1
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Beauchemin MP, Ji L, Williams AM, Nightingale CL, Dressler EV, Salsman JM, Santacroce SJ, Freyer DR, Roth ME, Parsons SK. Defining Practice Capacity for Cancer Care Delivery to Adolescents and Young Adults in the Community Setting: 2022 Landscape Assessment Results. J Adolesc Young Adult Oncol 2024. [PMID: 38394227 DOI: 10.1089/jayao.2023.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Background: Adolescents and young adults (AYAs) commonly receive cancer care in the community setting, but the availability of treatment options, resources, and support services for this population is not well known. The National Cancer Institute Community Oncology Research Program (NCORP) funds a network of practices whose mission is to increase access to cancer care and clinical trials in the community setting. We describe our interdisciplinary methodological approach to identify and characterize NCORP practices where AYAs receive cancer care. Methods: NCORP practices completed a cross-sectional Landscape Assessment to describe resources and practice characteristics. We established an interdisciplinary team of stakeholders to analyze the Landscape Assessment data relating to AYAs. Through an iterative process, we assessed NCORP practice responses to questions assessing AYA cancer care capacity, determined a threshold to define practices treating AYAs, and characterized these practices. Results: We determined that practices provide cancer care to AYAs if the following criteria were met: (1) endorsed having an AYA program (n = 20), (2) AYAs comprised ≥5% of annual cancer cases (n = 55), or (3) the practice treated ≥50 AYA cancer cases annually (n = 70). Of 271 NCORP practices, 100 (37%) met any criteria, whereas 87 (32%) did not; 84 (31%) could not be classified due to missing or unknown data. Conclusion: Using an interdisciplinary process, we define practices that treat AYAs in the community. We posit a uniform approach to examine resources and practice capacity for AYAs receiving cancer care across the United States to guide future AYA-focused cancer care delivery research development.
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Affiliation(s)
- Melissa P Beauchemin
- Division of Scholarship and Research, School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Lingyun Ji
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - AnnaLynn M Williams
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sheila J Santacroce
- School of Nursing and Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - David R Freyer
- Children's Hospital Los Angeles and USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Parsons
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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2
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Janardan SK, Miller TP. Adolescents and young adults (AYAs) vs pediatric patients: survival, risks, and barriers to enrollment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:581-586. [PMID: 38066874 PMCID: PMC10727024 DOI: 10.1182/hematology.2023000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Adolescents and young adults (AYAs; ages 15-39 years) with acute lymphoblastic leukemia (ALL) have worse outcomes than pediatric patients with ALL. Multiple factors contribute to this differential survival. AYAs are more likely to have higher-risk leukemia biology than children with ALL. AYA patients have more choices for treatment facility and treatment protocol, as well as barriers to clinical trial enrollment, both of which can affect survival. AYAs must also navigate psychosocial factors inherent to their unique developmental stage. Furthermore, AYAs typically sustain more treatment-related toxicities than pediatric patients. Treatment on pediatric or pediatric-inspired ALL protocols at pediatric cancer centers has been associated with improved outcomes for AYAs with ALL, but there is still variation in the treatment that AYAs with ALL receive. Clinical trials focused on AYAs with ALL and individualized decision-making regarding choice of treatment facility and treatment protocol are needed to optimize the survival and long-term outcomes of this patient population.
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Affiliation(s)
- Sanyukta K Janardan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tamara P Miller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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3
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Rangel-Patiño J, Lee-Tsai YL, Urbalejo-Ceniceros VI, Luna-Perez MEM, Espinosa-Bautista KA, Amador LF, Cabrera-García Á, Balderas-Delgado C, Inclan-Alarcon SI, Neme-Yunes Y, Sanchez-Albarrán JM, Apodaca EI, Meillon-García L, Stock W, Demichelis-Gómez R. A modified CALGB 10403 in adolescents and young adults with acute lymphoblastic leukemia in Central America. Blood Adv 2023; 7:5202-5209. [PMID: 37307212 PMCID: PMC10500455 DOI: 10.1182/bloodadvances.2023009754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023] Open
Abstract
Mexico and Central America have a high incidence of acute lymphoblastic leukemia (ALL) in adolescents and young adults. Historically, this patient group has been treated using adult-based regimens, which entails a high rate of treatment-related mortality and a poor overall survival (OS). The use of the CALGB 10403, a pediatric-inspired regimen, has been proven effective in this patient subgroup. Nonetheless, low- and middle-income countries (LMICs) may present limited access to standard care treatments implemented elsewhere, warranting the need for further research to improve outcomes among vulnerable populations. In this study, we present the outcomes in terms of safety and effectiveness of using a modified CALGB 10403 regimen to reflect drug and resource availability in LMICs. Modifications included the use of Escherichia coli asparaginase,6-mercaptopurine instead of thioguanine and the use of rituximab among patients with CD20+. A total of 95 patients with a median age of 23 (range, 14-49) years treated with this modified scheme were prospectively assessed at 5 centers in Mexico and 1 in Guatemala. Among these, 87.8% achieved a complete response after induction. During follow-up, 28.3% of patients relapsed. Two-year OS rate was 72.1%. Factors associated with worse OS included hyperleukocytosis (hazard ratio [HR], 4.28; 95% confidence interval [CI], 1.81-10.10) and postinduction minimal residual disease (HR, 4.67; 95% CI, 1.75-12.44). Most patients presented hepatotoxicity (51.6% and 53.7% during induction and consolidation, respectively), and the treatment-related mortality was 9.5%. Overall, results highlight that implementing a modified CALGB 10403 regimen in Central America is feasible, and it is associated with improvements in clinical outcomes and a manageable safety profile.
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Affiliation(s)
- Juan Rangel-Patiño
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Karla Adriana Espinosa-Bautista
- Hematology Department, Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
| | - Lauro Fabian Amador
- Hematology Department, Hospital Regional de Alta Especialidad del Bajío, León, Mexico
| | - Álvaro Cabrera-García
- Hematology Department, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico, Mexico
| | - Carolina Balderas-Delgado
- Hematology Department, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico, Mexico
| | | | | | - Jose Manuel Sanchez-Albarrán
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elia Ixel Apodaca
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Wendy Stock
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Roberta Demichelis-Gómez
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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4
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Grain A, Rialland-Battisti F, Chevallier P, Blin N, Dalle JH, Michel G, Dhédin N, Peffault de Latour R, Pochon C, Yakoub-Agha I, Bertrand Y, Sirvent A, Jubert C, Forcade E, Berceanu A, Gandemer V, Schneider P, Bay JO, Rohrlich PS, Brissot E, Paillard C, Plantaz D, Nguyen Quoc S, Gonzales F, Maillard N, Planche L, Baruchel A. Hematopoietic stem cell transplantation for acute lymphoblastic leukemia: why do adolescents and young adults outcomes differ from those of children? A retrospective study on behalf of the Francophone Society of Stem Cell Transplantation and Cellular Therapy (SFGM-TC). J Cancer Res Clin Oncol 2023; 149:1473-1483. [PMID: 35507103 DOI: 10.1007/s00432-022-04021-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/09/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE In the acute lymphoblastic leukemia (ALL) landscape, adolescents and young adults (AYA) often present high-risk diseases and increased chemotherapy-related toxicity. Studies analyzing the outcomes of AYA after hematopoietic stem cell transplantation (HSCT) are scarce. Our study aimed to compare the outcomes of children and AYA with ALL after HSCT and to determine the factors influencing potential differences. METHOD 891 patients, from the SFGM-TC registry, aged between 1 and 25 years who received HSCT between 2005 and 2012 were included. The outcomes of AYA were compared to the ones of their younger counterparts. RESULTS Five-year OS and GRFS were lower in AYA: 53.1% versus 64% and 36% versus 47% (p = 0.0012 and p = 0.007, respectively). WhileCIR was similar in both groups, 5 year-treatment related mortality was higher in AYA: 19% versus 13% (p = 0.04). The lower GRFS in AYA was mainly explained by a higher chronic graft versus host disease (cGvHD) incidence: 32% versus 19% (p < 0.001). Use of peripheral blood stem cells and use of anti-thymoglobulin appeared to be the main factors impacting cGvHD occurrence in AYA. CONCLUSION AYA have worse outcomes than children after HSCT for ALL because of a greater risk of TRM due to cGvHD. HSCT practices should be questioned in this population.
