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Extermann M, Artz A, Rebollo MA, Klepin HD, Krug U, Loh KP, Mims AS, Neuendorff N, Santini V, Stauder R, Vey N. Treating acute myelogenous leukemia in patients aged 70 and above: Recommendations from the International Society of Geriatric Oncology (SIOG). J Geriatr Oncol 2024; 15:101626. [PMID: 37741771 DOI: 10.1016/j.jgo.2023.101626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
Acute myeloid leukemia (AML) treatment is challenging in older patients. There is a lack of evidence-based recommendations for older patients ≥70, a group largely underrepresented in clinical trials. With new treatment options being available in recent years, recommendations are needed for these patients. As such the International Society of Geriatric Oncology (SIOG) assembled a task force to review the evidence specific to treatment and outcomes in this population of patients ≥70 years. Six questions were selected by the expert panel in domains of (1) baseline assessment, (2) frontline therapy, (3) post-remission therapy, (4) treatment for relapse, (5) targeted therapies, and (6) patient reported outcome/function and enhancing treatment tolerance. Information from current literature was extracted, combining evidence from systematic reviews/meta-analyses, decision models, individual trials targeting these patients, and subgroup data. Accordingly, recommendations were generated using a GRADE approach upon reviewing current evidence by consensus of the whole panel. It is our firm recommendation and hope that direct evidence should be generated for patients aged ≥70 as a distinct group in high need of improvement of their survival outcomes. Such studies should integrate information from a geriatric assessment to optimize external validity and outcomes.
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Affiliation(s)
- Martine Extermann
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
| | - Andrew Artz
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Maite Antonio Rebollo
- Institut Català d'Oncologia, Oncohematogeriatrics Unit, L'Hospitalet de Llobregat, Spain
| | - Heidi D Klepin
- Wake Forest University School of Medicine, Department of Internal Medicine, Section on Hematology and Oncology, Winston-Salem, NC, USA
| | - Utz Krug
- Klinikum Leverkusen, Department of Medicine 3, Leverkusen, Germany
| | - Kah Poh Loh
- University of Rochester Medical Center, Department of Medicine, Division of Hematology and Oncology, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Alice S Mims
- The Ohio State University Wexner Medical Center, Department of Internal Medicine, Columbus, OH, USA
| | - Nina Neuendorff
- University Hospital Essen, Department of Hematology and Stem-Cell Transplantation, Essen, Germany
| | - Valeria Santini
- MDS Unit, AOUC, Hematology, University of Florence, Florence, Italy
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Norbert Vey
- Aix-Marseille University, Institut Paoli-Calmettes, Hematology Department, Marseille, France
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2
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DeRyckere D, Huelse JM, Earp HS, Graham DK. TAM family kinases as therapeutic targets at the interface of cancer and immunity. Nat Rev Clin Oncol 2023; 20:755-779. [PMID: 37667010 DOI: 10.1038/s41571-023-00813-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
Novel treatment approaches are needed to overcome innate and acquired mechanisms of resistance to current anticancer therapies in cancer cells and the tumour immune microenvironment. The TAM (TYRO3, AXL and MERTK) family receptor tyrosine kinases (RTKs) are potential therapeutic targets in a wide range of cancers. In cancer cells, TAM RTKs activate signalling pathways that promote cell survival, metastasis and resistance to a variety of chemotherapeutic agents and targeted therapies. TAM RTKs also function in innate immune cells, contributing to various mechanisms that suppress antitumour immunity and promote resistance to immune-checkpoint inhibitors. Therefore, TAM antagonists provide an unprecedented opportunity for both direct and immune-mediated therapeutic activity provided by inhibition of a single target, and are likely to be particularly effective when used in combination with other cancer therapies. To exploit this potential, a variety of agents have been designed to selectively target TAM RTKs, many of which have now entered clinical testing. This Review provides an essential guide to the TAM RTKs for clinicians, including an overview of the rationale for therapeutic targeting of TAM RTKs in cancer cells and the tumour immune microenvironment, a description of the current preclinical and clinical experience with TAM inhibitors, and a perspective on strategies for continued development of TAM-targeted agents for oncology applications.
