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Chen H, Zhuang J, Zhang W, Zhou D, Wang X, Jia C, Zhao D. Vaginal involvement as a rare extranodal manifestation in advanced-stage follicular lymphoma: a case report and literature review. Ann Hematol 2024:10.1007/s00277-024-05950-2. [PMID: 39177796 DOI: 10.1007/s00277-024-05950-2] [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] [Received: 04/04/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024]
Abstract
Apart from bone marrow involvement, extranodal involvement of follicular lymphoma (FL) is rare. Gynecologic FL is seldom reported, among which the vagina is the rarest involved site. No vaginal involvement in advanced-staged FL was reported before. Here, we report a case of FL with systemic involvement including the vagina.
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Affiliation(s)
- Hongyun Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Junling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xiaoyu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Congwei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Danqing Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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2
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Sant M, Vener C, Lillini R, Rossi S, Bonfarnuzzo S, Marcos-Gragera R, Maynadié M, Innos K, Paapsi K, Visser O, Bernasconi A, Demuru E, Di Benedetto C, Mousavi SM, Blum M, Went P, Serraino D, Bennett D, Sánchez MJ, De Angelis R. Long-term survival for lymphoid neoplasms and national health expenditure (EUROCARE-6): a retrospective, population-based study. Lancet Oncol 2024; 25:731-743. [PMID: 38703784 DOI: 10.1016/s1470-2045(24)00141-4] [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: 11/13/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Management of lymphoid malignancies requires substantial health system resources. Total national health expenditure might influence population-based lymphoid malignancy survival. We studied the long-term survival of patients with 12 lymphoid malignancy types and examined whether different levels of national health expenditure might explain differences in lymphoid malignancy prognosis between European countries and regions. METHODS For this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset of patients aged 15 or older diagnosed between 2001 and 2013 with one of 12 lymphoid malignancies defined according to International Classification of Disease for Oncology (third edition) and WHO classification, and followed up to 2014 (Jan 1, 2001-Dec 31, 2014). Countries were classified according to their mean total national health expenditure quartile in 2001-13. For each lymphoid malignancy, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, gender, and total national health expenditure on the relative excess risk of death (RER). FINDINGS 82 cancer registries (61 regional and 21 national) from 27 European countries provided data eligible for 10-year survival estimates comprising 890 730 lymphoid malignancy cases diagnosed in 2001-13. Median follow-up time was 13 years (IQR 13-14). Of the 12 lymphoid malignancies, the 10-year ASRS in Europe was highest for hairy cell leukaemia (82·6% [95% CI 78·9-86·5) and Hodgkin lymphoma (79·3% [78·6-79·9]) and lowest for plasma cell neoplasms (29·5% [28·9-30·0]). RER increased with age at diagnosis, particularly from 55-64 years to 75 years or older, for all lymphoid malignancies. Women had higher ASRS than men for all lymphoid malignancies, except for precursor B, T, or natural killer cell, or not-otherwise specified lymphoblastic lymphoma or leukaemia. 10-year ASRS for each lymphoid malignancy was higher (and the RER lower) in countries in the highest national health expenditure quartile than in countries in the lowest quartile, with a decreasing pattern through quartiles for many lymphoid malignancies. 10-year ASRS for non-Hodgkin lymphoma, the most representative class for lymphoid malignancies based on the number of incident cases, was 59·3% (95% CI 58·7-60·0) in the first quartile, 57·6% (55·2-58·7) in the second quartile, 55·4% (54·3-56·5) in the third quartile, and 44·7% (43·6-45·8) in the fourth quartile; with reference to the European mean, the RER was 0·80 (95% CI 0·79-0·82) in the first, 0·91 (0·90-0·93) in the second, 0·94 (0·92-0·96) in the third, and 1·45 (1·42-1·48) in the fourth quartiles. INTERPRETATION Total national health expenditure is associated with geographical inequalities in lymphoid malignancy prognosis. Policy decisions on allocating economic resources and implementing evidence-based models of care are needed to reduce these differences. FUNDING Italian Ministry of Health, European Commission, Estonian Research Council.
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Affiliation(s)
- Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Vener
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Epidemiology and Prevention Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Roberto Lillini
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Simone Bonfarnuzzo
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - Marc Maynadié
- Registre des Hémopathies Malignes de Côte d'Or, University of Burgundy and Dijon University Hospital, Dijon, France
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Demuru
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Corrado Di Benedetto
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | | | - Marcel Blum
- East Switzerland Cancer Registry and Cancer Registry Liechtenstein, St Gallen, Switzerland
| | - Philip Went
- Institut für Pathologie, Kantonsspital Graubünden, Chur, Switzerland
| | | | - Damien Bennett
- Northern Ireland Cancer Registry (NICR), Belfast, UK; Queens University Belfast (QUB), Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, UK
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria ibs Granada, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
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3
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Watanabe T, Tobinai K, Wakabayashi M, Maruyama D, Yamamoto K, Kubota N, Shimada K, Asagoe K, Yamaguchi M, Ando K, Ogura M, Kuroda J, Suehiro Y, Matsuno Y, Tsukasaki K, Nagai H. R-CHOP treatment for patients with advanced follicular lymphoma: Over 15-year follow-up of JCOG0203. Br J Haematol 2024; 204:849-860. [PMID: 37996986 DOI: 10.1111/bjh.19213] [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] [Received: 09/01/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
Anti-CD20 antibody in combination with chemotherapy extends overall survival (OS) in untreated advanced-stage follicular lymphoma (FL), yet the optimal associated therapy is unclear. Data on the cumulative incidence of secondary malignancies postrelapse after conventional immunochemotherapy are scarce. A long-term analysis of rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) as first-line treatment was conducted in a randomised clinical trial. A six-cycle R-CHOP regimen was administered every 2 or 3 weeks without rituximab maintenance. A prespecified evaluation was conducted 15 years after the completion of enrolment, following initial analysis results that showed no significant differences in outcomes at the 3-year mark. In-depth analyses were performed on the cohort of 248 patients with FL who were allocated to the two treatment arms. With a median follow-up period of 15.9 years, the 15-year OS was 76.2%. There were no protocol treatment-related deaths, nor were there any fatal infections attributable to subsequent lymphoma treatment. At 15 years, the cumulative incidence of non-haematological and haematological malignancies was 12.8% and 3.7% respectively. Histological transformation appeared after a median of 8 years. R-CHOP maintains safety and efficacy in patients with advanced FL over extended follow-up, making it a viable first-line option for patients with advanced-stage FL.
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Affiliation(s)
- Takashi Watanabe
- Department of Haematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Haematology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Dai Maruyama
- Department of Haematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhito Yamamoto
- Department of Haematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
| | - Nobuko Kubota
- Department of Haematology, Saitama Cancer Center, Saitama, Japan
| | - Kazuyuki Shimada
- Department of Haematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohsuke Asagoe
- Department of Haematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Motoko Yamaguchi
- Department of Haematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kiyoshi Ando
- Division of Haematology/Oncology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Michinori Ogura
- Department of Haematology and Oncology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Junya Kuroda
- Division of Haematology and Oncology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Youko Suehiro
- Department of Haematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yoshihiro Matsuno
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Kunihiro Tsukasaki
- Department of Haematology, International Medical Center, Saitama Medical University, Moriyama, Japan
| | - Hirokazu Nagai
- Department of Haematology and Oncology Research National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
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4
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Meng P, Chen Z, Sun T, Wu L, Wang Y, Guo T, Yang J, Zhu J. Sheng-Mai-Yin inhibits doxorubicin-induced ferroptosis and cardiotoxicity through regulation of Hmox1. Aging (Albany NY) 2023; 15:10133-10145. [PMID: 37770231 PMCID: PMC10599746 DOI: 10.18632/aging.205062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/02/2023] [Indexed: 10/03/2023]
Abstract
Doxorubicin (DOX) is a potent chemotherapeutic drug used for treating various cancers. However, its clinical use is limited due to its severe cardiotoxicity, which often results in high mortality rates. Sheng-Mai-Yin (SMY), a Traditional Chinese medicine (TCM) prescription, has been reported to exert a cardioprotective effect in various cardiovascular diseases, including DOX-induced cardiotoxicity (DIC). This study aimed to provide novel insights into the underlying cardioprotective mechanism of SMY. SMY, composed of Codonopsis pilosula (Franch.), Ophiopogon japonicus (Thunb.), and Schisandra chinensis (Turcz.) at a ratio of 3:2:1, was intragastrically administered to male C57BL/6 mice for five days prior to the intraperitoneal injection of mitoTEMPO. One day later, DOX was intraperitoneally injected. Hematoxylin-eosin staining and Sirius red staining were carried out to estimate the pharmacological effect of SMY on cardiotoxicity. Mitochondrial function and ferroptosis biomarkers were also examined. AAV was utilized to overexpress Hmox1 to confirm whether Hmox1-mediated ferroptosis is associated with the cardioprotective effect of SMY on DOX-induced cardiotoxicity. The findings revealed that SMY therapy reduced the number of damaged cardiomyocytes. SMY therapy also reversed the inductions of cardiac MDA, serum MDA, LDH, and CK-MB contents, which dramatically decreased nonheme iron levels. In the meantime, SMY corrected the changes to ferroptosis indices brought on by DOX stimulation. Additionally, Hmox1 overexpression prevented SMY's ability to reverse cardiotoxicity. Our results showed that SMY effectively restrained lipid oxidation, reduced iron overload, and inhibited DOX-induced ferroptosis and cardiotoxicity, possibly via the mediation of Hmox1.
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Affiliation(s)
- Peina Meng
- Department of Preventive Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhaoyang Chen
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tianhui Sun
- Department of Preventive Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lili Wu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yifan Wang
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tianwei Guo
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jin Yang
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiebin Zhu
- Department of Preventive Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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5
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He Y, Xi J, Fang J, Zhang B, Cai W. Aloe-emodin alleviates doxorubicin-induced cardiotoxicity via inhibition of ferroptosis. Free Radic Biol Med 2023; 206:13-21. [PMID: 37364691 DOI: 10.1016/j.freeradbiomed.2023.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
Aloe-emodin (AE), a novel ferroptosis inhibitor, alleviates the doxorubicin (DOX)-induced cardiotoxicity in H9c2 rat cardiomyocytes. The inhibition of ferroptosis and the protective effect against cardiotoxicity were evaluated via MTT assay in H9c2 cells. The molecular mechanism of action (MOA) of nuclear factor erythroid 2-related factor 2 (Nrf2) activation, including transactivation of multiple downstream cytoprotective genes, were further assessed by Western blot, luciferase reporter assay and qRT-PCR analyses. Fluorescent imaging was performed to detect the change of intracellular reactive oxygen species, mitochondrial membrane potential and lipid peroxidation. In addition, an infrared spectroscopy was employed to detect the AE-Fe (II) complex. AE, alleviates oxidative stress in DOX-induced H9c2 cells by activating Nrf2 and increasing the expression of Nrf2 downstream antioxidant genes, SLC7A11 and GPX4. Furthermore, AE complexes bivalent iron and regulates the intracellular iron-related genes. In conclusion, the discovery of AE as a novel ferroptosis inhibitor and its MOA provides a new perspective for further exploration of cardio-protective agents in cancer patients during chemotherapy.
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Affiliation(s)
- Ying He
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Junmin Xi
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Jianguo Fang
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou, Gansu, 730000, China; School of Chemistry and Chemical Engineering, Nanjing University of Science & Technology, Nanjing, Jiangsu, 210094, China
| | - Baoxin Zhang
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou, Gansu, 730000, China.
| | - Wenqing Cai
- Regor Therapeutics Inc,1206 Zhangjiang Road, Building C, Pu Dong New District, Shanghai, 201210, China.
