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Manselle MK, Ries RE, Hylkema T, Leonti A, Kirkey DC, Furlan SN, Meshinchi S. Functional consequence and therapeutic targeting of cryptic ALK fusions in monosomy 7 acute myeloid leukemia. Pediatr Blood Cancer 2023; 70:e30180. [PMID: 36720638 DOI: 10.1002/pbc.30180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 02/02/2023]
Abstract
Acute myeloid leukemia (AML) patients have a wide array of cytogenetic and molecular aberrations, which can influence response to therapy. Monosomy 7 is a rare subset within pediatric AML (prevalence of <2%) that is highly associated with poor outcomes. Fusions involving the anaplastic tyrosine kinase (ALK) gene were exclusively identified in 14.3% of this high-risk cohort, while absent across all other AML. Given the dismal outcomes of monosomy 7, we evaluated the use of crizotinib, an FDA-approved tyrosine kinase inhibitor, used to treat patients with ALK fusions. Our findings suggest that crizotinib may serve as a novel therapy for these patients.
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Affiliation(s)
- Makia K Manselle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, University of Washington, Seattle, Washington, USA
| | - Rhonda E Ries
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Tiffany Hylkema
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Amanda Leonti
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Danielle C Kirkey
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, University of Washington, Seattle, Washington, USA
| | - Scott N Furlan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, University of Washington, Seattle, Washington, USA
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2
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Polomski M, Brachet-Botineau M, Juen L, Viaud-Massuard MC, Gouilleux F, Prié G. Inhibitors Targeting STAT5 Signaling in Myeloid Leukemias: New Tetrahydroquinoline Derivatives with Improved Antileukemic Potential. ChemMedChem 2021; 16:1034-1046. [PMID: 33275308 DOI: 10.1002/cmdc.202000841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 01/23/2023]
Abstract
Signal transducers and activators of transcription 5A and 5B (STAT5A and STAT5B) are two closely related STAT family members that are crucial downstream effectors of tyrosine kinase oncoproteins such as FLT3-ITD in acute myeloid leukemia (AML) and BCR-ABL in chronic myeloid leukemia (CML). We recently developed and reported the synthesis of a first molecule called 17 f that selectively inhibits STAT5 signaling in myeloid leukemia cells and overcomes their resistance to chemotherapeutic agents. To improve the antileukemic effect of 17 f, we synthesized ten analogs of this molecule and analyzed their impact on cell growth, survival, chemoresistance and STAT5 signaling. Two compounds, 7 a and 7 a', were identified as having similar or higher antileukemic effects in various AML and CML cell lines. Both molecules were found to be more effective than 17 f at inhibiting STAT5 activity/expression and suppressing the chemoresistance of CML.
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Affiliation(s)
- Marion Polomski
- Equipe IMT "Innovation Moléculaire et Thérapeutique" - GICC EA7501, Université de Tours-Labex SYNORG, Faculté de Pharmacie, 31 av. Monge, 37200, Tours, France
| | - Marie Brachet-Botineau
- Equipe LNOx "Niche Leucémique & Métabolisme Oxydatif" - GICC ERL 7001 CNRS, Université de Tours, Faculté de Médecine, Bâtiment Dutrochet, 10bis bvd Tonnellé, 37032, Tours, France
| | - Ludovic Juen
- Equipe IMT "Innovation Moléculaire et Thérapeutique" - GICC EA7501, Université de Tours-Labex SYNORG, Faculté de Pharmacie, 31 av. Monge, 37200, Tours, France
| | - Marie-Claude Viaud-Massuard
- Equipe IMT "Innovation Moléculaire et Thérapeutique" - GICC EA7501, Université de Tours-Labex SYNORG, Faculté de Pharmacie, 31 av. Monge, 37200, Tours, France
| | - Fabrice Gouilleux
