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Etienne G, Faberes C, Bauduer F, Adiko D, Lifermann F, Dagada C, Lenoir C, Schmitt A, Klein E, Fort MP, Bijou F, Turcq B, Robbesyn F, Durrieu F, Versmée L, Madene S, Moldovan M, Katsahian S, Charles-Nelson A, Lascaux A, Mahon FX, Dulucq S. Relevance of treatment-free remission recommendations in chronic phase chronic leukemia patients treated with frontline tyrosine kinase inhibitors. Cancer Med 2021; 10:3635-3645. [PMID: 33988316 PMCID: PMC8178499 DOI: 10.1002/cam4.3921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKI) can be safely discontinued in chronic phase chronic myeloid leukemia (CP-CML) patients who had achieved a sustained deep molecular response. Based on the results of discontinuation trials, recommendations regarding patient selection for a treatment-free remission (TFR) attempt had been proposed. The aims of this study were to evaluate the rate of patients eligible for TKI discontinuation and molecular recurrence-free survival (MRFS) after stop according to recommendations. METHODS Over a 10-year period, newly diagnosed CP-CML patients and treated with first-line TKI in the nine French participating centers were included. Eligibility to treatment discontinuation and MRFS were analyzed and compared according to selection criteria defined by recommendations and first-line treatments. RESULTS From January 2006 to December 2015, 398 patients were considered. Among them, 73% and 27% of patients received imatinib or either second or third generation tyrosine kinase inhibitors as frontline treatment, respectively. Considering the selection criteria defined by recommendations, up to 55% of the patients were selected as optimal candidates for treatment discontinuation. Overall 95/398 (24%) discontinued treatment. MRFS was 51.8% [95% CI 41.41-62.19] at 2 years and 43.8% [31.45-56.15] at 5 years. Patients receiving frontline second-generation TKI and fulfilling the eligibility criteria suggested by recommendations had the lowest probability of molecular relapse after TKI stop when compare to others. CONCLUSION One third of CP-CML patients treated with TKI frontline fulfilled the selection criteria suggested by European LeukemiaNet TFR recommendations. Meeting selection criteria and second-generation TKI frontline were associated with the highest MRFS.
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Affiliation(s)
- Gabriel Etienne
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France
| | - Carole Faberes
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Fréderic Bauduer
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Service d'Hématologie, Centre Hospitalier Côte Basque, Bayonne, France.,Collège des Sciences de la Santé, Université de Bordeaux, Bordeaux, France
| | - Didier Adiko
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Service d'Hématologie, Centre Hospitalier de Libourne, Libourne, France
| | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier de Dax-Côte d'Argent, Dax, France
| | - Corinne Dagada
- Service d'Oncologie-Hématologie, Centre Hospitalier de Pau, Pau, France
| | - Caroline Lenoir
- Service d'Hémato-Oncologie Radiothérapie, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Anna Schmitt
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Emilie Klein
- Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Fontanet Bijou
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Beatrice Turcq
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Centre National de la Recherche Scientifiue, SNC 5010, Bordeaux, France
| | - Fanny Robbesyn
- Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Laura Versmée
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Samia Madene
- Service de Médecine Interne et Hématologie, Centre Hospitalier Intercommunal Mont-de-Marsan - Pays des Sources, Mont de Marsan, France
| | - Marius Moldovan
- Hôpital de jour Hématologie-Oncologie, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sandrine Katsahian
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris 5 Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Equipe 22, Paris, France
| | - Anais Charles-Nelson
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, Module Epidémiologie Clinique, Paris, France
| | - Axelle Lascaux
- Service Des Maladies du Sang, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - François-Xavier Mahon
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France
