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Chu D, Ji C, Zhang Y, Wei C, Zhang X, Zhong Q, Yan H, Wang J. Identification of inhibitors targeting the FLT3-ITD mutation through 4D-QSAR, in vitro, and in silico. Eur J Med Chem 2025; 282:117089. [PMID: 39602994 DOI: 10.1016/j.ejmech.2024.117089] [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: 10/20/2024] [Revised: 11/16/2024] [Accepted: 11/20/2024] [Indexed: 11/29/2024]
Abstract
The FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutation is a key target for acute myeloid leukemia (AML) treatment. The second-generation inhibitors such as Gilteritinib still present off-target effects and associated side effects. Therefore, identifying novel FLT3-ITD inhibitors has become a promising strategy for AML treatment. In this study, a 4D-QSAR model was developed based on Gilteritinib and its analogues, and it was found that introducing hydrophobic bulky groups at the piperazine or piperidine of Gilteritinib would enhance the binding affinity to FLT3-ITD. So, three series of targeted compounds (A1-A5, B1-B5 and C1-C5) were designed and synthesized. The antiproliferative activity against MOLM-13 cells was evaluated in vitro. Compound A1 (IC50 = 25.65 nM), with a cubane group at the piperazine position; Compounds B2 (IC50 = 63.38 nM) and C2 (IC50 = 54.96 nM), with a norbornene group at the piperidine position, showed the strongest inhibition in their series. Their IC50 values were comparable to that of the positive control Gilteritinib (IC50 = 22.37 nM). FLT3-ITD was confirmed as the degradation target through a kinase inhibition assay, where the IC50 values were 2.12 nM (Compound A1), 1.29 nM (Compound B2), and 3.06 nM (Compound C2), which were comparable to that of Gilteritinib (IC50 = 0.43 nM). Additionally, molecular docking and molecular dynamics (MD) simulations showed that Compounds A1, B2, and C2 had similar binding modes to that of Gilteritinib with more stable affinities. Overall, these results demonstrated that Compounds A1, B2, and C2 were promising inhibitors for targeting AML with FLT3-ITD mutation.
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Affiliation(s)
- Dongchen Chu
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, 100124, PR China
| | - CuiCui Ji
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, 100124, PR China
| | - Yu Zhang
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, 100124, PR China
| | - Chaochun Wei
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, 100124, PR China
| | - Xiaokun Zhang
- Department of Chemistry, Tsinghua University, Beijing, 100084, PR China.
| | - Qidi Zhong
- School of Pharmacy, North China University of Science and Technology, Tangshan, 063210, PR China
| | - Hong Yan
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, 100124, PR China
| | - Juan Wang
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, 100124, PR China
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2
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Kudu E, Topal A, Alp E. Expanding insights on neutropenia: Emphasizing oncologic therapies and clinical nuances in emergency medicine. Am J Emerg Med 2025:S0735-6757(24)00757-5. [PMID: 39794203 DOI: 10.1016/j.ajem.2024.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Affiliation(s)
- Emre Kudu
- Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye.
| | - Alper Topal
- Department of Medical Oncology, Tokat Gaziosmanpasa University, Tokat, Türkiye
| | - Eda Alp
- Department of Infectious Disease and Clinical Microbiology, Istanbul Basaksehir Cam and Sakura City Hospital, İstanbul, Türkiye
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Martínez-Roca A, Jiménez-Vicente C, Merchán B, Castaño-Diez S, Zugasti I, Brillembourg H, Bataller Á, Guijarro F, Cortés-Bullich A, Trigueros A, Pérez-Valencia AI, Gallego C, Ballestar N, Rodríguez-Lobato LG, Carcelero E, Díaz-Beyá M, Esteve J, Fernández-Avilés F. At-Home Care Program for Acute Myeloid Leukemia Induction Phase in Patients Treated with Venetoclax-Based Low-Intensity Regimens. Cancers (Basel) 2024; 16:4274. [PMID: 39766173 PMCID: PMC11674946 DOI: 10.3390/cancers16244274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/16/2024] [Accepted: 12/20/2024] [Indexed: 01/11/2025] Open
Abstract
Background: Even though venetoclax in combination with azacitidine (VenAza) is considered a low-intensity regimen, its patients present a high incidence of cytopenia and infections during the first courses, making the initial management a challenging phase. Methods: This difficulty in our center led to the establishment of an At-Home (AH) program for ramp-up and follow-up patients during the VenAza combination induction phase focused on therapy administration, patient and caregiver education, and management of adverse events (AEs). A total of 70 patients with newly diagnosed acute myeloid leukemia (ND-AML) or relapsed/refractory AML (R/R AML) were treated with VenAza from March 2019 to May 2022. We compared outcomes between patients managed with a hospital-based (inpatient) approach and those managed through the AH program. Results: Despite most patients experiencing grade 3-4 cytopenias (96.9%), the incidence of serious infections and other AEs was comparable between both groups, with no significant difference in febrile neutropenia (42.3% vs. 27.8%, p = 0.38). Overall, the AH cohort demonstrated a significantly lower hospital readmission rate after ramp-up (29.5% vs. 84.6%, p = 0.001). Moreover, the inpatient cohort's admission days were longer than in the AH cohort (13 vs. 8, p = 0.28). Conclusions: AH management was feasible and safe, leading to better resource use, enhanced patient comfort, and improved treatment compliance. The potential of AH programs for managing low-intensity chemotherapy regimens can reduce hospital admissions and subsequently improve patient and caregiver well-being.
