1
|
Elmakaty I, Saglio G, Al-Khabori M, Elsayed A, Elsayed B, Elmarasi M, Elsabagh AA, Alshurafa A, Ali E, Yassin M. The Contemporary Role of Hematopoietic Stem Cell Transplantation in the Management of Chronic Myeloid Leukemia: Is It the Same in All Settings? Cancers (Basel) 2024; 16:754. [PMID: 38398145 PMCID: PMC10886670 DOI: 10.3390/cancers16040754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 02/25/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) for chronic myeloid leukemia (CML) patients has transitioned from the standard of care to a treatment option limited to those with unsatisfactory tyrosine kinase inhibitor (TKI) responses and advanced disease stages. In recent years, the threshold for undergoing HSCT has increased. Most CML patients now have life expectancies comparable to the general population, and therefore, the goal of therapy is shifting toward achieving treatment-free remission (TFR). While TKI discontinuation trials in CML show potential for achieving TFR, relapse risk is high, affirming allogeneic HSCT as the sole curative treatment. HSCT should be incorporated into treatment algorithms from the time of diagnosis and, in some patients, evaluated as soon as possible. In this review, we will look at some of the recent advances in HSCT, as well as its indication in the era of aiming for TFR in the presence of TKIs in CML.
Collapse
Affiliation(s)
- Ibrahim Elmakaty
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy
| | | | | | - Basant Elsayed
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Mohamed Elmarasi
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | | | - Awni Alshurafa
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Elrazi Ali
- Interfaith Medical Center, Brooklyn, NY 11213, USA
| | - Mohamed Yassin
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| |
Collapse
|
2
|
Obeng-Kusi M, MacDonald K, van Lierde MA, Lee CS, De Geest S, Abraham I. No margin for non-adherence: Probabilistic kaplan-meier modeling of imatinib non-adherence and treatment response in CML (ADAGIO study). Leuk Res 2021; 111:106734. [PMID: 34735932 DOI: 10.1016/j.leukres.2021.106734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although adherence to imatinib is critical for attaining treatment responses in chronic myeloid leukemia, there is evidence of varying adherence among patients. Our aim was to model and determine the margin of tolerance, if any, required to ensure treatment responses among patients prescribed imatinib before treatment response is at risk. METHOD We performed post hoc analyses of the ADAGIO study conducted in Belgium on 169 evaluable patients (Blood 2009). Applying Kaplan-Meier methods using adherence instead of the conventional time variable, we modeled the likelihood of complete cytogenetic (CCyR), complete hematological (CHR), major molecular (MMR) and optimal (OR) response as a function of 90-day pill count adherence. RESULTS Analyses showed that ∼100 % adherence of prescribed dose is associated with probabilities of 0.84 for CHR, 0.83 for CCyR, 0.82 for OR, and 0.77 for MMR; compared to, 0.37 (CHR and CCyR), 0.35 (OR), and 0.39 (MMR) at 90 % adherence. Increasing intake of imatinib from 90 % to 100 % of the prescribed dose increased the likelihood of the various treatment responses by 1.95-2.35-fold. CONCLUSION There is virtually no margin for nonadherence, if the objective is to optimize the likelihood of treatment response, and a minimal margin to avoid impaired treatment response.
Collapse
Affiliation(s)
- Mavis Obeng-Kusi
- Center for Health Outcomes and Pharmacoeconomic Research & Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | | | - Christopher S Lee
- Connell School of Nursing, Boston College, Boston, MA, USA; Australian Catholic University, Melbourne, Victoria, Australia
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Ivo Abraham
- Center for Health Outcomes and Pharmacoeconomic Research & Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Matrix45, Tucson, AZ, USA.
