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Ohanian M, Rozovski U, Kanagal-Shamanna R, Abruzzo LV, Loghavi S, Kadia T, Futreal A, Bhalla K, Zuo Z, Huh YO, Post SM, Ruvolo P, Garcia-Manero G, Andreeff M, Kornblau S, Borthakur G, Hu P, Medeiros LJ, Takahashi K, Hornbaker MJ, Zhang J, Nogueras-González GM, Huang X, Verstovsek S, Estrov Z, Pierce S, Ravandi F, Kantarjian HM, Bueso-Ramos CE, Cortes JE. MYC protein expression is an important prognostic factor in acute myeloid leukemia. Leuk Lymphoma 2019; 60:37-48. [PMID: 29741984 PMCID: PMC6226369 DOI: 10.1080/10428194.2018.1464158] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As new drugs targeting MYC show clinical activity in acute myeloid leukemia (AML), understanding MYC expression in AML is of critical importance. We assessed MYC protein expression by immunohistochemistry in bone marrow of patients with untreated AML (n = 265). Overall, 90% of patients demonstrated MYC overexpression and MYC immunopositivity ≤6% was associated with superior complete remission (CR) duration of 23 months versus 12 months for MYC immunopositivity >6% (p = .028). Among 241 patients at higher risk for relapse, including those ≥55 years of age and patients with intermediate- and high-risk AML, MYC immunopositivity ≤6% conferred significantly superior median overall survival (OS) (24 versus 13 months; p = .042), event-free survival (EFS) (14 versus 6 months; p = .048), and relapse-free survival (RFS) (25 versus 12 months; p = .024). The prognostic impact of MYC-immunopositivity was retained on multivariate analysis of OS, EFS, and RFS. We conclude that MYC immunopositivity is an important prognostic factor in patients with untreated AML, particularly those at higher risk for relapse.
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Affiliation(s)
- Maro Ohanian
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Uri Rozovski
- Department of Hematology, Davidoff Cancer Center at Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Lynne V. Abruzzo
- Department of Pathology, Ohio State University, Columbus, OH 43202
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Tapan Kadia
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | - Kapil Bhalla
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Zhuang Zuo
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Yang O. Huh
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Sean M. Post
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Peter Ruvolo
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Michael Andreeff
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Steven Kornblau
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Peter Hu
- School of Health Professions, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Marisa J. Hornbaker
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | | | - Xuelin Huang
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Zeev Estrov
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Sherry Pierce
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Hagop M. Kantarjian
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Carlos E. Bueso-Ramos
- Department of Hematopathology, The University of Texas at MD Anderson Cancer Center Houston, Texas
| | - Jorge E. Cortes
- Department of Leukemia, The University of Texas at MD Anderson Cancer Center, Houston, Texas
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Huang LW, Olin RL. Emerging therapeutic modalities for acute myeloid leukemia (AML) in older adults. J Geriatr Oncol 2017; 8:417-420. [PMID: 28835351 DOI: 10.1016/j.jgo.2017.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/29/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
Treatment for the older adult with acute myeloid leukemia (AML) is challenging, due to both more aggressive disease biology as well as patient-related risk factors that limit tolerance of intensive chemotherapy. The use of prognostic models and comprehensive geriatric assessments can help hematologists evaluate the suitability of intensive chemotherapy for individual patients. For older patients considered fit for intensive chemotherapy, standard induction therapy should be given, followed by consideration of reduced intensity allogeneic stem cell transplantation. Patients considered unfit for intensive therapy are standardly treated with hypomethylating agents. Several new therapeutic agents have shown promising results either by improving intensive chemotherapy (CPX-351), by improving upon lower intensity therapy (venetoclax, antibody drug conjugates), or by targeting somatic mutations (FLT3 inhibitors and others).
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Affiliation(s)
- Li-Wen Huang
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, USA.
| | - Rebecca L Olin
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, USA.
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