2
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Jaramillo AC, Bergman AM, Comijn EM, Jansen G, Kaspers GJL, Cloos J, Peters GJ. Effect of dexamethasone on the antileukemic effect of cytarabine: role of deoxycytidine kinase. NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2020; 39:1346. [PMID: 32727269 DOI: 10.1080/15257770.2020.1780441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dexamethasone (DEX) is often used in the initial treatment of leukemia. Earlier we demonstrated that DEX decreased the activity of deoxycytidine kinase (dCK) which is essential for the activation of cytarabine (ara-C). Therefore we investigated the effect of DEX on the in vivo sensitivity of acute myeloid leukemia (AML) to ara-C and another deoxycytidine analog, gemcitabine, in the Brown Norway Myeloid Leukemia (BNML) rat model for AML, and its ara-C resistant variant B-araC, in relation to the effects on dCK activity.The antileukemic effect was evaluated as survival of the rats, while dCK activity was measured in leukemic spleen (completely consisting of BNML cells) with liver as representative normal tissue, 24 hr after treatment with ara-C or DEX with radioactive deoxycytidine (CdR) as a substrate.Treatment with ara-C increased life-span of BNML by 200%, which was not affected by DEX. Gemcitabine was ineffective. In the liver of BNML bearing rats DEX decreased dCK activity 33%, while ara-C increased dCK activity slightly (to 129%), but in the combination of ara-C/DEX dCK activity was also decreased. In the livers of Bara-C bearing rats dCK was 2.7-fold higher compared to BNML rats, which was increased 179% in the gemcitabine-DEX treated rats. In BNML leukemic spleens DEX decreased dCK activity 41% and gem/dex 46%, but ara-C increased dCK activity to 123%, but in the combination this effect was neutralized. In Bara-C spleens only ara-C/dex decreased dCK activity (32%).In conclusion; in an AML rat model DEX did not affect the antileukemic effect of ara-C, nor the dCK activity.
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Affiliation(s)
- Adrian C Jaramillo
- Laboratory of Hematology, Amsterdam UMC, location VU University Medical Center, Amsterdam, the Netherlands
| | | | - Elizabeth M Comijn
- Laboratory Medical Oncology, Amsterdam UMC, location VU University Medical Center, Amsterdam, the Netherlands
| | - Gerrit Jansen
- Reumatology, Amsterdam UMC, location VU University Medical Center, Amsterdam, the Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, location VUMC, Pediatric Oncology, Amsterdam, The Netherlands.,Princess Maxima Center, Utrecht, the Netherlands
| | - Jacqueline Cloos
- Laboratory of Hematology, Amsterdam UMC, location VU University Medical Center, Amsterdam, the Netherlands
| | - Godefridus J Peters
- Laboratory Medical Oncology, Amsterdam UMC, location VU University Medical Center, Amsterdam, the Netherlands.,Department of Biochemistry, Medical University of Gdansk, Gdansk, Poland
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3
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Norsworthy KJ, DeZern AE, Tsai HL, Hand WA, Varadhan R, Gore SD, Gojo I, Pratz K, Carraway HE, Showel M, McDevitt MA, Gladstone D, Ghiaur G, Prince G, Seung AH, Benani D, Levis MJ, Karp JE, Smith BD. Timed sequential therapy for acute myelogenous leukemia: Results of a retrospective study of 301 patients and review of the literature. Leuk Res 2017; 61:25-32. [PMID: 28869816 DOI: 10.1016/j.leukres.2017.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/09/2017] [Accepted: 08/20/2017] [Indexed: 11/16/2022]
Abstract
Timed sequential therapy (TST) aims to improve outcomes in acute myelogenous leukemia (AML) by harnessing drug-induced cell cycle kinetics of AML, where a second drug is timed to coincide with peak leukemia proliferation induced by the first drugs. We analyzed outcomes in 301 newly diagnosed AML patients treated from 2004-2013 with cytarabine, anthracycline, and etoposide TST induction. Median age was 52 (range 20-74) and complete remission rate 68%. With median follow-up 5.8 years, 5-year DFS and overall survival (OS) were 37% (95% CI 31-45%) and 32% (95% CI 27-38%), respectively. In multivariate analysis, older age, unfavorable cytogenetics, and WBC≥50×109/L resulted in worse OS. Among patients not undergoing blood and marrow transplant, a propensity score analysis, which reduces imbalance in baseline characteristics, showed consolidation with TST compared with 1 or more cycles high-dose cytarabine trended toward lower DFS and post-remission survival with hazard ratio (HR) 1.9 (95% CI 0.9-4.0), and 1.6 (95% CI 0.7-3.6), respectively. Our results demonstrate the efficacy and feasibility of TST induction for newly diagnosed patients with AML, with results comparable to that seen in clinical trials with other TST therapies and 7+3.
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Affiliation(s)
- Kelly J Norsworthy
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Amy E DeZern
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Hua-Ling Tsai
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Wesley A Hand
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Ravi Varadhan
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Steven D Gore
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; Yale Cancer Center, New Haven, CT, United States
| | - Ivana Gojo
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Keith Pratz
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Hetty E Carraway
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, United States
| | - Margaret Showel
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Michael A McDevitt
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; Global Medicines Development, AstraZeneca, Gaithersburg, MD, United States
| | - Douglas Gladstone
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Gabriel Ghiaur
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Gabrielle Prince
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Amy H Seung
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; AssistRx, Orlando, FL, United States
| | - Dina Benani
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Mark J Levis
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Judith E Karp
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - B Douglas Smith
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States.
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5
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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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