| | - Stéphanie Dulucq
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
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Azam M, Nardi V, Shakespeare WC, Metcalf CA, Bohacek RS, Wang Y, Sundaramoorthi R, Sliz P, Veach DR, Bornmann WG, Clarkson B, Dalgarno DC, Sawyer TK, Daley GQ. Activity of dual SRC-ABL inhibitors highlights the role of BCR/ABL kinase dynamics in drug resistance. Proc Natl Acad Sci U S A 2006; 103:9244-9. [PMID: 16754879 PMCID: PMC1482597 DOI: 10.1073/pnas.0600001103] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mutation in the ABL kinase domain is the principal mechanism of imatinib resistance in patients with chronic myelogenous leukemia. Many mutations favor active kinase conformations that preclude imatinib binding. Because the active forms of ABL and SRC resemble one another, we tested two dual SRC-ABL kinase inhibitors, AP23464 and PD166326, against 58 imatinib-resistant (IM(R)) BCR/ABL kinase variants. Both compounds potently inhibit most IM(R) variants, and in vitro drug selection demonstrates that active (AP23464) and open (PD166326) conformation-specific compounds are less susceptible to resistance than imatinib. Combinations of inhibitors suppressed essentially all resistance mutations, with the notable exception of T315I. Guided by mutagenesis studies and molecular modeling, we designed a series of AP23464 analogues to target T315I. The analogue AP23846 inhibited both native and T315I variants of BCR/ABL with submicromolar potency but showed nonspecific cellular toxicity. Our data illustrate how conformational dynamics of the ABL kinase accounts for the activity of dual SRC-ABL inhibitors against IM(R)-mutants and provides a rationale for combining conformation specific inhibitors to suppress resistance.
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Affiliation(s)
- Mohammad Azam
- *Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, and Division of Hematology/Oncology, The Children's Hospital, Dana–Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA 02115
| | - Valentina Nardi
- *Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, and Division of Hematology/Oncology, The Children's Hospital, Dana–Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA 02115
| | | | | | | | - Yihan Wang
- Ariad Pharmaceuticals, Inc., Cambridge, MA 02139-4234
| | | | - Piotr Sliz
- *Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, and Division of Hematology/Oncology, The Children's Hospital, Dana–Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA 02115
| | - Darren R. Veach
- Memorial Sloan–Kettering Cancer Center, New York, NY 10021; and
| | - William G. Bornmann
- Department of Experimental Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, Houston, TX 77054
| | - Bayard Clarkson
- Memorial Sloan–Kettering Cancer Center, New York, NY 10021; and
| | | | | | - George Q. Daley
- *Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, and Division of Hematology/Oncology, The Children's Hospital, Dana–Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA 02115
- To whom correspondence should be addressed. E-mail:
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Jabbour E, Kantarjian H, O'Brien S, Rios MB, Abruzzo L, Verstovsek S, Garcia-Manero G, Cortes J. Sudden blastic transformation in patients with chronic myeloid leukemia treated with imatinib mesylate. Blood 2006; 107:480-2. [PMID: 16195326 DOI: 10.1182/blood-2005-05-1816] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Sudden blastic transformation (SBT) has been reported in 0.5% to 2.5% of patients treated with interferon-α (IFN-α) during the first 3 years of therapy. Imatinib is now standard therapy for patients with chronic myeloid leukemia in chronic phase. We investigated the occurrence of SBT among patients treated with imatinib. Among 541 patients treated with imatinib in chronic phase, 23 developed blast phase, which was of sudden onset (ie, occurring in patients previously in complete cytogenetic remission) in 4 patients (17%; 0.7% of the total), 2 lymphoid and 2 myeloid. Patients with SBT were found to have low-risk features more often at the time of presentation and had achieved optimal response with imatinib. Three of the 4 patients underwent allogeneic stem cell transplantation and achieved a molecular remission. SBT is still a rare event, probably less common than that observed with IFN-α therapy. Continuous monitoring of patients treated with imatinib is mandatory.
