients who participated in a clinical trial of imatinib discontinuation, mean eGFR (50.0 ± 6.5 to 56.0 ± 10.2 ml/min/1.73m², P < 0.05) and hemoglobin levels (12.0 ± 1.7 to 14.0 ± 1.6 g/dl, P < 0.01) improved significantly at 1 year after discontinuation. These findings suggest that long-term imatinib results in a partially reversible continuous decline in renal function and decreased hemoglobin levels.
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Affiliation(s)
- Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Daiki Karigane
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hidenori Kasahara
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eri Matsuki
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Risa Hashida
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yusuke Yamane
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryohei Abe
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuya Koda
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takaaki Toyama
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Kato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuta Yokoyama
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Sayo Suzuki
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Tomonori Nakamura
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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19
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Minami Y. Guest editorial: chronic myeloid leukemia. Int J Hematol 2018; 108:353-354. [PMID: 30155590 DOI: 10.1007/s12185-018-2521-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Yosuke Minami
- Department of Hematology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.
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20
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Cross NCP, White HE, Evans PAS, Hancock J, Copland M, Milojkovic D, Mason J, Craine S, Mead AJ. Consensus on BCR-ABL1 reporting in chronic myeloid leukaemia in the UK. Br J Haematol 2018; 182:777-788. [PMID: 30125955 PMCID: PMC6175193 DOI: 10.1111/bjh.15542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For patients with chronic myeloid leukaemia (CML), treatment guidelines recommend monitoring response to treatment with tyrosine kinase inhibitors (TKIs) by testing the BCR‐ABL1 fusion gene transcript level using reverse transcriptase quantitative polymerase chain reaction. Despite recent efforts to standardise protocols for BCR‐ABL1 testing, some variability remains among laboratories in the UK regarding the techniques used and the approach to reporting results. This increases the risk of misinterpretation of results by both clinicians and patients. An expert panel met to discuss current issues surrounding BCR‐ABL1 testing in the UK and to develop guidance for laboratories, with emphasis on the optimal approach to reporting laboratory results. Topics included the minimum required information to include in the laboratory report, units of measurement, test sensitivity and BCR‐ABL1 transcript variants. To aid communication between laboratories and clinics, standard forms were generated that could be used by (i) clinics when submitting samples to laboratories, and (ii) laboratories when reporting results to clinics. Standardising the way in which BCR‐ABL1 test results are reported from laboratories to clinics should help to improve communication, interpretation of results and patient care.
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Affiliation(s)
- Nicholas C P Cross
- University of Southampton, Southampton, UK.,Salisbury NHS Foundation Trust, Salisbury, UK
| | | | | | - Jeremy Hancock
- Bristol Genetics Laboratory, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dragana Milojkovic
- Hammersmith Hospital - Imperial College Healthcare NHS Trust, London, UK
| | - Joanne Mason
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Adam J Mead
- Oxford NIHR Biomedical Research Centre, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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21
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Mezei G, Debreceni IB, Kerenyi A, Remenyi G, Szasz R, Illes A, Kappelmayer J, Batar P. Dasatinib inhibits coated-platelet generation in patients with chronic myeloid leukemia. Platelets 2018; 30:836-843. [DOI: 10.1080/09537104.2018.1501470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gabriella Mezei
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Ildiko Beke Debreceni
- Clinical Center, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Adrienne Kerenyi
- Clinical Center, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Remenyi
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Robert Szasz
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Arpad Illes
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Janos Kappelmayer
- Clinical Center, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Batar
- Department of Hematology, University of Debrecen, Debrecen, Hungary
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22
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Molecular biology as a tool for the treatment of cancer. Clin Exp Med 2018; 18:457-464. [PMID: 30006681 DOI: 10.1007/s10238-018-0518-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/08/2018] [Indexed: 12/30/2022]
Abstract
Cancer is a genetic disease characterized by uncontrolled cell growth and metastasis. Cancer can have a number of causes, such the activation of oncogenes, the inactivation of tumor-suppressing genes, mutagenesis provoked by external factors, and epigenetic modifications. The development of diagnostic tools and treatments using a molecular biological approach permits the use of sensitive, low-cost, noninvasive tests for cancer patients. Biomarkers can be used to provide rapid, personalized oncology, in particular the molecular diagnosis of chronic myeloid leukemia, and gastric, colon, and breast cancers. Molecular tests based on DNA methylation can also be used to direct treatments or evaluate the toxic effects of chemotherapy. The adequate diagnosis, prognosis, and prediction of the response of cancer patients to treatment are essential to ensure the most effective therapy, reduce the damaging effects of treatment, and direct the therapy to specific targets, and in this context, molecular biology has become increasingly important in oncology. In this brief review, we will demonstrate the fundamental importance of molecular biology for the treatment of three types of cancer-chronic myeloid leukemia, hereditary diffuse gastric cancer, and astrocytomas (sporadic tumors of the central nervous system). In each of these three models, distinct biological mechanisms are involved in the transformation of the cells, but in all cases, molecular biology is fundamental to the development of personalized analyses for each patient and each type of neoplasia, and to guarantee the success of the treatment.
