1
|
Tao LL, Wen HT, Wang ZY, Cheng J, Zhao L. Azacitidine maintenance therapy for blastic plasmacytoid dendritic cell neoplasm allograft: A case report. World J Clin Cases 2024; 12:136-141. [PMID: 38292626 PMCID: PMC10824186 DOI: 10.12998/wjcc.v12.i1.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, highly invasive malignant neoplasm. There is no universally accepted standard of care because of its rarity and the dearth of prospective research. It is still challenging for some patients to achieve persistent clinical remission or cure, despite the success of allogeneic hematopoietic stem cell transplantation (allo-HSCT), indicating that there is still a significant recurrence rate. We report a case of prevention of BPDCN allograft recurrence by azacitidine maintenance therapy and review the relevant literature. CASE SUMMARY We report a 41-year-old man with BPDCN who was admitted to hospital due to skin sclerosis for > 5 mo' duration. BPDCN was diagnosed by combined clinical assessment and laboratory examinations. Following diagnosis, the patients underwent induction consolidation chemotherapy to achieve the first complete remission, followed by bridging allo-HSCT. Post-transplantation, azacitidine (75 mg/m2 for 7 d) was administered as maintenance therapy, with repeat administration every 4-6 wk and appropriate extension of the chemotherapy cycle. After 10 cycles, the patient has been disease free for 26 mo after transplantation. Regular assessments of bone marrow morphology, minimal residual disease, full donor chimerism, Epstein-Barr virus, and cytomegalovirus all yielded normal results with no abnormalities detected. CONCLUSION Azacitidine may be a safe and effective maintenance treatment for BPDCN following transplantation because there were no overt adverse events during the course of treatment.
Collapse
Affiliation(s)
- Li-Li Tao
- Department of Hematology, The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hui-Ting Wen
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Zi-Yi Wang
- Department of Hematology, The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Juan Cheng
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Li Zhao
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| |
Collapse
|
2
|
Du Y, Li C, Zhao Z, Liu Y, Zhang C, Yan J. Efficacy and safety of venetoclax combined with hypomethylating agents for relapse of acute myeloid leukemia and myelodysplastic syndrome post allogeneic hematopoietic stem cell transplantation: a systematic review and meta-analysis. BMC Cancer 2023; 23:764. [PMID: 37592239 PMCID: PMC10433628 DOI: 10.1186/s12885-023-11259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Currently, there is no standard treatment for managing relapse in patients with acute myeloid leukemia and myelodysplastic syndrome (AML/MDS) after allogeneic hematopoietic cell transplantation. Venetoclax-based therapies have been increasingly used for treating post-transplantation relapse of AML. The aim of this systematic review and meta-analysis was to evaluate the efficacy and adverse events of Venetoclax combined with hypomethylating agents (HMAs) for AML/MDS relapse post-transplantation. METHODS We searched PubMed, Web of Science, Excerpta Medica Database, Cochrane Library, and Clinical. gov for eligible studies from the inception to February 2022. The Methodological Index for Non-Randomized Studies was used to evaluate the quality of the included literatures. The inverse variance method calculated the pooled proportion and 95% confidence interval (CI). RESULTS This meta-analysis included 10 studies involving a total of 243 patients. The pooled complete response and complete response with incomplete blood count recovery rate of Venetoclax combined with HMAs for post-transplantation relapse in AML/MDS was 32% (95% CI, 26-39%, I2 = 0%), with an overall response rate of 48% (95% CI, 39-56%, I2 = 37%). The 6-month survival rate was 42% (95% CI, 29-55%, I2 = 62%) and the 1-year survival rate was 23% (95% CI, 11-38%, I2 = 78%). CONCLUSION This study demonstrated a moderate benefit of Venetoclax in combination with HMAs for patients with relapsed AML/MDS post-transplantation (including those who have received prior HMAs therapy), and may become one of treatment options in the future. Large-scale prospective studies are needed to confirm the potential benefit from venetoclax combined with HMAs.
Collapse
Affiliation(s)
- Yufeng Du
- Department of Hematology, Dalian Key Laboratory of hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian, 116027, China
- Blood Stem Cell Transplantation Institute, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Dalian Medical University, Dalian, 116044, China
| | - Chunhong Li
- Department of Hematology, Dalian Key Laboratory of hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Zhijia Zhao
- Department of Hematology, Dalian Key Laboratory of hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Yikun Liu
- School of Public Health, Dalian Medical University, Dalian, 116044, China
| | - Chengtao Zhang
- Department of Hematology, Dalian Key Laboratory of hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian, 116027, China.
| | - Jinsong Yan
- Department of Hematology, Dalian Key Laboratory of hematology, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, the Second Hospital of Dalian Medical University, Dalian, 116027, China.
- Blood Stem Cell Transplantation Institute, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Dalian Medical University, Dalian, 116044, China.
