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Li W, Shi M, Zhou P, Liu Y, Liu X, Xiao X, Zuo S, Bai Y, Sun K. Extramedullary infiltration in pediatric acute myeloid leukemia: Results from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) initiative. Pediatr Blood Cancer 2024; 71:e31014. [PMID: 38644612 DOI: 10.1002/pbc.31014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The outcome of extramedullary infiltration (EMI) in pediatric acute myeloid leukemia (AML) is controversial, and little is known about the implications of stem cell transplantation (SCT) and gemtuzumab ozogamicin (GO) treatment on patients with EMI. METHODS We retrieved the clinical data of 713 pediatric patients with AML from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) dataset, and analyzed the clinical and prognostic characteristics of patients with EMI at diagnosis and relapse. RESULTS A total of 123 patients were identified to have EMI at diagnosis and 64 presented with EMI at relapse. The presence of EMI was associated with age ≤2 years, M5 morphology, abnormal karyotype, and KMT2A rearrangements. Hyperleukocytosis and complex karyotype were more prevalent in patients with EMI at relapse. Additionally, patients with EMI at diagnosis had a reduced incidence of FLT3 ITD-/NPM1+, whereas those with EMI at relapse displayed a lower frequency of FLT3 ITD+. Patients with EMI at diagnosis exhibited a lower complete remission (CR) rate at the end of Induction Course 1 and higher relapse incidence. Importantly, EMI at diagnosis independently predicted both shorter event-free survival (EFS) and overall survival (OS). Regarding relapse patients, the occurrence of EMI at relapse showed no impact on OS. However, relapse patients with myeloid sarcoma (MS)/no central nervous system (CNS) exhibited poorer OS compared to those with CNS/no MS. Furthermore, regarding patients with EMI at diagnosis, SCT failed to improve the survival, whereas GO treatment potentially enhanced OS. CONCLUSION EMI at diagnosis is an independent adverse prognostic risk factor for pediatric AML, and GO treatment potentially improves survival for patients with EMI at diagnosis.
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Affiliation(s)
- Weiya Li
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Mingyue Shi
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Pan Zhou
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Ying Liu
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Xiaobo Liu
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Xingjun Xiao
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Suqiong Zuo
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Yanliang Bai
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Kai Sun
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
- Department of Hematology, Beijing JiShuiTan Hospital, Capital Medical University, Beijing, P. R. China
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2
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Kosti J, Mervak T, Terebelo H. Extramedullary Myeloid Leukemia in the Setting of a Myeloproliferative Neoplasm. J Med Cases 2022; 13:561-568. [PMID: 36506761 PMCID: PMC9728152 DOI: 10.14740/jmc3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/04/2022] [Indexed: 11/28/2022] Open
Abstract
Extramedullary acute myeloid leukemia (EML), also known as myeloid sarcoma (MS), is an extramedullary solid mass derived from the proliferation of myeloblasts outside of the bone marrow. EML can present independently or concurrently with intramedullary acute myeloid leukemia (iAML). It can happen de novo or secondary to iAML, myeloproliferative neoplasm (MPN), chronic myelomonocytic leukemia (CMML), or myelodysplastic syndrome (MDS). We present a 57-year-old female with a history of Janus kinase 2 (JAK-2)-positive essential thrombocythemia (ET) evolving into EML in the setting of a persistent TP53 mutation. We discuss the essential diagnostic studies including tissue biopsy and fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) imaging. We also investigate the significance of cytogenetics and next-generation sequencing (NGS) along with the unique pathogenesis, treatment and prognostic implications.
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Affiliation(s)
- Jorgena Kosti
- Department of Hematology and Oncology, Ascension Providence Hospital, Southfield, Michigan and Michigan State University, East Lansing, MI, USA,Corresponding Author: Jorgena Kosti, Department of Hematology and Oncology, Michigan State University, Ascension Providence, 22301 Foster Winter Drive, Southfield, Michigan, 48075, USA.
| | - Timothy Mervak
- Department of Pathology, Ascension Providence Hospital, Southfield, MI, USA
| | - Howard Terebelo
- Department of Hematology and Oncology, Ascension Providence Hospital, Southfield, Michigan and Michigan State University, East Lansing, MI, USA
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3
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Han S, Li Y, Niu T, Wang X, Li Z, Ren X, Gao J. Granulocytic sarcoma causing long spinal cord compression: Case report and literature review. J Spinal Cord Med 2022; 45:481-485. [PMID: 32543308 PMCID: PMC9135413 DOI: 10.1080/10790268.2020.1771506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context: Granulocytic sarcoma (GS) is an extramedullary form of proliferating myeloblasts. It is frequently reported in patients with acute myeloid leukemia (AML) but rarely in patients with chronic myeloid leukemia (CML). Spinal cord compression caused by CML-associated GS is exceedingly rare, with only few cases reported in the literature. To our knowledge, this is the first reported case in which GS caused such extensive compression.Findings: A 37-year-old man with CML suffered from back pain for 2 months. Notably, he had already achieved molecular remission (MR) after receiving imatinib mesylate for CML; bone marrow aspiration results were consistent with CML in chronic phase. Image examination revealed that developed GS occupied nearly the entire thoracic spinal canal, thereby causing extensive spinal cord compression. The tumor completely diminished after his treatment regimen was upgraded. He showed no signs of recurrence after 1-year follow-up.Conclusion: Extramedullary infiltration of CML should be taken into consideration when a mass lesion develops and compresses the spinal cord in a CML patient who has been receiving routine and standard treatment modalities; thus, a sudden and unexpected progression mandates a refinement and upgrade of treatment modality.
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Affiliation(s)
- Shiyuan Han
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China,Department of International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Tong Niu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xin Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhimin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyu Ren
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China,Correspondence to: Jun Gao, Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing100730, People’s Republic of China.
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4
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Abe H, Hamada S, Sakiyama H, Oshiro T, Kato M, Yagi T, Matsuda T, Higa T, Hyakuna N, Nakanishi K. Myeloid sarcoma concurrent with de novo KMT2A gene-rearranged infantile acute lymphoblastic leukemia. Pediatr Blood Cancer 2022; 69:e29573. [PMID: 35044058 DOI: 10.1002/pbc.29573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Hitomi Abe
- Department of Pediatrics, University of Ryukyus Hospital, Uehara, Nishihara, Okinawa, Japan
| | - Satoru Hamada
- Department of Pediatrics, University of Ryukyus Hospital, Uehara, Nishihara, Okinawa, Japan.,Department of Child Health and Welfare, Graduate School of Medicine, University of Ryukyus, Uehara, Nishihara, Okinawa, Japan
| | - Hideki Sakiyama
- Department of Pediatrics, University of Ryukyus Hospital, Uehara, Nishihara, Okinawa, Japan
| | - Tokiko Oshiro
- Department of Pediatrics, University of Ryukyus Hospital, Uehara, Nishihara, Okinawa, Japan.,Department of Child Health and Welfare, Graduate School of Medicine, University of Ryukyus, Uehara, Nishihara, Okinawa, Japan
| | - Miho Kato
- Department of Pediatric Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center Children's Medical Center, Haebaru, Okinawa, Japan
| | - Takeshi Yagi
- Department of Pediatric Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center Children's Medical Center, Haebaru, Okinawa, Japan
| | - Takehiro Matsuda
- Department of Pediatric Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center Children's Medical Center, Haebaru, Okinawa, Japan
| | - Takeshi Higa
- Department of Pediatric Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center Children's Medical Center, Haebaru, Okinawa, Japan
| | - Nobuyuki Hyakuna
- Department of Pediatrics, University of Ryukyus Hospital, Uehara, Nishihara, Okinawa, Japan.,Department of Child Health and Welfare, Graduate School of Medicine, University of Ryukyus, Uehara, Nishihara, Okinawa, Japan
| | - Koichi Nakanishi
- Department of Pediatrics, University of Ryukyus Hospital, Uehara, Nishihara, Okinawa, Japan.,Department of Child Health and Welfare, Graduate School of Medicine, University of Ryukyus, Uehara, Nishihara, Okinawa, Japan
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5
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Li J, Yin X. Gemtuzumab ozogamicin (GO) as monotherapy and in combination with hypomethylation agents in the treatment of acute myeloid leukemia: a systematic meta-analysis. Hematology 2022; 27:300-309. [PMID: 35225170 DOI: 10.1080/16078454.2022.2042964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jun Li
- Taixing People’s Hospital, Taixing, People’s Republic of China
- School of Medicine, Southeast University, Nanjing, People’s Republic of China
| | - Xiaoping Yin
- Taixing People’s Hospital, Taixing, People’s Republic of China
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6
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Küçükdiler AHE, Yavaşoğlu İ, Selim C, Mutlu CA, Karakuş A, Koyuncu MB, Bilgir O, Ayyıldız O, Tiftik EN, Bolaman AZ. Use of gemtuzumab ozogamicin in relapsed refractory acute myeloid leukemia: Multi-center real life data from Turkey. Leuk Res Rep 2021; 16:100280. [PMID: 34849337 PMCID: PMC8608612 DOI: 10.1016/j.lrr.2021.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 11/07/2022] Open
Abstract
We retrospectively evaluated the use of gemtuzumab ozogamicin (GO) in relapsed refractory (R/R) acute myeloid leukemia (AML) patients. Twenty-one CD33 positive R/R AML patients who received GO as a single agent in 4 hematology centers were included in this study. The median age was 59, and the median ECOG performance score was 2. According to cytogenetic analysis, 1 patient had favorable risk, 12 patients with intermediate, and 8 patients with adverse risk. The overall response rate was 52.3%. Partial response was achieved in 3 of 8 patients with adverse risk. 33.3% of patients developed grade 3 anemia. Grade 4 neutropenia and thrombocytopenia were observed in 80% of the patients. One of the patients died due to sinusoidal obstruction syndrome / veno-occlusive disease (SOS / VOD) due to GO side effects. GO may be considered as a good option for salvage therapy in R/R AML patients.