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23
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Takahashi N, Nishiwaki K, Nakaseko C, Aotsuka N, Sano K, Ohwada C, Kuroki J, Kimura H, Tokuhira M, Mitani K, Fujikawa K, Iwase O, Ohishi K, Kimura F, Fukuda T, Tanosaki S, Takahashi S, Kameoka Y, Nishikawa H, Wakita H. Treatment-free remission after two-year consolidation therapy with nilotinib in patients with chronic myeloid leukemia: STAT2 trial in Japan. Haematologica 2018; 103:1835-1842. [PMID: 29976734 PMCID: PMC6278957 DOI: 10.3324/haematol.2018.194894] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
The purpose of this trial was to evaluate the efficacy of 2-year consolidation therapy with nilotinib, at a dose of 300 mg twice daily, for achieving treatment-free remission in chronic myeloid leukemia patients with a deep molecular response (BCR-ABL1IS ≤0.0032%). Successful treatment-free remission was defined as no confirmed loss of deep molecular response. We recruited 96 Japanese patients, of whom 78 sustained a deep molecular response during the consolidation phase and were therefore eligible to discontinue nilotinib in the treatment-free remission phase; of these, 53 patients (67.9%; 95% confidence interval: 56.4–78.1%) remained free from molecular recurrence in the first 12 months. The estimated 3-year treatment-free survival was 62.8%. Nilotinib was readministered to all patients (n=29) who experienced a molecular recurrence during the treatment-free remission phase. After restarting treatment, rapid deep molecular response returned in 25 patients (86.2%), with 50% of patients achieving a deep molecular response within 3.5 months. Tyrosine kinase inhibitor withdrawal syndrome was reported in 11/78 patients during the early treatment-free remission phase. The treatment-free survival curve was significantly better in patients with undetectable molecular residual disease than in patients without (3-year treatment-free survival, 75.6 versus 48.6%, respectively; P=0.0126 by the log-rank test). There were no significant differences in treatment-free survival between subgroups based on tyrosine kinase inhibitor treatment before the nilotinib consolidation phase, tyrosine kinase inhibitor-withdrawal syndrome, or absolute number of natural killer cells. The results of this study indicate that it is safe and feasible to stop tyrosine kinase inhibitor therapy in patients with chronic myeloid leukemia who have achieved a sustained deep molecular response with 2 years of treatment with nilotinib. This study was registered with UMIN-CTR (UMIN000005904).
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Affiliation(s)
- Naoto Takahashi
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
| | - Kaichi Nishiwaki
- Department of Oncology and Hematology, Jikei University Kashiwa Hospital
| | - Chiaki Nakaseko
- Department of Hematology, International University of Health and Welfare School of Medicine, Narita.,Department of Hematology, Chiba University Hospital
| | - Nobuyuki Aotsuka
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital
| | - Koji Sano
- Department of Oncology and Hematology, Jikei University Kashiwa Hospital
| | | | - Jun Kuroki
- Department of Internal Medicine, Yuri General Hospital, Yurihonjo
| | - Hideo Kimura
- Department of Hematology, Northern Fukushima Medical Center, Date
| | - Michihide Tokuhira
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Kinuko Mitani
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi
| | | | - Osamu Iwase
- Department of Hematology, Tokyo Medical University Hachioji Medical Center
| | - Kohshi Ohishi
- Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu
| | - Fumihiko Kimura
- Division of Hematology, National Defense Medical College, Tokorozawa
| | - Tetsuya Fukuda
- Department of Hematology, Tokyo Medical and Dental University Hospital.,Department of Hematology, Tottori University Hospital, Yonago
| | - Sakae Tanosaki
- Department of Hematology, The Fraternity Memorial Hospital, Tokyo
| | - Saori Takahashi
- Clinical Research Promotion and Support Center, Akita University Hospital
| | - Yoshihiro Kameoka
