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Usuki K, Ohtake S, Honda S, Matsuda M, Wakita A, Nawa Y, Takase K, Maeda A, Sezaki N, Yokoyama H, Takada S, Hirano D, Tomikawa T, Sumi M, Yano S, Handa H, Ota S, Fujita H, Fujimaki K, Mugitani A, Kojima K, Kajiguchi T, Fujimoto K, Asou N, Usui N, Ishikawa Y, Katsumi A, Matsumura I, Kiyoi H, Miyazaki Y. Real-world data of AML in Japan: results of JALSG clinical observational study-11 (JALSG-CS-11). Int J Hematol 2024; 119:24-38. [PMID: 38015362 DOI: 10.1007/s12185-023-03677-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
This report covers acute myeloid leukemia (AML) results from a multicenter, prospective observational study of AML, myelodysplastic syndromes, and chronic myelomonocytic leukemia in Japan. From August 2011 to January 2016, 3728 AML patients were registered. Among them, 42% were younger than 65, and the male-to-female ratio was 1.57:1. With a median follow-up time of 1807 days (95% confidence interval [CI]: 1732-1844 days), the estimated 5-year overall survival (OS) rate in AML patients (n = 3707) was 31.1% (95% CI: 29.5-32.8%). Trial-enrolled patients had a 1.7-fold higher OS rate than non-enrolled patients (5-year OS, 58.9% [95% CI: 54.5-63.1%] vs 35.5% [33.3-37.8%], p < 0.0001). Women had a higher OS rate than men (5-year OS, 34% [95% CI; 31.4-36.7%] vs 27.7% [25.7-29.7%], p < 0.0001). The OS rate was lower in patients aged 40 and older than those under 40, and even lower in those over 65 (5-year OS for ages < 40, 40-64, 65-74, ≥ 75: 74.5% [95% CI; 69.3-79.0%] vs 47.5% [44.4-50.6%] vs 19.3% [16.8-22.0%] vs 7.3% [5.5-9.4%], respectively). This is the first paper to present large-scale data on survival and clinical characteristics in Japanese AML patients.
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Affiliation(s)
- Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Higashi-Gotanda 5-9-22, Shinagawa-Ku, Tokyo, 141-8625, Japan.
| | | | - Sumihisa Honda
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Atsushi Wakita
- Nagoya City University East Medical Center, Nagoya, Japan
| | - Yuichiro Nawa
- Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | | | | | | | - Satoru Takada
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Daiki Hirano
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Tatsuki Tomikawa
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | | | - Shingo Yano
- Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Hiroyuki Fujita
- Department of Hematology, Yokohama Nanbu Hospital, Yokohama, Japan
| | | | | | - Kensuke Kojima
- Department of Hematology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tomohiro Kajiguchi
- Department of Hematology and Oncology, Tosei General Hospital, Seto, Japan
| | - Ko Fujimoto
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Norio Asou
- International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Noriko Usui
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Katsumi
- Department of Hematology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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TRAORÉ C, NEBIÉ K, SAWADOGO S, SANOU AF, HÉMA A, KAFANDO É. [Prognostic factors and survival in adult acute leukemia in Burkina Faso]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i3.2023.409. [PMID: 38094491 PMCID: PMC10714604 DOI: 10.48327/mtsi.v3i3.2023.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/29/2023] [Indexed: 12/18/2023]
Abstract
Introduction Acute leukemia is both a diagnostic and therapeutic emergency. Our study aimed to describe the prognostic factors and survival of adults with acute leukemia in Burkina Faso. Patients and methods Cross-sectional descriptive study with retrospective data collection covering a period of 4.5 years (2018-2022) in two university hospitals in Burkina Faso. Were included all patients over 18 years hospitalized for acute leukemia in these sites with a usable medical record. Results A total of 42 cases were collected, of which 45% suffered from acute lymphoblastic leukemia and 43% from acute myeloid leukemia. In 12% of cases, acute leukemia was not classified. The average age was 35 ± 15 years, with extremes of 19 and 72 years. 12% of the patients presented an age of poor prognosis. Comorbidities were present in 14% of patients. The deterioration in general condition was fairly constant with 95% of patients at WHO stages 3 and 4. All patients presented with bone marrow failure syndrome and tumor syndrome was found in 45%. Anemia and thrombocytopenia were present in almost all cases. Hyperleukocytosis at diagnosis was present in 28 patients (67%); among them 18 patients (64%) had leukocytes greater than 50 G/L. Death in hospital was found in 38% of patients and loss of sight in 31%. The median survival was 3 months. Survival was 30% at 6 months and 0% at 12 months. Conclusion Acute leukemias are in our practice conditions of poor prognosis with a fairly short survival.
