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Sedeta E, Jemal A, Nisotel L, Sung H. Survival difference between secondary and de novo acute myeloid leukemia by age, antecedent cancer types, and chemotherapy receipt. Cancer 2024; 130:1952-1963. [PMID: 38244208 DOI: 10.1002/cncr.35214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/13/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND This study compared the survival of persons with secondary acute myeloid leukemia (sAML) to those with de novo AML (dnAML) by age at AML diagnosis, chemotherapy receipt, and cancer type preceding sAML diagnosis. METHODS Data from Surveillance, Epidemiology, and End Results 17 Registries were used, which included 47,704 individuals diagnosed with AML between 2001 and 2018. Multivariable Cox proportional hazards regression was used to compare AML-specific survival between sAML and dnAML. Trends in 5-year age-standardized relative survival were examined via the Joinpoint survival model. RESULTS Overall, individuals with sAML had an 8% higher risk of dying from AML (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.05-1.11) compared to those with dnAML. Disparities widened with younger age at diagnosis, particularly in those who received chemotherapy for AML (HR, 1.14; 95% CI, 1.10-1.19). In persons aged 20-64 years and who received chemotherapy, HRs were greatest for those with antecedent myelodysplastic syndrome (HR, 2.04; 95% CI, 1.83-2.28), ovarian cancer (HR, 1.91; 95% CI, 1.19-3.08), head and neck cancer (HR, 1.55; 95% CI, 1.02-2.36), leukemia (HR, 1.45; 95% CI, 1.12-1.89), and non-Hodgkin lymphoma (HR, 1.42; 95% CI, 1.20-1.69). Among those aged ≥65 years and who received chemotherapy, HRs were highest for those with antecedent cervical cancer (HR, 2.42; 95% CI, 1.15-5.10) and myelodysplastic syndrome (HR, 1.28; 95% CI, 1.19-1.38). The 5-year relative survival improved 0.3% per year for sAML slower than 0.86% per year for dnAML. Consequently, the survival gap widened from 7.2% (95% CI, 5.4%-9.0%) during the period 2001-2003 to 14.3% (95% CI, 12.8%-15.8%) during the period 2012-2014. CONCLUSIONS Significant survival disparities exist between sAML and dnAML on the basis of age at diagnosis, chemotherapy receipt, and antecedent cancer, which highlights opportunities to improve outcomes among those diagnosed with sAML.
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MESH Headings
- Humans
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Middle Aged
- Female
- Male
- Adult
- Aged
- SEER Program
- Young Adult
- Age Factors
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/epidemiology
- Aged, 80 and over
- Adolescent
- Proportional Hazards Models
- United States/epidemiology
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/epidemiology
- Neoplasms/mortality
- Neoplasms/drug therapy
- Neoplasms/epidemiology
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Affiliation(s)
- Ephrem Sedeta
- Brookdale University Hospital Medical Center, Brooklyn, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Lauren Nisotel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Song M, Zhang T, Yang D, Xiao H, Wang H, Ye Q, Zhai Z. Chromosomal aberrations and prognostic analysis of secondary acute myeloid leukemia-a retrospective study. PeerJ 2023; 11:e15333. [PMID: 37214104 PMCID: PMC10194067 DOI: 10.7717/peerj.15333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Secondary acute myeloid leukemia (S-AML) patients generally have a poor prognosis, but the chromosomal aberrations of S-AML have been rarely reported. We aimed to explore the chromosomal aberrations and clinical significance in patients with S-AML. Patients and methods The clinical characteristics and karyotypes of 26 patients with S-AML were retrospectively analyzed. The overall survival (OS) was measured from the time of the patients' transition to AML (i.e., at S-AML diagnosis). Results The study included 26 S-AML patients (13 males and 13 females), with a median age of 63 years (range, 20-77 years). They transformed from various hematologic malignancies or solid tumors; most of them were secondary to myelodysplastic syndrome (MDS). About 62% of the S-AML patients showed chromosomal aberrations. The serum lactate dehydrogenase (LDH) level in S-AML patients with abnormal karyotype was higher than those with normal karyotype. Apart from the differences in treatment regimens, S-AML patients with chromosomal aberrations had shorter OS (P < 0.05). Conclusion S-AML patients with abnormal karyotype have higher LDH levels and shorter OS than normal karyotype patients, and the OS of hypodiploidy was much shorter than hyperdiploid.
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Affiliation(s)
- Mingzhu Song
- Transfusion, The Affiliated Hospital of Anhui Medical University (Lu’an People’s Hospital), lu’an, Anhui Province, China
- Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, China
| | - Tun Zhang
- Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, Hefei, Anhui Province, China
| | - Dongdong Yang
- Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, Hefei, Anhui Province, China
| | - Hao Xiao
- Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, Hefei, Anhui Province, China
| | - Huiping Wang
- Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, Hefei, Anhui Province, China
| | - Qianling Ye
- Oncology, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, Shanghai, China
| | - Zhimin Zhai
- Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, Hefei, Anhui Province, China
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Atsou KM, Rachet B, Cornet E, Chretien M, Rossi C, Remontet L, Roche L, Giorgi R, Gauthier S, Girard S, Böckle J, Wasse SK, Rachou H, Bouzid L, Poncet J, Orazio S, Monnereau A, Troussard X, Mounier M, Maynadie M. Factors influencing access to specialised haematology units during acute myeloblastic leukaemia patient care: A population-based study in France. Cancer Med 2023; 12:8911-8923. [PMID: 36710405 PMCID: PMC10134294 DOI: 10.1002/cam4.5645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/23/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The excess mortality observed in Acute Myeloblastic Leukaemia (AML) patients, partly attributed to unequal access to curative treatments, could be linked to care pathways. METHODS We included 1039 AML incident cases diagnosed between 2012-2016 from the 3 French blood cancer registries (3,625,400 inhabitants). We describe patients according to age, the medical entry unit and access to the specialised haematology unit (SHU) during follow-up. Multivariate logistic regression model was done to determine the association between covariables and access to SHU. A total of 713 patients (69%) had access to SHU during care. RESULTS The most common care pathway concerned referral from the general practitioner to SHU, n = 459(44%). The univariate analysis observed a downward trend for the most deprived patients. Patients who consulted in SHU were younger (66 years vs. 83, p < 0.001), and 92% had access to cytogenetic analysis (vs. 54%, p < 0.001). They also had less poor prognosis AML-subtypes (AML-MRC, t-AML/MDS and AML-NOS) (38% vs. 69%); 77% with de novo AML (vs. 67%, p < 0.003)], more favourable cytogenetic prognostic status (23% vs. 6%, p < 0.001), less comorbidities (no comorbidity = 55% vs. 34%, p < 0.001) and treatments proposed were curative 68% (vs. 5.3%, p < 0.001). Factors limiting access to SHU were age over 80 years (OR, 0.14; 95% CI, 0.04-0.38), severe comorbidities (OR, 0.39; 95% CI, 0.21-0.69), emergency unit referral (OR, 0.28; 95% CI, 0.18-0.44) and non-SHU referral (OR, 0.12; 95% CI, 0.07-0.18). Consultation in an academic hospital increased access to SHU by 8.87 times (95% CI, 5.64-14.2). CONCLUSION The high proportion of access to cytogenetic testing and curative treatment among patients admitted to SHU, and the importance of early treatment in AML underlines the importance of access to SHU for both diagnosis and treatment.
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Affiliation(s)
- Kueshivi Midodji Atsou
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non‐communicable Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Edouard Cornet
- Registre régional des hémopathies malignes de Basse‐NormandieCHU Caen‐NormandieCaenFrance
| | - Marie‐Lorraine Chretien
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
- CHU Dijon BourgogneService d'Hématologie CliniqueDijonFrance
| | - Cédric Rossi
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
- CHU Dijon BourgogneService d'Hématologie CliniqueDijonFrance
| | - Laurent Remontet
- Pôle Santé Publique, Service de Biostatistique ‐ Bio‐informatiqueHospices Civils de LyonLyonFrance
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique‐SantéUniversité de Lyon, Université Lyon 1, CNRSVilleurbanneFrance
| | - Laurent Roche
- Pôle Santé Publique, Service de Biostatistique ‐ Bio‐informatiqueHospices Civils de LyonLyonFrance
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique‐SantéUniversité de Lyon, Université Lyon 1, CNRSVilleurbanneFrance
| | - Roch Giorgi
- SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la, CommunicationAix Marseille Univ, APHM, INSERM, IRDMarseilleFrance
| | - Sophie Gauthier
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
| | - Stéphanie Girard
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
| | - Johann Böckle
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
| | - Stéphane Kroudia Wasse
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
| | - Helene Rachou
- Registre des Hémopathies Malignes de GirondeInstitut BergoniéBordeauxFrance
- EPICENE Team, Inserm U1219, Bordeaux Population HealthUniversity of BordeauxBordeauxFrance
| | - Laila Bouzid
- Registre des Hémopathies Malignes de GirondeInstitut BergoniéBordeauxFrance
- EPICENE Team, Inserm U1219, Bordeaux Population HealthUniversity of BordeauxBordeauxFrance
| | - Jean‐Marc Poncet
- Registre régional des hémopathies malignes de Basse‐NormandieCHU Caen‐NormandieCaenFrance
| | - Sébastien Orazio
- Registre des Hémopathies Malignes de GirondeInstitut BergoniéBordeauxFrance
- EPICENE Team, Inserm U1219, Bordeaux Population HealthUniversity of BordeauxBordeauxFrance
| | - Alain Monnereau
- Registre des Hémopathies Malignes de GirondeInstitut BergoniéBordeauxFrance
- EPICENE Team, Inserm U1219, Bordeaux Population HealthUniversity of BordeauxBordeauxFrance
| | - Xavier Troussard
- Registre régional des hémopathies malignes de Basse‐NormandieCHU Caen‐NormandieCaenFrance
| | - Morgane Mounier
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
| | - Marc Maynadie
- Registre des Hémopathies Malignes de la Côte‐d'OrCHU de Dijon BourgogneDijonFrance
- UMR INSERM 1231Université Bourgogne Franche‐ComtéDijonFrance
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Association Between Granulocyte Colony-Stimulating Factor (G-CSF) Use and Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML) Among Elderly Patients with Breast, Lung, or Prostate Cancer. Adv Ther 2022; 39:2778-2795. [PMID: 35430673 DOI: 10.1007/s12325-022-02141-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/17/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Patients diagnosed with cancer have an increased risk both for myelodysplastic syndromes (MDS) and for acute myeloid leukemia (AML) following treatment. METHODS Using SEER-Medicare data, we selected patients aged 66 years and older who completed systemic therapy between 2002 and 2014 for breast (stage I-III), lung (stage I-III), or prostate (stage I-IV) cancer. For each cancer, we estimated the risk of a composite endpoint of MDS or AML in patients receiving granulocyte colony-stimulating factor (G-CSF) vs. not. RESULTS The 10-year cumulative risk difference (granulocyte colony-stimulating factor [G-CSF] - no G-CSF) for MDS-AML was 0.45% (95% CI 0.13-0.77%) in breast cancer and 0.39% (95% CI 0.15-0.62%) in lung cancer. G-CSF use was associated with a hazard ratio of 1.60 (95% CI 1.07-2.40) in breast cancer and 1.50 (95% CI 0.99-2.29) in lung cancer. Filgrastim use was associated with a hazard ratio of 1.01 (95% CI 1.00-1.03) per administration in breast cancer and 1.02 (95% CI 0.99-1.05) per administration in lung cancer. Pegfilgrastim was associated with a hazard ratio of 1.08 (95% CI 1.01-1.15) per administration in breast cancer and 1.12 (95% CI 1.00-1.25) per administration in lung cancer. Analyses in prostate cancer were limited because of the low number of events. CONCLUSIONS The use of G-CSF in patients diagnosed with breast and lung cancer is associated with an increased risk of MDS-AML. However, the MDS-AML absolute risk difference is very low.
