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Huang R, He H, Xu X, Lin X, Dong Y, Wang X, Jiang F, Huang P, Mo S, Huang Z, Wang Y, Tao H, Zheng Y, Wu M, Yang C, Zheng Z, Zhao Y, Zhang Y, Li Y. Venetoclax plus a hypomethylating agent versus cytarabine, aclarubicin, and granulocyte colony-stimulating factor chemotherapy as a first-line therapy for newly diagnosed acute myeloid leukemia: A propensity score-matched analysis. Cancer 2024; 130:2472-2481. [PMID: 38470375 DOI: 10.1002/cncr.35278] [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: 11/11/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Both venetoclax plus a hypomethylating agent (VEN/HMA) and cytarabine, aclarubicin, and granulocyte colony-stimulating factor (CAG) are low-intensity regimens for older patients with acute myeloid leukemia (AML) that show good efficacy and safety. It is unknown how VEN/HMA compares with the CAG regimen for the treatment of newly diagnosed AML. METHODS The outcomes of patients with newly diagnosed AML treated with VEN/HMA were compared with those of patients treated with a CAG-based regimen. Propensity score matching between these two cohorts at a 1:1 ratio was performed according to age at diagnosis, sex, Eastern Cooperative Oncology Group performance status, state of fitness, and European LeukemiaNet (ELN) 2022 risk stratification to minimize bias. RESULTS A total of 84 of 96 patients in the VEN/HMA cohort were matched with 84 of 147 patients in the CAG cohort. VEN/HMA resulted in a better response than the CAG-based regimens, as indicated by a higher composite complete remission (CRc) rate (82.1% vs. 60.7%; p = .002) and minimal residual disease negativity rate (88.2% vs. 68.2%; p = .009). In patients with an ELN adverse risk, VEN/HMA was associated with a higher CRc rate compared to CAG (80.5% vs. 58.3%; p = .006). VEN/HMA was associated with longer event-free survival (EFS) (median EFS, not reached vs. 4.5 months; p = .0004), whereas overall survival (OS) was comparable between the two cohorts (median OS, not reached vs. 18 months; p = .078). CONCLUSIONS The VEN/HMA regimen may result in a better response than CAG-based treatment in older patients with newly diagnosed AML.
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Affiliation(s)
- Rui Huang
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Honghua He
- Department of Hematology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoli Xu
- Department of Hematology, The First People's Hospital of Foshan, Foshan, China
| | - Xiaonan Lin
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ying Dong
- Department of Hematology, Maoming People's Hospital, Maoming, China
| | - Xiaotao Wang
- Department of Hematology, The Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Fang Jiang
- Department of Hematology, The Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Pengcheng Huang
- Department of Hematology, The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Shuyi Mo
- Department of Hematology, The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Zhenqian Huang
- Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaya Wang
- Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongfang Tao
- Department of Hematology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yaling Zheng
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ming Wu
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Chuting Yang
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ziyu Zheng
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ying Zhao
- Department of Hematology, The First People's Hospital of Foshan, Foshan, China
| | - Yuming Zhang
- Department of Hematology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuhua Li
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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The PIP4K2 inhibitor THZ-P1-2 exhibits antileukemia activity by disruption of mitochondrial homeostasis and autophagy. Blood Cancer J 2022; 12:151. [PMID: 36347832 PMCID: PMC9643393 DOI: 10.1038/s41408-022-00747-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
The treatment of acute leukemia is challenging because of the genetic heterogeneity between and within patients. Leukemic stem cells (LSCs) are relatively drug-resistant and frequently relapse. Their plasticity and capacity to adapt to extracellular stress, in which mitochondrial metabolism and autophagy play important roles, further complicates treatment. Genetic models of phosphatidylinositol-5-phosphate 4-kinase type 2 protein (PIP4K2s) inhibition have demonstrated the relevance of these enzymes in mitochondrial homeostasis and autophagic flux. Here, we uncovered the cellular and molecular effects of THZ-P1-2, a pan-inhibitor of PIP4K2s, in acute leukemia cells. THZ-P1-2 reduced cell viability and induced DNA damage, apoptosis, loss of mitochondrial membrane potential, and the accumulation of acidic vesicular organelles. Protein expression analysis revealed that THZ-P1-2 impaired autophagic flux. In addition, THZ-P1-2 induced cell differentiation and showed synergistic effects with venetoclax. In primary leukemia cells, LC-MS/MS-based proteome analysis revealed that sensitivity to THZ-P1-2 is associated with mitochondrial metabolism, cell cycle, cell-of-origin (hematopoietic stem cell and myeloid progenitor), and the TP53 pathway. The minimal effects of THZ-P1-2 observed in healthy CD34+ cells suggest a favorable therapeutic window. Our study provides insights into the pharmacological inhibition of PIP4K2s targeting mitochondrial homeostasis and autophagy, shedding light on a new class of drugs for acute leukemia.