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Affiliation(s)
- Catherine TRAORÉ
- Institut supérieur des sciences de la santé (IN.S.SA), Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Koumpingnin NEBIÉ
- Laboratoire d'hématologie, UFR SDS, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Salam SAWADOGO
- Laboratoire d'hématologie, UFR SDS, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | | | - Arsène HÉMA
- Centre hospitalier universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Éléonore KAFANDO
- Centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Foran JM, Sun Z, Lai C, Fernandez HF, Cripe LD, Ketterling RP, Racevskis J, Luger SM, Paietta E, Lazarus HM, Zhang Y, Bennett JM, Levine RL, Rowe JM, Litzow MR, Tallman MS. Obesity in adult acute myeloid leukemia is not associated with inferior response or survival even when dose capping anthracyclines: An ECOG-ACRIN analysis. Cancer 2023; 129:2479-2490. [PMID: 37185873 PMCID: PMC10932613 DOI: 10.1002/cncr.34807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/04/2023] [Accepted: 03/02/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Obesity (body mass index [BMI] ≥30 kg/m2 ) is an important epidemiological risk factor for developing acute myeloid leukemia (AML). Therefore, the authors studied the association of obesity with clinical and genetic phenotype and its impact on outcome in adults with AML. METHODS The authors analyzed BMI in 1088 adults who were receiving intensive remission induction and consolidation therapy in two prospective, randomized therapeutic clinical trials of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network: E1900 (ClinicalTrials.gov identifier NCT00049517; patients younger than 60 years) and E3999 (ClinicalTrials.gov identifier NCT00046930; patients aged 60 years or older). RESULTS Obesity was prevalent at diagnosis (33%) and, compared with nonobesity, was associated with intermediate-risk cytogenetics group (p = .008), poorer performance status (p = .01), and a trend toward older age (p = .06). Obesity was not associated with somatic mutations among a selected 18-gene panel that was tested in a subset of younger patients. Obesity was not associated with clinical outcome (including complete remission, early death, or overall survival), and the authors did not identify any patient subgroup that had inferior outcomes based on BMI. Obese patients were significantly more likely to receive <90% of the intended daunorubicin dose despite protocol specification, particularly in the E1900 high-dose (90 mg/m2 ) daunorubicin arm (p = .002); however, this did not correlate with inferior overall survival on multivariate analysis (hazard ratio, 1.39; 95% confidence interval, 0.90-2.13; p = .14). CONCLUSIONS Obesity is associated with unique clinical and disease-related phenotypic features in AML and may influence physician treatment decisions regarding daunorubicin dosing. However, the current study demonstrates that obesity is not a factor in survival, and strict adherence to body surface area-based dosing is not necessary because dose adjustments do not affect outcomes.