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Solana-Altabella A, Megías-Vericat JE, Ballesta-López O, Boluda B, Cano I, Acuña-Cruz E, Rodríguez-Veiga R, Torres-Miñana L, Sargas C, Sanz MÁ, Borrell-García C, López-Briz E, Poveda-Andrés JL, De la Rubia J, Montesinos P, Martínez-Cuadrón D. Healthcare Resource Utilization among Patients between 60-75 Years with Secondary Acute Myeloid Leukemia Receiving Intensive Chemotherapy Induction: A Spanish Retrospective Observational Study. Cancers (Basel) 2022; 14:cancers14081921. [PMID: 35454828 PMCID: PMC9032151 DOI: 10.3390/cancers14081921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Studies addressing the economic costs and burden of secondary acute myeloid leukemia (sAML) are scarce in the literature. We analyzed this topic in a real-life population of sAML patients between 60–75 years receiving intensive chemotherapy induction. In elderly patients with sAML and intensive regimens, it entails an increase in costs and a longer hospital stay. In these specific patients, almost a third of the time is spent hospitalized after the diagnosis of sAML. There are no studies with this type of population and diagnosis, which gives added value to the results obtained. Pharmacoeconomic studies in patients with AML are being carried out due to the need to evaluate the cost-effectiveness of new oral drugs, therapeutic schemes with higher costs than previous treatments. Abstract Background: Information regarding the impact on healthcare systems of secondary acute myeloid leukemia (sAML) is scarce. Methods: A retrospective review of medical charts identified patients aged 60–75 years with sAML between 2010 and 2019. Patient information was collected from diagnosis to death or last follow-up. Outpatient resource use, reimbursement, frequency and duration of hospitalization, and transfusion burden were assessed. Forty-six patients with a median age of 64 years were included. Anthracycline plus cytarabine regimens were the most common induction treatment (39 patients, 85%). The ratio of the total days hospitalized between the total follow-up was 29%, with a sum of 204 hospitalizations (average four/patient; average duration 21 days). The total average reimbursement was EUR 90,008 per patient, with the majority (EUR 77,827) related to hospital admissions (EUR 17,403/hospitalization). Most hospitalizations (163, mean 22 days) occurred in the period before the first allogeneic hematopoietic stem cell transplant (alloHSCT), costing EUR 59,698 per patient and EUR 15,857 per hospitalization. The period after alloHSCT (in only 10 patients) had 41 hospitalizations (mean 21 days), and a mean reimbursement cost of EUR 99,542 per patient and EUR 24,278 per hospitalization. In conclusion, there is a high consumption of economic and healthcare resources in elderly patients with sAML receiving active treatments in Spain.
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Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Juan Eduardo Megías-Vericat
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
| | - Blanca Boluda
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Isabel Cano
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Evelyn Acuña-Cruz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Laura Torres-Miñana
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Claudia Sargas
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Miguel Á. Sanz
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Carmela Borrell-García
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Eduardo López-Briz
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - José Luis Poveda-Andrés
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.-A.); (J.E.M.-V.); (O.B.-L.); (C.B.-G.); (E.L.-B.); (J.L.P.-A.)
| | - Javier De la Rubia
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- School of Medicine and Dentistry, Catholic University of Valencia, 46010 Valencia, Spain
| | - Pau Montesinos
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology and Hemotherapy, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (B.B.); (I.C.); (E.A.-C.); (R.R.-V.); (L.T.-M.); (C.S.); (M.Á.S.); (J.D.l.R.); (P.M.)
- Hematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-96-1244000 (ext. 4119661)
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Short NJ, Venugopal S, Qiao W, Kadia TM, Ravandi F, Macaron W, Dinardo CD, Daver N, Konopleva M, Borthakur G, Shpall EJ, Popat U, Champlin RE, Mehta R, Al-Atrash G, Oran B, Jabbour E, Garcia-Manero G, Issa GC, Montalban-Bravo G, Yilmaz M, Maiti A, Kantarjian H. Impact of frontline treatment approach on outcomes in patients with secondary AML with prior hypomethylating agent exposure. J Hematol Oncol 2022; 15:12. [PMID: 35093134 PMCID: PMC8800349 DOI: 10.1186/s13045-022-01229-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/19/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Treated secondary acute myeloid leukemia (ts-AML)-i.e., AML arising from a previously treated antecedent hematologic disorder-is associated with very poor outcomes. The optimal frontline treatment regimen for these patients is uncertain. METHODS We retrospectively analyzed 562 patients who developed AML from preceding myelodysplastic syndrome or chronic myelomonocytic leukemia for which they had received a hypomethylating agent (HMA). Patients with ts-AML were stratified by frontline AML treatment with intensive chemotherapy (IC, n = 271), low-intensity therapy (LIT) without venetoclax (n = 237), or HMA plus venetoclax (n = 54). RESULTS Compared with IC or LIT without venetoclax, HMA plus venetoclax resulted in higher CR/CRi rates (39% and 25%, respectively; P = 0.02) and superior OS (1-year OS 34% and 17%, respectively; P = 0.05). The benefit of HMA plus venetoclax was restricted to patients with non-adverse risk karyotype, where HMA plus venetoclax resulted in a median OS of 13.7 months and 1-year OS rate of 54%; in contrast, for patients with adverse risk karyotype, OS was similarly dismal regardless of treatment approach (median OS 3-5 months). A propensity score analysis accounting for relevant clinical variables confirmed the significant OS benefit of HMA plus venetoclax, as compared with other frontline treatment approaches. In a landmark analysis, patients with ts-AML who underwent subsequent hematopoietic stem cell transplantation (HSCT) had superior 3-year OS compared to non-transplanted patients (33% vs. 8%, respectively; P = 0.003). CONCLUSIONS The outcomes of ts-AML are poor but may be improved with use of an HMA plus venetoclax-based regimen, followed by HSCT, particularly in those with a non-adverse risk karyotype.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/drug therapy
- Male
- Middle Aged
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/drug therapy
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/therapy
- Retrospective Studies
- Sulfonamides/therapeutic use
- Young Adult
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Affiliation(s)
- Nicholas J Short
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Sangeetha Venugopal
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan M Kadia
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Farhad Ravandi
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Walid Macaron
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Courtney D Dinardo
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Naval Daver
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Marina Konopleva
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Gautam Borthakur
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gheath Al-Atrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Ghayas C Issa
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Guillermo Montalban-Bravo
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Musa Yilmaz
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Abhishek Maiti
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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7
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Treatment patterns and outcomes of 2310 patients with secondary acute myeloid leukemia: a PETHEMA registry study. Blood Adv 2021; 6:1278-1295. [PMID: 34794172 PMCID: PMC8864639 DOI: 10.1182/bloodadvances.2021005335] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022] Open
Abstract
The large PETHEMA registry shows that secondary AML represents 27% of AML cases and confirms its independent adverse prognostic value. Subcategories of secondary AML were analyzed, including MSD/MPN and therapy-related cases, with different features and outcomes.
Secondary acute myeloid leukemia (sAML) comprises a heterogeneous group of patients and is associated with poor overall survival (OS). We analyze the characteristics, treatment patterns, and outcomes of adult patients with sAML in the Programa Español de Tratamientos en Hematología (PETHEMA) registry. Overall, 6211 (72.9%) were de novo and 2310 (27.1%) had sAML, divided into myelodysplastic syndrome AML (MDS-AML, 44%), MDS/myeloproliferative AML (MDS/MPN-AML, 10%), MPN-AML (11%), therapy-related AML (t-AML, 25%), and antecedent neoplasia without prior chemotherapy/radiotherapy (neo-AML, 9%). Compared with de novo, patients with sAML were older (median age, 69 years), had more Eastern Cooperative Oncology Group ≥2 (35%) or high-risk cytogenetics (40%), less FMS-like tyrosine kinase 3 internal tandem duplication (11%), and nucleophosmin 1 (NPM1) mutations (21%) and received less intensive chemotherapy regimens (38%) (all P < .001). Median OS was higher for de novo than sAML (10.9 vs 5.6 months; P < .001) and shorter in sAML after hematologic disorder (MDS, MDS/MPN, or MPN) compared with t-AML and neo-AML (5.3 vs 6.1 vs 5.7 months, respectively; P = .04). After intensive chemotherapy, median OS was better among patients with de novo and neo-AML (17.2 and 14.6 months, respectively). No OS differences were observed after hypomethylating agents according to type of AML. sAML was an independent adverse prognostic factor for OS. We confirmed high prevalence and adverse features of sAML and established its independent adverse prognostic value. This trial was registered at www.clinicaltrials.gov as #NCT02607059.
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8
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Older adults with newly diagnosed high-risk/secondary AML who achieved remission with CPX-351: phase 3 post hoc analyses. Blood Adv 2021; 5:1719-1728. [PMID: 33724305 DOI: 10.1182/bloodadvances.2020003510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
CPX-351, a dual-drug liposomal encapsulation of daunorubicin/cytarabine in a synergistic 1:5 molar ratio, is approved for the treatment of adults with newly diagnosed, therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC). In a pivotal phase 3 study, patients aged 60 to 75 years with newly diagnosed, high-risk/secondary AML were randomized to receive CPX-351 or conventional 7+3 chemotherapy. In the primary endpoint analysis, CPX-351 demonstrated significantly prolonged median overall survival (OS) vs 7+3. These exploratory post hoc subgroup analyses evaluated the impact of achieving complete remission (CR) or CR with incomplete neutrophil or platelet recovery (CRi) with CPX-351 (73/153 [48%]) vs conventional 7+3 (52/56 [33%]) on outcomes. CPX-351 improved median OS vs 7+3 in patients who achieved CR or CRi (25.43 vs 10.41 months; hazard ratio = 0.49; 95% confidence interval, 0.31, 0.77). Improved median OS was seen across AML subtypes (t-AML, AML-MRC), age subgroups (60 to 69 vs 70 to 75 years), patients with prior hypomethylating agent exposure, and patients who did not undergo transplantation. Patients who achieved CR or CRi with CPX-351 also had a higher rate of transplantation, a longer median OS landmarked from the date of transplantation (not reached vs 11.65 months; hazard ratio = 0.43; 95% confidence interval, 0.21, 0.89), and a safety profile that was consistent with the known safety profile of 7+3. These results suggest deeper remissions may be achieved with CPX-351, leading to improved OS. This study was registered at www.clinicaltrials.gov as #NCT01696084.