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6
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Gao F, Liu H, Meng X, Liu J, Wang J, Yu J, Liu X, Liu X, Li L, Qiu L, Qian Z, Zhou S, Gong W, Meng B, Ren X, Golchehre Z, Chavoshzadeh Z, He J, Zhang H, Wang X. Integrative genomic and transcriptomic analysis reveals genetic alterations associated with the early progression of follicular lymphoma. Br J Haematol 2023; 202:1151-1164. [PMID: 37455019 DOI: 10.1111/bjh.18974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Follicular lymphoma (FL), the most common indolent lymphoma, is a clinically and genetically heterogeneous disease. However, the prognostic value of driver gene mutations and copy number alterations has not been systematically assessed. Here, we analysed the clinical-biological features of 415 FL patients to identify variables associated with disease progression within 24 months of first-line therapy (POD24). Patients with B symptoms, elevated lactate dehydrogenase and β2-microglobulin levels, unfavourable baseline haemoglobin levels, advanced stage, and high-risk FL International Prognostic Index (FLIPI) scores had an increased risk of POD24, with FLIPI being the most important factor in logistic regression. HIST1H1D, identified as a driver mutation, was correlated with POD24. Gains of 6p22.2 (HIST1H1D) and 18q21.33 (BCL2) and loss of 1p36.13 (NBPF1) predicted POD24 independent of FLIPI. Gene expression profiling of FL samples showed that the POD24 cohort was significantly enriched in the inflammatory response (mediated by interferon and tumour necrosis factor), cell cycle regulation (transcription, replication and proliferation) sets and PI3K-AKT-mTOR signalling. This result was further validated with transcriptome-wide information provided by RNA-seq at single-cell resolution. Our study, performed on a large cohort of FL patients, highlights the importance of distinctive genetic alterations and gene expression relevant to disease diagnosis and early progression.
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Affiliation(s)
- Fenghua Gao
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Hengqi Liu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xiangrui Meng
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Jing Liu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Jiesong Wang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
- Department of Lymphoma & Head and Neck Oncology, College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Jingwei Yu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xia Liu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xianming Liu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Lanfang Li
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Lihua Qiu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Zhengzi Qian
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Shiyong Zhou
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Wenchen Gong
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Bin Meng
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiubao Ren
- Department of Immunology/Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zahra Golchehre
- Department of Medical Genetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Chavoshzadeh
- Department of Immunology/Allergy, Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jin He
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xianhuo Wang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
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7
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Dreval K, Hilton LK, Cruz M, Shaalan H, Ben-Neriah S, Boyle M, Collinge B, Coyle KM, Duns G, Farinha P, Grande BM, Meissner B, Pararajalingam P, Rushton CK, Slack GW, Wong J, Mungall AJ, Marra MA, Connors JM, Steidl C, Scott DW, Morin RD. Genetic subdivisions of follicular lymphoma defined by distinct coding and noncoding mutation patterns. Blood 2023; 142:561-573. [PMID: 37084389 PMCID: PMC10644066 DOI: 10.1182/blood.2022018719] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
Follicular lymphoma (FL) accounts for ∼20% of all new lymphoma cases. Increases in cytological grade are a feature of the clinical progression of this malignancy, and eventual histologic transformation (HT) to the aggressive diffuse large B-cell lymphoma (DLBCL) occurs in up to 15% of patients. Clinical or genetic features to predict the risk and timing of HT have not been described comprehensively. In this study, we analyzed whole-genome sequencing data from 423 patients to compare the protein coding and noncoding mutation landscapes of untransformed FL, transformed FL, and de novo DLBCL. This revealed 2 genetically distinct subgroups of FL, which we have named DLBCL-like (dFL) and constrained FL (cFL). Each subgroup has distinguishing mutational patterns, aberrant somatic hypermutation rates, and biological and clinical characteristics. We implemented a machine learning-derived classification approach to stratify patients with FL into cFL and dFL subgroups based on their genomic features. Using separate validation cohorts, we demonstrate that cFL status, whether assigned with this full classifier or a single-gene approximation, is associated with a reduced rate of HT. This implies distinct biological features of cFL that constrain its evolution, and we highlight the potential for this classification to predict HT from genetic features present at diagnosis.
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Affiliation(s)
- Kostiantyn Dreval
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Laura K. Hilton
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Manuela Cruz
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Haya Shaalan
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | | | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Brett Collinge
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Krysta M. Coyle
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Gerben Duns
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | | | | | - Prasath Pararajalingam
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Christopher K. Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Jasper Wong
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Andrew J. Mungall
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Marco A. Marra
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | | | | | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Ryan D. Morin
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
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Zhang Y, Liu S, Peng J, Cheng S, Zhang Q, Zhang N, Zhou Z, Zhang Y, Zhao Y, Liu T. Biomimetic Nanozymes Suppressed Ferroptosis to Ameliorate Doxorubicin-Induced Cardiotoxicity via Synergetic Effect of Antioxidant Stress and GPX4 Restoration. Nutrients 2023; 15:nu15051090. [PMID: 36904089 PMCID: PMC10005374 DOI: 10.3390/nu15051090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Mitochondria-dependent ferroptosis plays an important role in the pathogenesis of doxorubicin (DOX)-induced cardiotoxicity (DIC), which remains a clinical challenge due to the lack of effective interventions. Cerium oxide (CeO2), a representative nanozyme, has attracted much attention because of its antioxidant properties. This study evaluated CeO2-based nanozymes for the prevention and treatment of DIC in vitro and in vivo by adding nanoparticles (NPs), which were synthesized by biomineralization, to the culture or giving them to the mice, and the ferroptosis-specific inhibitor ferrostatin-1 (Fer-1) was used as control. The prepared NPs exhibited an excellent antioxidant response and glutathione peroxidase 4 (GPX4)-depended bioregulation, with the additional merits of bio-clearance and long retention in the heart. The experiments showed that NP treatment could significantly reverse myocardial structural and electrical remodeling, and reduce myocardial necrosis. These cardioprotective therapeutic effects were associated with their ability to alleviate oxidative stress, mitochondrial lipid peroxidation, and mitochondrial membrane potential damage, with a superior efficiency to the Fer-1. The study also found that the NPs significantly restored the expression of GPX4 and mitochondrial-associated proteins, thereby restoring mitochondria-dependent ferroptosis. Therefore, the study provides some insights into the role of ferroptosis in DIC. It also shows that CeO2-based nanozymes could be a promising prevention and treatment candidate as a novel cardiomyocyte ferroptosis protector to mitigate DIC and improve prognosis and quality of life in cancer patients.
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Affiliation(s)
- Yunpeng Zhang
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Shuang Liu
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Jing Peng
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Shifeng Cheng
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Qingling Zhang
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Nan Zhang
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Zandong Zhou
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yue Zhang
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yang Zhao
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Correspondence: (Y.Z.); (T.L.); Tel.: +86-022-88328617 (T.L.)
| | - Tong Liu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Correspondence: (Y.Z.); (T.L.); Tel.: +86-022-88328617 (T.L.)
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Wan Y, He B, Zhu D, Wang L, Huang R, Wang S, Wang C, Zhang M, Ma L, Gao F. Nicorandil Ameliorates Doxorubicin-Induced Cardiotoxicity in Rats, as Evaluated by 7 T Cardiovascular Magnetic Resonance Imaging. Cardiovasc Drugs Ther 2023; 37:39-51. [PMID: 34595611 PMCID: PMC9834367 DOI: 10.1007/s10557-021-07252-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Doxorubicin-induced cardiotoxicity (DIC) is a common side effect of doxorubicin chemotherapy, and a major mechanism of DIC is inflammation. However, no effective method exists to prevent DIC. In the present study, we investigated the cardioprotective effects of nicorandil against DIC using multiparametric cardiac magnetic resonance (CMR) imaging and elucidated the anti-inflammatory properties of nicorandil in rat models. METHODS Male Sprague-Dawley rats received four weekly intraperitoneal doxorubicin doses (4 mg/kg/injection) to establish the DIC model. After treatment with or without nicorandil (3 mg/kg/day) or diazoxide (10 mg/kg/day) orally, all the groups underwent weekly CMR examinations, including cardiac function and strain assessment and T2 mapping, for 6 weeks. Additionally, blood samples and hearts were collected to examine inflammation and histopathology. RESULTS According to our results, the earliest DIC CMR parameter in the doxorubicin group was T2 mapping time prolongation compared with the DIC rats treated with nicorandil (doxorubicin+nicorandil group) at week 2. Subsequently, the left ventricular ejection fraction (LVEF) and global peak systolic myocardial strain in the doxorubicin group were significantly reduced, and nicorandil effectively inhibited these effects at week 6. Our results were confirmed by histopathological evaluations. Furthermore, nicorandil treatment had a protective effect against the doxorubicin-induced inflammatory response. Interestingly, similar protective results were obtained using the KATP channel opener diazoxide. CONCLUSION Collectively, our findings indicate that nicorandil application ameliorates DIC in rats with significantly higher cardiac function and myocardial strain and less fibrosis, apoptosis and inflammatory cytokine production. Nicorandil prevents T2 abnormalities in the early stages of DIC, showing a high clinical value for early nicorandil treatment in chemotherapy patients.
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Affiliation(s)
- Yixuan Wan
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, China
| | - Bo He
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, China
| | - Dongyong Zhu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, China
| | - Lei Wang
- Molecular Imaging Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruijue Huang
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, China
| | - Shiyu Wang
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Chunhua Wang
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, Radiation Oncology Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Shanghai, China
| | - Mengdi Zhang
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, China
| | - Lu Ma
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, China
| | - Fabao Gao
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, China.
- Molecular Imaging Center, West China Hospital, Sichuan University, Chengdu, China.
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Muehlberg F, Kornfeld M, Zange L, Ghani S, Reichardt A, Reichardt P, Schulz‐Menger J. Early myocardial oedema can predict subsequent cardiomyopathy in high-dose anthracycline therapy. ESC Heart Fail 2022; 10:616-627. [PMID: 36404640 PMCID: PMC9871709 DOI: 10.1002/ehf2.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
AIMS This study aims to assess subclinical changes in functional and morphologic myocardial MR parameters very early into a repetitive high-dose anthracycline treatment (planned cumulative dose >650 mg/m2 ), which may predict subsequent development of anthracycline-induced cardiomyopathy (aCMP). METHODS Thirty sarcoma patients with previous exposition of 300-360 mg/m2 doxorubicin-equivalent chemotherapy who were planned for a second treatment of anthracycline-based chemotherapy (360 mg/m2 doxorubicin-equivalent) were recruited. Enrolled individuals received three CMR studies (before treatment, 48 h after first anthracycline treatment and upon completion of treatment). Native T1 mapping (MOLLI 5s(3s)3s), T2 mapping, and extracellular volume (ECV) maps were acquired in addition to a conventional CMR with SSFP-cine imaging at 1.5 T. Patients were given 0.2 mmol/kg gadoteridol for ECV quantification and LGE imaging. Blood samples for cardiac biomarkers were obtained before each scan. Development of relevant aCMP was defined as drop of left ventricular ejection fraction (LVEF) by >10% compared with baseline. RESULTS Twenty-three complete datasets were available for analysis. Median treatment time was 20.7 ± 3.0 weeks. Eight patients developed aCMP with LVEF reduction >10% until end of chemotherapy. Baseline LVEF was not different between patients with and without subsequent aCMP. Patients with aCMP had decreased LV mass upon completion of therapy (99.4 ± 26.5 g vs. 90.3 ± 24.8 g; P = 0.02), whereas patients without aCMP did not show a change in LV mass (91.5 ± 20.0 g vs. 89.0 ± 23.6 g; P > 0.05). On strain analysis, GLS (-15.3 ± 1.3 vs. -13.4 ± 1.6; P = 0.02) and GCS (-16.7 ± 2.1 vs. -14.9 ± 2.6; P = 0.04) were decreased in aCMP patients upon completion of therapy, whereas non-aCMP individuals showed no change in GLS (-15.4 ± 3.3 vs. -15.4 ± 3.4; P = 0.97). When assessed 48 h after first dose of anthracyclines, patients with subsequent aCMP had significantly elevated myocardial T2 times compared with before therapy (53.0 ± 2.8 ms vs. 49.3 ± 5.2 ms, P = 0.02) than patients who did not develop aCMP (50.7 ± 5.1 ms vs. 51.1 ± 3.9 ms, P > 0.05). Native T1 times decreased at 48 h after first dose irrespective of development of subsequent aCMP (1020.2 ± 28.4 ms vs. 973.5 ± 40.3 ms). Upon completion of therapy, patients with aCMP had increased native T1 compared with baseline (1050.8 ± 17.9 ms vs. 1022.4 ± 22.0 ms; P = 0.01), whereas non-aCMP patients did not (1034.5 ± 46.6 ms vs. 1018.4 ± 29.7 ms; P = 0.15). No patient developed new myocardial scars or compact myocardial fibrosis under chemotherapy. Cardiac biomarkers were elevated independent of development of aCMP. CONCLUSIONS With high cumulative anthracycline doses, early increase of T2 times 48 h after first treatment with anthracyclines can predict the development of subsequent aCMP after completion of chemotherapy. Early drop of native T1 times occurs irrespective of development of aCMP in high-dose anthracycline therapy.