- Equipe LNOx "Niche Leucémique & Métabolisme Oxydatif" - GICC ERL 7001 CNRS, Université de Tours, Faculté de Médecine, Bâtiment Dutrochet, 10bis bvd Tonnellé, 37032, Tours, France
| | - Gildas Prié
- Equipe IMT "Innovation Moléculaire et Thérapeutique" - GICC EA7501, Université de Tours-Labex SYNORG, Faculté de Pharmacie, 31 av. Monge, 37200, Tours, France
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3
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Deng R, Fan FY, Yi H, Liu F, He GC, Sun HP, Su Y. PD-1 blockade potentially enhances adoptive cytotoxic T cell potency in a human acute myeloid leukaemia animal model. Hematology 2018; 23:740-746. [PMID: 29962321 DOI: 10.1080/10245332.2018.1486357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Rui Deng
- Hematology Department and Hematopoietic Stem Cell Transplantation and Cell Immunotherapy Center, Cheng Du Military General Hospital of PLA, Cheng Du, People’s Republic of China
| | - Fang-yi Fan
- Hematology Department and Hematopoietic Stem Cell Transplantation and Cell Immunotherapy Center, Cheng Du Military General Hospital of PLA, Cheng Du, People’s Republic of China
| | - Hai Yi
- Hematology Department and Hematopoietic Stem Cell Transplantation and Cell Immunotherapy Center, Cheng Du Military General Hospital of PLA, Cheng Du, People’s Republic of China
| | - Fang Liu
- Hematology Department and Hematopoietic Stem Cell Transplantation and Cell Immunotherapy Center, Cheng Du Military General Hospital of PLA, Cheng Du, People’s Republic of China
| | - Guang-cui He
- Hematology Department and Hematopoietic Stem Cell Transplantation and Cell Immunotherapy Center, Cheng Du Military General Hospital of PLA, Cheng Du, People’s Republic of China
| | - Hao-ping Sun
- Hematology Department and Hematopoietic Stem Cell Transplantation and Cell Immunotherapy Center, Cheng Du Military General Hospital of PLA, Cheng Du, People’s Republic of China
| | - Yi Su
- Hematology Department and Hematopoietic Stem Cell Transplantation and Cell Immunotherapy Center, Cheng Du Military General Hospital of PLA, Cheng Du, People’s Republic of China
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4
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Besse KL, Preussler JM, Murphy EA, Denzen EM, Lill MC, Chell JW, Senneka MK, Majhail NS, Williams EP. Estimating demand and unmet need for allogeneic hematopoietic cell transplantation in the United States using geographic information systems. J Oncol Pract 2016; 11:e120-30. [PMID: 25784576 DOI: 10.1200/jop.2014.000794] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Allogeneic hematopoietic cell transplantation (HCT) is an increasingly used therapy for many patients with hematologic malignancies and other marrow failure or immune system disorders. The purpose of this study was to quantify and visualize both the demand and unmet need for HCT. METHODS HCT use for 2012 was described using the Center for International Blood and Marrow Transplant Research registry. Potential demand for HCT was calculated using 2012 SEER data and published literature for HCT-treatable conditions. Point locations of transplant centers were geocoded using geographic information system (GIS) software; Thiessen polygons were created to establish adult (age 20 to 74 years) and pediatric (age 0 to 19 years) market areas. Market-area population estimates were calculated using 2012 population estimates by age aggregated by census block. RESULTS US market areas for HCTs were identified separately for transplant centers treating adult (n = 62) and pediatric patients (n = 52). Overall HCT demand among adults was 16,096, with an unmet need for HCTs of 10,276 patients. For pediatric patients, the total demand was 4,561, with an unmet need of 3,213 potential recipients. Evaluation of adult and pediatric market areas indicated that the largest unmet needs tended to be in areas with large populations. CONCLUSION Market-area maps and statistics developed using GIS will help communicate the unmet need for HCT, inform policy, and assist transplant centers in planning for the anticipated growth in HCT use.
