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Wu C, Zeng M, Chen Y, Wu Y. Tyrosine kinase inhibitors and reduced-dose chemotherapy for adult Philadelphia chromosome-positive acute lymphoblastic leukemia. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:1032-1040. [PMID: 36083141 DOI: 10.1080/16078454.2022.2119344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives: To compare the outcomes of tyrosine kinase inhibitors (TKIs) in combination with reduced-dose chemotherapy with those of standard induction chemotherapy, as well as the outcomes between chemotherapy and transplantation, in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL).Methods: We retrospectively reviewed cases of Ph+ ALL treated with TKIs and combination chemotherapy. The patients were allocated to either the TKIs with reduced-dose chemotherapy group or the TKIs with standard chemotherapy group. In additions, patients were further stratified into either the transplant group or the non-transplant group.Results: The complete remission rate (88.7% vs. 83.9%, p = 0.372), major molecular response (58.9% vs. 56.0%, p = 0.750), molecular complete response (20.5% vs. 22.0%, p = 0.891), and early mortality rate (3.2% vs. 3.5%, p = 0.922) were similar between the TKIs with reduced-dose chemotherapy group and the TKIs with standard chemotherapy group. The proportions of lung infections, bloodstream infections, patients with >21 days of hospitalization, the total costs, transfusion costs, and antimicrobial costs were higher in the standard chemotherapy group than in the TKIs with reduced-dose chemotherapy group. The 3-year overall survival rates (59.0% [95% CI, 46.6-74.7%] vs. 38.4% [95% CI, 29.9-49.4%]) and disease-free survival rates (48.6% [95% CI, 34.2-69.1%] vs. 32.0% [95% CI, 23.5-43.7%]) were significantly better in the transplant group than in the non-transplant group.Conclusion: An induction regimen combining TKIs with reduced-dose chemotherapy and transplantation during the first complete remission remains a suitable and effective option for patients with Ph+ ALL.
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Affiliation(s)
- Chunping Wu
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Mengting Zeng
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yuanzhong Chen
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yong Wu
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Chen M, Zhu Y, Lin Y, Tengwang T, Zhang L. Use of tyrosine kinase inhibitors for paediatric Philadelphia chromosome-positive acute lymphoblastic leukaemia: a systematic review and meta-analysis. BMJ Open 2021; 11:e042814. [PMID: 33468532 PMCID: PMC7817804 DOI: 10.1136/bmjopen-2020-042814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To investigate the effectiveness and safety of tyrosine kinase inhibitors (TKIs) in the management of paediatric Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ALL). DESIGN A systematic review and meta-analysis. DATA SOURCES Electronic searches were conducted on CENTRAL, MEDLINE, EMBASE, SIOP, ASPHO, ASCO, ASH and four Chinese databases from inception to 8 March 2020. Language of publications was restricted in English and Chinese. ELIGIBILITY CRITERIA Prospective and retrospective comparative studies were included. DATA EXTRACTION AND SYNTHESIS Two authors independently assessed and extracted data. Quality of studies was assessed by the Cochrane Collaboration's tool and Newcastle-Ottawa Scale. Subgroup analysis was performed by comparing different types of TKIs. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Two randomised controlled trials (RCTs) and four cohort studies enrolling 536 patients were included. For RCTs, the pooled HR was 0.68 (95% CI 0.26 to 1.78) in overall survival (OS), 0.63 (95% CI 0.28 to 1.42) in event-free survival (EFS), respectively, comparing TKI arm with non-TKI arm for treatment of paediatric Ph+ALL. There was significant difference in OS and EFS between imatinib arm and dasatinib arm (HR 2.26, 95% CI 1.02 to 5.01; HR 2.36; 95% CI 1.27 to 4.39, respectively). For cohort studies, the pooled HR was 0.25 (95% CI 0.14 to 0.47) in OS, 0.25 (95% CI 0.12 to 0.56) in EFS, respectively, comparing TKI arm with non-TKI arm. There was no significance difference in adverse drug reaction between TKI group and without TKI group (risk ratio (RR) 0.82, 95% CI 0.63 to 1.08 in RCT; RR 1.01, 95% CI 0.64 to 1.59 in cohort studies; respectively), and imatinib versus dasatinib (RR 0.97, 95% CI 0.77 to 1.23). The quality of evidence was rated as low for OS, EFS and adverse drug reaction (ADR). CONCLUSIONS The combination of TKIs with chemotherapy is likely to improve the OS and EFS rates in paediatric Ph+ALL, and dasatinib is superior than imatinib. Large sample size and prospective controlled studies are warranted. PROSPERO REGISTRATION NUMBER CRD42018104107.