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Bérard E, Röllig C, Bertoli S, Pigneux A, Tavitian S, Kramer M, Serve H, Bornhäuser M, Platzbecker U, Müller-Tidow C, Baldus CD, Martínez-Cuadrón D, Serrano J, Martínez-Sánchez P, Arbolí ER, Gil C, Bergua J, Bernal T, de la Fuente Burguera A, Delabesse E, Bidet A, Dumas PY, Montesinos P, Récher C. A scoring system for AML patients aged 70 years or older, eligible for intensive chemotherapy: a study based on a large European data set using the DATAML, SAL, and PETHEMA registries. Blood Cancer J 2022; 12:107. [PMID: 35821023 PMCID: PMC9276717 DOI: 10.1038/s41408-022-00700-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/09/2022] Open
Abstract
In a context of therapeutic revolution in older adults with AML, it is becoming increasingly important to select patients for the various treatment options by taking account of short-term efficacy and toxicity as well as long-term survival. Here, the data from three European registries for 1,199 AML patients aged 70 years or older treated with intensive chemotherapy were used to develop a prognostic scoring system. The median follow-up was 50.8 months. In the training set of 636 patients, age, performance status, secondary AML, leukocytosis, and cytogenetics, as well as NPM1 mutations (without FLT3-ITD), were all significantly associated with overall survival, albeit not to the same degree. These factors were used to develop a score that predicts long-term overall survival. Three risk-groups were identified: a lower, intermediate and higher-risk score with predicted 5-year overall survival (OS) probabilities of ≥12% (n = 283, 51%; median OS = 18 months), 3-12% (n = 226, 41%; median OS = 9 months) and <3% (n = 47, 8%; median OS = 3 months), respectively. This scoring system was also significantly associated with complete remission, early death and relapse-free survival; performed similarly in the external validation cohort (n = 563) and showed a lower false-positive rate than previously published scores. The European Scoring System ≥70, easy for routine calculation, predicts long-term survival in older AML patients considered for intensive chemotherapy.
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Affiliation(s)
- Emilie Bérard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, CERPOP, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum TU Dresden, Dresden, Germany
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Arnaud Pigneux
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Université de Bordeaux, Institut National de la Santé et de la Recherche Médicale, U1035, 33000, Bordeaux, France
| | - Suzanne Tavitian
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Michael Kramer
- Medizinische Klinik und Poliklinik I, Universitätsklinikum TU Dresden, Dresden, Germany
| | - Hubert Serve
- Medizinische Klinik 2, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum TU Dresden, Dresden, Germany
| | - Uwe Platzbecker
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Carsten Müller-Tidow
- Klinik für Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Claudia D Baldus
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | | | | | | | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Juan Bergua
- Hospital San Pedro Alcántara, Cáceres, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Asturias, Spain
| | | | - Eric Delabesse
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Laboratoire d'Hématologie Biologique, Toulouse, France
| | - Audrey Bidet
- CHU Bordeaux, Laboratoire d'Hématologie Biologique, F-33000, Bordeaux, France
| | - Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Université de Bordeaux, Institut National de la Santé et de la Recherche Médicale, U1035, 33000, Bordeaux, France
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France.
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