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Affiliation(s)
- Kelsey L Besse
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Jaime M Preussler
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Elizabeth A Murphy
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Ellen M Denzen
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Michael C Lill
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Jeffrey W Chell
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Mary K Senneka
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Navneet S Majhail
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
| | - Eric P Williams
- National Marrow Donor Program; Center for International Blood and Marrow Transplant Research, Minneapolis, MN; Cedars-Sinai Medical Center, Los Angeles, CA; and Cleveland Clinic, Cleveland, OH
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5
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Nelson EA, Walker SR, Xiang M, Weisberg E, Bar-Natan M, Barrett R, Liu S, Kharbanda S, Christie AL, Nicolais M, Griffin JD, Stone RM, Kung AL, Frank DA. The STAT5 Inhibitor Pimozide Displays Efficacy in Models of Acute Myelogenous Leukemia Driven by FLT3 Mutations. Genes Cancer 2012; 3:503-11. [PMID: 23264850 DOI: 10.1177/1947601912466555] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 10/19/2012] [Indexed: 01/10/2023] Open
Abstract
Activation of the transcription factor STAT5 is essential for the pathogenesis of acute myelogenous leukemia (AML) containing the FLT3 internal tandem duplication (ITD) mutation. FLT3 ITD is a constitutively active tyrosine kinase that drives the activation of STAT5, leading to the growth and survival of AML cells. Although there has been some success in identifying tyrosine kinase inhibitors that block the function of FLT3 ITD, there remains a continued need for effective treatment of this disease. We have identified the psychotropic drug pimozide as an effective inhibitor of STAT5 function. Pimozide inhibits the tyrosine phosphorylation of STAT5, leading to the death of AML cells through the induction of apoptosis. Pimozide shows a combinatorial effect with the tyrosine kinase inhibitors midostaurin (PKC412) and sunitinib in the inhibition of STAT5 tyrosine phosphorylation and the induction of apoptosis. Significantly, pimozide reduces the tumor burden in a mouse model of FLT3-driven AML. Therefore, identifying STAT5 inhibitors may provide a new avenue for the treatment of AML, and these may be effective alone or in combination with tyrosine kinase inhibitors.
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Affiliation(s)
- Erik A Nelson
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Boston, MA,USA
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6
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A phase 2 study of high-dose lenalidomide as initial therapy for older patients with acute myeloid leukemia. Blood 2010; 117:1828-33. [PMID: 21051557 DOI: 10.1182/blood-2010-07-297143] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Older patients with acute myeloid leukemia (AML) have limited treatment options and a poor prognosis, thereby warranting novel therapeutic strategies. We evaluated the efficacy of lenalidomide as front-line therapy for older AML patients. In this phase 2 study, patients 60 years of age or older with untreated AML received high-dose (HD) lenalidomide at 50 mg daily for up to 2 28-day cycles. If patients achieved a complete remission (CR)/CR with incomplete blood count recovery (CRi) or did not progress after 2 cycles of HD lenalidomide, they received low-dose lenalidomide (10 mg daily) until disease progression, an unacceptable adverse event, or completion of 12 cycles. Thirty-three AML patients (median age, 71 years) were enrolled with intermediate (55%), unfavorable (39%), or unknown (6%) cytogenetic risk. Overall CR/CRi rate was 30%, and 53% in patients completing HD lenalidomide. The CR/CRi rate was significantly higher in patients presenting with a low (< 1000/μL) circulating blast count (50%, P = .01). The median time to CR/CRi was 30 days, and duration of CR/CRi was 10 months (range, 1- ≥ 17 months). The most common grades ≥ 3 toxicities were thrombocytopenia, anemia, infection, and neutropenia. HD lenalidomide has evidence of clinical activity as initial therapy for older AML patients, and further study of lenalidomide in AML and MDS is warranted. This study is registered at www.clinicaltrials.gov as #NCT00546897.
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7
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Program death-1 signaling and regulatory T cells collaborate to resist the function of adoptively transferred cytotoxic T lymphocytes in advanced acute myeloid leukemia. Blood 2010; 116:2484-93. [PMID: 20570856 DOI: 10.1182/blood-2010-03-275446] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Tumor-induced immune defects can weaken host immune response and permit tumor cell growth. In a systemic model of murine acute myeloid leukemia (AML), tumor progression resulted in increased regulatory T cells (Treg) and elevation of program death-1 (PD-1) expression on CD8(+) cytotoxic T cells (CTLs) at the tumor site. PD-1 knockout mice were more resistant to AML despite the presence of similar percentage of Tregs compared with wild type. In vitro, intact Treg suppression of CD8(+) T-cell responses was dependent on PD-1 expression by T cells and Tregs and PD-L1 expression by antigen-presenting cells. In vivo, the function of adoptively transferred AML-reactive CTLs was reduced by AML-associated Tregs. Anti-PD-L1 monoclonal antibody treatment increased the proliferation and function of CTLs at tumor sites, reduced AML tumor burden, and resulted in long-term survivors. Treg depletion followed by PD-1/PD-L1 blockade showed superior efficacy for eradication of established AML. These data demonstrated that interaction between PD-1 and PD-L1 can facilitate Treg-induced suppression of T-effector cells and dampen the antitumor immune response. PD-1/PD-L1 blockade coupled with Treg depletion represents an important new approach that can be readily translated into the clinic to improve the therapeutic efficacy of adoptive AML-reactive CTLs in advanced AML disease.