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Affiliation(s)
- Min Chen
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yiping Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunzhu Lin
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Tianzi Tengwang
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Lingli Zhang
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Zawitkowska J, Lejman M, Zaucha-Prażmo A, Drabko K, Płonowski M, Bulsa J, Romiszewski M, Mizia-Malarz A, Kołtan A, Derwich K, Karolczyk G, Ociepa T, Ćwiklińska M, Trelińska J, Owoc-Lempach J, Niedźwiecki M, Kiermasz A, Kowalczyk J. Clinical characteristics and analysis of treatment result in children with Ph-positive acute lymphoblastic leukaemia in Poland between 2005 and 2017. Eur J Haematol 2018; 101:542-548. [DOI: 10.1111/ejh.13142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Joanna Zawitkowska
- Department of Paediatric Haematology, Oncology and Transplantology; Medical University of Lublin; Lublin Poland
| | - Monika Lejman
- Department of Paediatric Haematology, Oncology and Transplantology; Genetic Diagnostic Laboratory; University Children's Hospital; Lublin Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Paediatric Haematology, Oncology and Transplantology; Medical University of Lublin; Lublin Poland
| | - Katarzyna Drabko
- Department of Paediatric Haematology, Oncology and Transplantology; Medical University of Lublin; Lublin Poland
| | - Marcin Płonowski
- Department of Paediatric Oncology, Haematology; Medical University of Białystok; Białystok Poland
| | - Joanna Bulsa
- Department of Paediatrics, Haematology and Oncology; Medical University of Zabrze; Zabrze Poland
| | - Michał Romiszewski
- Department of Haematology and Paediatrics; Children's Hospital; Warsaw Poland
| | - Agnieszka Mizia-Malarz
- Department of Paediatric Oncology, Haematology and Chemotherapy; Medical University of Katowice; Katowice Poland
| | - Andrzej Kołtan
- Department of Paediatrics, Haematology and Oncology; Collegium Medicum of Bydgoszcz; Bydgoszcz Poland
| | - Katarzyna Derwich
- Department of Paediatric Oncology, Haematology and Transplantology; Medical University of Poznań; Poznań Poland
| | - Grażyna Karolczyk
- Department of Paediatric Oncology and Haematology; Children's Hospital; Kielce Poland
| | - Tomasz Ociepa
- Department of Paediatrics, Haematology and Oncology; Medical University of Szczecin; Szczecin Poland
| | - Magdalena Ćwiklińska
- Department of Paediatric Oncology and Haematology; Children's University Hospital; Kraków Poland
| | - Joanna Trelińska
- Department of Paediatrics, Oncology, Haematology and Diabetology; Medical University of Łódź; Łódź Poland
| | - Joanna Owoc-Lempach
- Department of Paediatric Transplantology, Oncology, Haematology; Medical University of Wrocław; Wrocław Poland
| | - Maciej Niedźwiecki
- Department of Paediatrics, Haematology, Oncology and Endocrinology; Medical University of Gdańsk; Gdańsk Poland
| | - Aleksandra Kiermasz
- Department of Paediatric Haematology and Oncology; Center of Paediatrics and Oncology; Chorzów Poland
| | - Jerzy Kowalczyk
- Department of Paediatric Haematology, Oncology and Transplantology; Medical University of Lublin; Lublin Poland
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Li H, Zhang W, Kuang P, Ye Y, Yang J, Dai Y, Lu X, Zheng Y, Liu T. Combination of IKZF1 deletion and early molecular response show significant roles on prognostic stratification in Philadelphia chromosome-positive acute lymphoblastic leukemia patients. Leuk Lymphoma 2017; 59:1890-1898. [PMID: 29214878 DOI: 10.1080/10428194.2017.1406933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We retrospectively analyzed the samples collected from 66 patients with Ph+ALL enrolled on ChiCTR-TNRC-09000309 clinical trial. CR rate was 95.5%, and estimated 2-year OS and DFS were 51.7 ± 11.7% and 26.9 ± 11.6%, 3-year OS and DFS were 31.6 ± 12.0% and 23.4 ± 11.6%. By combining IKZF1 deletion and early molecular responses, we redefined the patients as low, intermediate, and high risk 3 groups separately. Patients with double negative in IKZF1 and early molecular response experienced significant superior survival, while patients with double positive would have the worst outcome, and patients who were one or the other with IKZF1 deletion or MRD status had intermediate outcome. Significant differences were found among 3 groups in regard to both OS (p < .001) and DFS (p < .001). Our findings suggest that Ph+ALL is a heterogeneous group of diseases with significantly different prognosis. Combination of IKZF1 deletion and MRD status enable better risk stratification of patients for assignment to optimal therapeutic strategies.