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Affiliation(s)
- Audrey Grain
- Pediatric Hematology-Oncology Department, CHU Hopital Mère-Enfant, Nantes, France.
| | | | | | - Nicolas Blin
- Hematology Department, CHU Hotel Dieu, Nantes, France
| | - Jean-Hugues Dalle
- Robert Debré University Hospital (APHP), Université de Paris, Paris, France
| | - Gérard Michel
- Department of Paediatric Haematology and Oncology and EA3279, Timone Children Hospital and Aix-Marseille University, Marseille, France
| | - Nathalie Dhédin
- AYA Unit, Clinical Hematology Departments, Saint-Louis Hospital, Paris, France
| | | | - Cécile Pochon
- Allogeneic Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Oncohematology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | | | - Yves Bertrand
- Institut of Hematology and Pediatric Oncology, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Anne Sirvent
- Department of Clinical Haematology, CHU Montpellier, Montpellier, France
| | - Charlotte Jubert
- Department of Pediatric Hematology, Bordeaux Hospital, Bordeaux, France
| | - Edouard Forcade
- Department of Hematology and Cellular Therapy, CHU Bordeaux, Bordeaux, France
| | - Ana Berceanu
- Department of Hematology, CHU Besançon, Besançon, France
| | - Virginie Gandemer
- Department of Pediatric Oncology and Haematology, University Hospital of Rennes, Rennes, France
| | - Pascale Schneider
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Jacques-Olivier Bay
- Department of Hematology and Cellular Therapy CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Eolia Brissot
- Department of Haematology, Hôpital Saint-Antoine, Paris, France
| | - Catherine Paillard
- Pediatric Oncohematology and Bone Marrow Transplantation Unit, Hôpital de Hautepierre, CHRU, Strasbourg, France
| | - Dominique Plantaz
- Department of Pediatric Hematology-Oncology, University Hospital Grenoble, Grenoble, France
| | | | - Fanny Gonzales
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000, Lille, France
| | | | - Lucie Planche
- Clinical Research Unit, CHD Vendée, La Roche sur Yon, France
| | - André Baruchel
- Robert Debré University Hospital (APHP), Université de Paris, Paris, France
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5
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Sandley M, Angus J. Asparaginase therapy in patients with acute lymphoblastic leukemia: expert opinion on use and toxicity management. Leuk Lymphoma 2023; 64:776-787. [PMID: 36781296 DOI: 10.1080/10428194.2023.2171267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The addition of asparaginase to acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) treatment regimens provides significant patient benefits. Asparaginase therapies vary in origin (Escherichia coli- or Erwinia-derived) and preparation (native or pegylated), conferring distinct pharmacokinetic and immunogenic profiles. Clinical hypersensitivity reactions (HSRs) are commonly reported in patients and range from localized erythema to systemic anaphylaxis. Due to its favorable pharmacokinetic profile and reduced immunogenicity compared to native E. coli preparations, pegaspargase is the first-line asparaginase therapeutic option. Switching to an Erwinia-derived asparaginase is recommended for patients who experience HSRs or antibody-mediated inactivation to achieve the significant clinical benefit observed in patients who complete asparaginase treatment. Previous global shortages of asparaginase Erwinia chrysanthemi necessitated conversion mitigation strategies such as premedication protocols, desensitization, and asparaginase activity level monitoring. Here, we discuss the efficacy, safety, pharmacokinetics, current use, and administration of asparaginase therapies for pediatric and adolescent patients with ALL/LBL.
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Affiliation(s)
- Melissa Sandley
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Jonathan Angus
- Department of Pharmacy, Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
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6
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Poirée M, Neumann F, Thomas C, Simon P, Lunven AFR, Plantaz D, Doulet ST, Strullu M. [Prevention and management of pegaspargase associated-toxicities (excluding coagulation abnormalities). Recommendations of the French Society of Children and Adolescent Cancers (Leukemia committee)]. Bull Cancer 2022; 109:1125-1131. [PMID: 35987855 DOI: 10.1016/j.bulcan.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 02/05/2023]
Abstract
Pegaspargase (Oncaspar®), a pegylated form of native Escherichia Coli-derived L-asparaginase is an essential component chemotherapy used in the treatment of acute lymphoblastic leukemia (ALL) in pediatric and adult patients. Its particular toxicity profile requires a specific management to improve safety and tolerability and optimize treatment outcome and therefore survival. Within the framework of workshops of practice harmonization of the French Society of Children and Adolescent Cancers, diagnostic and management of the most commonly occuring toxicities (excluding coagulation abnormalities) during Pegaspargase treatment were reviewed according to the analysis of published studies.
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Affiliation(s)
- Marilyne Poirée
- CHU, service d'oncologie et hématologie pédiatrique, Nice, France.
| | - Florent Neumann
- CHU, service d'immuno hémato oncologie pédiatrique, Dijon, France
| | - Caroline Thomas
- CHU, service d'oncologie et d'immunologie pédiatrique, Nantes, France
| | - Pauline Simon
- CHRU, service d'hémato oncologie pédiatrique, Besançon, France
| | - Anne France Ray Lunven
- AP-HP, hôpital universitaire Robert-Debré, service d'hémato-immunologie pédiatrique, Paris, France
| | - Dominique Plantaz
- CHU, hôpital Couple enfant, clinique universitaire de pédiatrie, Grenoble, France
| | | | - Marion Strullu
- AP-HP, hôpital universitaire Robert-Debré, service d'hémato-immunologie pédiatrique, Paris, France
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7
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Angka L, Tanese de Souza C, Baxter KE, Khan ST, Market M, Martel AB, Tai LH, Kennedy MA, Bell JC, Auer RC. Perioperative arginine prevents metastases by accelerating natural killer cell recovery after surgery. Mol Ther 2022; 30:3270-3283. [PMID: 35619558 PMCID: PMC9552810 DOI: 10.1016/j.ymthe.2022.05.024] [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: 06/02/2021] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022] Open
Abstract
Profound natural killer (NK) cell suppression after cancer surgery is a main driver of metastases and recurrence, for which there is no clinically approved intervention available. Surgical stress is known to cause systemic postoperative changes that negatively modulate NK cell function including the expansion of surgery-induced myeloid-derived suppressor cells (Sx-MDSCs) and a marked reduction in arginine bioavailability. In this study, we determine that Sx-MDSCs regulate systemic arginine levels in the postoperative period and that restoring arginine imbalance after surgery by dietary intake alone was sufficient to significantly reduce surgery-induced metastases in our preclinical murine models. Importantly, the effects of perioperative arginine were dependent upon NK cells. Although perioperative arginine did not prevent immediate NK cell immunoparalysis after surgery, it did accelerate their return to preoperative cytotoxicity, interferon gamma secretion, and activating receptor expression. Finally, in a cohort of patients with colorectal cancer, postoperative arginine levels were shown to correlate with their Sx-MDSC levels. Therefore, this study lends further support for the use of perioperative arginine supplementation by improving NK cell recovery after surgery.
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Affiliation(s)
- Leonard Angka
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | | | - Katherine E Baxter
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Sarwat T Khan
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Marisa Market
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Andre B Martel
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, ON K1H 8L1, Canada; Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Lee-Hwa Tai
- Department of Immunology & Cell Biology, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Michael A Kennedy
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - John C Bell
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Rebecca C Auer
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, ON K1H 8L1, Canada; Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L1, Canada; Centre for Infection, Immunity, and Inflammation, University of Ottawa, Ottawa, ON K1H 8L1, Canada.
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8
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Evaluation of liver function tests to identify hepatotoxicity among acute lymphoblastic leukemia patients who are receiving chemotherapy induction. Sci Rep 2022; 12:13215. [PMID: 35918381 PMCID: PMC9346124 DOI: 10.1038/s41598-022-17618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
The effect of induction chemotherapy on liver function in patients with acute lymphoblastic leukemia is not well documented in Ethiopia. This study assessed hepatotoxicity in patients with acute lymphoblastic leukemia who were undergoing induction chemotherapy in Ethiopia. A 1-month cohort study was undertaken in forty patients with acute lymphoblastic leukemia, with measurements taken at the baseline, second, and fourth weeks. A Log 10 transformation was done because of the skewed distribution of liver function tests. Descriptive statistics such as mean and proportion were calculated. A mixed model ANOVA and Bonferroni post hoc test were computed. A p value < 0.05 was declared to determine statistical significance. Clinically significant hepatotoxicity was observed in 15% of patients. Mild liver injury occurred in 5% of patients. The mean of all liver function tests increased significantly from pre-induction to post-induction. ALT levels were significantly higher in patients who received blood transfusions, but not in those who did not. Regardless of other factors, ALP level in children is significantly higher than in adults, although total bilirubin in adults is higher than in children. A significant proportion of patients had hepatotoxicity. During chemotherapy induction, the mean of all liver function tests rose significantly, but this elevation of serum liver function tests may be transient. Chemotherapy drugs should be given without causing a significant alteration in serum liver function tests. Continuous monitoring of patients should be required.
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9
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Kasonkanji E, Kimani S, Skiver B, Ellis G, Seguin R, Kaimila B, Tomoka T, Mulenga M, Montgomery N, Fedoriw Y, Gopal S, Westmorland KD, Painschab MS. Clinical Characteristics and Outcomes of Acute Lymphoblastic Leukemia in Adolescents and Young Adults in Malawi. JCO Glob Oncol 2022; 8:e2100388. [PMID: 35772043 PMCID: PMC9276115 DOI: 10.1200/go.21.00388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There are limited data on treatment and outcomes for acute lymphoblastic leukemia (ALL) among adolescents and young adults in sub-Saharan Africa. We describe a prospective observational cohort in Malawi.