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Affiliation(s)
| | - İrfan Yavaşoğlu
- Aydin Adnan Menderes University Faculty of Medicine, Department of Hematology, Turkey
| | - Cem Selim
- Aydin Adnan Menderes University Faculty of Medicine, Department of Hematology, Turkey
| | - Cansu Atmaca Mutlu
- Izmir Bozyaka Training and Research Hospital, Department of Adult Hematology, Turkey
| | - Abdullah Karakuş
- Dicle University Faculty of Medicine, Department of Adult Hematology, Turkey
| | | | - Oktay Bilgir
- Izmir Bozyaka Training and Research Hospital, Department of Adult Hematology, Turkey
| | - Orhan Ayyıldız
- Dicle University Faculty of Medicine, Department of Adult Hematology, Turkey
| | - Eyüp Naci Tiftik
- Mersin University Faculty of Medicine, Department of Adult Hematology, Turkey
| | - Ali Zahit Bolaman
- Aydin Adnan Menderes University Faculty of Medicine, Department of Hematology, Turkey
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7
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Ovilla-Martinez R, Weber Sánchez LA, Cota-Rangel X, Baez-Islas PE. Gemtuzumab-ozogamicin and blinatumomab as treatment for refractory mixed-phenotype blast crisis in chronic myeloid leukaemia. BMJ Case Rep 2021; 14:e243745. [PMID: 34764108 PMCID: PMC8586884 DOI: 10.1136/bcr-2021-243745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
In the tyrosine kinase inhibitor era, the blast phase of chronic myeloid leukaemia (BP-CML) renders an uncommon presentation and has a poor prognosis with an estimated overall survival below 20%. Mixed-phenotype blast phase is even more infrequent, presenting in 3.3% of these patients. Blast phase manifests along haematological sarcomas, with extramedullary activity in lymph nodes, skin and bone. We report the case of a patient with an ovarian sarcoma as an extramedullary presentation of mixed-phenotype BP-CML refractory to conventional treatment which responded to immunotherapy against CD33 and CD19.
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Affiliation(s)
| | - Luis Alejandro Weber Sánchez
- Hematology Department, Hospital Angeles Lomas, Huixquilucan, Estado de Mexico, Mexico
- Surgery Department, Hospital Angeles Lomas, Huixquilucan, Estado de Mexico, Mexico
| | - Xóchitl Cota-Rangel
- Hematology Department, Hospital Angeles Lomas, Huixquilucan, Estado de Mexico, Mexico
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8
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Shatilova A, Girshova L, Zaytsev D, Budaeva I, Mirolyubova Y, Ryzhkova D, Grozov R, Bogdanov K, Nikulina T, Motorin D, Zammoeva D, Efremova S, Ivanov V, Petukhov A, Alekseeva Y, Zaritskey A. The myeloid sarcoma treated by Venetoclax with hypomethylating agent followed by stem cell transplantation: rare case report. BMC Womens Health 2021; 21:184. [PMID: 33933047 PMCID: PMC8088676 DOI: 10.1186/s12905-021-01328-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) is a very rare condition, develops both in patients with other hematological neoplasms, and as isolated tumor. MS of the gynecologic tract is extremely rare. An available literature data about diagnosis and management of MS is summarized in the article. The role of chemotherapy, radiation therapy, surgery and bone marrow transplantation in the treatment is discussed. Polychemotherapy and allogeneic bone marrow transplantation were suggested to be the optimal treatment strategy of MS of the gynecological tract. The use of new targeted agents results in promising clinical data. CASE PRESENTATION We are presenting a rare clinical case of a MS of the uterine cervix with concomitant bone marrow involvement and describe all the peculiarities of the clinical course, diagnosis, and treatment. The patient received chemotherapy followed by allogeneic bone marrow transplantation. The pre-transplant therapy allowed us to perform allogeneic bone marrow transplantation with the deepest response possible: complete PET-negative and MRD-negative remission of the disease. CONCLUSIONS MS remains a subject of discussion regarding its diagnostic and therapeutic aspects. The use of novel targeting agents can be perspective option for patient with extramedullary disease.
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Affiliation(s)
- Aleksina Shatilova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341.
| | - Larisa Girshova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Daniil Zaytsev
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Irina Budaeva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Yuliya Mirolyubova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Darya Ryzhkova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Roman Grozov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Konstantin Bogdanov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Tatiana Nikulina
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Dmitriy Motorin
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Darina Zammoeva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Svetlana Efremova
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Vladimir Ivanov
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Alexey Petukhov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Yuliya Alekseeva
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Andrey Zaritskey
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
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9
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Ibrahim M, Chen R, Vegel A, Panse K, Bhyravabhotla K, Harris K, Craig R, Safah H, Saba NS, Socola F. Treatment of myeloid sarcoma without bone marrow involvement with gemtuzumab ozogamicin-containing regimen. Leuk Res 2021; 106:106583. [PMID: 33906021 DOI: 10.1016/j.leukres.2021.106583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Moayed Ibrahim
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA, USA.
| | - Rebecca Chen
- Deming Department of Medicine, Tulane University, New Orleans, LA, USA
| | - Andrew Vegel
- Deming Department of Medicine, Tulane University, New Orleans, LA, USA
| | - Ketaki Panse
- Deming Department of Medicine, Tulane University, New Orleans, LA, USA
| | | | - Kendra Harris
- Department of Radiation Oncology, Tulane University, New Orleans, LA, USA
| | - Ryan Craig
- Department of Pathology and Laboratory Medicine, Tulane University, New Orleans, LA, USA
| | - Hana Safah
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA, USA
| | - Nakhle S Saba
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA, USA
| | - Francisco Socola
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA, USA
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10
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Xu G, Zhang H, Nong W, Li C, Meng L, Liu C, Li F. Isolated Intracranial Myeloid Sarcoma Mimicking Malignant Lymphoma: A Diagnostic Challenge and Literature Reviews. Onco Targets Ther 2020; 13:6085-6092. [PMID: 32612369 PMCID: PMC7323804 DOI: 10.2147/ott.s245828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022] Open
Abstract
Isolated intracranial myeloid sarcoma (MS) is an unusual variant tumor with few cases reported so far in the medical literature. A 29-year-old woman was admitted to our hospital presenting progressive visual loss in the right eye and weight loss (20 kg) without a previous history of hematological disease (HD). Radiologic evaluation showed the evidence of intracranial mass. Histologically, the resected tumor was composed of a uniform population of primitive cells and primarily misdiagnosed as a T-cell non-Hodgkin’s lymphoma (NHL). Chemotherapy with cyclophosphamide, doxorubicin, vinblastine, and prednisone (CHOP) was ineffective. A biopsy and histopathological evaluation were repeated, and immunohistochemical staining revealed the positivity of immature cells to an extensive panel of myeloid markers. These findings were consistent with a diagnosis of MS and bone marrow infiltration. Literature reviews of previous cases were also undertaken.
