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Expression of Hippo signaling pathway and Aurora kinase genes in chronic myeloid leukemia. Med Oncol 2018; 35:26. [PMID: 29387948 DOI: 10.1007/s12032-018-1079-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/08/2018] [Indexed: 12/19/2022]
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm resulting from clonal expansion of hematopoietic stem cells positive for the Philadelphia chromosome. The CML pathogenesis is associated with expression of the BCR-ABL1 oncogene, which encodes the Bcr-Abl protein with tyrosine kinase activity, promoting the leukemic cell exacerbated myeloproliferation and resistance to apoptosis. CML patients are usually treated with tyrosine kinase inhibitors (TKI), but some of them acquire resistance or are refractory to TKI. Thus, it is still relevant to elucidate the CML pathogenesis and seek new therapeutic targets, such as the Hippo signaling pathway and cell cycle regulatory genes from the Aurora kinase family. The present study quantified the expression level of genes encoding components of the Hippo signaling pathway (LATS1, LATS2, YAP, and TAZ), AURKA and AURKB in CML patients at different stages of the disease, who were resistant or sensitive to imatinib mesylate therapy, and in healthy individuals. The expression levels of the target genes were correlated with the CML Sokal's prognostic score. The most striking results were the LATS2 and AURKA overexpression in CML patients, the overexpression of TAZ and AURKB in CML patients at advanced phases and TAZ in CML IM-resistant. The development of drugs and/or identification of tumor markers for the Hippo signaling pathway and the Aurora kinase family, either alone or in combination, can optimize CML treatment by enhancing the susceptibility of leukemic cells to apoptosis and leading to a better disease prognosis.
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Sercan Z, Pehlivan M, Gokturk D, Sercan HO. Beta-Catenin Mutations are not Observed in Chronic Myeloid Leukemia. TUMORI JOURNAL 2018; 95:836-9. [DOI: 10.1177/030089160909500633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Studies reporting activated Wnt signaling in all stages of chronic myeloid leukemia (CML) have demonstrated that deregulation of the pathway plays a role in the pathogenesis of this disease. Several reports have suggested mechanisms for the deregulated Wnt signaling and beta-catenin stabilization observed in CML. One possible mechanism for beta-catenin stabilization could be the acquisition of mutations at its N-terminal domain, especially in the third exon where it is marked via phosphorylation for degradation. We sought to determine whether mutations in the third exon of the beta-catenin gene are responsible for the observed Wnt activation in CML Material and Methods We screened bone marrow specimens from 33 patients with CML in the chronic phase and also examined the K562 cell line for beta-catenin mutations. Results None of the patients nor the K562 cell line were found to carry mutations. Conclusion Beta-catenin amino-terminal mutations are not observed or very rare and therefore are not the underlying mechanism of activated Wnt signaling in CML.
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Affiliation(s)
- Zeynep Sercan
- Department of Medical Biology and Genetics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Melek Pehlivan
- Department of Medical Biology and Genetics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Dilek Gokturk
- Department of Medical Biology and Genetics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Hakki Ogun Sercan
- Department of Medical Biology and Genetics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Tanaka R, Kimura S. Abl tyrosine kinase inhibitors for overriding Bcr–Abl/T315I: from the second to third generation. Expert Rev Anticancer Ther 2014; 8:1387-98. [DOI: 10.1586/14737140.8.9.1387] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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4
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Dingli D, Traulsen A, Lenaerts T, Pacheco JM. Evolutionary dynamics of chronic myeloid leukemia. Genes Cancer 2011; 1:309-15. [PMID: 21779452 DOI: 10.1177/1947601910371122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cancer is an evolutionary process that arises due to mutations and expands through the selection of clones with higher reproductive success that will outcompete their peers. Most tumors require many mutations to explain the cancer phenotype, making it difficult to identify the gene(s) that confer the reproductive fitness to the clone. Moreover, the impact of any oncogene is context dependent: it can increase the fitness of particular stages of cell differentiation but not other stages. In addition, the fitness advantage of an oncogene is not irreversible: sometimes it can be reversed with targeted therapy, for example. The understanding of these dynamical processes and their consequences may be greatly simplified when addressed from an evolutionary perspective. Using the dynamics of chronic myeloid leukemia-perhaps the best understood human neoplasm-as an example, we show how three fundamental evolutionary behaviors provide insights into the dynamics of this disease: (1) BCR-ABL does not affect the reproductive success of any cell within the stem cell pool (resulting therefore in neutral drift), (2) BCR-ABL expression gives a fitness (selective) advantage to progenitor cells, and (3) imatinib therapy reduces the fitness of progenitor cells expressing the oncogene (selective disadvantage) and consequently leads to significant reductions in disease burden. These three different evolutionary dynamics scenarios based on the interpretation of mutation and gene expression as potentially leading to a fitness imbalance of cell populations clearly explain the course of the disease, providing as such a better grasp of cancer dynamics and the role of related therapies.