- Clinical Research Promotion and Support Center, Akita University Hospital
| | - Hiroyoshi Nishikawa
- Division of Cancer Immunology, Research Institute / Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Tokyo/Kashiwa
| | - Hisashi Wakita
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital.,Japanese Red Cross Chiba Blood Center, Funabashi, Japan
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24
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Switching to nilotinib is associated with deeper molecular responses in chronic myeloid leukemia chronic phase with major molecular responses to imatinib: STAT1 trial in Japan. Int J Hematol 2018; 108:176-183. [PMID: 29713954 DOI: 10.1007/s12185-018-2459-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
The purpose of this clinical trial was to evaluate the efficacy of 2-year consolidation therapy using nilotinib (NIL) for achieving a molecular response (MR4.5, BCR-ABL1IS ≤ 0.0032% on the International Scale) in patients with chronic myeloid leukemia in the chronic phase (CML-CP) who had achieved a major molecular response (MMR, BCR-ABL1IS ≤ 0.1%) with imatinib (IM). We recruited 76 Japanese patients for this trial. Nilotinib 300 mg, twice daily, was administered for 2 years, and 74 patients were evaluated in the study. The median age was 55.0 years. The median duration of IM treatment was 69.0 months. All patients showed MMR at the time of entry into the study; the median time to MMR on IM therapy was 20.4 months. The proportion of patients who achieved MR4.5 increased over time. The rates of MR4.5 in the 74 evaluable patients were 27.0% [90% confidence interval (CI) (18.7-36.8%)] and 44.6% [90% CI (34.7-54.8%)] at 12 and 24 months, respectively. The frequency of ABCG2 421C/A + A/A was an independent predictive biomarker for achieving a 24-month MR4.5. Switching to NIL led to safer, deeper molecular responses in patients with MMR on long-term IM therapy for future treatment-free remission.
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25
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Turkina AG, Chelysheva EY, Shuvaev VA, Gusarova GA, Bykova AV, Shukhov OA, Petrova AN, Vakhrusheva MV, Goryacheva SR, Kolosova LY, Krasikova PS, Fominykh MS, Martynkevich IS, Abdullaev AO, Sudarikov AB, Savchenko VG. [Results of following up patients with chronic myeloid leukemia and a deep molecular response without tyrosine kinase inhibitor therapy]. TERAPEVT ARKH 2018; 89:86-96. [PMID: 29411766 DOI: 10.17116/terarkh2017891286-96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To assess the results of following up patients with chronic myeloid leukemia (CML) and a deep molecular response (MR) without tyrosine kinase inhibitor (TKI) therapy. SUBJECTS AND METHODS The reasons for TKI discontinuation in 70 patients with CML and a deep MR of more than 1 year's duration were adverse events, pregnancy, and patients' decision. Information was collected retrospectively and prospectively in 2008-2016. RESULTS The median follow-up after TKI therapy discontinuation was 23 months (2 to 100 months). At 6, 12 and 24 months after TKI therapy discontinuation, the cumulative incidence of major MR (MMR) loss was 28, 41 and 48%, respectively; the survival rates without TKI therapy were 69, 50, and 39%, respectively. MMR loss was noted in 28 (88%) patients at 12 months; it was not seen without TKI therapy at 2-year follow-up. Deaths due to CML progression were absent. The Sokal risk group was a reliable factor influencing MMR loss (p ≤ 0.05). The cumulative recovery rate for deep MR after resumption of TKI use was 73 and 100% at 12 and 24 months, respectively, with a median follow-up of 24 months (1 to 116 months). Deep MR recovered at a later time when the therapy was resumed more than 30 days after MMR loss. CONCLUSION Safe follow-up is possible in about 50% of the patients with CML and stable deep MRs without TKI therapy. The introduction of this approach into clinical practice requires regular molecular genetic monitoring and organizational activities. Biological factors in maintaining remission after TKI discontinuation need to be separately studied.