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Affiliation(s)
- Guixuan Xu
- Department of Pathology and Key Laboratories for Xinjiang Endemic and Ethnic Diseases, The First Affiliated Hospital, Shihezi University of Medical, Shihezi, 832002, People's Republic of China
| | - Haijun Zhang
- Department of Pathology and Key Laboratories for Xinjiang Endemic and Ethnic Diseases, The First Affiliated Hospital, Shihezi University of Medical, Shihezi, 832002, People's Republic of China
| | - Weixia Nong
- Department of Hematology, The First Affiliated Hospital of Medical College of Shihezi University, Shihezi 832002, People's Republic of China
| | - Chunsen Li
- Department of Pathology and Key Laboratories for Xinjiang Endemic and Ethnic Diseases, The First Affiliated Hospital, Shihezi University of Medical, Shihezi, 832002, People's Republic of China
| | - Lian Meng
- Department of Pathology and Key Laboratories for Xinjiang Endemic and Ethnic Diseases, The First Affiliated Hospital, Shihezi University of Medical, Shihezi, 832002, People's Republic of China
| | - Chunxia Liu
- Department of Pathology and Key Laboratories for Xinjiang Endemic and Ethnic Diseases, The First Affiliated Hospital, Shihezi University of Medical, Shihezi, 832002, People's Republic of China
| | - Feng Li
- Department of Pathology and Key Laboratories for Xinjiang Endemic and Ethnic Diseases, The First Affiliated Hospital, Shihezi University of Medical, Shihezi, 832002, People's Republic of China.,Department of Pathology and Medical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
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11
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Lyon-University Hospital Experience with Gemtuzumab Ozogamicin Therapy in Acute Myeloid Leukemia: a 'Real-Life' Study. Mediterr J Hematol Infect Dis 2020; 12:e2020020. [PMID: 32395209 PMCID: PMC7202336 DOI: 10.4084/mjhid.2020.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/17/2020] [Indexed: 11/14/2022] Open
Abstract
Ninety-four adults with newly diagnosed or relapsed/refractory acute myeloid leukemia (AML) were treated with fractionated doses of gemtuzumab ozogamicin (GO) at one-single French center over ten years. We attempted to define predictive factors for response and survival. The overall response rate was 70% (86% in newly diagnosed and 65% in relapsed/refractory AML). Mortality during induction was 6%. Disease-free survival (DFS) and overall survival at three years after GO treatment was 36% and 31%, respectively. Median DFS in relapsed/refractory patients was eight months with a 3-year DFS at 34%. Among remitters, allogeneic hematopoietic stem cell transplantation (HSCT) can be performed in 28 cases (42%), including two patients in first-line therapy and 26 in further line. In relapsed/refractory patients undergoing allogeneic HSCT after responding to GO therapy, the median DFS was not reached. Incidences of transplant-related mortality, grade ≥ 3 acute graft-versus-host (GvH) disease, and extensive chronic GvH disease were 11%, 14%, and 25%, respectively. No sinusoidal obstruction syndromes were reported among allografted patients as among the other patients in the studied cohort. GO-based chemotherapy is a viable option for the treatment of relapsed/refractory AML patients and is a feasible schedule as a bridge to allogeneic transplant.
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12
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Piccin A, Sartori MT, Bisogno G, Van Schilfgaarde M, Saggiorato G, Pierro AMD, Corvetta D, Marcheselli L, Mega A, Gastl G, Cesaro S. New insights into sinusoidal obstruction syndrome. Intern Med J 2018; 47:1173-1183. [PMID: 28707749 DOI: 10.1111/imj.13550] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 04/27/2017] [Accepted: 07/01/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Entry criteria included patients who developed sinusoidal obstruction syndrome (SOS) at a single centre from January 2000 to December 2011. Patients who underwent haemopoietic stem cell transplantation or actinomicyn-based chemotherapy for nephroblastoma were selected. The study group comprised five patients with SOS who were compared with a control group of seven patients without SOS. AIM To study the relationships between endothelial extracellular vesicles (EV) and plasminogen-activator inhibitor type 1(PAI-1) to assess their modification in the early phase of SOS. METHODS Consecutive blood samples were tested for cell-derived EV, PAI-1 and coagulation parameters. Any statistically significant correlation between all datasets was searched. RESULTS Antithrombin level and platelet count were statistically significantly reduced in SOS patients, suggesting a consumption status. PAI-1:Ag and PAI-1:act showed an inverse relationship with platelet counts (coef. -0.034, SE = 0.016; P = 0.041 and -0.052, SE = 0.019; P = 0.011 respectively). During follow up, PAI-1:Ag was inversely related to EV CD144+ (coef. -0.261, SE = 0.094; P = 0.007) and antithrombin (coef -0.509, SE = 0.175; P = 0.005). PAI-1:act showed an inverse association with EV CD144+ (coef.-0.251, SE = 0.121; P = 0.043), EV CD31+/CD41+ (coef. -0.004, SE = 0.002; P = 0.026) and antithrombin (coef. -0.470, SE = 0.220; P = 0.038). EV generated by rupture of gap junctions (EV CD144+) were increased in SOS patients and also showed a change over time. CONCLUSION This study demonstrates the existence of an ongoing procoagulant and hypofibrinolytic status in SOS, indicating a possible role for anticoagulant therapy. Moreover, these findings suggest a role for EV CD 144+, either alone or in combination with PAI-1, as a new biomarker for SOS.
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Affiliation(s)
- Andrea Piccin
- Transfusion Service, San Maurizio Regional Hospital, Bolzano, Italy.,Department of Internal Medicine V, Medical University, Innsbruck, Austria.,IMREST (Interdisciplinary Medical Research Center South Tyrol), Bolzano, Italy
| | - Maria T Sartori
- Department of Internal Medicine, University of Medicine, Padova, Italy
| | - Gianni Bisogno
- Oncology Hematology Division, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | | | | | - Angela M D Pierro
- IMREST (Interdisciplinary Medical Research Center South Tyrol), Bolzano, Italy
| | - Daisy Corvetta
- IMREST (Interdisciplinary Medical Research Center South Tyrol), Bolzano, Italy
| | - Luigi Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Mega
- IMREST (Interdisciplinary Medical Research Center South Tyrol), Bolzano, Italy.,Gastroenterology Department, San Maurizio Regional Hospital, Bolzano, Italy
| | - Günther Gastl
- Department of Internal Medicine V, Medical University, Innsbruck, Austria
| | - Simone Cesaro
- Paediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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13
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Megías-Vericat JE, Martínez-Cuadrón D, Sanz MÁ, Montesinos P. Salvage regimens using conventional chemotherapy agents for relapsed/refractory adult AML patients: a systematic literature review. Ann Hematol 2018; 97:1115-1153. [DOI: 10.1007/s00277-018-3304-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/12/2018] [Indexed: 12/26/2022]
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Norsworthy KJ, Ko CW, Lee JE, Liu J, John CS, Przepiorka D, Farrell AT, Pazdur R. FDA Approval Summary: Mylotarg for Treatment of Patients with Relapsed or Refractory CD33-Positive Acute Myeloid Leukemia. Oncologist 2018; 23:1103-1108. [PMID: 29650683 DOI: 10.1634/theoncologist.2017-0604] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/23/2018] [Indexed: 01/30/2023] Open
Abstract
On September 2, 2017, the U.S. Food and Drug Administration approved gemtuzumab ozogamicin (GO; Mylotarg; Pfizer, New York City, NY) for treatment of relapsed or refractory (R/R) CD33-positive acute myeloid leukemia (AML) in patients 2 years of age and older. GO is a CD33-directed antibody drug conjugate linked to the cytotoxic antibiotic calicheamicin. It originally received accelerated approval for treatment of older patients with relapsed CD33-positive AML in 2000, but it was withdrawn from the market in 2010 when the confirmatory trial failed to demonstrate clinical benefit among safety concerns, such as a higher rate of induction fatalities on the GO combination arm compared with chemotherapy alone. In addition, GO was associated with hepatic veno-occlusive disease (VOD), which has substantial morbidity and mortality. Pharmacokinetic analyses suggested a lower maximum concentration of GO would result in less VOD without affecting target saturation or efficacy. A meta-analysis across dose schedules of GO in patients with R/R AML showed that a lower-dose "fractionated" schedule of 3 mg/m2 days 1, 4, and 7 was associated with less early mortality, hemorrhage, and VOD, without an apparent decrease in complete remission (CR) rate. MyloFrance 1 was a single-arm study evaluating response rates in patients with relapsed CD33-positive AML treated with the lower-dose fractionated GO regimen. The CR rate was 26% (95% confidence interval 16%-40%). Common adverse reactions were fever, infections, nausea, vomiting, constipation, bleeding, increased liver enzymes, and mucositis. There were no cases of VOD. These results supported the approval of GO as monotherapy for R/R CD33-positive AML using the lower-dose fractionated regimen. IMPLICATIONS FOR PRACTICE Gemtuzumab ozogamicin (GO) 3 mg/m2 days 1, 4, and 7 is an active regimen for induction of remission when used to treat patients with relapsed or refractory CD33-positive acute myeloid leukemia without curative intent. The risks of hepatic veno-occlusive disease and early mortality with this regimen appear to be lower than reported previously for GO 9 mg/m2 days 1 and 15. The data were not sufficient to enable conclusions about the safety of GO in children younger than 2 years of age.