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Affiliation(s)
- David Dingli
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Mendonça LS, Moreira JN, de Lima MCP, Simões S. Co-encapsulation of anti-BCR-ABL siRNA and imatinib mesylate in transferrin receptor-targeted sterically stabilized liposomes for chronic myeloid leukemia treatment. Biotechnol Bioeng 2010; 107:884-93. [DOI: 10.1002/bit.22858] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mendonça LS, Firmino F, Moreira JN, Pedroso de Lima MC, Simões S. Transferrin receptor-targeted liposomes encapsulating anti-BCR-ABL siRNA or asODN for chronic myeloid leukemia treatment. Bioconjug Chem 2010; 21:157-68. [PMID: 20000596 DOI: 10.1021/bc9004365] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The present work aimed at the development and application of transferrin receptor (TrfR)-targeted sterically stabilized liposomes encapsulating anti-BCR-ABL siRNA or asODN. Transferrin was coupled to the surface of liposomes encapsulating siRNA or asODN through the postinsertion method. Cell association and internalization were assessed by flow cytometry and confocal microscopy, respectively. BCR-ABL mRNA and Bcr-Abl protein levels were evaluated by qRT-PCR and Western blot, respectively. Cell viability was assessed using the resazurin reduction method. The amount of coupled transferrin and the size and stability over time of the liposomes were very satisfactory and reproducible. The siRNA encapsulation yield was dependent on the concentration of the encapsulation buffer used (20 or 300 mM), as opposed to asODN encapsulation yield which was high for both concentrations tested. Cell association and internalization studies were performed in leukemia cell lines treated with liposomes coupled to Trf (Trf-liposomes) or albumin (BSA-liposomes) or with nontargeted liposomes (NT-liposomes) encapsulating fluorescently labeled siRNA (Cy3-siRNA). These experiments clearly indicated that BSA- and NT-liposomes have no ability to promote the delivery of the encapsulated nucleic acids and that the Trf-liposomes deliver the nucleic acids by a Trf receptor-dependent mechanism. The Trf-liposomes encapsulating siRNA or asODN promote sequence-specific down-regulation of the BCR-ABL mRNA, although a certain extent of nonspecific sequence effects at the protein and cell viability level were observed. Overall, our results indicate that Trf-liposomes encapsulating gene silencing tools allow combining molecular and cellular targeting, which is a valuable approach for cancer treatment.
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Dingli D, Pacheco JM. Modeling the architecture and dynamics of hematopoiesis. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2010; 2:235-244. [DOI: 10.1002/wsbm.56] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- David Dingli
- Division of Hematology, Department of Molecular Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Biomathematics Research Group, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jorge M. Pacheco
- Applied Theoretical Physics Group, Departamento de Fisica de Faculdade de Ciencias, Universidade de Lisboa, 1649‐003 Lisboa Codex, Portugal
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Pacheco JM, Traulsen A, Dingli D. The allometry of chronic myeloid leukemia. J Theor Biol 2009; 259:635-40. [PMID: 19362566 DOI: 10.1016/j.jtbi.2009.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 04/02/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
Chronic myeloid leukemia (CML) is an acquired neoplastic hematopoietic stem cell (HSC) disorder characterized by the expression of the BCR-ABL oncoprotein. This gene product is necessary and sufficient to explain the chronic phase of CML. The only known cause of CML is radiation exposure leading to a mutation of at least one HSC, although the vast majority of patients with CML do not have a history of radiation exposure. Nonetheless, in humans, significant radiation exposure (after exposure to atomic bomb fallout) leads to disease diagnosis in 3-5 years. In murine models, disease dynamics are much faster and CML is fatal over the span of a few months. Our objective is to develop a model that accounts for CML across all mammals. In the following, we combine a model of CML dynamics in humans with allometric scaling of hematopoiesis across mammals to illustrate the natural history of chronic phase CML in various mammals. We show how a single cell can lead to a fatal illness in mice and humans but a higher burden of CML stem cells is necessary to induce disease in larger mammals such as elephants. The different dynamics of the disease is rationalized in terms of mammalian mass. Our work illustrates the relevance of animal models to understand human disease and highlights the importance of considering the re-scaling of the dynamics that accrues to the same biological process when planning experiments involving different species.
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Affiliation(s)
- Jorge M Pacheco
- ATP-Group, CFTC & Departamento de Física da Faculdade de Ciências, P-1649-003 Lisboa Codex, Portugal
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Yeh CH, Tseng R, Zhang Z, Cortes J, O'Brien S, Giles F, Hannah A, Estrov Z, Keating M, Kantarjian H, Albitar M. Circulating heat shock protein 70 and progression in patients with chronic myeloid leukemia. Leuk Res 2008; 33:212-7. [PMID: 18715642 DOI: 10.1016/j.leukres.2008.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
We evaluated the association of circulating levels of heat shock protein 70 (Hsp70) in plasma with clinical behavior and progression in 139 chronic myeloid leukemia (CML) patients. Circulating Hsp70 levels did not differ significantly between CML patients in the chronic phase (n=93; median 33.24 ng/mL, range 3.89-128.2 ng/mL) and those in the accelerated/blast phase (n=46; median 26.57 ng/mL, range 4.5-114.7 ng/mL). However, overall CML patients had significantly higher levels of Hsp70 than healthy subjects (n=95, median 4.17 ng/mL, range 1.75-24.7 ng/mL) (P<0.001). In chronic phase CML patients, Hsp70 levels above the median were associated with a higher rate of progression to the accelerated/blast phase and a tendency toward shorter survival. Plasma Hsp70 thus could be a potential marker for predicting disease progression in patients with chronic phase CML.
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Affiliation(s)
- Chen-Hsiung Yeh
- Department of Hematopathology, 33608 Ortega Highway, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA 92690, United States
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Dingli D, Traulsen A, Pacheco JM. Chronic Myeloid Leukemia: Origin, Development, Response to Therapy, and Relapse. ACTA ACUST UNITED AC 2008. [DOI: 10.3816/clk.2008.n.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dilda PJ, Hogg PJ. Arsenical-based cancer drugs. Cancer Treat Rev 2007; 33:542-64. [PMID: 17624680 DOI: 10.1016/j.ctrv.2007.05.001] [Citation(s) in RCA: 276] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 05/21/2007] [Accepted: 05/23/2007] [Indexed: 01/04/2023]
Abstract
Arsenic is a semi-metal or metalloid with two biologically important oxidation states, As(III) and As(V). As(III), in particular, reacts with closely spaced protein thiols, forming stable cyclic dithioarsinite complexes in which both sulfur atoms are bound to arsenic. It is this reaction that is mostly responsible for arsenics cytotoxicity. Arsenic compounds have been used as medicinal agents for many centuries for the treatment of diseases such as psoriasis, syphilis, and rheumatosis. From the 1700's until the introduction of and use of modern chemotherapy and radiation therapy in the mid 1900's, arsenic was a mainstay in the treatment of leukemia. Concerns about the toxicity of arsenical compounds led eventually to their abandonment for the treatment of cancer. The discovery in the 1980's that arsenic trioxide induces complete remission in a high percentage of patients with acute promyelocytic leukemia has awakened interest in this metalloid for the treatment of human disease. In particular, a new class or organoarsenicals are being trialed for the treatment of hematological malignancies and solid tumors. In this review, we discuss the arsenical-based compounds used in the past and present for the treatment of various forms of cancer. Mechanisms of action and selectivity and acute and chronic toxicities are discussed along with the prospects of this class of molecule.
