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Gao XN, Su YF, Li MY, Jing Y, Wang J, Xu L, Zhang LL, Wang A, Wang YZ, Zheng X, Li YF, Liu DH. Single-center phase 2 study of PD-1 inhibitor combined with DNA hypomethylation agent + CAG regimen in patients with relapsed/refractory acute myeloid leukemia. Cancer Immunol Immunother 2023:10.1007/s00262-023-03454-y. [PMID: 37166484 DOI: 10.1007/s00262-023-03454-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
Anti-PD-1 monotherapy had limited clinical efficacy in relapsed/refractory (r/r) AML patients with higher PD-1 and PD-L1 expression. Hence, we investigated the efficacy and safety of PD-1 inhibitor with DNA hypomethylating agent (HMA) + CAG regimen in patients who had failed prior AML therapy. In this phase 2, single-arm study, r/r AML patients received azacitidine or decitabine plus CAG regimen with tislelizumab. Primary endpoints were efficacy (objective response rate [ORR]) and safety. Secondary endpoints included overall survival (OS), event-free survival (EFS) and duration of response (DOR). Statistical analyses were performed using Stata 14.0 and SPSS 20.0 software where P < 0.05 denoted significance. Twenty-seven patients were enrolled patients and completed 1 cycle, and 14 (51.9%) and 4 (14.8%) patients completed 2 and 3 cycles, respectively. ORR was 63% (14: complete remission [CR]/CR with incomplete hematologic recovery [CRi], 3: partial remission (PR), 10: no response [NR]). Median OS (mOS) and EFS were 9.7 and 9.2 months, respectively. With a median follow-up of 8.2 months (1.1-26.9), the mOS was not reached in responders (CR/CRi/PR) while it was 2.4 months (0.0-5.4) in nonresponders (P = 0.002). Grade 2-3 immune-related adverse events (irAEs) were observed in 4 (14.8%) patients and 3 nonresponders died of lung infection after treatment. Tislelizumab + HMA + CAG regimen showed improved outcomes in r/r AML patients with lower pretherapy leukemia burden. irAEs were mild and low-grade and higher pretherapy bone marrow CD4+ CD127+ PD-1+ T cells might serve as a predictor of treatment response.ClinicalTrials.gov identifier NCT04541277.
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Affiliation(s)
- Xiao-Ning Gao
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China.
| | - Yong-Feng Su
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China
| | - Meng-Yue Li
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China
- Graduate School, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu Jing
- Department of Hematology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jun Wang
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China
| | - Lei Xu
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China
| | - Lin-Lin Zhang
- Department of Hematology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - An Wang
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China
| | - Yi-Zhi Wang
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China
| | - Xuan Zheng
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China
| | - Yan-Fen Li
- Department of Hematology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Dai-Hong Liu
- Senior Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, 8 East Main Street, Beijing, 100071, China.
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Zhang Y, Dai K, Zhang Q, Huang Y, Feng Y, Bhardwaj D, Yu K, Feng J. Normal Absolute Monocyte Count in Combination with Normal/High Absolute Lymphocyte Count at the Time of Relapse is Associated with Improved Survival in Patients with Early Relapsed Acute Myeloid Leukemia. Cancer Invest 2021; 39:550-558. [PMID: 34027748 DOI: 10.1080/07357907.2021.1933013] [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: 10/21/2022]
Abstract
This study aimed to examine the prognostic significance of peripheral absolute monocyte count (AMC) in combination with absolute lymphocyte count (ALC) at the time of relapse in a cohort of 57 patients with early relapsed (first complete remission <12 months) acute myeloid leukemia (AML). Both univariate and multivariate Cox proportional hazard regression analyses revealed that normal AMC in combination with normal/high ALC (versus low/high AMC in combination with low ALC) was significantly associated with improved OS. We concluded that the combination of AMC and ALC could be used as a prognostic marker for survival outcomes in early relapsed AML.
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Affiliation(s)
- Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Kanchun Dai
- Department of Hematology and Oncology, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo NO. 2 Hospital), Ningbo, PR China
| | - Qianying Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yisha Huang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yiyun Feng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Deeksha Bhardwaj
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Jianhua Feng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China.,Department of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
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Ruggeri A, Battipaglia G, Labopin M, Ehninger G, Beelen D, Tischer J, Ganser A, Schwerdtfeger R, Glass B, Finke J, Michallet M, Stelljes M, Jindra P, Arnold R, Kröger N, Mohty M, Nagler A. Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study. J Hematol Oncol 2016; 9:89. [PMID: 27639553 PMCID: PMC5027089 DOI: 10.1186/s13045-016-0321-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background Allogeneic stem cell transplantation is the only curative option for patients with acute myeloid leukemia (AML) experiencing relapse. Either matched sibling donor (MSD) or unrelated donor (UD) is indicated. Methods We analyzed 1554 adults with AML transplanted from MSD (n = 961) or UD (n = 593, HLA-matched 10/10, n = 481; 9/10, n = 112). Compared to MSD, UD recipients were older (49 vs 52 years, p = 0.001), transplanted more recently (2009 vs 2006, p = 0.001), and with a longer interval to transplant (10 vs 9 months, p = 0.001). Conditioning regimen was more frequently myeloablative for patients transplanted with a MSD (61 vs 46 %, p = 0.001). Median follow-up was 28 (range 3–157) months. Results Cumulative incidence (CI) of neutrophil engraftment (p = 0.07), grades II–IV acute GVHD (p = 0.11), chronic GVHD (p = 0.9), and non-relapse mortality (NRM, p = 0.24) was not different according to the type of donor. At 2 years, CI of relapse (relapse incidence (RI)) was 57 vs 49 % (p = 0.001). Leukemia-free survival (LFS) at 2 years was 21 vs 26 % (p = 0.001), and overall survival (OS) was 26 vs 33 % (p = 0.004) for MSD vs UD, respectively. Chronic GVHD as time-dependent variable was associated with lower RI (HR 0.78, p = 0.05), higher NRM (HR 1.71, p = 0.001), and higher OS (HR 0.69, p = 0.001). According to HLA match, RI was 57 vs 50 vs 45 %, (p = 0.001) NRM was 23 vs 23 vs 29 % (p = 0.26), and LFS at 2 years was 21 vs 27 vs 25 % (p = 0.003) for MSD, 10/10, and 9/10 UD, respectively. In multivariate analysis adjusted for differences between the two groups, UD was associated with lower RI (HR 0.76, p = 0.001) and higher LFS (HR 0.83, p = 0.001) compared to MSD. Interval between diagnosis and transplant was the other factor associated with better outcomes (RI (HR 0.62, p < 0.001) and LFS (HR 0.67, p < 0.001)). Conclusions Transplantation using UD was associated with better LFS and lower RI compared to MSD for high-risk patients with AML transplanted in first relapse.
