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Kegyes D, Ghiaur G, Bancos A, Tomuleasa C, Gale RP. Immune therapies of B-cell acute lymphoblastic leukaemia in children and adults. Crit Rev Oncol Hematol 2024; 196:104317. [PMID: 38437908 DOI: 10.1016/j.critrevonc.2024.104317] [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: 10/14/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
B-cell acute lymphoblastic leukaemia (B-cell ALL) is a common haematologic cancer in children and adults. About 10 percent of children and 50 percent of adults fail to achieve a histological complete remission or subsequently relapse despite current anti-leukaemia drug therapies and/or haematopoietic cell transplants. Several new immune therapies including monoclonal antibodies and chimeric antigen receptor (CAR)-T-cells are proved safe and effective in this setting. We review data on US Food and Drug Administration (FDA)-approved immune therapies for B-cell ALL in children and adults including blinatumomab, inotuzumab ozogamicin, tisagenlecleucel, and brexucabtagene autoleucel. We also summarize pharmaco-dynamics, pharmaco-kinetics, and pharmaco-economics of these interventions.
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Affiliation(s)
- David Kegyes
- Department of Hematology-Medfuture Research Center for Advanced Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca, Romania; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania; Academy of Romanian Scientists, Bucharest, Romania
| | - Gabriel Ghiaur
- Department of Hematology-Medfuture Research Center for Advanced Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca, Romania; Department of Leukemia, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Anamaria Bancos
- Department of Hematology-Medfuture Research Center for Advanced Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca, Romania; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Ciprian Tomuleasa
- Department of Hematology-Medfuture Research Center for Advanced Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca, Romania; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania; Academy of Romanian Scientists, Bucharest, Romania.
| | - Robert Peter Gale
- Centre for Haematology, Imperial College of Science, Technology and Medicine, London, UK; Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; Department of Hematology, Peking University People's Hospital, Beijing, China
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2
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Maksten EF, Jørgensen RRK, Pedersen MS, Fonager K, Bech RS, Mølle I, Ørskov AD, Schöllkopf C, Overgaard UM, Thomsen GN, El-Galaly TC, Severinsen MT. Work Disability and Return to Work After Treatment for Acute Lymphoblastic Leukemia: A Danish Nationwide Cohort Study. Clin Epidemiol 2024; 16:191-202. [PMID: 38500516 PMCID: PMC10946445 DOI: 10.2147/clep.s444270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose Most adult patients diagnosed with acute lymphoblastic leukemia (ALL) are below retirement age. The overall survival of patients with ALL has improved with implementation of high intensity pediatric-inspired treatment protocols. However, this treatment comes with a risk of long-term complications, which could affect the ability to work. The aim of this study was to investigate the risk of disability pension (DP) and return to work (RTW) for patients with ALL. Patients and Methods Patients aged 18-60 years diagnosed with ALL between 2005 and 2019 were identified in the Danish National Acute Leukemia Registry. Each patient was matched with five comparators from the general population on birth year, sex, and Charlson Comorbidity Index. The Aalen-Johansen estimator was used to calculate the cumulative risk of DP for patients and comparators from index date (defined as 1 year after diagnosis) with competing events (transplantation or relapse, death, retirement pension, or early retirement pension). Differences in cumulative incidences were calculated using Gray's test. RTW was calculated as proportions one, three, and five years after the index date for patients holding a job before diagnosis. Results A total of 154 patients with ALL and 770 matched comparators were included. The 5-year cumulative risk of DP was increased fivefold for patients with ALL compared with the general population. RTW was 41.7%, 65.7%, and 60.7% one, three, and five years after the index date, respectively. Conclusion The risk of DP in patients with ALL increased significantly compared with the general population. Five years after the index date, RTW was 60.7% for patients with ALL.
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Affiliation(s)
- Eva Futtrup Maksten
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Rask Kragh Jørgensen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mathilde Selmar Pedersen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Rie Sander Bech
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ingolf Mølle
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andreas Due Ørskov
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Claudia Schöllkopf
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Tarec C El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ghahramani Almanghadim H, Karimi B, Poursalehi N, Sanavandi M, Atefi Pourfardin S, Ghaedi K. The biological role of lncRNAs in the acute lymphocytic leukemia: An updated review. Gene 2024; 898:148074. [PMID: 38104953 DOI: 10.1016/j.gene.2023.148074] [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: 10/10/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
The cause of leukemia, a common malignancy of the hematological system, is unknown. The structure of long non-coding RNAs (lncRNAs) is similar to mRNA but no ability to encode proteins. Numerous malignancies, including different forms of leukemia, are linked to Lnc-RNAs. It is verified that the carcinogenesis and growth of a variety of human malignancies are significantly influenced by aberrant lncRNA expression. The body of evidence linking various types of lncRNAs to the etiology of leukemia has dramatically increased during the past ten years. Some lncRNAs are therefore anticipated to function as novel therapeutic targets, diagnostic biomarkers, and clinical outcome predictions. Additionally, these lncRNAs may provide new therapeutic options and insight into the pathophysiology of diseases, particularly leukemia. Thus, this review outlines the present comprehension of leukemia-associated lncRNAs.