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Affiliation(s)
- Fabian Muehlberg
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center – a joint cooperation between the Charité Medical Faculty and the Max‐Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner siteBerlinGermany
| | - Markus Kornfeld
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center – a joint cooperation between the Charité Medical Faculty and the Max‐Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner siteBerlinGermany
| | - Leonora Zange
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center – a joint cooperation between the Charité Medical Faculty and the Max‐Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner siteBerlinGermany
| | - Saeed Ghani
- Department for Interdisciplinary Oncology and Sarcoma CenterHELIOS Hospital Berlin‐BuchBerlinGermany
| | - Annette Reichardt
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center – a joint cooperation between the Charité Medical Faculty and the Max‐Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner siteBerlinGermany
| | - Peter Reichardt
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center – a joint cooperation between the Charité Medical Faculty and the Max‐Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner siteBerlinGermany
| | - Jeanette Schulz‐Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center – a joint cooperation between the Charité Medical Faculty and the Max‐Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner siteBerlinGermany
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11
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Huntington SF, Appukkuttan S, Wang W, Du Y, Hopson S, Babajanyan S. Treatment Patterns of Follicular Lymphoma in the United States: A Claims Analysis. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:115-122. [PMID: 36348725 PMCID: PMC9603402 DOI: 10.36469/001c.38070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
Background: A consensus is lacking on optimal treatment sequencing for follicular lymphoma (FL), the most common indolent lymphoma. FL is incurable, and many patients require multiple lines of therapy for successive relapses. Guidelines provide numerous recommendations for first-, second-, and third-line therapy; however, treatment patterns in the real world remain poorly understood. Objectives: The primary objective of this study is to evaluate real-world treatment patterns among commercially insured patients with FL in the United States. Methods: A retrospective cohort of patients with newly diagnosed FL was identified from June 2008 to September 2016 using the IBM MarketScan® database. Treatment pattern measures, including time to treatment from diagnosis, days from previous line of therapy, duration of therapy, and distribution of treatment regimens among lines of therapy, were assessed. Descriptive statistics were reported for baseline characteristics, primary outcome, and treatment pattern measures. Results: In total, 4232 patients were identified from the database and 2111 patients received at least 1 line of treatment. The most common first-line treatments included bendamustine + rituximab (39%), rituximab + cyclophosphamide + doxorubicin + vincristine (20%), and rituximab monotherapy (19%). Rituximab monotherapy was the most common second-line (34%) and third or greater line (57%) treatment. The median time from FL diagnosis to initiation of treatment was 50 days (interquartile range [IQR]: 28-191) for first-line treatment, 577 days (IQR: 312-1146) for second-line, and 776 days (IQR: 603-1290) for third-line. Discussion: At a median follow-up of 3.6 years, most patients had 1 or fewer lines of therapy. The use of combination therapy decreased with each line of therapy and the numbers of patients receiving third- or fourth-line therapy were small in this study, potentially due to the short follow-up. Rituximab as monotherapy or in combination was utilized most frequently; however, the variety of other therapies used demonstrates that the standard management of FL remains unclear. Conclusions: Consensus on optimal treatment sequencing is currently lacking, and patients receive a variety of active regimens during routine practice. In this contemporary cohort of patients diagnosed with FL in the United States, rituximab therapy predominated both in monotherapy and in combination.
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Affiliation(s)
| | | | - Wenyi Wang
- Bayer Healthcare U.S. LLC, Whippany, New Jersey
| | - Yuxian Du
- Bayer Healthcare U.S. LLC, Whippany, New Jersey
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12
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LASSO Model Better Predicted the Prognosis of DLBCL than Random Forest Model: A Retrospective Multicenter Analysis of HHLWG. JOURNAL OF ONCOLOGY 2022; 2022:1618272. [PMID: 36157230 PMCID: PMC9507678 DOI: 10.1155/2022/1618272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022]
Abstract
Background. Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous non-Hodgkin’s lymphoma with great clinical challenge. Machine learning (ML) has attracted substantial attention in diagnosis, prognosis, and treatment of diseases. This study is aimed at exploring the prognostic factors of DLBCL by ML. Methods. In total, 1211 DLBCL patients were retrieved from Huaihai Lymphoma Working Group (HHLWG). The least absolute shrinkage and selection operator (LASSO) and random forest algorithm were used to identify prognostic factors for the overall survival (OS) rate of DLBCL among twenty-five variables. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were utilized to compare the predictive performance and clinical effectiveness of the two models, respectively. Results. The median follow-up time was 43.4 months, and the 5-year OS was 58.5%. The LASSO model achieved an Area under the curve (AUC) of 75.8% for the prognosis of DLBCL, which was higher than that of the random forest model (AUC: 71.6%). DCA analysis also revealed that the LASSO model could augment net benefits and exhibited a wider range of threshold probabilities by risk stratification than the random forest model. In addition, multivariable analysis demonstrated that age, white blood cell count, hemoglobin, central nervous system involvement, gender, and Ann Arbor stage were independent prognostic factors for DLBCL. The LASSO model showed better discrimination of outcomes compared with the IPI and NCCN-IPI models and identified three groups of patients: low risk, high-intermediate risk, and high risk. Conclusions. The prognostic model of DLBCL based on the LASSO regression was more accurate than the random forest, IPI, and NCCN-IPI models.
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13
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Jong J, Pinney JR, Packard RRS. Anthracycline-induced cardiotoxicity: From pathobiology to identification of molecular targets for nuclear imaging. Front Cardiovasc Med 2022; 9:919719. [PMID: 35990941 PMCID: PMC9381993 DOI: 10.3389/fcvm.2022.919719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
Anthracyclines are a widely used class of chemotherapy in pediatric and adult cancers, however, their use is hampered by the development of cardiotoxic side-effects and ensuing complications, primarily heart failure. Clinically used imaging modalities to screen for cardiotoxicity are mostly echocardiography and occasionally cardiac magnetic resonance imaging. However, the assessment of diastolic and global or segmental systolic function may not be sensitive to detect subclinical or early stages of cardiotoxicity. Multiple studies have scrutinized molecular nuclear imaging strategies to improve the detection of anthracycline-induced cardiotoxicity. Anthracyclines can activate all forms of cell death in cardiomyocytes. Injury mechanisms associated with anthracycline usage include apoptosis, necrosis, autophagy, ferroptosis, pyroptosis, reactive oxygen species, mitochondrial dysfunction, as well as cardiac fibrosis and perturbation in sympathetic drive and myocardial blood flow; some of which have been targeted using nuclear probes. This review retraces the pathobiology of anthracycline-induced cardiac injury, details the evidence to date supporting a molecular nuclear imaging strategy, explores disease mechanisms which have not yet been targeted, and proposes a clinical strategy incorporating molecular imaging to improve patient management.
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Affiliation(s)
- Jeremy Jong
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - James R. Pinney
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, United States
| | - René R. Sevag Packard
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, United States
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Ren W, Wang X, Yang M, Wan H, Li X, Ye X, Meng B, Li W, Yu J, Lei M, Xie F, Jiang W, Kimby E, Huang H, Liu D, Li ZM, Wu K, Zhang H, Pan-Hammarström Q. Distinct clinical and genetic features of hepatitis B virus-associated follicular lymphoma in Chinese patients. Blood Adv 2022; 6:2731-2744. [PMID: 35030632 PMCID: PMC9092402 DOI: 10.1182/bloodadvances.2021006410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/19/2021] [Indexed: 12/15/2022] Open
Abstract
Hepatitis B virus (HBV) infection has been associated with an increased risk for B-cell lymphomas. We previously showed that 20% of diffuse large B-cell lymphoma (DLBCL) patients from China, an endemic area of HBV infection, have chronic HBV infection (surface antigen-positive, HBsAg+) and are characterized by distinct clinical and genetic features. Here, we showed that 24% of follicular lymphoma (FL) Chinese patients are HBsAg+. Compared with the HBsAg- FL patients, HBsAg+ patients are younger, have a higher histological grade at diagnosis, and have a higher incidence of disease progression within 24 months. Moreover, by sequencing the genomes of 109 FL tumors, we observed enhanced mutagenesis and distinct genetic profile in HBsAg+ FLs, with a unique set of preferentially mutated genes (TNFAIP3, FAS, HIST1H1C, KLF2, TP53, PIM1, TMSB4X, DUSP2, TAGAP, LYN, and SETD2) but lack of the hallmark of HBsAg- FLs (ie, IGH/BCL2 translocations and CREBBP mutations). Transcriptomic analyses further showed that HBsAg+ FLs displayed gene-expression signatures resembling the activated B-cell-like subtype of diffuse large B-cell lymphoma, involving IRF4-targeted genes and NF-κB/MYD88 signaling pathways. Finally, we identified an increased infiltration of CD8+ memory T cells, CD4+ Th1 cells, and M1 macrophages and higher T-cell exhaustion gene signature in HBsAg+ FL samples. Taken together, we present new genetic/epigenetic evidence that links chronic HBV infection to B-cell lymphomagenesis, and HBV-associated FL is likely to have a distinct cell-of-origin and represent as a separate subtype of FL. Targetable genetic/epigenetic alterations identified in tumors and their associated tumor microenvironment may provide potential novel therapeutic approaches for this subgroup of patients.
