1
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Hu M, Li W, Zhang Y, Liang C, Tan J, Wang Y. Venetoclax in adult acute myeloid leukemia. Biomed Pharmacother 2023; 168:115820. [PMID: 37925935 DOI: 10.1016/j.biopha.2023.115820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023] Open
Abstract
Venetoclax is a potent inhibitor that specifically targets B-cell lymphoma-2 (BCL-2), which has been demonstrated to be effective in preclinical studies utilizing acute myeloid leukemia (AML) cell lines and xenograft models. Significant antileukemic activity was also observed in clinical trials, both as a monotherapy and in combination with other drugs. This novel therapeutic approach has revolutionized the treatment prospects for AML patients with unfavorable prognoses and those who are unable to tolerate intensive chemotherapy. Nevertheless, further investigations are required to establish the optimal dosing, sequencing, and combinational strategies of venetoclax for AML treatments. Additionally, identifying biomarkers is crucial for predicting response and resistance to this targeted intervention. In this review, we provide an overview of venetoclax-based therapy for AML and explore potential avenues for future research.
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Affiliation(s)
- Mengci Hu
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Wenzhe Li
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Youshan Zhang
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Caixia Liang
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Jie Tan
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
| | - Ya Wang
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China; Department of Hubei Provincial Clinical Research Center for Personalized Diagnosis and Treatment of Cancer, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
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2
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Jia Y, Zhang W, Basyal M, Chang KH, Ostermann L, Burks JK, Ly C, Mu-Mosley H, Zhang Q, Han X, Fogler WE, Magnani JL, Lesegretain A, Zal AA, Zal T, Andreeff M. FLT3 inhibitors upregulate CXCR4 and E-selectin ligands via ERK suppression in AML cells and CXCR4/E-selectin inhibition enhances anti-leukemia efficacy of FLT3-targeted therapy in AML. Leukemia 2023:10.1038/s41375-023-01897-x. [PMID: 37085610 DOI: 10.1038/s41375-023-01897-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Yannan Jia
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Blood Diseases Hospital & Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Weiguo Zhang
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mahesh Basyal
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyung Hee Chang
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Ostermann
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jared K Burks
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charlie Ly
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hong Mu-Mosley
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qi Zhang
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Han
- Department of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Anna A Zal
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tomasz Zal
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Andreeff
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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3
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Real world molecular characterisation and clonal evolution of acute myeloid leukaemia reveals therapeutic opportunities and challenges. Pathology 2023; 55:64-70. [PMID: 36357248 DOI: 10.1016/j.pathol.2022.07.019] [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: 05/10/2022] [Revised: 07/16/2022] [Accepted: 07/28/2022] [Indexed: 11/06/2022]
Abstract
Acute myeloid leukaemia (AML) is an aggressive haematological malignancy with poor prognosis. Increasing understanding of the molecular mechanisms driving clonal proliferation has resulted in advancements in classification and available therapeutic targets. Fms-related tyrosine kinase 3 (FLT3) mutations are prognostically important and offer options for targeted inhibition, however they are not stable and can emerge or disappear at relapse. Our aim was to review diagnostic testing of consecutive cases of newly diagnosed and relapsed AML reported across Queensland in comparison to available literature. We conducted a retrospective review of 1531 samples from 1231 patients to identify patterns of molecular testing and AML subtypes in our cohort. Outcomes included World Health Organization (WHO) classification, European LeukaemiaNet (ELN) risk category and rates of missed FLT3 mutation testing. Patients aged <60 years had significantly more favourable risk AML (48% vs 25%, p<0.01), with favourable risk chromosomal translocations [t(8;21) and inv(16)] being more common. Thirteen patients (1%) did not have FLT3 mutation testing at diagnosis, with 103 relapse samples (39%) not being tested. Eighteen patients (10%) had FLT3 mutations lost at relapse, with five patients (3%) developing new FLT3 mutations at relapse. This study identifies the subtypes and risk stratification of a large cohort of AML patients over an extended period. The relatively high rate of absent FLT3 mutation testing at relapse as well as FLT3 loss or gain highlights the potential missed opportunities for salvage treatment strategies.
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4
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Yilmaz M, Kantarjian H, Short NJ, Reville P, Konopleva M, Kadia T, DiNardo C, Borthakur G, Pemmaraju N, Maiti A, Jabbour E, Jain N, Issa G, Takahashi K, Sasaki K, Ohanian M, Pierce S, Tang G, Loghavi S, Patel K, Wang SA, Garcia-Manero G, Andreeff M, Ravandi F, Daver N. Hypomethylating agent and venetoclax with FLT3 inhibitor "triplet" therapy in older/unfit patients with FLT3 mutated AML. Blood Cancer J 2022; 12:77. [PMID: 35501304 PMCID: PMC9061716 DOI: 10.1038/s41408-022-00670-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 01/12/2023] Open
Abstract
In older/unfit newly diagnosed patients with FLT3 mutated acute myeloid leukemia (AML), lower intensity chemotherapy (LIC) in combination with either a FLT3 inhibitor or with venetoclax results in poor overall survival (median 8 to 12.5 months). We performed a retrospective analysis of 87 newly diagnosed FLT3 mutated AML patients treated on triplet (LIC + FLT3 inhibitor + Venetoclax, [N = 27]) and doublet (LIC + FLT3 inhibitor, [N = 60]) regimens at our institution. Data were collected from prospective clinical trials in 75% (N = 65) and 25% (N = 22) who received the same treatment regimens outside of a clinical trial. Triplet therapy was associated with significantly higher rates of complete remission (CR) (67% versus 32%, P = 0.002), CR/CRi (93% versus 70%, P = 0.02), FLT3-PCR negativity (96% versus 54%, P < 0.01), and flow-cytometry negativity (83% versus 38%, P < 0.01) than doublets. At the end of the first cycle, the median time to ANC > 0.5 (40 versus 21 days, P = 0.15) and platelet > 50 K (29 versus 25 days, P = 0.6) among responders was numerically longer with triplets, but 60-day mortality was similar (7% v 10%). With a median follow-up of 24 months (median 12 months for triplet arm, and 63 months for doublet arm), patients receiving a triplet regimen had a longer median overall survival (not reached versus 9.5 months, P < 0.01). LIC combined with FLT3 inhibitor and venetoclax (triplet) may be an effective frontline regimen for older/unfit FLT3 mutated AML that should be further validated prospectively.
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Affiliation(s)
- Musa Yilmaz
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Hagop Kantarjian
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nicholas J. Short
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Patrick Reville
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Marina Konopleva
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Tapan Kadia
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Courtney DiNardo
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Gautam Borthakur
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Naveen Pemmaraju
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Abhishek Maiti
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Elias Jabbour
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nitin Jain
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ghayas Issa
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Koichi Takahashi
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Koji Sasaki
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Maro Ohanian
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sherry Pierce
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Guillin Tang
- grid.240145.60000 0001 2291 4776Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sanam Loghavi
- grid.240145.60000 0001 2291 4776Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Keyur Patel
- grid.240145.60000 0001 2291 4776Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sa A. Wang
- grid.240145.60000 0001 2291 4776Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Guillermo Garcia-Manero
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Michael Andreeff
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Farhad Ravandi
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Naval Daver
- grid.240145.60000 0001 2291 4776Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
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5
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Dillon R, Potter N, Freeman S, Russell N. How we use molecular minimal residual disease (MRD) testing in acute myeloid leukaemia (AML). Br J Haematol 2021; 193:231-244. [PMID: 33058194 DOI: 10.1111/bjh.17185] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In recent years there have been major advances in the use of molecular diagnostic and monitoring techniques for patients with acute myeloid leukaemia (AML). Coupled with the simultaneous explosion of new therapeutic agents, this has sown the seeds for significant improvements to treatment algorithms. Here we show, using a selection of real-life examples, how molecular monitoring can be used to refine clinical decision-making and to personalise treatment in patients with AML with nucleophosmin (NPM1) mutations, core binding factor translocations and other fusion genes. For each case we review the established evidence base and provide practical recommendations where evidence is lacking or conflicting. Finally, we review important technical considerations that clinicians should be aware of in order to safely exploit these technologies as they undergo widespread implementation.