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Affiliation(s)
| | - Bahareh Karimi
- Department of Cellular and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Negareh Poursalehi
- Department of Medical Biotechnology, School of Medicine Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Kamran Ghaedi
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Hezar Jerib Ave., Azadi Sq., 81746-73441 Isfahan, Iran.
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McClory SE, Maude SL. The Current State of Chimeric Antigen Receptor T Cell Therapy for B Lymphoblastic Leukemia. Hematol Oncol Clin North Am 2023; 37:1041-1052. [PMID: 37500380 DOI: 10.1016/j.hoc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Over the past decade, CAR T cell therapy has transformed the treatment of relapsed or refractory B-ALL in children and adults. CD19-directed CAR T cells can induce complete remissions in a large majority of patients with B-ALL, and up to half of these patients will go on to maintain durable remissions. However, significant challenges remain for patients who relapse or do not respond. This review will discuss the history of CAR T cell therapy for B-ALL, the treatment considerations for CAR T cell recipients, and current clinical trials and future directions for CAR T cell therapy in B-ALL.
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Affiliation(s)
- Susan E McClory
- Division of Oncology, Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shannon L Maude
- Division of Oncology, Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Loureiro G, Bahia DM, Lee MLM, de Souza MP, Kimura EYS, Rezende DC, Silva MCDA, Chauffaille MDLLF, Yamamoto M. MAPK/ERK and PI3K/AKT signaling pathways are activated in adolescent and adult acute lymphoblastic leukemia. Cancer Rep (Hoboken) 2023; 6:e1912. [PMID: 37867416 PMCID: PMC10728523 DOI: 10.1002/cnr2.1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/12/2023] [Accepted: 09/16/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The mitogen-activated protein kinase (MAPK)/ERK signaling cascade and the phosphoinosytol-3 phosphate/Akt (PI3K/Akt) pathways are involved in proliferation and differentiation of hematopoietic cells. The frequency of PI3K/Akt and MAPK pathway activation in adult acute lymphoblastic leukemia (ALL) still need to be elucidated. AIMS To assess the activity and prognostic implications of MAPK/ERK and PI3K/Akt pathways in adult (ALL). METHODS We examined 28 precursor-B-cell ALL and 6 T-cell primary ALL samples. Flow cytometry was employed to analyze the expression levels of phosphorylated ERK and phosphorylated Akt. RESULTS Ten out of 15 (67%) ALL fresh samples (7 B-cell, 3 T-cell) showed constitutive p-ERK expression. The p-ERK mean fluorescent index ratio (MFI (R)) showed a tendency to be higher in ALL than in normal T lymphocytes (1.26 [0.74-3.10] vs. 1.08 [1.02-1.21], respectively [p = .069]) and was significantly lower than in leukemic cell lines (median MFI (R) 3.83 [3.71-5.97] [p < .001]). Expression of p-Akt was found in 35% (12/34) (10 B-cell, 2 T-cell). The median MFI (R) expression for p-Akt in primary blast cell was 1.13 (0.48-9.90) compared to 1.01 (1.00-1.20) in normal T lymphocytes (p = ns) and lower than in leukemic cell lines (median MFI (R) 2.10 [1.77-3.40] [p = .037]). Moreover, expression of p-ERK was negatively associated with the expression of CD34 (1.22 [0.74-1.33] vs. 1.52 [1.15-3.10] for CD34(+) and CD34(-) group, respectively, p = .009). CONCLUSION Our findings suggest that both MAPK/ERK and PI3K/Akt are constitutively activated in adult ALL, indicating a targeted therapy potential for ALL by using inhibitors of these pathways.
