1
|
Zhu L, Wang P, Zhang W, Li Q, Xiong J, Li J, Deng X, Liu Y, Yang C, Kong P, Peng X, Zhong JF, Rao J, Zhang X. Plasmacytoid Dendritic Cell Infiltration in Acute Myeloid Leukemia. Cancer Manag Res 2020; 12:11411-11419. [PMID: 33192098 PMCID: PMC7654521 DOI: 10.2147/cmar.s260825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Increasing evidence has demonstrated that plasmacytoid dendritic cells (PDCs) in the tumor microenvironment (TME) play an important role in tumorigenesis and progression. PDC infiltration has been found in certain malignancies such as classic Hodgkin’s lymphoma and chronic myelomonocytic leukemia. Our previous work reported that PDC infiltration could occur in acute myeloid leukemia (AML), but the clinical significance of PDC in AML has not been thoroughly investigated. Patients and Methods Here, we evaluated the clinical significance of PDC to AML transition in a leukemia microenvironment. The frequency of PDCs in 80 acute myelomonocytic leukemia (AML-M4) and 83 acute monocytic leukemia (AML-M5) patients was determined by flow cytometry. Results We found 62 cases with PDC infiltration. These patients showed higher numbers of bone marrow blasts, higher mean Hb concentration, and required more cycles of chemotherapy before achieving complete remission (CR), but had lower white blood cell and platelet counts compared to patients without PDC infiltration. Drug sensitivity analysis showed that patients with PDC infiltration had lower sensitivity to standard chemotherapy regimens. Kaplan–Meier survival curves demonstrated that patients with PDC infiltration had a shorter overall survival (OS) time and progression-free survival time. Discussion These results suggested that PDC infiltration can be used for risk stratification of AML-M4/M5, and PDCs may transdifferentiate into leukemia in an AML microenvironment.
Collapse
Affiliation(s)
- Lidan Zhu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Ping Wang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Wei Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Qiong Li
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Jingkang Xiong
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Jiali Li
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Xiaojuan Deng
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Yao Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Chao Yang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Peiyan Kong
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Xiangui Peng
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Jiang F Zhong
- Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Jun Rao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, People's Republic of China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing 400037, People's Republic of China
| |
Collapse
|
2
|
Zhang JY, Li L, Liu W, Jin Y, Zhao M, Zhou Y, Fan Z. Comparison of efficacy of HCAG and CAG re-induction chemotherapy in elderly low- and intermediate-risk group patients diagnosed with acute myeloid leukemia. Clin Transl Oncol 2020; 23:48-57. [PMID: 32458310 DOI: 10.1007/s12094-020-02383-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The present study aimed to investigate the efficacy and severity of adverse effects of HCAG and CAG re-induction chemotherapy in elderly low- and intermediate-risk group patients diagnosed with acute myeloid leukemia (AML) following induction failure. METHODS A total of 94 AML patients were enrolled in the study, of whom 46 were treated with HCAG chemotherapy, while 48 were treated with CAG chemotherapy. RESULT The complete remission (CR) was 39.6% in the patients with HCAG, while the CR was 33.3% in the CAG group. The overall remission (ORR) was 63.0% and 43.5% in patients of the HCAG and CAG groups, respectively (P = 0.038). The median survival time of progression free survival (PFS) was 8.0 (95% CI 3.843-10.157) months in the HCAG group and 7.0 (95% CI 2.682-13.318) months in the CAG group (P = 0.032). A total of 31 patients in the HCAG group suffered from grade 4 hematological toxicity, whereas 29 patients were treated with CAG (P = 0.622). A total of 27 (58.7%) cases indicated apparent pulmonary infection in the HCAG group, while 25 (52.1%) were noted with this complication in the CAG group (P = 0.519). Oral cavity toxicity was evident for 13 (28.3%) and 11 (23.0%) cases in the HCAG and CAG groups, respectively (P = 0.216). CONCLUSION The HCAG regimen was more effective than the CAG regimen in elderly low- and intermediate-risk group patients diagnosed with acute myeloid leukemia although the HCAG regimen exhibited similar toxicity with that of the CAG group.
