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Ansari AS, K C R, Morales LC, Nasrullah M, Meenakshi Sundaram DN, Kucharski C, Jiang X, Brandwein J, Uludağ H. Lipopolymer mediated siRNA delivery targeting aberrant oncogenes for effective therapy of myeloid leukemia in preclinical animal models. J Control Release 2024; 367:821-836. [PMID: 38360178 DOI: 10.1016/j.jconrel.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
The clinical development of tyrosine kinase inhibitors (TKI) has led to great strides in improving the survival of chronic myeloid leukemia (CML) and acute myeloid leukemia (AML) patients. But even the new generation TKIs are rendered futile in the face of evolving landscape of acquired mutations leading to drug resistance, necessitating the pursuit of alternative therapeutic approaches. In contrast to exploiting proteins as targets like most conventional drugs and TKIs, RNA Interference (RNAi) exerts its therapeutic action towards disease-driving aberrant genes. To realize the potential of RNAi, the major challenge is to efficiently deliver the therapeutic mediator of RNAi, small interfering RNA (siRNA) molecules. In this study, we explored the feasibility of using aliphatic lipid (linoleic acid and lauric acid)-grafted polymers (lipopolymers) for the delivery of siRNAs against the FLT3 oncogene in AML and BCR-ABL oncogene in CML. The lipopolymer delivered siRNA potently suppressed the proliferation AML and CML cells via silencing of the targeted oncogenes. In both AML and CML subcutaneous xenografts generated in NCG mice, intravenously administered lipopolymer/siRNA complexes displayed significant inhibitory effect on tumor growth. Combining siFLT3 complexes with gilteritinib allowed for reduction of effective drug dosage, longer duration of remission, and enhanced survival after relapse, compared to gilteritinib monotherapy. Anti-leukemic activity of siBCR-ABL complexes was similar in wild-type and TKI-resistant cells, and therapeutic efficacy was confirmed in vivo through prolonged survival of the NCG hosts systemically implanted with TKI-resistant cells. These results demonstrate the preclinical efficacy of lipopolymer facilitated siRNA delivery, providing a novel therapeutic platform for myeloid leukemias.
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MESH Headings
- Humans
- Animals
- Mice
- RNA, Small Interfering
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Oncogenes
- Models, Animal
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/pharmacology
- Drug Resistance, Neoplasm
- Aniline Compounds
- Pyrazines
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Affiliation(s)
- Aysha S Ansari
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Remant K C
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Luis C Morales
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Mohammad Nasrullah
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton T6G 2H1, Alberta, Canada
| | | | - Cezary Kucharski
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada
| | - Xiaoyan Jiang
- Department of Molecular Genetics and Terry Fox Labs, University of British Columbia, Vancouver V5Z 1L3, British Columbia, Canada
| | - Joseph Brandwein
- Division of Hematology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton T6G 2E1, Alberta, Canada
| | - Hasan Uludağ
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton T6G 1H9, Alberta, Canada; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton T6G 2H1, Alberta, Canada.
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Elmakaty I, Saglio G, Al-Khabori M, Elsayed A, Elsayed B, Elmarasi M, Elsabagh AA, Alshurafa A, Ali E, Yassin M. The Contemporary Role of Hematopoietic Stem Cell Transplantation in the Management of Chronic Myeloid Leukemia: Is It the Same in All Settings? Cancers (Basel) 2024; 16:754. [PMID: 38398145 PMCID: PMC10886670 DOI: 10.3390/cancers16040754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 02/25/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) for chronic myeloid leukemia (CML) patients has transitioned from the standard of care to a treatment option limited to those with unsatisfactory tyrosine kinase inhibitor (TKI) responses and advanced disease stages. In recent years, the threshold for undergoing HSCT has increased. Most CML patients now have life expectancies comparable to the general population, and therefore, the goal of therapy is shifting toward achieving treatment-free remission (TFR). While TKI discontinuation trials in CML show potential for achieving TFR, relapse risk is high, affirming allogeneic HSCT as the sole curative treatment. HSCT should be incorporated into treatment algorithms from the time of diagnosis and, in some patients, evaluated as soon as possible. In this review, we will look at some of the recent advances in HSCT, as well as its indication in the era of aiming for TFR in the presence of TKIs in CML.