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Affiliation(s)
- Deborah DeRyckere
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Paediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Justus M Huelse
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Paediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - H Shelton Earp
- Department of Medicine, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Douglas K Graham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Paediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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3
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Dharmani C, Wang E, Tu N, Fofah O, Cueto J, Salas M, Kamel YM. Elderly patients with acute myeloid leukemia who only receive supportive care in the Surveillance, Epidemiology and End Results-Medicare database: demographics, treatment patterns and outcomes. Future Oncol 2023; 19:1677-1693. [PMID: 37345543 DOI: 10.2217/fon-2022-0786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
Aim: Elderly acute myeloid leukemia (AML) patients are often not treated with antileukemic therapy due to their poor overall health condition, leaving supportive care as the sole treatment option. Objective: To evaluate patient characteristics, treatment patterns and outcomes of elderly patients with AML who are treated with supportive care only. Methods: A retrospective analysis of elderly AML patients included in the Surveillance, Epidemiology and End Results-Medicare database from 2008 to 2015. Results: Of elderly patients with AML (n = 7665), 3209 (41.9%) received supportive care only. Their mean age was 79 years, 50.5% were males; 48.2% died during the first 3 months and 67.3% died during the first 6 months. 82.2% died within the first year; only 13.2% survived >12 months. 77.9% patients died due to leukemia. Conclusion: In elderly AML patients treated with supportive care only, older age, concurrent hypertension, chronic obstructive pulmonary disease, chronic kidney disease and acute myocardial infarction were identified as prognostic factors associated with decreased likelihood of survival. Ideally, these patients should be treated with antileukemic therapy in addition to supportive care, as most of them die from disease progression.
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Affiliation(s)
- Charles Dharmani
- Daiichi Sankyo, Inc., 211 Mt. Airy Rd., Basking Ridge, NJ, 07920 USA
| | - Eric Wang
- Daiichi Sankyo, Inc., 211 Mt. Airy Rd., Basking Ridge, NJ, 07920 USA
| | - Nora Tu
- Daiichi Sankyo, Inc., 211 Mt. Airy Rd., Basking Ridge, NJ, 07920 USA
| | - Oluwatosin Fofah
- Rutgers University, 160 Frelinghuysen Rd, Piscataway, NJ 08854 USA
| | - Jenilee Cueto
- Daiichi Sankyo, Inc., 211 Mt. Airy Rd., Basking Ridge, NJ, 07920 USA
| | - Maribel Salas
- Daiichi Sankyo, Inc., 211 Mt. Airy Rd., Basking Ridge, NJ, 07920 USA
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Sciumè M, Bosi A, Canzi M, Ceparano G, Serpenti F, De Roberto P, Fabris S, Tagliaferri E, Cavallaro F, Onida F, Fracchiolla NS. Real-life monocentric experience of venetoclax-based regimens for acute myeloid leukemia. Front Oncol 2023; 13:1149298. [PMID: 37051529 PMCID: PMC10083332 DOI: 10.3389/fonc.2023.1149298] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionCombination of venetoclax and hypomethylating agents (HMAs) has become a standard of care in acute myeloid leukemia (AML) aged >75 years or who have comorbidities that preclude intensive induction chemotherapy.MethodsWe conducted a monocentric retrospective analysis on adult patients affected by treatment-naïve AML not eligible for standard induction therapy or refractory/relapsed (R/R) AML treated with venetoclax combinations outside clinical trials. Venetoclax was administered at the dose of 400 mg/daily after a short ramp-up and reduced in case of concomitant CYP3A4 inhibitors.ResultsSixty consecutive AML were identified. Twenty-three patients (38%) were affected by treatment-naïve AML and 37 (62%) by R/R AML. Median age was 70 years. Among R/R AML 30% had received a prior allogeneic stem cell transplantation (allo-HSCT). In combination with venetoclax, 50 patients (83%) received azacitidine. Antifungal prophylaxis was performed in 33 patients (55%).Overall response rate was 60%, with 53% of complete remission (CR; 78% for treatment-naïve and 49% for R/R, p 0.017). Median overall survival was 130 days for R/R patients and 269 days for treatment-naïve patients; median event free survival was 145 days for R/R cohort and 199 days for treatment-naïve AML.Measurable residual disease was negative in 26% of evaluable patients in CR/CR with incomplete hematologic recovery after 2 cycles and in 50% after 4 cycles, with no significant association with survival.Eleven patients (18%) received an allo-HSCT after venetoclax combinations. Most common grade 3/4 adverse events were infectious (51% of the patients), or hematological without infections (25% of the patients). Use of CYP3A4 inhibitors was associated with a trend to shorter cytopenias and with a lower rate of infections. Invasive fungal infections were less frequent among patients receiving azole prophylaxis (6% vs 26%; p 0.0659).DiscussionVenetoclax-based regimens are a viable option for AML considered not eligible for standard induction therapy and a valid rescue therapy in the R/R setting.Azole prophylaxis did not significantly affect response and it was associated with a lower rate of invasive fungal infections. Despite a limited number of patients, the association of venetoclax and HMAs proved to be also a feasible bridging therapy to transplantation.