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Affiliation(s)
- Pierre J Dilda
- UNSW Cancer Research Centre, University of New South Wales and Department of Haematology, Prince of Wales Hospital, Sydney 2052, Australia
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Ito T, Tanaka H, Kimura A. Establishment and characterization of a novel imatinib-sensitive chronic myeloid leukemia cell line MYL, and an imatinib-resistant subline MYL-R showing overexpression of Lyn. Eur J Haematol 2007; 78:417-31. [PMID: 17432977 DOI: 10.1111/j.1600-0609.2007.00835.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In chronic myeloid leukemia (CML), resistance to imatinib is diverse. In addition to BCR-ABL-dependent mechanisms, BCR-ABL-independent mechanisms have been proposed. Here we established and characterized novel CML cell lines, an imatinib-sensitive cell line, MYL, and an imatinib-resistant subline, MYL-R. Treatment with imatinib inhibited phosphorylation of BCR-ABL and CrkL in both MYL and MYL-R, even though imatinib-induced apoptosis was preferentially observed in MYL than MYL-R, indicating that the resistance is based on a BCR-ABL-independent mechanism. MYL-R showed elevated expressions of Lyn mRNA, Lyn protein, phosphorylated Lyn, and phosphorylated STAT5. Silencing of Lyn by short-interfering RNA (siRNA) in MYL-R, but not in MYL, induced significant growth-inhibition, increased caspase-3 activity, and induced partial recovery from imatinib-resistance. Expression of Bcl-2, previously reported to be associated with Lyn-mediated resistance, was not elevated in MYL-R. Expression of Bim, which plays an important role in imatinib-induced cell-killing, was not suppressed in MYL-R. These results imply that diverse mechanisms of resistance exist among cell types. Treatment of MYL-R cells with various reagents known to have anti-leukemic activity revealed that zoledronic acid and the farnesyl transferase inhibitor (SCH 66336) showed strong synergism with imatinib; interferon alpha, PP2, CGP76030, and FK228 (depsipeptide) showed synergism; whereas soluble TRAIL and As2O3 showed additivity or antagonism, and 17-AAG and radicicol showed antagonism. Treatment with either PP2 or zoledronic acid induced greater growth-reduction in MYL-R than MYL. Taken together, Lyn may play an important role in imatinib-resistance in MYL-R. Some novel reagents, including siRNA targeting Lyn, may have good potential to overcome this resistance.
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Affiliation(s)
- Takuo Ito
- Department of Hematology and Oncology, Division of Clinical and Experimental Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Tanaka H, Ito T, Kyo T, Kimura A. Treatment with IFNalpha in vivo up-regulates serum-soluble TNF-related apoptosis inducing ligand (sTRAIL) levels and TRAIL mRNA expressions in neutrophils in chronic myelogenous leukemia patients. Eur J Haematol 2007; 78:389-98. [PMID: 17432976 DOI: 10.1111/j.1600-0609.2007.00834.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is an interferon alpha (IFNalpha)-induced, apoptosis-inducing molecule. TRAIL could be one of the reagents for therapeutic use in combination with imatinib in chronic myeloid leukemia (CML). Here we examined serum-soluble TRAIL (sTRAIL) levels in CML patients either before or during therapies with IFNalpha or imatinib. In untreated CML patients, serum sTRAIL was detectable and the levels were substantially comparable with those in healthy donors. sTRAIL levels significantly increased in patients during IFNalpha therapy, but not at all in patients during imatinib therapy. TRAIL mRNA expressions in neutrophils in CML patients undergoing IFNalpha therapy was significantly elevated when compared with those in patients prior to therapy. TRAIL mRNA expressions were also detectable in CD34-positive cells in bone marrow, and the levels increased in patients during IFNalpha therapy. In vitro IFNalpha stimulation of CML neutrophils increased intracellular TRAIL rather than cell-surface TRAIL, and the secretion of sTRAIL in the culture supernatant was observed. This sTRAIL secretion was augmented with lipopolysaccharide (LPS) stimulation only in IFNalpha-primed neutrophils, whereas LPS alone had no effect. Taken together, in vivo IFNalpha treatment provokes the release of sTRAIL when administered systematically in CML patients. The main source of the IFNalpha-induced serum sTRAIL may be neutrophils in CML, and sTRAIL may be one of the mechanisms of the anti-proliferative action of IFNalpha on CML. These findings give another rationale for the use of IFNalpha or recombinant sTRAIL in CML, and also implicate the potential importance of neutrophils in tumor immunosurveillance.