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Affiliation(s)
- He Li
- a Department of Hematology, Hematologic Research Laboratory , West China Hospital of Sichuan University , Chengdu , China
| | - Wanhua Zhang
- a Department of Hematology, Hematologic Research Laboratory , West China Hospital of Sichuan University , Chengdu , China
| | - Pu Kuang
- a Department of Hematology, Hematologic Research Laboratory , West China Hospital of Sichuan University , Chengdu , China
| | - Yuanxin Ye
- b Department of Laboratory Medicine , West China Hospital of Sichuan University , Chengdu , China
| | - Jinjun Yang
- a Department of Hematology, Hematologic Research Laboratory , West China Hospital of Sichuan University , Chengdu , China
| | - Yang Dai
- a Department of Hematology, Hematologic Research Laboratory , West China Hospital of Sichuan University , Chengdu , China
| | - Xiaojun Lu
- b Department of Laboratory Medicine , West China Hospital of Sichuan University , Chengdu , China
| | - Yuhuan Zheng
- a Department of Hematology, Hematologic Research Laboratory , West China Hospital of Sichuan University , Chengdu , China
| | - Ting Liu
- a Department of Hematology, Hematologic Research Laboratory , West China Hospital of Sichuan University , Chengdu , China
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Aref S, Azmy E, El-Bakry K, Ibrahim L, Mabed M. Prognostic impact of CD200 and CD56 expression in adult acute lymphoblastic leukemia patients. ACTA ACUST UNITED AC 2017; 23:263-270. [PMID: 29161980 DOI: 10.1080/10245332.2017.1404276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of the study is to determine the prognostic relevance of CD200/ CD56 expression in adult acute lymphoblastic leukemia patients. METHODS The expression of CD200 and CD56 by blast cells was assessed by flow cytometry before the start of chemotherapy in 70 B-ALL patients. RESULTS Positive expression of CD200 was detected in forty-six patients (66%) and CD56 was detected in 7 patients (10%) out of 70 patients, respectively. Only three patients (4.3%) had co-expression for CD200+ and CD56+. Splenomegaly and thrombocytopenia were frequently observed more in CD200+ patients. Increased frequency of CD34+ was associated with CD200+and CD56+ patients. The CD200+ and CD56+ subgroups of B-ALL patients had inferior OS and disease free survival compared to CD 200- and CD 56- patients. CONCLUSIONS CD200+ and/or CD56+ positive expression in B-ALL patients at diagnosis is a poor prognostic biomarker. Identification of CD200+ and CD56+ expression at diagnosis is recommended for a better stratification of adult B-ALL patients.
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Affiliation(s)
- Salah Aref
- a Hematology Unit, Mansoura University Oncology Center , Mansoura University , Mansoura , Egypt
| | - Emad Azmy
- b Hematology Unit, Internal Medicine Department, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Kadry El-Bakry
- c Physiology, Zoology Department, Faculty of Science , Damietta University , Damietta , Egypt
| | - Lobna Ibrahim
- c Physiology, Zoology Department, Faculty of Science , Damietta University , Damietta , Egypt
| | - Mohamed Mabed
- b Hematology Unit, Internal Medicine Department, Faculty of Medicine , Mansoura University , Mansoura , Egypt
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Chiaretti S, Gianfelici V, O'Brien SM, Mullighan CG. Advances in the Genetics and Therapy of Acute Lymphoblastic Leukemia. Am Soc Clin Oncol Educ Book 2017; 35:e314-22. [PMID: 27249738 DOI: 10.1200/edbk_156628] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute lymphoblastic leukemia (ALL) remains an important cause of morbidity in children and adults. In this article, we highlight advances in the genetics and therapy of three key subtypes of ALL: T-cell ALL, BCR-ABL1 (Philadelphia [Ph] chromosone-positive), and Ph-like ALL. T-ALL is an aggressive disease that accounts for about 15% and 25% of ALL among pediatric and adult cohorts, respectively, and exhibits a multistep nature of cancer initiation and progression. The integration of cytogenetics, molecular biology, and immunophenotype analyses has led to the identification of defined T-ALL subgroups, such as early T-cell precursor ALL and novel lesions with a prognostic role, for which specific inhibitors are being developed. Ph-positive ALL was historically regarded as a subtype of ALL with a poor prognosis, and allogeneic stem cell transplant was recommended for all patients who could undergo this procedure. The deep complete responses seen with combination tyrosine kinase inhibitors (TKIs) and chemotherapy in Ph-positive ALL, and the reports of long-term survival among some patients not undergoing allogeneic stem cell transplant, has raised the question of whether there is a subset of patients who could be cured without this intervention. Ph-like ALL is a subtype of B-progenitor ALL common among older children and adults and associated with a diverse range of genetic alterations that activate kinase signaling. Ph-like ALL is also associated with poor outcome, for which precision medicine trials identifying kinase alterations and testing TKI therapy are being developed.