Collapse
Affiliation(s)
- J Y Zhang
- Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - L Li
- Lishui Municipal Central Hospital, Lishui, Zhejiang, China.
| | - W Liu
- Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Y Jin
- Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - M Zhao
- Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Y Zhou
- Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Z Fan
- Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| |
Collapse
|
3
|
Abstract
Pegylated liposomal doxorubicin (Peg-Dox) treatment resulted in a good outcome for patients with lymphoma and multiple myeloma, with reduced cardiotoxicity and an improved pharmacokinetic profile when compared to those of conventional doxorubicin. However, the use of Peg-Dox in myeloid neoplasms remains poorly studied. In this study, we first tested the role of Peg-Dox in the killing of myeloid cell lines and of primary myeloid leukemia cells. Then, a Peg-Dox-based protocol was used to treat patients with myeloid neoplasms. The results showed that the Peg-Dox and Peg-Dox-based protocols had a similar killing ability in myeloid cell lines and in primary myeloid leukemia cells compared to that of conventional doxorubicin. The complete remission rate was 87.5% and 100% for patients with refractory/relapsed acute myeloid leukemia and myelodysplastic syndrome with excess blasts, respectively, after treatment with Peg-Dox. All patients developed grade 3 or 4 hematological toxicity and recovered approximately 2 weeks after completing chemotherapy. No deaths or other severe complications were reported. Our results showed that Peg-Dox can be used in the treatment of myeloid neoplasms with high rates of complete remission and with mild complications.
Collapse
|
4
|
Economides MP, McCue D, Borthakur G, Pemmaraju N. Topoisomerase II inhibitors in AML: past, present, and future. Expert Opin Pharmacother 2019; 20:1637-1644. [PMID: 31136213 DOI: 10.1080/14656566.2019.1621292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Topoisomerase II inhibitors have long been used in the frontline and as salvage therapy for AML, with daunorubicin and idarubicin being prototypical agents in this therapeutic class, classically in combination with nucleoside analogs, e.g. cytarabine. Most recently, several other compounds from this drug class have or are being investigated. Areas covered: The current paper reviews older and newer topoisomerase II inhibitors in clinical development for the treatment of AML. The authors discuss the clinical use of these agents, current trials involving them as well as their safety profile. Important side effects of these medications including therapy-related AML (t-AML) are also covered. Expert opinion: Topoisomerase II inhibitors have helped improve outcomes in AML. Recently, the FDA approved several agents including CPX-351 for the treatment of secondary and t-AML. CPX-351 may have applicability in other high-risk myeloid diseases. Future directions include a combination of these agents with other targeted therapies. Finally, the authors believe that small molecule inhibitors, such as venetoclax and possibly immunotherapy options could also be incorporated to our treatment paradigm in selected patients.
Collapse
Affiliation(s)
- Minas P Economides
- Department of Internal Medicine, The University of Texas School of Health Sciences at Houston , Houston , TX , USA
| | - Deborah McCue
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| |
Collapse
|
5
|
Megías-Vericat JE, Martínez-Cuadrón D, Sanz MÁ, Montesinos P. Salvage regimens using conventional chemotherapy agents for relapsed/refractory adult AML patients: a systematic literature review. Ann Hematol 2018; 97:1115-1153. [DOI: 10.1007/s00277-018-3304-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/12/2018] [Indexed: 12/26/2022]
|
6
|
Shin SH, Cho BS, Park SS, Cho SY, Jeon YW, Yoon JH, Yahng SA, Lee SE, Lee DG, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS, Kim HJ. Comparison of the modified low-dose cytarabine and etoposide with decitabine therapy for elderly acute myeloid leukemia patients unfit for intensive chemotherapy. Oncotarget 2017; 9:5823-5833. [PMID: 29464037 PMCID: PMC5814177 DOI: 10.18632/oncotarget.23629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/04/2017] [Indexed: 01/21/2023] Open
Abstract
To overcome unsatisfactory results of classical low-dose cytarabine (LDAC) of cytarabine ≤20 mg twice daily (BID) subcutaneously for 10 days for patients with elderly acute myeloid leukemia (eAML), we evaluated a modified LDAC (mLDAC) of cytarabine 20 mg/m2 BID subcutaneously plus etoposide 50 mg BID orally for 14 days. To determine its feasibility, we compared outcomes of 77 and 42 eAML patients who received, respectively, mLDAC and decitabine (DAC; 20 mg/m2 intravenously daily for 5 days), which has shown better outcomes compared to those of classical LDAC. Most of baseline characteristics of two groups were well balanced. The mLDAC group had a higher complete response (CR) rate compared to the DAC group (46.8% vs. 19.0%, P < 0.01). Unlike the classical LDAC, mLDAC induced CR in patients with adverse cytogenetics, with its rate similar to that of the DAC group (33.3% vs. 20.0%; P = 0.58). Meanwhile, mucositis, neutropenic fever and invasive aspergillosis were more frequently observed in the mLDAC group, with no difference in early mortality between two groups (P > 0.05). The median overall survival rates of the mLDAC and DAC groups were comparable (8.7 vs 8.3 months, respectively, P = 0.35), presumably because the advantage of higher CR rate in the mLDAC group was offset by beneficial effects of marrow response, which is observed dominantly in the DAC group. Our results suggested that the outcomes of classical LDAC could be improved by modest modifications, to be comparable to those of DAC.