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Affiliation(s)
- Annalisa Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.
| | - Giorgia Battipaglia
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.,Department of Hematology and Marrow Transplantation, University Federico II of Naples, Naples, Italy
| | - Myriam Labopin
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France
| | - Gerhard Ehninger
- Medical Clinic and Polyclinic, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Johanna Tischer
- Department of Internal Medicine III, UH of Munich (LMU), Munich, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Rainer Schwerdtfeger
- Department of Haematology, Oncology Helios-Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Bertram Glass
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Jurgen Finke
- Department of Hematology/Oncology and Stem Cell Transplantation, University Medical Center, Freiburg, Germany
| | - Mauricette Michallet
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | | | - Pavel Jindra
- Departments of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | | | - Nicolaus Kröger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mohamad Mohty
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.,Hôpital Saint-Antoine, Paris University UPMC, INSERM U938, Paris, France.,Université Pierre and Marie Curie, Paris, France
| | - Arnon Nagler
- Université Pierre and Marie Curie, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.,ALWP Office, Hôpital Saint Antoine, AP-HP, Paris, France
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Cao YG, Jiang EL, He Y, Wei JL, Zhang RL, Huang Y, Yang DL, Ma QL, Feng SZ, Han MZ. [Analyses of outcome and prognostic factors of adult acute myeloid leukemia patients received autologous hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:464-8. [PMID: 27431069 PMCID: PMC7348336 DOI: 10.3760/cma.j.issn.0253-2727.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the outcome of patients with acute myeloid leukemia (AML) received autologous hematopoietic stem cell transplantation (APBSCT) in complete remission (CR), and to study the prognostic factors. METHODS 55 cases of AML who underwent APBSCT in CR between 2008 and 2014 were retrospectively investigated. Major end points of study included overall survival (OS), disease free survival (DFS), relapse rate and transplantation related mortality. RESULTS The median follow-up time was 1 091(20-3 024) days after transplantation. The 3-year OS and DFS rates were 77.1% (95%CI 71.2%-83.8%), 73.7% (95%CI 67.2%-80.3%), respectively. 3-year DFS for patients needed less than 200 days to attain minimal residual disease (MRD) ≤0.03% was significantly higher than that of patients required 200 days or more (88.9% vs 46.9%, P=0.042). 3-year DFS for patients with constant MRD negative 90.0% was greater than that of the remaining group 61.1% , but the difference was insignificant (P=0.090). A multivariate analysis of risk factors for relapse identified days from diagnosis to MRD negative was the only independent factor [RR=0.022 (95% CI 0.001-0.604), P=0.024]. CONCLUSION The results suggested that most AML patients in CR obtained long-term DFS after APBSCT, and continuous monitoring minimal residual disease could be used to evaluate whether adult AML patients should receive APBSCT or not.
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Affiliation(s)
- Y G Cao
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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Gao Y, Gao J, Li M, Zheng Y, Wang Y, Zhang H, Wang W, Chu Y, Wang X, Xu M, Cheng T, Ju Z, Yuan W. Rheb1 promotes tumor progression through mTORC1 in MLL-AF9-initiated murine acute myeloid leukemia. J Hematol Oncol 2016; 9:36. [PMID: 27071307 PMCID: PMC4830070 DOI: 10.1186/s13045-016-0264-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/03/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The constitutive hyper-activation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathways has frequently been associated with acute myeloid leukemia (AML). While many inhibitors targeting these pathways have been developed, the anti-leukemic effect was not as robust as expected. As part of the molecular link between PI3K/Akt and mTOR kinase, the role of Rheb1 in AML remains unexplored. Our study aims to explore the role of Rheb1 in AML and estimate whether Rheb1 could be a potential target of AML treatment. METHODS The expressions of Rheb1 and other indicated genes were analyzed using real-time PCR. AML mouse model was established by retrovirus transduction. Leukemia cell properties and related signaling pathways were dissected by in vitro and in vivo studies. The transcriptional changes were analyzed via gene chip analysis. Molecular reagents including mTOR inhibitor and mTOR activator were used to evaluate the function of related signaling pathway in the mouse model. RESULTS We observed that Rheb1 is overexpressed in AML patients and the change of Rheb1 level in AML patients is associated with their median survival. Using a Rheb1-deficient MLL-AF9 murine AML model, we revealed that Rheb1 deletion prolonged the survival of AML mice by weakening LSC function. In addition, Rheb1 deletion arrested cell cycle progression and enhanced apoptosis of AML cells. Furthermore, while Rheb1 deletion reduced mTORC1 activity in AML cells, additional rapamycin treatment further decreased mTORC1 activity and increased the apoptosis of Rheb1 (Δ/Δ) AML cells. The mTOR activator 3BDO partially rescued mTORC1 signaling and inhibited apoptosis in Rheb1 (Δ/Δ) AML cells. CONCLUSIONS Our data suggest that Rheb1 promotes AML progression through mTORC1 signaling pathway and combinational drug treatments targeting Rheb1 and mTOR might have a better therapeutic effect on leukemia.