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Affiliation(s)
- Sabina Chiaretti
- From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Valentina Gianfelici
- From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Susan M O'Brien
- From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Charles G Mullighan
- From the Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Chao Family Comprehensive Cancer Center, School of Medicine, University of California, Irvine, CA; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
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Byun YJ, Suh JK, Lee SW, Lee D, Kim H, Choi ES, Koh KN, Im HJ, Seo JJ. Favorable outcome of allogeneic hematopoietic stem cell transplantation followed by post-transplant treatment with imatinib in children with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood Res 2015; 50:147-53. [PMID: 26457281 PMCID: PMC4595580 DOI: 10.5045/br.2015.50.3.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 11/17/2022] Open
Abstract
Background Allogeneic hematopoietic stem cell transplantation (HSCT) is the preferred curative therapy for children with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). We evaluated the treatment outcomes of children with Ph+ ALL who underwent allogeneic HSCT. Methods Fifteen children diagnosed with Ph+ ALL in Asan Medical Center Children's Hospital between 1998 and 2012 were retrospectively analyzed. Results Of 521 children diagnosed with ALL during the study period, 15 had a Philadelphia chromosome. Among these 15 patients, 13 attained complete remission (CR) following induction chemotherapy, and two died of intracerebral hemorrhage during leukapheresis and induction chemotherapy, respectively. Of the 13 patients who attained CR, 12 received allogeneic HSCT, mainly from unrelated donors. Of the 12 patients who received HSCT, one died of a transplant-related cause, one died of relapse after HSCT, and 10 remain in continuous CR. Of the 10 patients who remained in CR longer than six months after HSCT, seven received post-HSCT imatinib. For all 15 patients, the 5-year overall survival, event-free survival, and cumulative incidence of relapse were 60.0%, 48.6%, and 38.8%, respectively, with a median follow-up of 70 months. For the HSCT group, the 5-year overall survival, event-free survival, and cumulative incidence of relapse were 80.2%, 72.9%, and 29.3%, respectively, with a median follow-up of 100 months. Conclusion Allogeneic HSCT cures a significant proportion of Ph+ ALL patients. Because the use of imatinib appears to be a promising approach, strategies that include tyrosine kinase inhibitors before and after HSCT require further evaluation.
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Affiliation(s)
- Ye Jee Byun
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Kyung Suh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Wook Lee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Darae Lee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunjin Kim
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Seo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Madanat F, Jaber H, Azayyat I, Kamal N, Barakat F, Al-Kayed K, Rihani R. Features and outcomes of pediatric early T cell leukemia: King Hussein Cancer Center experience. Hematol Oncol Stem Cell Ther 2015; 9:126-8. [PMID: 26420052 DOI: 10.1016/j.hemonc.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/12/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Faris Madanat
- Pediatric Department Hematology-Oncology at King Hussein Cancer Center, Amman, Jordan.
| | - Hiba Jaber
- Pediatric Department Hematology-Oncology at King Hussein Cancer Center, Amman, Jordan
| | - Ismaeel Azayyat
- Pediatric Department Hematology-Oncology at King Hussein Cancer Center, Amman, Jordan
| | - Nazmi Kamal
- Pediatric Department Hematology-Oncology at King Hussein Cancer Center, Amman, Jordan
| | - Fareed Barakat
- Pediatric Department Hematology-Oncology at King Hussein Cancer Center, Amman, Jordan
| | - Khaldoun Al-Kayed
- Pediatric Department Hematology-Oncology at King Hussein Cancer Center, Amman, Jordan
| | - Rawad Rihani
- Pediatric Department Hematology-Oncology at King Hussein Cancer Center, Amman, Jordan
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