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Affiliation(s)
- Kelly J Norsworthy
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Chia-Wen Ko
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jee Eun Lee
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jiang Liu
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Christy S John
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Donna Przepiorka
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ann T Farrell
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Richard Pazdur
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A. Myeloid Sarcoma: Presentation, Diagnosis, and Treatment. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2017; 17:263-267. [PMID: 28342811 DOI: 10.1016/j.clml.2017.02.027] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/13/2017] [Accepted: 02/28/2017] [Indexed: 12/22/2022]
Abstract
Myeloid sarcoma is an extramedullary tumor of immature granulocytic cells. It is a rare condition, most often associated with acute myeloid leukemia (AML), although in some rare cases it may present in nonleukemic patients. It should therefore be considered as a differential diagnosis of any atypical cellular infiltrate. It may occur at any site, leading to very varied clinical presentations. Diagnosis is challenging and relies on a high index of suspicion as well as radiology, histology, immunophenotyping, and molecular analyses, which also are essential for risk stratification and treatment planning. Systemic chemotherapy using AML-like regimens should be commenced early, even in nonleukemic disease. Surgery and/or radiotherapy may be indicated for symptomatic lesions or tumors causing local organ dysfunction or obstruction. Allogeneic hematopoietic stem cell transplantation has demonstrated promising results, particularly in patients who achieved complete remission with AML-induction protocols, and recent advances in genetic profiling may enable the development of novel targeted therapies. Prospective multicenter controlled trials are required to further refine management decisions and investigate the role of novel targeted therapies.
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Affiliation(s)
- L Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - Maria Charalampakis
- Department of Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David Gourevitch
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anant Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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16
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Paubelle E, Ducastelle-Leprêtre S, Labussière-Wallet H, Nicolini FE, Barraco F, Plesa A, Salles G, Wattel E, Thomas X. Fractionated gemtuzumab ozogamicin combined with intermediate-dose cytarabine and daunorubicin as salvage therapy in very high-risk AML patients: a bridge to reduced intensity conditioning transplant? Ann Hematol 2016; 96:363-371. [DOI: 10.1007/s00277-016-2899-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022]
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17
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Bertuzzi C, Paolini S, Visani G, Piccaluga PP. Daunorubicin for the treatment of acute myeloid leukemia. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.949670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Peker D, Parekh V, Paluri R, Deal T, Borate U, Di Stasi A, Harada S, Arroyo EA, Reddy V. Clinicopathological and molecular features of myeloid sarcoma as initial presentation of therapy-related myeloid neoplasms: a single institution experience. Int J Hematol 2014; 100:457-63. [DOI: 10.1007/s12185-014-1659-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 12/25/2022]
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Abstract
INTRODUCTION Gemtuzumab ozogamicin (GO) is a combination of calicheamicin and a recombinant humanized IgG4 antibody directed against CD33. From 2000 to 2010, it was approved by the FDA for treatment of relapsed, older patients with CD33(+) acute myeloid leukemia (AML). After withdrawal from the market, several trials have provided new evidence on the safety and clinical efficacy of GO. AREAS COVERED In this review, we discuss pharmacological and clinical aspects of GO. GO was found to show benefit in AML patients as adjunct to intensive chemotherapy when it was given in parallel to induction therapy. The benefit was restricted to patients with a favorable- or an intermediate-risk cytogenetic profile. Higher doses of GO above 6 mg/m(2) per administration were associated with increased toxicity without survival benefit, whereas repetitive doses of 3 mg/m(2) resulting in cumulative doses of 9 mg/m(2) were well tolerated. Predictive markers for response to GO other than the cytogenetic profile and P-glycoprotein activity are still missing. EXPERT OPINION GO as adjunct and in parallel to intensive induction chemotherapy does significantly improve survival end points in AML patients with favorable/intermediate-risk cytogenetics. A dose of 3 mg/m(2) per administration appears safer compared with 6 mg/m(2) and even 9 mg/m(2).
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Affiliation(s)
- Felicitas Thol
- Hannover Medical School, Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation , Carl-Neuberg-Str. 1, 30625, Hannover , Germany
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Tsunemine H, Akasaka H, Sakane EI, Ito K, Kodaka T, Takahashi T. Successful repeated treatment of acute myeloid leukemia in early relapse with gemtuzumab ozogamicin alone. Int J Hematol 2013; 99:193-7. [DOI: 10.1007/s12185-013-1481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
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21
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Takeshita A. Efficacy and resistance of gemtuzumab ozogamicin for acute myeloid leukemia. Int J Hematol 2013; 97:703-16. [PMID: 23709007 DOI: 10.1007/s12185-013-1365-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 11/24/2022]
Abstract
Seventy to 80 % of patients with acute myeloid leukemia (AML) achieve complete remission following intensive chemotherapy, but more than 50 % of patients in remission subsequently relapse, which is often associated with clinical drug resistance. Therapy based on monoclonal antibodies (mAbs) has been developed to increase the selectivity of cytotoxic agents by conjugating them with a mAb. Gemtuzumab ozogamicin (GO) is a conjugate of a cytotoxic agent, a calicheamicin derivative, linked to a recombinant humanized mAb directed against the CD33 antigen, which is expressed on leukemia cells from more than 90 % of patients with AML. This conjugated mAb was introduced following promising results from phase I and II studies. However, the initial phase III study did not confirm the efficacy of GO in combination with conventional chemotherapies. Several subsequent phase III studies have shown the efficacy of GO in favorable and intermediate risk AML. Several resistance mechanisms against GO have been reported. Multidrug resistant (MDR) P-glycoprotein (P-gp), a trans-membrane glycoprotein that pumps out many anti-leukemic agents from cells, also affects GO. For this reasons, GO has been used in combination with MDR modifiers, such as cyclosporine, and in cases without P-gp. Several investigators have reported successful results of the use of GO in acute promyelocytic leukemia (APL). GO has also been described as effective in cases relapsed after treatment with all-trans retinoic acid (ATRA), arsenic acid and conventional chemotherapeutic agents. The efficacy of GO will be studied mainly in a favorable risk of AML, such as core binding factor leukemia and APL. In addition, suitable combinations with other chemotherapies and administration schedules should be discussed.
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Affiliation(s)
- Akihiro Takeshita
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Japan.
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22
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De novo AML patients with favourable–intermediate karyotype may benefit from the addition of low-dose gemtuzumab ozogamicin (GO) to fludarabine, Ara-C and idarubicin (FLAI): a contribution to the reopened “GO question”. Ann Hematol 2013; 92:1309-18. [DOI: 10.1007/s00277-013-1780-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/28/2013] [Indexed: 10/26/2022]
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Uchida H, Inokuchi K, Watanabe R, Tokuhira M, Kizaki M. New therapeutic approaches to acute myeloid leukemia. Expert Opin Drug Discov 2013; 3:689-706. [PMID: 23506149 DOI: 10.1517/17460441.3.6.689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The heterogeneity of acute myeloid leukemia (AML) has been established by many new insights into the pathogenesis and treatment of patients with AML. Understanding the basic cellular and molecular pathogenesis of leukemic cells is vital to the development of new treatment approaches. OBJECTIVE/METHODS To review progress until now with agents that are showing promise in the treatment of AML, we summarize the published preclinical and clinical trials that have been completed. RESULTS Based on recent progress of investigations, more specifically targeted agents have been developed for the treatment of AML such as tyrosine kinase inhibitors, monoclonal antibodies, epigenetic agents, antiangiogenic agents, and farnesyl transferase inhibitors. CONCLUSION In the future, in addition to performing therapeutic trials of these agents, it will be important to identify other highly specific therapeutic agents based on our evolving understanding of the biology of AML.
