OUP accepted manuscript

Improving nutritional status after allogeneic stem cell transplantation: results of phase 2 ALLONUT clinical trial

Malnutrition increases the risk of non-relapse mortality after allogeneic stem cell transplantation (aHSCT). Here are the results of the ALLONUT clinical trial designed to improve the nutritional outcome of patients receiving aHSCT. ALLONUT is a prospective open label phase 2 clinical trial assessing the efficacy of a close tailored nutritional support and management with traditional and original solutions to improve patients nutritional status following aHSCT. Nutritional status evaluation was performed before transplantation, on Day 0, 30, 100 and one year after transplantation. The study involved 70 patients treated by aHSCT. 10% of patients were moderately or severely malnutrition at baseline and 26.9 were severely malnutrition at D30. Patients' nutritional status improved thanks to the cooking classes and the personalized outpatient nutrition program. At D100, 23% were still malnutrition, while only 10.8% were severely malnutrition one year after transplantation. The QLQ-C30 show that quality of life (QoL) decreased until D30, and improve to reach the pre-transplant level on D100 before exceeding it on D360. The study confirmed that a close, personalized nutritional program combining traditional and original measures can improve both nutritional status and QoL for patients suffering from moderate or severe malnutrition after aHCST.

Silencing LINC00987 ameliorates adriamycin resistance of acute myeloid leukemia via miR-4458/HMGA2 axis

BACKGROUND

Most patients with acute myeloid leukemia (AML) eventually develop drug resistance, leading to a poor prognosis. Dysregulated long gene non coding RNAs (lincRNAs) have been implicated in chemoresistance in AML. Unfortunately, the effects of lincRNAs which participate in regulating the Adriamycin (ADR) resistance in AML cells remain unclear. Thus, the purpose of this study is to determine LINC00987 function in ADR-resistant AML.

METHODS

In this study, ADR-resistant cells were constructed. LINC00987, miRNAs, and HMGA2 mRNA expression were measured by qRT-PCR. P-GP, BCRP, and HMGA2 protein were measured by Western blot. The proliferation was analyzed by MTS and calculated IC50. Soft agar colony formation assay and TUNEL staining were used to analyze cell colony formation and apoptosis. Xenograft tumor experiment was used to analyze the xenograft tumor growth of ADR-resistant AML.

RESULTS

We found that higher expression of LINC00987 was observed in AML patients and associated with poor overall survival in AML patients. LINC00987 expression was increased in ADR-resistant AML cells, including ADR/MOLM13 and ADR/HL-60 cells. LINC00987 downregulation reduces ADR resistance in ADR/MOLM13 and ADR/HL-60 cells in vitro and in vivo, while LINC00987 overexpression enhanced ADR resistance in MOLM13 and HL-60 cells. Additionally, LINC00987 functions as a competing endogenous RNA for miR-4458 to affect ADR resistance in ADR/MOLM13 and ADR/HL-60 cells. HMGA2 is a target of miR-4458. LINC00987 knockdown and miR-4458 overexpression reduced HMGA2 expression. HMGA2 overexpression enhanced ADR resistance, which reversed the function of LINC00987 silencing in suppressing ADR resistance of ADR/MOLM13 and ADR/HL-60 cells.

CONCLUSIONS

Downregulation of LINC00987 weakens ADR resistance by releasing miR-4458 to deplete HMGA2 in ADR/MOLM13 and ADR/HL-60. Therefore, LINC00987 may act as the therapeutic target for treating chemoresistant AML.

Impact of a novel prognostic model on allogeneic hematopoietic stem cell transplantation outcomes in patients with CMML

Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell malignancy, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curable treatment. The outcomes after transplant are influenced by both disease characteristics and patient comorbidities. To develop a novel prognostic model to predict the post-transplant survival of CMML patients, we identified risk factors by applying univariable and multivariable Cox proportional hazards regression to a derivation cohort. In multivariable analysis, advanced age (hazard ratio [HR] 3.583), leukocyte count (HR 3.499), anemia (HR 3.439), bone marrow blast cell count (HR 2.095), and no chronic graft versus host disease (cGVHD; HR 4.799) were independently associated with worse survival. A novel prognostic model termed ABLAG (Age, Blast, Leukocyte, Anemia, cGVHD) was developed and the points were assigned according to the regression equation. The patients were categorized into low risk (0-1), intermediate risk (2, 3), and high risk (4-6) three groups and the 3-year overall survival (OS) were 93.3% (95%CI, 61%-99%), 78.9% (95%CI, 60%-90%), and 51.6% (95%CI, 32%-68%; p < .001), respectively. In internal and external validation cohort, the area under the receiver operating characteristic (ROC) curves of the ABLAG model were 0.829 (95% CI, 0.776-0.902) and 0.749 (95% CI, 0.684-0.854). Compared with existing models designed for the nontransplant setting, calibration plots, and decision curve analysis showed that the ABLAG model revealed a high consistency between predicted and observed outcomes and patients could benefit from this model. In conclusion, combining disease and patient characteristic, the ABLAG model provides better survival stratification for CMML patients receiving allo-HSCT.