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9
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Hassanein M, Fakih RE, Rasheed W, Ahmed S, Shaheen M, Chaudhri N, Alsharif F, Ahmed S, Hanbali A, AlShaibani A, Alfraih F, Alhayli S, Elhassan T, Alahmari A, Alzahrani H, Almohareb F, Aljurf M, Hashmi S. The outcomes of secondary AML post allogeneic hematopoietic cell transplantation significantly depend on the presence of poor-risk cytogenetic abnormalities. EJHAEM 2021; 2:249-256. [PMID: 35845278 PMCID: PMC9175943 DOI: 10.1002/jha2.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 11/12/2022]
Abstract
Secondary acute myeloid leukemia (sAML) includes AML as a complication of an antecedent hematological disorder or a therapy-related AML. Large registry-based data identified sAML as an independent poor-outcome type of AML post allogeneic hematopoietic cell transplantation (allo-HCT). In our study, we tried to define factors affecting outcomes of sAML post allo-HCT, and identify patients with sAML who may truly benefit from allo-HCT. We retrospectively analyzed the data of 64 patients aged (14-61 years) with sAML who received allo-HCT between September 2010 and February 2018 at our institute. Most of the patients were transplanted from matched related donors (MRD; 54, 84.4%). Our results showed that poor-risk cytogenetics were identified in 31 patients (48.4%), and their presence was an indicator of poor overall survival (OS) and disease-free survival (DFS; P-value = .009, and .004, respectively). The cumulative incidence of chronic graft-versus-host disease (cGVHD) was significantly lower in sAML patients with poor-risk cytogenetics (P-value = .003) resulting in a high risk of death without cGVHD in this group of patients (P-value = .02). Besides, GVHD relapse-free survival (GRFS) analysis showed that most of our studied patients experienced either relapse or debilitating grade II-IV cGVHD in the first 2 years post allo-HCT. We conclude that sAML patients with poor-risk cytogenetics have a significantly lower DFS post allo-HCT with a high risk of death without active cGVHD.
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Affiliation(s)
- Mona Hassanein
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
- Department of HematologyBone Marrow Transplant, King's College Hospital NHS Foundation TrustLondonUK
| | - Riad El Fakih
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Syed Ahmed
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Marwan Shaheen
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Naeem Chaudhri
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Fahad Alsharif
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Shad Ahmed
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Amr Hanbali
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | | | - Feras Alfraih
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Saud Alhayli
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Tusneem Elhassan
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Ali Alahmari
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Hazzaa Alzahrani
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Fahad Almohareb
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Shahrukh Hashmi
- King Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
- Department of MedicineMayo ClinicRochesterMinnesota
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10
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Kang JW, Kim Y, Lee Y, Myung K, Kim YH, Oh CK. AML poor prognosis factor, TPD52, is associated with the maintenance of haematopoietic stem cells through regulation of cell proliferation. J Cell Biochem 2020; 122:403-412. [PMID: 33166425 DOI: 10.1002/jcb.29869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022]
Abstract
Acute myeloid leukaemia (AML) is a blood cancer where undifferentiated myeloid cells are increased in the bone marrow and peripheral blood. As AML is dangerous and shows poor prognosis, many researchers categorised the relevant cytogenetic factors according to risk and prognosis. However, the specific reasons for poor cytogenetic factors remain unknown. We analysed a large data set from AML patients and found that TPD52 expression is elevated in patient groups with poor cytogenetic factors. As the amino acid sequence of TPD52 is evolutionally conserved in vertebrates, zebrafish embryos were used to investigate the function of TPD52. Since myeloid-biased haematopoietic stem cells (HSCs) are relevant to AML, the function of TPD52 in the development of HSCs was investigated. We determined that the zebrafish paralog, tpd52, is important for the maintenance of HSCs through regulation of cell proliferation. As tpd52 is linked to cell proliferation in zebrafish embryos, the proliferation-related gene, CD59, was correlated to TPD52 in every AML cohort with a high correlation coefficient. We suggest that TPD52 can be a novel therapeutic target for AML patients with poor cytogenetic factors. Additionally, more studies between TPD52 and CD59 will further increase the value of TPD52 as a novel target.
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Affiliation(s)
- Ji Wan Kang
- Interdisplinary Program of Genomic Science, Pusan National University, Yangsan, Republic of Korea
| | - Youngjoo Kim
- Interdisplinary Program of Genomic Science, Pusan National University, Yangsan, Republic of Korea
| | - Yoonsung Lee
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan, Republic of Korea
| | - Kyungjae Myung
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan, Republic of Korea
| | - Yun Hak Kim
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea.,Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Chang-Kyu Oh
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan, Republic of Korea
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11
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Cortes JE, Candoni A, Clark RE, Leber B, Montesinos P, Vyas P, Zeidan AM, Heuser M. Selection and management of older patients with acute myeloid leukemia treated with glasdegib plus low-dose cytarabine: expert panel review. Leuk Lymphoma 2020; 61:3287-3305. [DOI: 10.1080/10428194.2020.1817445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jorge E. Cortes
- Division of Hematology and SCT, Georgia Cancer Center, Augusta, GA, USA
| | - Anna Candoni
- University Hospital of Udine-ASUFC, Udine, Italy
| | - Richard E. Clark
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Brian Leber
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University Medical Centre, Hamilton, Canada
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Paresh Vyas
- Weatherall Institute of Molecular Medicine, Oxford, UK
- National Institute of Health Research Oxford, Biomedical Research Centre, Oxford, UK
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12
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Roboz GJ, Larson ML, Rubenstein SE, Solomon SR, Schiller GJ, An Q, Chiarella M, Louie AC, Lin TL. Final safety and efficacy results from the CPX-351 early access program for older patients with high-risk or secondary acute myeloid leukemia. Leuk Lymphoma 2020; 61:1188-1194. [DOI: 10.1080/10428194.2020.1725503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gail J. Roboz
- Weill Cornell Medicine and the New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Scott R. Solomon
- The Leukemia Program at Northside Hospital Cancer Center Institute, Atlanta, GA, USA
| | | | - Qi An
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | | | | | - Tara L. Lin
- University of Kansas Medical Center, Kansas City, KS, USA
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13
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Dhakal P, Pyakuryal B, Pudasainee P, Rajasurya V, Gundabolu K, Bhatt VR. Treatment Strategies for Therapy-related Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:147-155. [PMID: 31953046 DOI: 10.1016/j.clml.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 01/20/2023]
Abstract
Prospective evidence for management of therapy-related acute myeloid leukemia (t-AML) is limited, with evidence extrapolated from major AML trials. Optimal treatment is challenging and needs consideration of patient-specific, disease-specific, and therapy-specific factors. Clinical trials are recommended, especially for unfit patients or those with unfavorable cytogenetics or mutations. CPX-351 as an upfront intensive chemotherapy is preferred for fit patients; venetoclax with decitabine or azacitidine is an option for patients unfit for intensive chemotherapy. Hematopoietic cell transplant, the only curative option, should be offered to eligible patients with intermediate or unfavorable t-AML or patients with good-risk AML with minimal residual disease. Ongoing clinical trials focusing on treatment of t-AML, including targeted agents and immunotherapy, bode well for the future.
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Affiliation(s)
- Prajwal Dhakal
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE.
| | - Bimatshu Pyakuryal
- Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Prasun Pudasainee
- Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal
| | | | - Krishna Gundabolu
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Vijaya Raj Bhatt
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
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14
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Gaut D, Bejjani A, Sasine J, Schiller G. B-cell acute lymphoblastic leukemia as a secondary malignancy following diffuse large B-cell lymphoma. Hematol Rep 2019; 11:8100. [PMID: 31285810 PMCID: PMC6589539 DOI: 10.4081/hr.2019.8100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/13/2019] [Indexed: 11/23/2022] Open
Abstract
Secondary acute lymphoblastic leukemia (ALL) is a rare disease that has not been well characterized compared with secondary myelodysplastic syndrome or secondary acute myeloid leukemia. We present a report of two patients who developed ALL following complete remission of diffuse large B-cell lymphoma (DLBCL). The first case is more consistent with a therapy- related ALL as a PCR analysis of bone marrow aspirate revealed a distinct clone and the mixed-lineage leukemia gene rearrangement, commonly associated with exposure to topoisomerase II inhibitors. The second case is more consistent with clonal evolution given positive MYC and BCL2 fusion signals in the original diagnosis of DLBCL and the secondary ALL.
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Affiliation(s)
| | - Anthony Bejjani
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Joshua Sasine
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Gary Schiller
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
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15
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Bandyopadhyay S, Fowles JS, Yu L, Fisher DAC, Oh ST. Identification of functionally primitive and immunophenotypically distinct subpopulations in secondary acute myeloid leukemia by mass cytometry. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2019; 96:46-56. [PMID: 30426661 PMCID: PMC6343486 DOI: 10.1002/cyto.b.21743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/09/2018] [Accepted: 09/18/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Background: Mass cytometry (CyTOF) is a powerful tool for analyzing cellular networks at the single cell level. Due to the high-dimensional nature of this approach, analysis algorithms have been developed to visualize and interpret mass cytometry data. In this study, we applied these approaches to a cohort of patients with secondary acute myeloid leukemia (sAML). METHODS We utilized mass cytometry to interrogate localization and intensity of thrombopoietin-mediated intracellular signaling in sAML. Extracellular and intracellular phenotypes were dissected using SPADE, viSNE, and PhenoGraph. RESULTS Healthy controls exhibited highly localized signaling responses largely restricted to the hematopoietic stem/progenitor cell (HSPC) compartment. In contrast, sAML samples contained subpopulations outside the HSPC compartment exhibiting thrombopoietin (TPO) sensitivity comparable to or greater than immunophenotypically defined HSPCs. We employed unsupervised clustering by PhenoGraph to elucidate distinct subpopulations within these heterogeneous samples. One metacluster composed almost exclusively of Lin- CD61+ CD34- CD38- CD45low cells was identified. This subpopulation was not readily identified by established manual gating approaches, and generally exhibited greater STAT phosphorylation in response to TPO stimulation than did Lin- CD61- CD34+ CD38- cells. Lin- CD61+ CD34- CD38- CD45low cells were identified in three additional sAML patients analyzed independently using a manual gating approach based upon PhenoGraph results. Each patient exhibited a similar TPO hypersensitivity to the PhenoGraph metacluster. CONCLUSIONS The identification of this cellular subpopulation highlights the limitations of manual gating in sAML. Our study demonstrates the potential for mass cytometry to elucidate rare subpopulations in highly heterogeneous tumors by utilizing unsupervised high dimensional analysis. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Shovik Bandyopadhyay
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana
- Division of Hematology, Washington University School of Medicine, St Louis, Missouri
| | - Jared S Fowles
- Division of Hematology, Washington University School of Medicine, St Louis, Missouri
| | - Liyang Yu
- Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel A C Fisher
- Division of Hematology, Washington University School of Medicine, St Louis, Missouri
| | - Stephen T Oh
- Division of Hematology, Washington University School of Medicine, St Louis, Missouri
- Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri
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16
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Locally advanced cervical cancer complicating pregnancy: A case of competing risks from the Catholic University of the Sacred Heart in Rome. Gynecol Oncol 2018; 150:398-405. [PMID: 30126588 DOI: 10.1016/j.ygyno.2018.06.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A case of stage IB2 cervical cancer at 27 weeks of pregnancy, treated with neoadjuvant chemotherapy followed by radical Cesarean hysterectomy with full pelvic and infra-mesenteric lymphadenectomy, and adjuvant chemo-radiation is described. While she remains without disease, her baby was diagnosed with acute myelogenous leukemia. We highlight the pre-operative work-up, treatment options, safety, feasibility, and outcomes for the mother and her fetus.