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Affiliation(s)
- Hideo Tanaka
- Department of Hematology and Oncology, Division of Clinical and Experimental Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
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Pocaly M, Lagarde V, Etienne G, Ribeil JA, Claverol S, Bonneu M, Moreau-Gaudry F, Guyonnet-Duperat V, Hermine O, Melo JV, Dupouy M, Turcq B, Mahon FX, Pasquet JM. Overexpression of the heat-shock protein 70 is associated to imatinib resistance in chronic myeloid leukemia. Leukemia 2006; 21:93-101. [PMID: 17109025 DOI: 10.1038/sj.leu.2404463] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Imatinib is an effective therapy for chronic myeloid leukemia (CML), a myeloproliferative disorder characterized by the expression of the recombinant oncoprotein Bcr-Abl. In this investigation, we studied an imatinib-resistant cell line (K562-r) generated from the K562 cell line in which none of the previously described mechanisms of resistance had been detected. A threefold increase in the expression of the heat-shock protein 70 (Hsp70) was detected in these cells. This increase was not associated to heat-shock transcription factor-1 (HSF-1) overexpression or activation. RNA silencing of Hsp70 decreased dramatically its expression (90%), and was accompanied by a 34% reduction in cell viability. Overexpression of Hsp70 in the imatinib-sensitive K562 line induced resistance to imatinib as detected by a large reduction in cell death in the presence of 1 muM of imatinib. Hsp70 level was also increased in blast cells of CML patients resistant to imatinib, whereas the level remained low in responding patients. Taken together, the results demonstrate that overexpression of Hsp70 can lead to both in vitro and in vivo resistance to imatinib in CML cells. Moreover, the overexpression of Hsp70 detected in imatinib-resistant CML patients supports this mechanism and identifies potentially a marker and a therapeutic target of CML evolution.
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MESH Headings
- Biomarkers, Tumor
- Cell Line, Tumor
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Neoplastic
- HSP70 Heat-Shock Proteins/biosynthesis
- HSP70 Heat-Shock Proteins/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Up-Regulation
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Affiliation(s)
- M Pocaly
- E0217 INSERM, Université Victor SEGALEN Bordeaux 2, Hématopoïèse Leucémique et Cibles Thérapeutiques, Bordeaux cedex, France
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Wei Y, Hardling M, Olsson B, Hezaveh R, Ricksten A, Stockelberg D, Wadenvik H. Not all imatinib resistance in CML are BCR-ABL kinase domain mutations. Ann Hematol 2006; 85:841-7. [PMID: 17006667 DOI: 10.1007/s00277-006-0171-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 07/04/2006] [Indexed: 11/30/2022]
Abstract
Point mutations within the ABL kinase domain of the BCR-ABL gene are associated with clinical resistance to imatinib mesylate in chronic myeloid leukemia (CML). To obtain more information about the association between BCR-ABL mutations and type of imatinib resistance, we studied 30 early chronic phase (CP) CML patients, commencing imatinib therapy, using a conventional sequencing technique. Seven patients treated in late CP and three patients treated in the accelerated phase were included for comparison. Blood samples were collected before and every third month during imatinib therapy. Mutations were not seen in any blood sample collected before start of therapy. During imatinib treatment, 2 of the 30 early CP patients acquired point mutations and both of them had other signs of imatinib resistance. None of the five early CP patients with a complete hematologic response (HR), but no cytogenetic response at 12 months, displayed any missense mutation. Likewise, none of 12 early CP patients with detectable BCR-ABL transcripts but in complete hematologic and cytogenetic remission at 12 months displayed any mutation. We conclude that screening early CP patients for BCR-ABL mutations before start of imatinib therapy is not cost-effective. BCR-ABL kinase domain mutations do not appear to explain cytogenetic or molecular (detectable BCR-ABL transcripts by polymerase chain reaction) disease persistence in patients otherwise in stable disease. However, in patients with signs of expanding disease burden, a search for BCR-ABL mutations is warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Benzamides
- Drug Resistance, Neoplasm/genetics
- Female
- Fusion Proteins, bcr-abl/genetics
- Gene Frequency
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Mutation
- Neoplasm Staging
- Piperazines/therapeutic use
- Prognosis
- Protein Kinases/genetics
- Protein Structure, Tertiary/genetics
- Pyrimidines/therapeutic use
- Treatment Outcome
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Affiliation(s)
- Yuan Wei
- Department of Internal Medicine/Haematology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
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Abstract
Blood eosinophilia signifies either a cytokine-mediated reactive phenomenon (secondary) or an integral phenotype of an underlying haematological neoplasm (primary). Secondary eosinophilia is usually associated with parasitosis in Third World countries and allergic conditions in the West. Primary eosinophilia is operationally classified as being clonal or idiopathic, depending on the respective presence or absence of a molecular, cytogenetic or histological evidence for a myeloid malignancy. The current communication features a comprehensive clinical summary of both secondary and primary eosinophilic disorders with emphasis on recent developments in molecular pathogenesis and treatment.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Yang H, Eaves C, de Lima M, Lee MS, Champlin RE, McMannis JD, Robinson SN, Niu T, Decker WK, Xing D, Ng J, Li S, Yao X, Eaves AC, Jones R, Andersson BS, Shpall EJ. A novel triple purge strategy for eliminating chronic myelogenous leukemia (CML) cells from autografts. Bone Marrow Transplant 2006; 37:575-82. [PMID: 16435011 DOI: 10.1038/sj.bmt.1705284] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Imatinib-refractory chronic myelogenous leukemia (CML) patients can experience long-term disease-free survival with myeloablative therapy and allogeneic hematopoietic cell transplantation; however, associated complications carry a significant risk of mortality. Transplantation of autologous hematopoietic cells has a reduced risk of complications, but residual tumor cells in the autograft may contribute to relapse. Development of methods for purging tumor cells that do not compromise the engraftment potential of the normal hematopoietic cells in the autograft has been a long-standing goal. Since primitive CML cells differentiate more rapidly in vitro than their normal counterparts and are also preferentially killed by mafosfamide and imatinib, we examined the purging effectiveness on CD34(+) CML cells using a strategy that combines a brief exposure to imatinib (0.5-1.0 microM for 72 h) and then mafosfamide (30-90 microg/ml for 30 min) followed by 2 weeks in culture with cytokines (100 ng/ml each of stem cell factor, granulocyte colony-stimulating factor and thrombopoietin). Treatment with 1.0 microM imatinib, 60 microg/ml mafosfamide and 14 days of culture with cytokines eliminated BCR-ABL(+) cells from chronic phase CML patient aphereses, while preserving normal progenitors. This novel purging strategy may offer a new approach to improving the effectiveness of autologous transplantation in imatinib-refractory CML patients.