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Affiliation(s)
- Hideo Uchida
- TEPCO Hospital, Department of Internal Medicine, Shinjuku-ku, Tokyo 160-0016, Japan
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24
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Tsunemine H, Takahashi T. Gemtuzumab ozogamicin in the treatment of adult acute myeloid leukemia. Health (London) 2013. [DOI: 10.4236/health.2013.55a002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rao AV, Rizzieri DA, DeCastro CM, Diehl LF, Lagoo AS, Moore JO, Gockerman JP. Phase I study of dose dense induction and consolidation with gemtuzumab ozogamicin and high dose cytarabine in older adults with AML. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ricart AD. Antibody-drug conjugates of calicheamicin derivative: gemtuzumab ozogamicin and inotuzumab ozogamicin. Clin Cancer Res 2012; 17:6417-27. [PMID: 22003069 DOI: 10.1158/1078-0432.ccr-11-0486] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antibody-drug conjugates (ADC) are an attractive approach for the treatment of acute myeloid leukemia and non-Hodgkin lymphomas, which in most cases, are inherently sensitive to cytotoxic agents. CD33 and CD22 are specific markers of myeloid leukemias and B-cell malignancies, respectively. These endocytic receptors are ideal for an ADC strategy because they can effectively carry the cytotoxic payload into the cell. Gemtuzumab ozogamicin (GO, Mylotarg) and inotuzumab ozogamicin consist of a derivative of calicheamicin (a potent DNA-binding cytotoxic antibiotic) linked to a humanized monoclonal IgG4 antibody directed against CD33 or CD22, respectively. Both of these ADCs have a target-mediated pharmacokinetic disposition. GO was the first drug to prove the ADC concept in the clinic, specifically in phase II studies that included substantial proportions of older patients with relapsed acute myeloid leukemia. In contrast, in phase III studies, it has thus far failed to show clinical benefit in first-line treatment in combination with standard chemotherapy. Inotuzumab ozogamicin has shown remarkable clinical activity in relapsed/refractory B-cell non-Hodgkin lymphoma, and it has started phase III evaluation. The safety profile of these ADCs includes reversible myelosuppression (especially neutropenia and thrombocytopenia), elevated hepatic transaminases, and hyperbilirubinemia. There have been postmarketing reports of hepatotoxicity, especially veno-occlusive disease, associated with GO. The incidence is ~2%, but patients who undergo hematopoietic stem cell transplantation have an increased risk. As we steadily move toward the goal of personalized medicine, these kinds of agents will provide a unique opportunity to treat selected patient subpopulations based on the expression of their specific tumor targets.
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Affiliation(s)
- Alejandro D Ricart
- Biotechnology Unit and Oncology Clinical Research, Pfizer Inc., San Diego, California, USA.
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Abstract
Myeloid sarcoma is a rare disease that can present as an isolated extramedullary leukemic tumor, concurrently with or at relapse of acute myeloid leukemia. Owing to the rarity of this disorder, most of the literature comprises small retrospective studies and case reports. The aim of this review is to summarize the current published data regarding the clinical presentation, morphological, cytogenetic and molecular features, prognosis and treatment of myeloid sarcoma.
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Affiliation(s)
- Batia Avni
- Division of Hematology, Chaim Sheba Medical Center Tel Hashomer, Israel and Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - Maya Koren-Michowitz
- Division of Hematology, Chaim Sheba Medical Center Tel Hashomer, Israel and Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles CA, USA
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Hütter ML, Schlenk RF. Gemtuzumab ozogamicin in non-acute promyelocytic acute myeloid leukemia. Expert Opin Biol Ther 2011; 11:1369-80. [PMID: 21810061 DOI: 10.1517/14712598.2011.604630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gemtuzumab ozogamicin (GO) has been used in relapsed, refractory and newly diagnosed acute myeloid leukemia (AML) as a single agent and in combination with intensive chemotherapy. Results of recent Phase III trials have led to its withdrawal in the USA although a beneficial effect of GO in genetically defined AML subgroups was evident. AREAS COVERED This review examines the use of GO as a single agent or in combination with intensive chemotherapy in non-acute promyelocytic AML. The literature search was based on publications on GO indexed in the PubMed electronic database and selected meeting abstracts. GO has shown moderate activity as a single agent but promising activity in combination with intensive chemotherapy in refractory or relapsed AML. Relapsed AML defined molecularly by mutant nucleophosmin-1 without concurrent fms-related tyrosine kinase 3 (FLT3) internal tandem duplication seems to benefit most from GO. In newly diagnosed AML two up-front randomized Phase III trials evaluating GO in induction therapy failed to demonstrate an improvement in response and survival. Again, genetically defined subgroups may benefit. EXPERT OPINION Future challenges of personalized therapy in AML will be to integrate the signals from current subgroup analyses underlining the role of GO in genetically defined AML entities.
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Affiliation(s)
- Marie-Luise Hütter
- University of Ulm, Department of Internal Medicine III, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Perini GF, Santos FPDS, Esteves I, Nascimento CMDBD, Rodrigues M, Assis RAD, Helman R, Kutner JM, Ribeiro AAF, Hamerschlak N. Use of gemtuzumab ozogamycin combined with conventional chemotherapy in patients with acute myeloid leukemia. EINSTEIN-SAO PAULO 2011; 9:190-5. [DOI: 10.1590/s1679-45082011ao1987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To analyze the outcome of patients treated with gemtuzumab ozogamycin combined with conventional therapy treated at Hospital Israelita Albert Einstein. Methods: 14 patients who had high risk features (secondary leukemia, unfavorable cytogenetics, and refractory disease) were treated with gemtuzumab ozogamycin combined with conventional therapy and their outcome was analysed by reviewing their medical records. Results: Overall response rate was 58%, with 43% achieving complete response, with a median follow-up of 11 months, event-free survival was 3 months. Eleven patients died, 6 of them due to refractory acute myeloid leukemia. Only four patients presented with grade 3 to 4 toxicities and only one patient had sinusoidal obstruction syndrome after bone marrow transplant. Conclusion: gemtuzumab ozogamycin combined with chemotherapy is a feasible treatment regimen in acute myeloid leukemia patients. However, further studies are necessary to clarify which subgroup of patients may beneft from this treatment.
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30
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Usui N, Takeshita A, Nakaseko C, Dobashi N, Fujita H, Kiyoi H, Kobayashi Y, Sakura T, Yahagi Y, Shigeno K, Ohwada C, Miyazaki Y, Ohtake S, Miyawaki S, Naoe T, Ohnishi K. Phase I trial of gemtuzumab ozogamicin in intensive combination chemotherapy for relapsed or refractory adult acute myeloid leukemia (AML): Japan Adult Leukemia Study Group (JALSG)-AML206 study. Cancer Sci 2011; 102:1358-65. [PMID: 21585619 DOI: 10.1111/j.1349-7006.2011.01957.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In order to investigate better molecular-target therapy for acute myeloid leukemia (AML), we conducted a phase I trial of a combination of gemtuzumab ozogamicin (GO) with conventional chemotherapy. Between January 2007 and December 2009, a total of 19 adult Japanese patients with relapsed or refractory CD33-positive AML (excluding acute promyelocytic leukemia) were enrolled. All registered patients received a standard dose of cytarabine (Ara-C) (100 mg/m(2) × 7 days), combined with either idarubicin (IDR) (10-12 mg/m(2) × 3 days) or daunorubicin (DNR) (50 mg/m(2) × 3-5 days), and then GO (3-5 mg/m(2) ), which was administered 1 day after the last infusion of IDR (IAG regimen) or DNR (DAG regimen). While doses of both GO and IDR and the administration period of only DNR were increased, the dose-limiting toxicity (DLT) was assessed. Among 19 patients (nine in the IAG regimen, 10 in the DAG regimen), the median age was 59 years (range 33-64), and the relapsed/refractory ratio was 13/6. In the therapy using 3 mg/m(2) GO in the IAG or DAG regimen, grade 3/4 leukopenia and neutropenia were observed in all patients, but none had grade 3/4 non-hematological toxicities, except febrile neutropenia. Three patients in the IAG regimen who were administered 5 mg/m(2) GO showed DLT. No patients had veno-occlusive disease or sinusoidal obstructive syndrome. In conclusion, 3 mg/m(2) GO combined with Ara-C and IDR or DNR can be safely administered, and phase II trials should be conducted to investigate the clinical efficacy of the combination therapy.