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Affiliation(s)
- Elias Jabbour
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Alimena G, Breccia M, Latagliata R, Carmosino I, Russo E, Biondo F, Diverio D, Mancini M, Nanni M, Mandelli F. Sudden blast crisis in patients with Philadelphia chromosome-positive chronic myeloid leukemia who achieved complete cytogenetic remission after imatinib therapy. Cancer 2006; 107:1008-13. [PMID: 16878324 DOI: 10.1002/cncr.22046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Most patients with Philadelphia chromosome (Ph)-positive chronic myeloid leukemia (CML) in chronic phase (CP) who receive treatment with imatinib achieve complete cytogenetic remission (CCR), which is correlated tightly with long-term progression-free survival. In these patients, the occurrence of blastic crisis (BC) is rare, and its clinical biologic characteristics are not well known. METHODS Among 164 patients who received imatinib and were followed for a median of 35 months, 11 patients (6.7%) developed a BC; this was sudden (i.e., it occurred within 3 months of a documented CCR) in 6 patients (54.5%). Those patients were analyzed with respect to their clinical and biologic features and were compared with previous reports. RESULTS At the time of diagnosis, there were 3 low-risk patients and 3 intermediate-risk patients; 4 patients had received pretreatment with interferon, and 2 patients received only imatinib. The median CP was 18 months, and the median duration of imatinib therapy was 7 months. The median time to CCR was 3 months, and the median time from CCR to BC was 4 months. BC phenotype was lymphoid in 2 patients, myeloid in 3 patients (including 2 patients who had extramedullary localization), and biclonal in 1 patient. Karyotype evolution was detected in 4 patients, whereas a Ph-positive/Ph-negative mosaicism was evident in all 6 patients. One patient presented an M351T mutation. The overall median survival was 3 months. CONCLUSIONS Sudden BC generally is an uncommon phenomenon that may be relatively frequent in patients with CML who receive imatinib. Clinical and biologic features also seem to characterize this peculiar type of abrupt disease evolution, which intervenes in patients' response to this drug. Close monitoring of disease markers and full disease eradication are warranted.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Benzamides
- Blast Crisis
- Female
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/prevention & control
- Male
- Middle Aged
- Piperazines/therapeutic use
- Pyrimidines/therapeutic use
- Remission Induction
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Affiliation(s)
- Giuliana Alimena
- Department of Cellular Biotechnology andHematology, University La Sapienza, Rome, Italy.
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Marin D, Kaeda J, Szydlo R, Saunders S, Fleming A, Howard J, Andreasson C, Bua M, Olavarria E, Rahemtulla A, Dazzi F, Kanfer E, Goldman JM, Apperley JF. Monitoring patients in complete cytogenetic remission after treatment of CML in chronic phase with imatinib: patterns of residual leukaemia and prognostic factors for cytogenetic relapse. Leukemia 2005; 19:507-12. [PMID: 15703781 DOI: 10.1038/sj.leu.2403664] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We monitored BCR-ABL transcript levels by quantitative real-time PCR in 103 patients treated with imatinib for chronic myeloid leukaemia in chronic phase for a median of 30.3 months (range 5.5-49.9) after they achieved complete cytogenetic remission (CCyR). The patients could be divided into three groups: (1) in 32 patients transcript levels continued to decline during the period of observation (nadir BCR-ABL/ABL ratio 0.015%); in five of these patients BCR-ABL transcripts became undetectable on repeated testing, (2) in 42 patients the transcript levels reached a plateau and (3) in 26 patients transcript numbers increased and the initial CCyR was lost. Three patients were not evaluable. Patients who remained in CCyR for at least 24 months appeared to have a low risk of subsequent cytogenetic relapse. We conclude that the pattern of 'residual' disease after achieving CCyR on imatinib is variable: some patients in CCyR show a progressive reduction in the level of residual disease, some reach a plateau where transcript numbers are relatively stable and others relapse with Ph-positive metaphases.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Benzamides
- Female
- Follow-Up Studies
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Incidence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/epidemiology
- Neoplasm, Residual/genetics
- Piperazines/therapeutic use
- Polymerase Chain Reaction
- Prognosis
- Pyrimidines/therapeutic use
- Recurrence
- Remission Induction
- Risk Factors
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Affiliation(s)
- D Marin
- Department of Haematology, Imperial College London at Hammersmith Hospital, London, UK
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