| |
Collapse
|
3
|
Levy MY, McGarry LJ, Huang H, Lustgarten S, Chiroli S, Iannazzo S. Benefits and risks of ponatinib versus bosutinib following treatment failure of two prior tyrosine kinase inhibitors in patients with chronic phase chronic myeloid leukemia: a matching-adjusted indirect comparison. Curr Med Res Opin 2019; 35:479-487. [PMID: 30086654 DOI: 10.1080/03007995.2018.1510225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Comparing the benefit-risk profiles of ponatinib vs. bosutinib in third-line (3L) treatment of chronic phase chronic myeloid leukemia (CP-CML) is challenging because their pivotal trials lacked comparator arms. To characterize the overall benefit-risk profile in 3L CP-CML patients treated with bosutinib vs. ponatinib, a matching-adjusted indirect comparison (MAIC) was performed to compare efficacy outcomes and treatment duration after adjusting for trial subjects' baseline characteristics, and tolerability was assessed with an unadjusted comparison of study-drug discontinuation. METHODS The MAIC was performed using published data from the pivotal bosutinib trial and the most recent individual-patient-level data on file from the pivotal ponatinib trial. RESULTS Responses were more frequent and durable with ponatinib (n = 70 MAIC-adjusted) than with bosutinib (n = 119) - complete cytogenetic response (CCyR): 61% vs. 26%; Kaplan-Meier estimate of maintaining CCyR at 4 years: 89% vs. 54%. Median treatment duration was longer with ponatinib than with bosutinib: 38.4 vs. 8.6 months. Only 9% of ponatinib patients (n = 97 unadjusted) vs. 42% of bosutinib patients discontinued due to death, disease progression or unsatisfactory response; 19% vs. 24% discontinued due to adverse events. CONCLUSIONS Based on these surrogate measures of patient benefit-risk profiles, ponatinib appears to provide a net overall benefit vs. bosutinib in 3L CP-CML.
Collapse
Affiliation(s)
| | - Lisa J McGarry
- b Ariad Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
- c Currently affiliated with Vertex Pharmaceuticals Inc. , Boston , MA , USA
| | - Hui Huang
- b Ariad Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Stephanie Lustgarten
- b Ariad Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Silvia Chiroli
- d Incyte Biosciences International Sàrl , Epalinges , Switzerland
- e Currently affiliated with Prothena Switzerland GmbH , Zug , Switzerland
| | | |
Collapse
|
4
|
García-Gutiérrez V, Gómez-Casares MT, Puerta JM, Alonso-Domínguez JM, Osorio S, Hernández-Boluda JC, Collado R, Ramírez MJ, Ibáñez F, Martín ML, Rodríguez-Gambarte JD, Martínez-Laperche C, Gómez M, Fiallo DV, Redondo S, Rodríguez A, Ruiz-Nuño C, Steegmann JL, Jiménez-Velasco A. A BCR-ABL1 cutoff of 1.5% at 3 months, determined by the GeneXpert system, predicts an optimal response in patients with chronic myeloid leukemia. PLoS One 2017; 12:e0173532. [PMID: 28278193 PMCID: PMC5344481 DOI: 10.1371/journal.pone.0173532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/21/2017] [Indexed: 11/18/2022] Open
Abstract
In chronic myeloid leukemia (CML) patients, 3-month BCR-ABL1 levels have consistently been correlated with further outcomes. Monitoring molecular responses in CML using the GeneXpert (Cepheid) platform has shown an optimal correlation with standardized RQ-PCR (IS) when measuring BCR-ABL1 levels lower than 10%, as it is not accurate for values over 10%. The aim of the present study was to determine the predictive molecular value at three months on different outcome variables using the Xpert BCR-ABL1 MonitorTM assay (Xpert BCR-ABL1). We monitored 125 newly diagnosed consecutive CML patients in the chronic phase (CML-CP) using an automated method: Xpert BCR-ABL1. Only 5% of patients did not achieve an optimal response at 3 months, and the 10% BCR-ABL1 cutoff defined by RQ-PCR (IS) methods was unable to identify significant differences in the probabilities of achieving a complete cytogenetic response (CCyR) (50% vs. 87%, p = 0.1) or a major molecular response (MMR) (60% vs. 80%, p = 0.29) by 12 months. In contrast, a cutoff of 1.5% more accurately identified differences in the probabilities of achieving CCyR (98% vs. 54%, p<0.001) and MMR (88% vs. 56%, p<0.001) by 12 months, as well as probabilities of treatment changes (p = 0.005). Therefore, when using the Xpert BCR-ABL1 assay, a cutoff of 1.5% at 3 months could with high probability identify patients able to achieve an optimal response at 12 months.