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Affiliation(s)
- Mariarita Sciumè
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Mariarita Sciumè,
| | - Alessandro Bosi
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Marta Canzi
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Giusy Ceparano
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Fabio Serpenti
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Pasquale De Roberto
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Fabris
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Tagliaferri
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Cavallaro
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Onida
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Nicola Stefano Fracchiolla
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Dharmani C, Wang E, Tu N, Salas M, Kamel YM. Characteristics and outcomes of elderly patients with acute myeloid leukemia who receive no treatment in the Surveillance, Epidemiology and End Results-Medicare database. Future Oncol 2023; 19:159-171. [PMID: 36912693 DOI: 10.2217/fon-2022-0565] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background: Without treatment, acute myeloid leukemia (AML) is rapidly fatal. Nevertheless, a large proportion of elderly AML patients do not receive any treatment. Aim: To characterize the demographics, comorbidities, survival and prognostic factors of elderly AML patients who do not receive any AML treatment or supportive care (SC). Methods: A retrospective cohort analysis of the Surveillance, Epidemiology and End Results-Medicare database (2008-2015). Results: Of 7665 AML patients, 2373 (31%) did not receive any AML treatment or SC. The mean age was 80.4 years, 52.8% were males and 79.7% and 95.3% died within the first 60 and 180 days, respectively; 2.1% survived >12 months and only 5.5% of patients had remission or relapse codes populated. Conclusion: Older age, male gender, concurrent depression, ischemic heart disease, chronic kidney disease and benign prostatic hyperplasia were associated with a decreased likelihood of survival. Multiple factors contribute to the complex clinical status of these patients preventing intensive chemotherapy; they should still ideally be treated, at least with the best SC.
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Affiliation(s)
- Charles Dharmani
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Eric Wang
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Nora Tu
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Maribel Salas
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
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Optimizing outcomes in secondary AML. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:23-29. [PMID: 36485116 PMCID: PMC9820930 DOI: 10.1182/hematology.2022000324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute myeloid leukemia (AML) secondary to antecedent hematologic disorder or prior therapeutics for cancer represent a diverse group of leukemias often associated with inferior outcomes. Conventional therapy with cytarabine-based chemotherapy has been the mainstay of care for the past 30 years with disappointing overall outcomes. Novel therapies, including liposomal cytarabine/daunorubicin, and venetoclax-based therapies have emerged as options in recent years based on studies showing improvement in outcomes over standard-of-care therapies. Despite these advances, mutations in TP53 are associated with inferior response to both therapies and represent an area of unmet clinical need. Novel strategies with immune-targeted therapies such as CD47 monoclonal antibodies appear active in early-phase studies, but randomized studies have yet to report outcomes leading to approval. Allogeneic transplant remains the only known curative therapy for many of these cases. Nonetheless, pretransplant high-risk molecular features of secondary AML are associated with inferior outcome despite transplantation. An optimal approach to secondary AML is yet to be determined.
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7
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Winters AC, Bosma G, Abbott D, Minhajuddin M, Jordan C, Pollyea DA, Gutman JA. Outcomes Are Similar After Allogeneic Hematopoietic Stem Cell Transplant for Newly Diagnosed Acute Myeloid Leukemia Patients who Received Venetoclax + Azacitidine Versus Intensive Chemotherapy. Transplant Cell Ther 2022; 28:694.e1-694.e9. [DOI: 10.1016/j.jtct.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/05/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
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8
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Use of Azacitidine or Decitabine for the Up-Front Setting in Acute Myeloid Leukaemia: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13225677. [PMID: 34830832 PMCID: PMC8616518 DOI: 10.3390/cancers13225677] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Azacitidine and decitabine have been increasingly used for the treatment of acute myeloid leukaemia in older patients. The choice between azacitidine and decitabine depends mostly on the experience and preference of the attending physician, since they have not been compared directly in a randomised clinical trial. In this study, we identified the best treatment regimen for each drug and compare the efficacy of decitabine and azacitidine monotherapy in newly diagnosed acute myeloid leukaemia. We found no significant differences regarding 1-year mortality and overall survival for azacitidine and decitabine (roughly 9 months). Moreover, there were no significant differences in the efficacy of 5-day versus 10-day schedules of decitabine. However, patients treated with the shortened 5-day azacitidine scheme showed worsened outcomes compared to the standard 7-day regimen. Hopefully, our results might be helpful for the design of azacitidine/decitabine-based combination schedules to be tested in future trials. Abstract Irruption of decitabine and azacitidine has led to profound changes in the upfront management of older acute myeloid leukaemia (AML). However, they have not been directly compared in a randomised clinical trial. In addition, there are no studies comparing the optimal treatment schedule of each drug in AML. A systematic review and meta-analysis on the efficacy of decitabine and azacitidine monotherapy in newly diagnosed AML was conducted. Randomised controlled trials and retrospective studies were included. A total of 2743 patients from 23 cohorts were analysed (10 cohorts of azacitidine and 13 of decitabine). Similar response rates were observed for azacitidine (38%, 95% CI: 30–47%) compared to decitabine (40%, 95% CI: 32–48%) (p = 0.825). Overall survival (OS) between azacitidine (10.04 months, 95% CI: 8.36–11.72) and decitabine (8.79 months, 95% CI: 7.62–9.96) was also similar (p = 0.386). Patients treated with azacitidine showed a lower median OS when azacitidine was administered for 5 days (6.28 months, 95% CI: 4.23–8.32) compared to the standard 7-day schedule (10.83 months, 95% CI: 9.07–12.59, p = 0.002). Among patients treated with decitabine, response rates and OS were not significantly different between 5-day and 10-day decitabine regimens. Despite heterogeneity between studies, we found no differences in response rates and OS in AML patients treated with azacitidine or decitabine.