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Affiliation(s)
- Yanan Gao
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Juan Gao
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Minghao Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Yawei Zheng
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Yajie Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Hongyan Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Weili Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Yajing Chu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Xiaomin Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China.
| | - Mingjiang Xu
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, USA
| | - Tao Cheng
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China
| | - Zhenyu Ju
- Institute of Aging, Hangzhou Normal University, Hangzhou, 310036, China
| | - Weiping Yuan
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Center for Stem Cell Medicine, CAMS & PUMC, Beijing, China.
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Bahl A, Sharma A, Raina V, Kumar L, Bakhshi S, Gupta R, Kumar R. Long-term outcomes for patients with acute myeloid leukemia: a single-center experience from AIIMS, India. Asia Pac J Clin Oncol 2015; 11:242-52. [PMID: 25639656 DOI: 10.1111/ajco.12333] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Abstract
AIM To analyze clinicopathological characteristics of acute myeloid leukemia (AML) patients and to evaluate long-term outcome of these patients presented to single tertiary care center in India. METHODS We evaluated outcomes of 480 patients (age 8-60 years), classified into good, intermediate and poor risk according to cytogenetic results. Standard "3 + 7" induction therapy with dose of daunorubicin ranging from 45 to 90 mg/m(2) followed by two to three courses of high-dose cytarabine (12-18 g/m(2) ) as consolidation therapy was given to majority. RESULTS The complete remission rate of the treated population (407 patients) was 70% with 84.8% in good risk, 67.9% in intermediate risk and 54.2% in poor risk (P = 0.0001). Induction mortality was 18.4%. One hundred twenty-nine patients relapsed with median treatment free interval of 10.4 months. At a median follow-up of 34.5 months, the median overall survival (OS) was 20.6 months with an estimated 5-year survival rate of 35.5%. No difference was found in OS between the three risk groups; however, patients with intermediate risk had a better leukemia-free survival (LFS) in comparison to good risk. Multivariate analysis showed age, performance status, treatment completion and hematopoietic stem cell transplant affecting OS, while only treatment completion affected LFS. CONCLUSION This is one of the largest single-center studies reflecting more accurately the outcome of AML in India. These results are likely due to uniform treatment protocols, intensification of induction and post-remission treatments with comprehensive supportive care.
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Affiliation(s)
- Ankur Bahl
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Laboratory Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Chi HT, Ly BTK, Vu HA, Sato Y, Dung PC, Xinh PT. Synergistic effect of all‑trans retinoic acid in combination with protein kinase C 412 in FMS-like tyrosine kinase 3-mutated acute myeloid leukemia cells. Mol Med Rep 2015; 11:3969-75. [PMID: 25592076 DOI: 10.3892/mmr.2015.3203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 11/20/2014] [Indexed: 11/06/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease. Numerous molecular abnormalities have been identified in AML and, amongst these, FMS‑like tyrosine kinase 3 (FLT3) mutations are one of the most common somatic alterations detected. In the present study, an in vitro investigation was performed to evaluate the effects of all‑trans retinoic acid (ATRA) and PKC412, alone and in combination, in FLT3‑mutated AML cell lines. Trypan blue exclusion test, as well as morphological, western blot and isobologram analyses were conducted. The results indicated that the combined ATRA and PKC412 treatment exhibited additive or synergistic effects in FLT3‑mutated AML cell lines. These results provided in vitro evidence for the future clinical trials evaluating the effects of a combination treatment using PKC412 and ATRA on AML patients with FLT3‑mutations.
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Affiliation(s)
- Hoang Thanh Chi
- Department of Molecular Cytogenetics, Blood Transfusion and Hematology Hospital Ho Chi Minh City, Ho Chi Minh City 711512, Vietnam
| | - Bui Thi Kim Ly
- Department of Medical Genome Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo 108‑8639, Japan
| | - Hoang Anh Vu
- Center for Molecular Biomedicine, The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 748908, Vietnam
| | - Yuko Sato
- Japanese Red Cross College of Nursing, Tokyo 150‑0012, Japan
| | - Phu Chi Dung
- Department of First Pediatric Hematology, Blood Transfusion and Hematology Hospital Ho Chi Minh City, Ho Chi Minh City 711512, Vietnam
| | - Phan Thi Xinh
- Department of Molecular Cytogenetics, Blood Transfusion and Hematology Hospital Ho Chi Minh City, Ho Chi Minh City 711512, Vietnam
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Alwan AF, Matti BF, Naji AS, Jawad AM. The Efficacy of Fludarabine, High Dose Cytosine Arabinoside with Granulocyte Colony Stimulating Factor (FLAG) Protocol as Salvage Therapy for Refractory/Relapsed Acute Leukemias in Adult Iraqi Patients. Indian J Hematol Blood Transfus 2013; 30:231-5. [PMID: 25435719 DOI: 10.1007/s12288-013-0244-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/11/2013] [Indexed: 10/27/2022] Open
Abstract
Refractory/relapsed acute leukemia has always been a challenging problem for hematologist. Over the past decade emphasis has been made in the development of regimens containing fludarabine, combined with cytosine arabinoside for the treatment of refractory/relapsed acute leukemias. The aim of this study is to evaluate the efficacy and toxicity of the combination of fludarabine, high dose cytarabine, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia, a prospective study is being conducted at the National Center of Hematology and hematology unit/Baghdad teaching hospital from July 2008 to July 2010. Twenty Patients with refractory/relapsed acute leukemia were treated with fludarabine 30 mg/m(2) and cytosine arabinoside (Ara-C) 2 g/m(2) for 5 days, and granulocyte colony stimulating factor G-CSF 300 µg/day from day 0 till neutrophil recovery (ANC > 1.0 × 10(9)/L). Response was evaluated by bone marrow examination on day 30 post chemotherapy. Patients included were refractory acute lymphoblastic leukemia (ALL) (five patients), relapsed ALL (four patients), refractory acute myeloid leukemia (AML) (eight patients), relapsed AML (three patients). Complete remission (CR) was achieved in nine (45 %) patients, while three (15 %) patients got partial remission. Three (15 %) patients died because of post chemotherapy complications and five (25 %) patient failed to achieve remission. Major complications encountered were: anemia, fever, bleeding, mucositis and bacterial infections. FLAG protocol is well tolerated and effective regimen in relapsed/refractory acute leukemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures.