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Affiliation(s)
| | - Stephen Kimani
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Grace Ellis
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Ryan Seguin
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Bongani Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tamiwe Tomoka
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Nathan Montgomery
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Yuri Fedoriw
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD
| | - Katherine D. Westmorland
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
| | - Matthew S. Painschab
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer, University of North Carolina, Chapel Hill, NC
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10
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Villanueva-Flores F, Zárate-Romero A, Torres AG, Huerta-Saquero A. Encapsulation of Asparaginase as a Promising Strategy to Improve In Vivo Drug Performance. Pharmaceutics 2021; 13:1965. [PMID: 34834379 PMCID: PMC8625962 DOI: 10.3390/pharmaceutics13111965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023] Open
Abstract
Asparaginase (ASNase) is a widely applied chemotherapeutic drug that is used to treat Acute Lymphoblastic Leukemia (ALL); however, immune responses and silent inactivation of the drug often limit its bioavailability. Many strategies have been proposed to overcome these drawbacks, including the development of improved formulations (biobetters), but only two of them are currently on the market. Nano- and micro-encapsulation are some of the most promising and novel approaches to enhance in vivo performance of ASNase, preventing the direct contact of the enzyme with the environment, protecting it from protease degradation, increasing the enzymes catalytic half-life, and in some cases, reducing immunogenicity. This review summarizes the strategies, particularly for ASNase nano- and micro-encapsulation, and their main findings, constraints, and current gaps in the state-of-the-art knowledge. The pros and cons of the use of different nanocarriers are discussed with the idea to ultimately provide safer and more effective treatments for patients with ALL.
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Affiliation(s)
- Francisca Villanueva-Flores
- Centro de Nanociencias y Nanotecnología, Universidad Nacional Autónoma de México, Km. 107 Carretera Tijuana-Ensenada, Ensenada 22860, Mexico; (F.V.-F.); (A.Z.-R.)
| | - Andrés Zárate-Romero
- Centro de Nanociencias y Nanotecnología, Universidad Nacional Autónoma de México, Km. 107 Carretera Tijuana-Ensenada, Ensenada 22860, Mexico; (F.V.-F.); (A.Z.-R.)
| | - Alfredo G. Torres
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77550, USA;
| | - Alejandro Huerta-Saquero
- Centro de Nanociencias y Nanotecnología, Universidad Nacional Autónoma de México, Km. 107 Carretera Tijuana-Ensenada, Ensenada 22860, Mexico; (F.V.-F.); (A.Z.-R.)
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77550, USA;
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11
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Afkhami M, Ally F, Pullarkat V, Pillai RK. Genetics and Diagnostic Approach to Lymphoblastic Leukemia/Lymphoma. Cancer Treat Res 2021; 181:17-43. [PMID: 34626353 DOI: 10.1007/978-3-030-78311-2_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Our understanding of the genetics and biology of lymphoblastic leukemia/lymphoma (acute lymphoblastic leukemia, ALL) has advanced rapidly in the past decade with advances in sequencing and other molecular techniques. Besides recurrent chromosomal abnormalities detected by karyotyping or fluorescence in situ hybridization, these leukemias/lymphomas are characterized by a variety of mutations, gene rearrangements as well as copy number alterations. This is particularly true in the case of Philadelphia-like (Ph-like) ALL, a major subset which has the same gene expression signature as Philadelphia chromosome-positive ALL but lacks BCR-ABL1 translocation. Ph-like ALL is associated with a worse prognosis and hence its detection is critical. However, techniques to detect this entity are complex and are not widely available. This chapter discusses various subsets of ALL and describes our approach to the accurate classification and prognostication of these cases.
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Affiliation(s)
- Michelle Afkhami
- City of Hope Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA.
| | - Feras Ally
- City of Hope Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA
| | - Vinod Pullarkat
- City of Hope Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA
| | - Raju K Pillai
- City of Hope Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA
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12
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Schmidt MP, Ivanov AV, Coriu D, Miron IC. L-Asparaginase Toxicity in the Treatment of Children and Adolescents with Acute Lymphoblastic Leukemia. J Clin Med 2021; 10:jcm10194419. [PMID: 34640436 PMCID: PMC8509606 DOI: 10.3390/jcm10194419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Asparaginase is a basic component of chemotherapy in pediatric acute lymphoblastic leukemia (ALL) and has played a crucial role in improving the long-term survival of this disease. The objectives of this retrospective study were to elucidate the toxicity profile associated with asparaginase in children and adolescents with ALL, to analyze the impact of each type of toxicity on long-term outcomes, and to identify risk factors. We analyzed the medical charts of 165 patients diagnosed with ALL at Sf. Maria Iasi Children’s Hospital from 2010 to 2019 and treated according to a chemotherapeutic protocol containing asparaginase. The median duration of follow-up was 5 years (0.1–11.5 years). Groups of patients with specific types of toxicity were compared to groups of patients without toxicity. We found the following incidence of asparaginase-associated toxicity: 24.1% clinical hypersensitivity, 19.4% hepatotoxicity, 6.7% hypertriglyceridemia, 4.2% hyperglycemia, 3.7% osteonecrosis, 3% pancreatitis, 2.4% thrombosis, and 1.2% cerebral thrombosis. Overall, 82 patients (49.7%) had at least one type of toxicity related to asparaginase. No type of toxicity had a significant impact on overall survival or event-free survival. Being older than 14 years was associated with a higher risk of osteonecrosis (p = 0.015) and hypertriglyceridemia (p = 0.043) and a lower risk of clinical hypersensitivity (p = 0.04). Asparaginase-related toxicity is common and has a varied profile, and its early detection is important for realizing efficient and appropriate management.
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Affiliation(s)
- Madalina-Petronela Schmidt
- Department Hemato-Oncology, “Sf. Maria” Children’s Hospital, 700309 Iasi, Romania; (A.-V.I.); (I.-C.M.)
- Correspondence:
| | - Anca-Viorica Ivanov
- Department Hemato-Oncology, “Sf. Maria” Children’s Hospital, 700309 Iasi, Romania; (A.-V.I.); (I.-C.M.)
- Department Mother and Child Care, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daniel Coriu
- Department Hematology, “Carol Davila” University of Medicine and Pharmacy, 020022 Bucharest, Romania;
- Department Hematology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ingrith-Crenguta Miron
- Department Hemato-Oncology, “Sf. Maria” Children’s Hospital, 700309 Iasi, Romania; (A.-V.I.); (I.-C.M.)
- Department Mother and Child Care, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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13
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Derwich K, Brzezinski A, Karpenko C, Morar V, Atukoralalage U. Acute Lymphoblastic Leukemia in Adolescents and Young Adults: A Polish Perspective. J Adolesc Young Adult Oncol 2021; 11:1-5. [PMID: 34232789 DOI: 10.1089/jayao.2021.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a disease that affects immature lymphocytes in the blood and presents a high prevalence rate in children and adolescent young adult (AYA) populations (15-39 years). AYAs are a unique group who face a significant therapeutic disadvantage when treated with the adult regimen, as evident with lower remission rates, whereas the opposite is true in children. A recent study by EUROCARE-5 showed a marked decrease with age in 5 years relative to survival outcomes based on cancer registries of 27 European countries: 85.8% for patients 0-14 years of age and a decreased 62.2% and 52.8% for patients 15-19 and 20-39 years, respectively. There is growing evidence demonstrating that the pediatric ALL treatment regimen is effective and beneficial when treating AYAs. Treatment of ALL in AYAs around the world is showing improved remission rates with therapeutic advancements and increasing amount of data available with updated clinical trials and regimens. The addition of l-asparaginase into adult treatment regimens has significantly increased the remission rates. This administration to AYAs is more difficult but shows a positive benefit in comparison with the toxicity ratio. This review article will discuss the controversy of AYA patients diagnosed with ALL treated with pediatric or adult protocols and their perspectives in Poland and will focus on ALL etiology, epidemiology, and prognostic factors with comparison of compliance of medications between both populations of patients.