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Parinet V, Chapiro E, Bidet A, Gaillard B, Maarek O, Simon L, Lefebvre C, Defasque S, Mozziconacci MJ, Quinquenel A, Decamp M, Lifermann F, Ali-Ammar N, Maillon A, Baron M, Martin M, Struski S, Penther D, Micol JB, Auger N, Bilhou-Nabera C, Martignoles JA, Tondeur S, Nguyen-Khac F, Hirsch P, Roos-Weil D. Myeloid malignancies with translocation t(4;12)(q11-13;p13): molecular landscape, clonal hierarchy and clinical outcomes. J Cell Mol Med 2021; 25:9557-9566. [PMID: 34492730 PMCID: PMC8505829 DOI: 10.1111/jcmm.16895] [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: 07/05/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/28/2022] Open
Abstract
Translocation t(4;12)(q11‐13;p13) is a recurrent but very rare chromosomal aberration in acute myeloid leukaemia (AML) resulting in the non‐constant expression of a CHIC2/ETV6 fusion transcript. We report clinico‐biological features, molecular characteristics and outcomes of 21 cases of t(4;12) including 19 AML and two myelodysplastic syndromes (MDS). Median age at the time of t(4;12) was 78 years (range, 56–88). Multilineage dysplasia was described in 10 of 19 (53%) AML cases and CD7 and/or CD56 expression in 90%. FISH analyses identified ETV6 and CHIC2 region rearrangements in respectively 18 of 18 and 15 of 17 studied cases. The t(4;12) was the sole cytogenetic abnormality in 48% of cases. The most frequent associated mutated genes were ASXL1 (n = 8/16, 50%), IDH1/2 (n = 7/16, 44%), SRSF2 (n = 5/16, 31%) and RUNX1 (n = 4/16, 25%). Interestingly, concurrent FISH and molecular analyses showed that t(4;12) can be, but not always, a founding oncogenic event. Median OS was 7.8 months for the entire cohort. In the 16 of 21 patients (76%) who received antitumoral treatment, overall response and first complete remission rates were 37% and 31%, respectively. Median progression‐free survival in responders was 13.7 months. Finally, t(4;12) cases harboured many characteristics of AML with myelodysplasia‐related changes (multilineage dysplasia, MDS‐related cytogenetic abnormalities, frequent ASXL1 mutations) and a poor prognosis.
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Affiliation(s)
- Vincent Parinet
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Elise Chapiro
- Sorbonne Université, Unité de Cytogénétique, Hôpital Pitié-Salpêtrière, APHP, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Université de Paris, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Université, Paris, France
| | - Audrey Bidet
- Laboratoire d'Hématologie Biologique, CHU Bordeaux, Bordeaux, France
| | - Baptiste Gaillard
- Laboratoire d'Hématologie, Hôpital Robert Debré, Reims, France.,Laboratoire de cytogénétique, Centre Hospitalier de Troyes, Troyes, France
| | - Odile Maarek
- Hematology Laboratory, Hôpital Saint-Louis, APHP, University of Paris, Paris, France
| | - Laurence Simon
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Christine Lefebvre
- Laboratoire de Génétique des Hémopathies, CHU Grenoble Alpes, Grenoble, France
| | - Sabine Defasque
- Secteur cytogénétique hématologique, Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | | | - Anne Quinquenel
- CHU de Reims, Hôpital Robert Debré, Reims, France.,Unité de Formation et de recherche (UFR) Médecine, Université Reims Champagne-Ardenne, Reims, France
| | | | | | - Nadia Ali-Ammar
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Agathe Maillon
- Sorbonne Université, Unité de Cytogénétique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Marine Baron
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Mélanie Martin
- Laboratoire de Cytogénétique, CHU Caremeau, Nîmes, France
| | - Stéphanie Struski
- Laboratoire d'hématologie/Plateau Technique Hématologie-Oncologie, IUCT Oncopole, Toulouse, France
| | - Dominique Penther
- Laboratoire de Génétique Oncologique, CLCC Henri Becquerel & INSERM U1245, Rouen, France
| | - Jean-Baptiste Micol
- Hematology Department, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Nathalie Auger
- Laboratoire de Cytogénétique, Institut Gustave Roussy, Villejuif, France
| | - Chrystèle Bilhou-Nabera
- Service d'Hématologie Biologique, Unité de Cytogénétique onco-hématologique, Hôpital Saint-Antoine, APHP, Sorbonne Université, Paris, France.,Département d'hématologie biologique, INSERM, Centre de Recherche Saint-Antoine Sorbonne, Université, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Jean-Alain Martignoles
- Département d'hématologie biologique, INSERM, Centre de Recherche Saint-Antoine Sorbonne, Université, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Sylvie Tondeur
- Laboratoire de Génétique des Hémopathies, CHU Grenoble Alpes, Grenoble, France
| | - Florence Nguyen-Khac