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Affiliation(s)
- Gustavo Loureiro
- Division of HematologyUniversidade Federal de São Paulo (EPM‐UNIFESP)São PauloSão PauloBrazil
| | - Daniella M. Bahia
- Division of HematologyUniversidade Federal de São Paulo (EPM‐UNIFESP)São PauloSão PauloBrazil
| | - Maria Lucia M. Lee
- Instituto de Oncologia PediátricaGrupo de Apoio ao Adolescente e a Criança com Câncer (GRAACC)São PauloSão PauloBrazil
| | | | - Eliza Y. S. Kimura
- Division of HematologyUniversidade Federal de São Paulo (EPM‐UNIFESP)São PauloSão PauloBrazil
| | - Denise Carvalho Rezende
- Division of HematologyUniversidade Federal de São Paulo (EPM‐UNIFESP)São PauloSão PauloBrazil
| | | | | | - Mihoko Yamamoto
- Division of HematologyUniversidade Federal de São Paulo (EPM‐UNIFESP)São PauloSão PauloBrazil
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Zarling LC, Stevenson PA, Soma LA, Martino CH, Percival MEM, Halpern AB, Ghiuzeli CM, Becker PS, Oehler VG, Cooper JP, Orozco JJ, Hendrie PC, Walter RB, Estey EH, Cassaday RD. Hyper-CVAD versus dose-adjusted EPOCH as initial treatment for adults with acute lymphoblastic leukemia. Eur J Haematol 2023; 111:863-871. [PMID: 37670560 DOI: 10.1111/ejh.14089] [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: 06/19/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES We recently performed a single-arm phase II trial of DA-EPOCH in adults with acute lymphoblastic leukemia (ALL). We sought to compare these results to those with standard Hyper-CVAD. METHODS We created a retrospective matched cohort of patients who received Hyper-CVAD (n = 69) at our center and otherwise met eligibility criteria for the DA-EPOCH trial (n = 53). RESULTS Our outcomes support the use of Hyper-CVAD over DA-EPOCH in Ph- disease for both overall survival (OS; HR 0.18, p = .004) and event-free survival (EFS; HR 0.51, p = .06). In contrast, outcomes were similar in Ph+ disease (OS HR 0.97, p = .96; EFS HR 0.65, p = .21). Rates of morphologic remission and measurable residual-disease negativity were similar between the regimens. Hyper-CVAD was associated with significantly more febrile neutropenia (OR 1.9, p = .03) and a greater incidence of Grade 4 or 5 adverse events (20% vs. 6%). Average transfusions per cycle of both red blood cells (p < .001) and platelets (p < .001) were five-fold higher with Hyper-CVAD. CONCLUSIONS Our findings support continued use of Hyper-CVAD for Ph- ALL but suggest that DA-EPOCH may be a reasonable alternative for Ph+ ALL. These data also highlight a potential role for DA-EPOCH in resource-limited settings or when more intense therapy is not feasible.
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Affiliation(s)
- Lucas C Zarling
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
| | - Philip A Stevenson
- Clinical Statistics Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Lorinda A Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Christen H Martino
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Mary-Elizabeth M Percival
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Anna B Halpern
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Cristina M Ghiuzeli
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Pamela S Becker
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Vivian G Oehler
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Jason P Cooper
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Johnnie J Orozco
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Paul C Hendrie
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Roland B Walter
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Elihu H Estey
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
| | - Ryan D Cassaday
- Department of Medicine, University of Washington, Seattle, Washington, DC, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, DC, USA
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Sijs-Szabo A, Dinmohamed AG, Versluis J, van der Holt B, Bellido M, Hazenberg MD, van Gelder M, Schaap NPM, Meijer E, van der Wagen LE, Halkes CJM, Rijneveld AW, Cornelissen JJ. Allogeneic Stem Cell Transplantation in Patients >40 Years of Age With Acute Lymphoblastic Leukemia: Reduced Intensity Versus Myeloablative Conditioning. Transplantation 2023; 107:2561-2567. [PMID: 37389645 DOI: 10.1097/tp.0000000000004706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND The outcome in older patients with acute lymphoblastic leukemia (ALL) remains unsatisfactory due to high relapse and nonrelapse mortality (NRM) rates. Allogeneic stem cell transplantation (alloHSCT) as postremission therapy has an important role in reducing relapse rate, albeit its application is limited in older adult patients due to alloHSCT-related morbidity and mortality. Reduced-intensity conditioning (RIC) alloHSCT has been developed as a less toxic conditioning regimen, but comparative studies with myeloablative conditioning (MAC) are limited in patients with ALL. METHODS In this retrospective study, RIC-alloHSCT (n = 111) was compared with MAC-alloHSCT (n = 77) in patients aged 41 to 65 y with ALL in first complete remission. MAC was predominantly applied by combining high-dose total body irradiation and cyclophosphamide, whereas RIC mainly consisted of fludarabine and 2 Gy total body irradiation. RESULTS Unadjusted overall survival was 54% (95% confidence interval [CI], 42%-65%) at 5 y in MAC recipients compared with 39% (95% CI, 29%-49%) in RIC recipients. Overall survival and relapse-free survival were not significantly associated with type of conditioning after adjusted for the covariates age, leukemia risk status at diagnosis, donor type, and donor and recipient gender combination. NRM was significantly lower after RIC (subdistribution hazard ratio: 0.41, 95% CI, 0.22-0.78; P = 0.006), whereas relapse was significantly higher (subdistribution hazard ratio: 3.04, 95% CI, 1.71-5.40; P < 0.001). CONCLUSIONS Collectively, RIC-alloHSCT has resulted in less NRM, but it was also found to be associated with a significantly higher relapse rate. These results suggest that MAC-alloHSCT may provide a more effective type of consolidation therapy for the reduction of relapse and that RIC-alloHSCT may be restricted to patients at higher risk for NRM.