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Affiliation(s)
- Weicheng Ren
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xianhuo Wang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Mingyu Yang
- BGI-Shenzhen, Shenzhen, China
- Guangdong Provincial Key Laboratory of Human Disease Genomics, Shenzhen Key Laboratory of Genomics, Shenzhen, China
| | - Hui Wan
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Xiaobo Li
- BGI-Shenzhen, Shenzhen, China
- Guangdong Provincial Key Laboratory of Human Disease Genomics, Shenzhen Key Laboratory of Genomics, Shenzhen, China
| | - Xiaofei Ye
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Bing Meng
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wei Li
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jingwei Yu
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Mengyue Lei
- BGI-Shenzhen, Shenzhen, China
- Guangdong Provincial Key Laboratory of Human Disease Genomics, Shenzhen Key Laboratory of Genomics, Shenzhen, China
| | - Fanfan Xie
- BGI-Shenzhen, Shenzhen, China
- Guangdong Provincial Key Laboratory of Human Disease Genomics, Shenzhen Key Laboratory of Genomics, Shenzhen, China
| | - Wenqi Jiang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Eva Kimby
- Unit of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, Stockholm, Sweden; and
| | - Huiqiang Huang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Dongbing Liu
- BGI-Shenzhen, Shenzhen, China
- Guangdong Provincial Key Laboratory of Human Disease Genomics, Shenzhen Key Laboratory of Genomics, Shenzhen, China
| | - Zhi-Ming Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Kui Wu
- BGI-Shenzhen, Shenzhen, China
- Guangdong Provincial Key Laboratory of Human Disease Genomics, Shenzhen Key Laboratory of Genomics, Shenzhen, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Qiang Pan-Hammarström
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- BGI-Shenzhen, Shenzhen, China
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15
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Chen H, Zhu J, Le Y, Pan J, Liu Y, Liu Z, Wang C, Dou X, Lu D. Salidroside inhibits doxorubicin-induced cardiomyopathy by modulating a ferroptosis-dependent pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 99:153964. [PMID: 35180677 DOI: 10.1016/j.phymed.2022.153964] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/09/2022] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Doxorubicin-induced cardiotoxicity (DIC) limits the clinical application of the drug in treatment of cancers and imposes a severe health burden on the patients. Therefore, there is an urgent need to develop alternative therapeutic strategies or drugs to minimize DIC. Salidroside is a phenylpropanoid glycoside extracted from Rhodiola rosea with multiple biological effects such as anti-inflammation and antioxidant properties. However, its mechanism of action in DIC is still poorly understood. PURPOSE The present study was aimed to investigate the role of salidroside in DIC and associated mechanism of action for the described effects. METHODS Cardiac dysfunction was induced through treatment of mice with doxorubicin in vivo and in vitro. The mechanism of action of salidroside was investigated using western blot assay, qPCR, immunofluorescence, histochemistry, echocardiography, and high-content imaging system. RESULTS Results of the current study found that treatment of mice with salidroside significantly improved doxorubicin-induced cardiac dysfunction, ferroptosis-like cell damage, and fibrosis in vivo. Further, it was noted that salidroside inhibited ferroptosis in vivo and in vitro by limiting iron accumulation, restoring GPX4-dependent antioxidant capacity, and preventing lipid peroxidation at the cellular or mitochondrial levels. Mechanistically, salidroside inhibited DOX-induced mitochondrial ROS, Fe2+, and lipid peroxidation as well as restored mitochondrial membrane potential by promoting mitochondrial biogenesis, improving mitochondrial iron-sulfur clusters, and restoring mitochondrial OXPHOS complexes, thereby improving mitochondrial function. In addition, AMPK is a key protein that coordinates mitochondria, metabolism, and ferroptosis. Therefore, it was found that compound C (CC), an AMPK inhibitor, disrupted the regulation of cellular lipid metabolism and mitochondrial function of salidroside as well as led to failure of the protective effect of salidroside against ferroptotic cell death. CONCLUSIONS The present study evidently demonstrated the cardioprotective effects of salidroside against doxorubicin-induced cardiomyopathy. Further, salidroside markedly down-regulated ferroptotic cell death by activating AMPK-dependent signaling pathways including regulating abnormal fatty acid metabolism and maintaining mitochondrial function. Therefore, salidroside is can be exploited to develop a novel medication for clinical DIC and salidroside may represent a novel treatment that improves recovery from DIC by targeting ferroptosis.
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Affiliation(s)
- Hang Chen
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ji Zhu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 330106, China
| | - Yifei Le
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Jieli Pan
- Academy of Chinese Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ying Liu
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Zhijun Liu
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Cui Wang
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Xiaobing Dou
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Dezhao Lu
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China.
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16
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Zha J, Fan L, Yi S, Yu H, Zheng Z, Xu W, Deng M, Lin Z, Li Z, Ping L, He X, Chen F, Xie Y, Chen B, Zhang H, Wang L, Ding K, Li W, Yang H, Zhao W, Qiu L, Li Z, Song Y, Xu B. Clinical features and outcomes of 1845 patients with follicular lymphoma: a real-world multicenter experience in China. J Hematol Oncol 2021; 14:131. [PMID: 34425858 PMCID: PMC8383436 DOI: 10.1186/s13045-021-01139-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Clinical features and outcomes of FL patients in Chinese population are limited, thus promoting us to perform this analysis on a large cohort of 1845 patients with FL enrolled from nine medical centers nationwide in China. In this cohort, the median age of patients at diagnosis was 53 years, which was comparable to that reported previously for Chinese FL patients (49-51 years) but younger than that for Western FL patients (60-65 years). In contrast with Western patients, Chinese FL patients more likely involved extranodal sites but less frequently infiltrated bone marrow. Other clinical characteristics were comparable between two populations. In this study, 91% of patients were managed with chemotherapy, yielding 72% and 46% of overall-response rate and complete remission. After median 55-month follow-up, 5-year progressive-free and overall survival were 61% and 89%, respectively. Both were analogous to those reported in prior Chinese and Western studies. Consistent with published data, addition of rituximab into both induction (Ri) and maintenance (Rm) treatment led to the most favorable outcomes. Interestingly, Ri only had better outcomes than Rm only. Notably, 7% of patients experienced histologic transformation (HT) and correlated with poor survival. Of the transformed FL cases, 3% and 4% of HT events occurred prior to or post-treatment, respectively. Importantly, the latter displayed worse outcomes than the former. Altogether, this study provides real-world information of the largest cohort of FL patients so far in China, which might lay a foundation for clinical investigation of Chinese FL in future.
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Affiliation(s)
- Jie Zha
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Liyuan Fan
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Blood Diseases Hospital and Institute of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Haifeng Yu
- Department of Lymphoma, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Department of Lymphoma, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Zhong Zheng
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Manman Deng
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Zhijuan Lin
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Zhifeng Li
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Lingyan Ping
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaohua He
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Feili Chen
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Xie
- Shengli Clinical Medical College of Fujian Medical University, Department of Hematology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Biyun Chen
- Shengli Clinical Medical College of Fujian Medical University, Department of Hematology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Hospital, Tianjin, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Kaiyang Ding
- Department of Hematology, The First Affiliated Hospital of USTC Anhui Provincial Hospital, Hefei, China
| | - Wenyu Li
- Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyan Yang
- Department of Lymphoma, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Department of Lymphoma, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Weili Zhao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Blood Diseases Hospital and Institute of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zhiming Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,State Key Laboratory of Oncology in South China, Guangzhou, China. .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China.
| | - Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China. .,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China.
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17
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Bennett S, Cubukcu A, Wong CW, Griffith T, Oxley C, Barker D, Duckett S, Satchithananda D, Patwala A, Heatlie G, Kwok CS. The role of the Tei index in assessing for cardiotoxicity from anthracycline chemotherapy: a systematic review. Echo Res Pract 2021; 8:R1-R11. [PMID: 33793418 PMCID: PMC8185452 DOI: 10.1530/erp-20-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/01/2021] [Indexed: 01/02/2023] Open
Abstract
Background Anthracycline agents are known to be effective in treating tumors and hematological malignancies. Although these agents improve survival, their use is associated with cardiotoxic effects, which most commonly manifests as left ventricular systolic dysfunction (LVSD). As such, guidelines recommend the periodic assessment of left ventricular ejection fraction (LVEF). However, as diastolic dysfunction likely proceeds systolic impairment in this setting, the role of Tei index may offer additional benefit in detecting subclinical LVSD. Methods We conducted a systematic review to investigate the evidence for the use of Tei index in assessing subclinical cardiotoxicity in patients receiving anticancer agents. A search of Medline and EMBASE was performed and relevant studies were reviewed and narratively synthesized. Results A total of 13 studies were included with a total of 800 patients (mean age range 46–62 years, percentage of male participants ranged from 0–86.9%). An increase in Tei index was observed in 11 studies, which suggested a decline in cardiac function following chemotherapy. Out of these, six studies indicated that the Tei index is a useful parameter in predicting cardiotoxic LVSD. Furthermore, five studies indicated Tei index to be superior to LVEF in detecting subclinical cardiotoxicity. Conclusions Though there are some studies that suggest that Tei index may be a useful indicator in assessing subclinical anthracycline-related cardiotoxicity, the findings are inconsistent and so more studies are needed before the evaluation of Tei index is performed routinely in patients receiving chemotherapy.
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Affiliation(s)
| | - Arzu Cubukcu
- Royal Stoke University Hospital, Stoke-on-Trent, UK.,Macclesfield District General Hospital, Macclesfield, UK
| | - Chun Wai Wong
- Royal Stoke University Hospital, Stoke-on-Trent, UK.,Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK
| | | | - Cheryl Oxley
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Diane Barker
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | | | | | | | - Chun Shing Kwok
- Royal Stoke University Hospital, Stoke-on-Trent, UK.,Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK
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18
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Visone V, Szabó I, Perugino G, Hudecz F, Bánóczi Z, Valenti A. Topoisomerases inhibition and DNA binding mode of daunomycin-oligoarginine conjugate. J Enzyme Inhib Med Chem 2021; 35:1363-1371. [PMID: 32552137 PMCID: PMC7717705 DOI: 10.1080/14756366.2020.1780226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cancer is a major health issue adsorbing the attention of a biomedical research. To fight this disease, new drugs are developed, specifically tailored to target biological pathways or peculiar components of the tumour cells. Particularly interesting is the use of intercalating agents as drugs capable to bind DNA and inhibit enzymes involved in DNA metabolism. Anthracyclines are the most commonly used anticancer drugs. In particular, daunomycin is used to cancer treatment by exploiting its ability to intercalate DNA and inhibit the activity of DNA topoisomerases implicated in the replication processes. Unfortunately, clinical application of anthracyclines is limited by their side effects. The conjugation with specific carriers could affect the selectivity and reduce side effect by improving stability and/or cellular uptake properties. We here report the biochemical characterisation of a daunomycin oligopeptide conjugate containing six residues of arginine, by the analysis of its fluorescence properties, DNA interaction and topoisomerases inhibitory effects.
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Affiliation(s)
- Valeria Visone
- Institute of Biosciences and BioResources, National Research Council of Italy, Naples, Italy
| | - Ildikó Szabó
- MTA-ELTE Research Group of Peptide Chemistry, Budapest, Hungary
| | - Giuseppe Perugino
- Institute of Biosciences and BioResources, National Research Council of Italy, Naples, Italy
| | - Ferenc Hudecz
- Department of Organic Chemistry, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Zoltán Bánóczi
- Department of Organic Chemistry, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Anna Valenti
- Institute of Biosciences and BioResources, National Research Council of Italy, Naples, Italy
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19
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Rajamäki A, Sunela K, Prusila REI, Kuusisto MEL, Mercadal S, Selander T, Kuitunen H, Pollari M, Jantunen E, Nystrand I, Sancho JM, Sorigue M, Kuittinen O. Female patients with follicular lymphoma have a better prognosis if primary remission lasts over 24 months. Leuk Lymphoma 2021; 62:1639-1647. [PMID: 33546574 DOI: 10.1080/10428194.2021.1872073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Findings regarding the role of sex in follicular lymphoma (FL) are contradictory and the prognostic value of sex among patients with early progression of disease (POD) remains unclear. We collected real-life data from nine hospitals in Finland and Spain including 1020 FL patients to study the influence of sex on disease outcome. The median follow-up duration was 67 months (range 0-226 months). Female patients showed better progression-free survival (PFS) (hazard ratio [HR], 0.720; 95% confidence interval [CI], 0.588-0.881), disease-specific survival (DSS) (HR, 0.653; 95% CI, 0.448-0.951), and overall survival (OS) (HR, 0.653; 95% CI, 0.501-0.853) than male patients. However, there were no significant sex differences in prognosis in patients with early POD. This study strengthens the understanding that male sex is an adverse prognostic factor for FL. However, this difference does not apply to patients with early POD.