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Affiliation(s)
- Alaa Fadhil Alwan
- The National Center of Hematology, Almustansiriya University, Baghdad, Iraq
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Domínguez Senín L, Rodríguez Rodríguez JN, Garrido Martínez MT, Sánchez Argáiz M, Martín Chacón E. [Effectiveness and safety of the FLAG-IDA regimen in acute refractory or recurrent leukaemia]. FARMACIA HOSPITALARIA 2011; 36:261-7. [PMID: 22137611 DOI: 10.1016/j.farma.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 04/18/2011] [Accepted: 05/17/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of the FLAG-IDA regimen in patients with acute refractory and/or recurrent leukaemia. METHOD Descriptive, retrospective, observational study of the clinical histories of patients with the FLAG-IDA regimen during the period of 2005-2010. Effectiveness was measured using objective response, progression-free interval, and global survival. Safety was measured using the NCI classification system of common toxicity criteria for adverse events. RESULTS We registered 12 patients (52.17±8.26 years in women, and 54.83±7.22 years in men), 11 cases were acute myeloid leukaemia (5 refractory, 3 in recurrence, 1 secondary to chronic refractory myeloid leukaemia (CML) and 2 secondary to myelodysplastic syndrome (MDS), one of which was refractory and the other had not been previously treated) and one case was acute refractory lymphoblastic leukaemia (ALL). Six patients (50%) reached a complete response (CR). One patient reached a partial response (PR), which was followed by another protocol that produced a CR, two died due to disease progression, and three due to secondary complications from treatment. The progression-free interval for patients that reached a CR was 24.38 weeks (6 months). Median global survival was 8.4 weeks. Mean time needed for the recovery of neutropenia was 23 and 37 days in the first and second cycle, respectively. The mean time required for recuperation of thrombocytopenia was 24 and 35 days in each cycle. CONCLUSIONS The FLAG-IDA induction regimen for the treatment of high-risk leukaemia patients is an established protocol, with good tolerance and acceptable toxicity levels that offers an opportunity for facilitating the transplantation of haematopoietic progenitors.
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Affiliation(s)
- L Domínguez Senín
- Servicio de Farmacia Hospitalaria, Hospital Juan Ramón Jiménez, Huelva, España.
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Atfy M, Al Azizi NM, Elnaggar AM. Incidence of Philadelphia-chromosome in acute myelogenous leukemia and biphenotypic acute leukemia patients: And its role in their outcome. Leuk Res 2011; 35:1339-44. [DOI: 10.1016/j.leukres.2011.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/11/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
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Valeri A, Alonso-Ferrero ME, Cerrato L, Martínez S, Bueren JA, Albella B. Development of an in vitro model for the simultaneous study of the efficacy and hematotoxicity of antileukemic compounds. Toxicol Lett 2010; 199:317-22. [PMID: 20883753 DOI: 10.1016/j.toxlet.2010.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/20/2010] [Accepted: 09/22/2010] [Indexed: 10/19/2022]
Abstract
Hematopoietic system displays a wide spectrum of cell populations hierarchically organized in the bone marrow. Homeostasis in this system requires equilibrium between the self-renewal of the stem cells and their capacity of differentiation. Any failure on this equilibrium could lead to fatal consequences, such as the development of leukemia. Due to its rapid rate of renewal, hematopoietic tissue is a major target for antitumoral compounds and often becomes a dose limiting factor in the development of antineoplastics. Our aim was to develop an in vitro model for predicting the efficacy of antitumoral compounds on leukemic cells and their toxic effects on the healthy hematopoietic cells. The mouse myelomonocytic leukemia WEHI-3b was transduced with a lentiviral vector for expressing the green fluorescence protein. Mixed semisolid clonogenic cultures of transduced WEHI-3b and murine bone marrow cells were exposed to five pharmaceuticals: daunorubicin (positive control), atropine sulphate (negative control) and three in different stages of clinical development (trabectedin, Zalypsis(®) and PM01183). Colonies of leukemic cells were distinguishable from healthy CFU-GM under fluorescence microscope. The sensitivity of leukemic cells to daunorubicin, trabectedin, Zalypsis(®) and PM01183 was higher compared to healthy cells. The effect of a non-antitumoral compound, atropine sulphate, was the same on both populations. Our results show that this in vitro model is a valuable tool for studying the effect of antitumoral compounds in both tumoral and normal hematopoietic cells under the same toxic microenvironment and could safe time and facilitate the reduction of the number of animals used in preclinical development of pharmaceuticals.
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Affiliation(s)
- Antonio Valeri
- CIEMAT, Division of Hematopoiesis. Avenida Complutense, No. 22, 28040 Madrid, Spain
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12
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Manor E, Bodner L, Kachko P, Kapelushnik J. Derivative (22)t(3;22)(q12;p11.1) in desmoplastic medulloblastoma. ACTA ACUST UNITED AC 2010; 196:175-8. [PMID: 20082855 DOI: 10.1016/j.cancergencyto.2009.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 09/12/2009] [Indexed: 11/19/2022]
Abstract
Medulloblastoma is a malignant invasive embryonal tumor of the cerebellum, representing 15-30% of pediatric brain tumors. An i(17q) abnormality appears in 40% of medulloblastomas, and usually not as a sole aberration; however, cytogenetic data for medulloblastoma are limited. Cytogenetic work-up of tumors is an important tool for diagnosis and prognosis, and in some cases has led to the development of new therapeutic modalities. In the present case, cytogenetic analysis of a medulloblastoma revealed an unbalanced karyotype in all cells analyzed: 46,XY,der(22)t(3;22)(q12;p11.1). This sole unbalanced translocation led to partial trisomy of 3q. The significance of this finding and its role in the pathogenesis of medulloblastoma need further clarification.