Collapse
MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/genetics
- Cohort Studies
- Female
- Follow-Up Studies
- Fusion Proteins, bcr-abl/genetics
- Gene Rearrangement
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Neoplasm Staging
- Polymerase Chain Reaction/methods
- Prognosis
- Protein Kinase Inhibitors/therapeutic use
Collapse
Affiliation(s)
| | - María T. Gómez-Casares
- Hematology Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - José M. Puerta
- Unidad de Gestión Clínica Hematología y Hemoterapia, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Santiago Osorio
- Hematology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Rosa Collado
- Genetic Laboratory, Hematology Department, Consorcio Hospital General Universitario, Valencia, Spain
| | - María J. Ramírez
- Hematology Department, Hospital de Jerez de la Frontera, Cádiz, Spain
| | - Fátima Ibáñez
- Hematology Department, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - María L. Martín
- Hematology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Montse Gómez
- Hematology Department, Hospital Clínico, Valencia, Spain
| | - Dolly V. Fiallo
- Hematology Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Sara Redondo
- Hematology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Alicia Rodríguez
- Hematology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Concepción Ruiz-Nuño
- Hematology Department, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Juan L. Steegmann
- Hematology Department & IIS-IP, Hospital Universitario de la Princesa, Madrid, Spain
| | - Antonio Jiménez-Velasco
- Hematology Department, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
- * E-mail:
| | | |
Collapse
|
5
|
Xiao Y, Jiao C, Lin Y, Chen M, Zhang J, Wang J, Zhang Z. lncRNA UCA1 Contributes to Imatinib Resistance by Acting as a ceRNA Against miR-16 in Chronic Myeloid Leukemia Cells. DNA Cell Biol 2016; 36:18-25. [PMID: 27854515 DOI: 10.1089/dna.2016.3533] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Imatinib (IM) has been applied to the chronic phase of chronic myeloid leukemia (CML) and has great benefit on the prognosis of patients with CML. The function of drug efflux mediated by multidrug resistance protein-1 (MDR1) is considered as a main reason for IM drug resistance in CML cells. However, the exact mechanisms of MDR1 modulation in IM resistance of CML cells remain unclear. In the present study, long noncoding RNA (lncRNA) UCA1 was identified as an important modulator of MDR1 by a model system of leukemia cell lines with a gradual increase of MDR1 expression and IM resistance. Overexpression of UCA1 increased MDR1 expression to promote IM resistance of CML cells. Furthermore, for the first time, we demonstrated that UCA1 functions as a competitive endogenous (ceRNA) of MDR1 through completely binding the common miR-16. UCA1-MDR1 might be a novel target for enhancing the therapeutic efficacy of CML patients with IM resistance.
Collapse
Affiliation(s)
- Yun Xiao
- 1 Department of Clinical Laboratory, Zhongshan Hospital of Xiamen University , Xiamen, Fujian Province, China
| | - Changjie Jiao
- 2 Department of Cardiothoracic Surgery, The Affiliated Dongnan Hospital of Xiamen University , Xiamen, Fujian Province, China
| | - Yiqiang Lin
- 1 Department of Clinical Laboratory, Zhongshan Hospital of Xiamen University , Xiamen, Fujian Province, China
| | - Meijun Chen
- 1 Department of Clinical Laboratory, Zhongshan Hospital of Xiamen University , Xiamen, Fujian Province, China
| | - Jingwen Zhang
- 1 Department of Clinical Laboratory, Zhongshan Hospital of Xiamen University , Xiamen, Fujian Province, China
| | - Jiajia Wang
- 1 Department of Clinical Laboratory, Zhongshan Hospital of Xiamen University , Xiamen, Fujian Province, China
| | - Zhongying Zhang
- 1 Department of Clinical Laboratory, Zhongshan Hospital of Xiamen University , Xiamen, Fujian Province, China
| |
Collapse
|