- Sorbonne Université, Unité de Cytogénétique, Hôpital Pitié-Salpêtrière, APHP, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Université de Paris, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Université, Paris, France
| | - Pierre Hirsch
- Département d'hématologie biologique, INSERM, Centre de Recherche Saint-Antoine Sorbonne, Université, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Damien Roos-Weil
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Université de Paris, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Université, Paris, France
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Hubscher E, Sikirica S, Bell T, Brown A, Welch V, Russell-Smith A, D'Amico P. Patterns of undertreatment among patients with acute myeloid leukemia (AML): considerations for patients eligible for non-intensive chemotherapy (NIC). J Cancer Res Clin Oncol 2021; 147:3359-3368. [PMID: 34462785 PMCID: PMC8484094 DOI: 10.1007/s00432-021-03756-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
Acute myeloid leukemia (AML) is a life-threatening malignancy that is more prevalent in the elderly. Because the patient population is heterogenous and advanced in age, choosing the optimal therapy can be challenging. There is strong evidence supporting antileukemic therapy, including standard intensive induction chemotherapy (IC) and non-intensive chemotherapy (NIC), for older patients with AML, and guidelines recommend treatment selection based on a patient’s individual and disease characteristics as opposed to age alone. Nonetheless, historic evidence indicates that a high proportion of patients who may be candidates for NIC receive no active antileukemic treatment (NAAT), instead receiving only best supportive care (BSC). We conducted a focused literature review to assess current real-world patterns of undertreatment in AML. From a total of 25 identified studies reporting the proportion of patients with AML receiving NAAT, the proportion of patients treated with NAAT varied widely, ranging from 10 to 61.4% in the US and 24.1 to 35% in Europe. Characteristics associated with receipt of NAAT included clinical factors such as age, poor performance status, comorbidities, and uncontrolled concomitant conditions, as well as sociodemographic factors such as female sex, unmarried status, and lower income. Survival was diminished among patients receiving NAAT, with reported median overall survival values ranging from 1.2 to 4.8 months compared to 5 to 14.4 months with NIC. These findings suggest a proportion of patients who are candidates for NIC receive NAAT, potentially forfeiting the survival benefit of active antileukemic treatment.
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Kadia TM, Ravandi F, Borthakur G, Konopleva M, DiNardo CD, Daver N, Pemmaraju N, Kanagal‐Shamanna R, Wang X, Huang X, Pierce S, Rausch C, Burger J, Ferrajoli A, Jain N, Popat U, Estrov Z, Verstovsek S, Jabbour E, Garcia‐Manero G, Kantarjian H. Long-term results of low-intensity chemotherapy with clofarabine or cladribine combined with low-dose cytarabine alternating with decitabine in older patients with newly diagnosed acute myeloid leukemia. Am J Hematol 2021; 96:914-924. [PMID: 33901324 DOI: 10.1002/ajh.26206] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
The treatment of older patients with newly diagnosed acute myeloid leukemia (AML) using intensive chemotherapy is associated with treatment intolerance and poor survival. We evaluated two new lower-intensity regimens with clofarabine (n = 119) or cladribine (n = 129) combined with low-dose cytarabine (LDAC) alternating with decitabine. We reviewed response rates by subgroup and long term outcomes of 248 patients with newly diagnosed non core-binding-factor AML treated on two clinical trials investigating double nucleoside-analogue therapy (DNT) alternating with HMA from October, 2008 to April, 2018. Of 248 patients with a median age of 69 years (range, 49-85 years), 102 patients (41%) were ≥ 70 years, and 108 (44%) had adverse karyotype. Overall, 164 patients (66%) responded: 147 (59%) complete remission (CR) and 17 (7%) CR with incomplete count recovery (CRi). With a median follow up of 60 months, median relapse-free and overall survival (OS) were 10.8 and 12.5 months, respectively. The 2-year OS was 29%. Among patients with normal karyotype, the CR/CRi rate was 79% and the median OS 19.9 months. High response rates and OS were observed in patients with mutations in NPM1, FLT3, IDH2, and RUNX1. The 4- and 8-week mortality rates were 2% and 11%, respectively. The backbone of clofarabine or cladribine and LDAC alternating with decitabine was effective and safe for the treatment of older patients with newly diagnosed AML. Incorporating targeted therapies could extend the efficacy of this approach and provide more curative therapeutic options in this AML population.