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Affiliation(s)
- Katarzyna Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | | | | | - Vanisha Morar
- Poznan University of Medical Sciences, Poznań, Poland
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14
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Gupta A, Damania RC, Talati R, O'Riordan MA, Matloub YH, Ahuja SP. Increased Toxicity Among Adolescents and Young Adults Compared with Children Hospitalized with Acute Lymphoblastic Leukemia at Children's Hospitals in the United States. J Adolesc Young Adult Oncol 2021; 10:645-653. [PMID: 33512257 DOI: 10.1089/jayao.2020.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose: Adolescent and young adult (AYA) patients (15-39 years old) with acute lymphoblastic leukemia (ALL) have less favorable outcomes and higher treatment-related mortality as compared with older children with ALL. Minimal data exist regarding how well AYA patients tolerate the intensity of chemotherapy at doses and regimens designed for children, and the toxicities suffered by this population at children's hospitals have not been thoroughly characterized. Methods: Pediatric Health Information Systems database was queried to analyze health care outcomes in pediatric (ages 10-14) and AYA patients (ages 15-39) with ALL hospitalized between January 1999 and December 2014. We extracted relevant ICD-9 data for each patient related to grades 3 or 4 toxicities as outlined by the NCI. Results: A total of 5345 hospital admissions met inclusion criteria, representing 4046 unique patients. Of these admissions, 2195 (41.1%) were in the AYA age group, and the remainder were in the 10-14-year-old group. AYA patients had a significantly higher incidence of intensive care unit stay but no difference in median hospital stay nor mortality. AYA patients had increased toxicities in almost every organ system as compared with older children. Conclusions: In this large multicenter US database study, we found an overall increased number of toxicities among AYA patients with ALL in children's hospitals. Compared with children between the ages of 10 and 15, AYA patients developed disproportionately higher toxicities from drugs commonly used in pediatric protocols for ALL. Prospective studies are needed to assess whether dose modifications for certain chemotherapeutics may improve the toxicity profile and health care burden of AYA patients with ALL treated in children's hospitals.
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Affiliation(s)
- Ajay Gupta
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Rahul C Damania
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ravi Talati
- Division of Hematology, Oncology, and Blood and Marrow Transplant, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Mary Ann O'Riordan
- Women's & Children's Services, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Yousif H Matloub
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sanjay P Ahuja
- Division of Pediatric Hematology/Oncology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
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15
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Olivier-Gougenheim L, Arfeuille C, Suciu S, Sirvent N, Plat G, Ferster A, de Moerloose B, Domenech C, Uyttebroeck A, Rohrlich PS, Cavé H, Bertrand Y. Pediatric randomized trial EORTC CLG 58951: Outcome for adolescent population with acute lymphoblastic leukemia. Hematol Oncol 2020; 38:763-772. [PMID: 32809224 DOI: 10.1002/hon.2791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022]
Abstract
Over the years, the prognosis of adolescents treated for acute lymphoblastic leukemia (ALL) has improved. However, this age group still represents a challenge with an overall survival (OS) of 60% compared to 85% in younger children. Herein, we report the outcome of adolescents treated in the European Organisation for Research and Treatment of Cancer (EORTC) 58951 clinical trial. EORTC 58951 clinical trial included patients with de novo ALL between 1998 and 2008. For this study, we analyzed data of all adolescents between 15 and under 18. Data from 97 adolescents were analyzed, 70 had B-lineage and 27 had T-lineage ALL. The 8-year event-free survival (EFS) and OS for the B-cell precursor ALL cases were 72.3% (59.4%-81.7%) and 80.8% (67.4%-89.1%), respectively. For the T-lineage, the 8-year EFS and OS were 57.4% (36.1%-74.0%) and 59.0% (36.1%-76.2%), respectively. "B-other" ALL, defined as BCP-ALL lacking any known recurrent genetic abnormalities were more frequent in our adolescent population (52.8%) than in younger children (27.1%). Outcome of adolescents in the EORTC 58951 study is supporting the findings that adolescents have better outcome in pediatric compared to adults' trials. Nevertheless, in pediatric studies, adolescents still have a worse prognosis than younger children. Despite the fact that specific unfavorable characteristics may be linked to the adolescent population, a careful study and characterization of adolescents "B-other" genetic abnormalities in ALL is critical to improve the outcome of this population.
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Affiliation(s)
- Laura Olivier-Gougenheim
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France
| | - Chloe Arfeuille
- Department of Genetic Biochemistry, Robert-Debré Hospital, AP-HP and University of Paris-Diderot, Paris, France
| | - Stefan Suciu
- European Organization for Research and Treatment of Cancer (EORTC), EORTC Headquarters, Brussels, Belgium
| | - Nicolas Sirvent
- Department of Pediatric and Adolescent Hematology-Oncology, Arnaud de Villeneuve Children's Hospital, Montpellier, France
| | - Geneviève Plat
- Department of Pediatric Hematology and Oncology, Toulouse University Hospital, Toulouse, France
| | - Alina Ferster
- Department of Hematology-Oncology, Reine Fabiola Children Hospital, Brussels, Belgium
| | | | - Carine Domenech
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France
| | - Anne Uyttebroeck
- Department of Pediatric Hematology-Oncology, University Hospitals Leuven, Leuven, Belgium
| | | | - Helene Cavé
- Department of Genetic Biochemistry, Robert-Debré Hospital, AP-HP and University of Paris-Diderot, Paris, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France
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16
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Rank CU, Schmiegelow K. Optimal approach to the treatment of young adults with acute lymphoblastic leukemia in 2020. Semin Hematol 2020; 57:102-114. [PMID: 33256899 DOI: 10.1053/j.seminhematol.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 01/19/2023]
Abstract
Akin to the introduction of tyrosine kinase inhibitors to Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL), pediatric-based asparaginase-heavy approaches have revolutionized the treatment of young adults with the Philadelphia chromosome-negative subset the past decades. Once again, we are approaching a new era. An era of precision medicine with immunotherapy and other molecularly targeted treatments that offers unique opportunities to customize treatment intensity with or without hematopoietic stem cell transplantation, reduce the burden of toxicities, and combat persistent residual disease. Recently approved agents for refractory/relapsed B-cell precursor ALL include the chimeric antigen receptor-modified T-cells, the anti-CD22 monoclonal antibody-drug conjugate, inotuzumab ozogamicin, and the bispecific anti-CD19 T-cell engager, blinatumomab. These agents are expected to move widely into the frontline setting along with the proteasome inhibitors, bortezomib and carfilzomib, as well as tyrosine kinase inhibitors for Philadelphia-like rearrangements that are especially frequent among young adults. To this add the BH3 mimetics, venetoclax and navitoclax, which are being widely explored in refractory/relapsed as well as frontline settings for B- and T-cell ALL. The promising anti-CD38 monoclonal antibody, daratumumab, is entering the scene of refractory/relapsed T-ALL, whereas the old purine analogue, nelarabine, is being evaluated in a new upfront setting. This review focuses on 2 main questions: How do we optimize frontline as well as salvage ALL treatment of young adults in the 2020s? Not least, how do we address the current burden of serious toxicities unique to young adults?
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Affiliation(s)
- Cecilie Utke Rank
- Pediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Pediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.
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17
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Raze T, Lacour B, Cowppli-Bony A, Delafosse P, Velten M, Trétarre B, Defossez G, Hammas K, Woronoff AS, Ganry O, Plouvier S, Coureau G, Guizard AV, Bara S, Monnereau A, Daubisse-Marliac L, Troussard X, D'Almeida T, Baldi I, Bouvier V, Boissel N, Clavel J, Desandes E. Cancer Among Adolescents and Young Adults Between 2000 and 2016 in France: Incidence and Improved Survival. J Adolesc Young Adult Oncol 2020; 10:29-45. [PMID: 32412825 DOI: 10.1089/jayao.2020.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose: This study was undertaken to determine cancer survival and describe the spectrum of cancers diagnosed among French adolescent and young adult (AYA) population. Methods: All cases of cancer diagnosed in 15-24 years, recorded by all French population-based registries (18% of the French population), over the 2000-2016 period, were included. Age-standardized incidence rates, conventional annual percentage change (cAPC) of incidence over time, and 5-year overall survival (5yOS) were calculated. Results: We analyzed 2734 cancer diagnoses in adolescents and 4199 in young adults. Overall incidence rates were 231.9/106 in 15-19 year olds and 354.0/106 in 20-24 year olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors (GCT), Hodgkin lymphoma (HL), and malignant melanoma and were HL, thyroid carcinoma, and malignant melanoma in females. Cancer incidence was stable over time with a cAPC of 0.8% (p = 0.72). For all cancers combined, 5yOS was 86.6% (95% CI: 85.8-87.4), >85% for HL, non-Hodgkin lymphomas (NHL), GCT, thyroid carcinomas, and malignant melanomas, and around 60% and lower for osteosarcomas, Ewing tumors, hepatic carcinomas, and rhabdomyosarcomas. The 5yOS has significantly improved from 2000-2007 to 2008-2015 for all cancers pooled, with a substantial gain of 4% for 15-19 year olds and 3% for 20-24 year olds. Conclusion: Notwithstanding the encouraging results for some cancers, and overall, persistent poorer survivals in AYA were shown compared to children for acute lymphoblastic leukemia, osteosarcoma, Ewing tumor, rhabdomyosarcoma, and malignant hepatic tumors. These disparities require further investigation to identify and address the causes of these inferior outcomes.