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Affiliation(s)
- Aniko Sijs-Szabo
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jurjen Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Bronno van der Holt
- Department of Hematology, HOVON Data Center, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Mar Bellido
- Department of Hematology, Rijksuniversity Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mette D Hazenberg
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michel van Gelder
- Department of Hematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nicolaas P M Schaap
- Department of Hematology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Ellen Meijer
- Department of Hematology, Amsterdam University Medical Center, Free University, Amsterdam, the Netherlands
| | | | | | - Anita W Rijneveld
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
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Hirschbühl K, Labopin M, Polge E, Blaise D, Bourhis JH, Socié G, Forcade E, Yakoub-Agha I, Labussière-Wallet H, Bethge W, Chevallier P, Bonnet S, Stelljes M, Spyridonidis A, Peric Z, Brissot E, Savani B, Giebel S, Schmid C, Ciceri F, Nagler A, Mohty M. Total body irradiation versus busulfan based intermediate intensity conditioning for stem cell transplantation in ALL patients >45 years-a registry-based study by the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 2023; 58:874-880. [PMID: 37147469 PMCID: PMC10400409 DOI: 10.1038/s41409-023-01966-w] [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: 10/28/2022] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 05/07/2023]
Abstract
Allogeneic hematopoietic cell transplantation is a potentially curative treatment in high-risk acute lymphoblastic leukemia (ALL). Conditioning regimens based on ≥12 Gray total body irradiation (TBI) represent the current standard in patients ≤45 years, whereas elderly patients frequently receive intermediate intensity conditioning (IIC) to reduce toxicity. To evaluate the role of TBI as a backbone of IIC in ALL, a retrospective, registry-based study included patients >45 years transplanted from matched donors in first complete remission, who had received either fludarabine/TBI 8 Gy (FluTBI8, n = 262), or the most popular, irradiation-free alternative fludarabine/busulfan, comprising busulfan 6.4 mg/kg (FluBu6.4, n = 188) or 9.6 mg/kg (FluBu9.6, n = 51). At two years, overall survival (OS) was 68.5%, 57%, and 62.2%, leukemia-free survival (LFS) was 58%, 42.7%, and 45%, relapse incidence (RI) was 27.2%, 40%, and 30.9%, and non-relapse-mortality (NRM) was 23.1%, 20.7%, and 26.8% for patients receiving FluTBI8Gy, FluBu6.4, and FluBu9.6, respectively. In multivariate analysis, the risk of NRM, acute and chronic graft-versus-host disease was not influenced by conditioning. However, RI was higher after FluBu6.4 (hazard ratio [HR] [95% CI]: 1.85 [1.16-2.95]), and LFS was lower after both FluBu6.4 (HR: 1.56 [1.09-2.23]) and FluBu9.6 (HR: 1.63 [1.02-2.58]) as compared to FluTBI8. Although only resulting in a non-significant advantage in OS, this observation indicates a stronger anti-leukemic efficacy of TBI-based intermediate intensity conditioning.
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Affiliation(s)
- Klaus Hirschbühl
- Augsburg University Hospital and Medical Faculty, Augsburg, Germany
| | - Myriam Labopin
- EBMT Statistical Unit, Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, 75 012, Paris, France
| | - Emmanuelle Polge
- EBMT Statistical Unit, Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, 75 012, Paris, France
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Jean Henri Bourhis
- Department of Hematology, Gustave Roussy Cancer Campus BMT Service, Villejuif, France
| | - Gerard Socié
- Department of Hematology - BMT, Hopital St. Louis, Paris, France
| | | | | | | | - Wolfgang Bethge
- Universitaet Tuebingen, Medizinische Klinik, Abteilung II, Tuebingen, Germany
| | | | - Sarah Bonnet
- Département d'Hématologie Clinique, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Matthias Stelljes
- Department of Medicine A-Hematology, Hemostaseology, Oncology, Pulmonology, University Hospital Muenster, 48149, Munster, Germany
| | - Alexandros Spyridonidis
- Department of Internal Medicine, BMT Unit and CBMDP Donor Center, University of Patras, Patras, Greece
| | - Zinaida Peric
- Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Eolia Brissot
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie Cellulaire, Paris, France
| | - Bipin Savani
- Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Christoph Schmid
- Augsburg University Hospital and Medical Faculty, Augsburg, Germany.