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8
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Ruiz-Argüelles GJ, Gómez-Almaguer D, David-Gomez-Rangel J, Vela-Ojeda J, Cantú-Rodríguez OG, Jaime-Pérez JC, González-Llano O, Herrera-Garza JL. Allogeneic Hematopoietic Stem Cell Transplantation with Non-Myeloablative Conditioning in Patients with Acute Myelogenous Leukemia Eligible for Conventional Allografting: A Prospective Study. Leuk Lymphoma 2009; 45:1191-5. [PMID: 15360000 DOI: 10.1080/10428190310001642846] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Using a non-myeloablative stem cell trasplantation (NST) program, 25 allografts were prospectively given to 24 patients with acute myelogenous leukemia (AML) eligible for conventional allografting; 2 individuals had secondary forms of AML. The median age of the patients was 35 years, with a range of 12 to 56. All patients engrafted; median time to achieve an absolute neutrophil count > 0.5 x 10(9)/1 was 12 days (range 0-26), whereas the median time to a platelet count > 20 x 10(9)/1 was 13 days (range 0-26). Patients developed mixed chimerism 15 to 100 (median 30) days after the allograft. The follow-up periods range between 33 and 2670 days (median 450). The median post-transplant overall survival of the patients has not been reached and is above 89 months, whereas the 683 days both overall and progression-free survival is 66%. In 14 grafts (56%) acute GVHD ensued; in 12 cases grades I-II and in 2 cases grade IV which was fatal in both. In 9/19 patients (47%) limited chronic GVHD developed. In 22 cases (88%), the procedure could be completed fully on an outpatient basis. The 100-day and the transplant-related mortality were both 8%. NST appears to be an effective additional therapeutic option for patients with AML in remission and a matched donor available.
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9
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Single-agent lenalidomide induces complete remission of acute myeloid leukemia in patients with isolated trisomy 13. Blood 2008; 113:1002-5. [PMID: 18824593 DOI: 10.1182/blood-2008-04-152678] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Patients with acute myeloid leukemia (AML) frequently fail chemotherapy due to refractory disease, relapse, or toxicity. Among older AML patients (age > 60 years), there are few long-term survivors. Lenalidomide is a candidate for study in AML based on its clinical activity in a related disorder, myelodysplastic syndrome (MDS), with the 5q- chromosomal abnormality. We report induction of sustained morphologic and cytogenetic complete remission in 2 older AML patients treated with high-dose, single-agent lenalidomide; each patient had trisomy 13 as the sole cytogenetic abnormality. We show for the first time that lenalidomide has clinical activity in this poor-risk cytogenetic subset of AML. The clinical trials described in this paper have been registered with www.clinicaltrials.gov under identifiers NCT00466895 and NCT00546897.
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10
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Lin JM, Li B, Rimmer E, VanRoey M, Jooss K. Enhancement of the anti-tumor efficacy of a GM-CSF-secreting tumor cell immunotherapy in preclinical models by cytosine arabinoside. Exp Hematol 2008; 36:319-28. [PMID: 18279719 DOI: 10.1016/j.exphem.2007.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 11/08/2007] [Accepted: 11/13/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Acute myeloid leukemia (AML) is a highly malignant neoplasm responsible for nearly 10,000 cancer-related deaths annually in the United States. Treatment options for elderly patients with AML remain limited. Standard regimens using cytarabine (cytosine arabinoside [AraC]), a nucleotide analogue, result in significant toxicity with poor overall response. Combination of a cytotoxic chemotherapy and tumor-specific immunotherapy has the potential to improve overall efficacy by inducing an anti-tumor immune response against minimal residual disease. The studies reported here were performed to evaluate the therapeutic benefit of combining a granulocyte macrophage colony-stimulating factor (GM-CSF)-secreting tumor cell immunotherapy with AraC treatment. MATERIALS AND METHODS C57Bl/6 mice were challenged with C1498-luc cells intravenously and evaluated by in vivo imaging throughout the study to monitor the systemic progression of the tumor. Individual animals were euthanized when in vivo total photon counts exceeded 5 x 10(8) and/or when they were in poor clinical condition. Cytotoxicity assay was performed to evaluate effector function and flow cytometry was used for phenotyping of splenocytes from experimental animals. RESULTS Administration of GM-CSF-secreting tumor cell immunotherapy during AraC -induced cytopenia enhanced the anti-tumor efficacy of the immunotherapy, resulting in prolonged survival. AraC treatment did not negatively impact antigen-specific T-cell activation elicited by the immunotherapy and surviving animals treated with the combination demonstrated strong tumor-specific memory responses. CONCLUSION GM-CSF-secreting tumor cell immunotherapy in combination with AraC prolongs survival of tumor-bearing mice, with a median survival time of 61 days observed in mice treated with AraC alone and 90% of mice treated with the combination therapy still alive by day 150.