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MESH Headings
- Antigens, CD/blood
- Antigens, CD34/blood
- Antineoplastic Agents/therapeutic use
- Benzamides
- Bone Marrow Purging/methods
- Cell Separation/methods
- Cell Survival
- Cyclophosphamide/analogs & derivatives
- Cyclophosphamide/therapeutic use
- Flow Cytometry
- Humans
- Imatinib Mesylate
- K562 Cells
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Neoplastic Cells, Circulating/pathology
- Piperazines/therapeutic use
- Pyrimidines/therapeutic use
- Stem Cell Transplantation/methods
- Transplantation, Autologous/methods
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Affiliation(s)
- H Yang
- Department of Blood and Marrow Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Savani BN, Montero A, Kurlander R, Childs R, Hensel N, Barrett AJ. Imatinib synergizes with donor lymphocyte infusions to achieve rapid molecular remission of CML relapsing after allogeneic stem cell transplantation. Bone Marrow Transplant 2006; 36:1009-15. [PMID: 16205732 DOI: 10.1038/sj.bmt.1705167] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Donor lymphocyte infusions (DLI) have been the mainstay of treatment for chronic myeloid leukemia (CML) relapsing after allogeneic stem cell transplantation (allo-SCT). Imatinib mesylate (IM) is also effective in these patients. However, advanced phase relapse (APRel) responds poorly with either treatment. To test the possibility that combinations of DLI and IM might be more effective, 37 patients with CML relapsing after allo-SCT between August 1994 and May 2004 were studied. Ten had molecular relapse (MRel), 14 hematological relapse (HRel) and 13 APRel. Thirteen received DLI, 9 IM and 11 DLI+IM. Four patients received DLI+IM but not concurrently. Thirty (81%) patients responded (actuarial survival and current leukemia-free survival of 80.6 +/- 6.7% and 69.1 +/- 7.7%). Of 30 patients, 26 are in molecular remission (MR), median follow-up of 1,226 days (range 249-3257) since relapse. Ten of 11 patients (including four with APRel) treated with DLI+IM achieved MR in 3 months and all are alive in MR. In contrast, only two of 22 treated with either modality (1/13 DLI and 1/9 IM) achieved MR at 3 months, 15 are alive, 11 in MR. Four patients receiving nonconcurrent DLI+IM are also alive in MR. In conclusion, DLI appears to synergize with IM to induce rapid and durable MR.
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Affiliation(s)
- B N Savani
- Stem Cell Allogeneic Transplantation Section, Hematology Branch, NHLBI, National Institutes of Health, Building 10, Hatfield CRC, 10 Center Drive MSC 1202, Bethesda, MD 20892-1202, USA
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21
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Mauro MJ, Maziarz RT. Stem cell transplantation in patients with chronic myelogenous leukemia: when should it be used? Mayo Clin Proc 2006; 81:404-16. [PMID: 16529146 DOI: 10.4065/81.3.404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hematopoietic stem cell transplantation has been a cornerstone of therapy for chronic myelogenous leukemia (CML) for more than 15 years and is still a standard treatment option for patients with CML. The advent of imatinib mesylate, an inhibitor of the molecular defect driving CML, the BCR-ABL tyrosine kinase, has rewritten treatment algorithms for this disease and has shifted focus away from allografting. Despite advances in stem cell transplantation, such as broader availability with the use of modified conditioning regimens, use of allografting has diminished. Also, the nearly universal patient exposure to imatinib or other kinase inhibitors before transplantation may affect the biology of the disease that is currently being treated with an allograft and ultimately may affect outcomes. Exceedingly high rates of meaningful and stable response with longer follow-up continue to drive enthusiasm for imatinib use, and understanding of resistance mechanisms has driven rapid investigation of second-generation tyrosine kinase inhibitors to address imatinib failure and suboptimal response. In most patients, imatinib reduces CML to a minimal residual disease state in which options to further deepen remission, such as immunotherapy, are sought; monitoring techniques and interpretation of response advance in parallel to meet demands; and uncertainty remains as a new natural history of CML is defined in an era of kinase inhibitor therapy. This review summarizes the state of transplant and nontransplant therapy for CML and discusses the decision making for patients with an aim to optimize the use of our best therapies for CML in an era of uncertainty.
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Affiliation(s)
- Michael J Mauro
- Center for Hematologic Malignancies, Oregon Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN73C, Portland, OR 97239, USA.