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Affiliation(s)
- Esther Manor
- Genetics Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Be'er Sheva, 84501 Israel.
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13
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Stapnes C, Gjertsen BT, Reikvam H, Bruserud Ø. Targeted therapy in acute myeloid leukaemia: current status and future directions. Expert Opin Investig Drugs 2009; 18:433-55. [DOI: 10.1517/14728220902787628] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Camilla Stapnes
- Haukeland University Hospital, Department of Medicine, Section for Haematology, N-5021 Bergen, Norway ;
| | - Bjørn Tore Gjertsen
- Haukeland University Hospital, Department of Medicine, Section for Haematology, N-5021 Bergen, Norway ;
| | - Håkon Reikvam
- Haukeland University Hospital, Department of Medicine, Section for Haematology, N-5021 Bergen, Norway ;
| | - Øystein Bruserud
- Haukeland University Hospital, Department of Medicine, Section for Haematology, N-5021 Bergen, Norway ;
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Hämäläinen S, Kuittinen T, Matinlauri I, Nousiainen T, Koivula I, Jantunen E. Neutropenic fever and severe sepsis in adult acute myeloid leukemia (AML) patients receiving intensive chemotherapy: Causes and consequences. Leuk Lymphoma 2008; 49:495-501. [PMID: 18297526 DOI: 10.1080/10428190701809172] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this study was to evaluate etiology and consequences of neutropenic fever in AML patients. Two hundred and ninety neutropenic periods following chemotherapy in 84 AML patients were retrospectively evaluated. Neutropenic fever was found in 280 periods (97%). Severe sepsis developed in 35 occasions (13%) and 9 patients (11%) died due to severe sepsis. In 165 episodes with neutropenic fever (59%), the potential causative organism was found in blood cultures. Gram-negative bacteria were more commonly found in patients who developed severe sepsis (40% vs. 23%, p = 0.03). CRP after 2 - 3 days from start with fever was higher in patients with severe sepsis (190 mg/L vs. 96 mg/L, p < 0.001) but the rise in CRP rather coincided than preceded with the development of severe sepsis. Severe sepsis is associated with significant mortality in AML patients. Earlier methods than CRP are needed to predict development of severe sepsis.
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Affiliation(s)
- Sari Hämäläinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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15
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López-Guillermo A, Mercadal S. The clinical use of antibodies in haematological malignancies. Ann Oncol 2007; 18 Suppl 9:ix51-7. [PMID: 17631596 DOI: 10.1093/annonc/mdm294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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16
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Möllgård L, Deneberg S, Nahi H, Bengtzen S, Jonsson-Videsäter K, Fioretos T, Andersson A, Paul C, Lehmann S. The FLT3 inhibitor PKC412 in combination with cytostatic drugs in vitro in acute myeloid leukemia. Cancer Chemother Pharmacol 2007; 62:439-48. [PMID: 17960382 DOI: 10.1007/s00280-007-0623-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 10/01/2007] [Indexed: 11/26/2022]
Abstract
An internal tandem duplication of FLT3 (FLT3/ITD) occurs in approximately 25% of newly diagnosed AML. PKC412 inhibits the growth of leukemic cell lines with FLT3 mutations such as the MV4-11. This study evaluated the in vitro effects of the combination of PKC412 and ara-C or daunorubicin, studying the effect of co-incubation, pre-incubation and sequential incubation of the drugs in patient samples and cell lines. Thirty-three patients with AML were included. Two cell lines were studied; MV4-11 that expresses the FLT3/ITD and HL-60 that does not. In the patient cells PKC412 exerted its effect at concentrations between 0.1 and 2.0 microM. For MV4-11 cells concentrations down to 1 nM were effective. In patient samples, the results of co-incubation of PKC412 with ara-C were synergistic in 5%, additive in 67%, sub additive in 17% and antagonistic in 11% of the cases. In patient cells, incubations with ara-C and PKC412 resulted in synergistic effects in 17% of the FLT3/ITD positive samples compared to 0% synergistic in the FLT3/ITD negative samples (p < 0.01). Antagonistic effects were more common in the FLT3/ITD negative samples. The timing of the drugs had little impact on the effect. In cell lines, antagonistic effects were seen frequently in HL-60 (90%) and less so in MV4-11 (60%) regardless of sequence or timing of the drugs. The combination of daunorubicin and PKC412 resulted in more synergistic and less antagonistic effects compared to combinations with ara-C, in both patient material and cell lines. The combination of Lonafarnib, a farnesyl-transferase inhibitor (FTI) and PKC412 had additive and synergistic effects in both FLT3/ITD positive and negative cell lines. In conclusion, the combination of PKC412 together with chemotherapeutic drugs is more effective in FLT3/ITD positive AML cells. Antagonistic effects can be seen, especially in patient samples without FLT3/ITD. Also, the combination of PKC412 and the farnesylinhibitor lonafarnib should be further explored.