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Affiliation(s)
- Alexandra Martínez-Roca
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Carlos Jiménez-Vicente
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Beatriz Merchán
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Sandra Castaño-Diez
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
- Hemopathology Unit, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Inés Zugasti
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Helena Brillembourg
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Álex Bataller
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
- Hemopathology Unit, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Francesca Guijarro
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
- Hemopathology Unit, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Albert Cortés-Bullich
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Ana Trigueros
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Amanda Isabel Pérez-Valencia
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Cristina Gallego
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Nuria Ballestar
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Esther Carcelero
- Pharmacy Service, Division of Medicine, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Marina Díaz-Beyá
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Jordi Esteve
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Francesc Fernández-Avilés
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
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Li P, Luo Z, Deng J. Strategies for the prophylaxis of invasive fungal diseases in acute myeloid leukemia patients undergoing Bcl-2 inhibitor venetoclax treatment. J Infect Chemother 2024:S1341-321X(24)00323-4. [PMID: 39643209 DOI: 10.1016/j.jiac.2024.12.005] [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: 09/17/2024] [Revised: 11/30/2024] [Accepted: 12/03/2024] [Indexed: 12/09/2024]
Abstract
Patients with acute myeloid leukemia (AML) are at high risk of developing invasive fungal disease (IFD) with high morbidity and attributable mortality, including those who were received Venetoclax treatment. Venetoclax, a new oral Bcl-2 inhibitor, targets tumor cells' ability to induce apoptosis. It is the only one which is approved by Food and Drug Administration (FDA) for treating newly diagnosed AML patients who are 75 years of age or older and are ineligible for intensive induction chemotherapy due to existing comorbidities. It has been shown that venetoclax-based regimens raise the risk of invasive fungal diseases (IFD) for AML patients in clinical practice. Because it can lead to prolonged and profound neutropenia in AML patients, with IFD incidence rates ranging from 5.1 % to 32 %, resulting in higher mortality rates. Because of drug-drug interactions between Venetoclax and partial antifungal agents, to choose anti-fungal prophylaxis and to adjust the dosage of agents rationally for AML patients seems crucial to physicians to those who are undergoing venetoclax-based chemotherapy. Therefore, this review aims to summary the mechanism and characteristic of IFD in AML patients and provide practical clinical suggestions and details for the prophylaxis of IFD in AML patients suffering Venetoclax-based treatment.
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Affiliation(s)
- Pengfei Li
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Zhiming Luo
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Jianchuan Deng
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Czech MM, Schulz E, Mina A, Gea-Banacloche J. Infections and antimicrobial prophylaxis in patients with myelodysplastic syndromes. Semin Hematol 2024; 61:348-357. [PMID: 39198132 PMCID: PMC11646186 DOI: 10.1053/j.seminhematol.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/29/2024] [Indexed: 09/01/2024]
Abstract
Infectious complications are an important cause of morbidity and mortality in patients with myelodysplastic syndromes (MDS). Preventing infections could significantly improve both survival and quality of life. Unfortunately, both infections and antimicrobial prophylaxis in patients with MDS are incompletely assessed due to the heterogeneity of disorders included in each publication, changing definitions over time, and lack of standardized prophylaxis practices. Despite these limitations, some basic statements can be made. Infections in MDS are associated with neutropenia. Patients with lower-risk (LR) MDS tend to have fewer infections compared to patients with higher-risk (HR) MDS, which may be related to the different prevalence of neutropenia in the 2 groups. Pneumonia is the most common infection, and bacteria are the most common pathogens. Invasive fungal infections (IFI) are uncommon. Reactivation of latent viruses are rare. With the limited data available, we agree that antibacterial prophylaxis can be considered in patients with HR-MDS during severe neutropenia and early cycles of therapy when infections are most likely to occur. Given the low prevalence of IFI and viral reactivation, antimicrobial prophylaxis for these pathogens is less likely to be advantageous for most patients, although antifungal prophylaxis with activity against mold is commonly used in patients with persistent, profound neutropenia. Ultimately, improved data collection regarding infections and antimicrobial prophylaxis is needed to improve care for patients with MDS.
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Affiliation(s)
- Mary M Czech
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
| | - Eduard Schulz
- Myeloid Malignancy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alain Mina
- Myeloid Malignancy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Juan Gea-Banacloche
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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6
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Costa A, Scalzulli E, Carmosino I, Ielo C, Bisegna ML, Martelli M, Breccia M. Clinical and biological advances of critical complications in acute myeloid leukemia. Leuk Lymphoma 2024:1-20. [PMID: 39582141 DOI: 10.1080/10428194.2024.2425051] [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: 06/12/2024] [Revised: 10/24/2024] [Accepted: 10/27/2024] [Indexed: 11/26/2024]
Abstract
Managing acute myeloid leukemia (AML) and its critical complications requires understanding the complex interplay between disease biology, treatment strategies, and patient characteristics. Complications like sepsis, acute respiratory failure (ARF), hyperleukocytosis, coagulopathy, tumor lysis syndrome (TLS) and central nervous system (CNS) involvement present unique challenges needing precise evaluation and tailored interventions. Venetoclax-induced TLS and differentiation syndrome (DS) from IDH1/IDH2 or menin inhibitors highlight the need for ongoing research and innovative approaches. As the microbiological landscape evolves and new therapeutic agents emerge, adapting strategies to mitigate harmful pharmacological interactions is crucial. Advances in understanding the genetic profiles of patients with hyperleukocytosis contribute to better-targeted therapeutic strategies. Effective AML management relies on collaborative efforts from hematologists, specialized services, and intensive care units (ICUs). This review analyzes recent data on critical AML complications, identifies areas for further investigation, and proposes ways to advance clinical research and enhance patient care strategies.