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Affiliation(s)
- Noriko Usui
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
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Ando T, Mitani N, Matsunaga K, Nakazora T, Gondo T, Yujiri T, Tanizawa Y. Gemtuzumab Ozogamicin Therapy for Isolated Extramedullary AML Relapse after Allogeneic Hematopoietic Stem-Cell Transplantation. TOHOKU J EXP MED 2010; 220:121-6. [DOI: 10.1620/tjem.220.121] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toshihiko Ando
- Third Department of Internal Medicine, Yamaguchi University School of Medicine
| | - Noriyuki Mitani
- Third Department of Internal Medicine, Yamaguchi University School of Medicine
| | - Kimie Matsunaga
- Third Department of Internal Medicine, Yamaguchi University School of Medicine
| | - Tatsuki Nakazora
- Third Department of Internal Medicine, Yamaguchi University School of Medicine
| | - Toshikazu Gondo
- First Department of Pathology, Yamaguchi University School of Medicine
| | - Toshiaki Yujiri
- Third Department of Internal Medicine, Yamaguchi University School of Medicine
| | - Yukio Tanizawa
- Third Department of Internal Medicine, Yamaguchi University School of Medicine
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Takahashi T, Tsukuda H, Kimura H, Yoshimoto M, Tsujisaki M. Extramedullary relapse of AML with t(9;11)(p22;q23) associated with clonal evolution from trisomy 8 into tetrasomy 8. Intern Med 2010; 49:447-51. [PMID: 20190481 DOI: 10.2169/internalmedicine.49.2904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This report describes a patient with extramedullary relapse of acute myeloid leukemia (AML) without involving bone marrow. A 57-year-old man was diagnosed as having acute monoblastic leukemia with t(9;11)(p22;q23) and trisomy 8. Ten months after achieving complete response (CR) with chemotherapy, masses developed in his left forearm and in the back of his thigh, preceded by enigmatic peripheral neurological symptoms. Aspiration from the forearm showed leukemic relapse, and fluorescence in situ hybridization (FISH) revealed that the majority of the cells had 11q23 anomaly and tetrasomy 8. Bone marrow or meningeal relapse was not observed. To our knowledge, this is the first case report of clonal evolution associated with the development of myeloid sarcoma as a relapse in AML.
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MESH Headings
- Chromosome Aberrations
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 8/genetics
- Chromosomes, Human, Pair 9/genetics
- Drug Therapy
- Forearm
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Male
- Middle Aged
- Recurrence
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/genetics
- Thigh
- Trisomy/genetics
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Affiliation(s)
- Tohru Takahashi
- Department of Hematology and Gastroenterology, Tenshi Hospital, Sapporo.
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33
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Martin MG, Augustin KM, Uy GL, Welch JS, Hladnik L, Goyal S, Tiwari D, Monahan RS, Reichley RM, Cashen AF, Stockerl-Goldstein K, Westervelt P, Abboud CN, Dipersio JF, Vij R. Salvage therapy for acute myeloid leukemia with fludarabine, cytarabine, and idarubicin with or without gemtuzumab ozogamicin and with concurrent or sequential G-CSF. Am J Hematol 2009; 84:733-7. [PMID: 19806665 DOI: 10.1002/ajh.21545] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The current salvage therapies for relapsed/refractory acute myeloid leukemia (AML) are unsatisfactory. Over the past 7 years, we have used two salvage regimens: fludarabine, cytarabine, and idarubicin with (FLAG-IM) or without gemtuzumab ozogamicin (GO) (9 mg/m(2) on Day 8) (FLAG-I) in relapsed/refractory AML. Three-quarters of patients also received concurrent G-CSF. Seventy-one patients were treated, 23 with FLAG-I and 48 with FLAG-IM. The median duration of follow-up was 30.6 months. The treatment groups were well balanced with median ages of 48 years (range 18-70) and 47 years (range 20-68), unfavorable cytogenetics in 57% and 35%, prior allogeneic stem cell transplant in 43% and 42%, and CR1 duration <1 year in 60% and 67%, respectively, for FLAG-I and FLAG-IM. The complete remission (CR) rate in the FLAG-I group was 39% with an additional 13% achieving a CRp [overall response rate (ORR) 52%]; the CR rate in the FLAG-IM group was 29% with an additional 27% achieving a CRp (ORR 56%). The median duration of response (DOR; 16.8 vs. 8.3 months), event-free survival (EFS; 7.4 vs. 4.1 months), and overall survival (OS; 8.8 vs. 5.0 months) trended to favor FLAG-I over FLAG-IM. The patients who received G-CSF concurrent with chemotherapy had superior overall response rate (ORR; 62% vs. 29%, P = 0.026), median EFS (6.2 vs. 3.4 months, P = 0.010), and OS (8.8 vs. 3.9 months, P = 0.004) when compared with those who sequentially received G-CSF and chemotherapy, regardless of chemotherapy regimen. The addition of GO, at this dose and schedule, to FLAG-I failed to improve the outcomes in patients with relapsed/refractory AML. The patients who received G-CSF concurrently with chemotherapy had improved outcomes. Am. J. Hematol., 2009. (c) 2009 Wiley-Liss, Inc.
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Affiliation(s)
- Mike G Martin
- Section of Leukemia and Bone Marrow Transplantation, Division of Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
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34
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Duong HK, Sekeres MA. Targeted treatment of acute myeloid leukemia in older adults: role of gemtuzumab ozogamicin. Clin Interv Aging 2009; 4:197-205. [PMID: 19503782 PMCID: PMC2685241 DOI: 10.2147/cia.s3968] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
As the overall prognosis and treatment response rate to standard chemotherapy for acute myeloid leukemia (AML) remains poor in the older adult population, there is a need for more effective therapeutic agents with lower toxicity profiles that can be offered to these patients. Gemtuzumab ozogamicin (GO) is an anti-CD33 monoclonal antibody that was approved by the US Food and Drug Administration for use as monotherapy in patients 60 years of age and older with relapsed AML. GO consists of a humanized anti-CD33 antibody (hP67.6) which is linked to N-acetyl-gamma calicheamicin 1,2-dimethyl hydrazine dichloride. Once the antibody attaches to the surface antigen, it is rapidly internalized. Calicheamicin, a potent enediyne, is subsequently released and acts as a cytotoxic anti-tumor agent. In this population, GO has an acceptable toxicity and yields response rates approaching 30%. The efficacy of GO as monotherapy and in combination therapy for treatment of both de novo and relapsed AML continues to be investigated.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Aminoglycosides/administration & dosage
- Aminoglycosides/pharmacology
- Aminoglycosides/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/drug effects
- Antigens, Differentiation, Myelomonocytic/drug effects
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Gemtuzumab
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/physiopathology
- Middle Aged
- Sialic Acid Binding Ig-like Lectin 3
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Hien K Duong
- Cleveland Clinic Taussig Cancer Institute Cleveland, Ohio USA
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35
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Moccia A, Ghielmini M. Monoclonal Antibodies for the Treatment of Hematologic Malignancies: Schedule and Maintenance Therapy. Semin Hematol 2008; 45:75-84. [DOI: 10.1053/j.seminhematol.2008.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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36
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Stasi R. Gemtuzumab ozogamicin: an anti-CD33 immunoconjugate for the treatment of acute myeloid leukaemia. Expert Opin Biol Ther 2008; 8:527-40. [DOI: 10.1517/14712598.8.4.527] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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37
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Nagai S, Asai T, Watanabe T, Oshima K, Hangaishi A, Kanda Y, Motokura T, Chiba S, Aoki S, Ohtomo K, Kurokawa M. Simultaneous appearance of central nervous system relapse and subarachnoid hemorrhage during the treatment for acute promyelocytic leukemia. Ann Hematol 2008; 87:593-5. [DOI: 10.1007/s00277-008-0436-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 01/02/2008] [Indexed: 11/29/2022]
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38
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Stasi R, Evangelista ML, Buccisano F, Venditti A, Amadori S. Gemtuzumab ozogamicin in the treatment of acute myeloid leukemia. Cancer Treat Rev 2007; 34:49-60. [PMID: 17942233 DOI: 10.1016/j.ctrv.2007.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Accepted: 09/03/2007] [Indexed: 01/24/2023]
Abstract
Gemtuzumab ozogamicin (GO) is a chemotherapeutic agent that consists of a humanized anti-CD33 antibody (hP67.6) linked to N-acetyl-calicheamicin 1,2-dimethyl hydrazine dichloride, a potent enediyne antitumor antibiotic. GO was approved conditionally by the Federal Drug Administration in May 2000 as single-agent therapy for first recurrence of acute myeloid leukemia (AML) in patients over the age of 60 years who are unfit for conventional cytotoxic therapy. In this setting, it produces a complete response (CR) rate of 13%, with another 13% achieving CR with inadequate platelet recovery (CRp). The most common adverse effects associated with GO are infusion-related reactions and myelosuppression. GO monotherapy at the dose of 9 mg/m(2) is complicated with hepatic veno-occlusive disease in approximately 5% of cases, particularly prior to or following stem cell transplantation. Attenuated doses of GO or fractionated doses appear to be equally effective and better tolerated. GO has shown remarkable activity in acute promyelocytic leukemia, particularly for the elimination of minimal residual disease. Combinations of GO with chemotherapy as induction or post-remission therapy are promising, and phase III trials are ongoing.