| | - Fabio Ciceri
- IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- EBMT Statistical Unit, Sorbonne Université, INSERM UMR-S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, 75 012, Paris, France
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9
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Sbirkov Y, Vergov B, Mehterov N, Sarafian V. miRNAs in Lymphocytic Leukaemias-The miRror of Drug Resistance. Int J Mol Sci 2022; 23:ijms23094657. [PMID: 35563051 PMCID: PMC9103677 DOI: 10.3390/ijms23094657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023] Open
Abstract
Refractory disease and relapse remain the main causes of cancer therapy failure. Refined risk stratification, treatment regimens and improved early diagnosis and detection of minimal residual disease have increased cure rates in malignancies like childhood acute lymphoblastic leukaemia (ALL) to 90%. Nevertheless, overall survival in the context of drug resistance remains poor. The regulatory role of micro RNAs (miRNAs) in cell differentiation, homeostasis and tumorigenesis has been under extensive investigation in different cancers. There is accumulating data demonstrating the significance of miRNAs for therapy outcomes in lymphoid malignancies and some direct demonstrations of the interplay between these small molecules and drug response. Here, we summarise miRNAs' impact on chemotherapy resistance in adult and paediatric ALL and chronic lymphocytic leukaemia (CLL). The main focus of this review is on the modulation of particular signaling pathways like PI3K-AKT, transcription factors such as NF-κB, and apoptotic mediators, all of which are bona fide and pivotal elements orchestrating the survival of malignant lymphocytic cells. Finally, we discuss the attractive strategy of using mimics, antimiRs and other molecular approaches pointing at miRNAs as promising therapeutic targets. Such novel strategies to circumvent ALL and CLL resistance networks may potentially improve patients' responses and survival rates.
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Affiliation(s)
- Yordan Sbirkov
- Department of Medical Biology, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (B.V.); (N.M.)
- Division of Molecular and Regenerative Medicine, Research Institute at Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Correspondence: (Y.S.); (V.S.)
| | - Bozhidar Vergov
- Department of Medical Biology, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (B.V.); (N.M.)
| | - Nikolay Mehterov
- Department of Medical Biology, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (B.V.); (N.M.)
- Division of Molecular and Regenerative Medicine, Research Institute at Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Victoria Sarafian
- Department of Medical Biology, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (B.V.); (N.M.)
- Division of Molecular and Regenerative Medicine, Research Institute at Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Correspondence: (Y.S.); (V.S.)
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10
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Sulley S, Abimbola S, Ndanga M. Acute lymphocytic leukemia severity and mortality hospitalizations in the United States: A population-based study. Int J Health Sci (Qassim) 2022; 16:4-10. [PMID: 35599942 PMCID: PMC9092538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives The objective of the study was to understand the relationship between social and economic indicators of health and its association with hospitalization severity and mortality risk among ALL patients. Methods In this retrospective study, hospitalizations with primary and secondary diagnosis were identified using International Classification of Diseases (ICD 10) codes (C91.00, C91.01, C91.02) of ALL in the National Inpatient Sample (NIS) between 2016 and 2018. Hospitalization outcomes such as LOS, mortality, severity and mortality risk, cost, diagnosis (NDX), number of procedures (NPR) were analyzed by race and ethnicity, household income, and patient location among patients with primary and secondary ALL diagnoses. Results A total of 158090 hospitalizations were identified as meeting the inclusion criteria without missing cases with a primary or secondary diagnosis of ALL using ICD-10 codes. Severity risk at presentation varied from one area to the next, with the highest rate (per 10K) presentations in the New England region for both extreme likelihood (778) and extreme loss of function (2198) at presentation. Mortality and severity among uninsured patients were the second highest (614, 2193) compared to other payers. Extreme mortality risk at presentation was higher among African American (711), Caucasian (648), and Native American (612) populations compared to other racial and ethnic groups. Conclusion The findings of this study suggest a relative decrease in presentation rate by year and higher mortality among specific groups-based demographics indicators. It also confirms the impact of advanced therapeutics and improved severity and mortality among younger populations with ALL compared to the older population.