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Affiliation(s)
- Alessandro Costa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Maria Laura Bisegna
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
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Pawińska-Wąsikowska K, Czogała M, Bukowska-Strakova K, Surman M, Rygielska M, Książek T, Sadowska B, Pac A, Skalska-Sadowska J, Samborska M, Wachowiak J, Ciebiera M, Chaber R, Tomaszewska R, Szczepański T, Zielezińska K, Urasiński T, Rodziewicz-Konarska A, Kałwak K, Kozłowska M, Irga-Jaworska N, Sikorska-Fic B, Chyżyński B, Łaguna P, Muszyńska-Rosłan K, Krawczuk-Rybak M, Deleszkiewicz P, Drabko K, Bobeff K, Młynarski W, Chodała-Grzywacz A, Karolczyk G, Mycko K, Badowska W, Bartoszewicz N, Styczyński J, Machnik K, Stolpa W, Mizia-Malarz A, Balwierz W, Skoczeń S. Analysis of early and treatment related deaths among children and adolescents with acute myeloid leukemia in Poland: 2005-2023. Front Pediatr 2024; 12:1482720. [PMID: 39483533 PMCID: PMC11524810 DOI: 10.3389/fped.2024.1482720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 09/30/2024] [Indexed: 11/03/2024] Open
Abstract
Background A personalised approach to the treatment of acute myeloid leukemia (AML) in children and adolescents, as well as the development of supportive therapies, has significantly improved survival. Despite this, some patients still die before starting treatment or in an early phase of therapy before achieving remission. The study analysed the frequency, clinical features and risk factors for early deaths (ED) and treatment related deaths (TRD) of children and adolescents with AML. Methods From January 2005 to November 2023, 646 children with AML treated in the centers of the Polish Pediatric Leukemia and Lymphoma Study Group according to three subsequent therapeutic protocols were evaluated: AML-BFM 2004 Interim (385 children), AML-BFM 2012 Registry (131 children) and AML-BFM 2019 (130 children). Results Out of 646 children, early death occurred in 30 children, including 15 girls. The median age was 10.7 years (1 day to 18 years). More than half of the patients (53%) were diagnosed with acute myelomonocytic leukemia (M5) and 13% with acute promyelocytic leukemia (M3). The ED rate for the three consecutive AML-BFM protocols was 4.9% vs. 5.3% vs. 3.1%, respectively. In 19 patients, death occurred before the 15th day of treatment, in 11 between the 15th and 42nd day. The most common cause of death before the 15th day (ED15) was leukostasis and bleeding, whereas between the 15th and 42nd day (ED15-42), infections, mainly bacterial sepsis. A significant association was found between ED15 and high leukocyte count (>10 × 109/L), M3 leukemia (p < 0.001), and ED15-42 and age <1 year (p = 0.029). In the univariate analysis only initial high leukocyte count >100 × 109/L, was a significant predictor of early death. The overall TRD for the entire study period was 3.4%. The main cause of death were infections, mainly bacterial sepsis (10 children out of 22, 45.4%). Conclusions Hyperleukocytosis remains significant factor of early mortality in patients with AML, despite the introduction of various cytoreductive methods. Infections are still the main cause of treatment related deaths. A more individualized approach by using new targeted drugs may be the therapeutic option of choice in the future.
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Affiliation(s)
- Katarzyna Pawińska-Wąsikowska
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children Hospital of Krakow, Krakow, Poland
| | - Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children Hospital of Krakow, Krakow, Poland
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Surman
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Rygielska
- Department of Pediatric Oncology and Hematology, Hematology Laboratory, University Children’s Hospital, Krakow, Poland
| | - Teofila Książek
- Department of Molecular Genetics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Beata Sadowska
- Department of Pediatric Oncology and Hematology, Cytogenetics and Molecular Genetics Laboratory, University Children’s Hospital, Krakow, Poland
| | - Agnieszka Pac
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Samborska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Ciebiera
- Department of Pediatric Oncohematology, Clinical Province Hospital of Rzeszow, Rzeszow, Poland
- Department of Pediatrics, Institute of Medical Sciences, Medical College, University of Rzeszow, Rzeszow, Poland
| | - Radosław Chaber
- Department of Pediatric Oncohematology, Clinical Province Hospital of Rzeszow, Rzeszow, Poland
- Department of Pediatrics, Institute of Medical Sciences, Medical College, University of Rzeszow, Rzeszow, Poland
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Karolina Zielezińska
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Anna Rodziewicz-Konarska
- Clinical Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Clinical Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Kozłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Barbara Sikorska-Fic
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Chyżyński
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Łaguna
- Department of Oncology, Pediatric Hematology, Transplantology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | | | - Maryna Krawczuk-Rybak
- Departament of Pediatrics, Oncology and Hematology Medical University of Bialystok, Bialystok, Poland
| | - Paulina Deleszkiewicz
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Bobeff
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | | | - Grażyna Karolczyk
- Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, Kielce, Poland
| | - Katarzyna Mycko
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, Olsztyn, Poland
| | - Wanda Badowska
- Department of Pediatrics and Hematology and Oncology, Province Children’s Hospital, Olsztyn, Poland
| | - Natalia Bartoszewicz
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Katarzyna Machnik
- Department of Pediatrics, Hematology and Oncology, City Hospital, Chorzow, Poland
| | - Weronika Stolpa
- Department of Pediatrics, Upper Silesia Children’s Care Health Centre, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Mizia-Malarz
- Department of Pediatrics, Upper Silesia Children’s Care Health Centre, Medical University of Silesia, Katowice, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children Hospital of Krakow, Krakow, Poland
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, University Children Hospital of Krakow, Krakow, Poland
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8
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Taş Z, Metan G, Telli Dizman G, Yavuz E, Dizdar Ö, Büyükaşık Y, Uzun Ö, Akova M. An Institutional Febrile Neutropenia Protocol Improved the Antibacterial Treatment and Encouraged the Development of a Computerized Clinical Decision Support System. Antibiotics (Basel) 2024; 13:832. [PMID: 39335006 PMCID: PMC11429046 DOI: 10.3390/antibiotics13090832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/23/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
We investigated the influence of a local guideline on the quality of febrile neutropenia (FN) management and the applicability of a computerized decision support system (CDSS) using real-life data. The study included 227 FN patients between April 2016 and January 2019. The primary outcome measure was the achievement of a 20% increase in the rate of appropriate empirical treatment of FN in bacteremic patients. The compatibility of the CDSS (the development of which was completed in November 2021) with local protocols was tested using standard patient scenarios and empirical antibiotic recommendations for bacteremic FN patients. In total, 91 patients were evaluated before (P1: between April 2016 and May 2017) and 136 after (P2: between May 2017 and January 2019) the guideline's release (May 2017). The demographic characteristics were similar. Appropriate empirical antibacterial treatment was achieved in 58.3% of P1 and 88.1% of P2 patients (p = 0.006). The need for escalation of antibacterial treatment was significantly lower in P2 (49.5% vs. 35.3%; p = 0.03). In P2, the performance of the CDSS and consulting physicians was similar (CDSS 88.8% vs. physician 88.83%; p = 1) regarding appropriate empirical antibacterial treatment. The introduction of the local guideline improved the appropriateness of initial empirical treatment and reduced escalation rates in FN patients. The high rate of compliance of the CDSS with the local guideline-based decisions in P2 highlights the usefulness of the CDSS for these patients.