- Department of Pediatric, Pediatric Oncology and Hematology Center, Diamond Bay institute of Hematology, Second Hospital of Dalian Medical University, Dalian, 116027, China.
| |
Collapse
|
3
|
Xi Y, Chenglong L, Rong Z, Wen W, Yu W, Jiao C, Juan H, Feifei C, Rong X, Tao J, Hui L, Xiaobing H. Chidamide-based 3-drug combination regimen reverses molecular relapse post transplantation in AML1-ETO-positive acute myeloid leukemia. Front Pharmacol 2023; 13:1059930. [PMID: 36712661 PMCID: PMC9880285 DOI: 10.3389/fphar.2022.1059930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Objective: We aimed to explore a new method to reverse early relapse in patients with AML1-ETO-positive acute myeloid cell transplantation. Methods: A chidamide-based 3-drug combination regimen was used in our center to treat patients with AML1-ETO-positive AML post transplantation but negative flow cytometry results. A retrospective analysis was performed of the survival rate and possible influencing factors of patients with relapse treated with this regimen in our center from January 2018 to January 2022. Results: The overall response rate was 95.8% (23/24), and the median number of treatment courses was 4 (range, 3-12 courses). The total molecular complete response (MCR) was 79.1% (19/24) after all treatments, and the molecular complete response was 37.5% (9/24) after one cycle of treatment but reached 58.3% (14/24) after four cycles; overall, the proportion of MCR increased gradually with the increase in treatment cycles. The projected 5-year overall survival rate was 73.9%. The projected 5-year leukemia-free survival rate was 64.8%, and the projected 1-year cumulative relapse rate was 35.5%. The incidence of grade II-IV graft-versus-host diseases (GVHD) was 29.2% (7/24), and that of grade III-IV GVHD was 20.8% (5/24), which could be effectively controlled by glucocorticoid therapy combined with calcineurin inhibitors The total incidence of chronic GVHD was 29.2% (7/24), and all cases were localized chronic GVHD. The total infection rate was 33.3% (8/24), mainly involving bacterial and fungal infections, and the incidence of life-threatening infections was 4.17% (1/24). The treatment-related mortality rate was 0%; and the total mortality rate was 20.8% (5/24). Nausea and vomiting, thrombocytopenia, and neutropenia were common adverse reactions, all of which were Common Terminology Criteria for Adverse Events grade 2-3 events and reversible after drug withdrawal. In terms of immunity, Th1 cell counts gradually increased, Th17 cell counts gradually decreased, and the Th1/Th17 ratio gradually increased after treatment. The CD8+ T lymphocyte count increased gradually, while the CD4+ T lymphocyte count did not change significantly. Conclusion: Our chidamide-based 3-drug combination regimen led to a high remission rate and tolerable adverse reactions in patients with AML1-ETO-positive post-transplant relapse, and most patients can achieve long-term survival with this regimen.
Collapse
Affiliation(s)
- Yang Xi
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Huang Xiaobing,
| | - Li Chenglong
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Huang Xiaobing,
| | - Zhang Rong
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Wang Wen
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Wang Yu
- Sichuan Provincial People’s Hospital (Medical Group), Dongli Hospital, Chengdu, China
| | - Chen Jiao
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Huang Juan
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Che Feifei
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiao Rong
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jiang Tao
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Li Hui
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Huang Xiaobing
- Sichuan Provincial People’s Hospital, Affliated Hospital of University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Huang Xiaobing,
| |
Collapse
|
4
|
Boovarahan SR, Kurian GA. Preconditioning the rat heart with 5-azacytidine attenuates myocardial ischemia/reperfusion injury via PI3K/GSK3β and mitochondrial K ATP signaling axis. J Biochem Mol Toxicol 2021; 35:e22911. [PMID: 34462995 DOI: 10.1002/jbt.22911] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
5-Azacytidine is well known for its clinical usage in cancer treatments. The present study investigates the role of 5-azacytidine as a cardioprotective agent to ameliorate ischemia/reperfusion (I/R) injury. The cardioprotective effect of 5-azacytidine was evaluated in three experimental models: in vitro, ex vivo, and in vivo. The cardioprotective effect was evaluated via cell viability, hemodynamic indices, infarct size measurement, and assessment of histopathology, oxidative stress, and mitochondrial function. The experiments were repeated in the presence of PI3K/GSK3β and mitochondrial KATP (mtKATP ) cardioprotective signaling pathway inhibitors to understand the underlying mechanism. 5-Azacytidine improved the cell viability by 29% in I/R-challenged H9C2 cells. Both isolated rat heart and LAD ligation model confirmed the infarct sparing effect of 5-azacytidine against I/R. It also provided a beneficial effect by normalizing the altered hemodynamics, reducing the infarct size and cardiac injury markers, reversing the perturbation of mitochondria, reduced oxidative stress, and improved the pPI3K and pAKT protein expression from I/R. In addition, it also augmented the activation of PI3K/AKT and mtKATP signaling pathway, confirmed by using wortmannin (PI3K inhibitor), SB216763 (GSK3β inhibitor), and glibenclamide (mtKATP channel closer). The effectiveness of 5-azacytidine as a cardioprotective agent is attributed to its activation of the PI3K/GSK3β and mtKATP channel signaling axis, thereby preserving mitochondrial function and reducing oxidative stress.
Collapse
Affiliation(s)
- Sri Rahavi Boovarahan
- School of Chemical and Biotechnology, Vascular Biology Lab, SASTRA Deemed University, Thanjavur, Tamilnadu, India
| | - Gino A Kurian
- School of Chemical and Biotechnology, Vascular Biology Lab, SASTRA Deemed University, Thanjavur, Tamilnadu, India
| |
Collapse
|