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22
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Jørgensen HG, Allan EK, Mountford JC, Richmond L, Harrison S, Elliott MA, Holyoake TL. Enhanced CML stem cell elimination in vitro by bryostatin priming with imatinib mesylate. Exp Hematol 2005; 33:1140-6. [PMID: 16219536 DOI: 10.1016/j.exphem.2005.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 05/24/2005] [Accepted: 05/27/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In chronic myeloid leukemia (CML), imatinib mesylate (IM; Gleevec, Glivec) induces a G0/G1 cell-cycle block in total CD34(+) cells without causing significant apoptosis. Bryostatin-1 (bryo), a protein kinase C (PKC) modulator, was investigated for its ability to increase IM-mediated apoptosis either through induction of cycling of G0/G1 Ph(+) cells or antagonism of the IM-induced cell-cycle block. METHODS The Ph(+) K562 cell line and primary CD34(+) CML cells were studied for cell-cycle progression (PI staining), proliferation ((3)H thymidine uptake), and survival (dye exclusion). RESULTS Following 48 hours exposure to IM, on average more than 80% of surviving K562 cells were in G0/G1 as compared to approximately 50% for untreated control cultures (p < 0.001). After accounting for IM-induced cell kill, the absolute number of viable G0/G1 cells was significantly increased, confirming its anti-proliferative effect. However, pretreatment for 24 hours with bryo both increased K562 total cell kill and normalized the percentage of cells recovered in G0/G1, thus reducing their absolute number. For primary CML CD34(+) cells, pretreatment with bryo prior to IM significantly enhanced cell death of both total and, critically, G0/G1 populations. CONCLUSION These results suggest that carefully scheduled drug combinations that include an agent to antagonize the anti-proliferative effect of IM may prove more efficacious within the Ph(+) stem cell compartment than IM monotherapy.
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MESH Headings
- Antigens, CD34/metabolism
- Antineoplastic Agents/pharmacology
- Apoptosis/drug effects
- Benzamides
- Bryostatins
- Drug Antagonism
- G1 Phase/drug effects
- Hematopoietic Stem Cells/metabolism
- Hematopoietic Stem Cells/pathology
- Humans
- Imatinib Mesylate
- K562 Cells
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Macrolides/antagonists & inhibitors
- Macrolides/pharmacology
- Piperazines/antagonists & inhibitors
- Piperazines/pharmacology
- Protein Kinase C/antagonists & inhibitors
- Protein Kinase C/metabolism
- Pyrimidines/antagonists & inhibitors
- Pyrimidines/pharmacology
- Resting Phase, Cell Cycle/drug effects
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23
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Perseghin P, Gambacorti-Passerini C, Tornaghi L, Dassi M, Pioltelli P, Parma M, Colnaghi F, Giudici G, Elli E, Fumagalli M, Ponchio L, Biondi A, Pogliani EM. Peripheral blood progenitor cell collection in chronic myeloid leukemia patients with complete cytogenetic response after treatment with imatinib mesylate. Transfusion 2005; 45:1214-20. [PMID: 15987369 DOI: 10.1111/j.1537-2995.2005.00175.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Imatinib mesylate (IM) was introduced in chronic myeloid leukemia (CML) treatment in the late 1990s and substantially changed the therapeutic approach to the disease, by inducing complete cytogenetic response (CCR) in approximately 60 percent of cases. Nevertheless, some concerns exist about the duration of response to treatment and the onset of resistance to IM. STUDY DESIGN AND METHODS Twenty-five chronic-phase CML patients in stable CCR (>6 months) treated for at least 1 year with IM at the standard dose (400 mg/day) were mobilized with recombinant human granulocyte-colony-stimulating factor (Filgrastim) at 10 microg per kg for 4 to 6 days, with the aim of collecting at least 2 x 10(6) CD34+ cells per kg. Standard cytogenetic analysis and first-round and/or nested polymerase chain reaction were performed in basal and postmobilization samples to examine the presence of bcr-abl transcripts. RESULTS CD34+ cells collection was successful in 16 patients, yielding a median of 3.01 x 10(6) +/- 1.09 x 10(6) CD34+ cells per kg at the first attempt, and in 4 of the 9 remaining patients who were remobilized after a temporary withdrawal of IM, yielding a median of 2.65 x 10(6) +/- 0.7 x 10(6) CD34+ cells per kg, with an overall 80 percent success rate. No correlation between mobilization and duration of the disease, length of IM treatment, or previous interferon-alpha and/or hydroxyurea treatment was found. CONCLUSIONS Autologous CD34+ cells may be mobilized and collected in most CML patients who achieve CCR after IM treatment, with a view to possible use in the event that resistance to IM occurs in patients not eligible for allogeneic peripheral blood progenitor cell transplantation or those lacking an HLA-matched donor.
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Affiliation(s)
- Paolo Perseghin
- Department of Clinical Pathology-Immunohematology and Transfusion Service, Therapeutic Apheresis Unit, San Gerardo de' Tintori Hospital, Monza, Italy.
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24
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Leguay T, Desplat V, Lagarde V, Marit G, Reiffers J, Mahon FX. An amino-acid switch in the BCR-ABL kinase domain modifies sensitivity to imatinib mesylate. Leukemia 2005; 19:1671-3. [PMID: 15973458 DOI: 10.1038/sj.leu.2403831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Amino Acid Substitution
- Apoptosis/drug effects
- Benzamides
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Drug Resistance, Neoplasm/genetics
- Female
- Fusion Proteins, bcr-abl
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Middle Aged
- Mutagenesis, Site-Directed
- Piperazines/administration & dosage
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Point Mutation
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
- Pyrimidines/administration & dosage
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
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25
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Baron F, Maris MB, Storer BE, Sandmaier BM, Stuart MJ, McSweeney PA, Radich JP, Pulsipher MA, Agura ED, Chauncey TR, Maloney DG, Shizuru JA, Storb R. HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative conditioning for patients with chronic myeloid leukemia. Biol Blood Marrow Transplant 2005; 11:272-9. [PMID: 15812392 DOI: 10.1016/j.bbmt.2004.12.326] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We evaluated 10/10 HLA antigen-matched unrelated hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning with fludarabine 3 x 30 mg/m2 and 2 Gy of total body irradiation as treatment for patients with chronic myeloid leukemia who were ineligible for conventional HCT. Data from 21 consecutive patients in first chronic phase (CP1; n = 12), accelerated phase (AP; n = 5), second CP (CP2; n = 3), and blast crisis (n = 1) were analyzed. Stem cell sources were bone marrow (n = 4) or granulocyte colony-stimulating factor-mobilized peripheral blood mononuclear cells (G-PBMCs; n = 17). The patient who underwent transplantation in blast crisis died on day 21 (too early to be evaluated for engraftment) from progressive disease. Sustained engraftment was achieved in 5 of 12 patients who underwent transplantation in CP1, 4 of 5 patients who underwent transplantation in AP, and 2 of 3 patients who underwent transplantation in CP2, whereas 9 patients rejected their grafts between 28 and 400 days after HCT. Specifically, 1 of 4 marrow recipients and 10 of 17 G-PBMC recipients achieved sustained engraftment. Graft rejections were nonfatal in all cases and were followed by autologous reconstitution with persistence or recurrence of chronic myeloid leukemia. Seven of 11 patients with sustained engraftment--including all 5 patients in CP1, 2 of 4 patients in AP, and neither of the 2 patients in CP2--were alive in complete cytogenetic remissions 118 to 1205 days (median, 867 days) after HCT. Two of the remaining 4 patients died of nonrelapse causes in complete (n = 1) or major (n = 1) cytogenetic remissions, and 2 died of progressive disease. Further efforts are directed at reducing the risk of graft rejection by exclusive use of G-PBMC and increasing the degree of pretransplantation immunosuppression.