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Affiliation(s)
- Richard Dillon
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College, London, UK
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Nicola Potter
- Cancer Genetics Laboratory, Department of Medical and Molecular Genetics, King's College, London, UK
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nigel Russell
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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6
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Voso MT, Ottone T, Lavorgna S, Venditti A, Maurillo L, Lo-Coco F, Buccisano F. MRD in AML: The Role of New Techniques. Front Oncol 2019; 9:655. [PMID: 31396481 PMCID: PMC6664148 DOI: 10.3389/fonc.2019.00655] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022] Open
Abstract
In the context of precision medicine, assessment of minimal residual disease (MRD) has been used in acute myeloid leukemia (AML) to direct individual treatment programs, including allogeneic stem cell transplantation in patients at high-risk of relapse. One of the limits of this approach has been in the past the paucity of AML markers suitable for MRD assessment. Recently, the number of biomarkers has increased, due to the identification of highly specific leukemia-associated immunophenotypes by multicolor flow-cytometry, and of rare mutated gene sequences by digital droplet PCR, or next-generation sequencing (NGS). In addition, NGS allowed unraveling of clonal heterogeneity, present in AML at initial diagnosis or developing during treatment, which influences reliability of specific biomarkers, that may be unstable during the disease course. The technological advances have increased the application of MRD-based strategies to a significantly higher number of AML patients, and the information deriving from MRD assessment has been used to design individual post-remission protocols and pre-emptive treatments in patients with sub-clinical relapse. This led to the definition of MRD-negative complete remission as outcome definition in the recently published European Leukemianet MRD guidelines. In this review, we summarized the principles of modern technologies and their clinical applications for MRD detection in AML patients, according to the specific leukemic markers.
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Affiliation(s)
- Maria Teresa Voso
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
- Santa Lucia Foundation, IRCCS, Neuro-Oncohematology, Rome, Italy
| | - Tiziana Ottone
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
- Santa Lucia Foundation, IRCCS, Neuro-Oncohematology, Rome, Italy
| | - Serena Lavorgna
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Adriano Venditti
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Luca Maurillo
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Francesco Buccisano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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7
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A next-generation sequencing-based assay for minimal residual disease assessment in AML patients with FLT3-ITD mutations. Blood Adv 2019; 2:825-831. [PMID: 29643105 DOI: 10.1182/bloodadvances.2018015925] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022] Open
Abstract
Internal tandem duplications in fms-like tyrosine kinase 3 (FLT3-ITDs) are common in acute myeloid leukemia (AML) and confer a poor prognosis. A sensitive and specific assay for the detection of minimal residual disease (MRD) in FLT3-ITD mutated AML could guide therapy decisions. Existing assays for MRD in FLT3-ITD AML have not been particularly useful because of limited sensitivity. We developed a sensitive and specific MRD assay for FLT3-ITD mutations using next-generation sequencing. The initial validation of this assay was performed by spiking fixed amounts of mutant DNA into wild-type DNA to establish a sensitivity of detection equivalent to ≥1 FLT3-ITD-containing cell in 10 000, with a minimum input of 100 000 cell equivalents of DNA. We subsequently validated the assay in bone marrow samples from patients with FLT3-ITD AML in remission. Finally, we analyzed bone marrow samples from 80 patients with FLT3-ITD relapsed/refractory AML participating in a trial of a novel FLT3 inhibitor, gilteritinib, and demonstrated a relationship between the mutation burden, as detected by the assay, and overall survival. This novel MRD assay is specific and 2 orders of magnitude more sensitive than currently available polymerase chain reaction- or next-generation sequencing-based FLT3-ITD assays. The assay is being prospectively validated in ongoing randomized clinical trials.
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8
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Zhang W, Ly C, Ishizawa J, Mu H, Ruvolo V, Shacham S, Daver N, Andreeff M. Combinatorial targeting of XPO1 and FLT3 exerts synergistic anti-leukemia effects through induction of differentiation and apoptosis in FLT3-mutated acute myeloid leukemias: from concept to clinical trial. Haematologica 2018; 103:1642-1653. [PMID: 29773601 PMCID: PMC6165819 DOI: 10.3324/haematol.2017.185082] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/16/2018] [Indexed: 01/01/2023] Open
Abstract
Targeted therapies against FLT3-mutated acute myeloid leukemias have shown limited clinical efficacy primarily because of the acquisition of secondary mutations in FLT3 and persistent activation of downstream pro-survival pathways such as MEK/ERK, PI3K/AKT, and STAT5. Activation of these additional kinases may also result in phosphorylation of tumor suppressor proteins promoting their nuclear export. Thus, co-targeting nuclear export proteins (e.g., XPO1) and FLT3 concomitantly may be therapeutically effective. Here we report on the combinatorial inhibition of XPO1 using selinexor and FLT3 using sorafenib. Selinexor exerted marked cell killing of human and murine FLT3-mutant acute myeloid leukemia cells, including those harboring internal tandem duplication and/or tyrosine kinase domain point mutations. Interestingly, selinexor treatment of murine FLT3-mutant acute myeloid leukemia cells activated FLT3 and its downstream MAPK or AKT signaling pathways. When combined with sorafenib, selinexor triggered marked synergistic pro-apoptotic effects. This was preceded by elevated nuclear levels of ERK, AKT, NFκB, and FOXO3a. Five days of in vitro combination treatment using low doses (i.e., 5 to 10 nM) of each agent promoted early myeloid differentiation of MOLM13 and MOLM14 cells without noticeable cell killing. The combinatorial therapy demonstrated profound in vivo anti-leukemia efficacy in a human FLT3-mutated xenograft model. In an ongoing phase IB clinical trial the selinexor/sorafenib combination induced complete/partial remissions in six of 14 patients with refractory acute myeloid leukemia, who had received a median of three prior therapies (ClinicalTrials.gov: NCT02530476). These results provide pre-clinical and clinical evidence for an effective combinatorial treatment strategy targeting XPO1 and FLT3 in FLT3- mutated acute myeloid leukemias.
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MESH Headings
- Animals
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Apoptosis/drug effects
- Apoptosis/genetics
- Cell Line, Tumor
- Dose-Response Relationship, Drug
- Female
- Humans
- Hydrazines/pharmacology
- Karyopherins/antagonists & inhibitors
- Karyopherins/genetics
- Karyopherins/metabolism
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Male
- Mice
- Mutation
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/metabolism
- Sorafenib/pharmacology
- Triazoles/pharmacology
- fms-Like Tyrosine Kinase 3/antagonists & inhibitors
- fms-Like Tyrosine Kinase 3/genetics
- fms-Like Tyrosine Kinase 3/metabolism
- Exportin 1 Protein
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Affiliation(s)
- Weiguo Zhang
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charlie Ly
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jo Ishizawa
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hong Mu
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivian Ruvolo
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Andreeff
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Sexauer AN, Tasian SK. Targeting FLT3 Signaling in Childhood Acute Myeloid Leukemia. Front Pediatr 2017; 5:248. [PMID: 29209600 PMCID: PMC5702014 DOI: 10.3389/fped.2017.00248] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/06/2017] [Indexed: 11/13/2022] Open
Abstract
Acute myeloid leukemia (AML) is the second most common leukemia of childhood and is associated with high rates of chemotherapy resistance and relapse. Clinical outcomes for children with AML treated with maximally intensive multi-agent chemotherapy lag far behind those of children with the more common acute lymphoblastic leukemia, demonstrating continued need for new therapeutic approaches to decrease relapse risk and improve long-term survival. Mutations in the FMS-like tyrosine kinase-3 receptor gene (FLT3) occur in approximately 25% of children and adults with AML and are associated with particularly poor prognoses. Identification and development of targeted FLT3 inhibitors represents a major precision medicine paradigm shift in the treatment of patients with AML. While further development of many first-generation FLT3 inhibitors was hampered by limited potency and significant toxicity due to effects upon other kinases, the more selective second- and third-generation FLT3 inhibitors have demonstrated excellent tolerability and remarkable efficacy in the relapsed/refractory and now de novo FLT3-mutated AML settings. While these newest and most promising inhibitors have largely been studied in the adult population, pediatric investigation of FLT3 inhibitors with chemotherapy is relatively recently ongoing or planned. Successful development of FLT3 inhibitor-based therapies will be essential to improve outcomes in children with this high-risk subtype of AML.