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Affiliation(s)
- Saanie Sulley
- Health Informatics, Independent Researcher, Washington DC, USA,Address for correspondence: Saanie Sulley, Health Informatics, Independent Researcher, Washington DC, USA. E-mail:
| | - Saka Abimbola
- Translational Research, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Memory Ndanga
- Health Informatics, Rutgers University, Piscataway, NJ, USA
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11
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Bergfelt Lennmyr E, Engvall M, Barbany G, Fogelstrand L, Rhodin H, Hallböök H. Cytogenetic aberrations in adult acute lymphoblastic leukemia—A population‐based study. EJHAEM 2021; 2:813-817. [PMID: 35845183 PMCID: PMC9175914 DOI: 10.1002/jha2.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Marie Engvall
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
| | - Gisela Barbany
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
| | - Linda Fogelstrand
- Department of Clinical Chemistry Sahlgrenska University Hospital Gothenburg Sweden
- Department of Laboratory Medicine, Institute of Biomedicine University of Gothenburg Gothenburg Sweden
| | - Hanna Rhodin
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Helene Hallböök
- Department of Medical Sciences Uppsala University Uppsala Sweden
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12
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Ganesan P, Kayal S. How I Treat Adult Acute Lymphoblastic Leukemia in India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1731979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Prasanth Ganesan
- Department of Medical Oncology, Regional Cancer Center, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Smita Kayal
- Department of Medical Oncology, Regional Cancer Center, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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13
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Abstract
Dasatinib is an oral, once-daily tyrosine kinase inhibitor used in the treatment of chronic myeloid leukaemia and Philadelphia chromosome-positive acute lymphoblastic leukaemia. Dasatinib is rapidly absorbed, with the time for maximal serum concentration varying between 0.25 and 1.5 h. Oral absorption is not affected by food. The absolute bioavailability of dasatinib in humans is unknown due to the lack of an intravenous formulation preventing calculation of the reference exposure. Dasatinib is eliminated through cytochrome P450 (CYP) 3A4-mediated metabolism, with a terminal half-life of 3-4 h. Based on total radioactivity, only 20% of the oral dose (100 mg) is recovered unchanged in faeces (19%, including potential non-absorption) and urine (1%) after 168 h. Dasatinib pharmacokinetics are not influenced by age (children, and adults up to 86 years of age), race and renal insufficiency. Dasatinib absorption is decreased by pH-modifying agents (antacids, H2-receptor blockers, proton pump inhibitors), and dasatinib is also subject to drug interactions with CYP3A4 inducers or inhibitors.
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14
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Yang S, Zhang X, Wang Y, Wen C, Wang C, Zhou Z, Lin G. Development of UPLC-MS/MS Method for Studying the Pharmacokinetic Interaction Between Dasatinib and Posaconazole in Rats. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:2171-2178. [PMID: 34079220 PMCID: PMC8163634 DOI: 10.2147/dddt.s301241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022]
Abstract
Background and Aim Dasatinib is approved for the treatment of leukaemia worldwide. Triazole agents such as posaconazole may be used for the control of secondary fungal infection with leukaemia. This work aimed to develop a bioanalytical method to study the potential interaction between dasatinib and posaconazole. Methods An ultrahigh-performance liquid chromatography-tandem mass spectrometry method was established to measure the plasma concentrations of dasatinib and posaconazole in rats simultaneously. Simple protein precipitation with acetonitrile was applied to extract dasatinib and posaconazole in samples. The chromatographic separation of analytes was conducted on an UPLC BEH C18 column using a mobile phase consisting of 0.1% aqueous formic acid and acetonitrile. Dasatinib and posaconazole were monitored in positive ion mode with the following mass transition pairs: m/z 488.2→401.1 for dasatinib and m/z 701.3→683.4 for posaconazole. The method was successfully applied for pharmacokinetic interaction between dasatinib and posaconazole. Results The established method expressed good linearity in 1–1000 ng/mL of dasatinib and 5–5000 ng/mL of posaconazole, with limit of detection was 1 ng/mL and 5 ng/mL, respectively. Methodology validations, including accuracy, precision, matrix effect, recovery, and stability, met the US Food and Drug Administration (FDA) acceptance criteria for bioanalytical method validation. Dasatinib strongly inhibited the clearance of posaconazole in vivo, while posaconazole expressed no significant effect on the pharmacokinetics of dasatinib. Conclusion Dasatinib alters the pharmacokinetics of posaconazole. Attention should be paid to the unexpected risk of adverse clinical outcomes when posaconazole is co-administered with dasatinib.