Collapse
Affiliation(s)
- Seung-Hwan Shin
- Department of Hematology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soo Park
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Yeon Cho
- Department of Infectious Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Woo Jeon
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Yoon
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Ah Yahng
- Department of Hematology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gun Lee
- Department of Infectious Disease, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Seong Eom
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo-Jin Kim
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Wook Kim
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Wook Lee
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo-Sung Min
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
7
|
Liu H, Zhang J, Ren S, Chen M, Liu L, Zhang H. Using low-dose homoharringtonine and cytarabine in combination with granulocyte colony-stimulating factor in a priming induction therapy for acute myeloid leukemia: a retrospective study of 29 cases in china. Leuk Lymphoma 2017; 58:2758-2761. [PMID: 28406352 DOI: 10.1080/10428194.2017.1312378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Haihui Liu
- a Department of Graduate School , Jining Medical University , Jining , Shandong Province , China
| | - Jingjing Zhang
- b Department of Hematology , Affiliated Hospital of Jining Medical University , Jining , Shandong Province , China
| | - Saisai Ren
- a Department of Graduate School , Jining Medical University , Jining , Shandong Province , China
| | - Mingtai Chen
- c Department of Central Laboratory , Affiliated Hospital of Jining Medical University , Jining , Shandong Province , China
| | - Lulu Liu
- c Department of Central Laboratory , Affiliated Hospital of Jining Medical University , Jining , Shandong Province , China
| | - Hao Zhang
- b Department of Hematology , Affiliated Hospital of Jining Medical University , Jining , Shandong Province , China
| |
Collapse
|
8
|
Qu Q, Liu L, Zhang Y, Li X, Wu D. Increasing aclarubicin dosage of the conventional CAG (low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor) regimen is more efficacious as a salvage therapy than CAG for relapsed/refractory acute myeloid leukemia. Leuk Res 2015; 39:1353-9. [DOI: 10.1016/j.leukres.2015.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/10/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
|
9
|
Zhang C, Chen XH, Liu J, Gao L, Liu Y, Gao L, Kong PY, Zhang X. Decitabine as a conditioning regimen in haploidentical stem cell transplantation for refractory acute myeloid leukaemia. J Clin Pharm Ther 2015; 40:336-8. [PMID: 25825260 DOI: 10.1111/jcpt.12251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 01/28/2015] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Chemotherapy can increase treatment-related mortality associated with future haematopoietic stem cell transplantation (HSCT) for patients with relapsed/refractory acute myeloid leukaemia (AML). There is usually insufficient time to find a suitable unrelated donor for these patients. We report on the use of decitabine, a DNA methyltransferase inhibitor as a conditioning regimen for a patient undergoing HSCT. CASE SUMMARY Our patient was a 21-year-old male diagnosed with AML-M1 with 84·5% blast cells and a normal karyotype. His risk stratum was intermediate, without specific mutations of FLT3/ITD, NPM1, CEBPA and C-kit. He underwent successful haploidentical HSCT using decitabine, a conditioning regimen. WHAT IS NEW AND CONCLUSION We present the first report of a patient with refractory AML (with 58% blast cells) treated successfully with decitabine as a conditioning regimen in haploidentical HSCT.