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17
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Sengsayadeth S, Labopin M, Boumendil A, Finke J, Ganser A, Stelljes M, Ehninger G, Beelen D, Niederwieser D, Blaise D, Dreger P, Mufti G, Chevallier P, Mailhol A, Gatwood KS, Gorin N, Esteve J, Ciceri F, Baron F, Schmid C, Giebel S, Mohty M, Savani BN, Nagler A. Transplant Outcomes for Secondary Acute Myeloid Leukemia: Acute Leukemia Working Party of the European Society for Blood and Bone Marrow Transplantation Study. Biol Blood Marrow Transplant 2018; 24:1406-1414. [DOI: 10.1016/j.bbmt.2018.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022]
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18
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Gassas A, Sivaprakasam P, Cummins M, Breslin P, Patrick K, Slatter M, Skinner R, Shenton G, Gibson B, Lawson S, Petterson T, Potter M, James B, Hough R, Hiwarkar P, Vora A, Veys P, De La Fuente J, Wynn R, Amrolia P. High transplant-related mortality associated with haematopoietic stem cell transplantation for paediatric therapy-related acute myeloid leukaemia (t-AML). A study on behalf of the United Kingdom Paediatric Blood and Bone Marrow Transplant Group. Bone Marrow Transplant 2018; 53:1165-1169. [PMID: 29545594 DOI: 10.1038/s41409-018-0157-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 11/09/2022]
Abstract
Paediatric therapy-related acute myeloid leukaemia (t-AML) is rare and the outcome is poor. While allogeneic haematopoietic stem cell transplantation (HSCT) is generally the accepted modality of treatment, data regarding salvage chemotherapy, remission induction, conditioning regimens, transplant-related mortality and outcome is scarce. Between 2000 and2016, 36 children with t-AML were treated in seven UK paediatric HSCT centres. The most common salvage protocol for remission induction was FLAG with or without idarubicin and 28 patients were in complete morphological remission prior to BMT. Only 12 patients survived (33%). Transplant-related mortality (TRM) was the leading cause of death.
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Affiliation(s)
- Adam Gassas
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK.
| | - Ponni Sivaprakasam
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK
| | - Michelle Cummins
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK
| | - Patricia Breslin
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK
| | - Katharine Patrick
- Department of Haematology and Oncology, Sheffield Children's Hospital, Sheffield, UK
| | - Mary Slatter
- Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Roderick Skinner
- Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Geof Shenton
- Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Brenda Gibson
- Department of Haematology and Oncology, Royal Hospital for Children, Glasgow, UK
| | - Sarah Lawson
- Department of Haematology and Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Toni Petterson
- Department of Haematology and Oncology, Royal Marsden Hospital, Sutton, UK
| | - Michael Potter
- Department of Haematology and Oncology, Royal Marsden Hospital, Sutton, UK
| | - Beki James
- Department of Haematology and Oncology, Leeds Teaching Hospital, Leeds, UK
| | - Rachael Hough
- Department of Haematology and Oncology, University College of London, London, UK
| | - Prashant Hiwarkar
- Department of Haematology and Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ajay Vora
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Veys
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Josu De La Fuente
- Department of Haematology and Oncology, St Marys Hospital, Imperial College, London, UK
| | - Robert Wynn
- Department of Haematology and Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Persis Amrolia
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
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19
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Borlenghi E, Pagani C, Zappasodi P, Bernardi M, Basilico C, Todisco E, Fracchiolla N, Mancini V, Turrini M, Da Vià M, Sala E, Cattaneo C, Petullà M, Serana F, Ferrario A, Cairoli R, Cortelezzi A, Santoro A, Castagnola C, Rossi G. Secondary acute myeloid leukaemia in elderly patients: Patient's fitness criteria and ELN prognostic stratification can be applied to guide treatment decisions. An analysis of 280 patients by the network rete ematologica lombarda (REL). Am J Hematol 2018; 93:E54-E57. [PMID: 29164738 DOI: 10.1002/ajh.24977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Erika Borlenghi
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Chiara Pagani
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Patrizia Zappasodi
- Division of Haematology; Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | - Massimo Bernardi
- San Raffaele Scientific Institute Haematology and Bone Marrow Transplantation Unit; Milano Italy
| | - Claudia Basilico
- Division of Haematology; ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Elisabetta Todisco
- Humanitas Cancer Center, Humanitas Clinical and Research Center; Rozzano-Milano Italy
| | - Nicola Fracchiolla
- U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milano Italy
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano Milano, Milano, Italy
| | - Mauro Turrini
- Division of Haematology Department of Medicine; Valduce Hospital; Como Italy
| | - Matteo Da Vià
- Division of Haematology; Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | - Elisa Sala
- San Raffaele Scientific Institute Haematology and Bone Marrow Transplantation Unit; Milano Italy
| | - Chiara Cattaneo
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Marta Petullà
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Federico Serana
- CREA Laboratory, Diagnostics Department, Clinical Chemistry Laboratory, Diagnostics Department ASST Spedali Civili of Brescia; Brescia Italy
| | - Andrea Ferrario
- Division of Haematology; ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Roberto Cairoli
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano Milano, Milano, Italy
| | - Agostino Cortelezzi
- U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milano Italy
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Humanitas University; Rozzano Milano Italy
| | - Carlo Castagnola
- Division of Haematology; Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | - Giuseppe Rossi
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
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20
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Mukhopadhyay MK, Shaw M, Nath D. Chemopreventive Potential of Major Flavonoid Compound of Methanolic Bark Extract of Saraca asoca (Roxb.) in Benzene-induced Toxicity of Acute Myeloid Leukemia Mice. Pharmacogn Mag 2017; 13:S216-S223. [PMID: 28808383 PMCID: PMC5538157 DOI: 10.4103/pm.pm_326_15] [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: 07/22/2015] [Revised: 09/03/2015] [Indexed: 11/07/2022] Open
Abstract
Background: Saraca asoca (SA) (Roxb.) is one of the folk medicinal plants found in India, Bangladesh, and Sri Lanka. Its major biological activity appears due to the presence of flavonoid group of compounds in its bark extract. Objective: In this study, our research aims to analyze the chemopreventive effect of flavonoids, especially a natural phenol catechin present in the bark methanolic extract of SA on acute myeloid leukemia (AML) mice. Materials and Methods: The total bark extract was partitioned and analyzed on thin-layer chromatography (TLC) plate. The yellow-brown material of spot 4 was analyzed and identified as catechin. The yellowish brown material (YBM) was tested for their chemopreventive potential. An in vivo AML mice model was used to test the efficacy. Hematological parameters (Hb %, red blood cell, and white blood cell count), expression of cell cycle regulatory proteins, and DNA fragmentation analysis were performed. Results: After treatment of benzene-exposed mice with the major flavonoid compound, namely catechin, the above parameters increase significantly (P < 0.05). There was an upregulation of p53 and p21, caspase 11 myeloperoxidase, bcl2, and CYP2EI in catechin-treated group. DNA was less fragmented in flavonoid-treated group compared to that of control (P ≤ 0.05). The present study indicates that the secondary metabolites of SA methanolic bark extract, comprising flavonoid catechin as major constituents, have modulatory effect in cell cycle deregulation and hematological abnormalities induced by benzene in mice. Conclusions: Our data suggest that catechin from methanolic bark extract of SA effectively attenuates benzene-induced secondary AML in bone marrow, which is likely associated with the anticell cycle deregulation properties of this flavan-3-ol. This study was supported by the observation that catechin (YBM), like doxorubicin, can act as the neutralizer and protector of mortality in cancer cases. SUMMARY The catechin from methanolic bark extract of Saraca asoca has chemoprotective activity in benzene-induced secondary acute myeloid leukemia.(AML) in bone marrow Hematological parameters, structural analysis of DNA showed that the purified catechin attenuates the conditions responsible for the development of AML The purified flavonol, catechin has a modulatory effect on different cell cycle deregulations induced by benzene in AML model.
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Affiliation(s)
- Manas Kumar Mukhopadhyay
- Department of Zoology, Cytogenetics and Molecular Biology Laboratory, University of Kalyani, Nadia, West Bengal, India
| | - Mithun Shaw
- Department of Zoology, Cytogenetics and Molecular Biology Laboratory, University of Kalyani, Nadia, West Bengal, India
| | - Debjani Nath
- Department of Zoology, Cytogenetics and Molecular Biology Laboratory, University of Kalyani, Nadia, West Bengal, India
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21
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Treated secondary acute myeloid leukemia: a distinct high-risk subset of AML with adverse prognosis. Blood Adv 2017; 1:1312-1323. [PMID: 29296774 DOI: 10.1182/bloodadvances.2017008227] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/14/2017] [Indexed: 12/20/2022] Open
Abstract
Secondary acute myeloid leukemia (s-AML) includes therapy-related AML and AML evolving from antecedent hematological disorder (AHD). s-AML arising after treating AHD likely represents a prognostically distinct, high-risk disease category. In this study, treated s-AML (ts-AML) was defined by: (1) prior diagnosis of myelodysplasia, myeloproliferative neoplasm, or aplastic anemia and (2) at least 1 therapy for that diagnosis. ts-AML was categorized by age (< or ≥60 years), and each cohort assessed for response rates and overall survival (OS) on various treatment regimens. Survival outcomes were compared against other high-risk prognostic subsets. Results showed that complete response and 8-week mortality rates were 32% and 27% in the younger, and 24% and 19% in the older age groups, respectively. There was a significant OS difference within s-AML based on prior treatment of AHD (ie, ts-AML vs s-AML with untreated AHD, 4.2 vs 9.2 months; P < .001). Survival in ts-AML was poor across both cohorts (younger and older, 5 and 4.7 months, respectively). In younger AML, survival was significantly inferior in ts-AML when compared with deletion 5/7, TP53, 3q abnormality, and therapy-related AML groups (median, 5 vs 7.9, 7.8, 7.9, and 11.2 months, respectively; P < .01). Additional adverse karyotype within ts-AML was associated with even worse outcomes (OS range, 1.6-2.8 months). ts-AML represents a very high-risk category, even in younger AML patients. s-AML should be further classified to describe ts-AML, an entity less responsive to currently applied treatment approaches. Future AML trial designs should accommodate ts-AML as a distinct subgroup.