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Affiliation(s)
- Suili Yang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiaoshan Zhang
- College of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.,Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yuzhen Wang
- College of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.,Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Congcong Wen
- Laboratory Animal Center, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chenxiang Wang
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ziye Zhou
- Clinical Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Guanyang Lin
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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15
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Feng Q, de Smith AJ, Vergara-Lluri M, Muskens IS, McKean-Cowdin R, Kogan S, Brynes R, Wiemels JL. Trends in Acute Lymphoblastic Leukemia Incidence in the United States by Race/Ethnicity From 2000 to 2016. Am J Epidemiol 2021; 190:519-527. [PMID: 33034340 DOI: 10.1093/aje/kwaa215] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 12/16/2022] Open
Abstract
Incidence trends in acute lymphoblastic leukemia (ALL) demonstrate disparities by race and ethnicity. We used data from the Surveillance, Epidemiology, and End Results Registry to evaluate patterns in ALL incidence from 2000 to 2016, including the association between percentage of people born in a foreign country at the county level and ALL incidence. Among 23,829 persons of all ages diagnosed with ALL, 8,297 (34.8%) were Latinos, 11,714 (49.2%) were non-Latino (NL) Whites, and 1,639 (6.9%) were NL Blacks. Latinos had the largest increase in the age-adjusted incidence rate (AAIR) of ALL during this period compared with other races/ethnicities for both children and adults: The AAIR was 1.6 times higher for Latinos (AAIR = 2.43, 95% confidence interval (CI): 2.37, 2.49) than for NL Whites (AAIR = 1.56, 95% CI: 1.53, 1.59) (P < 0.01). The AAIR for all subjects increased approximately 1% per year from 2000 to 2016 (annual percent change = 0.97, 95% CI: 0.67, 1.27), with the highest increase being observed in Latinos (annual percent change = 1.18, 95% CI: 0.76, 1.60). In multivariable models evaluating the contribution of percentage of county residents who were foreign-born to ALL risk, a positive association was found for percentage foreign-born for NL Whites (P for trend < 0.01) and NL Blacks (P for trend < 0.01), but the reverse was found for Latinos (P for trend < 0.01); this is consistent with tenets of the "Hispanic paradox," in which better health outcomes exist for foreign-born Latinos.
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16
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Schwartz M, Wieduwilt MJ. New approaches to the treatment of older adults with acute lymphoblastic leukemia. Semin Hematol 2020; 57:122-129. [PMID: 33256901 DOI: 10.1053/j.seminhematol.2020.09.001] [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] [Received: 03/13/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/11/2022]
Abstract
Outcomes for older adults (defined here as ≥55-65 years old) with acute lymphoblastic leukemia (ALL) are poor, with long-term survival less than 20%. Pediatric chemotherapy regimens produce long-term cure rates of 80% to 90% in children and 60% to 70% in adolescents and young adults with Ph-negative ALL, however, tolerability of intensive chemotherapy becomes problematic with advanced age due to comorbidities and reduced tolerability of chemotherapy leading to high rates of treatment-related mortality. For older adults with Ph-positive ALL, BCR-ABL1-directed tyrosine kinase inhibitors in combination with corticosteroids or chemotherapy produce deep remissions with low treatment-related toxicity but optimal postremission therapy is not known. New therapeutic approaches for older adults with ALL involve integration of the novel targeted agents including monoclonal antibody-based therapy with blinatumomab and inotuzumab ozogamicin in the frontline. Ongoing studies will ideally define optimal combinations and sequencing of novel agents with or without chemotherapy, tyrosine kinase inhibitors, and/or corticosteroids to maximize efficacy while avoiding treatment-related death. Anti-CD19 chimeric antigen receptor modified T cells are a promising modality, with high rates of remission and minimal residual disease negativity achieved in early phase trials for adults with relapsed/refractory B-cell ALL but the tolerability of chimeric antigen receptor modified T cell therapies in older adults is yet to be well defined. Advances in minimal residual disease detection have helped to effectively stratify adults in complete response in terms of relapse risk and predicted relative benefit for allogeneic hematopoietic cell transplant. For older adults with ALL in complete response at high risk for relapse for whom myeloablative conditioning is predicted to result in excessive transplant-related mortality, reduced-intensity conditioning allogeneic hematopoietic cell transplant is a less toxic approach for providing a graft-versus-leukemia effect and long-term disease control.
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Affiliation(s)
- Marc Schwartz
- Division of Hematology/Oncology, University of California, San Diego, CA
| | - Matthew J Wieduwilt
- Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California, San Diego, CA.