Collapse
Affiliation(s)
- C Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Gao L, Zhang X. Haploidentical hematopoietic transplantation without T-cell depletion: current status and future perspectives. Stem Cell Investig 2015; 2:20. [PMID: 27358888 DOI: 10.3978/j.issn.2306-9759.2015.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023]
Abstract
Human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplantation (HLA-haplo HSCT) without T-cell depletion has tremendously progressed over the past 20 years and has become a feasible treatment option for leukemia patients without an HLA-identical sibling donor. Advances in conditioning regimens, graft manipulation, and pharmacological graft-versus-host disease (GVHD) prophylaxis have reduced the risk of fatal graft failure and severe GVHD, two of the most serious complications of traversing the HLA barrier. According to clinical observations, killer immunoglobulin-like receptor (KIR) mismatch and donor-specific anti-HLA (DSA) antibodies-negative status play potential roles in reducing the risk of GVHD and graft failure following HLA-haploidentical SCT. New strategies to improve transplant outcomes include donor lymphocyte, NK cell and selected T-cell subset infusion, mesenchymal stem cell (MSC) co-transplantation and interleukin-2 (IL-2) application. Future challenges remain in improving post-transplant immune reconstitution and finding the best approach to reduce the incidence and severity of GVHD while simultaneously preserving the graft-versus leukemia effect to prevent the recurrence of underlying malignancy.
Collapse
Affiliation(s)
- Lei Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing 40037, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing 40037, China
| |
Collapse
|
11
|
Gao L, Wen Q, Chen X, Liu Y, Zhang C, Gao L, Kong P, Zhang Y, Li Y, Liu J, Wang Q, Su Y, Wang C, Wang S, Zeng Y, Sun A, Du X, Zeng D, Liu H, Peng X, Zhang X. Effects of priming with recombinant human granulocyte colony-stimulating factor on conditioning regimen for high-risk acute myeloid leukemia patients undergoing human leukocyte antigen-haploidentical hematopoietic stem cell transplantation: a multicenter randomized controlled study in southwest China. Biol Blood Marrow Transplant 2014; 20:1932-9. [PMID: 25109850 DOI: 10.1016/j.bbmt.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is an effective and immediate treatment for high-risk acute myeloid leukemia (HR-AML) patients lacking matched donors. Relapse remains the leading cause of death for HR-AML patients after haplo-HSCT. Accordingly, the prevention of relapse remains a challenge in the treatment of HR-AML. In a multicenter randomized controlled trial in southwestern China, 178 HR-AML patients received haplo-HSCT with conditioning regimens involving recombinant human granulocyte colony-stimulating factor (rhG-CSF) or non-rhG-CSF. The cumulative incidences of relapse and graft-versus-host disease (GVHD), 2-year leukemia-free survival (LFS), and overall survival (OS) were evaluated. HR-AML patients who underwent the priming conditioning regimen with rhG-CSF had a lower relapse rate than those who were treated with non-rhG-CSF (38.2%; 95% confidence interval [CI], 28.1% to 48.3% versus 60.7%, 95% CI, 50.5% to 70.8%; P < .01). The cumulative incidences of acute GVHD, chronic GVHD, transplantation-related toxicity, and infectious complications appeared to be equivalent. In total, 53 patients in the rhG-CSF-priming group and 31 patients in the non-rhG-CSF-priming group were still alive at the median follow-up time of 42 months (range, 24 to 80 months). The 2-year probabilities of LFS and OS in the rhG-CSF-priming and non-rhG-CSF-priming groups were 55.1% (95% CI, 44.7% to 65.4%) versus 32.6% (95% CI, 22.8% to 42.3%) (P < .01) and 59.6% (95% CI, 49.4% to 69.7%) versus 34.8% (95% CI, 24.9% to 44.7%) (P < .01), respectively. Multivariate analyses indicated that the 2-year probability of LFS of patients who achieved complete remission (CR) before transplantation was better than that of patients who did not achieve CR. The 2-year probability of LFS of patients with no M4/M5/M6 subtype was better than that of patients with the M4/M5/M6 subtype in the G-CSF-priming group (67.4%; 95% CI, 53.8% to 80.9% versus 41.9%; 95% CI, 27.1% to 56.6%; P < .05). This study suggests that the rhG-CSF-priming conditioning regimen is an acceptable choice for HR-AML patients, especially for the patients with no M4/M5/M6 subtype who achieved CR before transplantation.