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Affiliation(s)
- Thomas Raze
- Registre National des Cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | - Brigitte Lacour
- Registre National des Cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, CHRU Nancy, Vandœuvre-lès-Nancy, France.,Centre de Recherche en Epidémiologie et en Statistique Sorbonne-Paris Cité (CRESS), UMR 1153, INSERM, Université Paris-Descartes, Paris, France
| | - Anne Cowppli-Bony
- Registre des Tumeurs de Loire-Atlantique et Vendée, CHU de Nantes, SIRIC-ILIAD, Nantes, France
| | | | - Michel Velten
- Registre des Cancers du Bas-Rhin, Laboratoire d'épidémiologie et de Santé Publique, Inserm UMR-S1113/Centre Paul Strauss, Service de Santé Publique, Université de Strasbourg, Strasbourg, France
| | | | - Gautier Defossez
- Registre des Cancers de Poitou-Charentes, CHU Poitiers, Poitiers, France
| | - Karima Hammas
- Registre des Cancers du Haut-Rhin, ARER68, Groupe Hospitalier de la Région de Mulhouse et Sud-Alsace (GHRMSA), Mulhouse, France
| | | | - Olivier Ganry
- Registre Général du Cancer de la Somme, CHU Amiens, Amiens, France
| | - Sandrine Plouvier
- Registre Général des Cancers de Lille et de sa Région, GCS-C2RC, Lille, France
| | - Gaelle Coureau
- Epicene, Centre Inserm U1219/CHU de Bordeaux, Service d'information Médicale, Université Bordeaux, Bordeaux, France
| | | | - Simona Bara
- Registre des Cancers de la Manche, Cherbourg-Octeville, France
| | - Alain Monnereau
- Institut Bergonié, Registre des Hémopathies Malignes de la Gironde/Université de Bordeaux, Inserm U1219, équipe EPICENE, ISPED, Bordeaux, France
| | - Laetitia Daubisse-Marliac
- Institut Claudius Regaud, IUCT-O, Registre des Cancers du Tarn, CHU Toulouse/UMR 1027 Université de Toulouse, UPS, Inserm, Toulouse, France
| | - Xavier Troussard
- Registre des Hémopathies Malignes de Basse Normandie, Caen, France
| | - Tania D'Almeida
- Registre Général des Cancers en Région Limousin, CHU de Limoges, Limoges, France
| | - Isabelle Baldi
- Equipe EPICENE, INSERM U1219, Université de Bordeaux/Service Santé Travail Environnement, CHU Bordeaux, Bordeaux, France
| | | | - Nicolas Boissel
- Unité d'Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris/EA-3518, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Jacqueline Clavel
- Centre de Recherche en Epidémiologie et en Statistique Sorbonne-Paris Cité (CRESS), UMR 1153, INSERM, Université Paris-Descartes, Paris, France.,Registre National des Hémopathies Malignes de l'Enfant, Villejuif, France
| | - Emmanuel Desandes
- Registre National des Cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, CHRU Nancy, Vandœuvre-lès-Nancy, France.,Centre de Recherche en Epidémiologie et en Statistique Sorbonne-Paris Cité (CRESS), UMR 1153, INSERM, Université Paris-Descartes, Paris, France
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18
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Kozak MM, Yoo CH, Gutkin PM, von Eyben R, Agarwal R, Donaldson SS, Muffly L, Hiniker SM. Central Nervous System Relapse After Stem Cell Transplantation in Adolescents and Young Adults with Acute Lymphoblastic Leukemia: A Single-Institution Experience. J Adolesc Young Adult Oncol 2020; 9:166-171. [DOI: 10.1089/jayao.2019.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Margaret M. Kozak
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Christopher H. Yoo
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Paulina M. Gutkin
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Rajni Agarwal
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Sarah S. Donaldson
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Lori Muffly
- Division of Blood and Bone Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California
| | - Susan M. Hiniker
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
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19
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Nathan PC, Bremner KE, Liu N, Gupta S, Greenberg ML, McBride ML, Krahn MD, de Oliveira C. Resource Utilization and Costs in Adolescents Treated for Cancer in Pediatric vs Adult Institutions. J Natl Cancer Inst 2020; 111:322-330. [PMID: 30053118 DOI: 10.1093/jnci/djy119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Adolescents with cancer can receive care in pediatric or adult institutions. Survival often differs by locus, but little is known about relative health care utilization and costs. We estimated these in a population-based cohort of adolescents. METHODS All Ontario adolescents (15.0-17.9 years) diagnosed with cancer between 1995 and 2010 were identified from provincial cancer registries. We compared health care resource utilization (hospitalizations, emergency department visits, same-day surgeries, outpatient chemotherapy, radiation, diagnostic/laboratory tests, physician services, home care) and costs (2012 Canadian dollars) during four discrete care phases-prediagnosis (60 days), initial (360 days), continuing (variable), and terminal (360 days)-between adolescents treated in pediatric vs adult institutions, for the whole cohort and within seven diagnostic categories. All statistical tests were two-sided. RESULTS Of 1356 eligible adolescents, 691 and 665 were treated in adult and pediatric institutions, respectively. Hospitalization rates were higher in pediatric institutions during prediagnosis (14.9% vs 6.9%, P < .001), initial (95.1% vs 73.3%, P < .001), and continuing phases (43.2% vs 34.4%, P = .002), but similar (96.1% vs 96.3%, P = .93) during the terminal phase. Average length of stay was higher at pediatric institutions within most diagnoses and phases. For all diagnoses, median initial phase costs were higher in pediatric than adult institutions (eg, leukemia: $153 926 vs $102 418 per 360 days, P < .001; lymphoma: $65 025 vs $19 846, P < .001, respectively). CONCLUSIONS The costs of caring for adolescents with the same malignancy are considerably higher in pediatric than adult institutions during most phases. Resource utilization, particularly hospitalization, drives much of the cost difference, making these data applicable to other jurisdictions.
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Affiliation(s)
- Paul C Nathan
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Mark L Greenberg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Mary L McBride
- British Columbia Cancer Agency, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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20
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Vincristine induces procoagulant activity of the human lymphoblastic leukemia cell line Jurkat through the release of extracellular vesicles. J Thromb Thrombolysis 2020; 48:195-202. [PMID: 31175530 DOI: 10.1007/s11239-019-01894-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Thromboembolic events are frequent and serious complications of acute lymphoblastic leukaemia treatment. The importance of chemotherapy in the pathogenesis of this increased risk is enhanced by the fact that thrombosis rarely occurs at diagnosis. Our study aims at investigating the effect of chemotherapy on pro-coagulant activity (PCA), phosphatidylserine (PS) exposure, tissue factor (TF) activity and derived extracellular vesicles (EV) of Jurkat cells. Jurkat cells were treated with two commonly used chemotherapeutics: Vincristine (VCR) or Daunorubicin (DNR), at relevant concentrations. PCA of cells and derived EV were evaluated using Thrombin generation Assay (TGA). Cells or EV were incubated with annexin V or anti TF antibodies to assess the respective contribution of TF and PS. PS exposure on cells was analysed by flow cytometry. Derived EV were evaluated in fluorescence microscopy and flow cytometry. Untreated Jurkat cells and EV support thrombin generation. Thrombin generation was abolished when PS activity was inhibited by annexin V. VCR treatment resulted in a time dependent increase of thrombin generation. After VCR exposure, TF activity increased as well as PS exposure increased on the cell surface. The increase in TF activity was abolished by annexin V indicating that PS was required. A spontaneous release of EV from Jurkat cells was observed and VCR treatment increased the number of generated EV. Our results indicate that VCR increased the PCA of Jurkat cells predominantly through PS exposure and increased EV generation. Lymphoid blasts derived EV could be biomarkers to determine high thrombotic risk ALL patients.
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21
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Nikonorova IA, Zhu Q, Signore CC, Mirek ET, Jonsson WO, Kong B, Guo GL, Belden WJ, Anthony TG. Age modulates liver responses to asparaginase-induced amino acid stress in mice. J Biol Chem 2019; 294:13864-13875. [PMID: 31413113 DOI: 10.1074/jbc.ra119.009864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/06/2019] [Indexed: 11/06/2022] Open
Abstract
Asparaginase is an amino acid-depleting agent used to treat blood cancers. Metabolic complications due to asparaginase affect liver function in humans. To examine how the liver response to asparaginase changes during maturity to adulthood, here we treated juvenile (2-week), young adult (8-week), and mature adult (16-week) mice with drug or excipient for 1 week and conducted RNA-Seq and functional analyses. Asparaginase reduced body growth and liver mass in juveniles but not in the adult animals. Unbiased exploration of the effect of asparaginase on the liver transcriptome revealed that the integrated stress response (ISR) was the only molecular signature shared across the ages, corroborating similar eukaryotic initiation factor 2 phosphorylation responses to asparaginase at all ages. Juvenile livers exhibited steatosis and iron accumulation following asparaginase exposure along with a hepatic gene signature indicating that asparaginase uniquely affects lipid, cholesterol, and iron metabolism in juvenile mice. In contrast, asparaginase-treated adult mice displayed greater variability in liver function, which correlated with an acute-phase inflammatory response gene signature. Asparaginase-exposed adults also had a serine/glycine/one-carbon metabolism gene signature in liver that corresponded with reduced circulating glycine and serine levels. These results establish the ISR as a conserved response to asparaginase-mediated amino acid deprivation and provide new insights into the relationship between the liver transcriptome and hepatic function upon asparaginase exposure.