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Affiliation(s)
- Amy N Sexauer
- Dana-Farber Cancer Institute, Boston, MA, United States.,Boston Children's Hospital, Department of Pediatrics, Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Boston, MA, United States
| | - Sarah K Tasian
- Children's Hospital of Philadelphia, Division of Oncology, Center for Childhood Cancer Research, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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10
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Zhang W, Borthakur G, Gao C, Chen Y, Mu H, Ruvolo VR, Nomoto K, Zhao N, Konopleva M, Andreeff M. The Dual MEK/FLT3 Inhibitor E6201 Exerts Cytotoxic Activity against Acute Myeloid Leukemia Cells Harboring Resistance-Conferring FLT3 Mutations. Cancer Res 2016; 76:1528-37. [PMID: 26822154 DOI: 10.1158/0008-5472.can-15-1580] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023]
Abstract
Fms-like tyrosine kinase 3 (FLT3) inhibition has elicited encouraging responses in acute myeloid leukemia (AML) therapy. Unfortunately, unless combined with a bone marrow transplant, disease relapse is frequent. In addition to the acquired point mutations in the FLT3 kinase domain that contribute to FLT3 inhibitor resistance, MEK/ERK signaling is persistently activated in AML cells even when FLT3 phosphorylation is continually suppressed. Thus, concomitant targeting of FLT3 and MAPK may potentially exert synergistic activity to counteract the resistance of AML cells to FLT3-targeted therapy. In this study, we investigated the antileukemia activity of a MEK1 and FLT3 dual inhibitor, E6201, in AML cells resistant to FLT3 inhibition. We found that E6201 exerted profound apoptogenic effects on AML cells harboring resistance-conferring FLT3 mutations. This activity appeared to be p53 dependent, and E6201-induced cytotoxicity was retained under hypoxic culture conditions and during coculture with mesenchymal stem cells that mimic the AML microenvironment. Furthermore, E6201 markedly reduced leukemia burden and improved the survival of mice in a human FLT3-mutated AML model. Collectively, our data provide a preclinical basis for the clinical evaluation of E6201 in AML patients harboring FLT3 mutations, including those who relapse following FLT3-targeted monotherapy.
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Affiliation(s)
- Weiguo Zhang
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Gautam Borthakur
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Chen Gao
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Ye Chen
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Hong Mu
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Vivian R Ruvolo
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas
| | | | | | - Marina Konopleva
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Michael Andreeff
- Section of Molecular Hematology and Therapy, The University of Texas MD Anderson Cancer Center, Houston Texas. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston Texas.
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11
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Abstract
OBJECTIVES This session of the 2013 Society of Hematopathology/European Association for Haematopathology workshop focused on extramedullary manifestations of myeloid neoplasms. METHODS We divided the submitted cases into four subgroups: (1) isolated myeloid sarcoma (MS); (2) MS with concurrent acute myeloid leukemia (AML), with a focus on karyotypic and molecular findings; (3) extramedullary relapse of AML, including relapse in the posttransplant setting; and (4) blast phase/transformation of a myeloproliferative neoplasm or chronic myelomonocytic leukemia. RESULTS Establishing a diagnosis of isolated MS requires a high index of suspicion and use of immunophenotypic methods. Recurrent cytogenetic abnormalities or gene mutations that occur in MS mirror those known to occur in AML. CONCLUSIONS In the era of targeted therapy and sophisticated risk stratification, every attempt must be made to perform a complete workup on MS cases (or concurrent AML) since the diagnosis of MS, in itself, is no longer adequate for patient management. Cases of blastic plasmacytoid dendritic cell neoplasm were also included and discussed in this session.
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Affiliation(s)
- Carla S. Wilson
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque
| | - L. Jeffrey Medeiros
- The Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston
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12
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Hsu AL, Kondrashova O, Lunke S, Love CJ, Meldrum C, Marquis-Nicholson R, Corboy G, Pham K, Wakefield M, Waring PM, Taylor GR. AmpliVar: mutation detection in high-throughput sequence from amplicon-based libraries. Hum Mutat 2015; 36:411-8. [PMID: 25664426 DOI: 10.1002/humu.22763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/21/2015] [Indexed: 12/30/2022]
Abstract
Conventional means of identifying variants in high-throughput sequencing align each read against a reference sequence, and then call variants at each position. Here, we demonstrate an orthogonal means of identifying sequence variation by grouping the reads as amplicons prior to any alignment. We used AmpliVar to make key-value hashes of sequence reads and group reads as individual amplicons using a table of flanking sequences. Low-abundance reads were removed according to a selectable threshold, and reads above this threshold were aligned as groups, rather than as individual reads, permitting the use of sensitive alignment tools. We show that this approach is more sensitive, more specific, and more computationally efficient than comparable methods for the analysis of amplicon-based high-throughput sequencing data. The method can be extended to enable alignment-free confirmation of variants seen in hybridization capture target-enrichment data.
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Affiliation(s)
- Arthur L Hsu
- Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
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13
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Falk IJ, Fyrberg A, Paul E, Nahi H, Hermanson M, Rosenquist R, Höglund M, Palmqvist L, Stockelberg D, Wei Y, Gréen H, Lotfi K. Decreased survival in normal karyotype AML with single-nucleotide polymorphisms in genes encoding the AraC metabolizing enzymes cytidine deaminase and 5'-nucleotidase. Am J Hematol 2013; 88:1001-6. [PMID: 23873772 DOI: 10.1002/ajh.23549] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/09/2022]
Abstract
De novo acute myeloid leukemia with normal karyotype (NK-AML) comprises a large group of patients with no common cytogenetic alterations and with a large variation in treatment response. Single-nucleotide polymorphisms (SNPs) in genes related to the metabolism of the nucleoside analogue AraC, the backbone in AML treatment, might affect drug sensitivity and treatment outcome. Therefore, SNPs may serve as prognostic biomarkers aiding clinicians in individualized treatment decisions, with the aim of improving patient outcomes. We analyzed polymorphisms in genes encoding cytidine deaminase (CDA 79A>C rs2072671 and -451C>T rs532545), 5'-nucleotidase (cN-II 7A>G rs10883841), and deoxycytidine kinase (DCK 3'UTR 948T>C rs4643786) in 205 de novo NK-AML patients. In FLT3-internal tandem duplication (ITD)-positive patients, the CDA 79C/C and -451T/T genotypes were associated with shorter overall survival compared to other genotypes (5 vs. 24 months, P < 0.001 and 5 vs. 23 months, P = 0.015, respectively), and this was most pronounced in FLT3-ITD-positive/NPM1-positive patients. We observed altered in vitro sensitivity to topoisomerase inhibitory drugs, but not to nucleoside analogues, and a decrease in global DNA methylation in cells carrying both CDA variant alleles. A shorter survival was also observed for the cN-II variant allele, but only in FLT3-ITD-negative patients (25 vs. 31 months, P = 0.075). Our results indicate that polymorphisms in genes related to nucleoside analog drug metabolism may serve as prognostic markers in de novo NK-AML.