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Affiliation(s)
- Roberto Stasi
- Department of Medical Sciences, Ospedale Regina Apostolorum, Regina Apostolorum Hospital, Via S Francesco, 50, Albano Laziale, Italy.
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39
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Visani G, Olivieri A, Malagola M, Brunori M, Piccaluga PP, Capelli D, Pomponio G, Martinelli G, Isidori A, Sparaventi G, Leoni P. Consolidation therapy for adult acute myeloid leukemia: a systematic analysis according to evidence based medicine. Leuk Lymphoma 2007; 47:1091-102. [PMID: 16840201 DOI: 10.1080/10428190500513595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Post-remission therapy in acute myeloid leukemia (AML) remains problematic. It has been demonstrated that younger patients can maintain longer complete remissions (CR) with aggressive post-remission therapies after induction treatment: allogeneic (allo), autologous (auto) stem cell transplantation (SCT), or intensive chemotherapy (ICC). The purpose of our study was to identify the most important randomized and controlled studies comparing these three therapeutic options, in order to draw conclusions and possible suggestions for post-remission therapy of AML, according to the evidence based medicine (EBM) rules. We performed an exhaustive analysis of the literature, searching either in electronic databases or among the references of the identified articles (hand searching). We searched the MEDLINE computer database for reports from 1985 through January 2005 and selected for analysis the clinical trials conducted over adults affected by newly diagnosed AML aged less than 65 years. The study design had to satisfy strict methodological criteria and must consider global mortality and/or disease free survival as primary outcomes. Overall we found 7750 papers; by using the limits "clinical trial" as publication type, "all adults 19+ years", we were able to select 344 papers. Among these, a further selection was made, based on two main clinical queries: 1) is auto-SCT superior to ICC/no other therapy in improving DFS and/or OS in adult AML patients in first CR? 2) is allo-SCT superior to auto-SCT/other therapeutic options in improving DFS and/or OS in adult AML patients in first CR? Concerning the first query, a possible advantage of auto-SCT over ICC was not clearly supported by data from clinical trials; there is no evidence that auto-SCT is superior in terms of OS to chemotherapy. Nevertheless, the reported TRM has been significantly reduced within the past years. Thus, the percentage of patients suitable for auto-SCT in CR has increased. Moreover, the scarce data concerning the comparison between auto-SCT and chemotherapy in different subsets of patients are unable to suggest a differentiated approach in patients with high-risk, standard-risk or low-risk AML. Data from the literature show that patients with unfavorable risk disease are more often addressed to allo-SCT and patients with low-risk disease receive more often intensive consolidation chemotherapy. Concerning the second query, interpretation of data from the main prospective studies about the role of allo-SCT in previously untreated AML is not easy. The first problem is the lack of real randomized clinical trials; in fact, according to the reported studies, AML patients generally receive allo-SCT on the basis of donor availability (the so called "genetic randomization"). The second problem is the frequent absence of intention to treat analysis. Despite methodological limitations, it was possible to compare allo-SCT with auto-SCT on a donor versus no-donor analysis and within risk groups. No overall benefit of allo-grafting on survival was demonstrated by any trial. In conclusion, the EBM approach highlighted the limitations observed in the published studies concerning consolidation therapy in AML; some suggestions, emerging from non-randomized, as well as randomized studies, are adequate, but not conclusive. This point, coupled with the intrinsic complexity to study AML biological heterogeneity, is probably a major obstacle to draw conclusive evidences for consolidation therapy in AML. These observations should plan to address new randomized studies on AML therapy; however, due to the emergence of genetic subgroups and new drugs targeting specific abnormalities, these trials should probably be designed directly focusing on the single entities. In this way, the cure of AML could eventually become the cure of each specific AML subset with its peculiar biological, molecular and prognostic features.
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Affiliation(s)
- G Visani
- Hematology, San Salvatore Hospital, Pesaro, Italy.
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40
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Clavio M, Vignolo L, Albarello A, Varaldo R, Pierri I, Catania G, Balocco M, Michelis G, Miglino M, Manna A, Balleari E, Carella AM, Sessarego M, Van Lint MT, Bacigalupo A, Gobbi M. Adding low-dose gemtuzumab ozogamicin to fludarabine, Ara-C and idarubicin (MY-FLAI) may improve disease-free and overall survival in elderly patients with non-M3 acute myeloid leukaemia: results of a prospective, pilot, multi-centre trial and comparison with a historical cohort of patients. Br J Haematol 2007; 138:186-95. [PMID: 17593025 DOI: 10.1111/j.1365-2141.2007.06646.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the final results of a prospective multi-centre trial testing the combination of chemotherapy (fludarabine, cytosine arabinoside and idarubicin; FLAI) followed by low-dose gemtuzumab ozogamicin (GO), for induction treatment of patients with CD33+ acute myeloid leukaemia (AML). Forty-six consecutive patients were treated: the median age was 66 (range: 60-80) years; the karyotype was unfavourable in 12 patients (26%), intermediate in 33 (71%) and favourable in one (3%). Eleven major infectious complications were recorded. There was one early death. Of the 45 evaluable patients, 24 achieved a complete response (CR; 52%), 66% and 33% in good-intermediate/poor karyotype patients. Median duration of CR was 7 (3-24) months. The cumulative incidence of relapse was 37% with an actuarial 2-year survival of 54%. These results were compared with 47 patients matched for age and karyotype who received FLAI, without GO. The proportion of patients achieving CR was comparable. However, patients with de novo AML receiving GO (n = 26) had a significantly lower risk of relapse at 2 years when compared with patients not receiving GO (n = 35) (40% vs. 80%, P = 0.01) and significantly better overall 2-year survival (40% vs. 14%P = 0.02). Patients with secondary AML had comparable outcome whether or not they received GO. This GO-based induction chemotherapy has a good toxicity profile. In keeping with a recent prospective randomised trial, the addition of GO seems to prolong disease-free survival.
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Affiliation(s)
- Marino Clavio
- Department of Haematology and Oncology, University of Genova and S. Martino Hospital, Genova, Italy
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41
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Owonikoko T, Agha M, Balassanian R, Smith R, Raptis A. Gemtuzumab therapy for isolated extramedullary AML relapse following allogeneic stem-cell transplant. ACTA ACUST UNITED AC 2007; 4:491-5. [PMID: 17657254 DOI: 10.1038/ncponc0899] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/04/2007] [Indexed: 01/21/2023]
Abstract
BACKGROUND A 19-year-old male with primary refractory acute myeloid leukemia received salvage therapy with mitoxantrone and cytarabine combination. He received consolidation therapy 3 months later with a matched-unrelated-donor stem-cell transplant. The disease relapsed in the bone marrow (BM) 9 months after the initial stem-cell transplant, and was successfully treated by repeat transplant from the same donor. Ten months following repeat transplant, the patient presented with an increasing number of extramedullary sites of biopsy-proven disease relapse (i.e. cranial and peripheral nerves, tongue, abdominal wall and chest wall). Repeated biopsy of the BM and chimera study showed no morphologic evidence of leukemic infiltrate with 100% donor-cell population. INVESTIGATIONS Physical examination, complete blood count, BM biopsy, flow cytometry, cytogenetic analysis, chimera study, tongue biopsy, abdominal-wall biopsy, cytology and immunohistochemistry, CT scan of the chest, abdomen and pelvis, MRI of the brain, and cerebrospinal fluid analysis. DIAGNOSIS Isolated extramedullary relapse of acute myeloid leukemia after stem-cell transplant. MANAGEMENT Primary leukemia treatment with idarubicin, cytarabine, etoposide, dexamethasone, tioguanine on protocol and salvage therapy with mitoxantrone and cytarabine combination for primary refractory disease. A matched-unrelated-donor stem-cell transplant for consolidation and donor-lymphocyte infusions were performed, followed by repeat unrelated-donor transplant for leukemia relapse in the marrow, radiation therapy and gemtuzumab ozogamicin for multiple sites of extramedullary leukemia relapse.