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22
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Xu B, Wang S, Li R, Chen K, He L, Deng M, Kannappan V, Zha J, Dong H, Wang W. Disulfiram/copper selectively eradicates AML leukemia stem cells in vitro and in vivo by simultaneous induction of ROS-JNK and inhibition of NF-κB and Nrf2. Cell Death Dis 2017; 8:e2797. [PMID: 28518151 PMCID: PMC5520701 DOI: 10.1038/cddis.2017.176] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/22/2022]
Abstract
Acute myeloid leukemia (AML) is a heterogeneous malignancy. Despite the advances in past decades, the clinical outcomes of AML patients remain poor. Leukemia stem cells (LSCs) is the major cause of the recurrence of AML even after aggressive treatment making, promoting development of LSC-targeted agents is an urgent clinical need. Although the antitumor activity of disulfiram (DS), an approved anti-alcoholism drug, has been demonstrated in multiple types of tumors including hematological malignancies such as AML, it remains unknown whether this agent would also be able to target cancer stem cells like LSCs. Here, we report the in vitro and in vivo activity of DS in combination with copper (Cu) against CD34+/CD38+ leukemia stem-like cells sorted from KG1α and Kasumi-1 AML cell lines, as well as primary CD34+ AML samples. DS plus Cu (DS/Cu) displayed marked inhibition of proliferation, induction of apoptosis, and suppression of colony formation in cultured AML cells while sparing the normal counterparts. DS/Cu also significantly inhibited the growth of human CD34+/CD38+ leukemic cell-derived xenografts in NOD/SCID mice. Mechanistically, DS/Cu-induced cytotoxicity was closely associated with activation of the stress-related ROS-JNK pathway as well as simultaneous inactivation of the pro-survival Nrf2 and nuclear factor-κB pathways. In summary, our findings indicate that DS/Cu selectively targets leukemia stem-like cells both in vitro and in vivo, thus suggesting a promising LSC-targeted activity of this repurposed agent for treatment of relapsed and refractory AML.
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Affiliation(s)
- Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shiyun Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rongwei Li
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kai Chen
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lingli He
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Manman Deng
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Vinodh Kannappan
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Jie Zha
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huijuan Dong
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weiguang Wang
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
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23
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Boddu PC, Kantarjian HM, Ravandi F, Garcia-Manero G, Verstovsek S, Jabbour EJ, Takahashi K, Bhalla K, Konopleva M, DiNardo CD, Ohanian M, Pemmaraju N, Jain N, Pierce S, Wierda WG, Cortes JE, Kadia TM. Characteristics and outcomes of older patients with secondary acute myeloid leukemia according to treatment approach. Cancer 2017; 123:3050-3060. [PMID: 28387922 DOI: 10.1002/cncr.30704] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The development of newer strategies to improve outcomes for older patients with secondary acute myeloid leukemia (s-AML) is a critical unmet need. Establishing baseline metrics for evaluating newer approaches is important. METHODS s-AML was defined as 1 or more of the following: a history of an antecedent hematologic disorder (AHD), a diagnosis of therapy-related acute myeloid leukemia (AML), and AML with karyotype abnormalities characteristic of myelodysplastic syndrome. Newly diagnosed s-AML patients aged 60 to 75 years were grouped into 5 treatment cohorts: 1) patients receiving high- or intermediate-dose cytarabine-based intensive chemotherapy (IC), 2) patients receiving a hypomethylating agent (HMA) or HMA combinations, 3) patients receiving low-dose cytarabine (LDAC) combinations, 4) patients receiving CPX-351, and 5) patients receiving investigational (INV) agents. Nine hundred thirty-one patients met the age and s-AML criteria. RESULTS Complete remission rates were statistically lower in the HMA group (36%) versus the IC (46%), CPX-351 (45%), and LDAC groups (43%). Patients receiving less intensive regimens (the HMA and LDAC groups combined) had superior overall survival (OS) in comparison with patients receiving IC-based regimens (median 6.9 vs 5.4 months; P = .048). Only 4.3% of the IC patients proceeded to transplantation, whereas 10.3% of the patients on lower intensity regimens did (P = .001). There was no difference in median survival between patients treated with CPX-351 and patients treated with conventional lower intensity approaches (P = .75). Age > 70 years, an adverse karyotype, and a prior AHD were associated with decreased OS in a multivariate analysis. CONCLUSIONS Lower intensity approaches are associated with lower early mortality rates and improved OS in comparison with intensive regimens. OS is poor with currently available therapies with a median OS of 6 months (5.4-7.6 months across regimens). Unsatisfactory outcomes with other INV agents underscore the need for more effective therapies. Cancer 2017;123:3050-60. © 2017 American Cancer Society.
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Affiliation(s)
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maro Ohanian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge E Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Azacitidine or intensive chemotherapy for older patients with secondary or therapy-related acute myeloid leukemia. Oncotarget 2017; 8:79126-79136. [PMID: 29108292 PMCID: PMC5668025 DOI: 10.18632/oncotarget.15988] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/27/2017] [Indexed: 12/21/2022] Open
Abstract
The treatment of older patients with acute myeloid leukemia that is secondary to previous myelodysplastic syndrome, myeloproliferative neoplasm, or prior cytotoxic exposure remains unsatisfactory. We compared 92 and 107 patients treated, respectively, with intensive chemotherapy or azacitidine within two centres. Diagnoses were 37.5% post-myelodysplastic syndrome, 17.4% post-myeloproliferative neoplasia, and 45.1% therapy-related acute myeloid leukemia. Patients treated by chemotherapy had less adverse cytogenetics, higher white blood-cell counts, and were younger: the latter two being independent factors entered into the multivariate analyses. Median overall-survival times with chemotherapy and azacitidine were 9.6 (IQR: 3.6-22.8) and 10.8 months (IQR: 4.8-26.4), respectively (p = 0.899). Adjusted time-dependent analyses showed that, before 1.6 years post-treatment, there were no differences in survival times between chemotherapy and azacitidine treatments whereas, after this time-point, patients that received chemotherapy had a lower risk of death compared to those that received azacitidine (adjusted HR 0.61, 95%CI: 0.38-0.99 at 1.6 years). There were no interactions between treatment arms and secondary acute myeloid leukemia subtypes in all multivariate analyses, indicating that the treatments had similar effects in all three subtypes. Although a comparison between chemotherapy and azacitidine remains challenging, azacitidine represents a valuable alternative to chemotherapy in older patients that have secondary acute myeloid leukemia because it provides similar midterm outcomes with less toxicity.
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25
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Zhou J, Chng WJ. Aberrant RNA splicing and mutations in spliceosome complex in acute myeloid leukemia. Stem Cell Investig 2017; 4:6. [PMID: 28217708 DOI: 10.21037/sci.2017.01.06] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/29/2016] [Indexed: 12/19/2022]
Abstract
The spliceosome, the cellular splicing machinery, regulates RNA splicing of messenger RNA precursors (pre-mRNAs) into maturation of protein coding RNAs. Recurrent mutations and copy number changes in genes encoding spliceosomal proteins and splicing regulatory factors have tumor promoting or suppressive functions in hematological malignancies, as well as some other cancers. Leukemia stem cell (LSC) populations, although rare, are essential contributors of treatment failure and relapse. Recent researches have provided the compelling evidence that link the erratic spicing activity to the LSC phenotype in acute myeloid leukemia (AML). In this article, we describe the diverse roles of aberrant splicing in hematological malignancies, particularly in AML and their contributions to the characteristics of LSC. We review these promising strategies to exploit the addiction of aberrant spliceosomal machinery for anti-leukemic therapy with aim to eradicate LSC. However, given the complexity and plasticity of spliceosome and not fully known functions of splicing in cancer, the challenges facing the development of the therapeutic strategies targeting RAN splicing are highlighted and future directions are discussed too.
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Affiliation(s)
- Jianbiao Zhou
- Cancer Science Institute of Singapore, National University of Singapore, Centre for Translational Medicine, Singapore 117599, Singapore;; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Wee-Joo Chng
- Cancer Science Institute of Singapore, National University of Singapore, Centre for Translational Medicine, Singapore 117599, Singapore;; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;; Department of Hematology-Oncology, National University Cancer Institute of Singapore (NCIS), The National University Health System (NUHS), Singapore 119228, Singapore
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26
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Damiani D, Tiribelli M, Raspadori D, Sirianni S, Meneghel A, Cavalllin M, Michelutti A, Toffoletti E, Geromin A, Simeone E, Bocchia M, Fanin R. Clinical impact of CD200 expression in patients with acute myeloid leukemia and correlation with other molecular prognostic factors. Oncotarget 2016; 6:30212-21. [PMID: 26338961 PMCID: PMC4745791 DOI: 10.18632/oncotarget.4901] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/07/2015] [Indexed: 01/25/2023] Open
Abstract
CD200, a protein belonging to the immunoglobulin superfamily, has been associated with a poor prognosis in lymphoproliferative disorders and in acute leukemia. We studied the expression of CD200 in a series of 244 patients with diagnosis of acute myeloid leukemia (AML), to evaluate its impact on outcome and its possible association with other known prognostic factors. CD200 was found in 136/244 (56%) patients, in 41 of whom (30%) with high intensity of expression (MFI ≥ 11). CD200 was more frequent in secondary compared to de novo leukemia (p = 0.0006), in CD34 positive cases (p = 0.00001), in Bcl2 overexpressing cases (p = 0.01), in those wild-type Flt3 (p = 0.004) and with favorable or unfavorable compared to intermediate karyotype (p = 0.0003). CD200+ patients have a two-fold lower probability to attain complete remission, both in univariate (p = 0.006) and multivariate (p = 0.04) analysis. The negative impact of CD200 was found also in overall survival (p = 0.02) and was correlated with the intensity of expression of the molecule (p = 0.024). CD200 has an additive negative impact on survival in patients with unfavorable cytogenetic (p = 0.046) and in secondary leukemia (p = 0.05), and is associate with a worsening of outcome in patients with favorable biological markers, such as mutated NPM (p = 0.02), wild-type Flt3 (p = 0.034), negativity of CD34 (p = 0.03) and of CD56 (p = 0.03). In conclusion, CD200 is emerging as both a prognostic factor and a potential target of novel therapeutic approaches for AML, aiming to reverse the “do not eat me” signal of CD200 or to manipulate the suppressive immune microenvironment induced by CD200 binding to its receptor.