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Affiliation(s)
- Tapan M. Kadia
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Gautam Borthakur
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marina Konopleva
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Courtney D. DiNardo
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naval Daver
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Naveen Pemmaraju
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Rashmi Kanagal‐Shamanna
- Department of Hematopathology University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Xuemei Wang
- Department of Biostatistics University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Xuelin Huang
- Department of Biostatistics University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Caitlin Rausch
- Department of Pharmacy University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Jan Burger
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Alessandra Ferrajoli
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Nitin Jain
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Uday Popat
- Department of Stem Cell Transplant University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zeev Estrov
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Srdan Verstovsek
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Elias Jabbour
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Hagop Kantarjian
- Department of Leukemia University of Texas MD Anderson Cancer Center Houston Texas USA
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12
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Heuser M, Smith BD, Fiedler W, Sekeres MA, Montesinos P, Leber B, Merchant A, Papayannidis C, Pérez-Simón JA, Hoang CJ, O'Brien T, Ma WW, Zeremski M, O'Connell A, Chan G, Cortes JE. Clinical benefit of glasdegib plus low-dose cytarabine in patients with de novo and secondary acute myeloid leukemia: long-term analysis of a phase II randomized trial. Ann Hematol 2021; 100:1181-1194. [PMID: 33740113 PMCID: PMC8043884 DOI: 10.1007/s00277-021-04465-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
This analysis from the phase II BRIGHT AML 1003 trial reports the long-term efficacy and safety of glasdegib + low-dose cytarabine (LDAC) in patients with acute myeloid leukemia ineligible for intensive chemotherapy. The multicenter, open-label study randomized (2:1) patients to receive glasdegib + LDAC (de novo, n = 38; secondary acute myeloid leukemia, n = 40) or LDAC alone (de novo, n = 18; secondary acute myeloid leukemia, n = 20). At the time of analysis, 90% of patients had died, with the longest follow-up since randomization 36 months. The combination of glasdegib and LDAC conferred superior overall survival (OS) versus LDAC alone; hazard ratio (HR) 0.495; (95% confidence interval [CI] 0.325–0.752); p = 0.0004; median OS was 8.3 versus 4.3 months. Improvement in OS was consistent across cytogenetic risk groups. In a post-hoc subgroup analysis, a survival trend with glasdegib + LDAC was observed in patients with de novo acute myeloid leukemia (HR 0.720; 95% CI 0.395–1.312; p = 0.14; median OS 6.6 vs 4.3 months) and secondary acute myeloid leukemia (HR 0.287; 95% CI 0.151–0.548; p < 0.0001; median OS 9.1 vs 4.1 months). The incidence of adverse events in the glasdegib + LDAC arm decreased after 90 days’ therapy: 83.7% versus 98.7% during the first 90 days. Glasdegib + LDAC versus LDAC alone continued to demonstrate superior OS in patients with acute myeloid leukemia; the clinical benefit with glasdegib + LDAC was particularly prominent in patients with secondary acute myeloid leukemia. ClinicalTrials.gov identifier: NCT01546038.