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Affiliation(s)
- Lars Möllgård
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
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17
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Breems DA, Löwenberg B. Acute Myeloid Leukemia and the Position of Autologous Stem Cell Transplantation. Semin Hematol 2007; 44:259-66. [DOI: 10.1053/j.seminhematol.2007.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Koistinen P, Räty R, Itälä M, Jantunen E, Koivunen E, Nousiainen T, Pelliniemi TT, Remes K, Ruutu T, Savolainen ER, Siitonen T, Silvennoinen R, Volin L, Elonen E. Long-term outcome of intensive chemotherapy for adults with de novo acute myeloid leukaemia (AML): the nationwide AML-92 study by the Finnish Leukaemia Group. Eur J Haematol 2007; 78:477-86. [PMID: 17391337 DOI: 10.1111/j.1600-0609.2007.00846.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the long-term outcome of idarubicin- and cytarabine-based intensive chemotherapy in adult acute myeloid leukaemia (AML). PATIENTS AND METHODS A total of 327 consecutive patients with de novo AML (promyelocytic leukaemia excluded) aged 16-65 yr were recruited into the study between September 1992 and December 2001. The latest follow-up data were collected in October 2006. After remission achievement with the first (conventional cytarabine) or second (high-dose cytarabine) chemotherapy cycle, three intensive consolidation courses each containing high- or intermediate-dose cytarabine were given. RESULTS A total of 268 patients (82%) achieved complete remission (CR). CR rate was 82% and 84% for patients <60 and > or =60 yr of age, respectively. CR rates in patients with favourable (93%) and intermediate/normal karyotypes (87%) were significantly (P < 0.01) higher than CR rate in patients with adverse karyotype (61%). Median relapse-free survival (RFS) for the patients not transplanted in the first CR (n = 195) was 1.7 yr (95% CI: 0.81-2.60). At 4 yr, a plateau of 70% in RFS was reached for patients with favourable karyotypes. The 5-yr survival was 71%, 47% and 37% for the non-transplanted patients (n = 202) with favourable, intermediate/normal and intermediate/abnormal karyotypes, respectively, while only 8% of the patients having adverse karyotype were alive at 5 yr (P < 0.01). Of the patients with favourable, intermediate/normal or intermediate/abnormal karyotypes, respectively, 58%, 41% and 31% were expected to be alive at 10 yr. CONCLUSIONS Idarubicin- and cytarabine-based intensive chemotherapy regimen is very effective in de novo AML for adult patients up to 65 yr of age. New treatment strategies are needed, however, to improve the outcome of the patients with intermediate and adverse karyotypes.
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Affiliation(s)
- Pirjo Koistinen
- Department of Medicine, Oulu University Hospital, Oulu, Finland.
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19
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Chantry AD, Snowden JA, Craddock C, Peggs K, Roddie C, Craig JIO, Orchard K, Towlson KE, Pearce RM, Marks DI. Long-Term Outcomes of Myeloablation and Autologous Transplantation of Relapsed Acute Myeloid Leukemia in Second Remission: A British Society of Blood and Marrow Transplantation Registry Study. Biol Blood Marrow Transplant 2006; 12:1310-7. [PMID: 17162213 DOI: 10.1016/j.bbmt.2006.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 07/31/2006] [Indexed: 11/26/2022]
Abstract
Relapsed acute myeloid leukemia (AML) in adults has a poor prognosis if treated with chemotherapy alone. Case series have previously supported the role of myeloablation and autologous transplantation as a potentially curative treatment. This study aimed to use the large numbers and extended follow-up data in the British Society of Blood and Marrow Transplantation (BSBMT) registry database to establish long-term outcomes and relate these to biological and procedural factors. The BSBMT registry database was used to retrospectively identify 152 adult patients (age, 16-69 years) with AML in second remission treated with autologous transplantation in 1982-2003. Cytogenetic data were available for 68% of the patients; of these, at diagnosis, 42% had good risk features, 57% had standard risk features, and 1% had poor risk features. Conditioning regimens varied; autologous rescue was provided with bone marrow (BM) (71%), peripheral blood stem cells (PBSCs) (18%), or both (11%), which were harvested during first complete remission (CR1) and/or second CR (CR2). Median follow-up was 84 months (range, 2-200 months). At 10 years, actuarial overall survival (OS) was 32%, progression-free survival (PFS) was 28%, and relapse rate (RR) was 57%. The 100-day nonrelapse mortality (NRM) was 7%, rising to 11% at 1 year and to 14% at 10 years. OS was significantly related to M3 subtype (5-year OS, 66%; P = .005), patient age at diagnosis (P = .005) and transplantation (P = .026), and length of CR1, with greatest significance if the patient was dichotomized at CR1 duration of < 8 months or > or = 8 months (P = .0001). There was no difference in OS between regimens containing total body irradiation (TBI) and chemotherapy alone (P = .7). In relation to the nature of autologous graft material, there was improved OS (P = .025) and PFS (P = .009) with the use of cells harvested entirely in CR1 compared with cells harvested in CR2 or in both CR1 and CR2. Engraftment times were significantly shortened with the use of PBSCs alone or in combination with BM compared with BM alone (P = .0001), but there was no significant long-term impact on OS, PFS, RR, or NRM. This study provides long-term follow-up data in one of the largest series of patients with standard-risk and good-risk AML in CR2 treated with autologous transplantation and supports earlier observations that long-term survival is achievable in about 1/3 of patients overall and in about 2/3 of patients with M3 with a relatively low NRM. Outcomes are better in patients with CR1 > or = 8 months by use of grafts obtained entirely in CR1 and use of PBSCs. TBI conditioning did not confer an advantage. Randomized studies against unrelated donor transplantation are warranted.
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Affiliation(s)
- Andrew D Chantry
- Academic Unit of Bone Biology, University of Sheffield Medical School, Sheffield, UK.
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20
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Milligan DW, Grimwade D, Cullis JO, Bond L, Swirsky D, Craddock C, Kell J, Homewood J, Campbell K, McGinley S, Wheatley K, Jackson G. Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol 2006; 135:450-74. [PMID: 17054678 DOI: 10.1111/j.1365-2141.2006.06314.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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Affiliation(s)
- Alan K Burnett
- Wales School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN
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22
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Breems DA, Löwenberg B. Autologous stem cell transplantation in the treatment of adults with acute myeloid leukaemia. Br J Haematol 2005; 130:825-33. [PMID: 16156852 DOI: 10.1111/j.1365-2141.2005.05628.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Most adult patients under 60 years with acute myeloid leukaemia (AML) who achieve a complete remission after induction chemotherapy will relapse if they do not receive further therapy. Consolidation treatment with autologous stem cell transplantation (SCT) is one option that has been studied extensively. High-dose cytotoxic therapy followed by autologous SCT or intensive cycles of chemotherapy furnish overall approximately similar probabilities of survival when applied in first remission. Here, we present a concise update regarding the place of autologous SCT in the treatment of AML. Particular issues discussed are the value of autologous SCT in different prognostic subsets of AML and the value of autologous mobilised peripheral blood stem cell transplants, which offer a much faster haematopoietic recovery.