SUMO specific peptidase 1 decreases after induction treatment, and its reduction predicts lower disease risk, better treatment response, longer survival of acute myeloid leukemia

Small ubiquitin-related modifier-specific peptidase 1 (SENP1) takes part in the pathogenesis and progression of hematological malignancies, while its clinical role in acute myeloid leukemia (AML) is unclear. This study aimed to explore the potential of SENP1 to serve as a biomarker reflecting disease risk, treatment response, and survival of AML. A total of 110 AML patients, 30 disease controls (DCs), and 30 healthy controls (HCs) were included. SENP1 in bone marrow samples was detected by RT-qPCR. SENP1 was the top in AML patients (median (interquartile range (IQR)): 2.429 (1.854-3.772)), the second top in DCs (median (IQR): 1.587 (1.023-2.217)), and the lowest in HCs (median (IQR): 0.992 (0.806-1.702)) (p < 0.001). In AML patients, SENP1 was positively associated with white blood cells (rs = 0.210, p = 0.028) and bone marrow blasts (rs = 0.212, p = 0.026) but negatively linked to Inv(16) or t(16;16) presence (p = 0.040). Furthermore, SENP1 was decreased post-treatment vs. at baseline (before induction treatment) in total AML patients (p < 0.001), and in patients with CR (p < 0.001), but not in patients with non-CR (p = 0.055). Additionally, SENP1 at baseline slightly (p = 0.050) but SENP1 post-treatment dramatically (p < 0.001) decreased in patients with CR compared to those with non-CR. Notably, low SENP1 at baseline was related to prolonged EFS (p = 0.007) and OS (p = 0.039); meanwhile, declined SENP1 post-induction treatment showed a more predominant linkage with satisfied EFS (p < 0.001) and OS (p < 0.001). SENP1 is decreased after induction therapy, whose reduction is related to low disease risk, favorable treatment response, and prolonged survival of AML.

Azacitidine Post-Remission Therapy for Elderly Patients with AML: A Randomized Phase-3 Trial (QoLESS AZA-AMLE)

This phase-3 randomized multicenter trial evaluated the efficacy of subcutaneous azacitidine (AZA) post-remission therapy vs. best supportive care (BSC) in elderly acute myeloid leukemia (AML) patients. The primary endpoint was the difference in disease-free survival (DFS) from complete remission (CR) to relapse/death. Patients with newly diagnosed AML aged ≥61 years received two courses of induction chemotherapy ("3+7" daunorubicin and cytarabine) followed by consolidation (cytarabine). At CR, 54 patients were randomized (1:1) to receive BSC (N = 27) or AZA (N = 27) at a dose of 50 mg/m² for 7 days every 28 days and the dose increased after the 1st cycle to 75 mg/m² for a further 5 cycles, followed by cycles every 56 days for 4.5 years. At 2 years, median DFS was 6.0 (95% CI: 0.2-11.7) months for patients receiving BSC vs. 10.8 months (95% CI: 1.9-19.6, p = 0.20) months for AZA. At 5 years, DFS was 6.0 (95% CI: 0.2-11.7) months in the BSC arm vs. 10.8 (95% CI: 1.9-19.6, p = 0.23) months in the AZA arm. Significant benefit was afforded by AZA on DFS at 2 and 5 years in patients aged >68 years (HR = 0.34, 95% CI: 0.13-0.90, p = 0.030 and HR = 0.37, 95% CI: 0.15-0.93, p = 0.034, respectively). No deaths occurred prior to leukemic relapse. Neutropenia was the most frequent adverse event. There were no differences in patient-reported outcome measures between study arms. In conclusion, AZA post-remission therapy was found to provide benefit in AML patients aged >68 years.

How to improve the outcomes of elderly acute myeloid leukemia patients through allogeneic hematopoietic stem cell transplantation

In recent years, with the gradual advancement of haploidentical transplantation technology, the availability of donors has increased significantly, along with the widespread use of reduced-intensity conditioning and the improvement of nursing techniques, giving more elderly acute myeloid leukemia (AML) patients the chance to receive allogeneic hematopoietic stem cell transplantation. We have summarized the classic and recently proposed pre-transplant assessment methods and assessed the various sources of donors, conditioning regimens, and post-transplant complication management based on the outcomes of large-scale clinical studies for elderly AML patients.

Therapeutic Strategy of Mesenchymal-Stem-Cell-Derived Extracellular Vesicles as Regenerative Medicine

Extracellular vesicles (EVs) are lipid bilayer membrane particles that play critical roles in intracellular communication through EV-encapsulated informative content, including proteins, lipids, and nucleic acids. Mesenchymal stem cells (MSCs) are pluripotent stem cells with self-renewal ability derived from bone marrow, fat, umbilical cord, menstruation blood, pulp, etc., which they use to induce tissue regeneration by their direct recruitment into injured tissues, including the heart, liver, lung, kidney, etc., or secreting factors, such as vascular endothelial growth factor or insulin-like growth factor. Recently, MSC-derived EVs have been shown to have regenerative effects against various diseases, partially due to the post-transcriptional regulation of target genes by miRNAs. Furthermore, EVs have garnered attention as novel drug delivery systems, because they can specially encapsulate various target molecules. In this review, we summarize the regenerative effects and molecular mechanisms of MSC-derived EVs.