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Affiliation(s)
- Inna A Nikonorova
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey 08901
| | - Qiaoqiao Zhu
- Department of Animal Sciences, Rutgers University, New Brunswick, New Jersey 08901
| | - Christina C Signore
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey 08901
| | - Emily T Mirek
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey 08901
| | - William O Jonsson
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey 08901
| | - Bo Kong
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey 08854
| | - Grace L Guo
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey 08854
| | - William J Belden
- Department of Animal Sciences, Rutgers University, New Brunswick, New Jersey 08901
| | - Tracy G Anthony
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey 08901
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GAPDH Expression Predicts the Response to R-CHOP, the Tumor Metabolic Status, and the Response of DLBCL Patients to Metabolic Inhibitors. Cell Metab 2019; 29:1243-1257.e10. [PMID: 30827861 DOI: 10.1016/j.cmet.2019.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 02/06/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease treated with anti-CD20-based immuno-chemotherapy (R-CHOP). We identified that low levels of GAPDH predict a poor response to R-CHOP treatment. Importantly, we demonstrated that GAPDHlow lymphomas use OxPhos metabolism and rely on mTORC1 signaling and glutaminolysis. Consistently, disruptors of OxPhos metabolism (phenformin) or glutaminolysis (L-asparaginase) induce cytotoxic responses in GAPDHlow B cells and improve GAPDHlow B cell-lymphoma-bearing mice survival, while they are low or not efficient on GAPDHhigh B cell lymphomas. Ultimately, we selected four GAPDHlow DLBCL patients, who were refractory to all anti-CD20-based therapies, and targeted DLBCL metabolism using L-asparaginase (K), mTOR inhibitor (T), and metformin (M) (called KTM therapy). Three out of the four patients presented a complete response upon one cycle of KTM. These findings establish that the GAPDH expression level predicts DLBCL patients' response to R-CHOP treatment and their sensitivity to specific metabolic inhibitors.
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23
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Marini BL, Brown J, Benitez L, Walling E, Hutchinson RJ, Mody R, Jasty Rao R, Slagle L, Bishop L, Pettit K, Bixby DL, Burke PW, Perissinotti AJ. A single-center multidisciplinary approach to managing the global Erwinia asparaginase shortage. Leuk Lymphoma 2019; 60:2854-2868. [PMID: 31099289 DOI: 10.1080/10428194.2019.1608530] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The availability of Erwinia Asparaginase has been limited across the world due to manufacturing shortages or for some countries due to the high acquisition cost, putting patients at risk for inferior outcomes. This manuscript provides guidance on how to manage hypersensitivity reactions and utilize therapeutic drug monitoring (TDM) to conserve and limit Erwinia use. The clinical and financial impact of a multidisciplinary committee are also discussed. Faced with a global Erwinia shortage, a multidisciplinary asparaginase allergy committee was created to review all hypersensitivity reactions to asparaginase therapy, staff education was performed on the management of asparaginase hypersensitivity reactions, an institution-wide premedication policy was mandated, and standardized guidelines were created for TDM. This multidisciplinary approach reduced the PEG-asparaginase to Erwinia switch rate from 21% (35 of 163) to 7% (10 of 134) (p = .0035). A multifaceted approach can safely maintain patients on PEG-asparaginase and conserve Erwinia for patients who need it most.
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Affiliation(s)
- Bernard L Marini
- Department of Pharmacy Services and Clinical Sciences Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Julia Brown
- Department of Pharmacy Services and Clinical Sciences Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Lydia Benitez
- Department of Pharmacy Services and Clinical Sciences Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Emily Walling
- Department of Pediatrics and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Raymond J Hutchinson
- Department of Pediatrics and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rajen Mody
- Department of Pediatrics and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rama Jasty Rao
- Department of Pediatrics and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lynn Slagle
- Department of Pediatrics and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lauren Bishop
- Department of Pediatrics and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristen Pettit
- Department of Internal Medicine Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Dale L Bixby
- Department of Internal Medicine Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Patrick W Burke
- Department of Internal Medicine Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Sciences Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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24
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Bade NA, Lu C, Patzke CL, Baer MR, Duong VH, Law JY, Lee ST, Sausville EA, Zimrin AB, Duffy AP, Lawson J, Emadi A. Optimizing pegylated asparaginase use: An institutional guideline for dosing, monitoring, and management. J Oncol Pharm Pract 2019; 26:74-92. [PMID: 30917738 DOI: 10.1177/1078155219838316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The incorporation of L-asparaginase and pegylated asparaginase into pediatric-inspired regimens has conferred a survival advantage in treatment of adults with acute lymphoblastic leukemia. Use of asparaginase products requires careful prevention, monitoring, and management of adverse effects including hypersensitivity, hepatotoxicity, pancreatitis, coagulopathy, and thrombosis. Currently, there is limited published literature to offer guidance on management of these toxicities. At the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, a standard of practice guideline was created to prevent and manage asparaginase-related adverse events. By sharing our long-term experience with asparaginase products and clinical management of asparaginase-induced toxicities, this article aims to improve patient safety and optimize treatment outcomes.
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Affiliation(s)
- Najeebah A Bade
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Crystal Lu
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ciera L Patzke
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, Piscataway, NJ, USA.,Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Maria R Baer
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vu H Duong
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jennie Y Law
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seung T Lee
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward A Sausville
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann B Zimrin
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alison P Duffy
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Pharmacy Practice, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Justin Lawson
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashkan Emadi
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Successful Management of a Child With Drug-induced Necrotizing Pancreatitis During Acute Lymphoblastic Leukemia Therapy: A Case Report. J Pediatr Hematol Oncol 2019; 41:e125-e128. [PMID: 29683955 DOI: 10.1097/mph.0000000000001181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Acute pancreatitis in children acute lymphoblastic leukemia is commonly caused by drugs, for example, L-Asparaginase, pegapargase, steroids. The incidence of this complication is estimated at 6.7% to 18%. Although the majority of drug-induced acute pancreatitis cases are mild, severe cases can rarely occur. This work presents a case of successful management of a child with drug-induced necrotizing pancreatitis during acute lymphoblastic leukemia therapy. This case illustrates that comprehensive care and immediate intensive treatment can rescue patient despite poor prognosis. Administration of octreotide may serve a role in limiting the severity of the disease.
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26
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Acute lymphoblastic leukemia in adolescent and young adults: treat as adults or as children? Blood 2018; 132:351-361. [DOI: 10.1182/blood-2018-02-778530] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/08/2018] [Indexed: 12/21/2022] Open
Abstract
Abstract
Adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) are recognized as a unique population with specific characteristics and needs. In adolescents age 15 to 20 years, the use of fully pediatric protocols is supported by many comparative studies of pediatric and adult cooperative groups. In young adults, growing evidence suggests that pediatric-inspired or even fully pediatric approaches may also dramatically improve outcomes, leading to long-term survival rates of almost 70%, despite diminishing indications of hematopoietic stem-cell transplantation. In the last decade, better knowledge of the ALL oncogenic landscape according to age distribution and minimal residual disease assessments has improved risk stratification. New targets have emerged, mostly in the heterogeneous B-other group, particularly in the Philadelphia-like ALL subgroup, which requires both in-depth molecular investigations and specific evaluations of targeted treatments. The remaining gap in the excellent results reported in children has many other contributing factors that should not be underestimated, including late or difficult access to care and/or trials, increased acute toxicities, and poor adherence to treatment. Specific programs should be designed to take into account those factors and finally ameliorate survival and quality of life for AYAs with ALL.