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Affiliation(s)
- Jian Min Lin
- Department of Preclinical Oncology, Cell Genesys Inc, South San Francisco, CA 94080, USA
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12
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Petersdorf SH, Rankin C, Head DR, Terebelo HR, Willman CL, Balcerzak SP, Karnad AB, Dakhil SR, Appelbaum FR. Phase II evaluation of an intensified induction therapy with standard daunomycin and cytarabine followed by high dose cytarabine for adults with previously untreated acute myeloid leukemia: a Southwest Oncology Group study (SWOG-9500). Am J Hematol 2007; 82:1056-62. [PMID: 17696203 DOI: 10.1002/ajh.20994] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Induction therapy for acute myeloid leukemia (AML) usually consists of 7 days of cytarabine at 100-200 mg/m(2)/day and an anthracycline. Such combinations produce complete response (CR) rates of 60-80% in patients with de novo AML. On the basis of a previous report, suggesting a higher CR rate using a regimen of standard daunomycin and cytarabine followed by 3 days of high-dose cytarabine (HDAC), 101 eligible patients received this regimen in a phase II trial. Sixty patients [59%, 95% confidence interval (CI) 49-69%] achieved a CR, and 10 patients died of infection during induction. Although cytogenetic risk group affected overall survival (P = 0.0016) and relapse-free survival (P = 0.0043), it had no impact on CR rate (P = 0.63). Patients received postremission therapy with repetitive courses of alternate day high-dose cytarabine; this was associated with considerable toxicity and the majority of patients could not receive all of the scheduled postremission therapy. The estimated median survival was 23 months (95% CI 15-34 months), and the estimated probability of surviving 5 years was 34% (95% CI 24-43%). The results of this intensive induction regimen were similar to that seen in previous trials and were not as promising as reported in the previous pilot study.
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Affiliation(s)
- Stephen H Petersdorf
- Division of Medical Oncology, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Puget Sound Oncology Consortium, Seattle, Washington 98109, USA.
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13
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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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Harousseau JL, Lancet JE, Reiffers J, Lowenberg B, Thomas X, Huguet F, Fenaux P, Zhang S, Rackoff W, De Porre P, Stone R. A phase 2 study of the oral farnesyltransferase inhibitor tipifarnib in patients with refractory or relapsed acute myeloid leukemia. Blood 2007; 109:5151-6. [PMID: 17351110 DOI: 10.1182/blood-2006-09-046144] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This phase 2 study evaluated the efficacy and safety of the oral farnesyltransferase inhibitor tipifarnib in adults with refractory or relapsed acute myeloid leukemia (AML). Patients (n=252) received tipifarnib 600 mg twice a day for 21 days in 28-day cycles. Median age was 62 years; 99 (39%) patients were 65 years or older. Eleven (4%) of 252 patients achieved complete remission (CR) or complete remission with incomplete platelet recovery (CRp; 9 CR and 2 CRp). Nineteen patients (8%), including those who achieved CR/CRp, achieved a reduction in bone marrow blasts to less than 5% blasts. Bone marrow blasts were reduced more than 50% in an additional 8 patients (total = 27; 11%). Median survival was 369 days for patients who achieved CR/CRp. Myelosuppression was the most common adverse event. The most common nonhematologic toxicities were fever, nausea, and hypokalemia. Single-agent treatment with tipifarnib induced durable CR/CRp, which was associated with prolonged survival, in some patients with refractory or relapsed AML. The response rate observed in this heavily pretreated group of patients suggests the requirement to enhance the response rate either by combining tipifarnib with other active agents or determining factors that are predictive of response.