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Affiliation(s)
- Ibrahim Elmakaty
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy
| | | | | | - Basant Elsayed
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Mohamed Elmarasi
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | | | - Awni Alshurafa
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Elrazi Ali
- Interfaith Medical Center, Brooklyn, NY 11213, USA
| | - Mohamed Yassin
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
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Cantu-Rodriguez OG, Osorno-Rodriguez KL, Dorsey-Trevino EG, Gutierrez-Aguirre CH, Jaime-Perez JC, Gomez-Villarreal JP, Rios-Rodelo MR, Gonzalez-Cantu GA, Contreras-Arce A, Colunga-Pedraza PR, Gomez-De Leon A, Mancias-Guerra MDC, Tarin-Arzaga LDC, Gomez-Almaguer D. Long-Term Efficacy of High-Dose Imatinib in Hispanic Patients Without Access to Second-Generation Tyrosine Kinase Inhibitors Treated in LATAM Centers. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e386-e392. [PMID: 37625952 DOI: 10.1016/j.clml.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND While second-generation tyrosine kinase inhibitors (TKI) revolutionized treatment for patients with chronic myeloid leukemia (CML) who developed a suboptimal response to imatinib, many patients in developing countries are fixed to the latter due to socioeconomic barriers. Despite this scenario, scarce information is available to evaluate the clinical prognosis of these patients. METHODS We conducted a retrospective cohort analysis to compare the overall mortality of patients with CML who developed a suboptimal response to a standard dose of imatinib and were treated with either high-dose imatinib or a second-generation TKI. We created a marginal structural model with inverse probability weighting and stabilized weights. Our primary outcome was overall survival (OS) at 150 months. Our secondary outcomes were disease-free survival (DFS) at 150 months and adverse events. RESULTS The cohort included 148 patients, of which 32 received high-dose imatinib and 116 a second-generation TKI. No difference was found in the 150-month overall survival risk (RR: 95% CI 0.91, 0.55-1.95, P-value = .77; RD: -0.04, -0.3 to 0.21, P-value = .78) and disease-free survival (RR: 1.02, 95% CI 0.53-2.71, P-value = .96; RD: 0.01, -0.26 to 0.22, P-value = .96). There was also no difference in the incidence of adverse events in either group. CONCLUSION Ideally, patients who develop a suboptimal response to imatinib should be switched to a second-generation TKI. If impossible, however, our findings suggest that patients treated with high-dose imatinib have a similar overall survival and disease-free survival prognosis to patients receiving a second-generation TKI.
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Affiliation(s)
- Olga Graciela Cantu-Rodriguez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico.
| | - Karen Lorena Osorno-Rodriguez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Edgar Gerardo Dorsey-Trevino
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Cesar Homero Gutierrez-Aguirre
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Jose Carlos Jaime-Perez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | | | | | - Graciela Alejandra Gonzalez-Cantu
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Alan Contreras-Arce
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Perla Rocio Colunga-Pedraza
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Andres Gomez-De Leon
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Maria Del Consuelo Mancias-Guerra
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - Luz Del Carmen Tarin-Arzaga
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
| | - David Gomez-Almaguer
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Hematologia, Monterrey, Nuevo León, Mexico
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Ning L, Hu C, Lu P, Que Y, Zhu X, Li D. Trends in disease burden of chronic myeloid leukemia at the global, regional, and national levels: a population-based epidemiologic study. Exp Hematol Oncol 2020; 9:29. [PMID: 33292593 PMCID: PMC7607878 DOI: 10.1186/s40164-020-00185-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Outcomes of chronic myeloid leukemia (CML) has been improved dramatically in the past two decades, but survival levels of CML patients varied in regions. Comprehensive epidemiological research is necessary to evaluate the global burden of CML. METHODS All data used in our study came from the Global Burden of Disease (GBD) study 2017. Incidence cases, death cases, disability-adjusted life-years (DALYs), and its corresponding age-standardized rate between 1990 to 2017 were used to describe the distribution of CML burden, according to age, sex, social-demographic index (SDI), and countries. Data about attributable risk factors contributing to CML deaths and DALYs were also extracted and analyzed. RESULTS Globally, the disease burden of CML gradually decreased from 1990 to 2017. Higher SDI countries achieved a remarkable effect on diminishing the CML burden. Conversely, due to population growth, the incidence cases, death cases, and DALYs of CML in lower SDI quintiles showed an upward trend. India had the most incidence cases and death cases of CML in the world. Additionally, smoking was the most significant attributable risk factor contributing to CML deaths and DALYs, followed by high body mass index. CONCLUSION The disease burden of CML decreased globally, especially in higher SDI countries in the past 28 years. The increasing incidence cases and death cases were mainly observed in lower SDI countries. Additionally, strategies to control modifiable risk factors such as smoking and high body mass index might be useful in diminishing mortality and DALYs.