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Affiliation(s)
- Zahit Taş
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Eren Yavuz
- Hemosoft Software Development Department, Ankara 06800, Turkey
| | - Ömer Dizdar
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yahya Büyükaşık
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
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9
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Mao X, Wu S, Huang D, Li C. Complications and comorbidities associated with antineoplastic chemotherapy: Rethinking drug design and delivery for anticancer therapy. Acta Pharm Sin B 2024; 14:2901-2926. [PMID: 39027258 PMCID: PMC11252465 DOI: 10.1016/j.apsb.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 07/20/2024] Open
Abstract
Despite the considerable advancements in chemotherapy as a cornerstone modality in cancer treatment, the prevalence of complications and pre-existing diseases is on the rise among cancer patients along with prolonged survival and aging population. The relationships between these disorders and cancer are intricate, bearing significant influence on the survival and quality of life of individuals with cancer and presenting challenges for the prognosis and outcomes of malignancies. Herein, we review the prevailing complications and comorbidities that often accompany chemotherapy and summarize the lessons to learn from inadequate research and management of this scenario, with an emphasis on possible strategies for reducing potential complications and alleviating comorbidities, as well as an overview of current preclinical cancer models and practical advice for establishing bio-faithful preclinical models in such complex context.
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Affiliation(s)
- Xiaoman Mao
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Shuang Wu
- Medical Research Institute, Southwest University, Chongqing 400715, China
| | - Dandan Huang
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Chong Li
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
- Medical Research Institute, Southwest University, Chongqing 400715, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
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10
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Shah M, El Chaer F, Ho DY, El Boghdadly Z. Managing infectious challenges in the age of molecular-targeted therapies for adult hematological malignancies. Transpl Infect Dis 2024; 26:e14283. [PMID: 38698640 DOI: 10.1111/tid.14283] [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: 11/15/2023] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
Over the last decade, the therapeutic landscape for hematological malignancies (HMs) has witnessed a remarkable surge in the development of novel biological and small-molecule-targeted immunomodulatory agents. These therapies have drastically improved survival, but some come at the cost of increased risk of bacterial, viral, and/or fungal infections and on-target off-tumor immunological side effects. To mitigate such risks, physicians must be well informed about infectious complications and necessary preventive measures, such as screening, vaccinations, and antimicrobial prophylaxis. Furthermore, physicians should be vigilant about the noninfectious side effects of these agents that can mimic infections and understand their potential drug-drug interactions with antimicrobials. Strengthening and harmonizing the current surveillance and reporting system for drug-associated infections in real-world settings is essential to better ascertain the potential infections associated with these agents. In this review, we aimed to summarize the infection risks associated with novel agents used for specific HMs and outline recommended strategies for monitoring and prophylaxis.
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Affiliation(s)
- Manan Shah
- Division of Hematology and Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Firas El Chaer
- Division of Hematology and Oncology, Department of Medicine, The University of Virginia, Charlottesville, Virginia, USA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, Virginia, USA
| | - Zeinab El Boghdadly
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
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11
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Şahinkaya Ş, Ture Z, Unal A, Ünüvar GK, Kılıç AU. Determination of Risk Factors for Infectious Diarrhea in Patients with Hematological Malignancy. Infect Chemother 2024; 56:239-246. [PMID: 38403877 PMCID: PMC11224029 DOI: 10.3947/ic.2023.0102] [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: 10/11/2023] [Accepted: 11/26/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND This study aimed to determine the risk factors of infectious diarrhea in patients undergoing chemotherapy or hematopoietic stem cell transplantation for hematological malignancies. MATERIALS AND METHODS This was a prospective, observational study. Patients in whom the infectious agent was determined by laboratory examination were considered to have infectious diarrhea. Patients with diarrhea were categorized as infectious or unidentified and compared in terms of demographic data, treatments, risk factors, laboratory findings, and prognosis. RESULTS A total of 838 patients were hospitalized, among which 105 patients who met the inclusion criteria were included (12.5%). The patients were divided into two groups: 67 (63.8%) with unidentified diarrhea and 38 (36.2%) with infectious diarrhea. There were no differences between these groups in terms of age, sex, types of hematological malignancies, and presence of comorbidities. The most commonly isolated microorganism was Clostridioides difficile (12.4%). The rate of corticosteroid use was higher in the group with infectious diarrhea (39.5%) than in the group with unidentified diarrhea (7.5%) (P <0.001). The rate of granulocyte colony-stimulating factor (GCSF) use was higher in patients with unidentified diarrhea than in patients with infectious diarrhea (67.2% vs. 42.1%, P=0.022). The median duration of diarrhea was 9 (4-10) days in the group with infectious diarrhea and 5 (3-8) days in the group with unidentified diarrhea (P=0.012). According to the multivariate logistic regression model, corticosteroid treatment increased the risk of infectious diarrhea by a 4.75-fold (95% confidence interval [CI], 1.32-17.02) times. Moreover, the duration of diarrhea may result in a 1.15 (95% CI, 1.02-1.31) fold increase in the risk of infectious diarrhea, while GCSF treatment had a 2.84 (1/0.35) (95% CI, 0.12-0.96) fold risk-reducing effect against infectious diarrhea. CONCLUSION Infectious diarrhea lasts longer than unidentified diarrhea in patients with hematological malignancies. Although corticosteroid use is a risk factor for developing infectious diarrhea, GCSF use has a protective effect.