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Affiliation(s)
- James M. Foran
- Division of Hematology and Medical Oncology and Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida
| | - Zhuoxin Sun
- ECOG-ACRIN Biostatistics Center, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hugo F. Fernandez
- Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Larry D. Cripe
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Rhett P. Ketterling
- Department of Laboratory Medicine and Pathology and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Selina M. Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Yanming Zhang
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John M. Bennett
- Hematopathology Division, Department of Pathology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Ross L. Levine
- Cytogenetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Mark R. Litzow
- Department of Laboratory Medicine and Pathology and Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Martin S. Tallman
- Northwestern University Feinberg School of Medicine, Robert H.Lurie Comprehensive Cancer Center, Chicago, Illinois
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Jimbu L, Valeanu M, Trifa AP, Mesaros O, Bojan A, Dima D, Parvu A, Rus IC, Tomuleasa C, Torok T, Urian L, Vasilache A, Zdrenghea M. A Survival Analysis of Acute Myeloid Leukemia Patients Treated With Intensive Chemotherapy: A Single Center Experience. Cureus 2023; 15:e43794. [PMID: 37731446 PMCID: PMC10508193 DOI: 10.7759/cureus.43794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Acute myeloid leukaemia (AML) is a haematological disease associated with a dismal prognosis, despite major progress made in recent years in terms of antileukemic agents and supportive care. METHODS We investigated the results of the intensive treatment of 133 fit AML patients (de novo and secondary) from a referral cancer centre in Romania, treated between January 2015 and December 2021. RESULTS We included 79 male and 54 female patients with a median age of 53 years (range 18-70). Molecular biology analysis was available for 82.7% of patients, whereas karyotype analysis was only available for 33% of patients. The median overall survival (OS) was 8.7 months, and the disease-free survival rate was 26.3% at a median follow-up of 33.7 months. The complete remission (CR) rate after induction was 48.9% for all patients and 61.9% for patients who were assessable (excluding patients who died before being assessed for response). Twelve patients underwent allogeneic bone marrow transplantation (BMT), with the median OS not reached. Early mortality (EM), defined as death during the first 30 days after admission, was 17.3%, with the main cause of death being septic shock (78.3%). Elderly patients (≥60 years of age) had a lower OS, more primary refractory disease, and higher rates of early mortality. CONCLUSION Complete remission rates and OS in our cohort were lower than in other reports. Early mortality was unexpectedly high, mainly due to infections, which were the main causes of death in our cohort.
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Affiliation(s)
- Laura Jimbu
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Madalina Valeanu
- Statistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Adrian P Trifa
- Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, ROU
- Genetics, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
| | - Oana Mesaros
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Anca Bojan
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Delia Dima
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
| | - Andrada Parvu
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Ioana C Rus
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
| | - Ciprian Tomuleasa
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj Napoca, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Tunde Torok
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Laura Urian
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Anca Vasilache
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
| | - Mihnea Zdrenghea
- Hematology, 'Ion Chiricuta' Oncology Institute, Cluj-Napoca, ROU
- Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
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Dumas PY, Raffoux E, Bérard E, Bertoli S, Hospital MA, Heiblig M, Desbrosses Y, Bonmati C, Pautas C, Lambert J, Orvain C, Banos A, Pasquier F, Peterlin P, Marchand T, Uzunov M, Frayfer J, Turlure P, Cluzeau T, Jourdan E, Himberlin C, Tavernier E, Villate A, Haiat S, Chretien ML, Carre M, Chantepie S, Vaida I, Wemeau M, Chebrek S, Guillerm G, Guièze R, Debarri H, Gehlkopf E, Laribi K, Marcais A, Santagostino A, Béné MC, Mineur A, Pigneux A, Dombret H, Récher C. Gilteritinib activity in refractory or relapsed FLT3-mutated acute myeloid leukemia patients previously treated by intensive chemotherapy and midostaurin: a study from the French AML Intergroup ALFA/FILO. Leukemia 2023; 37:91-101. [PMID: 36376378 DOI: 10.1038/s41375-022-01742-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
The real-world efficacy and safety of gilteritinib was assessed in an ambispective study that included 167 R/R FLT3-mutated AML patients. Among them, 140 received gilteritinib as single agent (cohort B), including 67 previously treated by intensive chemotherapy and midostaurin (cohort C). The main differences in patient characteristics in this study compared to the ADMIRAL trial were ECOG ≥ 2 (83.6% vs. 16.6%), FLT3-TKD mutation (21.0% vs. 8.5%), primary induction failure (15.0% vs. 40.0%) and line of treatment (beyond 2nd in 37.1% vs. 0.0%). The rates of composite complete remission, excluding those that occurred after hematopoietic stem cell transplantation (HSCT), were similar at respectively 25.4% and 27.5% in cohorts B and C. Median overall survival (OS) for these two groups was also similar at respectively 6.4 and 7.8 months. Multivariate analyses for prognostic factors associated with OS identified female gender (HR 1.61), adverse cytogenetic risk (HR 2.52), and allogenic HSCT after gilteritinib (HR 0.13). Although these patients were more heavily pretreated, these real-world data reproduce the results of ADMIRAL and provide new insights into the course of patients previously treated by intensive chemotherapy and midostaurin and beyond the 2nd line of treatment who can benefit from treatment in an outpatient setting.