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Affiliation(s)
- Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - B Douglas Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Walter Fiedler
- Department of Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mikkael A Sekeres
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, FL, Miami, USA
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Brian Leber
- Juravinski Hospital at Hamilton Health Sciences, Hamilton, ON, Canada
| | - Akil Merchant
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IbiS)/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | | | | | | | | | | | | | - Jorge E Cortes
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Georgia Cancer Center, Augusta, GA, USA
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13
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Han YC, Kahler J, Piché-Nicholas N, Hu W, Thibault S, Jiang F, Leal M, Katragadda M, Maderna A, Dushin R, Prashad N, Charati MB, Clark T, Tumey LN, Tan X, Giannakou A, Rosfjord E, Gerber HP, Tchistiakova L, Loganzo F, O'Donnell CJ, Sapra P. Development of Highly Optimized Antibody-Drug Conjugates against CD33 and CD123 for Acute Myeloid Leukemia. Clin Cancer Res 2021; 27:622-631. [PMID: 33148666 DOI: 10.1158/1078-0432.ccr-20-2149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/15/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Mortality due to acute myeloid leukemia (AML) remains high, and the management of relapsed or refractory AML continues to be therapeutically challenging. The reapproval of Mylotarg, an anti-CD33-calicheamicin antibody-drug conjugate (ADC), has provided a proof of concept for an ADC-based therapeutic for AML. Several other ADCs have since entered clinical development of AML, but have met with limited success. We sought to develop a next-generation ADC for AML with a wide therapeutic index (TI) that overcomes the shortcomings of previous generations of ADCs. EXPERIMENTAL DESIGN We compared the TI of our novel CD33-targeted ADC platform with other currently available CD33-targeted ADCs in preclinical models of AML. Next, using this next-generation ADC platform, we performed a head-to-head comparison of two attractive AML antigens, CD33 and CD123. RESULTS Our novel ADC platform offered improved safety and TI when compared with certain currently available ADC platforms in preclinical models of AML. Differentiation between the CD33- and CD123-targeted ADCs was observed in safety studies conducted in cynomolgus monkeys. The CD33-targeted ADC produced severe hematologic toxicity, whereas minimal hematologic toxicity was observed with the CD123-targeted ADC at the same doses and exposures. The improved toxicity profile of an ADC targeting CD123 over CD33 was consistent with the more restricted expression of CD123 in normal tissues. CONCLUSIONS We optimized all components of ADC design (i.e., leukemia antigen, antibody, and linker-payload) to develop an ADC that has the potential to translate into an effective new therapy against AML.
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Affiliation(s)
- Yoon-Chi Han
- Pfizer Inc., Oncology Research & Development, Pearl River, New York.
| | - Jennifer Kahler
- Pfizer Inc., Oncology Research & Development, Pearl River, New York
| | | | - Wenyue Hu
- Pfizer Inc., Drug Safety Research & Development, La Jolla, California
| | - Stephane Thibault
- Pfizer Inc., Drug Safety Research & Development, La Jolla, California
| | - Fan Jiang
- Pfizer Inc., Oncology Research & Development, Pearl River, New York
| | - Mauricio Leal
- Pfizer Inc., BioMedicine Design, Cambridge, Massachusetts and Pearl River, New York
| | - Madan Katragadda
- Pfizer Inc., BioMedicine Design, Cambridge, Massachusetts and Pearl River, New York
| | - Andreas Maderna
- Pfizer Inc., Worldwide Medicinal Chemistry, Groton, Connecticut
| | - Russell Dushin
- Pfizer Inc., Worldwide Medicinal Chemistry, Groton, Connecticut
| | - Nadira Prashad
- Pfizer Inc., Oncology Research & Development, Pearl River, New York
| | - Manoj B Charati
- Pfizer Inc., Oncology Research & Development, Pearl River, New York
| | | | - L Nathan Tumey
- Pfizer Inc., Worldwide Medicinal Chemistry, Groton, Connecticut
| | - Xingzhi Tan
- Pfizer Inc., Oncology Research & Development, Pearl River, New York
| | | | - Edward Rosfjord
- Pfizer Inc., Oncology Research & Development, Pearl River, New York
| | | | | | - Frank Loganzo
- Pfizer Inc., Oncology Research & Development, Pearl River, New York
| | | | - Puja Sapra
- Pfizer Inc., Oncology Research & Development, Pearl River, New York.
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14
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Precision medicine treatment in acute myeloid leukemia using prospective genomic profiling: feasibility and preliminary efficacy of the Beat AML Master Trial. Nat Med 2020; 26:1852-1858. [PMID: 33106665 DOI: 10.1038/s41591-020-1089-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022]
Abstract
Acute myeloid leukemia (AML) is the most common diagnosed leukemia. In older adults, AML confers an adverse outcome1,2. AML originates from a dominant mutation, then acquires collaborative transformative mutations leading to myeloid transformation and clinical/biological heterogeneity. Currently, AML treatment is initiated rapidly, precluding the ability to consider the mutational profile of a patient's leukemia for treatment decisions. Untreated patients with AML ≥ 60 years were prospectively enrolled on the ongoing Beat AML trial (ClinicalTrials.gov NCT03013998 ), which aims to provide cytogenetic and mutational data within 7 days (d) from sample receipt and before treatment selection, followed by treatment assignment to a sub-study based on the dominant clone. A total of 487 patients with suspected AML were enrolled; 395 were eligible. Median age was 72 years (range 60-92 years; 38% ≥75 years); 374 patients (94.7%) had genetic and cytogenetic analysis completed within 7 d and were centrally assigned to a Beat AML sub-study; 224 (56.7%) were enrolled on a Beat AML sub-study. The remaining 171 patients elected standard of care (SOC) (103), investigational therapy (28) or palliative care (40); 9 died before treatment assignment. Demographic, laboratory and molecular characteristics were not significantly different between patients on the Beat AML sub-studies and those receiving SOC (induction with cytarabine + daunorubicin (7 + 3 or equivalent) or hypomethylation agent). Thirty-day mortality was less frequent and overall survival was significantly longer for patients enrolled on the Beat AML sub-studies versus those who elected SOC. A precision medicine therapy strategy in AML is feasible within 7 d, allowing patients and physicians to rapidly incorporate genomic data into treatment decisions without increasing early death or adversely impacting overall survival.
