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Huang Q, Wang T, Xiong Y, Qu L, Yin Q, Zou W. Safety and efficacy of Compound Huangdai Tablets combined with all-trans retinoic acid for treatment of acute promyelocytic leukemia: Clinical evidence and potential mechanisms. CHINESE HERBAL MEDICINES 2022; 14:154-165. [PMID: 36120125 PMCID: PMC9476755 DOI: 10.1016/j.chmed.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/29/2020] [Accepted: 03/26/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the safety and efficacy of Compound Huangdai Tablets (Realgar-Indigo Naturalis formula, RIF) combined with all-trans retinoic acid (ATRA) to treat acute promyelocytic leukemia (APL). Methods This study was registered in PROSPERO (CRD42018108118). The relevant literatures on RIF treatment of APL were systematically searched in the following databases: China National Knowledge Infrastructure, Wanfang, VIP Medical Information System, Chinese Biomedical Database, EMBASE, Cochrane Library, and PubMed. The quality of the included studies was evaluated and Review Manager 5.3 software and Stata 13.0 software were used to perform the Meta-analysis. In addition, this study used the method of network pharmacology to conduct a preliminary exploration of the mechanism of RIF on APL. Results The study included 12 studies involving 775 APL patients. The Meta-analysis showed that there was no significant difference (P > 0.05) between the RIF group and the arsenic trioxide (ATO) group for primary outcomes, secondary outcomes apart from liver dysfunction. The incidence of liver dysfunction (P = 0.006) in the RIF group were significantly lower than those in the ATO group. In addition, the cost of maintenance therapy in the RIF group was significantly lower (P < 0.05) than the ATO group. Besides, the active ingredients in RIF mainly act on targets proteins such as ACHE, NCOA2, RXRA, and then play a role in the treatment of APL through regulating multiple molecular mechanisms, such as TP53 regulates transcription of cell cycle genes, nuclear receptor transcription pathway. Conclusion There was no significant difference in efficacy of oral RIF combined with ATRA compared with intravenous ATO combined with ATRA for the treatment of APL. The oral RIF exposed patients to less risk, offered more convenience and had lower prices. RIF can treat APL by multi-target and multi-pathway interventions that inducing apoptosis of APL cells and inhibiting the proliferation of APL cells, and so on. Therefore, oral RIF in the treatment of APL is worthy of further research and development.
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Affiliation(s)
- Qianqian Huang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Tao Wang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yan Xiong
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Liping Qu
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Qiaozhi Yin
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Wenjun Zou
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
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Alsulami HA, Alnashri MM, Bawazir AF, Alrashid LT, Dly RA, Alharbi YA, Qari MH. Prognostics and Clinical Outcomes in Patients Diagnosed With Acute Myeloid Leukemia (AML) in a Teaching Hospital. Cureus 2021; 13:e18915. [PMID: 34812301 PMCID: PMC8603085 DOI: 10.7759/cureus.18915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Acute myeloid leukemia (AML) is a heterogeneous disease. Prognosis and survival depend on several factors that determine tumor behavior and response to therapy. AML has a poor prognosis that depends on several factors: patient's age, gender, body mass index (BMI), baseline white blood cells count, and bone marrow blast (BMB) cell count at the time of diagnosis. Therefore, this study aimed to determine the prognostic role of these factors and their impact on outcomes, and how these prognostic factors may affect AML patients before and after induction chemotherapy. Methods: The study design is an observational, retrospective record review. We included records of patients diagnosed with primary and secondary AML who received chemotherapy between 2013 and 2019 at King Abdulaziz University in Jeddah, Saudi Arabia. Data were extracted from medical records, entered into an Excel sheet (Microsoft Corp., Redmond, WA), and analyzed using SPSS Statistics, version 25 (IBM Corp., Armonk, NY). Results: Forty-two AML patients who were started on chemotherapy were analyzed. The mean age at diagnosis was 35 ± 22.2 years; 52.4% were male. The ability to achieve the first remission varied according to age group; the 21-45 age group had the higher ability and survival rate of 75.0%. On the other hand, the mortality incidence was higher (at 70.0%) in both the 11-20 and the 46-70 age groups. A strong negative correlation was observed between age and survival duration after treatment (SDAT) (r = - 0.618, p = 0.004). The death incidence was increased in the BMI ranges that were under and above the normal weight range. SDAT differed significantly between the three groups in favor of the normal-weight patients (p = 0.019). We found that patients with BMB < 5 had the most deaths. There was a significant negative association between BMB and days to achieve the first remission after treatment (p = 0.033). Conclusion: Age, BMI, and BMB are considered effective prognostic factors for AML patients.