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15
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Dobashi N, Asai O, Yano S, Osawa H, Takei Y, Yamaguchi Y, Saito T, Yamazaki H, Kobayashi T, Usui N. Aclarubicin plus behenoyl cytarabine and prednisolone for previously treated acute myeloid leukemia patients. Leuk Lymphoma 2007; 47:2203-7. [PMID: 17071496 DOI: 10.1080/10428190600756490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study analysed the clinical outcome of salvage therapy consisting of aclarubicin (ACR) plus behenoyl cytarabine (BHAC) and prednisolone (PSL) for patients with acute myeloid leukemia (AML). ACR was administered at a dose of 13 mg/m2 per day for 14 days; BHAC, at 130 mg/m2 per day for 14 days; and PSL was administered orally at a dose of 60 mg/m2 per day for 5 days. Of 47 patients, 25 (53.2%) achieved CR. The CR rates of patients in whom induction failed was 55% and that of relapsed patients was 51.9%. Four patients received allogeneic hematopoietic stem cell transplantation after achieving CR. Five patients achieved long-term survival without relapse. The 10-year relapse-free and overall survival rates were 20% and 10.6%, respectively. ACR in combination with BHAC showed a substantial anti-leukemic efficacy in previously treated AML patients and the role of ACR and BHAC may be considered while devising strategies for AML treatments.
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Affiliation(s)
- Nobuaki Dobashi
- Division of Hematology and Oncology, Department of Internal Medicine, Jikei University School of Medicine, Nishi-Shinbashi, Tokyo, Japan.
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Barnard DR, Woods WG. Treatment-related myelodysplastic syndrome/acute myeloid leukemia in survivors of childhood cancer--an update. Leuk Lymphoma 2005; 46:651-63. [PMID: 16019502 DOI: 10.1080/10428190500051042] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Treatment-related myelodysplastic syndrome/acute myeloid leukemia (t-MDS/t-AML) is a devastating complication of treatment for childhood cancer. However, the major cause of premature death of children treated for cancer remains their primary cancer. The understanding of the presentation, incidence, predisposing risk factors and pathobiology of t-MDS/t-AML is increasing. This increased understanding has not yet been translated into improved outcomes of therapy for t-MDS/t-AML. However, newer approaches are under study.
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Affiliation(s)
- D R Barnard
- Division of Pediatric Hematology/Oncology, IWK Health Center, 5850 University Ave, Halifax, Nova Scotia, Canada.
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17
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Mesa RA, Loegering D, Powell HL, Flatten K, Arlander SJH, Dai NT, Heldebrant MP, Vroman BT, Smith BD, Karp JE, Eyck CJT, Erlichman C, Kaufmann SH, Karnitz LM. Heat shock protein 90 inhibition sensitizes acute myelogenous leukemia cells to cytarabine. Blood 2005; 106:318-27. [PMID: 15784732 PMCID: PMC1895127 DOI: 10.1182/blood-2004-09-3523] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Previous studies demonstrated that ataxia telangiectasia mutated- and Rad3-related (ATR) kinase and its downstream target checkpoint kinase 1 (Chk1) facilitate survival of cells treated with nucleoside analogs and other replication inhibitors. Recent results also demonstrated that Chk1 is depleted when cells are treated with heat shock protein 90 (Hsp90) inhibitor 17-allylamino-17-demethoxygeldanamycin (17-AAG). The present study examined the effects of 17-AAG and its major metabolite, 17-aminogeldanamycin (17-AG), on Chk1 levels and cellular responses to cytarabine in human acute myelogenous leukemia (AML) cell lines and clinical isolates. Cytarabine, at concentrations as low as 30 nM, caused activating phosphorylation of Chk1, loss of the phosphatase Cdc25A, and S-phase slowing. Conversely, treatment with 100 to 300 nM 17-AAG for 24 hours caused Chk1 depletion that was accompanied by diminished cytarabine-induced S-phase accumulation, decreased Cdc25A degradation, and enhanced cytotoxicity as measured by inhibition of colony formation and induction of apoptosis. Additional studies demonstrated that small inhibitory RNA (siRNA) depletion of Chk1 also sensitized cells to cytarabine, whereas disruption of the phosphatidylinositol 3-kinase (PI3k) signaling pathway, which is also blocked by Hsp90 inhibition, did not. Collectively, these results suggest that treatment with 17-AAG might represent a means of reversing checkpoint-mediated cytarabine resistance in AML.