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27
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Crespo‐Solis E, Espinosa‐Bautista K, Alvarado‐Ibarra M, Rozen‐Fuller E, Pérez‐Rocha F, Nava‐Gómez C, Ortiz‐Zepeda M, Álvarez‐Vera JL, Ramos‐Peñafiel CO, Meillón‐García LA, Rodríguez‐Rodríguez S, Pomerantz‐Okon A, Turrubiates‐Hernández FJ, Demichelis‐Gómez R. Survival analysis of adult patients with ALL in Mexico City: first report from the Acute Leukemia Workgroup (ALWG) (GTLA). Cancer Med 2018; 7:2423-2433. [PMID: 29733512 PMCID: PMC6010727 DOI: 10.1002/cam4.1513] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 11/03/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a hematologic malignancy characterized by the clonal expansion of hematopoietic lymphoid progenitors. With new target therapies, the survival of adults with ALL has improved in the past few decades. Unfortunately, there are no large ALL patient series in many Latin American countries. Data from the Acute Leukemia Workgroup that includes five Mexico City referral centers were used. Survival was estimated for adult patients with ALL during 2009-2015. In total, 559 adults with ALL were included. The median age was 28 years; 67% were classified into the adolescent and young adult group. Cytogenetic information was available in 54.5% of cases. Of the 305 analyzed cases, most had a normal caryotype (70.5%) and Philadelphia-positive was present in 16.7%. The most commonly used treatment regimen was hyper-CVAD. In approximately 20% of cases, there was considerable delay in the administration of chemotherapy. Primarily refractory cases accounted for 13.1% of patients. At the time of analysis, 26.7% of cases had survived. The 3-year overall survival was 22.1%. The main cause of death was disease progression in 228 (55.6%). Clinical and public health strategies are needed to improve diagnosis, treatment and survivorship care for adult with ALL. This multicentric report represents the largest series in Mexico of adult ALL patients in which a survival analysis and risk identification were obtained.
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Affiliation(s)
- Erick Crespo‐Solis
- Hospital Regional de Alta Especialidad de Ciudad VictoriaCiudad VictoriaTamaulipasMéxico
| | | | | | | | | | | | | | | | | | | | | | - Alan Pomerantz‐Okon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránCiudad de MéxicoMéxico
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28
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Thu Huynh V, Bergeron S. Asparaginase Toxicities: Identification and Management in Patients With Acute Lymphoblastic Leukemia
. Clin J Oncol Nurs 2018; 21:E248-E259. [PMID: 28945721 DOI: 10.1188/17.cjon.e248-e259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is a common cancer in children, and outcomes have greatly improved because of the refinement of multiagent chemotherapy regimens that include intensified asparaginase therapy. Asparaginase, a cornerstone of modern pediatric chemotherapy regimens for ALL and asparaginase-containing protocols, is increasingly used in adolescent and adult patients historically treated with asparaginase-free regimens.
. OBJECTIVES This article is an overview of commonly encountered asparaginase-
associated toxicities and offers recommendations for treatment management.
. METHODS A literature review was conducted, reviewing asparaginase and common toxicities, specifically hypersensitivity, pancreatitis, thrombosis, hyperbilirubinemia, and hyperglycemia.
. FINDINGS The rapid identification and management of common asparaginase-associated adverse events can reduce symptom severity and limit potential interruptions to therapy, possibly improving outcomes.
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29
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Friend BD, Schiller GJ. Closing the gap: Novel therapies in treating acute lymphoblastic leukemia in adolescents and young adults. Blood Rev 2018; 32:122-129. [DOI: 10.1016/j.blre.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/28/2017] [Accepted: 09/19/2017] [Indexed: 12/13/2022]
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30
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Theron A, Biron-Andreani C, Haouy S, Saumet L, Saguintah M, Jeziorski E, Sirvent N. [Thromboembolic disease in pediatric oncology]. Arch Pediatr 2018; 25:139-144. [PMID: 29325825 DOI: 10.1016/j.arcped.2017.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 08/20/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
Abstract
The survival rate of children with cancer is now close to 80 %, as a result of continuous improvement in diagnostic and treatment procedures. Prevention and treatment of treatment-associated complications is now a major challenge. Thromboembolic venous disease, due to multifactorial pathogenesis, is a frequent complication (up to 40 % asymptomatic thrombosis in children with cancer), responsible for significant morbidity. Predominantly in children with acute lymphoblastic leukemia, lymphoma, or sarcoma, thromboembolic disease justifies primary prophylaxis in certain populations at risk, whether genetic or environmental. The curative treatment, well codified, is based on the administration of low-molecular-weight heparin. In the absence of robust pediatric prospective studies, this article proposes a concise decision tree summarizing the preventive and curative strategy.
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Affiliation(s)
- A Theron
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Département d'hématologie biologie, centre régional de traitement de l'hémophilie, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - C Biron-Andreani
- Département d'hématologie biologie, centre régional de traitement de l'hémophilie, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - S Haouy
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - L Saumet
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - M Saguintah
- Département de radiologie pédiatrique, CHRU de Montpellier, 371, avenue du Doyen-Gaston Giraud, 34090 Montpellier, France
| | - E Jeziorski
- Département de pédiatrie générale, CHU de Montpellier, 371, avenue du Doyen-Gaston Giraud, 34090 Montpellier, France
| | - N Sirvent
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
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31
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Lassaletta A, Ramaswamy V. Medulloblastoma in adults: they're not just big kids. Neuro Oncol 2018; 18:895-7. [PMID: 27271088 DOI: 10.1093/neuonc/now110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alvaro Lassaletta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada (V.R., A.L.); Department of Pediatric Hematology/Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain (A.L.)
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada (V.R., A.L.); Department of Pediatric Hematology/Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain (A.L.)
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32
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Salzer W, Bostrom B, Messinger Y, Perissinotti AJ, Marini B. Asparaginase activity levels and monitoring in patients with acute lymphoblastic leukemia. Leuk Lymphoma 2017; 59:1797-1806. [DOI: 10.1080/10428194.2017.1386305] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Wanda Salzer
- U.S. Army, Medical Research and Materiel Command, Fort Detrick, MD, USA
| | | | | | | | - Bernard Marini
- University of Michigan, College of Pharmacy, Ann Arbor, MI, USA
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Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia. Leukemia 2017; 32:606-615. [PMID: 28819280 DOI: 10.1038/leu.2017.265] [Citation(s) in RCA: 261] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/06/2017] [Accepted: 08/09/2017] [Indexed: 12/31/2022]
Abstract
Adults with acute lymphoblastic leukemia (ALL) do worse than children. From 7/2008 to 12/2014, Nordic and Baltic centers treated 1509 consecutive patients aged 1-45 years with Philadelphia chromosome-negative ALL according to the NOPHO ALL2008 without cranial irradiation. Overall, 1022 patients were of age 1-9 years (A), 266 were 10-17 years (B) and 221 were 18-45 years (C). Sixteen patients (three adults) died during induction. All others achieved remission after induction or 1-3 intensive blocks. Subsequently, 45 patients (12 adults) died, 122 patients relapsed (32 adults) with a median time to relapse of 1.6 years and 13 (no adult) developed a second malignancy. Median follow-up time was 4.6 years. Among the three age groups, older patients more often had higher risk ALL due to T-ALL (32%/25%/9%, P<0.001), KMT2A rearrangements (6%/5%/3%, P<0.001) and higher day 29 residual leukemia for B-lineage (P<0.001), but not T-ALL (P=0.53). Event-free survival rates (pEFS5y) were 89±1% (A), 80±3% (B) and 74±4% (C) with significant differences only for non-high risk groups. Except for thrombosis, pancreatitis and osteonecrosis, the risk of 19 specified toxicities was not enhanced by age above 10 years. In conclusion, a pediatric-based protocol is tolerable and effective for young adults, despite their increased frequency of higher risk features.
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34
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Boissel N. How should we treat the AYA patient with newly diagnosed ALL? Best Pract Res Clin Haematol 2017; 30:175-183. [PMID: 29050690 DOI: 10.1016/j.beha.2017.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 01/19/2023]
Abstract
Adolescent and young adult (AYA) patients with acute lymphoblastic leukaemia (ALL) are recognized as a unique population with specific characteristics and needs. In adolescents aged 15-20 years old, the use of full paediatric protocols is supported by many comparative studies of paediatric and adult cooperative groups. In young adults, growing evidence suggests that paediatric-inspired approaches may also improve outcomes and lead to long-term survival rates of almost 70%. In the last decade, better knowledge of ALL oncogenic landscape, age distribution, and minimal residual disease prognostic impact have improved risk stratification. New targets have emerged mostly in the heterogeneous subgroup of Philadelphia-like ALL and will require both in-depth molecular investigations and specific evaluations in rare subgroups of ALL. The remaining gap with the excellent results reported in children has many other contributing factors that should not be underestimated including late or difficult access to care, or poor adherence to treatment.
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Affiliation(s)
- Nicolas Boissel
- Adolescent & Young Adult Hematology Unit, Saint-Louis Hospital, EA-3518, Paris 7 University, 1 avenue Claude Vellefaux, 75010, Paris, France.