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Affiliation(s)
- Ingrid Jakobsen Falk
- Clinical Pharmacology, Department of Medical and Health Sciences, Faculty of Health SciencesLinköping UniversityLinköping Sweden
| | - Anna Fyrberg
- Faculty of Health Sciences, Centre for Biomedical ResourcesLinköping UniversityLinköping Sweden
| | - Esbjörn Paul
- Department of Medicine Division of HematologyKarolinska InstitutetHuddinge Stockholm Sweden
| | - Hareth Nahi
- Department of Medicine Division of HematologyKarolinska InstitutetHuddinge Stockholm Sweden
| | - Monica Hermanson
- Department of Immunology, Genetics and Pathology, Rudbeck LaboratoryUppsala UniversityUppsala Sweden
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Rudbeck LaboratoryUppsala UniversityUppsala Sweden
| | - Martin Höglund
- Division of Hematology Department of Medical SciencesUppsala UniversityUppsala Sweden
| | - Lars Palmqvist
- Department of Clinical Chemistry and Transfusion MedicineInstitute of BiomedicineUniversity of GothenburgGothenburg Sweden
| | - Dick Stockelberg
- Department of internal medicine, Section for Hematology and CoagulationSahlgrenska University HospitalGothenburg Sweden
| | - Yuan Wei
- Department of internal medicine, Section for Hematology and CoagulationSahlgrenska University HospitalGothenburg Sweden
| | - Henrik Gréen
- Clinical Pharmacology, Department of Medical and Health Sciences, Faculty of Health SciencesLinköping UniversityLinköping Sweden
- Science for Life LaboratoryKTH Royal Institute of TechnologySchool of BiotechnologySolna Sweden
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic MedicineLinköping Sweden
| | - Kourosh Lotfi
- Clinical Pharmacology, Department of Medical and Health Sciences, Faculty of Health SciencesLinköping UniversityLinköping Sweden
- Department of HematologyLinköping University HospitalLinköping Sweden
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14
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FLT3/D835Y mutation knock-in mice display less aggressive disease compared with FLT3/internal tandem duplication (ITD) mice. Proc Natl Acad Sci U S A 2013; 110:21113-8. [PMID: 24255108 DOI: 10.1073/pnas.1310559110] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
FMS-like tyrosine kinase 3 (FLT3) is mutated in approximately one third of acute myeloid leukemia cases. The most common FLT3 mutations in acute myeloid leukemia are internal tandem duplication (ITD) mutations in the juxtamembrane domain (23%) and point mutations in the tyrosine kinase domain (10%). The mutation substituting the aspartic acid at position 838 (equivalent to the human aspartic acid residue at position 835) with a tyrosine (referred to as FLT3/D835Y hereafter) is the most frequent kinase domain mutation, converting aspartic acid to tyrosine. Although both of these mutations constitutively activate FLT3, patients with an ITD mutation have a significantly poorer prognosis. To elucidate the mechanisms behind this prognostic difference, we have generated a knock-in mouse model with a D838Y point mutation in FLT3 that corresponds to the FLT3/D835Y mutation described in humans. Compared with FLT3/ITD knock-in mice, the FLT3/D835Y knock-in mice survive significantly longer. The majority of these mice develop myeloproliferative neoplasms with a less-aggressive phenotype. In addition, FLT3/D835Y mice have distinct hematopoietic development patterns. Unlike the tremendous depletion of the hematopoietic stem cell compartment we have observed in FLT3/ITD mice, FLT3/D835Y mutant mice are not depleted in hematopoietic stem cells. Further comparisons of these FLT3/D835Y knock-in mice with FLT3/ITD mice should provide an ideal platform for dissecting the molecular mechanisms that underlie the prognostic differences between the two different types of FLT3 mutations.
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15
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Heidary DK, Huang G, Boucher D, Ma J, Forster C, Grey R, Xu J, Arnost M, Choquette D, Chen G, Zhou JH, Yao YM, Ball ED, Namchuk M, Davies RJ, Henkel G. VX-322: A Novel Dual Receptor Tyrosine Kinase Inhibitor for the Treatment of Acute Myelogenous Leukemia. J Med Chem 2012; 55:725-34. [DOI: 10.1021/jm201198w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David K. Heidary
- University of Kentucky, Department of
Chemistry, Lexington Kentucky 40506, United States
| | - George Huang
- Vertex Pharmaceutical Incorporated, 11010 Torreyana Road, San Diego, California 92121, United States
| | - Diane Boucher
- Vertex Pharmaceuticals Incorporated, 130 Waverly Street, Cambridge, Massachusetts
02139, United States
| | - Jianguo Ma
- EMD Serono Research Institute, 45A Middlesex Turnpike,
Billerica, Massachusetts 01821, United States
| | - Cornelia Forster
- Novartis IBMR, 250 Massachusetts
Avenue, Cambridge, Massachusetts 02139, United States
| | - Ron Grey
- Vertex Pharmaceuticals Incorporated, 130 Waverly Street, Cambridge, Massachusetts
02139, United States
| | - Jinwang Xu
- Vertex Pharmaceuticals Incorporated, 130 Waverly Street, Cambridge, Massachusetts
02139, United States
| | - Michael Arnost
- Vertex Pharmaceuticals Incorporated, 130 Waverly Street, Cambridge, Massachusetts
02139, United States
| | - Deborah Choquette
- Amgen, 1 Kendall Square,
Cambridge, Massachusetts 02139, United States
| | - Guanjing Chen
- Novartis IBMR, 250 Massachusetts
Avenue, Cambridge, Massachusetts 02139, United States
| | - Jie-Hua Zhou
- Amgen, 1 Kendall Square,
Cambridge, Massachusetts 02139, United States
| | - Yung-Mae Yao
- Novartis IBMR, 250 Massachusetts
Avenue, Cambridge, Massachusetts 02139, United States
| | - Edward D. Ball
- Division of Blood and Marrow Transplantation,
Department of Medicine and the Moores UCSD Cancer Center, University of California San Diego, La Jolla, California
92093-0960, United States
| | - Mark Namchuk
- Vertex Pharmaceuticals Incorporated, 130 Waverly Street, Cambridge, Massachusetts
02139, United States
| | - Robert J. Davies
- Vertex Pharmaceuticals Incorporated, 130 Waverly Street, Cambridge, Massachusetts
02139, United States
| | - Greg Henkel
- Arisan Therapeutics, 21512 Canaria, Mission
Viejo, California 92692, United States
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16
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Davies RJ, Pierce AC, Forster C, Grey R, Xu J, Arnost M, Choquette D, Galullo V, Tian SK, Henkel G, Chen G, Heidary DK, Ma J, Stuver-Moody C, Namchuk M. Design, Synthesis, and Evaluation of a Novel Dual Fms-Like Tyrosine Kinase 3/Stem Cell Factor Receptor (FLT3/c-KIT) Inhibitor for the Treatment of Acute Myelogenous Leukemia. J Med Chem 2011; 54:7184-92. [DOI: 10.1021/jm200712h] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Robert J. Davies
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Albert C. Pierce
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Cornelia Forster
- Novartis IBMR, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Ron Grey
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Jinwang Xu
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Michael Arnost
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Deborah Choquette
- Amgen, 1 Kendall Square, Cambridge, Massachusetts 02139, United States
| | - Vincent Galullo
- Astra Zeneca R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Shi-Kai Tian
- University of Science & Technology of China, Hefei, Anhui 230026, China
| | - Greg Henkel
- Arisan Therapeutics, 21512 Canaria, Mission Viejo, California 92692, United States
| | - Guanjing Chen
- Novartis IBMR, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - David K. Heidary
- University of Kentucky, Lexington, Kentucky 40506, United States
| | - Joanne Ma
- Merck West Point, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Cameron Stuver-Moody
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Mark Namchuk
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
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17
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William AD, Lee ACH, Blanchard S, Poulsen A, Teo EL, Nagaraj H, Tan E, Chen D, Williams M, Sun ET, Goh KC, Ong WC, Goh SK, Hart S, Jayaraman R, Pasha MK, Ethirajulu K, Wood JM, Dymock BW. Discovery of the macrocycle 11-(2-pyrrolidin-1-yl-ethoxy)-14,19-dioxa-5,7,26-triaza-tetracyclo[19.3.1.1(2,6).1(8,12)]heptacosa-1(25),2(26),3,5,8,10,12(27),16,21,23-decaene (SB1518), a potent Janus kinase 2/fms-like tyrosine kinase-3 (JAK2/FLT3) inhibitor for the treatment of myelofibrosis and lymphoma. J Med Chem 2011; 54:4638-58. [PMID: 21604762 DOI: 10.1021/jm200326p] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Discovery of the activating mutation V617F in Janus Kinase 2 (JAK2(V617F)), a tyrosine kinase critically involved in receptor signaling, recently ignited interest in JAK2 inhibitor therapy as a treatment for myelofibrosis (MF). Herein, we describe the design and synthesis of a series of small molecule 4-aryl-2-aminopyrimidine macrocycles and their biological evaluation against the JAK family of kinase enzymes and FLT3. The most promising leads were assessed for their in vitro ADME properties culminating in the discovery of 21c, a potent JAK2 (IC(50) = 23 and 19 nM for JAK2(WT) and JAK2(V617F), respectively) and FLT3 (IC(50) = 22 nM) inhibitor with selectivity against JAK1 and JAK3 (IC(50) = 1280 and 520 nM, respectively). Further profiling of 21c in preclinical species and mouse xenograft and allograft models is described. Compound 21c (SB1518) was selected as a development candidate and progressed into clinical trials where it is currently in phase 2 for MF and lymphoma.