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Affiliation(s)
- Ruben A Mesa
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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18
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Bali P, George P, Cohen P, Tao J, Guo F, Sigua C, Vishvanath A, Scuto A, Annavarapu S, Fiskus W, Moscinski L, Atadja P, Bhalla K. Superior activity of the combination of histone deacetylase inhibitor LAQ824 and the FLT-3 kinase inhibitor PKC412 against human acute myelogenous leukemia cells with mutant FLT-3. Clin Cancer Res 2005; 10:4991-7. [PMID: 15297399 DOI: 10.1158/1078-0432.ccr-04-0210] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Mutant FLT-3 receptor tyrosine kinase is a client protein of the molecular chaperone heat shock protein 90 and is commonly present and contributes to the leukemia phenotype in acute myelogenous leukemia (AML). LAQ824, a cinnamyl hydroxamate histone deacetylase inhibitor, is known to induce acetylation and inhibition of heat shock protein 90. Here, we determined the effects of LAQ824 and/or PKC412 (a FLT-3 kinase inhibitor) on the levels of mutant FLT-3 and its downstream signaling, as well as growth arrest and cell-death of cultured and primary human AML cells. EXPERIMENTAL DESIGN The effect of LAQ824 and/or PKC412 treatment was determined on the levels of FLT-3 and phosphorylated (p)-FLT-3, on downstream pro-growth and pro-survival effectors, e.g., p-STAT5, p-AKT, and p-extracellular signal-regulated kinase (ERK) 1/2, and on the cell cycle status and apoptosis in the cultured MV4-11 and primary AML cells with mutant FLT-3. RESULTS Treatment with LAQ824 promoted proteasomal degradation and attenuation of the levels of FLT-3 and p-FLT-3, associated with cell cycle G(1)-phase accumulation and apoptosis of MV4-11 cells. This was accompanied by attenuation of p-STAT5, p-AKT, and p-ERK1/2 levels. STAT-5 DNA-binding activity and the levels of c-Myc and oncostatin M were also down-regulated. Cotreatment with LAQ824 and PKC412 synergistically induced apoptosis of MV4-11 cells and induced more apoptosis of the primary AML cells expressing mutant FLT-3. This was also associated with more attenuation of p-FLT-3, p-AKT, p-ERK1/2, and p-STAT5. CONCLUSIONS The combination of LAQ824 and PKC412 is highly active against human AML cells with mutant FLT-3, which merits in vivo studies of the combination against human AML.
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Affiliation(s)
- Purva Bali
- Department of Interdisciplinary Oncology, Moffitt Cancer Center and Research Institute University of South Florida, Tampa, Florida 33612, USA
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19
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Walters DK, Stoffregen EP, Heinrich MC, Deininger MW, Druker BJ. RNAi-induced down-regulation of FLT3 expression in AML cell lines increases sensitivity to MLN518. Blood 2004; 105:2952-4. [PMID: 15585651 DOI: 10.1182/blood-2004-07-2758] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
FMS-like tyrosine kinase 3 (FLT3) is a receptor tyrosine kinase that is constitutively activated in approximately 30% of acute myelogenous leukemia (AML) patients and appears to confer an adverse prognosis. Thus, development of inhibitors and/or antibodies that specifically target FLT3 has been of substantial interest. In this regard, phase 1 and 2 trials involving FLT3 inhibitors have recently reported FLT3 inhibition and leukemic blast reduction in some patients. Despite this, issues such as specificity and resistance need to be addressed. Consequently, the development of alternative approaches for targeting FLT3 would be of great consequence. In the present report, we demonstrate that FLT3 siRNA effectively down-regulates FLT3 expression in Ba/F3 cells transfected with FLT3 containing an activating internal tandem duplication (ITD) in the juxtamembrane domain and FLT3-ITD-positive Molm-14 human leukemia cells. Treatment with the FLT3 siRNA results in growth inhibition and apoptosis of these cells. Furthermore, siRNA-induced down-regulation of FLT3 increased the sensitivity of both cell lines to treatment with the FLT3 inhibitor MLN518. This illustrates the potential benefit of combined therapeutic approaches.