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Affiliation(s)
- Taofeek Owonikoko
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA 15232, USA
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42
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Pagano L, Fianchi L, Caira M, Rutella S, Leone G. The role of Gemtuzumab Ozogamicin in the treatment of acute myeloid leukemia patients. Oncogene 2007; 26:3679-90. [PMID: 17530021 DOI: 10.1038/sj.onc.1210364] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Gemtuzumab Ozogamicin (GO) is an antibody-targeted chemotherapy agent consisting of the humanized murine CD33 antibody (clone P67.6) to which the calicheamicin-g1 derivative is attached via a hydrolysable bifunctional linker. GO is able to induce apoptosis in vitro in CD33-expressing cells and it has been approved in USA and in Europe as monotherapy for the treatment of elderly patients (older than 60 years) with relapsed acute myeloid leukemia (AML). GO administered as a single agent has resulted in overall response rates of about 30% in previously relapsed adults AML patients (including also with incomplete platelet recovery). Preliminary data indicate a potential role for GO also as a component of induction or consolidation regimens in adults and children. As for adverse events, veno-occlusive syndrome characterizes its tolerability profile, but GO is comparatively well tolerated by most patients.
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MESH Headings
- Aminoglycosides/adverse effects
- Aminoglycosides/immunology
- Aminoglycosides/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Gemtuzumab
- Hematologic Tests
- Humans
- Immunotherapy
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Sensitivity and Specificity
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Affiliation(s)
- L Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
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43
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Molnár I, Powell BL. What role does gemtuzumab ozogamicin have in the treatment of acute myelogenous leukemia? Curr Hematol Malig Rep 2007; 2:104-10. [PMID: 20425358 DOI: 10.1007/s11899-007-0015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gemtuzumab ozogamicin (GO) is a novel, targeted chemotherapy designed to treat acute myeloid leukemia (AML). GO consists of an antitumor antibiotic, calicheamicin, linked to a humanized monoclonal antibody against CD33. It has been approved in the United States since 2000 to treat CD33+ AML in first relapse in older adults who are not candidates for cytotoxic therapy. Beyond this indication, the role of GO is evolving. Single-agent GO has a limited role in de novo AML. Incorporation of GO into standard induction treatment in de novo and relapsed AML is feasible. Comparative phase III studies of such an approach are ongoing. GO is associated with serious toxicities, such as infusional reactions, transient liver function test abnormalities, and veno-occlusive disease of the liver, especially in patients who undergo hematopoietic stem cell transplantation.
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Affiliation(s)
- István Molnár
- Section on Hematology and Oncology, Department of Medicine,Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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44
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Ramasamy K, Lim Z, Pagliuca A, Devereux S, Ho AYL, Mufti GJ. Acute myeloid leukaemia presenting with mediastinal myeloid sarcoma: report of three cases and review of literature. Leuk Lymphoma 2007; 48:290-4. [PMID: 17325888 DOI: 10.1080/10428190601059803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although myeloid sarcomas (MS) are frequently associated with acute myeloid leukaemia (AML), the occurrence of mediastinal MS is a much rarer event. The authors describe a distinct group of three AML patients with mediastinal MS and complex cytogenetics presenting at their centre over a 7-year period. Clinical features consistent with superior vena caval obstruction were noted at presentation in two of the three patients. Mediastinal mass was detected on routine chest radiography, and biopsies confirmed the diagnosis of MS. One patient relapsed after consolidation chemotherapy and died from progressive disease. Two patients underwent allogeneic haemopoietic stem cell transplant, but succumbed to transplant related complications. Review of mediastinal MS over the last 20 years shows that a significant proportion of patients have complex cytogenetic abnormalities and a poor long-term prognosis. Early and accurate diagnosis is essential and patients should be managed along the lines of high risk AML.
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MESH Headings
- Adult
- Chromosome Aberrations
- Female
- Humans
- Leukemia, Monocytic, Acute/diagnosis
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/therapy
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/therapy
- Male
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/genetics
- Mediastinal Neoplasms/therapy
- Neoplasms, Second Primary/diagnosis
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/therapy
- Superior Vena Cava Syndrome/pathology
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Affiliation(s)
- Karthik Ramasamy
- Department of Haematological Medicine, King's College London and King's College Hospital, UK
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45
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Pileri SA, Ascani S, Cox MC, Campidelli C, Bacci F, Piccioli M, Piccaluga PP, Agostinelli C, Asioli S, Novero D, Bisceglia M, Ponzoni M, Gentile A, Rinaldi P, Franco V, Vincelli D, Pileri A, Gasbarra R, Falini B, Zinzani PL, Baccarani M. Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia 2006; 21:340-50. [PMID: 17170724 DOI: 10.1038/sj.leu.2404491] [Citation(s) in RCA: 420] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Myeloid sarcoma (MS) is a rare neoplasm whose knowledge is largely based on case reports and/or technically dated contributions. Ninety-two MSs in adulthood with clinical data available were evaluated both morphologically and immunohistochemically. Seventy-four cases were also studied by fluorescent in situ hybridization on tissue sections and/or conventional karyotyping on bone marrow or peripheral blood. Histologically, 50% of the tumors were of the blastic type, 43.5% either monoblastic or myelomonocytic and 6.5% corresponded to different histotypes. CD68/KP1 was the most commonly expressed marker (100%), followed by myeloperoxidase (83.6%), CD117 (80.4%), CD99 (54.3%), CD68/PG-M1 (51%), CD34 (43.4%), terminal-deoxy-nucleotidyl-transferase (31.5%), CD56 (13%), CD61/linker for activation of T cells (2.2%), CD30 (2.2%) and CD4 (1.1%). Foci of plasmacytoid monocyte differentiation were observed in intestinal cases carrying inv16. Chromosomal aberrations were detected in about 54% of cases: monosomy 7(10.8%), trisomy 8(10.4%) and mixed lineage leukemia-splitting (8.5%) were the commonest abnormalities, whereas t(8;21) was rare (2.2%). The behavior was dramatic irrespective of presentation, age, sex, phenotype and cytogenetics. Most if not all, long survivors received bone-marrow transplantation. The present report expands the spectrum of our knowledge showing that MS has frequent monoblastic/myelomonocytic differentiation, displays distinctive phenotypic profile, carries chromosomal aberrations other than t(8;21), and requires supra-maximal therapy.
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Affiliation(s)
- S A Pileri
- Institute of Hematology and Clinical Oncology 'L and A Seràgnoli, University of Bologna, Bologna, Italy.
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46
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Tsimberidou AM, Giles FJ, Estey E, O'Brien S, Keating MJ, Kantarjian HM. The role of gemtuzumab ozogamicin in acute leukaemia therapy. Br J Haematol 2006; 132:398-409. [PMID: 16412015 DOI: 10.1111/j.1365-2141.2005.05872.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gemtuzumab ozogamicin (GO) is an immunoconjugate that binds to CD33 on the surface of acute myeloid leukaemia (AML) blasts and, after internalisation, releases a cytotoxic drug, calicheamicin. GO is approved by the US Food and Drug Administration for the treatment of CD33-positive AML at first relapse in patients 60 years and older who are not candidates for other cytotoxic therapy. GO as a single agent has low antileukaemic activity. When given to patients meeting the criteria noted above, it produces a complete response (CR) rate of only 12%, with another 12% achieving CR with inadequate platelet recovery (CRp). The median survival of patients treated with GO monotherapy is 11.2 months. GO therapy at 9 mg/m(2) is complicated with hepatic veno-occlusive disease in 5-10% of patients, particularly prior to or following stem cell transplantation. GO at lower doses combined with chemotherapy as induction or postremission therapy is promising, however, and phase III trials are ongoing. GO is probably most active in acute promyelocytic leukaemia (APL). It is used for induction regimens in high-risk APL and for the elimination of minimal residual APL. Case reports suggest that GO also has activity in CD33-positive acute lymphoblastic leukaemia. In conclusion, single agent GO can induce responses in patients with CD33-positive AML in first recurrence. The future of GO is its use in combination with other cytotoxic agents. Ongoing clinical trials may better define the role of GO combinations, particularly in untreated AML.
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MESH Headings
- Acute Disease
- Aminoglycosides/administration & dosage
- Aminoglycosides/metabolism
- Aminoglycosides/therapeutic use
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/therapeutic use
- Antibodies, Monoclonal/metabolism
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Drug Resistance
- Enediynes
- Gemtuzumab
- Humans
- Immunotoxins/metabolism
- Immunotoxins/therapeutic use
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/metabolism
- Protein Binding
- Randomized Controlled Trials as Topic
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3
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