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Affiliation(s)
- Daniela Damiani
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | | | | | - Alessia Meneghel
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Margherita Cavalllin
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Angela Michelutti
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Eleonora Toffoletti
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Antonella Geromin
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Erica Simeone
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Monica Bocchia
- Division of Hematology, University of Siena, Siena, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
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Bhatt VR, Giri S, Verma V, Dahal S, Shah BK, Pathak R, Bociek RG, Vose JM, Armitage JO. Secondary acute myeloid leukemia in survivors of Hodgkin lymphoma. Future Oncol 2016; 12:1565-75. [DOI: 10.2217/fon-2016-0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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28
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Dan C, Chi J, Wang L. Molecular mechanisms of the progression of myelodysplastic syndrome to secondary acute myeloid leukaemia and implication for therapy. Ann Med 2015; 47:209-17. [PMID: 25861829 DOI: 10.3109/07853890.2015.1009156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Myelodysplastic syndrome (MDS) includes a heterogeneous group of clonal haematological stem cell disorders characterized by dysplasia, cytopenias, ineffective haematopoiesis, and an increased risk of progression to acute myeloid leukaemia (AML), which is also called secondary AML (sAML). Approximately one-third of patients with MDS will progress to sAML within a few months to a few years, and this type of transformation is more common and rapid in patients with high-risk MDS (HR-MDS). However, the precise mechanisms underlying the evolution of MDS to sAML remain unclear. Currently, chemotherapy for sAML has minimal efficacy. The only method of curing patients with sAML is allogeneic haematopoietic stem cell transplantation (Allo-HSCT). Unfortunately, only a few patients are appropriate for transplantation because this disease primarily affects older adult patients. Additionally, compared to de novo AML, sAML is more difficult to cure, and the prognosis is often worse. Therefore, it is important to clarify the molecular mechanisms of the progression of MDS to sAML and to explore the potent drugs for clinical use. This review will highlight several molecular mechanisms of the progression of MDS to sAML and new therapeutic strategies of this disease.
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Affiliation(s)
- Chunli Dan
- Department of Haematology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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29
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Stone RM, Mazzola E, Neuberg D, Allen SL, Pigneux A, Stuart RK, Wetzler M, Rizzieri D, Erba HP, Damon L, Jang JH, Tallman MS, Warzocha K, Masszi T, Sekeres MA, Egyed M, Horst HA, Selleslag D, Solomon SR, Venugopal P, Lundberg AS, Powell B. Phase III Open-Label Randomized Study of Cytarabine in Combination With Amonafide L-Malate or Daunorubicin As Induction Therapy for Patients With Secondary Acute Myeloid Leukemia. J Clin Oncol 2015; 33:1252-7. [DOI: 10.1200/jco.2014.57.0952] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Secondary acute myeloid leukemia (sAML), defined as AML arising after a prior myelodysplastic syndrome or after antineoplastic therapy, responds poorly to current therapies. It is often associated with adverse karyotypic abnormalities and overexpression of proteins that mediate drug resistance. We performed a phase III trial to determine whether induction therapy with cytarabine and amonafide L-malate, a DNA intercalator and non–ATP-dependent topoisomerase II inhibitor that evades drug resistance mechanisms, yielded a superior complete remission rate than standard therapy with cytarabine and daunorubicin in sAML. Patients and Methods Patients with previously untreated sAML were randomly assigned at a one-to-one ratio to cytarabine 200 mg/m2 continuous intravenous (IV) infusion once per day on days 1 to 7 plus either amonafide 600 mg/m2 IV over 4 hours on days 1 to 5 (A + C arm) or daunorubicin 45 mg/m2 IV over 30 minutes once per day on days 1 to 3 (D + C arm). Results The complete remission (CR) rate was 46% (99 of 216 patients) in A + C arm and 45% (97 of 217 patients) in D + C arm (P = .81). The 30- and 60-day mortality rates were 19% and 28% in A + C arm and 13% and 21% in D + C arm, respectively. Conclusion Induction treatment with A + C did not improve the CR rate compared with D + C in patients with sAML.
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Affiliation(s)
- Richard M. Stone
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Emanuele Mazzola
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Donna Neuberg
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Steven L. Allen
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Arnaud Pigneux
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Robert K. Stuart
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Meir Wetzler
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - David Rizzieri
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Harry P. Erba
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Lloyd Damon
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Jun-Ho Jang
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Martin S. Tallman
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Krzysztof Warzocha
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Tamás Masszi
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Mikkael A. Sekeres
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Miklos Egyed
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Heinz-August Horst
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Dominik Selleslag
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Scott R. Solomon
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Parameswaran Venugopal
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Ante S. Lundberg
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
| | - Bayard Powell
- Richard M. Stone, Emanuele Mazzola, and Donna Neuberg, Dana-Farber Cancer Institute, Boston; Ante S. Lundberg, Antisoma, Cambridge, MA; Steven L. Allen, Hofstra North Shore–Long Island Jewish School of Medicine, Lake Success; Meir Wetzler, Roswell Park Cancer Institute, Buffalo; Martin S. Tallman, Memorial Sloan Kettering Cancer Center, New York, NY; Arnaud Pigneux, Hopital Haut-Leveque, Pessac, France; Robert K. Stuart, Medical University of South Carolina, Charleston, SC; David Rizzieri, Duke
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Hulegårdh E, Nilsson C, Lazarevic V, Garelius H, Antunovic P, Rangert Derolf Å, Möllgård L, Uggla B, Wennström L, Wahlin A, Höglund M, Juliusson G, Stockelberg D, Lehmann S. Characterization and prognostic features of secondary acute myeloid leukemia in a population-based setting: a report from the Swedish Acute Leukemia Registry. Am J Hematol 2015; 90:208-14. [PMID: 25421221 DOI: 10.1002/ajh.23908] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 12/29/2022]
Abstract
Patients with secondary acute myeloid leukemia (AML) often escape inclusion in clinical trials and thus, population-based studies are crucial for its accurate characterization. In this first large population-based study on secondary AML, we studied AML with an antecedent hematological disease (AHD-AML) or therapy-related AML (t-AML) in the population-based Swedish Acute Leukemia Registry. The study included 3,363 adult patients of which 2,474 (73.6%) had de novo AML, 630 (18.7%) AHD-AML, and 259 (7.7%) t-AML. Secondary AML differed significantly compared to de novo AML with respect to age, gender, and cytogenetic risk. Complete remission (CR) rates were significantly lower but early death rates similar in secondary AML. In a multivariable analysis, AHD-AML (HR 1.51; 95% CI 1.26-1.79) and t-AML (1.72; 1.38-2.15) were independent risk factors for poor survival. The negative impact of AHD-AML and t-AML on survival was highly age dependent with a considerable impact in younger patients, but without independent prognostic value in the elderly. Although patients with secondary leukemia did poorly with intensive treatment, early death rates and survival were significantly worse with palliative treatment. We conclude that secondary AML in a population-based setting has a striking impact on survival in younger AML patients, whereas it lacks prognostic value among the elderly patients.
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Affiliation(s)
- Erik Hulegårdh
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
| | - Christer Nilsson
- Hematology Centre; Karolinska University Hospital, Huddinge, Stockholm and Regional Tumor Registry; Stockholm Sweden
| | - Vladimir Lazarevic
- Department of Hematology and Regional Tumor Registry; Skåne University Hospital and Lund University; Lund Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Hege Garelius
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Petar Antunovic
- Swedish Acute Myeloid Leukemia Group
- Department of Hematology and Regional Tumor Registry; Linköping University Hospital; Linköping Sweden
| | - Åsa Rangert Derolf
- Swedish Acute Myeloid Leukemia Group
- Center of Hematology and Regional Tumor Registry; Karolinska University Hospital; Solna Stockholm Sweden
| | - Lars Möllgård
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Bertil Uggla
- Swedish Acute Myeloid Leukemia Group
- Department of Medicine; Örebro University Hospital; Örebro Sweden
| | - Lovisa Wennström
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Anders Wahlin
- Swedish Acute Myeloid Leukemia Group
- Department of Radiation Sciences; University of Umeå and Regional Tumor Registry, Norrland University Hospital; Umeå Sweden
| | - Martin Höglund
- Swedish Acute Myeloid Leukemia Group
- Department of Hematology and Regional Tumor Registry; Academic Hospital, Uppsala; Sweden
| | - Gunnar Juliusson
- Department of Hematology and Regional Tumor Registry; Skåne University Hospital and Lund University; Lund Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Dick Stockelberg
- Department of Medicine and Regional Tumor Registry; Sahlgrenska University Hospital; Göteborg Sweden
- Swedish Acute Myeloid Leukemia Group
| | - Sören Lehmann
- Hematology Centre; Karolinska University Hospital, Huddinge, Stockholm and Regional Tumor Registry; Stockholm Sweden
- Swedish Acute Myeloid Leukemia Group
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31
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Choi Y, Kim SD, Park YH, Lee JS, Kim DY, Lee JH, Lee KH, Seol M, Lee YS, Kang YA, Jeon M, Jung AR, Lee JH. Up-front allogeneic hematopoietic cell transplantation in acute myeloid leukemia arising from the myelodysplastic syndrome. Acta Haematol 2014; 133:183-92. [PMID: 25323649 DOI: 10.1159/000362260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/16/2014] [Indexed: 11/19/2022]
Abstract
In patients with secondary acute myeloid leukemia (s-AML) arising from the myelodysplastic syndrome (MDS), treatment outcome is unsatisfactory. We compared up-front allogeneic hematopoietic cell transplantation (HCT) to induction chemotherapy (IC) as an initial treatment in patients with s-AML arising from MDS. This retrospective study included 85 patients who were diagnosed with s-AML arising from MDS; 11 patients proceeded to up-front HCT without IC (HCT group) and 74 received IC (IC group) as an initial treatment for s-AML, 28 of whom subsequently underwent HCT. In the IC group, 41.9% achieved complete remission (CR) compared to 81.8% in the HCT group (p = 0.013). The HCT group showed a significantly longer event-free survival (EFS) than the IC group (median 29.2 vs. 5.2 months, p = 0.042). Overall survival of the HCT group was higher than that of the IC group, but the difference was not statistically significant (median 34.6 vs. 7.6 months, p = 0.149). After adjustment for other clinical factors, outcome in the HCT group was significantly better than in the IC group in terms of CR rate (hazard ratio, HR, 11.195; p = 0.007) and EFS (HR, 0.384; p = 0.029). Up-front HCT is a viable option in s-AML arising from MDS if an appropriate donor is available.
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Affiliation(s)
- Yunsuk Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gangatharan SA, Grove CS, P'ng S, O'Reilly J, Joske D, Leahy MF, Threlfall T, Wright MP. Acute myeloid leukaemia in Western Australia 1991-2005: a retrospective population-based study of 898 patients regarding epidemiology, cytogenetics, treatment and outcome. Intern Med J 2014; 43:903-11. [PMID: 23611681 DOI: 10.1111/imj.12169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/18/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient characteristics and cytogenetics of acute myeloid leukaemia (AML) in clinical trials do not reflect that of the general population. There has not been a large population-based study that has examined cytogenetic features and outcomes of AML in Australia. AIM Investigation of epidemiological, prognostic, treatment and outcome data in adults diagnosed with AML in Western Australia between 1991 and 2005. METHODS Patients were identified utilising the Western Australia Cancer Registry, cytogenetic databases and hospital inpatient discharge diagnoses. Data were retrospectively collected from patients presenting to tertiary hospitals on patient characteristics, karyotype, induction therapy, remission, transplantation and survival. RESULTS A total of 987 patients with AML was identified, of which 91% (898) attended a tertiary hospital. Median age was 67 years and 45% of cases represented secondary AML. Cytogenetic analysis was available in 81% of patients. Frequent karyotypes were normal (38.8%), complex (13.8%) and -7/add(7q)/del(7q) (12.1%). Aggressive therapy was initiated in 62.6%. Less than 15% were enrolled in clinical trials. Overall 16.5% received a stem cell transplant. Median overall survival for all patients was 5.6 months. In patients treated aggressively, complete remission was achieved in 56.9% and median overall survival was 12.2 months. Age, secondary disease and karyotype were significantly predictive of remission and overall survival. CONCLUSION Age distribution, remission and survival rates were comparable with published population-based studies. High median age was reflected in the rate of secondary AML and trial eligibility. These findings highlight the need for prospective data collection.