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Affiliation(s)
- Anthony D William
- S*BIO Pte. Ltd., The Capricorn, Singapore Science Park II, Singapore.
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18
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JAK2-V617F mutation in patients with myeloproliferative neoplasms: Association with FLT3-ITD mutation. SRP ARK CELOK LEK 2010; 138:614-8. [DOI: 10.2298/sarh1010614s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. An acquired somatic mutation V617F in Janus kinase 2 gene
(JAK2) is the cause of uncontrolled proliferation in patients with
myeloproliferative neoplasms. It is known that uncontrolled myeloid cell
proliferation is also provoked by alteration in other genes, e.g. mutations
in receptor tyrosine kinase FLT3 gene. FLT3 represents the most frequently
mutated gene in acute myeloid leukaemia. Interestingly, mutated FLT3- ITD
(internal tandem duplication) protein is a member of the same signalling
pathway as JAK2 protein, the STAT5 signalling pathway. STAT5 activation is
recognized as important for selfrenewal of haematopoetic stem cells.
Objective. The aim of this study was the detection of JAK2- V617F mutation in
patients with myeloproliferative neoplasms. Additionally, we investigated the
presence of FLT3-ITD mutation in JAK2-V617F-positive patients in order to
shed the light on the hypothesis of a similar role of these two molecular
markers in haematological malignancies. Methods. Using allele-specific PCR,
61 patients with known or suspected diagnosis of myeloproliferative neoplasms
were tested for the presence of JAK2-V617F mutation. Samples that were
positive for JAK2 mutation were subsequently tested for the presence of
FLT3-ITD mutation by PCR. Results. Eighteen of 61 analysed patients were
positive for JAK2-V617F mutation. Among them, 8/18 samples were diagnosed as
polycythaemia vera, and 10/18 as essential thrombocythaemia. None of
JAK2-V617F-positive patient was positive for FLT3-ITD mutation. Conclusion.
This study suggests that one activating mutation is sufficient for aberrant
cell proliferation leading to malignant transformation of haematopoetic stem
cell.
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19
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Lee JY, Joo YD, Oh SH, Shin JH, Kim HR, Lee SM, Lee JN. Prognostic Significance of FLT3 Internal Tandem Duplication in Acute Myeloid Leukemia with Normal Karyotype. THE KOREAN JOURNAL OF HEMATOLOGY 2009. [DOI: 10.5045/kjh.2009.44.2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ja Young Lee
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - Young Don Joo
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Seung Hwan Oh
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
- Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Korea
| | - Hye Ran Kim
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - Sang Min Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jeong Nyeo Lee
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
- Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Korea
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20
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Kasper S, Breitenbuecher F, Hoehn Y, Heidel F, Lipka DB, Markova B, Huber C, Kindler T, Fischer T. The kinase inhibitor LS104 induces apoptosis, enhances cytotoxic effects of chemotherapeutic drugs and is targeting the receptor tyrosine kinase FLT3 in acute myeloid leukemia. Leuk Res 2008; 32:1698-708. [DOI: 10.1016/j.leukres.2008.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 04/29/2008] [Accepted: 05/03/2008] [Indexed: 02/01/2023]
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21
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Abstract
Constitutional (hereditary) genetic variation and somatic genetic alterations acquired during transformation to the neoplastic phenotype are both critical determinants of cancer outcome, and can ultimately have a significant effect on cancer survivorship. This article discusses the role of constitutional and somatic genetics in determining outcome and survivorship following a diagnosis of cancer using illustrative examples primarily from the hematologic malignancies.
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Affiliation(s)
- James M Allan
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
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22
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Lipka D, Heidel F, Huber C, Fischer T. [Development of tyrosine kinase inhibitors for hematologic neoplasms. FLT3 and JAK2 as therapeutic targets]. PHARMAZIE IN UNSERER ZEIT 2008; 37:394-403. [PMID: 18729264 DOI: 10.1002/pauz.200800280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Daniel Lipka
- Medizinstudium an der Ruprecht-Karls-Universität Heidelberg
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23
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Abou-Jawde RM, Sobecks R, Pohlman B, Rybicki L, Advani A, Sekeres M, Kalaycio M. The role of post-remission chemotherapy for older patients with acute myelogenous leukemia. Leuk Lymphoma 2007; 47:689-95. [PMID: 16690528 DOI: 10.1080/10428190500353554] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Standard practice in older patients with acute myeloid leukemia (AML) is induction chemotherapy (ICT) followed by post-remission chemotherapy (PRT). We previously reported a median disease-free survival (DFS) and overall survival (OS) for patients in complete remission (CR) of 7.5 and 13.5 months, respectively, in 30 older patients treated with standard ICT and PRT (study A). We designed a subsequent trial excluding PRT (study B). Forty patients with AML age > or =60 years were treated with ICT consisting of standard dose cytosine arabinoside and mitoxantrone followed with granulocyte-macrophage colony-stimulating factor subcutaneously starting day 11 if the bone marrow aspirate and biopsy was hypocellular. Median age was 68 years. Myelodysplasia preceded AML in 37% of patients. Favourable, normal, and unfavourable karyotypes were seen in 7.5%, 55%, and 37.5% of patients, respectively. Twenty-one patients (52.5%) achieved CR. Median DFS and OS for patients in CR were 6.2 and 10.8 months, respectively. Study A and B differed by the addition of PRT in study A. However, DFS and OS did not differ significantly between patients treated in study A or study B (P = 0.21 and P = 0.15, respectively). PRT has not clearly improved survival in older patients with AML, and therefore the routine addition of chemotherapy to older patients in complete remission is not indicated.