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Affiliation(s)
- Aino Rajamäki
- Department of Oncology, Central Finland Central Hospital, Jyväskylä, Finland.,Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Sunela
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Roosa E I Prusila
- Medical Research Centre and Cancer and Translational Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Milla E L Kuusisto
- Medical Research Centre and Cancer and Translational Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Haematology, Oulu University Hospital, Oulu, Finland
| | | | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanne Kuitunen
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - Marjukka Pollari
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Esa Jantunen
- Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Department of Medicine, North Carelia Central Hospital, Joensuu, Finland
| | - Ilja Nystrand
- Research Program Unit, Medical Faculty, University of Helsinki, Finland
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Functional cytomics-IJC, Badalona, Spain
| | - Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Functional cytomics-IJC, Badalona, Spain
| | - Outi Kuittinen
- Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland, Kuopio, Finland.,Medical Research Centre and Cancer and Translational Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Oncology, Kuopio University Hospital, Kuopio, Finland
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20
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Conditional relative survival among patients with follicular lymphoma: a population-based study in the Netherlands. Blood Cancer J 2021; 11:12. [PMID: 33441537 PMCID: PMC7806661 DOI: 10.1038/s41408-020-00399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 11/09/2022] Open
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21
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Bhatia S. Genetics of Anthracycline Cardiomyopathy in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review. JACC: CARDIOONCOLOGY 2020; 2:539-552. [PMID: 33364618 PMCID: PMC7757557 DOI: 10.1016/j.jaccao.2020.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Anthracyclines are an integral part of chemotherapy regimens used to treat a variety of childhood-onset and adult-onset cancers. However, the development of cardiac dysfunction and heart failure often compromises the clinical utility of anthracyclines. The risk of cardiac dysfunction increases with anthracycline dose. This anthracycline-cardiac dysfunction association is modified by several demographic and clinical factors, such as age at anthracycline exposure (<4 years and ≥65 years); female sex; chest radiation; presence of cardiovascular risk factors (diabetes, hypertension); and concurrent use of cyclophosphamide, paclitaxel, and trastuzumab. However, the clinical variables alone yield modest predictive power in detecting cardiac dysfunction. Recently, attention has focused on the molecular basis of anthracycline-related cardiac dysfunction, providing an initial understanding of the mechanism of anthracycline-related cardiomyopathy. This review describes the current state of knowledge with respect to the pathogenesis of anthracycline-related cardiomyopathy and identifies the critical next steps to mitigate this problem. Anthracycline chemotherapy results in an increased risk of cardiac dysfunction. Most recent studies have suggested that there is a genetic basis for anthracycline-related cardiac dysfunction. Integration of genetics with the clinical characteristics may be used to enhance the ability to predict the risk for anthracycline-related cardiomyopathy.
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Affiliation(s)
- Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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Drug Repurposing in Medulloblastoma: Challenges and Recommendations. Curr Treat Options Oncol 2020; 22:6. [PMID: 33245404 DOI: 10.1007/s11864-020-00805-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT Medulloblastoma is the most frequently diagnosed primary malignant brain tumor among children. Currently available therapeutic strategies are based on surgical resection, chemotherapy, and/or radiotherapy. However, majority of patients quickly develop therapeutic resistance and are often left with long-term therapy-related side effects and sequelae. Therefore, there remains a dire need to develop more effective therapeutics to overcome the acquired resistance to currently available therapies. Unfortunately, the process of developing novel anti-neoplastic drugs from bench to bedside is highly time-consuming and very expensive. A wide range of drugs that are already in clinical use for treating non-cancerous diseases might commonly target tumor-associated signaling pathways as well and hence be of interest in treating different cancers. This is referred to as drug repurposing or repositioning. In medulloblastoma, drug repurposing has recently gained a remarkable interest as an alternative therapy to overcome therapy resistance, wherein existing non-tumor drugs are being tested for their potential anti-neoplastic effects outside the scope of their original use.
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23
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Orosomucoid 1 Attenuates Doxorubicin-Induced Oxidative Stress and Apoptosis in Cardiomyocytes via Nrf2 Signaling. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5923572. [PMID: 33134382 PMCID: PMC7591952 DOI: 10.1155/2020/5923572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/22/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022]
Abstract
Doxorubicin (DOX) is an effective anticancer drug, but its therapeutic use is limited by its cardiotoxicity. The principal mechanisms of DOX-induced cardiotoxicity are oxidative stress and apoptosis in cardiomyocytes. Orosomucoid 1 (ORM1), an acute-phase protein, plays important roles in inflammation and ischemic stroke; however, the roles and mechanisms of ORM1 in DOX-induced cardiotoxicity remain unknown. Therefore, in the present study, we aimed to investigate the function of ORM1 in cardiomyocytes experiencing DOX-induced oxidative stress and apoptosis. A DOX-induced cardiotoxicity animal model was established in C57BL/6 mice by administering an intraperitoneal injection of DOX (20 mg/kg), and the control group was intraperitoneally injected with the same volume of sterilized saline. The effects were assessed after 7 d. Additionally, H9c2 cells were stimulated with DOX (10 μM) for 24 h. The results showed decreased ORM1 and increased oxidative stress and apoptosis after DOX stimulation in vivo and in vitro. ORM1 overexpression significantly reduced DOX-induced oxidative stress and apoptosis in H9c2 cells. ORM1 significantly increased the expression of nuclear factor-like 2 (Nrf2) and its downstream protein heme oxygenase 1 (HO-1) and reduced the expression of the lipid peroxidation end product 4-hydroxynonenal (4-HNE) and the level of cleaved caspase-3. In addition, Nrf2 silencing reversed the effects of ORM1 on DOX-induced oxidative stress and apoptosis in cardiomyocytes. In conclusion, ORM1 inhibited DOX-induced oxidative stress and apoptosis in cardiomyocytes by regulating the Nrf2/HO-1 pathway, which might provide a new treatment strategy for DOX-induced cardiotoxicity.
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24
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Ayuna A, Abidin N. The role of neurohormonal blockers in the primary prevention of acute-, early-, and late-onset anthracycline-induced cardiotoxicity. Egypt Heart J 2020; 72:59. [PMID: 32915331 PMCID: PMC7486348 DOI: 10.1186/s43044-020-00090-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background Anthracycline-induced cardiotoxicity has been classified based on its onset into acute, early, and late. It may have a significant burden on the quality and quantity of life of those exposed to this class of medication. Currently, there are several ongoing debates on the role of different measures in the primary prevention of cardiotoxicity in cancer survivors. Our article aims to focus on the role of neurohormonal blockers in the primary prevention of anthracycline-induced cardiotoxicity, whether it is acute, early, or late onset. Main body of the abstract PubMed and Google Scholar database were searched for the relevant articles; we reviewed and appraised 15 RCTs, and we found that angiotensin-converting enzyme inhibitors (ACEI) and B-blockers were the most commonly used agents. Angiotensin II receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs) were used in a few other trials. The follow-up period was on the range of 1–156 weeks (mode 26 weeks). Left ventricular ejection fraction (LVEF), left ventricular diameters, and diastolic function were assessed by either echocardiogram or occasionally by cardiac magnetic resonance imaging (MRI). The occurrence of myocardial injury was assessed by troponin I. It was obvious that neurohormonal blockers reduced the occurrence of LVEF and myocardial injury in 14/15 RCTs. Short conclusion Beta-blockers, especially carvedilol and ACEI, especially enalapril, should be considered for the primary prevention of acute- and early-onset cardiotoxicity. ARB and MRA are suitable alternatives when patients are intolerant to ACE-I and B-blockers. We recommend further studies to explore and establish the role of neurohormonal blockers in the primary prevention of the acute-, early-, and late-onset cardiotoxicity.
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Affiliation(s)
- Ahmed Ayuna
- Salford Royal NHS Foundation Trust, Manchester, UK.
| | - Nik Abidin
- Salford Royal NHS Foundation Trust, Manchester, UK
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25
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A review on various analytical methods for determination of anthracyclines and their metabolites as anti–cancer chemotherapy drugs in different matrices over the last four decades. Trends Analyt Chem 2020. [DOI: 10.1016/j.trac.2020.115991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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26
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Abstract
PURPOSE OF REVIEW Unlike for diffuse large-cell lymphoma, both the management of elderly patients with follicular lymphoma and the role of comprehensive geriatric evaluation to optimize treatment choices have been rarely addressed. This review analyses available evidence on follicular lymphoma occurring in aged persons. RECENT FINDINGS Most retrospective studies and expert recommendations agree that the diagnostic approach and the treatment algorithm in elderly follicular lymphoma should not differ from younger patients up to the age of 80. However, slowly progressing follicular lymphoma low-tumor burden should start treatment even though asymptomatic. Prospective identification of those unfit patients is needed where a treatment deintensification may not be detrimental. Octogenarians have more aggressive disease and do not benefit from chemoimmunotherapy more than from single-agent rituximab. An activity of daily living loss significantly impact on their outcome and specific prognostic scores may help in the better manage these oldest patients. SUMMARY Given the lack of prospective studies there is an urgent need to investigate if geriatric assessment including comorbidities, geriatric parameters, patient's reported outcomes and quality of life issues, may help selecting those frail elderly follicular lymphoma patients less suitable for full-dose treatments. In addition, the potential usefulness of the new noncytotoxic agents of proven efficacy in follicular lymphoma warrants specific investigations in older patients.
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27
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Lisi L, Chiavari M, Ciotti GMP, Lacal PM, Navarra P, Graziani G. DNA inhibitors for the treatment of brain tumors. Expert Opin Drug Metab Toxicol 2020; 16:195-207. [PMID: 32067518 DOI: 10.1080/17425255.2020.1729352] [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] [Indexed: 12/28/2022]
Abstract
Introduction: The worldwide incidence of central nervous system (CNS) primary tumors is increasing. Most of the chemotherapeutic agents used for treating these cancer types induce DNA damage, and their activity is affected by the functional status of repair systems involved in the detection or correction of DNA lesions. Unfortunately, treatment of malignant high-grade tumors is still an unmet medical need.Areas covered: We summarize the action mechanisms of the main DNA inhibitors used for the treatment of brain tumors. In addition, studies on new agents or drug combinations investigated for this indication are reviewed, focusing our attention on clinical trials that in the last 3 years have been completed, terminated or are still recruiting patients.Expert opinion: Much still needs to be done to render aggressive CNS tumors curable or at least to transform them from lethal to chronic diseases, as it is possible for other cancer types. Drugs with improved penetration in the CNS, toxicity profile, and activity against primary and recurrent tumors are eagerly needed. Targeted agents with innovative mechanisms of action and ability to harness the cells of the tumor microenvironment against cancer cells represent a promising approach for improving the clinical outcome of CNS tumors.
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Affiliation(s)
- Lucia Lisi
- Department of Safety and Bioethics, Catholic University Medical School, Rome, Italy
| | - Marta Chiavari
- Department of Safety and Bioethics, Catholic University Medical School, Rome, Italy
| | | | - Pedro M Lacal
- Laboratory of Molecular Oncology, IDI-IRCCS, Rome, Italy
| | - Pierluigi Navarra
- Department of Safety and Bioethics, Catholic University Medical School, Rome, Italy.,Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Grazia Graziani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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28
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Albarmawi H, Nagarajan M, Onukwugha E, Gandhi AB, Keating KN, Appukkuttan S, Yared J. Follicular lymphoma treatment patterns between 2000 and 2014: a SEER-Medicare analysis of elderly patients. Future Oncol 2020; 16:353-365. [PMID: 32043384 DOI: 10.2217/fon-2019-0660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Characterize follicular lymphoma (FL) treatment patterns among elderly patients using a dataset with longer follow-up time. Materials & methods: Using the linked Surveillance, Epidemiology and End Results-Medicare data, we identified patients diagnosed with FL between 2000 and 2013 with claims data until 2014. We investigated the treatments received and assigned them to lines of treatment. Results: We identified 10,238 elderly patients. Over a 4.7-year median follow-up, 78% of the patients received at least first-line treatment. Fewer individuals received second-line (47%) and third-line (30%) treatments. RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone), RCVP (rituximab, cyclophosphamide, vincristine and prednisolone) and rituximab monotherapy were the most common treatment regimens. Conclusion: One in five elderly patients did not receive FL-directed therapy. The most common treatment regimens were limited to RCHOP, RCVP and rituximab monotherapy.