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Affiliation(s)
- Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France.
| | - Emmanuel Raffoux
- Hôpital Saint Louis, APHP, service d'hématologie adultes, Paris, France
| | - Emilie Bérard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, CERPOP, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Maël Heiblig
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie clinique, Pierre Bénite, France
| | | | - Caroline Bonmati
- Service d'Hématologie, CHU Nancy Brabois, 54500, Vandoeuvre les Nancy, France
| | - Cécile Pautas
- CHU Henri-Mondor, Service d'Hématologie Clinique et de Thérapie Cellulaire; 1, rue Gustave Eiffel, 94010, Créteil, France
| | - Juliette Lambert
- Centre hospitalier de Versailles, Service Hématologie, Le Chesnay, France
| | - Corentin Orvain
- Service des maladies du sang, CHU d'Angers, France/Fédération hospitalo-universitaire « Grand Ouest against Leukemia »/Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France
| | - Anne Banos
- Service Hématologie, Centre Hospitalier de la Côte Basque, 64100, Bayonne, France
| | - Florence Pasquier
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Tony Marchand
- Service d'hématologie Clinique, CHU de Rennes, 35000, Rennes, France
| | - Madalina Uzunov
- Hôpital Pitié Salpetrière, Service d'hématologie, Paris, France
| | | | - Pascal Turlure
- CHU limoges, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-87000, Limoges, France
| | - Thomas Cluzeau
- Université Cote d'Azur, CHU de Nice, Département d'hématologie clinique, Nice, France
| | - Eric Jourdan
- Department of Hematology, Nîmes University Hospital, Nîmes, France
| | - Chantal Himberlin
- Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | - Emmanuelle Tavernier
- CHU Saint Etienne. Service d'hématologie clinique et thérapie cellulaire, 42 000, Saint Etienne, France
| | - Alban Villate
- Hématologie et thérapie cellulaire, CHRU de Tours, Tours, France
| | - Stephanie Haiat
- Centre hospitalier Sud francilien, Service d'hématologie clinique, Corbeil-Essonnes, France
| | | | | | | | - Ioana Vaida
- Centre Hospitalier René Dubos, Service d'hématologie et thérapie cellulaire, Cergy-Pontoise, France
| | - Mathieu Wemeau
- CH Roubaix, service d'hématologie, F-59100, Roubaix, France
| | - Safia Chebrek
- CH Avignon, service d'onco-hématologie, Avignon, France
| | - Gaelle Guillerm
- CHU Brest, Hôpital Morvan, Service de cancérologie-hématologie, Brest, France
| | - Romain Guièze
- Service d'hématologie clinique et de thérapie cellulaire, CHU de Clermont-Ferrand, Clermont-Ferrand, France; EA 7453 (CHELTER), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Houria Debarri
- CHR Metz-Thionville, Hôpital Mercy, service d'hématologie, Metz, France
| | - Eve Gehlkopf
- Hôpital Saint Eloi CHU Montpellier, Service d'Hématologie Clinique, 34295, Montpellier, France
| | - Kamel Laribi
- Department of Haematology, Centre hospitalier Le Mans, Le Mans, France
| | - Ambroise Marcais
- Service Hématologie Adultes, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Cité, Paris, France
| | | | | | - Ariane Mineur
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France
| | - Arnaud Pigneux
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France
| | - Hervé Dombret
- Hôpital Saint Louis, APHP, service d'hématologie adultes, Paris, France
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
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Stabellini N, Tomlinson B, Cullen J, Shanahan J, Waite K, Montero AJ, Barnholtz-Sloan JS, Hamerschlak N. Sex differences in adults with acute myeloid leukemia and the impact of sex on overall survival. Cancer Med 2022; 12:6711-6721. [PMID: 36419242 PMCID: PMC10067038 DOI: 10.1002/cam4.5461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a male predominance of acute myeloid leukemia (AML) incidence, but survival data are conflicting. The objective of this study is to carry out a comprehensive analysis of sex differences in AML, and to investigate the impact of sex disparities in survival. METHODS The cohort included patients ≥18 years diagnosed with AML (2010-2022). Demographics, treatment patterns, treatment adverse events, and survival were analyzed. The population was described and compared by sex, and sex-based risks and associations were obtained via Cox proportional-hazards regression. RESULTS