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Affiliation(s)
- Rony M Abou-Jawde
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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24
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Colovic N, Tosic N, Aveic S, Djuric M, Milic N, Bumbasirevic V, Colovic M, Pavlovic S. Importance of early detection and follow-up of FLT3 mutations in patients with acute myeloid leukemia. Ann Hematol 2007; 86:741-7. [PMID: 17579862 DOI: 10.1007/s00277-007-0325-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 05/28/2007] [Indexed: 11/24/2022]
Abstract
Mutations in the fms-like tyrosine kinase 3 (FLT3) gene, such as internal tandem duplication (FLT3/ITD) in the juxtamembrane domain and point mutations in the tyrosine kinase domain, are the most common abnormalities in acute myeloid leukemia (AML). FLT3/ITD and FLT3/D835 mutations were analyzed in 113 Serbian adult AML patients using polymerase chain reaction. Twenty patients were found to be FLT3/ITD positive (17.7%). The mutations occurred most frequently in M5 and M0 subtypes of AML. They were mainly associated with the normal karyotype. All patients harboring FLT3/ITD had a higher number of white blood cells than patients without it (p = 0.027). FLT3/ITD mutations were associated with lower complete remission (CR) rate (chi (2 )= 5.706; p = 0.017) and shorter overall survival (OS; Log rank = 8.76; p = 0.0031). As for disease-free survival, the difference between FLT3/ITD-positive and FLT3/ITD-negative patients was not statistically significant (Log rank = 0.78; p = 0.3764). In multivariate analysis, the presence of FLT3/ITD mutations was the most significant prognostic factor for both OS and CR rate (p = 0.0287; relative risk = 1.73; 95% CI = 1.06-2.82). However, in the group of patients with the intermediate-risk karyotype, the mere presence of FLT3/ITD was not associated with inferior clinical outcome. FLT3/D835 point mutation was found in four patients (3.5%) only. Follow-up of the FLT3/ITD-positive patients revealed stability of this mutation during the course of the disease. However, changes in the pattern of FLT3/D835 mutations in initial and relapsed AML were observed. Our results indicate an association of FLT3/ITD with the adverse outcome in AML patients treated with standard induction chemotherapy. Because FLT3/ITD mutation is a target for specific therapeutic inhibition, its early detection could be helpful in clinical practice.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Chromosome Aberrations
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Leukocyte Count
- Male
- Middle Aged
- Point Mutation
- Recurrence
- Risk Factors
- Stem Cell Transplantation
- Survival Rate
- Transplantation, Homologous
- Yugoslavia
- fms-Like Tyrosine Kinase 3/genetics
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Affiliation(s)
- Natasa Colovic
- Institute of Hematology, Clinical Center of Serbia, Belgrade, Serbia
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25
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Palmieri S, Ferrara F, Leoni F, Ciolli S, Pollio F, D'Amico MR, Celentano M, Viola A, Vicari L, Izzo B, Pane F. Myeloablative chemotherapy followed by autologous stem cell infusion may overcome the adverse prognostic impact of FLT3 (foetal liver tyrosine kinase 3) mutations in patients with acute myeloid leukaemia and normal karyotype. Hematol Oncol 2007; 25:1-5. [PMID: 17036374 DOI: 10.1002/hon.794] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we analysed the prognostic relevance of foetal liver tyrosine kinase 3 (FLT3) mutations in 73 patients with acute myeloid leukaemia (AML) with normal karyotype, who survived induction and consolidation and received autologous stem cell transplantation (ASCT) after successful mobilization of peripheral blood stem cell (PBSC). There were 44 males and 29 females with a median age of 54 years (range 20-77). Overall, 16 out of 73 autografted patients (22%) had FLT3 mutations. More in detail, FLT3/ITDs were detected in 10 out of 73 patients (14%), while FLT3 D835 mutations were detected in five cases (7%). One patient (1%) was found as having both abnormalities. White blood cell count (p=0.009), serum concentration of lactate dehydrogenase (p=0.01), and percentages of peripheral blood (p=0.002) and bone marrow blasts (p=0.03) were significantly higher in patients showing the FLT3 mutations. On the contrary, overall survival and disease-free survival were similar between patients with or without FLT3 mutations (p=0.73 and 0.78, respectively). In conclusion, our data suggest that myeloablative chemotherapy supported by auto-PBSCT may overcome the adverse prognostic implications of FLT3 mutations in AML. However, it is to consider that autografted patients are highly selected for best response to induction, consolidation and mobilization, as well as for minor non-haematologic toxicity.
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Affiliation(s)
- Salvatore Palmieri
- Division of Haematology and Stem cell Transplantation Unit, Cardarelli Hospital, Naples, Italy.
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Krug U, Serve H, Müller-Tidow C, Mesters RM, Steffen B, Büchner T, Berdel WE. New molecular therapy targets in acute myeloid leukemia. Recent Results Cancer Res 2007; 176:243-62. [PMID: 17607931 DOI: 10.1007/978-3-540-46091-6_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Despite improvements to acute myelogenous leukemia (AML) therapy during the last 25 years, the majority of patients still succumb to the disease. Thus, there remains an urgent need for further improvements in this field. The present chapter focuses on exciting areas of research in the field of AML therapy, including promising results with regards to recent improvements in our understanding of angiogenesis, tyrosine kinase signaling, farnesylation, cell cycling, modulation of gene expression, protein degradation, modulation of intracellular proteins, apoptosis, metabolism, and the possible retargeting of oncogenic proteins.
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Affiliation(s)
- Utz Krug
- Medizinische Klinik A, Universitätsklinikum Münster, Germany
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27
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Piloto O, Wright M, Brown P, Kim KT, Levis M, Small D. Prolonged exposure to FLT3 inhibitors leads to resistance via activation of parallel signaling pathways. Blood 2006; 109:1643-52. [PMID: 17047150 PMCID: PMC1794049 DOI: 10.1182/blood-2006-05-023804] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Continuous treatment of malignancies with tyrosine kinase inhibitors (TKIs) may select for resistant clones (ie, imatinib mesylate). To study resistance to TKIs targeting FLT3, a receptor tyrosine kinase that is frequently mutated in acute myelogenous leukemia (AML), we developed resistant human cell lines through prolonged coculture with FLT3 TKIs. FLT3 TKI-resistant cell lines and primary samples still exhibit inhibition of FLT3 phosphorylation on FLT3 TKI treatment. However, FLT3 TKI-resistant cell lines and primary samples often show continued activation of downstream PI3K/Akt and/or Ras/MEK/MAPK signaling pathways as well as continued expression of genes involved in FLT3-mediated cellular transformation. Inhibition of these signaling pathways restores partial sensitivity to FLT3 TKIs. Mutational screening of FLT3 TKI-resistant cell lines revealed activating N-Ras mutations in 2 cell lines that were not present in the parental FLT3 TKI-sensitive cell line. Taken together, these data indicate that FLT3 TKI-resistant cells most frequently become FLT3 independent because of activation of parallel signaling pathways that provide compensatory survival/proliferation signals when FLT3 is inhibited. Anti-FLT3 mAb treatment was still cytotoxic to FLT3 TKI-resistant clones. An approach combining FLT3 TKIs with anti-FLT3 antibodies and/or inhibitors of important pathways downstream of FLT3 may reduce the chances of developing resistance.