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15
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Labbozzetta M, Notarbartolo M, Poma P. Can NF-κB Be Considered a Valid Drug Target in Neoplastic Diseases? Our Point of View. Int J Mol Sci 2020; 21:ijms21093070. [PMID: 32349210 PMCID: PMC7246796 DOI: 10.3390/ijms21093070] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Multidrug resistance (MDR), of the innate and acquired types, is one of major problems in treating tumor diseases with a good chance of success. In this review, we examine the key role of nuclear factor-kappa B (NF-κB) to induce MDR in three tumor models characterized precisely by innate or acquired MDR, in particular triple negative breast cancer (TNBC), hepatocellular carcinoma (HCC), and acute myeloid leukemia (AML). We also present different pharmacological approaches that our group have employed to reduce the expression/activation of this transcriptional factor and thus to restore chemo-sensitivity. Finally, we examine the latest scientific evidence found by other groups, the most significant clinical trials regarding NF-κB, and new perspectives on the possibility to consider this transcriptional factor a valid drug target in neoplastic diseases.
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16
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Shallis RM, Boddu PC, Bewersdorf JP, Zeidan AM. The golden age for patients in their golden years: The progressive upheaval of age and the treatment of newly-diagnosed acute myeloid leukemia. Blood Rev 2020; 40:100639. [DOI: 10.1016/j.blre.2019.100639] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022]
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17
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Ferrara F, Picardi A. Is outcome of older people with acute myeloid leukemia improving with new therapeutic approaches and stem cell transplantation? Expert Rev Hematol 2020; 13:99-108. [PMID: 31922453 DOI: 10.1080/17474086.2020.1715207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The clinical outcome of older patients with acute myeloid leukemia (AML) is still poor, especially for those who are unfit to treatments aimed at altering the natural course of the disease. Hypomethylating agents (HMA) offer an important therapeutic opportunity to a consistent number of patients, but long-term results are largely unsatisfactory.Area covered: Recently, a number of new agents have been registered for AML, some of which selectively available for older patient population, with promising results in terms of response rate and survival. Furthermore, the upper age limit for allogeneic stem cell transplantation is constantly increasing, so that this procedure is offered and actually given to an increasing number of older patients with AML. A literature review was conducted of the PubMed database for articles published in English as well as for abstracts from most important and recent hematology meetings on AML in older patients.Expert opinion: Appropriate selection among different options on the basis of clinical fitness and molecular findings at diagnosis as well as at relapse would result in improvement of therapeutic results, sparing unnecessary toxicity and optimizing health systems resources.
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Affiliation(s)
- Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Program, AORN Cardarelli Hospital, Naples, Italy
| | - Alessandra Picardi
- Division of Hematology and Stem Cell Transplantation Program, AORN Cardarelli Hospital, Naples, Italy.,Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
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18
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Essential Oil Composition of Alluaudia procera and in Vitro Biological Activity on Two Drug-Resistant Models. Molecules 2019; 24:molecules24162871. [PMID: 31394879 PMCID: PMC6720003 DOI: 10.3390/molecules24162871] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 01/02/2023] Open
Abstract
Drug resistance is a major obstacle in antibiotic and antitumor chemotherapy. In response to the necessity to find new therapeutic strategies, plant secondary metabolites including essential oils (EOs) may represent one of the best sources. EOs in plants act as constitutive defenses against biotic and abiotic stress, and they play an important role in the pharmacology for their low toxicity, good pharmacokinetic and multitarget activity. In this context, natural products such as EOs are one of the most important sources of drugs used in pharmaceutical therapeutics. The aim of this paper was to identify the chemical composition of the essential oil of Alluaudia procera leaves, obtained by hydrodistillation and analysed by gas chromatography-mass spectrometry, and to verify its biological activities on acute myeloid leukemia cancer cell HL60 and its multidrugresistant variant HL60R and the Gram-positive Staphylococcus aureus exhibiting multi-antibiotic resistance. We speculate that cytotoxic and antibiotic effects observed in the tested resistant models may be due to the coordinate activities of forty compounds detected or to the C16 macrocyclic lactones which are the major ones (30%). Our data confirm the possibility of using EOs as therapeutic strategies in resistant models is due to the heterogeneous composition of the oils themselves.
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