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Affiliation(s)
- Frédéric Baron
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA
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26
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Hughes T, Branford S. Molecular monitoring of BCR-ABL as a guide to clinical management in chronic myeloid leukaemia. Blood Rev 2005; 20:29-41. [PMID: 16426942 DOI: 10.1016/j.blre.2005.01.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Molecular monitoring of BCR-ABL transcript levels by real-time quantitative PCR is increasingly used to assess treatment response in patients with chronic myeloid leukaemia (CML). This has become particularly relevant in the era of imatinib therapy when residual levels of leukaemia usually fall below the level of detection by bone marrow cytogenetic analysis. Studies of imatinib-treated patients have determined that BCR-ABL levels measured early in therapy can predict subsequent response and the probability of acquired resistance. The defining of a molecular level of response that indicates a high probability of progression-free survival highlights the relevance of molecular analysis for clinical management. Small increases in the BCR-ABL level can identify patients with kinase domain mutations that lead to imatinib resistance. Therefore, these assays can be used as a screening strategy for mutation analysis. As second generation kinase inhibitors commence clinical trials, the molecular response will be a primary end-point that determines efficacy.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Benzamides
- Biomarkers/blood
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Piperazines/therapeutic use
- Pyrimidines/therapeutic use
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Affiliation(s)
- Timothy Hughes
- Institute of Medical and Veterinary Science, Frome Road, Adelaide, 5000 SA, Australia.
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27
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Tefferi A, Dewald GW, Litzow ML, Cortes J, Mauro MJ, Talpaz M, Kantarjian HM. Chronic myeloid leukemia: current application of cytogenetics and molecular testing for diagnosis and treatment. Mayo Clin Proc 2005; 80:390-402. [PMID: 15757021 DOI: 10.4065/80.3.390] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic myeloid leukemia provides an illustrative disease model for both molecular pathogenesis of cancer and rational drug therapy. Chronic myeloid leukemia is a clonal stem cell disease caused by an acquired somatic mutation that fuses, through chromosomal translocation, the abl and bcr genes on chromosomes 9 and 22, respectively. The bcr/abl gene product is an oncogenic protein that localizes to the cytoskeleton and displays an up-regulated tyrosine kinase activity that leads to the recruitment of downstream effectors of cell proliferation and cell survival and consequently cell transformation. Such molecular information on pathogenesis has facilitated accurate diagnosis, the development of pathogenesis-targeted drug therapy, and most recently the application of molecular techniques for monitoring minimal residual disease after successful therapy. These issues are discussed within the context of clinical practice.
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MESH Headings
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/therapeutic use
- Benzamides
- Cytarabine/therapeutic use
- Genes, abl/genetics
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Neoplasm, Residual/diagnosis
- Philadelphia Chromosome
- Piperazines/therapeutic use
- Prognosis
- Pyrimidines/therapeutic use
- Reverse Transcriptase Polymerase Chain Reaction
- Stem Cell Transplantation
- Treatment Outcome
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Affiliation(s)
- Ayalew Tefferi
- Department of Internal Medicine and Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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28
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Abstract
Imatinib, a potent inhibitor of the oncogenic tyrosine kinase BCR-ABL, has shown remarkable clinical activity in patients with chronic myelogenous leukaemia (CML). However, this drug does not completely eradicate BCR-ABL-expressing cells from the body, and resistance to imatinib emerges. Although BCR-ABL remains an attractive therapeutic target, it is important to identify other components involved in CML pathogenesis to overcome this resistance. What have clinical trials of imatinib and studies using mouse models for BCR-ABL leukaemogenesis taught us about the functions of BCR-ABL beyond its kinase activity, and how these functions contribute to CML pathogenesis?
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MESH Headings
- Animals
- Antineoplastic Agents/pharmacology
- Benzamides
- Cell Transformation, Neoplastic
- Disease Models, Animal
- Gene Expression Regulation, Neoplastic
- Genes, abl
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Mice
- Oncogene Proteins v-abl/pharmacology
- Piperazines/pharmacology
- Proto-Oncogene Proteins c-abl/pharmacology
- Pyrimidines/pharmacology
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Affiliation(s)
- Ruibao Ren
- Rosenstiel Basic Medical Sciences Research Center, MS029, Brandeis University, 415 South Street, Waltham, Massachusetts 02454-9110, USA.