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Affiliation(s)
- Obdulio Piloto
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21202, USA
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28
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Platzbecker U, Thiede C, Füssel M, Geissler G, Illmer T, Mohr B, Hänel M, Mahlberg R, Krümpelmann U, Weissinger F, Schaich M, Theuser C, Ehninger G, Bornhäuser M. Reduced intensity conditioning allows for up-front allogeneic hematopoietic stem cell transplantation after cytoreductive induction therapy in newly-diagnosed high-risk acute myeloid leukemia. Leukemia 2006; 20:707-14. [PMID: 16482208 DOI: 10.1038/sj.leu.2404143] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is substantial need to improve the outcome of patients with high-risk acute myeloid leukemia (AML). The clinical trial reported here investigated a new approach of up-front allogeneic hematopoietic stem cell transplantation (HSCT), provided a median of 40 days (range 22-74) after diagnosis, in twenty-six consecutive patients with newly-diagnosed high-risk AML characterized by poor-risk cytogenetics (n = 19) or inadequate blast clearance by induction chemotherapy (IC, n = 7). The median age was 49 years (range 17-68). During IC-induced aplasia after the 1st (n = 11) or 2nd (n = 15) cycle, patients received allogeneic peripheral blood stem cells (PBSC) from related (n = 11) or unrelated (n = 15) donors following a fludarabine-based reduced-intensity regimen. Seventeen patients were not in remission before HSCT with a median marrow blast count of 34% (range 6-70). All patients achieved rapid engraftment and went into remission with complete myeloid and lymphatic chimerism. Grades II to IV acute GvHD occurred in 14 (56%) and extensive chronic GvHD was documented in 8 (35%) patients. The probability of disease-free survival was 61% with only three patients relapsing 5, 6 and 7 months after transplantation, respectively. Up-front allogeneic HSCT as part of primary induction therapy seems to be an effective strategy in high-risk AML patients and warrants further investigation.
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Affiliation(s)
- U Platzbecker
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
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29
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Ferrara F, Palmieri S, Pollio F, Lo Pardo C, Graziano D, Celentano M, D’Amico MR, Vicari L, Izzo B, Pane F. Presence of FLT3 Mutations Does Not Impair Stem Cell Mobilization and Feasibility of Autologous Peripheral Blood Stem Cell Transplantation in Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2006; 12:981-6. [DOI: 10.1016/j.bbmt.2006.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Accepted: 05/31/2006] [Indexed: 02/06/2023]
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30
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Cloos J, Goemans BF, Hess CJ, van Oostveen JW, Waisfisz Q, Corthals S, de Lange D, Boeckx N, Hählen K, Reinhardt D, Creutzig U, Schuurhuis GJ, Zwaan CM, Kaspers GJL. Stability and prognostic influence of FLT3 mutations in paired initial and relapsed AML samples. Leukemia 2006; 20:1217-20. [PMID: 16642044 DOI: 10.1038/sj.leu.2404246] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In acute myeloid leukemia (AML), activating mutations in the fms-like tyrosine kinase 3 (FLT3) gene predict poor prognosis. We determined FLT3 internal tandem duplications (FLT3/ITD) and D835 point mutations in paired initial and relapse samples from 80 pediatric and adult AML patients. One D835 point mutation was found in an initial pediatric AML sample. Fms-like tyrosine kinase 3/ITDs were present in 21 initial and 22 relapse samples (26.3 and 27.5%, respectively). Interestingly, FLT3/ITD positivity was related to a significantly shorter time to relapse, most pronounced when the ITD-positive status was found at relapse (P<0.001). However, FLT3/ITD status changed between diagnosis and relapse in 14 cases. In four patients, the FLT3/ITD became undetectable at relapse in five patients FLT3/ITDs were only detected at relapse, and in five patients the length or number of FLT3/ITDs changed. Gain of FLT3/ITDs may suggest oligoclonality with selective outgrowth of the FLT3/ITD-positive clone, whereas losses may reflect ITDs in the more mature leukemic cells rather than in the leukemic stem cell, or, alternatively, that other genetic aberrations provided a greater selective advantage. Studying FLT3/ITD kinetics in minimal residual disease setting may provide some answers for the changes we observed. Fms-like tyrosine kinase 3/ITD is a relevant marker for prognosis, and remains an important target for therapeutic inhibition.
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MESH Headings
- Adolescent
- Adult
- Female
- Genetic Markers
- Genetic Predisposition to Disease/epidemiology
- Humans
- Leukemia, Erythroblastic, Acute/genetics
- Leukemia, Megakaryoblastic, Acute/genetics
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Neoplasm, Residual/epidemiology
- Neoplasm, Residual/genetics
- Point Mutation
- Prognosis
- Recurrence
- Risk Factors
- Tandem Repeat Sequences
- fms-Like Tyrosine Kinase 3/genetics
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Affiliation(s)
- J Cloos
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands.
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31
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Strodtbeck D, Bornhäuser M, Hänel M, Lerche L, Schaich M, Illmer T, Thiede C, Geissler G, Herbst R, Ehninger G, Platzbecker U. Graft clonogenicity and intensity of pre-treatment: factors affecting outcome of autologous peripheral hematopoietic cell transplantation in patients with acute myeloid leukemia in first remission. Bone Marrow Transplant 2006; 36:1083-8. [PMID: 16247435 DOI: 10.1038/sj.bmt.1705176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A total of 22 patients with acute myeloid leukemia (AML) in first complete remission receiving autologous blood stem cell transplantation (ABSCT) were investigated in order to determine factors affecting outcome. All but two patients had a normal karyotype and received the same high-dose chemotherapy followed by G-CSF-mobilized peripheral blood stem cells after the second (n=5) or third (n=17) course of induction and post-remission chemotherapy, respectively. With a median follow-up of 30 months, the median disease-free survival is 24.1 months. Univariate analysis showed that three chemotherapy cycles before ABSCT were associated with a significant better disease-free survival (P=0.0018) and overall survival (P=0.0033), whereas the presence of an FLT3-mutation (n=6) showed no impact. The number of megakaryocytic progenitors (CFU-MK) infused tended to correlate with primary platelet engraftment (P=0.07) and were predictive for neutrophil (P=0.011) and platelet counts (P=0.009) 180 days after transplantation. Patients receiving a higher amount of CFU-MK had a better event-free survival (P=0.02). Our data suggest that the content of CFU-MK within the graft predicts the quality of hematological recovery and long-term disease control. Additionally, a minimum of three chemotherapy cycles before ABSCT seems to be associated with an improved outcome.
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Affiliation(s)
- D Strodtbeck
- Medizinische Klinik und Poliklinik I, Universitätsklinikum 'Carl Gustav Carus', Dresden, Germany
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32
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Schnittger S, Schoch C, Kern W, Mecucci C, Tschulik C, Martelli MF, Haferlach T, Hiddemann W, Falini B. Nucleophosmin gene mutations are predictors of favorable prognosis in acute myelogenous leukemia with a normal karyotype. Blood 2005; 106:3733-9. [PMID: 16076867 DOI: 10.1182/blood-2005-06-2248] [Citation(s) in RCA: 520] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nucleophosmin (NPM1) exon-12 gene mutations are the hallmark of a large acute myelogenous leukemia (AML) subgroup with normal karyotype, but their prognostic value in this AML subset has not yet been determined. We screened 401 AML patients with normal karyotype treated within the German AML Cooperative Group Protocol 99 (AMLCG99) study for NPM1 mutations. Results were related with partial tandem duplications within the MLL gene (MLL-PTD), Fms-like tyrosine kinase 3–length mutations (FLT3-LM), the tyrosine kinase domain of FLT3 (FLT3-TKD), NRAS, KIT, and CEBPA mutations and with clinical characteristics and outcome. NPM1 mutations were detected in 212 (52.9%) of 401 patients. Fourteen mutations, including 8 new variants, were identified. NPM1-mutated cases associated frequently with FLT3 mutations but rarely with other mutations. The NPM1-mutated group had a higher complete remission (CR) rate (70.5% vs 54.7%, P = .003), a trend to a longer overall survival (OS; median 1012 vs 549 days, P = .076), and significantly longer event-free survival (EFS; median 428 vs 336 days; P = .012). The favorable impact of NPM1 mutations on OS and EFS clearly emerged in the large group (264 [66.8%] of 395 cases) of normal-karyotype AML without FLT3-LM. This positive effect was lost in the presence of a concomitant FLT3-LM, since survival of the NPM1+/FLT3-LM+ double positive was similar to NPM1–/FLT3-LM+ cases. In conclusion, this study demonstrates that NPM1+/FLT3-LM– mutations are an independent predictor for a favorable outcome in AML with normal karyotype.