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Affiliation(s)
- Liqing Ning
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chuanyu Hu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Pingfan Lu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yimei Que
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaojian Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Dengju Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Bezerra ED, Flowers ME, Onstad LE, Chielens D, Radich J, Higano CS. A phase 2 study of alpha interferon for molecularly measurable residual disease in chronic myeloid leukemia after allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2019; 60:2754-2761. [PMID: 31014151 DOI: 10.1080/10428194.2019.1605508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CML therapy has improved dramatically with the development of tyrosine kinase inhibitors (TKIs). Prior to the TKI era, we conducted two trials of alpha-interferon (IFN) for post-transplant hematologic and cytogenetic relapse. The complete cytogenetic response rate was 33% and 57% respectively. This report describes a third trial in which 40 patients with molecular relapse between 6 and 12 months post-transplant were treated with IFN. The projected cytogenetic relapse at 4.5 years was 12.6% compared with 42% in the historical control group. Although this data may not apply to most patients with CML today due to the availability of multiple TKIs, the effectiveness of short term IFN in post-transplant molecular relapse is supported by long-term treatment-free-survival in 75% of patients after a median follow-up of 15.6 years. This report suggests that alpha-interferon is potentially useful in the rare patient who has post-transplant molecular relapse who does not tolerate, or is resistant to TKIs.
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Affiliation(s)
- Evandro D Bezerra
- Department of Medicine Division of Oncology, University of Washington, Seattle, WA, USA
| | - Mary E Flowers
- Department of Medicine Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Lynn E Onstad
- Clinical Research Division Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Jerald Radich
- Department of Medicine Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Celestia S Higano
- Department of Medicine Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
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Awidi A, Abbasi S, Alrabi K, Kheirallah KA. Generic Imatinib Therapy Among Jordanians: An Observational Assessment of Efficacy and Safety in Routine Clinical Practice. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:e55-e61. [DOI: 10.1016/j.clml.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/01/2017] [Indexed: 01/28/2023]
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Gomez-de-León A, Gómez-Almaguer D, Ruiz-Delgado GJ, Ruiz-Arguelles GJ. Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective. Expert Rev Hematol 2017; 10:809-819. [PMID: 28742419 DOI: 10.1080/17474086.2017.1360180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.
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Affiliation(s)
- Andrés Gomez-de-León
- a Universidad Autónoma de Nuevo León , Facultad de Medicina y Hospital Universitario "Dr.José Eleuterio González". Hematology Service, Monterrey , Nuevo León , México
| | - David Gómez-Almaguer
- a Universidad Autónoma de Nuevo León , Facultad de Medicina y Hospital Universitario "Dr.José Eleuterio González". Hematology Service, Monterrey , Nuevo León , México
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Gómez-Almaguer D, Jaime-Pérez J. Effective medicine and the economy. MEDICINA UNIVERSITARIA 2017. [DOI: 10.1016/j.rmu.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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