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Affiliation(s)
- Husam Albarmawi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Madhuram Nagarajan
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Aakash Bipin Gandhi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Karen N Keating
- Bayer Healthcare Pharmaceuticals, Inc., Whippany, NJ 07981, USA
| | | | - Jean Yared
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
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Patient-level Factors Associated With the Initial Management of Older Adults Diagnosed With Follicular Lymphoma: A Surveillance, Epidemiology, and End Results-Medicare Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e184-e194. [PMID: 31956071 DOI: 10.1016/j.clml.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We evaluated patient-level factors associated with the initial management of older adults diagnosed with follicular lymphoma (FL). MATERIALS AND METHODS Using linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) data; we identified 11,500 beneficiaries aged ≥ 66 years, diagnosed with FL between 2000 and 2013. A logistic regression model was used to estimate adjusted odds ratios (AORs) for factors associated with the receipt of active treatment versus watchful waiting (WW) as an initial management strategy. A multinomial logistic regression model was used to predict factors associated with receipt of specific active treatments, namely chemoimmunotherapy, rituximab monotherapy, chemotherapy, or radiation as compared with WW. RESULTS Overall, the initial management strategies adopted were WW (49%), chemoimmunotherapy (25%), radiation (10%), rituximab monotherapy (9%), and chemotherapy (7%). In reference to WW, grade III FL (AOR, 2.21; 95% confidence interval [CI], 1.99-2.46), increasing disease stage (Stage IV AOR, 1.80; 95% CI, 1.62-2.00), and use of preventive services (AOR, 1.18; 95% CI, 1.07-1.30) were associated with increased odds of active treatment receipt. Age > 80 years (AOR, 0.79; 95% CI, 0.71-0.87), Non-Hispanic African-American race (AOR, 0.64; 95% CI, 0.50-0.80), and state buy-in coverage (AOR, 0.81; 95% CI, 0.70-0.94) were associated with decreased odds of active treatment receipt. In reference to WW, the multinomial logistic regression model displayed differences in the receipt of rituximab-based therapies by age and comorbidity burden. Non-Hispanic African-American race and state buy-in coverage were associated with decreased odds of receiving rituximab-based therapies. CONCLUSION The present analysis identifies disparities in the initial management of older adults with FL owing to race and socioeconomic status. Future research should examine implications for subsequent treatment and health outcomes.
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Gertz ZM, Cain C, Kraskauskas D, Devarakonda T, Mauro AG, Thompson J, Samidurai A, Chen Q, Gordon SW, Lesnefsky EJ, Das A, Salloum FN. Remote Ischemic Pre-Conditioning Attenuates Adverse Cardiac Remodeling and Mortality Following Doxorubicin Administration in Mice. JACC: CARDIOONCOLOGY 2019; 1:221-234. [PMID: 32699841 PMCID: PMC7375406 DOI: 10.1016/j.jaccao.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives Because of its multifaceted cardioprotective effects, remote ischemic pre-conditioning (RIPC) was examined as a strategy to attenuate doxorubicin (DOX) cardiotoxicity. Background The use of DOX is limited by dose-dependent cardiotoxicity and heart failure. Oxidative stress, mitochondrial dysfunction, inflammation, and autophagy modulation have been proposed as mediators of DOX cardiotoxicity. Methods After baseline echocardiography, adult male CD1 mice were randomized to either sham or RIPC protocol (3 cycles of 5 min femoral artery occlusion followed by 5 min reperfusion) 1 h before receiving DOX (20 mg/kg, intraperitoneal). The mice were observed primarily for survival over 85 days (86 mice). An additional cohort of 50 mice was randomized to either sham or RIPC 1 h before DOX treatment and was followed for 25 days, at which time cardiac fibrosis, apoptosis, and mitochondrial oxidative phosphorylation were assessed, as well as the expression profiles of apoptosis and autophagy markers. Results Survival was significantly improved in the RIPC cohort compared with the sham cohort (p = 0.007). DOX-induced cardiac fibrosis and apoptosis were significantly attenuated with RIPC compared with sham (p < 0.05 and p < 0.001, respectively). Although no mitochondrial dysfunction was detected at 25 days, there was a significant increase in autophagy markers with DOX that was attenuated with RIPC. Moreover, DOX caused a 49% decline in cardiac BCL2/BAX expression, which was restored with RIPC (p < 0.05 vs. DOX). DOX also resulted in a 17% reduction in left ventricular mass at 25 days, which was prevented with RIPC (p < 0.01), despite the lack of significant changes in left ventricular ejection fraction. Conclusions Our preclinical results suggested that RIPC before DOX administration might be a promising approach for attenuating DOX cardiotoxicity.
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Affiliation(s)
- Zachary M Gertz
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Chad Cain
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Donatas Kraskauskas
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Teja Devarakonda
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Adolfo G Mauro
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jeremy Thompson
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Arun Samidurai
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Qun Chen
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Sarah W Gordon
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Edward J Lesnefsky
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia.,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia.,Medical Service, McGuire VA Medical Center, Richmond, Virginia
| | - Anindita Das
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Fadi N Salloum
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
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Albarmawi H, Onukwugha E, Keating KN, Appukkuttan S, Yared J. Survival benefit associated with treating follicular lymphoma in patients 80 years or older. J Geriatr Oncol 2019; 11:55-61. [PMID: 31706831 DOI: 10.1016/j.jgo.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the overall survival benefit associated with follicular lymphoma (FL)-directed therapy among patients diagnosed with FL at 80+ years. PATIENTS AND METHODS This retrospective cohort study utilized the linked Surveillance, Epidemiology and End Results-Medicare dataset to identify patients 80+ years, diagnosed with FL between 2000 and 2013. We identified FL-directed treatments based on published guidelines. We utilized a propensity-score matched sample to compare treated and untreated groups who had similar observed characteristics. We reported the median overall survival time and the 3-year restricted mean survival time (RMST) of the study groups as well as the hazard ratio (HR) of death associated with treatment receipt. RESULTS We identified 3705 older patients with FL (mean [SD] age, 84 [3.6] years). Over a median follow-up of 2.9 years, 68% of the sample received FL-directed therapy and the most common regimen was rituximab monotherapy (N = 768, 21%). The matched sample included 2306 patients. The median overall survival for the treated group was 4.31 years (95% confidence interval [CI], 4.00-4.61) compared to 2.86 years (95% CI, 2.59-3.16) for the untreated group. The 3-year RMST for the treated group was 2.36 years (95% CI, 2.30-2.41), while it was 2.05 years (95% CI, 1.98-2.11) for the untreated group. Treatment was associated with a 23% reduction in the hazards of death (HR: 0.77, 95% CI: 0.70-0.85; p < .001). CONCLUSION FL-directed therapy was associated with improved survival among patients diagnosed with FL at 80+ years. These findings can support treatment decision-making for individuals diagnosed with FL at older ages.
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Affiliation(s)
- Husam Albarmawi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | | | - Jean Yared
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Ritter AJ, Goldstein JS, Ayers AA, Flowers CR. Rural and urban patients with diffuse large B-cell and follicular lymphoma experience reduced overall survival: a National Cancer DataBase study. Leuk Lymphoma 2019; 60:1656-1667. [PMID: 30632824 PMCID: PMC6594869 DOI: 10.1080/10428194.2018.1546855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/31/2018] [Indexed: 12/27/2022]
Abstract
We examined 83,108 patients with diffuse large B-cell lymphoma (DLBCL) and 43,393 patients with follicular lymphoma (FL) to investigate disparities related to geographic population density, stratified as rural, urban, or metropolitan. We found that urban and rural patients less commonly had private insurance and high socioeconomic status. Urban and rural DLBCL patients were more likely to receive treatment within 14 days of diagnosis (OR 0.93, 95% confidence interval [CI] 0.89-0.98; and OR 0.81, 95% CI 0.72-0.91) while urban FL patients were more likely to have treatment >14 days after diagnosis (OR 1.08, 95% CI 1.01-1.16). Multivariable analyses demonstrated that rural and urban patients had worse overall survival with DLBCL (hazard ratio [HR] 1.09; 95% CI 1-1.19 and HR 1.08; 95% CI 1.04-1.11) and FL (HR 1.11; 95% CI 1.04-1.18 and HR 1.2; 95% CI 1.02-1.41), respectively, suggesting needs for focused study and interventions for these populations.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cities
- Databases, Factual
- Female
- Follow-Up Studies
- Georgia/epidemiology
- Humans
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Rural Population/statistics & numerical data
- Social Class
- Survival Rate
- Urban Population/statistics & numerical data
- Young Adult
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Affiliation(s)
| | | | - Amy A Ayers
- b Winship Cancer Institute , Atlanta , GA , USA
| | - Christopher R Flowers
- b Winship Cancer Institute , Atlanta , GA , USA
- c Department of Hematology and Medical Oncology , Emory University School of Medicine , Atlanta , GA , USA
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Krohn M, Zoufal V, Mairinger S, Wanek T, Paarmann K, Brüning T, Eiriz I, Brackhan M, Langer O, Pahnke J. Generation and Characterization of an Abcc1 Humanized Mouse Model ( hABCC1flx/flx ) with Knockout Capability. Mol Pharmacol 2019; 96:138-147. [PMID: 31189668 DOI: 10.1124/mol.119.115824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/03/2019] [Indexed: 01/18/2023] Open
Abstract
ATP-binding cassette (ABC) transporters such as ABCB1 (P-glycoprotein), ABCC1 (MRP1), and ABCG2 (BCRP) are well known for their role in rendering cancer cells resistant to chemotherapy. Additionally, recent research provided evidence that, along with other ABC transporters (ABCA1 and ABCA7), they might be cornerstones to tackle neurodegenerative diseases. Overcoming chemoresistance in cancer, understanding drug-drug interactions, and developing efficient and specific drugs that alter ABC transporter function are hindered by a lack of in vivo research models, which are fully predictive for humans. Hence, the humanization of ABC transporters in mice has become a major focus in pharmaceutical and neurodegenerative research. Here, we present a characterization of the first Abcc1 humanized mouse line. To preserve endogenous expression profiles, we chose to generate a knockin mouse model that leads to the expression of a chimeric protein that is fully human except for one amino acid. We found robust mRNA and protein expression within all major organs analyzed (brain, lung, spleen, and kidney). Furthermore, we demonstrate the functionality of the expressed human ABCC1 protein in brain and lungs using functional positron emission tomography imaging in vivo. Through the introduction of loxP sites, we additionally enabled this humanized mouse model for highly sophisticated studies involving cell type-specific transporter ablation. Based on our data, the presented mouse model appears to be a promising tool for the investigation of cell-specific ABCC1 function. It can provide a new basis for better translation of preclinical research.
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Affiliation(s)
- Markus Krohn
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Viktoria Zoufal
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Severin Mairinger
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Thomas Wanek
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Kristin Paarmann
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Thomas Brüning
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Ivan Eiriz
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Mirjam Brackhan
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Oliver Langer
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
| | - Jens Pahnke
- Department of Neuro-/Pathology and Oslo University Hospital, University of Oslo, Oslo, Norway (M.K., K.P., T.B., I.E., M.B., J.P.); Biomedical Systems, Center for Health & Bioresources, Austrian Institute of Technology, Seibersdorf, Austria (V.Z., S.M., T.W., O.L.); Department of Clinical Pharmacology and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (O.L.); Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany (J.P.); Leibniz-Institute of Plant Biochemistry, Halle, Germany (J.P.); and Department of Pharmacology, Medical Faculty, University of Latvia, Rīga, Latvia (J.P.)
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Cui N, Wu F, Lu WJ, Bai R, Ke B, Liu T, Li L, Lan F, Cui M. Doxorubicin-induced cardiotoxicity is maturation dependent due to the shift from topoisomerase IIα to IIβ in human stem cell derived cardiomyocytes. J Cell Mol Med 2019; 23:4627-4639. [PMID: 31106979 PMCID: PMC6584544 DOI: 10.1111/jcmm.14346] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/09/2019] [Accepted: 04/01/2019] [Indexed: 01/06/2023] Open
Abstract
Doxorubicin (DOX) is widely used to treat various cancers affecting adults and children; however, its clinical application is limited by its cardiotoxicity. Previous studies have shown that children are more susceptible to the cardiotoxic effects of DOX than adults, which may be related to different maturity levels of cardiomyocyte, but the underlying mechanisms are not fully understood. Moreover, researchers investigating DOX‐induced cardiotoxicity caused by human‐induced pluripotent stem cell‐derived cardiomyocytes (hiPSC‐CMs) have shown that dexrazoxane, the recognized cardioprotective drug for treating DOX‐induced cardiotoxicity, does not alleviate the toxicity of DOX on hiPSC‐CMs cultured for 30 days. We have suggested that this may be ascribed to the immaturity of the 30 days hiPSC‐CMs. In this study, we investigated the mechanisms of DOX induced cardiotoxicity in cardiomyocytes of different maturity. We selected 30‐day‐old and 60‐day‐old hiPSC‐CMs (day 30 and day 60 groups), which we term ‘immature’ and ‘relatively mature’ hiPSC‐CMs, respectively. The day 30 CMs were found to be more susceptible to DOX than the day 60 CMs. DOX leads to more ROS (reactive oxygen species) production in the day 60 CMs than in the relatively immature group due to increased mitochondria number. Moreover, the day 60 CMs mainly expressed topoisomerase IIβ presented less severe DNA damage, whereas the day 30 CMs dominantly expressed topoisomerase IIα exhibited much more severe DNA damage. These results suggest that immature cardiomyocytes are more sensitive to DOX as a result of a higher concentration of topoisomerase IIα, which leads to more DNA damage.