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Affiliation(s)
- Hind A Alsulami
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Maryam M Alnashri
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Alanoud F Bawazir
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Laila T Alrashid
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Raghdah A Dly
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Yusr A Alharbi
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mohamad H Qari
- Hematology Department, King Abdulaziz University Hospital, Jeddah, SAU
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3
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Sheng XF, Hong LL, Li H, Huang FY, Wen Q, Zhuang HF. Long non-coding RNA MALAT1 modulate cell migration, proliferation and apoptosis by sponging microRNA-146a to regulate CXCR4 expression in acute myeloid leukemia. ACTA ACUST UNITED AC 2021; 26:43-52. [PMID: 33382018 DOI: 10.1080/16078454.2020.1867781] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate the role of Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in acute myeloid leukemia (AML) and analyze the potential regulatory network of MALAT1/miR-146a/ CXCR4. METHODS The expressions of MALAT1, miR-146a and CXCR4 were performed by qRT-PCR and Western Blot. We conducted trans-well assay, CCK-8 assay and flow cytometry to evaluate the migration, proliferation and apoptosis of AML cells. Also by using luciferase reporter assay, we investigated the interaction between miR-146a and MALAT1 or CXCR4. RESULTS Firstly, MALAT1 and CXCR4 were upregulated while miR-146a was downregulated in AML patients compared with healthy controls. We observed a negative correlation between miR-146a and MALAT1 or CXCR4, but a positive correlation between MALAT1 and CXCR4 in AML patients. MALAT1 knockdown inhibited migration and proliferation but induced apoptosis of HL-60 cells. MALAT1 restrained miR-146a expression by acting as a ceRNA. miR-146a regulated HL-60 cells migration, proliferation and apoptosis by directly targeting CXCR4 expression. Finally, we found that CXCR4 expression was downregulated by MALAT1 knockdown and partially restored by miR-146a abrogation. CONCLUSIONS Our results showed that MALAT1 regulates migration, proliferation and apoptosis by sponging miR-146a to regulate CXCR4 expression in AML cells, providing novel insights into the role of MALAT1 as a therapeutic target in AML.
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Affiliation(s)
- Xian-Fu Sheng
- The department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Li-Li Hong
- The department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Hui Li
- The department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Fei-Yan Huang
- The department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Qiang Wen
- The department of Cancer, Cancer Hospital of University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Hai-Feng Zhuang
- The department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
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4
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Liu M, Ren Y, Wang X, Lu X, Li M, Kim YM, Li S, Zhang L. Two rare cases of acute myeloid leukemia with t(8;16)(p11.2;p13.3) and 1q duplication: case presentation and literature review. Mol Cytogenet 2020; 13:37. [PMID: 32863883 PMCID: PMC7448493 DOI: 10.1186/s13039-020-00507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is a complex hematological disease characterized by genetic and clinical heterogeneity. The identification and understanding of chromosomal abnormalities are important for the diagnosis and management of AML patients. Compared with recurrent chromosomal translocations in AML, t(8;16)(p11.2;p13.3) can be found in any age group but is very rare and typically associated with poor prognosis. Methods Conventional cytogenetic studies were performed among 1,824 AML patients recorded in our oncology database over the last 20 years. Fluorescence in situ hybridization (FISH) was carried out to detect the translocation fusion. Array comparative genome hybridization (aCGH) was carried out to further characterize the duplication of chromosomes. Results We identified three AML patients with t(8;16)(p11.2;p13.3) by chromosome analysis. Two of the three patients, who harbored an additional 1q duplication, were detected by FISH and aCGH. aCGH characterized a 46.7 Mb and 49.9 Mb gain in chromosome 1 at band q32.1q44 separately in these two patients. One patient achieved complete remission (CR) but relapsed 3 months later. The other patient never experienced CR and died 2 years after diagnosis. Conclusion A 1q duplication was detected in two of three AML patients with t(8;16)(p11.2;p13.3), suggesting that 1q duplication can be a recurrent event in AML patients with t(8;16). In concert with the findings of previous studies on similar patients, our work suggests that 1q duplication may also be an unfavorable prognostic factor of the disease.