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Affiliation(s)
- Şükran Şahinkaya
- Department of Infection Control Committee, Erciyes University, Kayseri, Turkey
| | - Zeynep Ture
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Ali Unal
- Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gamze Kalın Ünüvar
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ayşegül Ulu Kılıç
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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12
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Wu X, Ma X, Song T, Liu J, Sun Y, Wu D. The indirect effects of CMV reactivation on patients following allogeneic hematopoietic stem cell transplantation: an evidence mapping. Ann Hematol 2024; 103:917-933. [PMID: 38227006 PMCID: PMC10866798 DOI: 10.1007/s00277-023-05509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/11/2023] [Indexed: 01/17/2024]
Abstract
Cytomegalovirus (CMV) reactivation following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a challenging problem, and the impact on the risk of overall mortality (OM) and non-relapse mortality (NRM) in patients following allo-HSCT is still controversial. Utilizing the evidence mapping method, we aimed to assess the effect of CMV infection on outcomes of patients post-transplantation and identify research gaps through systematic reviews (SRs) and clinical studies. PubMed, EMBASE, Web of Science, and Cochrane library databases were searched from inception until 5 July 2022 to identify relevant literature. After systematic literature screening and data extraction, evidence mapping of the effects of CMV reactivation on patients post-allo-HSCT was conducted. Three SRs and 22 clinical studies were included. In one SR, CMV reactivation was associated with an increased risk of mortality (HR 1.46; 95% CI, 1.24-1.72; P ≤ 0.001). In two SRs, CMV reactivation was associated with NRM. One SR reported CMV reactivation was potentially associated with significant protection against relapse in patients with acute myelocytic leukemia (AML), but no significant correlation with graft-versus-host disease (GVHD) was found. Lastly, in one SR CMV reactivation significantly increased the risk of invasive fungal disease (IFD). Most clinical articles reported that CMV reactivation increased the risk of renal dysfunction, poor graft function, re-hospitalization, and bacterial infections. CMV reactivation following allo-HSCT is associated with an increased risk of OM, NRM, IFD, and renal dysfunction, as well as a reduced risk of relapse in patients with AML.
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Affiliation(s)
- Xiaojin Wu
- The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, 215000, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, 215000, China
| | - Xiao Ma
- The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, 215000, China
| | - Tiemei Song
- The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, 215000, China
| | - Jie Liu
- MRL Global Medical Affairs, MSD China, Shanghai, 200233, China
| | - Yi Sun
- MRL Global Medical Affairs, MSD China, Shanghai, 200233, China
| | - Depei Wu
- The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, 215000, China.
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13
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Mori G, Diotallevi S, Farina F, Lolatto R, Galli L, Chiurlo M, Acerbis A, Xue E, Clerici D, Mastaglio S, Lupo Stanghellini MT, Ripa M, Corti C, Peccatori J, Puoti M, Bernardi M, Castagna A, Ciceri F, Greco R, Oltolini C. High-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies. Microorganisms 2024; 12:117. [PMID: 38257945 PMCID: PMC10818361 DOI: 10.3390/microorganisms12010117] [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: 12/11/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Invasive fungal diseases (IFDs) still represent a relevant cause of mortality in patients affected by hematological malignancies, especially acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) undergoing remission induction chemotherapy, and in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Mold-active antifungal prophylaxis (MAP) has been established as a standard of care. However, breakthrough IFDs (b-IFDs) have emerged as a significant issue, particularly invasive aspergillosis and non-Aspergillus invasive mold diseases. Here, we perform a narrative review, discussing the major advances of the last decade on prophylaxis, the diagnosis of and the treatment of IFDs in patients with high-risk neutropenic fever undergoing remission induction chemotherapy for AML/MDS and allo-HSCT. Then, we present our single-center retrospective experience on b-IFDs in 184 AML/MDS patients undergoing high-dose chemotherapy while receiving posaconazole (n = 153 induction treatments, n = 126 consolidation treatments, n = 60 salvage treatments). Six cases of probable/proven b-IFDs were recorded in six patients, with an overall incidence rate of 1.7% (6/339), which is in line with the literature focused on MAP with azoles. The incidence rates (IRs) of b-IFDs (95% confidence interval (95% CI), per 100 person years follow-up (PYFU)) were 5.04 (0.47, 14.45) in induction (n = 2), 3.25 (0.0013, 12.76) in consolidation (n = 1) and 18.38 (3.46, 45.06) in salvage chemotherapy (n = 3). Finally, we highlight the current challenges in the field of b-IFDs; these include the improvement of diagnoses, the expanding treatment landscape of AML with molecular targeted drugs (and related drug-drug interactions with azoles), evolving transplantation techniques (and their related impacts on IFDs' risk stratification), and new antifungals and their features (rezafungin and olorofim).
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Affiliation(s)
- Giovanni Mori
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.)
- Infectious Diseases Unit, Ospedale Santa Chiara, 38122 Trento, Italy
| | - Sara Diotallevi
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Francesca Farina
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Laura Galli
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Matteo Chiurlo
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.)
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Andrea Acerbis
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.)
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Elisabetta Xue
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Centre for Immuno-Oncology, National Cancer Institute, Eliminate NIH, Bethesda, MD 20850, USA
| | - Daniela Clerici
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Sara Mastaglio
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | - Marco Ripa
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.)
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Consuelo Corti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Jacopo Peccatori
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Massimo Puoti
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20161 Milan, Italy
- Faculty of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Massimo Bernardi
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.)
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Fabio Ciceri
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.M.)