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Affiliation(s)
- Dimitri A Breems
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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23
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Breems DA, Van Putten WLJ, Huijgens PC, Ossenkoppele GJ, Verhoef GEG, Verdonck LF, Vellenga E, De Greef GE, Jacky E, Van der Lelie J, Boogaerts MA, Löwenberg B. Prognostic Index for Adult Patients With Acute Myeloid Leukemia in First Relapse. J Clin Oncol 2005; 23:1969-78. [PMID: 15632409 DOI: 10.1200/jco.2005.06.027] [Citation(s) in RCA: 385] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The treatment of acute myeloid leukemia (AML) in first relapse is associated with unsatisfactory rates of complete responses that usually are short lived. Therefore, a clinically useful prognostic index can facilitate therapeutic decision making and evaluation of investigational treatment strategies at relapse of AML. Patients and Methods A prognostic score is presented based on the multivariate analysis of 667 AML patients in first relapse among 1,540 newly diagnosed non-M3 AML patients (age 15 to 60 years) entered onto three successive Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research Collaborative Group trials. Results Four clinically relevant parameters are included in this index (ie, length of relapse-free interval after first complete remission, cytogenetics at diagnosis, age at relapse, and whether previous stem-cell transplantation was performed). Using this stratification system, three risk groups were defined: a favorable prognostic group A (overall survival [OS] of 70% at 1 year and 46% at 5 years), an intermediate-risk group B (OS of 49% at 1 year and 18% at 5 years), and a poor-risk group C (OS of 16% at 1 year and 4% at 5 years). Conclusion The prognostic index estimates the outcome of AML patients in first relapse using four commonly applied clinical parameters and might identify patients who are candidates for salvage and investigational therapy.
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Affiliation(s)
- Dimitri A Breems
- Erasmus University Medical Center, Department of Hematology, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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24
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Breems DA, Boogaerts MA, Dekker AW, Van Putten WLJ, Sonneveld P, Huijgens PC, Van der Lelie J, Vellenga E, Gratwohl A, Verhoef GEG, Verdonck LF, Löwenberg B. Autologous bone marrow transplantation as consolidation therapy in the treatment of adult patients under 60 years with acute myeloid leukaemia in first complete remission: a prospective randomized Dutch-Belgian Haemato-Oncology Co-operative Group (HOVON) and Swiss Group for Clinical Cancer Research (SAKK) trial. Br J Haematol 2005; 128:59-65. [PMID: 15606550 DOI: 10.1111/j.1365-2141.2004.05282.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The question as to whether autologous stem cell transplantation (SCT) after consolidation chemotherapy improves the probability of survival of patients with acute myeloid leukaemia (AML) in first remission has not been settled. Here, we present the results of a phase III study conducted in newly diagnosed adult AML patients aged <60 years. Patients who had reached a complete remission (CR) after two courses of induction chemotherapy and who were not eligible for a human leucocyte antigen-matched sibling SCT (n = 130), were randomized after a third consolidation cycle of chemotherapy between high-dose cytotoxic treatment and autologous bone marrow transplantation or no further treatment. No significant differences in disease-free survival and overall survival were observed between the two treatment arms. A slightly better overall survival in the no further treatment arm was because of fewer deaths in the first CR and a significantly better overall survival after the first relapse. The results are discussed in relation to the generic problems of applying autologous transplantation and in the perspective of the limited statistical power of this and other previously published studies.
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Affiliation(s)
- Dimitri A Breems
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Aversa F, Martelli MF. Transplantation of haploidentically mismatched stem cells for the treatment of malignant diseases. ACTA ACUST UNITED AC 2004; 26:155-68. [PMID: 15378270 DOI: 10.1007/s00281-004-0161-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2004] [Accepted: 04/18/2004] [Indexed: 10/26/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) from HLA haploidentical mismatched donors has recently been developed for patients with high-risk acute leukemia who do not have a matched donor. After a high intensity conditioning regimen the HLA barrier is overcome by infusing a graft containing a megadose of T cell-depleted progenitor cells. Nowadays, for graft processing automated peripheral blood CD34(+) cell immunoselection is time and labor saving and ensures a high CD34(+) cell recovery rate. Besides providing 4.5 log T cell depletion of the graft, it guarantees a 3.5 log B cell depletion, which helps prevent EBV-related lymphoproliferative disorders. Excellent engraftment rates are associated with a very low incidence of graft-versus-host disease and regimen-related mortality even in patients who are over 40 years old. Overall, event-free survival and transplant-related mortality compare favorably with reports from unrelated matched transplants. Donor natural killer cell alloreactivity also plays a role in improving outcome in patients with acute myeloid leukemia. These results show the haploidentical transplant to be a viable, alternative source of stem cells for adults with acute leukemia at high-risk of relapse who do not have matched donors, and encourage extending it to patients with an indication to transplant.
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Affiliation(s)
- Franco Aversa
- Hematology and Clinical Immunology Section, Department of Clinical and Experimental Medicine, University of Perugia, Via Brunamonti, 06123 Perugia, Italy.