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Affiliation(s)
- Meng Liu
- Department of Hematology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000 Liaoning People's Republic of China.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Yuan Ren
- Department of Hematology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000 Liaoning People's Republic of China.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Xianfu Wang
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Xianglan Lu
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Ming Li
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA.,Department of Neurology, The Second Hospital of Jilin University, Jilin, People's Republic of China
| | - Young Mi Kim
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Shibo Li
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Lijun Zhang
- Department of Hematology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000 Liaoning People's Republic of China
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Morales ML, Arenas A, Ortiz-Ruiz A, Leivas A, Rapado I, Rodríguez-García A, Castro N, Zagorac I, Quintela-Fandino M, Gómez-López G, Gallardo M, Ayala R, Linares M, Martínez-López J. MEK inhibition enhances the response to tyrosine kinase inhibitors in acute myeloid leukemia. Sci Rep 2019; 9:18630. [PMID: 31819100 PMCID: PMC6901485 DOI: 10.1038/s41598-019-54901-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022] Open
Abstract
FMS-like tyrosine kinase 3 (FLT3) is a key driver of acute myeloid leukemia (AML). Several tyrosine kinase inhibitors (TKIs) targeting FLT3 have been evaluated clinically, but their effects are limited when used in monotherapy due to the emergence of drug-resistance. Thus, a better understanding of drug-resistance pathways could be a good strategy to explore and evaluate new combinational therapies for AML. Here, we used phosphoproteomics to identify differentially-phosphorylated proteins in patients with AML and TKI resistance. We then studied resistance mechanisms in vitro and evaluated the efficacy and safety of rational combinational therapy in vitro, ex vivo and in vivo in mice. Proteomic and immunohistochemical studies showed the sustained activation of ERK1/2 in bone marrow samples of patients with AML after developing resistance to FLT3 inhibitors, which was identified as a common resistance pathway. We examined the concomitant inhibition of MEK-ERK1/2 and FLT3 as a strategy to overcome drug-resistance, finding that the MEK inhibitor trametinib remained potent in TKI-resistant cells and exerted strong synergy when combined with the TKI midostaurin in cells with mutated and wild-type FLT3. Importantly, this combination was not toxic to CD34+ cells from healthy donors, but produced survival improvements in vivo when compared with single therapy groups. Thus, our data point to trametinib plus midostaurin as a potentially beneficial therapy in patients with AML.
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Affiliation(s)
- María Luz Morales
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Alicia Arenas
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Alejandra Ortiz-Ruiz
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Alejandra Leivas
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Inmaculada Rapado
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
- Servicio de Hematología, Hospital 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), ISCIII, Madrid, Spain
| | - Alba Rodríguez-García
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Nerea Castro
- Servicio de Hematología, Hospital 12 de Octubre, Madrid, Spain
| | - Ivana Zagorac
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Miguel Quintela-Fandino
- Breast Cancer Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Gonzalo Gómez-López
- Bioinformatics Unit, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Miguel Gallardo
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Rosa Ayala
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
- Servicio de Hematología, Hospital 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), ISCIII, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - María Linares
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain.
- Universidad Complutense de Madrid, Madrid, Spain.
| | - Joaquín Martínez-López
- H12O-CNIO Haematological Malignancies Clinical Research Unit, Hospital 12 de Octubre - Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
- Servicio de Hematología, Hospital 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), ISCIII, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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Elsayed AH, Cao X, Crews KR, Gandhi V, Plunkett W, Rubnitz JE, Ribeiro RC, Pounds SB, Lamba JK. Comprehensive Ara-C SNP score predicts leukemic cell intracellular ara-CTP levels in pediatric acute myeloid leukemia patients. Pharmacogenomics 2018; 19:1101-1110. [PMID: 30088438 PMCID: PMC6219441 DOI: 10.2217/pgs-2018-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/03/2018] [Indexed: 12/16/2022] Open
Abstract
AIM Cytarabine (Ara-C), a mainstay of acute myeloid leukemia (AML) treatment, is a prodrug requiring activation to ara-CTP for its antileukemic activity. Aim of this study was to evaluate impact of genetic variants in the key genes involved in ara-C metabolism on the leukemic cell intracellular levels of ara-CTP. METHOD We investigated SNPs in 14 ara-C metabolic-pathway genes, for association with intracellular ara-CTP levels, in leukemic cells obtained post-initiation of cytarabine infusion in pediatric AML patients (n = 68). RESULTS Nine SNPs were significantly associated with leukemic cell intracellular concentration of ara-CTP. A comprehensive ara-CTP-SNP-score (ACSS) was further developed from top four SNPs identified in regression model. Patients were classified into three groups based on ACSS: high-ACSS (score >0), intermediate-ACSS (score = 0) and low-ACSS (score <0). ACSS designation was significant predictor of intracellular ara-CTP levels (p = 0.00012), suggesting a cumulative or synergistic effect of the significant SNPs. CONCLUSION ACSS score designation holds promise in definfing ara-C dose. Validation of the clinical utility of ACSS score in other independent cohorts will help identification of patients with potentially lower or higher levels of the ara-CTP in leukemic cells, thereby opening up opportunities for dose management to reduce toxicity and enhance efficacy.
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Affiliation(s)
- Abdelrahman H Elsayed
- Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Xueyuan Cao
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
- Department of Acute & Tertiary Care, University of Tennessee Health Science Center, Memphis 38163, TN, USA
| | - Kristine R Crews
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Varsha Gandhi
- Department of Experimental Therapeutics, MD Anderson Cancer Center, Houston, TX 77054, USA
| | - William Plunkett
- Department of Experimental Therapeutics, MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Jeffrey E Rubnitz
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Raul C Ribeiro
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Stanley B Pounds
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jatinder K Lamba
- Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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