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Affiliation(s)
- A G Turkina
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - E Yu Chelysheva
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V A Shuvaev
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint Petersburg, Russia
| | - G A Gusarova
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A V Bykova
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - O A Shukhov
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A N Petrova
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - M V Vakhrusheva
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S R Goryacheva
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - L Yu Kolosova
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - P S Krasikova
- Orenburg Regional Clinical Hospital, Orenburg, Russia
| | - M S Fominykh
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint Petersburg, Russia
| | - I S Martynkevich
- Russian Research Institute of Hematology and Transfusiology, Federal Biomedical Agency of Russia, Saint Petersburg, Russia
| | - A O Abdullaev
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A B Sudarikov
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V G Savchenko
- National Medical Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
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26
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Rea D, Mahon FX. How I manage relapse of chronic myeloid leukaemia after stopping tyrosine kinase inhibitor therapy. Br J Haematol 2017; 180:24-32. [PMID: 29048128 DOI: 10.1111/bjh.14973] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
During the last 10 years, clinical trials formally demonstrated that about 50% of patients with chronic phase (CP) chronic myeloid leukaemia (CML) who achieve and maintain deep molecular responses for a prolonged period of time during treatment with imatinib or new generation tyrosine kinase inhibitors (TKIs) may successfully stop their anti-leukaemic therapy. Based on the accumulated knowledge from abundant clinical trial experience, TKI discontinuation is becoming an important goal to achieve and is about to enter clinical practice. This review focuses on relapse definition, laboratory tests to identify relapse and relapse management after TKI discontinuation.
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Affiliation(s)
- Delphine Rea
- Service d'hématologie Adulte, Unité INSERM, UMR-1160 and France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France
| | - François-Xavier Mahon
- Unicancer Center, Institut Bergonié and France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Bordeaux, France
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27
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Takahashi N, Tauchi T, Kitamura K, Miyamura K, Saburi Y, Hatta Y, Miyata Y, Kobayashi S, Usuki K, Matsumura I, Minami Y, Usui N, Fukuda T, Takada S, Ishikawa M, Fujimaki K, Gomyo H, Sasaki O, Ohishi K, Miyake T, Imai K, Suzushima H, Mitsui H, Togitani K, Kiguchi T, Atsuta Y, Ohtake S, Ohnishi K, Kobayashi Y, Kiyoi H, Miyazaki Y, Naoe T. Deeper molecular response is a predictive factor for treatment-free remission after imatinib discontinuation in patients with chronic phase chronic myeloid leukemia: the JALSG-STIM213 study. Int J Hematol 2017; 107:185-193. [PMID: 28929332 DOI: 10.1007/s12185-017-2334-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
The objective of this prospective clinical trial (JALSG-STIM213, UMIN000011971) was to evaluate treatment-free remission (TFR) rates after discontinuation of imatinib in chronic myeloid leukemia (CML). CML patients who received imatinib treatment for at least 3 years and sustained deep molecular response for at least 2 years were eligible. Molecular recurrence was defined as loss of major molecular response (MMR). Of the 68 eligible patients, 38.2% were women, the median age was 55.0 years, and the median duration of imatinib treatment was 97.5 months. The 12-month TFR rate was 67.6%. Patients who lost MMR were immediately treated with imatinib again; all re-achieved MMR. Three-year treatment-free survival (TFS) was estimated as 64.6% using the Kaplan-Meier method. Undetectable molecular residual disease (UMRD) was defined as no BCR-ABL1 in > 100,000 ABL1 control genes using international scale polymerase chain reaction. UMRD at the study baseline was found to be predictive of continuation of TFR. Our findings suggest that CML patients who meet all the eligibility criteria that have commonly been used in the TFR trials are able to discontinue imatinib use safely. TFR may thus be valuable as a new goal for CML treatment in Japan.
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Affiliation(s)
- Naoto Takahashi
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
| | - Tetsuzo Tauchi
- Department of Hematology, Tokyo Medical University, Tokyo Medical University, Tokyo, Japan
| | - Kunio Kitamura
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yoshio Saburi
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
| | - Yoshihiro Hatta
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuhiko Miyata
- National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Shinichi Kobayashi
- Division of Hematology, National Defense Medical College, Tokorozawa, Japan
| | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Yosuke Minami
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Noriko Usui
- Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Fukuda
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Takada
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Maho Ishikawa
- Department of Hematology, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Hiroshi Gomyo
- Department of Hematology, Hyogo Cancer Center, Akashi, Japan
| | - Osamu Sasaki
- Department of Hematology, Miyagi Cancer Center, Natori, Japan
| | - Kohshi Ohishi
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Takaaki Miyake
- Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan
| | - Kiyotoshi Imai
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Hitoshi Suzushima
- Department of Hematology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Hideki Mitsui
- Department of Hematology, Otemae Hospital, Osaka, Japan
| | - Kazuto Togitani
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi, Japan
| | - Toru Kiguchi
- Department of Hematology, Chugoku Central Hospital, Fukuyama, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | | | | | - Yukio Kobayashi
- Hematology Division, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Tomoki Naoe
- National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
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