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26
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Glenjen N, Hovland R, Wergeland L, Wendelbo Ø, Ernst P, Bruserud Ø. The angioregulatory phenotype of native human acute myelogenous leukemia cells: influence of karyotype, Flt3 abnormalities and differentiation status. Eur J Haematol 2003; 71:163-73. [PMID: 12930316 DOI: 10.1034/j.1600-0609.2003.00130.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The cytogenetic abnormalities and the response to induction therapy have been regarded as the most important prognostic parameters in acute myelogenous leukemia (AML) patients. Recent studies have demonstrated that internal tandem duplications and specific D-835 point mutations of the Flt3 gene, as well as the angioregulatory phenotype represent additional adverse prognostic factors. The aim of the study was to investigate possible associations between genetic abnormalities, differentiation status and angioregulatory phenotype in native human AML blasts. METHOD Native AML blasts derived from consecutive patients were cultured in vitro and concentrations of angioregulatory molecules determined in the supernatants. RESULTS Most patients released at least two different angioregulatory mediators. Pro-angiogenic interleukin 8 (IL8) was released at relatively high levels for most patients, many of these patients showed additional release of pro-angiogenic vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF). High release of anti-angiogenic IL12 was associated with high release of pro-angiogenic IL8 and VEGF. Furthermore, patients with D-835 mutations showed increased IL12 release, whereas patients with normal karyotype had decreased HGF release. Myelomonocytic differentiation was associated with IL18 release and CD34 expression with low IL12 release. CONCLUSION Our results suggest that native human AML blasts have a pro-angiogenic phenotype. Although the investigated genetic abnormalities are associated with variation in the in vitro release of angioregulators, these differences are relatively small and do not quantitatively involve the most important IL8 release. It therefore seems unlikely that this phenotypic variation can explain the prognostic impact of the genetic abnormalities.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD34/analysis
- Cell Differentiation
- Collagen/metabolism
- Endostatins
- Endothelial Growth Factors/metabolism
- Female
- Fibroblast Growth Factor 2/metabolism
- Hepatocyte Growth Factor/metabolism
- Humans
- Intercellular Signaling Peptides and Proteins/metabolism
- Interleukin-12/metabolism
- Interleukin-18/metabolism
- Interleukin-8/metabolism
- Karyotyping
- Leptin/metabolism
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/physiopathology
- Lymphokines/metabolism
- Male
- Middle Aged
- Neovascularization, Pathologic
- Peptide Fragments/metabolism
- Phenotype
- Point Mutation
- Prognosis
- Proto-Oncogene Proteins/genetics
- Receptor Protein-Tyrosine Kinases/genetics
- Tumor Cells, Cultured
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
- fms-Like Tyrosine Kinase 3
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Affiliation(s)
- Nils Glenjen
- Section for Hematology, Department of Medicine, Haukeland University Hospital and the University of Bergen, Bergen, Norway.
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27
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Giles FJ, Keating A, Goldstone AH, Avivi I, Willman CL, Kantarjian HM. Acute myeloid leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2003:73-110. [PMID: 12446420 DOI: 10.1182/asheducation-2002.1.73] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In this chapter, Drs. Keating and Willman review recent advances in our understanding of the pathophysiology of acute myeloid leukemia (AML) and allied conditions, including the advanced myelodysplastic syndromes (MDS), while Drs. Goldstone, Avivi, Giles, and Kantarjian focus on therapeutic data with an emphasis on current patient care and future research studies. In Section I, Dr. Armand Keating reviews the role of the hematopoietic microenvironment in the initiation and progression of leukemia. He also discusses recent data on the stromal, or nonhematopoietic, marrow mesenchymal cell population and its possible role in AML. In Section II, Drs. Anthony Goldstone and Irit Avivi review the current role of stem cell transplantation as therapy for AML and MDS. They focus on data generated on recent Medical Research Council studies and promising investigation approaches. In Section III, Dr. Cheryl Willman reviews the current role of molecular genetics and gene expression analysis as tools to assist in AML disease classification systems, modeling of gene expression profiles associated with response or resistance to various interventions, and identifying novel therapeutic targets. In Section IV, Drs. Hagop Kantarjian and Francis Giles review some promising agents and strategies under investigation in the therapy of AML and MDS with an emphasis on novel delivery systems for cytotoxic therapy and on targeted biologic agents.
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Affiliation(s)
- Francis J Giles
- M.D. Anderson Cancer Center, Department of Leukemia, Houston, TX 77030, USA
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28
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Kalk E, Goede A, Rose P. Acute arterial thrombosis in acute promyelocytic leukaemia. CLINICAL AND LABORATORY HAEMATOLOGY 2003; 25:267-70. [PMID: 12890169 DOI: 10.1046/j.1365-2257.2003.00526.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Localized large vessel thrombosis in acute leukaemia is rare, haemorrhagic complications being more common. METHOD We present a patient with acute promyelocytic leukaemia (APL) presenting with an acutely ischaemic lower limb. Large vessel thrombosis is a rare presentation of APL. We reviewed the literature on the coagulopathy of APL and discuss the pathology and current treatment options. DISCUSSION Disordered haemostasis is typical of acute promyelocytic leukaemia (FAB M3) and relates to the intrinsic properties of the blast cells as well as thrombocytopenia from bone marrow involvement. Expression of procoagulants, stimulation of cytokines and alterations in endothelial cell anticoagulant properties initiate a disseminated intravascular coagulation (DIC) resulting in the typical clinical and laboratory findings in APL. The promyelocytes are characterized by the balanced reciprocal translocation between chromosomes 15 and 17. All-trans-retinoic acid (ATRA) induces differentiation in these cells, revolutionizing the treatment of APL. CONCLUSION Unexpected limb ischaemia in a young, apparently healthy patient might be the presenting symptom of an underlying haematological disorder such as APL. A thorough haematological investigation should be performed prior to contemplating surgery. New treatment strategies based on knowledge of the molecular biology of APL has improved the prognosis of patients suffering from APL.
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Affiliation(s)
- E Kalk
- Departments of Haematology and Surgery, Warwick Hospital, Warwick, UK
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