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Raffaella Greco
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Chiara Oltolini
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20161 Milan, Italy
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14
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Hogan CA, Miller S, Piantadosi A, Gaston DC, Simner PJ, Nash S, Babady NE. Which trial do we need? Plasma metagenomic next-generation sequencing to diagnose infections in patients with haematological malignancies and febrile neutropenia: proposal for a randomized-controlled trial. Clin Microbiol Infect 2023; 29:1474-1479. [PMID: 37244468 DOI: 10.1016/j.cmi.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Catherine A Hogan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Miller
- Delve Bio, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Anne Piantadosi
- Emory University Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA; Emory University Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - David C Gaston
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patricia J Simner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen Nash
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - N Esther Babady
- Department of Pathology and Laboratory Medicine, Clinical Microbiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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15
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Scamuffa MC, Latagliata R, Carmosino I, Di Veroli A, Scalzulli E, Trapè G, Ciotti G, De Angelis G, Tartaglia G, Tarnani M, Breccia M, Girmenia C. Pulmonary infections in patients with acute myeloid leukemia receiving frontline treatment with hypomethylating agents. Leuk Lymphoma 2023; 64:1840-1846. [PMID: 37554018 DOI: 10.1080/10428194.2023.2239407] [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: 03/16/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/10/2023]
Abstract
Pulmonary infections (PIs) are a major complication of Acute Myeloid Leukemia (AML) treated with hypomethylating agents (HMA). We retrospectively evaluated 147 AML patients treated frontline with HMA in 2 Centers. Total number of HMA cycles was 1397. There were 88 episodes of PI in 64 patients (43.5%). Thirty-five/147 patients at risk (23.8%) developed at least 1 episode of early PI (during cycles 1-2). Median OS in patients who developed early PI was 3.3 months (95% CI 0.8 - 5.8) versus 10.5 months (95% CI 8.4 - 12.7) in patients without PI or with PI beyond the 2nd cycle (p < .001). Early PIs were an independent factor predicting lower survival (OR 1.94, 95% CI 1.28 - 2.93; p = .002). In conclusion, early PIs are common in AML patients receiving HMA and are associated with an unfavorable outcome. The results of our study raise the issue of a tailored infection prevention strategy.
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Affiliation(s)
- Maria Cristina Scamuffa
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giulia Ciotti
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Germana Tartaglia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Corrado Girmenia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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16
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Hoover A, Thielen BK, Ebens CL. Fever and neutropenia in pediatric oncology and stem cell transplant patients: an editorial commentary on updated international clinical practice guidelines. Transl Pediatr 2023; 12:1908-1912. [PMID: 37969121 PMCID: PMC10644023 DOI: 10.21037/tp-23-368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Alex Hoover
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Beth K. Thielen
- Division of Infectious Diseases, Department of Pediatrics, Global Pediatrics Program, Minneapolis, MN, USA
| | - Christen L. Ebens
- Division of Blood and Marrow Transplant & Cellular Therapy, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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17
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Molica M, Perrone S, Andriola C, Rossi M. Immunotherapy with Monoclonal Antibodies for Acute Myeloid Leukemia: A Work in Progress. Cancers (Basel) 2023; 15:5060. [PMID: 37894427 PMCID: PMC10605302 DOI: 10.3390/cancers15205060] [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: 08/31/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
In the last few years, molecularly targeted agents and immune-based treatments (ITs) have significantly changed the landscape of anti-cancer therapy. Indeed, ITs have been proven to be very effective when used against metastatic solid tumors, for which outcomes are extremely poor when using standard approaches. Such a scenario has only been partially reproduced in hematologic malignancies. In the context of acute myeloid leukemia (AML), as innovative drugs are eagerly awaited in the relapsed/refractory setting, different ITs have been explored, but the results are still unsatisfactory. In this work, we will discuss the most important clinical studies to date that adopt ITs in AML, providing the basis to understand how this approach, although still in its infancy, may represent a promising therapeutic tool for the future treatment of AML patients.
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Affiliation(s)
- Matteo Molica
- Department of Hematology-Oncology, Azienda Universitaria Ospedaliera Renato Dulbecco, 88100 Catanzaro, Italy;
| | - Salvatore Perrone
- Department of Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, 04100 Latina, Italy;
| | - Costanza Andriola
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00100 Rome, Italy;
| | - Marco Rossi
- Department of Hematology-Oncology, Azienda Universitaria Ospedaliera Renato Dulbecco, 88100 Catanzaro, Italy;
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18
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Khosla AA, Jatwani K, Singh R, Reddy A, Jaiyesimi I, Desai A. Bispecific Antibodies in Lung Cancer: A State-of-the-Art Review. Pharmaceuticals (Basel) 2023; 16:1461. [PMID: 37895932 PMCID: PMC10609957 DOI: 10.3390/ph16101461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Bispecific antibodies have emerged as a promising class of therapeutics in the field of oncology, offering an innovative approach to target cancer cells while sparing healthy tissues. These antibodies are designed to bind two different antigens, enabling them to bridge immune cells with cancer cells, resulting in enhanced tumor cell killing and improved treatment responses. This review article summarizes the current landscape of bispecific antibodies in lung cancer, including their mechanisms of action, clinical development, and potential applications in other solid tumor malignancies. Additionally, the challenges and opportunities associated with their use in the clinic are discussed, along with future directions for research and development in this exciting area of cancer immunotherapy.