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Affiliation(s)
- Ning Cui
- Department of Cardiology, Peking University Third Hospital, Beijing, China.,Department of Respiration, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fujian Wu
- Beijing Lab for Cardiovascular Precision Medicine, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen-Jing Lu
- Beijing Lab for Cardiovascular Precision Medicine, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Bai
- Beijing Lab for Cardiovascular Precision Medicine, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bingbing Ke
- Beijing Lab for Cardiovascular Precision Medicine, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taoyan Liu
- Beijing Lab for Cardiovascular Precision Medicine, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Li
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Feng Lan
- Beijing Lab for Cardiovascular Precision Medicine, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Cui
- Department of Cardiology, Peking University Third Hospital, Beijing, China
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Hester LL, Park SI, Wood WA, Stürmer T, Brookhart MA, Lund JL. Cause-specific mortality among Medicare beneficiaries with newly diagnosed non-Hodgkin lymphoma subtypes. Cancer 2019; 125:1101-1112. [PMID: 30548238 PMCID: PMC6719299 DOI: 10.1002/cncr.31821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/27/2018] [Accepted: 08/31/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND As the US population ages and non-Hodgkin lymphoma (NHL)-specific mortality declines, deaths from causes other than NHL will become increasingly important in treatment decision making for older patients with NHL. The objective of the current study was to describe how the 5-year cumulative incidence of NHL-specific and other-cause mortality varies by subtype, age, comorbidity level, and time since diagnosis in older patients. METHODS Using the Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims, patients aged ≥66 years were identified at the time of diagnosis with a first, primary NHL diagnosis from 2004 through 2013. Death certificate data and Fine-Gray competing risks models were used to estimate the 5-year cumulative incidence of NHL-specific and other-cause mortality by NHL subtype, age, and comorbidity level. Estimates were displayed over time using stacked cumulative incidence curves. RESULTS Among 30,666 patients with NHL, 32% died of NHL and 13% died of other causes within 5 years of diagnosis. The cumulative incidence of other-cause mortality increased with age and comorbidity level for all subtypes. Among patients with aggressive NHL subtypes, NHL-specific mortality exceeded other-cause mortality across all age groups, comorbidity levels, and number of years after diagnosis. For patients with indolent NHL subtypes, other-cause mortality was similar to or exceeded NHL-specific mortality, especially among older patients with severe comorbidity or with the indolent marginal zone, lymphoplasmacytic, and mycosis fungoides subtypes. CONCLUSIONS The findings of the current study suggest that mortality from causes other than NHL are important for patients of an older age, with a higher comorbidity level, and with indolent disease. Evidence from the current study can guide the development of tools for estimating individual prognosis that inform treatment discussions in patients with NHL.
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MESH Headings
- Aged
- Aged, 80 and over
- Burkitt Lymphoma/mortality
- Cause of Death
- Comorbidity
- Female
- Humans
- Incidence
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, Follicular/mortality
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Mantle-Cell/mortality
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, T-Cell, Peripheral/mortality
- Male
- Medicare
- Mycosis Fungoides/mortality
- SEER Program
- Skin Neoplasms/mortality
- United States
- Waldenstrom Macroglobulinemia/mortality
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Affiliation(s)
- Laura L Hester
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Steven I Park
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Hematology and Oncology, Levine Cancer Institute, Charlotte, North Carolina
| | - William A Wood
- Leukemia, Lymphoma, and Myeloma Program, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Nonapoptotic cell death-induced tissue damage has been implicated in a variety of diseases, including neurodegenerative disorder, inflammation, and stroke. In this study, we demonstrate that ferroptosis, a newly defined iron-dependent cell death, mediates both chemotherapy- and ischemia/reperfusion-induced cardiomyopathy. RNA-sequencing analysis revealed up-regulation of heme oxygenase 1 by doxorubicin as a major mechanism of ferroptotic cardiomyopathy. As a result, heme oxygenase 1 degrades heme and releases free iron in cardiomyocytes, which in turn leads to generation of oxidized lipids in the mitochondria membrane. Most importantly, both iron chelation therapy and pharmacologically blocking ferroptosis could significantly alleviate cardiomyopathy in mice. These findings suggest targeting ferroptosis as a strategy for treating deadly heart disease. Heart disease is the leading cause of death worldwide. A key pathogenic factor in the development of lethal heart failure is loss of terminally differentiated cardiomyocytes. However, mechanisms of cardiomyocyte death remain unclear. Here, we discovered and demonstrated that ferroptosis, a programmed iron-dependent cell death, as a mechanism in murine models of doxorubicin (DOX)- and ischemia/reperfusion (I/R)-induced cardiomyopathy. In canonical apoptosis and/or necroptosis-defective Ripk3−/−, Mlkl−/−, or Fadd−/−Mlkl−/− mice, DOX-treated cardiomyocytes showed features of typical ferroptotic cell death. Consistently, compared with dexrazoxane, the only FDA-approved drug for treating DOX-induced cardiotoxicity, inhibition of ferroptosis by ferrostatin-1 significantly reduced DOX cardiomyopathy. RNA-sequencing results revealed that heme oxygenase-1 (Hmox1) was significantly up-regulated in DOX-treated murine hearts. Administering DOX to mice induced cardiomyopathy with a rapid, systemic accumulation of nonheme iron via heme degradation by Nrf2-mediated up-regulation of Hmox1, which effect was abolished in Nrf2-deficent mice. Conversely, zinc protoporphyrin IX, an Hmox1 antagonist, protected the DOX-treated mice, suggesting free iron released on heme degradation is necessary and sufficient to induce cardiac injury. Given that ferroptosis is driven by damage to lipid membranes, we further investigated and found that excess free iron accumulated in mitochondria and caused lipid peroxidation on its membrane. Mitochondria-targeted antioxidant MitoTEMPO significantly rescued DOX cardiomyopathy, supporting oxidative damage of mitochondria as a major mechanism in ferroptosis-induced heart damage. Importantly, ferrostatin-1 and iron chelation also ameliorated heart failure induced by both acute and chronic I/R in mice. These findings highlight that targeting ferroptosis serves as a cardioprotective strategy for cardiomyopathy prevention.
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Çağlayan Ç, Terawaki H, Ayer T, Goldstein JS, Rai A, Chen Q, Flowers C. Assessing the Effectiveness of Treatment Sequences for Older Patients With High-risk Follicular Lymphoma With a Multistate Model. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:300-309.e5. [PMID: 30686772 DOI: 10.1016/j.clml.2018.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/01/2018] [Accepted: 12/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Disease progression within < 2 years of initial chemoimmunotherapy and patient age > 60 years have been associated with poor overall survival (OS) in follicular lymphoma (FL). No standard treatment exists for these high-risk patients, and the effectiveness of sequential therapies remains unclear. PATIENTS AND METHODS We studied the course of FL with first-, second-, and third-line treatment. Using large population-based data, we identified 5234 patients with FL diagnosed in 2000 to 2009. Of these patients, 71% had received second-line therapy < 2 years, and 29% had received no therapy after first-line therapy, with a median OS of < 3 years. Treatment included rituximab, R-CVP (rituximab, cyclophosphamide, vincristine), R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine), R-Other (other rituximab-containing), and other regimens. The Aalen-Johansen estimator and Cox proportional hazards models were used to quantify the outcomes and assess the effects of the clinical and sociodemographic factors. RESULTS R-CHOP demonstrated the most favorable 5-year OS among first- (71%), second- (55%), and third-line (61%) therapies. First-line R-CHOP improved OS (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.50-0.64) and reduced the mortality risks after first-line (HR, 0.60; 95% CI, 0.47-0.77), second-line (HR, 0.40; 95% CI, 0.29-0.53), and third-line (HR, 0.63; 95% CI, 0.53-0.76) treatments. B-symptoms, being married, and histologic grade 1/2 were associated with the use of earlier second-line therapy. Early progression from second- to third-line therapy was associated with poor OS. The repeated use of R-CHOP or R-CVP as first- and second-line treatment yielded high 2-year mortality rates (R-CHOP + R-CHOP, 17.3%; R-CVP + R-CVP, 21.1%). CONCLUSION Our multistate approach assessed the effect of sequential therapy on the immediate and subsequent treatment-line outcomes. We found that R-CHOP in any line improved OS for patients with high-risk FL.
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Affiliation(s)
- Çağlar Çağlayan
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA.
| | | | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA
| | | | - Ashish Rai
- American Cancer Society, Inc, Atlanta, GA
| | - Qiushi Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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Morrison VA, Shou Y, Bell JA, Hamilton L, Ogbonnaya A, Raju A, Hennenfent K, Eaddy M, Galaznik A. Treatment Patterns and Survival Outcomes in Patients With Follicular Lymphoma: A 2007 to 2015 Humedica Database Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e172-e183. [PMID: 30691994 DOI: 10.1016/j.clml.2018.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/20/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have evaluated real-world treatment patterns and survival in follicular lymphoma (FL). This study evaluated these outcomes among newly diagnosed patients with FL in routine clinical care. PATIENTS AND METHODS A retrospective study was conducted in newly diagnosed patients with FL from Humedica, a large United States electronic medical record database, from January 1, 2008 to July 31, 2015. Patients were followed from treatment initiation until death, loss to follow-up, or end of study (September 30, 2015). Treatment patterns were assessed in the follow-up period. Progression-free survival (PFS) and overall survival (OS) at 2 years were evaluated in the overall population using Kaplan-Meier analyses. OS was also compared between patients with and without evidence of disease progression within 2 years following first-line therapy (ie, early progressors vs. non-early progressors). RESULTS A total of 1346 patients were included in the study, with most patients receiving rituximab-based regimens. Fewer early progressors received rituximab-based regimens. Across all lines, combination therapies predominated, particularly bendamustine + rituximab. Following first-line therapy, OS was 86.9% at 2 years, and median OS was not reached. Two-year PFS after first-line therapy was 64.6%, and median PFS was 48.1 months (95% confidence interval, 39.4-58.4 months). OS at 2 years was 76.8% among early progressors versus 90.4% among non-early progressors (P < .001); the median OS was not reached in both groups. CONCLUSION In routine clinical practice, rituximab-based regimens predominated; however, utilization of these regimens differed among early and non-early progressors. The assessment of survival outcomes also highlights the negative impact of early progression on OS in the rituximab-era.