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Affiliation(s)
- Denise K Walters
- Department of Hematology and Oncology, Howard Hughes Medical Institute, Oregon Health and Science University, and Portland Veterans Affairs (VA) Medical Center, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA.
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20
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Daser A, Rabbitts TH. Extending the repertoire of the mixed-lineage leukemia gene MLL in leukemogenesis. Genes Dev 2004; 18:965-74. [PMID: 15132992 DOI: 10.1101/gad.1195504] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Angelika Daser
- MRC Laboratory of Molecular Biology, Cambridge CB2 2QH, UK
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21
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Wiederhold NP, Lewis RE, Kontoyiannis DP. Invasive aspergillosis in patients with hematologic malignancies. Pharmacotherapy 2004; 23:1592-610. [PMID: 14695039 DOI: 10.1592/phco.23.15.1592.31965] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Invasive aspergillosis is an increasingly common and often fatal opportunistic fungal infection in patients with hematologic malignancies. Prolonged and profound neutropenia remains a key risk factor for the development of invasive aspergillosis. However, qualitative deficiencies in host immune responses resulting from prolonged corticosteroid therapy, graft-versus-host disease, and cytomegalovirus infection are important risk factors for the recurrence and progression of Aspergillus infections after bone marrow recovery. Early diagnosis of invasive aspergillosis remains a challenge, and few tools are available for monitoring its course once the diagnosis is established. Even with the recent introduction of new antifungal therapies, mortality in patients with invasive aspergillosis remains high, and uniformly effective prophylaxis or preemptive therapeutic strategies are lacking. Strategies such as combination antifungal therapy and immunotherapy often are used as first-line treatment approaches in patients with documented invasive aspergillosis despite a paucity of clinical trial data. Recent advances in our understanding of the epidemiology, pathogenesis, and treatment of invasive aspergillosis in patients with hematologic malignancies are reviewed. The problems and controversies associated with defining optimal treatment strategies for invasive aspergillosis in this heavily immunocompromised population are highlighted.
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22
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Liu TF, Urieto JO, Moore JE, Miller MS, Lowe AC, Thorburn A, Frankel AE. Diphtheria toxin fused to variant interleukin-3 provides enhanced binding to the interleukin-3 receptor and more potent leukemia cell cytotoxicity. Exp Hematol 2004; 32:277-81. [PMID: 15003313 DOI: 10.1016/j.exphem.2003.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Revised: 11/15/2003] [Accepted: 11/21/2003] [Indexed: 01/02/2023]
Abstract
Chemoresistance is a common cause of treatment failure in patients with acute myeloid leukemia (AML). We generated a diphtheria toxin (DT) fusion protein composed of the catalytic and translocation domains of DT (DT388) fused to interleukin-3 (IL-3). IL-3 receptors (IL-3R) are overexpressed on blasts from many AML patients. DT388IL-3 showed cytotoxicity to leukemic blasts in vitro and in vivo and minimal damage to normal tissues in nonhuman primate models. However, only a fraction of patient leukemic samples were sensitive to the agent. To enhance the potency and specificity of the DT388IL-3 molecule, we constructed variants with altered residues in the IL-3 moiety. Two of these variants, DT388IL-3[K116W] and DT388IL-3[Delta125-133], were produced and partially purified from Escherichia coli with excellent yields. They showed enhanced binding to the human IL-3R and greater cytotoxicity to human leukemia cell lines relative to wild-type DT388IL-3. Interestingly, the results support a previously hypothesized model for interaction of the C-terminal residues of IL-3 with a hydrophobic patch on the alpha-subunit of IL-3R. Rational modification of the targeting domain based on structural analysis can produce a fusion toxin with increased ability to kill tumor cells. One or both of these variant fusion proteins merit further development for therapy of chemotherapy refractory AML.
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Affiliation(s)
- Tie Fu Liu
- Department of Medicine and Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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