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35
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Al-Baghdadi RJT, Nikonorova IA, Mirek ET, Wang Y, Park J, Belden WJ, Wek RC, Anthony TG. Role of activating transcription factor 4 in the hepatic response to amino acid depletion by asparaginase. Sci Rep 2017; 7:1272. [PMID: 28455513 PMCID: PMC5430736 DOI: 10.1038/s41598-017-01041-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/17/2017] [Indexed: 12/18/2022] Open
Abstract
The anti-leukemic agent asparaginase activates the integrated stress response (ISR) kinase GCN2 and inhibits signaling via mechanistic target of rapamycin complex 1 (mTORC1). The study objective was to investigate the protective role of activating transcription factor 4 (ATF4) in controlling the hepatic transcriptome and mediating GCN2-mTORC1 signaling during asparaginase. We compared global gene expression patterns in livers from wildtype, Gcn2−/−, and Atf4−/− mice treated with asparaginase or excipient and further explored selected responses in livers from Atf4+/− mice. Here, we show that ATF4 controls a hepatic gene expression profile that overlaps with GCN2 but is not required for downregulation of mTORC1 during asparaginase. Ingenuity pathway analysis indicates GCN2 independently influences inflammation-mediated hepatic processes whereas ATF4 uniquely associates with cholesterol metabolism and endoplasmic reticulum (ER) stress. Livers from Atf4−/− or Atf4+/− mice displayed an amplification of the amino acid response and ER stress response transcriptional signatures. In contrast, reduction in hepatic mTORC1 signaling was retained in Atf4−/− mice treated with asparaginase. Conclusions: GCN2 and ATF4 serve complementary roles in the hepatic response to asparaginase. GCN2 functions to limit inflammation and mTORC1 signaling whereas ATF4 serves to limit the amino acid response and prevent ER stress during amino acid depletion by asparaginase.
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Affiliation(s)
- Rana J T Al-Baghdadi
- Endocrinology and Animal Biosciences Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, NJ, 0890, USA.,Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Al-Qadisiyah, Al-Qadisiayah, Iraq
| | - Inna A Nikonorova
- Department of Nutritional Sciences and the New Jersey Institute for Food, Nutrition and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Emily T Mirek
- Department of Nutritional Sciences and the New Jersey Institute for Food, Nutrition and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Yongping Wang
- Department of Nutritional Sciences and the New Jersey Institute for Food, Nutrition and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Jinhee Park
- Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, 0890, USA
| | - William J Belden
- Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, 0890, USA
| | - Ronald C Wek
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Tracy G Anthony
- Department of Nutritional Sciences and the New Jersey Institute for Food, Nutrition and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.
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Barba P, Dapena JL, Montesinos P, Rives S. Asparaginase use for the treatment of acute lymphoblastic leukemia. Med Clin (Barc) 2017; 148:225-231. [PMID: 28118965 DOI: 10.1016/j.medcli.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/04/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Pere Barba
- Servicio de Hematología, Hospital Universitari Vall d'Hebrón, Universidad Autònoma de Barcelona, Barcelona, España.
| | - José Luis Dapena
- Servicio de Oncología y Hematología pediátricas, Hospital Universitari Vall d'Hebrón, Barcelona, España
| | - Pau Montesinos
- Hospital Universitari i Politècnic la Fe, València, España
| | - Susana Rives
- Hospital Universitari Sant Joan de Déu, Barcelona, España
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Lutz S, Williams E, Muthu P. Engineering Therapeutic Enzymes. DIRECTED ENZYME EVOLUTION: ADVANCES AND APPLICATIONS 2017:17-67. [DOI: 10.1007/978-3-319-50413-1_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Muffly L, Lichtensztajn D, Shiraz P, Abrahão R, McNeer J, Stock W, Keegan T, Gomez SL. Adoption of pediatric-inspired acute lymphoblastic leukemia regimens by adult oncologists treating adolescents and young adults: A population-based study. Cancer 2017; 123:122-130. [PMID: 27622953 PMCID: PMC5161602 DOI: 10.1002/cncr.30322] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies have demonstrated superior outcomes for adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) who are treated using pediatric versus adult therapeutic regimens. To the best of our knowledge, whether adult oncologists in the United States have adopted this approach to ALL in AYA patients is currently unknown. The objective of the current study was to provide a population-based description of ALL treatment patterns in AYA individuals over the past decade. METHODS Data regarding AYA patients aged 15 to 39 years and diagnosed with ALL between 2004 and 2014 while living in the Greater Bay Area were obtained from the Greater Bay Area Cancer Registry (GBACR). Treating facilities were designated as pediatric or adult centers; induction treatment regimens were abstracted from registry text data fields. RESULTS Of 304 patients diagnosed in the GBACR catchment region, complete treatment data were available for 229 (75%). The location of care was identified for 296 patients (97%) treated at 31 unique centers. Approximately 70% of AYA patients received induction therapy at an adult treatment center. All AYA patients who were treated at pediatric centers received pediatric ALL regimens. Among AYA patients treated by adult oncologists with complete treatment data, none received a pediatric regimen before 2008. Between 2008 and 2012, while the US Adult Intergroup C10403 pediatric-inspired ALL protocol was open to accrual, 31% of AYA patients treated by adult oncologists received pediatric regimens. This rate fell to 21% from 2013 through 2014. Adult facilities treating ≥ 2 AYA patients with ALL per year captured in the GBACR were more likely to administer pediatric regimens than lower volume centers (P = .03). CONCLUSIONS As of 2014, only a minority of AYA patients with ALL received pediatric ALL regimens at adult cancer centers. Cancer 2017;122-130. © 2016 American Cancer Society.
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Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California
- Stanford Cancer Institute, Stanford University, Stanford, California
| | | | - Parveen Shiraz
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California
| | - Renata Abrahão
- Cancer Prevention Institute of California, Freemont, California
| | - Jennifer McNeer
- Section of Hematology/Oncology, Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Theresa Keegan
- Division of Hematology and Oncology, Department of Medicine, University of California at Davis School of Medicine, Sacramento, California
| | - Scarlett Lin Gomez
- Stanford Cancer Institute, Stanford University, Stanford, California
- Cancer Prevention Institute of California, Freemont, California
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Guzauskas GF, Villa KF, Vanhove GF, Fisher VL, Veenstra DL. Risk-Benefit Analysis of Pediatric-Inspired Versus Hyperfractionated Cyclophosphamide, Vincristine, Doxorubicin, and Dexamethasone Protocols for Acute Lymphoblastic Leukemia in Adolescents and Young Adults. J Adolesc Young Adult Oncol 2016; 6:53-61. [PMID: 27779442 PMCID: PMC5346961 DOI: 10.1089/jayao.2016.0049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: To estimate the risk–benefit trade-off of a pediatric-inspired regimen versus hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) for first-line treatment of adolescents/young adult (AYA; ages 16–39 years) patients with Philadelphia-negative acute lymphoblastic leukemia. Methods: Patient outcomes were simulated using a 6-state Markov model, including complete response (CR), no CR, first relapse, second CR, second relapse, and death. A Weibull distribution was fit to the progression-free survival curve of hyper-CVAD–treated AYA patients from a single-center study, and comparable patient data from a retrospective study of pediatric regimen–treated AYA patients were utilized to estimate a relative progression difference (hazard ratio = 0.51) and model survival differences. Health-state utilities were estimated based on treatment stage, with an assumption that the pediatric protocol had 0.10 disutility compared with hyper-CVAD before the maintenance phase of treatment. Total life-years and quality-adjusted life-years (QALYs) were compared between treatment protocols at 1, 5, and 10 years, with additional probabilistic sensitivity analyses. Results: Treatment with the pediatric-inspired protocol was associated with a 0.04 increase in life-years, but a 0.01 decrease in QALYs at 1 year. By years 5 and 10, the pediatric-inspired protocol resulted in 0.18 and 0.24 increase in life-years and 0.25 and 0.32 increase in QALYs, respectively, relative to hyper-CVAD. The lower quality of life associated with the induction and intensification phases of pediatric treatment was offset by more favorable progression-free survival and overall survival relative to hyper-CVAD. Conclusions: Our exploratory analysis suggests that, compared with hyper-CVAD, pediatric-inspired protocols may increase life-years throughout treatment stages and QALYs in the long term.
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Affiliation(s)
- Gregory F Guzauskas
- 1 Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington , Seattle, Washington
| | | | | | | | - David L Veenstra
- 1 Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington , Seattle, Washington
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40
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Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271-89. [PMID: 27253694 DOI: 10.3322/caac.21349] [Citation(s) in RCA: 3404] [Impact Index Per Article: 425.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
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Affiliation(s)
- Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Director, Health Services Research, Intramural Research Department, American Cancer Society, Atlanta, GA
| | - Angela B Mariotto
- Branch Chief, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Joan L Kramer
- Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Julia H Rowland
- Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
| | - Kevin D Stein
- Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Rick Alteri
- Medical Editor, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Pui CH. Is Erwinase Necessary for all Children With ALL and Allergic Reactions to E. coli Asparaginase? Pediatr Blood Cancer 2016; 63:587-8. [PMID: 26739648 PMCID: PMC4755852 DOI: 10.1002/pbc.25876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Ching-Hon Pui
- Departments of Oncology and Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee,Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee,Correspondence to: Ching-Hon Pui, MD, Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678.
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