Collapse
Affiliation(s)
- Lei Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qin Wen
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xinghua Chen
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yao Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Peiyan Kong
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yanqi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Yunlong Li
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jia Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qingyu Wang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yi Su
- Department of Hematology, General Hospital of Chengdu Military Region of PLA, Chengdu, China
| | - Chunsen Wang
- Department of Hematology, Sichuan Provincial Peoples Hospital, Chengdu, China
| | - Sanbin Wang
- Department of Hematology, General Hospital of Kunming Military Region of PLA, Kunming, China
| | - Yun Zeng
- Department of Hematology, Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Aihua Sun
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xin Du
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Dongfeng Zeng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Hong Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiangui Peng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
| |
Collapse
|
12
|
The connection between the toxicity of anthracyclines and their ability to modulate the P-glycoprotein-mediated transport in A549, HepG2, and MCF-7 cells. ScientificWorldJournal 2014; 2014:819548. [PMID: 24574923 PMCID: PMC3916056 DOI: 10.1155/2014/819548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/29/2013] [Indexed: 11/27/2022] Open
Abstract
Multidrug resistance (MDR) is a major obstacle to the successful chemotherapy of solid tumors. We compared the resistance of the most popular solid tumors, breast adenocarcinoma (MCF-7 cell line) and nonsmall cell lung (A549 cell line) hepatocellular liver carcinoma (HepG2 cells), to aclarubicin (ACL) and doxorubicin (DOX). This research aimed at determining the relation between the toxicity of ACL and DOX, their cell accumulation, and then effect on P-glycoprotein functionality. ACL is more cytotoxic for tumor cells compared to DOX. The intracellular concentration of drugs in cancer cells was dependent on the dose of the drugs and the time of incubation. The P-gp inhibitor Verapamil (V) increased DOX accumulation in all tested cell lines. By contrast, the intracellular level of ACL was not affected by this modifying agent. The assessment of the uptake of 5,5′,6,6′-tetrachloro-1,1′,3,3′-tetraethylbenzimidazolocarbocyanine iodide (JC-1) or Rhodamine 123 (R123) allows the evaluation of the different influence of drugs on P-gp activity which is in agreement with the estimation of expression measured by MDR-1 shift assay. These data suggest that ACL is less P-gp dependent than DOX and consequently may be used in a clinical setting to increase treatment efficacy in resistant human tumors.
Collapse
|
13
|
Gao L, Gao L, Gong Y, Zhang C, Chen XH, Zhang X. Reduced-intensity conditioning therapy with fludarabine, idarubicin, busulfan and cytarabine for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia and myelodysplastic syndrome. Leuk Res 2013; 37:1482-7. [PMID: 24054720 DOI: 10.1016/j.leukres.2013.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/06/2013] [Accepted: 08/24/2013] [Indexed: 12/01/2022]
Abstract
We retrospectively analyzed allogenic stem cell transplantation (allo-SCT) outcomes in 82 patients with AML or MDS were conditioned with fludarabine, idarubicin, intravenous-busulfan and cytarabine (FIBA) or busulfan and cyclophosphamide (BuCy). Compared to BuCy regimen, reduced intensity conditioning (RIC) with FIBA was associated with a lower incidence of severe acute GVHD, lower NRM and a similar relapse rate. There was no significant difference in the 3 year overall survival (OS), but this is possibly due to the limited number of patients. The FIBA regimen is promising to replace BuCy regimen because of better security and similar relapse rate.
Collapse
Affiliation(s)
- Li Gao
- Department of Hematology for Xinqiao Hospital Affiliated to the Third Military Medical University, Shaping District of Chongqing 400037, People's Republic of China
| | | | | | | | | | | |
Collapse
|