In total, 1020 AML patients were analyzed (57.4% males), with lower risk of death for females (aHR = 0.41, 95% CI 0.26-0.66). Among females, BMT (aHR = 0.51, 95% CI 0.27-0.97), hospitalization record (aHR = 0.65, 95%CI 0.45-0.93), and higher appointment completion rates (aHR = 0.98, 95% CI 0.98-0.98) were associated with lower risk of death. Overall, and similarly in males, higher age at diagnosis (aHR = 1.03, 95% CI 1.02-1.04) and a TP53 mutation (aHR = 2.24, 95% CI 1.69-2.97) were associated with higher risk of death. CONCLUSION Sex differences exist in both AML incidence and overall survival. Treatment and health care factors should be addressed by caregivers and public policies developed to reduce mortality rates and mitigate existing sex differences.
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Affiliation(s)
- Nickolas Stabellini
- Graduate Education Office, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA.,Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin Tomlinson
- Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - John Shanahan
- Cancer Informatics, Seidman Cancer Center at University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Kristin Waite
- Division of Cancer Epidemiology and Genetics (DCEG), Trans-Divisional Research Program (TDRP), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alberto J Montero
- Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Jill S Barnholtz-Sloan
- Division of Cancer Epidemiology and Genetics (DCEG), Trans-Divisional Research Program (TDRP), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Center for Biomedical Informatics and Information Technology (CBIIT), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nelson Hamerschlak
- Oncohematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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7
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Targeted activation of GPER enhances the efficacy of venetoclax by boosting leukemic pyroptosis and CD8+ T cell immune function in acute myeloid leukemia. Cell Death Dis 2022; 13:915. [PMID: 36316313 PMCID: PMC9622865 DOI: 10.1038/s41419-022-05357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
Acute myeloid leukemia (AML) is a rapidly progressing and often fatal hematopoietic malignancy. Venetoclax (VEN), a recent FDA-approved BCL-2 selective inhibitor, has high initial response rates in elderly AML patients, but the majority of patients eventually acquire resistance. Multiple studies have demonstrated that the female sex is associated with better outcomes in patients with AML, which are predominantly attributed to estrogen signaling. As a novel membrane estrogen receptor, G protein-coupled estrogen receptor (GPER)-mediated-rapid estrogen effects have attracted considerable attention. However, whether targeting GPER enhances the antileukemic activity of VEN is unknown. In this study, we first demonstrated that GPER expression was dramatically reduced in AML cells owing to promoter hypermethylation. Furthermore, pharmacological activation of GPER by G-1 combined with VEN resulted in synergistic antileukemic activity in vitro and in vivo. Mechanistically, G-1/VEN combination synergistically triggered concurrent mitochondria-related apoptosis and gasdermin E (GSDME)-dependent pyroptosis by activating p38-MAPK/myeloid cell leukemia 1 (MCL-1) axis. Importantly, leukemic pyroptosis heightened CD8+ T cell immune function by releasing interleukin (IL)-1β/18 into the tumor microenvironment. Our study corroborates that GPER activation shows a synergistic antileukemic effect with VEN, making it a promising therapeutic regimen for AML.
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Integrative analysis identifies an older female-linked AML patient group with better risk in ECOG-ACRIN Cancer Research Group's clinical trial E3999. Blood Cancer J 2022; 12:137. [PMID: 36151075 PMCID: PMC9508258 DOI: 10.1038/s41408-022-00736-z] [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: 06/07/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/14/2023] Open
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Dutcher JP. Gender effects in cancer treatment and outcome. Br J Haematol 2021; 194:229-230. [PMID: 34145565 DOI: 10.1111/bjh.17529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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