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Affiliation(s)
- Vicki A Morrison
- University of Minnesota, Hennepin County Medical Center, Minneapolis, MN
| | - Yaping Shou
- Millennium Pharmaceuticals, Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Jill A Bell
- Millennium Pharmaceuticals, Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | | | | | | | | | | | - Aaron Galaznik
- Millennium Pharmaceuticals, Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
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Monga N, Nastoupil L, Garside J, Quigley J, Hudson M, O’Donovan P, Parisi L, Tapprich C, Thieblemont C. Burden of illness of follicular lymphoma and marginal zone lymphoma. Ann Hematol 2018; 98:175-183. [DOI: 10.1007/s00277-018-3501-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022]
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Muehlberg F, Funk S, Zange L, von Knobelsdorff-Brenkenhoff F, Blaszczyk E, Schulz A, Ghani S, Reichardt A, Reichardt P, Schulz-Menger J. Native myocardial T1 time can predict development of subsequent anthracycline-induced cardiomyopathy. ESC Heart Fail 2018; 5:620-629. [PMID: 29673122 PMCID: PMC6073029 DOI: 10.1002/ehf2.12277] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/19/2018] [Accepted: 01/30/2018] [Indexed: 02/06/2023] Open
Abstract
Aims This study aims to assess subclinical changes in functional and morphological myocardial magnetic resonance parameters very early into an anthracycline treatment, which may predict subsequent development of anthracycline‐induced cardiomyopathy (aCMP). Methods and results Thirty sarcoma patients with planned anthracycline‐based chemotherapy (360–400 mg/m2 doxorubicin‐equivalent) were recruited. Median treatment time was 19.1 ± 2.1 weeks. Enrolled individuals received three cardiovascular magnetic resonance studies (before treatment, 48 h after first anthracycline treatment, and upon completion of treatment). Native T1 mapping (modified Look–Locker inversion recovery 5s(3s)3s), T2 mapping, and extracellular volume maps were acquired in addition to a conventional cardiovascular magnetic resonance with steady‐state free precession cine imaging at 1.5 T. Patients were given 0.2 mmol/kg gadoteridol for extracellular volume quantification and late gadolinium enhancement imaging. Development of relevant aCMP was defined as drop of left ventricular ejection fraction (LVEF) by >10%. For analysis, 23 complete data sets were available. Nine patients developed aCMP with LVEF reduction >10% until end of chemotherapy. Baseline LVEF was not different between patients with and without subsequent aCMP. When assessed 48 h after first dose of antracyclines, patients with subsequent aCMP had significantly lower native myocardial T1 times compared with before therapy (1002.0 ± 37.9 vs. 956.5 ± 29.2 ms, P < 0.01) than patients who did not develop aCMP (990.9 ± 56.4 vs. 978.4 ± 57.4 ms, P > 0.05). Patients with aCMP had decreased left ventricular mass upon completion of therapy (86.9 ± 24.5 vs. 81.1 ± 22.3 g; P = 0.02), while patients without aCMP did not show a change in left ventricular mass (81.8 ± 21.0 vs. 79.2 ± 18.1 g; P > 0.05). No patient developed new myocardial scars or compact myocardial fibrosis under chemotherapy. Conclusions Early decrease of T1 times 48 h after first treatment with anthracyclines can predict the development of subsequent aCMP after completion of chemotherapy.
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Affiliation(s)
- Fabian Muehlberg
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Stephanie Funk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Leonora Zange
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.,Clinic Agatharied, Department of Cardiology, Ludwig-Maximilian University of Munich, Hausham, Germany
| | - Edyta Blaszczyk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Alexander Schulz
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Saeed Ghani
- Department for Interdisciplinary Oncology and Sarcoma Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Annete Reichardt
- Department for Interdisciplinary Oncology and Sarcoma Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Peter Reichardt
- Department for Interdisciplinary Oncology and Sarcoma Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
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Alig S, Jurinovic V, Pastore A, Bararia D, Häbe S, Hellmuth JC, Kridel R, Gascoyne R, Schmidt C, Zöllner AK, Buske C, Dreyling M, Unterhalt M, Hiddemann W, Hoster E, Weigert O. Impact of age on genetics and treatment efficacy in follicular lymphoma. Haematologica 2018; 103:e364-e367. [PMID: 29545350 DOI: 10.3324/haematol.2018.187773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Stefan Alig
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Vindi Jurinovic
- Department of Medicine III, University Hospital, LMU Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Germany
| | | | - Deepak Bararia
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Sarah Häbe
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Johannes C Hellmuth
- Department of Medicine III, University Hospital, LMU Munich, Germany.,Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, NY, USA
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Randy Gascoyne
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, BC Cancer Agency, Vancouver, BC, Canada
| | - Christian Schmidt
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | | | - Christian Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital Ulm, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Michael Unterhalt
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, LMU Munich, Germany.,German Cancer Consortium (DKTK), Munich, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Hoster
- Department of Medicine III, University Hospital, LMU Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Germany
| | - Oliver Weigert
- Department of Medicine III, University Hospital, LMU Munich, Germany .,German Cancer Consortium (DKTK), Munich, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
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Pfreundschuh M. Age and Sex in Non-Hodgkin Lymphoma Therapy: It's Not All Created Equal, or Is It? Am Soc Clin Oncol Educ Book 2017; 37:505-511. [PMID: 28561693 DOI: 10.1200/edbk_175447] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Age is the most prominent factor for survival in all patients diagnosed with lymphoma, and male sex implies an increased and independent risk for a worse progression-free survival (PFS) and overall survival (OS) in most lymphomas, possibly with the exception of mantle cell lymphoma (MCL). The worse outcome for elderly patients is only partially explained by decreased tolerance to treatment regimens associated with the increasing number and severity of comorbidities. Little is known about specific differences in lymphoma biology with respect to age and sex, and this is changing only slowly despite the recent rise in interest about these issues. To better understand the differences and their underlying mechanisms, questions of age- and sex-specific outcomes, their correlation with pharmacokinetic data, and planned and received doses, must be addressed and reported in prospective clinical trials. Such studies must be accompanied by translational research that investigates biologic differences of lymphomas between old and young and male and female patients by addressing the microenvironment, cytogenetics including next-generation sequencing and systems biology of lymphomas, and correlation of these findings with treatment results. This knowledge will enable us to adjust lymphoma treatment to the necessities of more personalized medicine.
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Affiliation(s)
- Michael Pfreundschuh
- From the German High-Grade Non-Hodgkin Lymphoma Study Group, Internal Medicine I, Saarland University Medical School, Homburg, Germany
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Abstract
Anthracycline chemotherapy maintains a prominent role in treating many forms of cancer. Cardiotoxic side effects limit their dosing and improved cancer outcomes expose the cancer survivor to increased cardiovascular morbidity and mortality. The basic mechanisms of cardiotoxicity may involve direct pathways for reactive oxygen species generation and topoisomerase 2 as well as other indirect pathways. Cardioprotective treatments are few and those that have been examined include renin angiotensin system blockade, beta blockers, or the iron chelator dexrazoxane. New treatments exploiting the ErbB or other novel pro-survival pathways, such as conditioning, are on the cardioprotection horizon. Even in the forthcoming era of targeted cancer therapies, the substantial proportion of today's anthracycline-treated cancer patients may become tomorrow's cardiac patient.
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Affiliation(s)
- John V McGowan
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Robin Chung
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Angshuman Maulik
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Izabela Piotrowska
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - J Malcolm Walker
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK.
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Nabhan C, Zhou X, Day BM, Dawson K, Zelenetz AD, Friedberg JW, Cerhan JR, Link BK, Flowers CR. Disease, treatment, and outcome differences between men and women with follicular lymphoma in the United States. Am J Hematol 2016; 91:770-5. [PMID: 27124800 DOI: 10.1002/ajh.24401] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/05/2016] [Accepted: 04/22/2016] [Indexed: 01/04/2023]
Abstract
We aimed to comprehensively study sex differences in disease and patients' characteristics, treatment and outcomes in patients with follicular lymphoma (FL) in the United States (USA) utilizing the National LymphoCare Study registry (2004-2014). Among evaluable males (n = 1277) and females (n = 1375) with FL, females less commonly received anthracyclines and were more likely to receive rituximab monotherapy. Overall response rates were comparable between sex groups. With a median follow-up of 8.1 years, male sex emerged as an adverse factor for PFS (HR, 0.84, 95% CI, 0.72-0.97). Lymphoma-related mortality (HR, 0.46; 0.23-0.93) and overall survival (HR, 0.63; 0.41-0.97) favored females aged ≤60 years. There are subtle differences in outcomes between male and female FL patients diagnosed and treated in the contemporary era. These data represent the largest prospective analysis of FL patients in the USA based on sex and can aid design of clinical trials for this disease. Am. J. Hematol. 91:770-775, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Chadi Nabhan
- Section of Hematology and Oncology; Department of Medicine; the University of Chicago
| | - Xiaolei Zhou
- Biometrics, RTI Health Solutions; North Carolina
| | | | | | - Andrew D. Zelenetz
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York
| | | | | | - Brian K. Link
- Department of Medicine; the University of Iowa; Iowa
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Nabhan C, Chaffee KG, Slager SL, Galanina N, Achenbach SJ, Schwager SM, Kay NE, Shanafelt TD. Analysis of racial variations in disease characteristics, treatment patterns, and outcomes of patients with chronic lymphocytic leukemia. Am J Hematol 2016; 91:677-80. [PMID: 27013143 DOI: 10.1002/ajh.24374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/14/2023]
Abstract
The impact of race on outcomes of patients with chronic lymphocytic leukemia (CLL), the most common leukemia in the west, is not well studied. We aimed to understand racial variations in clinical and disease characteristics, treatment patterns, and outcomes in patients with CLL. We utilized the Mayo Clinic CLL database to perform an analysis of these characteristics and natural history of non-white (NW) compared to white (W) CLL patients. Differences by race in median overall survival (OS) and time-to-first-treatment (TTFT) were investigated. Of the 4215 CLL patients, 4114 (97.6%) were W and 101 (2.4%) were NW. NW patients were younger (median age at diagnosis 59.4 vs. 63.4; P = 0.003) and more likely to have an elevated LDH (28.0% vs. 16.2%; P = 0.02). No differences in prognostic parameters were noted. No major differences were observed in treatment selection. OS and TTFT were similar between both groups. In the largest analysis of NW-CLL patients in North America, and contrary to historical retrospective reports, W and NW patients appear to have comparable outcomes when treated similarly. These findings suggest previously noted outcome differences may be due to disparities in access to care and management rather than differences in disease biology. Am. J. Hematol. 91:677-680, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Chadi Nabhan
- Department of Medicine; Section of Hematology and Oncology, the University of Chicago; Chicago Illinois
| | - Kari G. Chaffee
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Susan L. Slager
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Natalie Galanina
- Department of Medicine; Section of Hematology and Oncology, the University of Chicago; Chicago Illinois
| | - Sara J. Achenbach
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Susan M. Schwager
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - Neil E. Kay
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - Tait D. Shanafelt
- Division of Hematology; Department of Medicine; Mayo Clinic; Rochester Minnesota
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Barrientos JC. Idelalisib for the treatment of indolent non-Hodgkin lymphoma: a review of its clinical potential. Onco Targets Ther 2016; 9:2945-53. [PMID: 27274288 PMCID: PMC4876096 DOI: 10.2147/ott.s102573] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Idelalisib is a first-in-class, oral, selective phosphatidylinositol 3-kinase δ inhibitor that offers a chemotherapy-free option for patients with relapsed or refractory (R/R) indolent non-Hodgkin lymphoma (iNHL). Clinical trials in iNHL have evaluated idelalisib as monotherapy and as combination therapy with rituximab, bendamustine, and rituximab + bendamustine. When administered to heavily pretreated patients with R/R iNHL, idelalisib monotherapy or combination therapy showed durable antitumor activity accompanied by sustained or improved quality-of-life outcomes. Idelalisib has an acceptable safety profile; however, serious or fatal diarrhea/colitis, hepatoxicity, pneumonitis, and intestinal perforation have occurred in treated patients. Selective inhibition of phosphatidylinositol 3-kinase δ with idelalisib is a valuable addition to available treatment options for patients with iNHL, many of whom do not respond to or cannot tolerate chemoimmunotherapy. Two Phase III, randomized, placebo-controlled trials of idelalisib as combination therapy with rituximab or bendamustine + rituximab and a Phase I trial of idelalisib in combination with the Bruton’s tyrosine kinase inhibitor ONO/GS-4059 in R/R B-cell malignancies are currently ongoing. A Phase III monotherapy trial in previously treated follicular lymphoma or small lymphocytic lymphoma is planned. The development of other kinase inhibitors for the treatment of iNHL raises the potential for new treatment combinations. Additional research is needed to determine optimal therapy (monotherapy vs combination regimens), treatment sequencing, and long-term management.
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Affiliation(s)
- Jacqueline C Barrientos
- CLL Research and Treatment Program, Division of Hematology/Oncology, Department of Medicine, Hofstra Northwell School of Medicine, Hofstra University, Lake Success, NY, USA
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