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Affiliation(s)
- Atulya Aman Khosla
- Division of Internal Medicine, William Beaumont University Hospital, Royal Oak, MI 48073, USA;
| | - Karan Jatwani
- Division of Hematology-Oncology, Roswell Park Cancer Center, Buffalo, NY 14203, USA
| | - Rohit Singh
- Division of Hematology-Oncology, University of Vermont, Burlington, VT 05405, USA
| | - Aswanth Reddy
- Division of Hematology-Oncology, Mercy Clinic, Fort Smith, AR 72903, USA
| | - Ishmael Jaiyesimi
- Division of Hematology-Oncology, William Beaumont University Hospital, Royal Oak, MI 48073, USA
| | - Aakash Desai
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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19
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Tangella AV, Gajre A, Kantheti VV. Isocitrate Dehydrogenase 1 Mutation and Ivosidenib in Patients With Acute Myeloid Leukemia: A Comprehensive Review. Cureus 2023; 15:e44802. [PMID: 37692182 PMCID: PMC10483130 DOI: 10.7759/cureus.44802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Abstract
Acute myeloid leukemia (AML) arises from immature myeloid progenitors, resulting in a stem-cell-like proliferative state. This leads to excessive pools of immature cells that cannot function, which usually happens at the cost of the production of mature functional cells, leading to deleterious consequences. The management of AML has intensified as newer targeted therapies have come into existence owing to deeper genetic analysis of the disease and patients. Isocitrate dehydrogenase (IDH) is a cytosolic enzyme that is a part of the Krebs cycle and is extremely important in maintaining the homeostasis of the cell. It is produced by two different genes: IDH1 and IDH2. Ivosidenib has been associated with IDH1 inhibition and has been studied in numerous cancers. This review highlights the studies that have dealt with ivosidenib, an IDH1 inhibitor, in AML, the side effect profile, and the possible future course of the drug. After a scoping review of the available literature, we have identified that studies have consistently shown positive outcomes and that ivosidenib is a promising avenue for the management of AML. But it also has to be kept in mind that resistance to IDH inhibitors is on the rise, and the need to identify ways to circumvent this is to be addressed.
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Affiliation(s)
| | - Ashwin Gajre
- Internal Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, IND
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20
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Rubinstein JD, O’Brien MM. Inotuzumab ozogamicin in B-cell precursor acute lymphoblastic leukemia: efficacy, toxicity, and practical considerations. Front Immunol 2023; 14:1237738. [PMID: 37600823 PMCID: PMC10435844 DOI: 10.3389/fimmu.2023.1237738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Inotuzumab ozogamicin (InO) is an antibody drug conjugate composed of a humanized monoclonal antibody targeting the cell surface receptor CD22 coupled to a cytotoxic calicheamicin payload via an acid labile linker. InO has shown significant activity in relapsed and refractory B-cell precursor acute lymphoblastic leukemia (BCP-ALL) in both single agent and combination chemotherapy regimens in adult and pediatric trials. Its use in newly diagnosed elderly patients has also been established while clinical trials investigating its use in newly diagnosed pediatric patients and fit adults are ongoing. Notable toxicities include sinusoidal obstruction syndrome (SOS), particularly in patients who undergo hematopoietic stem cell transplantation (HSCT) after InO as well as myelosuppression and B-cell aplasia which confer increased infection risk, particularly in combination with cytotoxic chemotherapy. In the relapsed/refractory (R/R) setting, the planned subsequent curative therapy modality must be considered when using InO to mitigate SOS risk if proceeding to HSCT and account for potential B-cell aplasia if proceeding to chimeric antigen receptor CAR-T therapy. Studies exploring mechanisms of resistance or failure of InO are ongoing but modulation or loss CD22 expression, alternative CD22 splicing, and high Bcl-2 expression have been implicated. In this review, we will summarize the currently available data on InO, with an emphasis on pediatric trials, and explore future directions including combinatorial therapy.
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Affiliation(s)
- Jeremy D. Rubinstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Maureen M. O’Brien
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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21
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Salvatorelli E, Minotti G, Menna P. New Targeted Drugs for Acute Myeloid Leukemia and Antifungals: Pharmacokinetic Challenges and Opportunities. Chemotherapy 2023; 68:170-182. [PMID: 37004510 DOI: 10.1159/000530447] [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: 01/27/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a life-threatening disease whose treatment is made difficult by a number of mutations or receptor overexpression in the proliferating cellular clones. Life expectancy of patients diagnosed with new, relapsed-refractory, or secondary AML has been improved by drugs targeted at such moieties. Regrettably, however, clinical use of new AML drugs is complicated by pharmacokinetic interactions with other drugs the patient is exposed to. SUMMARY The most relevant drug-drug interactions (DDI) with clinical implications build on competition for or induction/inhibition of CYP3A4, which is a versatile metabolizer of a plethora of pharmacological agents. Here, we review DDI between AML drugs and the agents used to prevent or treat invasive fungal infections (IFI). The pathophysiology of AML, characterized by functionally defective white blood cells and neutropenic/immunosuppressive effects of concomitant induction chemotherapy, can in fact increase the risk of infectious complications, with IFI causing high rates of morbidity and mortality. Triazole antifungals, such as posaconazole, are strong inhibitors of CYP3A4 and may thus cause patient's overexposure to AML drugs that are metabolized by CYP3A4. We describe potential strategies to minimize the consequences of DDI between triazole antifungals and targeted therapies for AML and the role that collaboration between clinical pharmacologists, hematologists, and clinical or laboratory microbiologists may have in these settings. KEY MESSAGES Therapeutic drug monitoring and clinical pharmacology stewardship could represent two strategies that best express multidisciplinary collaboration for improving patient management.
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Affiliation(s)
| | - Giorgio Minotti
- Department of Medicine, University Campus Bio-Medico, Rome, Italy
- Research Unit of Clinical Pharmacology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pierantonio Menna
- Research Unit of Clinical Pharmacology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Science and Technology for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, Rome, Italy
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22
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Ledoux MP, Herbrecht R. Invasive Pulmonary Aspergillosis. J Fungi (Basel) 2023; 9:jof9020131. [PMID: 36836246 PMCID: PMC9962768 DOI: 10.3390/jof9020131] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Invasive pulmonary aspergillosis is growing in incidence, as patients at risk are growing in diversity. Outside the classical context of neutropenia, new risk factors are emerging or newly identified, such as new anticancer drugs, viral pneumonias and hepatic dysfunctions. Clinical signs remain unspecific in these populations and the diagnostic work-up has considerably expanded. Computed tomography is key to assess the pulmonary lesions of aspergillosis, whose various features must be acknowledged. Positron-emission tomography can bring additional information for diagnosis and follow-up. The mycological argument for diagnosis is rarely fully conclusive, as biopsy from a sterile site is challenging in most clinical contexts. In patients with a risk and suggestive radiological findings, probable invasive aspergillosis is diagnosed through blood and bronchoalveolar lavage fluid samples by detecting galactomannan or DNA, or by direct microscopy and culture for the latter. Diagnosis is considered possible with mold infection in lack of mycological criterion. Nevertheless, the therapeutic decision should not be hindered by these research-oriented categories, that have been completed by better adapted ones in specific settings. Survival has been improved over the past decades with the development of relevant antifungals, including lipid formulations of amphotericin B and new azoles. New antifungals, including first-in-class molecules, are awaited.