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Affiliation(s)
- Susanne Schnittger
- Department of Internal Medicine III, University Hospital Grosshadern, Ludwig Maximilian's University, Munich, Germany.
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33
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Kern W, Schoch C, Haferlach T, Schnittger S. Monitoring of minimal residual disease in acute myeloid leukemia. Crit Rev Oncol Hematol 2005; 56:283-309. [PMID: 16213150 DOI: 10.1016/j.critrevonc.2004.06.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Revised: 06/24/2004] [Accepted: 06/24/2004] [Indexed: 11/17/2022] Open
Abstract
Monitoring minimal residual disease (MRD) becomes increasingly important in the risk-adapted management of patients with acute myeloid leukemia (AML). The two most sensitive and quantitative methods for MRD detection are multiparameter flow cytometry (MFC) and real-time polymerase chain reaction (QRT-PCR). Fusion gene-specific PCR in AML is based on the RNA level, and thus in contrast to MFC expression levels rather than cell counts are assessed. For both methods independent prognostic values have been shown. The strong power of MFC has been shown mainly in the assessment of early clearance of the malignant clone. MRD levels in AML with fusion genes have the strongest prognostic power after the end of consolidation therapy. In addition, with QRT-PCR highly predictive initial expression levels can be assessed. With both methods early detection of relapse is possible. So far, validated PCR-based MRD was done with fusion genes that are detectable in only 20-25% of all AML MFC is superior since it is applicable for most AML. However, QRT-PCR is still more sensitive in most cases. Thus, it is desirable to establish new molecular markers for PCR-based studies. Large clinical trials will determine the role and place of immunologic and PCR-based monitoring in the prognostic stratification of patients with AML.
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Affiliation(s)
- Wolfgang Kern
- Laboratory for Leukemia Diagnostics, Ludwig-Maximilians-University, University Hospital Grosshadern, Department of Internal Medicine III, 81366 Muenchen, Germany.
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34
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Heidel F, Solem FK, Breitenbuecher F, Lipka DB, Kasper S, Thiede MH, Brandts C, Serve H, Roesel J, Giles F, Feldman E, Ehninger G, Schiller GJ, Nimer S, Stone RM, Wang Y, Kindler T, Cohen PS, Huber C, Fischer T. Clinical resistance to the kinase inhibitor PKC412 in acute myeloid leukemia by mutation of Asn-676 in the FLT3 tyrosine kinase domain. Blood 2005; 107:293-300. [PMID: 16150941 DOI: 10.1182/blood-2005-06-2469] [Citation(s) in RCA: 222] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Activating mutations in the FLT3 tyrosine kinase (TK) occur in approximately 35% of patients with acute myeloid leukemia (AML). Therefore, targeting mutated FLT3 is an attractive therapeutic strategy, and early clinical trials testing FLT3 TK inhibitors (TKI) showed measurable clinical responses. Most of these responses were transient; however, in a subset of patients blast recurrence was preceded by an interval of prolonged remission. The etiology of clinical resistance to FLT3-TKI in AML is unclear but is of major significance for the development of future therapeutic strategies. We searched for mechanisms of resistance in 6 patients with AML who had relapses upon PKC412 treatment. In an index AML patient, an algorithm of analyses was applied using clinical material. In vivo and in vitro investigation of primary blasts at relapse revealed persistent TK phosphorylation of FLT3 despite sufficient PKC412 serum levels. Through additional molecular analyses, we identified a single amino acid substitution at position 676 (N676K) within the FLT3 kinase domain as the sole cause of resistance to PKC412 in this patient. Reconstitution experiments expressing the N676K mutant in 32D cells demonstrated that FLT3-ITD-N676K was sufficient to confer an intermediate level of resistance to PKC412 in vitro. These studies point out that a genetically complex malignancy such as AML may retain dependence on a single oncogenic signal.
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Affiliation(s)
- Florian Heidel
- 3rd Medical Department, Johannes Gutenberg University Mainz Langenbeckstrasse 1, 55101 Mainz, Germany
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35
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Grundler R, Miething C, Thiede C, Peschel C, Duyster J. FLT3-ITD and tyrosine kinase domain mutants induce 2 distinct phenotypes in a murine bone marrow transplantation model. Blood 2005; 105:4792-9. [PMID: 15718420 DOI: 10.1182/blood-2004-11-4430] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Activating mutations of the Fms-like tyrosine kinase 3 (FLT3) receptor are the most common genetic alteration in acute myeloid leukemia (AML). Two distinct groups of FLT3 mutations are found: internal tandem duplications (ITDs) of the juxtamembrane region and point mutations within the tyrosine kinase domain (TKD). Recently, point mutations within the activation loop of FLT3 have also been described in childhood acute lymphoblastic leukemia (ALL). FLT3-ITD has been shown to induce a myeloproliferative syndrome in a murine bone marrow transplantation model. The phenotype of FLT3-TKD in mice has not yet been investigated. We transduced murine bone marrow with retrovirus-expressing FLT3-TKD mutants or FLT3-ITD and transplanted these cells into lethally irradiated mice. Mice that received a transplant of FLT3-ITD developed an oligoclonal myeloproliferative disease as previously described. In contrast, FLT3-TKD mutants induced an oligoclonal lymphoid disorder with longer latency and distinct hematologic manifestations: importantly, induction of the lymphoid phenotype was not due to a low number of transplanted cells. The lymphoid manifestation and longer latency of FLT3-TKD compared with FLT3-ITD mutants together with the lack of influence of FLT3-TKD mutations on the clinical outcome of patients with AML suggest differences in cell signaling between FLT3-TKD mutants and FLT3-ITDs. Indeed strong signal transducers and activators of transcription 5 (STAT5) activation could only be demonstrated for FLT3-ITDs.
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Affiliation(s)
- Rebekka Grundler
- Department of Internal Medicine III, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Germany
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36
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Kang HJ, Hong SH, Kim IH, Park BK, Han KS, Cho HI, Shin HY, Ahn HS. Prognostic significance of FLT3 mutations in pediatric non-promyelocytic acute myeloid leukemia. Leuk Res 2005; 29:617-23. [PMID: 15863200 DOI: 10.1016/j.leukres.2004.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 11/02/2004] [Indexed: 11/23/2022]
Abstract
FLT3 is a receptor tyrosine kinase involved in the survival of hematopoietic stem cells, and mutations of FLT3 have been reported to be of prognostic significance. This is the first study of FLT3 mutations in pediatric non-promyelocytic AML patients that received the same treatment scheme in single institute. FLT3 internal tandem duplication of the juxtamembrane domain (FLT3/ITD) and a point mutation in the tyrosine kinase domain (FLT3/TKD) were analyzed in 61 patients by PCR of genomic DNA. The incidence of FLT/ITD and FLT/TKD were 6.6% (4/61) and 3.3% (2/61), respectively. Patients with FLT3/TKD remain alive after autologous stem cell transplantation. The disease-free survival (DFS) of patients with FLT3/ITD (0%) was significantly lower than that of the others (52%). FLT3/ITD was the sole adverse prognostic factor for DFS by multivariate analysis (RR=5.6). Patients with FLT3/ITD relapsed early after complete remission even after receiving bone marrow transplantation from a matched related donor with little BuCy conditioning. New therapeutic scheme such as stem cell transplantation with more intensive conditioning just after complete remission could be applied in pediatric non-promyelocytic AML patients with the FLT3/ITD mutation.
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Affiliation(s)
- Hyoung Jin Kang
- Pediatric Oncology Branch, Division of Specific Organs Cancer, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
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37
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Recent publications in hematological oncology. Hematol Oncol 2003; 21:141-8. [PMID: 14594017 DOI: 10.1002/hon.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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