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Affiliation(s)
- S A Gangatharan
- Department of Haematology, Royal Perth Hospital, Perth, Australia.
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Hu XM, Tanaka S, Onda K, Yuan B, Toyoda H, Ma R, Liu F, Hirano T. Arsenic disulfide induced apoptosis and concurrently promoted erythroid differentiation in cytokine-dependent myelodysplastic syndrome-progressed leukemia cell line F-36p with complex karyotype including monosomy 7. Chin J Integr Med 2014; 20:387-93. [PMID: 24610410 DOI: 10.1007/s11655-013-1514-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Acute myeloid leukemia progressed from myelodysplastic syndrome (MDS/AML) is generally incurable with poor prognosis for complex karyotype including monosomy 7 (-7). Qinghuang Powder (, QHP), which includes Qing Dai (Indigo naturalis) and Xiong Huang (realgar) in the formula, is effective in treating MDS or MDS/AML even with the unfavorable karyotype, and its therapeutic efficacy could be enhanced by increasing the Xiong huang content in the formula, while Xiong huang contains > 90% arsenic disulfide (As2S2). F-36p cell line was established from a MDS/AML patient with complex karyotype including -7, and was in cytokine-dependent. The present study was to investigate the effects of As2S2 on F-36p cells. METHODS Cell proliferation was measured by an 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Cell apoptosis was identified by Annexin V-staining. Cell viability was determined by a propidium iodide (PI) exclusion. Erythroid differentiation was evaluated by the expression of cell surface antigen CD235a (GpA). RESULTS After treatment with As2S2 at concentrations of 0.5 to 16 μmol/L for 72 h, As2S2 inhibited the proliferation of F-36p cells. The 50% inhibitory concentrations (IC50) of As2S2 against the proliferation of F-36p cells was 6 μmol/L. The apoptotic cells significantly increased in a dose-dependent mannar (P<0.05). The cell viabilities were significantly inhibited by As2S2 dose-dependent in a dose-dependent manner (P<0.05). Significant increases of CD235a-positive cells were concurrently observed (P<0.05) also in a dose-dependent manner. CONCLUSIONS As2S2 could inhibit proliferation and viability, induce apoptosis, and concurrently promote erythroid differentiation dose-dependently in F-36p cells. As2S2 can inhibit proliferation and viability, induce apoptosis, and concurrently promote erythroid differentiation in cytokine-dependent MDS-progressed human leukemia cell line F-36p with complex karyotype including -7. The data suggest that QHP and/or As2S2 could be a potential candidate in the treatment of MDS or MDS/AML even with unfavorable cytogenetics.
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Affiliation(s)
- Xiao-mei Hu
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, 192-0392, Japan
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Schiller GJ. Evolving treatment strategies in patients with high-risk acute myeloid leukemia. Leuk Lymphoma 2014; 55:2438-48. [DOI: 10.3109/10428194.2014.881479] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Gary J. Schiller
- Hematological Malignancy, Stem Cell Transplant Program, David Geffen School of Medicine at UCLA,
Los Angeles, CA, USA
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35
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Liersch R, Müller-Tidow C, Berdel WE, Krug U. Prognostic factors for acute myeloid leukaemia in adults - biological significance and clinical use. Br J Haematol 2014; 165:17-38. [DOI: 10.1111/bjh.12750] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ruediger Liersch
- Department of Haematology and Oncology; Internal Medicine III; Clemenshospital Muenster; Muenster Germany
| | - Carsten Müller-Tidow
- Department of Medicine A - Haematology and Oncology; University Hospital of Muenster; Muenster Germany
| | - Wolfgang E. Berdel
- Department of Medicine A - Haematology and Oncology; University Hospital of Muenster; Muenster Germany
| | - Utz Krug
- Department of Medicine A - Haematology and Oncology; University Hospital of Muenster; Muenster Germany
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Mukhopadhyay MK, Nath D. Physiologically based toxicokinetic modeling of secondary acute myelolytic leukemia. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2014; 37:378-389. [PMID: 24440606 DOI: 10.1016/j.etap.2013.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/29/2013] [Accepted: 11/30/2013] [Indexed: 06/03/2023]
Abstract
Benzene, designated as environmental and occupational carcinogen and hematotoxin, has been associated with secondary leukemia. To develop a toxicokinetic model of AML, benzene can be used as leukemogenic agent. The aim of the present study was to optimize the dose, period and time of cumulative benzene exposure of Swiss Albino mice and to analyze survival rate; alteration in cell cycle regulation and other clinical manifestations in mice exposed to benzene vapour at a dose 300 ppm × 6 h/day × 5 days/week for 2 weeks, i.e., 9000(a)ppm cumulative dose. Analyzing physiological parameters like plasma enzyme profile, complete hematology (Hb %, RBC indices and WBC differentials), hematopoietic cells morphology, expression of cell cycle regulatory proteins, tissue histology and analysis of DNA fragmentation, optimum conditions were established. Down regulation of p53 and p21 and up regulation of CDK2, CDK4, CDK6, cyclin D1 and E in this exposed group were marked as the optimum conditions of cellular deregulation for the development of secondary AML. Elevated level of Plasma AST/ALT with corresponding changes in liver histology showing extended sinusoids within the hepatocytic cell cords in optimally exposed animals also confirmed the toxicokinetic relation of benzene with leukemia. It can be concluded from the above observations that the 9000(a)ppm exposed animals can serve as the induced laboratory model of secondary acute myeloid leukemia.
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Affiliation(s)
- Manas Kumar Mukhopadhyay
- Cytogenetics & Molecular Biology Laboratory, Department of Zoology, University of Kalyani, Kalyani 741235, Nadia, West Bengal, India
| | - Debjani Nath
- Cytogenetics & Molecular Biology Laboratory, Department of Zoology, University of Kalyani, Kalyani 741235, Nadia, West Bengal, India.
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37
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Hu XM, Yuan B, Tanaka S, Song MM, Onda K, Tohyama K, Zhou AX, Toyoda H, Hirano T. Arsenic disulfide-triggered apoptosis and erythroid differentiation in myelodysplastic syndrome and acute myeloid leukemia cell lines. ACTA ACUST UNITED AC 2013; 19:352-60. [PMID: 24192507 DOI: 10.1179/1607845413y.0000000138] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Effects of arsenic disulfide (As2S2) were investigated by focusing on growth inhibition, apoptosis induction, and erythroid differentiation in MDS-L, F-36p and HL-60 cells, derived from myelodysplastic syndrome (MDS), MDS/acute myeloid leukemia (AML), and de novo AML, respectively. METHODS Cell viability was determined by MTT assay. Apoptosis induction was analyzed using Annexin V/propidium iodide staining. Erythroid differentiation was assessed by the expression level of CD235a, a marker for detection of the erythroid cell lineage. The activation of p38 MAPK and the expression profile of apoptosis-related proteins Bcl-2 and Bid were analyzed using western blot. RESULTS As2S2 inhibited cell growth of these cell lines. Of note, the IC50 value of As2S2 in MDS-L cells was comparable to that in F-36p cells, and was half of that in HL-60 cells. A dose-dependent decrease in cell viability and concomitant increase in the percentage of apoptotic cells were observed in F-36p cells treated with 8 and 16 µM As2S2 for 72 hours. However, similar phenomena were only observed in HL-60 cells when treated with as high as 16 µM As2S2. Furthermore, As2S2 exerted more potent erythroid differentiation-inducing activity on F-36p cells than HL-60 cells. Interestingly, negative correlation between p38 MAPK signaling pathway and As2S2-induced erythroid differentiation was observed in HL-60 cells. Treatment with relatively high concentration of As2S2 resulted in the downregulation of Bcl-2 and Bid proteins in HL-60 cells. DISCUSSION These results suggest that compared to AML cell line, MDS and MDS/AML cell lines are more sensitive to not only the erythroid differentiation-inducing activity of As2S2, but also its cytotoxicity associated with apoptosis induction. These findings further provide novel insight into As2S2 action toward its use for clinical application in patients with hematological disorders.
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Abstract
Acute myeloid leukemia (AML) represents a malignant accumulation of immature myeloid cells in the marrow, presenting with impaired hematopoiesis and its attendant complications, including bleeding, infection, and organ infiltration. Chromosomal abnormalities remain the most powerful predictors of AML prognosis and help to identify a subgroup with favorable prognosis. However, the majority of AML patients who are not in the favorable category succumb to the disease. Therefore, better efforts to identify those patients who may benefit from more aggressive and investigational therapeutic approaches are needed. Newer molecular markers aim at better characterizing the large group of intermediate-risk patients and to identify newer targets for therapy. A group that has seen little improvement over the years is the older AML group, usually defined as age ≥ 60. Efforts to develop less intensive but equally efficacious therapy for this vulnerable population are underway.
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Affiliation(s)
- Fuad El Rassi
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Martha Arellano
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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The CIBMTR score predicts survival of AML patients undergoing allogeneic transplantation with active disease after a myeloablative or reduced intensity conditioning: a retrospective analysis of the Gruppo Italiano Trapianto Di Midollo Osseo. Leukemia 2013; 27:2086-91. [PMID: 23835862 PMCID: PMC3806246 DOI: 10.1038/leu.2013.208] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leunis A, Redekop WK, van Montfort KAGM, Löwenberg B, Uyl-de Groot CA. The development and validation of a decision-analytic model representing the full disease course of acute myeloid leukemia. PHARMACOECONOMICS 2013; 31:605-621. [PMID: 23640102 DOI: 10.1007/s40273-013-0058-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The treatment of acute myeloid leukemia (AML) is moving towards personalized medicine. However, due to the low incidence of AML, it is not always feasible to evaluate the cost-effectiveness of personalized medicine using clinical trials. Decision analytic models provide an alternative data source. OBJECTIVE The aim of this study was to develop and validate a decision analytic model that represents the full disease course of AML. METHODS We used a micro simulation with discrete event components to incorporate both patient and disease heterogeneity. Input parameters were calculated from patient-level data. Two hematologists critically evaluated the model to ensure face validity. Internal and external validity was tested by comparing complete remission (CR) rates and survival outcomes of the model with original data, other clinical trials and a population-based study. RESULTS No significant differences in patient and treatment characteristics, CR rate, 5-year overall and disease-free survival were found between the simulated and original data. External validation showed no significant differences in survival between simulated data and other clinical trials. However, differences existed between the simulated data and a population-based study. CONCLUSIONS The model developed in this study is proved to be valid for analysis of an AML population participating in a clinical trial. The generalizability of the model to a broader patient population has not been proven yet. Further research is needed to identify differences between the clinical trial population and other AML patients and to incorporate these differences in the model.