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29
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Zhang Z, Li M, Rayburn ER, Hill DL, Zhang R, Wang H. Oncogenes as Novel Targets for Cancer Therapy (Part I). ACTA ACUST UNITED AC 2005; 5:173-90. [PMID: 15952871 DOI: 10.2165/00129785-200505030-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the past 10 years, progress made in cancer biology, genetics, and biotechnology has led to a major transition in cancer drug design and development. There has been a change from an emphasis on non-specific, cytotoxic agents to specific, molecular-based therapeutics. Mechanism-based therapy is designed to act on cellular and molecular targets that are causally involved in the formation, growth, and progression of human cancers. These agents, which may have greater selectivity for cancer versus normal cells, and which may produce better anti-tumor efficacy and lower host toxicity, can be small molecules, natural or engineered peptides, proteins, antibodies, or synthetic nucleic acids (e.g. antisense oligonucleotides, ribozymes, and siRNAs). Novel targets are identified and validated by state-of-the-art approaches, including high-throughput screening, combinatorial chemistry, and gene expression arrays, which increase the speed and efficiency of drug discovery and development. Examples of oncogene-based, molecular therapeutics that show promising clinical activity include trastuzumab (Herceptin), imatinib (Gleevec), and gefitinib (Iressa). However, the full potential of oncogenes as novel targets for cancer therapy has not been realized and many challenges remain, from the validation of novel targets, to the design of specific agents, to the evaluation of these agents in both preclinical and clinical settings. In maximizing the benefits of molecular therapeutics in monotherapy or combination therapy of cancer, it is necessary to have an understanding of the underlying molecular abnormalities and mechanisms involved. This is the first part of a four-part review in which we discuss progress made in the last decade as it relates to the discovery of novel oncogenes and signal transduction pathways, in the context of their potential as targets for cancer therapy. This part delineates the latest discoveries about the potential use of growth factors and protein tyrosine kinases as targets for therapy. Later parts focus on intermediate signaling pathways, transcription factors, and proteins involved in cell cycle, DNA damage, and apoptotic pathways.
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Affiliation(s)
- Zhuo Zhang
- Department of Pharmacology and Toxicology, and Division of Clinical Pharmacology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA
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30
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Baccarani M, Martinelli G, Rosti G, Trabacchi E, Testoni N, Bassi S, Amabile M, Soverini S, Castagnetti F, Cilloni D, Izzo B, de Vivo A, Messa E, Bonifazi F, Poerio A, Luatti S, Giugliano E, Alberti D, Fincato G, Russo D, Pane F, Saglio G. Imatinib and pegylated human recombinant interferon-α2b in early chronic-phase chronic myeloid leukemia. Blood 2004; 104:4245-51. [PMID: 15319292 DOI: 10.1182/blood-2004-03-0826] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Since interferon-α and imatinib (IM; STI571, Glivec, Gleevec) are effective for the treatment of chronic myeloid leukemia (CML), and their mechanisms of action are different, we designed an exploratory study investigating the effects of a standard IM dose (400 mg/d) and a variable pegylated interferon-α (PegIFN) dose (50 μg/wk, 100 μg/wk, and 150 μg/wk). The criteria for dose adjustment were designed so as to ensure the delivery of the IM dose and to protect life quality. There were 76 patients with previously untreated Philadelphia (Ph)–positive CML enrolled in the study. There were 3 patients who discontinued IM and 45 patients who discontinued PegIFN. The severity of adverse events increased with increasing PegIFN dose. The IM dose could be administered to the patients who were assigned to receive 50 μg/wk or 100 μg/wk PegIFN but not to those who were assigned to receive 150 μg/wk. The median administered dose of PegIFN ranged between 32 μg/wk and 36 μg/wk. The cytogenetic response was 70% complete (Ph-neg 100%) and 83% major (Ph-neg > 65%). The BCR/ABL transcript was reduced by at least 3 logs in 68% of complete cytogenetic responders. These data of toxicity, compliance, and efficacy may assist in the design and preparation of prospective studies.
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Affiliation(s)
- Michele Baccarani
- Institute of Hematology and Medical Oncology L. and A. Seràgnoli, University of Bologna, Via Massarenti, 9-40138 Bologna, Italy.
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31
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Affiliation(s)
- Gösta Gahrton
- Department of Medicine, Karolinska Institute, Huddinge Hospital, S 141 86 Huddinge, Sweden.
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32
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Hochhaus A, La Rosée P. Imatinib therapy in chronic myelogenous leukemia: strategies to avoid and overcome resistance. Leukemia 2004; 18:1321-31. [PMID: 15215876 DOI: 10.1038/sj.leu.2403426] [Citation(s) in RCA: 230] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Imatinib is a molecularly targeted therapy that inhibits the oncogenic fusion protein BCR-ABL, the tyrosine kinase involved in the pathogenesis of chronic myelogenous leukemia (CML). Selective inhibition of BCR-ABL activity by imatinib has demonstrated efficacy in the treatment of CML, particularly in chronic phase. Some patients, however, primarily those with advanced disease, are either refractory to imatinib or eventually relapse. Relapse with imatinib frequently depends not only on re-emergence of BCR-ABL kinase activity but may also indicate BCR-ABL-independent disease progression not amenable to imatinib inhibition. Results from phase 2/3 trials suggest that rates of resistance and relapse correlate with the stage of disease and with the monitoring parameters--hematologic, cytogenetic and molecular response. These observations and more recent trials with imatinib, combined with insights provided by an increased understanding of the molecular mechanisms of resistance, have established the rationale for strategies to avoid and overcome imatinib resistance in the management of CML patients. To prevent resistance, early diagnosis and prompt treatment with appropriate initial dosing is essential. Management of resistance may include therapeutic strategies such as dose escalation to achieve individual optimal levels, combination therapy, as well as treatment interruption.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzamides
- Cytogenetics
- Drug Resistance, Neoplasm
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Neoplasm, Residual/diagnosis
- Piperazines/therapeutic use
- Pyrimidines/therapeutic use
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Affiliation(s)
- A Hochhaus
- III Medizinische Klinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany.
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