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23
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A real-world pharmacovigilance study of FDA Adverse Event Reporting System (FAERS) events for venetoclax. PLoS One 2022; 17:e0278725. [PMID: 36477747 PMCID: PMC9728853 DOI: 10.1371/journal.pone.0278725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Venetoclax (VEN) is the first selective small molecule Bcl-2 inhibitor approved by FDA and used in adult chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL) and some acute myeloid leukemia (AML). However, the long-term safety of VEN in large sample population was unknown. This study evaluated the adverse events (AEs) of VEN from FDA Adverse Event Reporting System (FAERS) since its approval in 2016 by data mining. METHODS The disproportionality analyses, including four algorithms of reporting odd ratio (ROR), proportional reporting ratio (PRR), bayesian configuration promotion neural network (BCPNN), and multi item gamma poisson shrinker (MGPS), were employed to quantify the signals of VEN-associated AEs. RESULTS From the FAERS database, a total of 8,379,682 reports were collected during the study period. After removing the duplication, the number of reports with VEN as the primary suspect (PS) was 19,107. The 19,107 cases of AEs involved 27 organ systems, 256 significant PTs which conforming to the four algorithms. Unexpected serious AEs, such as pleural effusion, splenic infarction, atrial fibrillation, skin squamous cell carcinoma, etc., have signals. The median time of occurrence of AEs related to VEN was 31 days (inter quartile range [IQR] 7-131 days), and half of the reported AEs occurred within 1 month after administration. CONCLUSION Our research has found new significant AEs signals of VEN, which improved its safety information in real-world after marketing approval, and contributed to its risk control of use in clinic.
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24
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Kang J, Sun T, Zhang Y. Immunotherapeutic progress and application of bispecific antibody in cancer. Front Immunol 2022; 13:1020003. [PMID: 36341333 PMCID: PMC9630604 DOI: 10.3389/fimmu.2022.1020003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/05/2022] [Indexed: 08/19/2023] Open
Abstract
Bispecific antibodies (bsAbs) are artificial antibodies with two distinct antigen-binding sites that can bind to different antigens or different epitopes on the same antigen. Based on a variety of technology platforms currently developed, bsAbs can exhibit different formats and mechanisms of action. The upgrading of antibody technology has promoted the development of bsAbs, which has been effectively used in the treatment of tumors. So far, 7 bsAbs have been approved for marketing in the world, and more than 200 bsAbs are in clinical and preclinical research stages. Here, we summarize the development process of bsAbs, application in tumor treatment and look forward to the challenges in future development.
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Affiliation(s)
- Jingyue Kang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tonglin Sun
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Division of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zhang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Division of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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25
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Woll PS, Yoshizato T, Hellström‐Lindberg E, Fioretos T, Ebert BL, Jacobsen SEW. Targeting stem cells in myelodysplastic syndromes and acute myeloid leukemia. J Intern Med 2022; 292:262-277. [PMID: 35822488 PMCID: PMC9544124 DOI: 10.1111/joim.13535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The genetic architecture of cancer has been delineated through advances in high-throughput next-generation sequencing, where the sequential acquisition of recurrent driver mutations initially targeted towards normal cells ultimately leads to malignant transformation. Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are hematologic malignancies frequently initiated by mutations in the normal hematopoietic stem cell compartment leading to the establishment of leukemic stem cells. Although the genetic characterization of MDS and AML has led to identification of new therapeutic targets and development of new promising therapeutic strategies, disease progression, relapse, and treatment-related mortality remain a major challenge in MDS and AML. The selective persistence of rare leukemic stem cells following therapy-induced remission implies unique resistance mechanisms of leukemic stem cells towards conventional therapeutic strategies and that leukemic stem cells represent the cellular origin of relapse. Therefore, targeted surveillance of leukemic stem cells following therapy should, in the future, allow better prediction of relapse and disease progression, but is currently challenged by our restricted ability to distinguish leukemic stem cells from other leukemic cells and residual normal cells. To advance current and new clinical strategies for the treatment of MDS and AML, there is a need to improve our understanding and characterization of MDS and AML stem cells at the cellular, molecular, and genetic levels. Such work has already led to the identification of promising new candidate leukemic stem cell molecular targets that can now be exploited in preclinical and clinical therapeutic strategies, towards more efficient and specific elimination of leukemic stem cells.
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Affiliation(s)
- Petter S. Woll
- Department of Medicine HuddingeCenter for Hematology and Regenerative MedicineKarolinska InstitutetStockholmSweden
| | - Tetsuichi Yoshizato
- Department of Medicine HuddingeCenter for Hematology and Regenerative MedicineKarolinska InstitutetStockholmSweden
| | - Eva Hellström‐Lindberg
- Department of Medicine HuddingeCenter for Hematology and Regenerative MedicineKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Thoas Fioretos
- Division of Clinical GeneticsDepartment of Laboratory MedicineLund UniversityLundSweden
- Division of Laboratory MedicineDepartment of Clinical Genetics and PathologyLundSweden
| | - Benjamin L. Ebert
- Department of Medical OncologyDana–Farber Cancer InstituteBostonMassachusettsUSA
- Broad Institute of Harvard and MITCambridgeMassachusettsUSA
- Howard Hughes Medical InstituteBostonMassachusettsUSA
| | - Sten Eirik W. Jacobsen
- Department of Medicine HuddingeCenter for Hematology and Regenerative MedicineKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
- MRC Molecular Haematology UnitMRC Weatherall Institute of Molecular MedicineUniversity of OxfordOxfordUK
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