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Affiliation(s)
- Annemieke Leunis
- Institute for Medical Technology Assessment/Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
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Fernandez C, Santos-Silva MC, López A, Matarraz S, Jara-Acevedo M, Ciudad J, Gutierrez ML, Sánchez ML, Salvador-Osuna C, Berruezo MJ, Díaz-Arias JÁ, Palomo-Hernández AM, Colado E, González N, Gallardo D, Asensio A, García-Sánchez R, Saldaña R, Cerveró C, Carboné-Bañeres A, Gutierrez O, Orfao A. Newly diagnosed adult AML and MPAL patients frequently show clonal residual hematopoiesis. Leukemia 2013; 27:2149-56. [DOI: 10.1038/leu.2013.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 11/09/2022]
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Chapuis A, Ragnarsson GB, Nguyen HN, Chaney CN, Pufnock JS, Schmitt TM, Duerkopp N, Roberts IM, Pogosov GL, Ho WY, Ochsenreither S, Wölfl M, Bar M, Radich JP, Yee C, Greenberg PD. Transferred WT1-reactive CD8+ T cells can mediate antileukemic activity and persist in post-transplant patients. Sci Transl Med 2013; 5:174ra27. [PMID: 23447018 PMCID: PMC3678970 DOI: 10.1126/scitranslmed.3004916] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Relapse remains a leading cause of death after allogeneic hematopoietic cell transplantation (HCT) for patients with high-risk leukemias. The potentially beneficial donor T cell-mediated graft-versus-leukemia (GVL) effect is often mitigated by concurrent graft-versus-host disease (GVHD). Providing T cells that can selectively target Wilms tumor antigen 1 (WT1), a transcription factor overexpressed in leukemias that contributes to the malignant phenotype, represents an opportunity to promote antileukemic activity without inducing GVHD. HLA-A*0201-restricted WT1-specific donor-derived CD8 cytotoxic T cell (CTL) clones were administered after HCT to 11 relapsed or high-risk leukemia patients without evidence of on-target toxicity. The last four treated patients received CTL clones generated with exposure to interleukin-21 (IL-21) to prolong in vivo CTL survival, because IL-21 can limit terminal differentiation of antigen-specific T cells generated in vitro. Transferred cells exhibited direct evidence of antileukemic activity in two patients: a transient response in one patient with advanced progressive disease and the induction of a prolonged remission in a patient with minimal residual disease (MRD). Additionally, three treated patients at high risk for relapse after HCT survive without leukemia relapse, GVHD, or additional antileukemic treatment. CTLs generated in the presence of IL-21, which were transferred in these latter three patients and the patient with MRD, all remained detectable long-term and maintained or acquired in vivo phenotypic and functional characteristics associated with long-lived memory CD8 T cells. This study supports expanding efforts to immunologically target WT1 and provides insights into the requirements necessary to establish potent persistent T cell responses.
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Affiliation(s)
- A.G. Chapuis
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - G. B. Ragnarsson
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - H. N. Nguyen
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - C. N. Chaney
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - J. S. Pufnock
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - T. M. Schmitt
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - N. Duerkopp
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - I. M. Roberts
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | | | - W. Y. Ho
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - S. Ochsenreither
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - M. Wölfl
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - M. Bar
- Clinical Research Division, FHCRC, Seattle, WA, USA
| | - J. P. Radich
- Clinical Research Division, FHCRC, Seattle, WA, USA
| | - C Yee
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
| | - P. D. Greenberg
- Program in Immunology, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
- Department of Immunology, University of Washington, Seattle, WA, USA
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Choi Y, Lee JH, Kim SD, Kim DY, Lee JH, Seol M, Kang YA, Jeon M, Jung AR, Lee KH. Prognostic implications of CD14 positivity in acute myeloid leukemia arising from myelodysplastic syndrome. Int J Hematol 2013; 97:246-55. [DOI: 10.1007/s12185-013-1266-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/07/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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Walter MJ, Shen D, Ding L, Shao J, Koboldt DC, Chen K, Larson DE, McLellan MD, Dooling D, Abbott R, Fulton R, Magrini V, Schmidt H, Kalicki-Veizer J, O'Laughlin M, Fan X, Grillot M, Witowski S, Heath S, Frater JL, Eades W, Tomasson M, Westervelt P, DiPersio JF, Link DC, Mardis ER, Ley TJ, Wilson RK, Graubert TA. Clonal architecture of secondary acute myeloid leukemia. N Engl J Med 2012; 366:1090-8. [PMID: 22417201 PMCID: PMC3320218 DOI: 10.1056/nejmoa1106968] [Citation(s) in RCA: 603] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The myelodysplastic syndromes are a group of hematologic disorders that often evolve into secondary acute myeloid leukemia (AML). The genetic changes that underlie progression from the myelodysplastic syndromes to secondary AML are not well understood. METHODS We performed whole-genome sequencing of seven paired samples of skin and bone marrow in seven subjects with secondary AML to identify somatic mutations specific to secondary AML. We then genotyped a bone marrow sample obtained during the antecedent myelodysplastic-syndrome stage from each subject to determine the presence or absence of the specific somatic mutations. We identified recurrent mutations in coding genes and defined the clonal architecture of each pair of samples from the myelodysplastic-syndrome stage and the secondary-AML stage, using the allele burden of hundreds of mutations. RESULTS Approximately 85% of bone marrow cells were clonal in the myelodysplastic-syndrome and secondary-AML samples, regardless of the myeloblast count. The secondary-AML samples contained mutations in 11 recurrently mutated genes, including 4 genes that have not been previously implicated in the myelodysplastic syndromes or AML. In every case, progression to acute leukemia was defined by the persistence of an antecedent founding clone containing 182 to 660 somatic mutations and the outgrowth or emergence of at least one subclone, harboring dozens to hundreds of new mutations. All founding clones and subclones contained at least one mutation in a coding gene. CONCLUSIONS Nearly all the bone marrow cells in patients with myelodysplastic syndromes and secondary AML are clonally derived. Genetic evolution of secondary AML is a dynamic process shaped by multiple cycles of mutation acquisition and clonal selection. Recurrent gene mutations are found in both founding clones and daughter subclones. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Matthew J Walter
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Arellano M, Bernal-Mizrachi L, Pan L, Tighiouart M, Souza L, Guo X, McLemore M, Lima L, Sunay S, Heffner LT, Chen Z, Chen GZ, Langston A, Winton E, Khoury HJ. Prognostic Significance of Leukopenia at the Time of Diagnosis in Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:427-32. [DOI: 10.1016/j.clml.2011.03.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/15/2011] [Accepted: 03/22/2011] [Indexed: 11/24/2022]
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Allen SL, Lundberg AS. Amonafide: a potential role in treating acute myeloid leukemia. Expert Opin Investig Drugs 2011; 20:995-1003. [PMID: 21591994 DOI: 10.1517/13543784.2011.585756] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Amonafide is a novel topoisomerase II (Topo II) inhibitor and DNA intercalator that induces apoptotic signaling by blocking the binding of Topo II to DNA. Amonafide retains cytotoxic activity even in the presence of P-glycoprotein (Pgp)-mediated multi-drug resistance (MDR), a major contributor to clinical treatment failure. AREAS COVERED In vitro, Pgp-mediated transport (efflux) of amonafide from myeloblasts obtained from patients with secondary acute myeloid leukemia (sAML) was significantly less than efflux of daunorubicin. Amonafide has shown efficacy in patients with sAML, as well as in patients with poor prognostic characteristics such as older age and unfavorable cytogenetics, all associated with MDR. Improved antileukemic activity is observed when amonafide is given together with cytarabine, rather than as monotherapy, with a complete remission rate of ∼ 40% in a recent Phase II trial in sAML. The efficacy of amonafide was maintained among poor-risk subsets of patients, including older patients and patients who had previous myelodysplastic syndrome or previous leukemogenic therapy. The safety profile was acceptable and manageable. EXPERT OPINION Amonafide plus cytarabine may have clinical utility in patients with sAML and in other poor-risk subgroups of acute myeloid leukemia (AML). Ongoing trials will help define the role for amonafide in the treatment of poor-risk AML.
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Affiliation(s)
- Steven L Allen
- Hofstra North Shore - LIJ School of Medicine, Monter Cancer Center, Lake Success, NY 10042, USA.
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Ferrara F. Treatment of Unfit Patients With Acute Myeloid Leukemia: A Still Open Clinical Challenge. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:10-6. [DOI: 10.3816/clml.2011.n.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ferrara F, Palmieri S, Izzo T, Criscuolo C, Riccardi C. Continuous sequential infusion of fludarabine and cytarabine for elderly patients with acute myeloid leukaemia secondary to a previously diagnosed myelodysplastic syndrome. Hematol Oncol 2010; 28:202-8. [DOI: 10.1002/hon.943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Koh Y, Kim I, Bae JY, Song EY, Kim HK, Yoon SS, Lee DS, Park SS, Park MH, Park S, Kim BK. Prognosis of Secondary Acute Myeloid Leukemia is Affected by the Type of the Preceding Hematologic Disorders and the Presence of Trisomy 8. Jpn J Clin Oncol 2010; 40:1037-45. [DOI: 10.1093/jjco/hyq097] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ostgård LSG, Kjeldsen E, Holm MS, Brown PDN, Pedersen BB, Bendix K, Johansen P, Kristensen JS, Nørgaard JM. Reasons for treating secondary AML as de novo AML. Eur J Haematol 2010; 85:217-26. [PMID: 20456491 DOI: 10.1111/j.1600-0609.2010.01464.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a Danish bi-regional registry-based study, we conducted an analysis of the incidence and clinical importance of secondary acute myeloid leukaemia (AML). In a total of 630 cases of AML, we found 157 (25%) cases of secondary AML. The secondary leukaemia arose from MDS (myelodysplastic syndrome) in 77 cases (49%), CMPD (chronic myeloproliferative disorder) in 43 cases (27%) and was therapy-related AML (t-AML) in 37 cases (24%). Median age at diagnosis of AML was 69 yr in secondary cases when compared to 66 yr in de novo cases (P = 0.006). In univariate analyses, secondary AML was associated with an inferior complete remission (CR) rate (P = 0.008) and poorer overall survival (OS, P = 0.003) whereas in complete remitters, disease-free survival (DFS) of secondary cases was equal to that of de novo cases. Interestingly, in all further analyses of CR-rates, OS and DFS, when correcting for the influence of age, cytogenetic abnormalities, performance status and leucocyte count (WBC), presence of secondary AML completely lost prognostic significance. We conclude that the presence of secondary AML does not per se convey an unfavourable prognosis and that patients with secondary AML should be offered the chance of benefiting from treatment according to current frontline AML protocols.
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