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17
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Zhao Z, Zhou Y, Wang J, Zhang T, Li J, Zhang B, Li Q, Deng S. The value of 18F-FDG PET/CT in the prediction of clinical outcomes of patients with acute leukemia treated with allogeneic hematopoietic stem cell transplantation. Oncol Lett 2020; 20:175. [PMID: 32934742 PMCID: PMC7471646 DOI: 10.3892/ol.2020.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/12/2020] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to determine whether 18F-FDG PET/CT performed before and/or after allogeneic hematopoietic stem cell transplantation (allo-HSCT) can predict clinical outcomes in acute leukemia (AL). A total of 79 examinations comprising 72 patients with AL who underwent 18F-FDG PET/CT before and/or after allo-HSCT were retrospectively enrolled between January 2011 and January 2019. Outcomes were assessed using overall survival (OS) and disease-free survival (DFS). A total of 63 examinations were PET-positive, while 16 examinations were PET-negative. Increased BM and splenic 18F-FDG uptake were observed in 24 (19/79) and 14% (11/79) of examinations, respectively. 18F-FDG-avid lymph nodes were observed in 38% (30/79) of examinations. ENEMES involvement was detected in 44% (35/79) of examinations. The presence of ENEMES involvement [OS hazard ratio (HR), 6.399; 95% confidence interval (CI), 1.843–22.224; P=0.003; post-HSCT OS: HR, 7.203; 95% CI, 1.510–34.369; P=0.013; DFS HR, 3.671; 95% CI, 1.145–11.768; P=0.029], post-transplantation minimal residual disease (DFS HR, 4.381; 95% CI, 1.594–12.040; P=0.004; pre-HSCT OS HR, 11.455; 95% CI, 1.336–98.179; P=0.026) and disease status (OS HR, 0.330; 95% CI, 0.128–0.848; P=0.021; post-HSCT OS HR, 0.195; 95% CI, 0.050–0.762; P=0.019; DFS: HR, 0.278; 95% CI, 0.091–0.851; P=0.025) could serve as an adverse prognostic factor in patients with AL treated with allo-HSCT. 18F-FDG PET/CT before and/or after allo-HSCT was a predictor for OS and DFS in patients with AL. ENEMES involvement detected using 18F-FDG PET/CT may help identify patients with AL who are likely to have unfavorable clinical outcomes.
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Affiliation(s)
- Zixuan Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Yeye Zhou
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jing Wang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Tongtong Zhang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jihui Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Bin Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Qingru Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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18
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Pan C, Liu P, Ma D, Zhang S, Ni M, Fang Q, Wang J. Bone marrow mesenchymal stem cells in microenvironment transform into cancer-associated fibroblasts to promote the progression of B-cell acute lymphoblastic leukemia. Biomed Pharmacother 2020; 130:110610. [PMID: 34321159 DOI: 10.1016/j.biopha.2020.110610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Bone marrow microenvironment is essential for leukemia cells to survive and escape the killing effect of chemotherapeutics. Cancer-associated fibroblasts (CAFs) are the dominant stromal cells in tumor microenvironment (TME), but their role in B-cell acute lymphoblastic leukemia (B-ALL) remains unclear. Here, RT-PCR and Western blotting in bone marrow mononuclear cells revealed higher proportions of CAFs markers α-SMA and FAP in the newly diagnosed and relapsed B-ALL patients. In vitro experiments, bone marrow mesenchymal stem cells (BM-MSCs) acquired a CAFs phenotype after co-culture with leukemia cells, which produced high level of tumor-promoting growth factors and reduced the daunorubicin (DNR)-induced damage to B-ALL cells. As for its mechanism, CAFs activation was mediated by TGF-β up-regulation in the co-culture system, and TGF-β triggered MSCs conversion into CAFs relying on the SDF-1/CXCR4 pathway. Further LY2109761 and AMD3100 effectively decreased the activation of CAFs through inhibiting TGF-β receptor and CXCR4. Comparative experiments with MSCs and transformed CAFs prompted that CAFs had more obvious effect than MSCs on stimulating leukemia progression through accelerating leukemia cell migration and invasion. These results clarified the important role of CAFs in B-ALL progression and the possible mechanisms of CAFs activation in leukemia microenvironment, which might provide a theoretical basis for B-ALL patients to find more effective targeted therapies targeting the bone marrow microenvironment.
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Affiliation(s)
- Chengyun Pan
- Department of Haematology, Affiliated Hospital of Guizhou Medical University, Guizhou, China; School of Basic Medical Sciences, Guizhou Medical University, Guizhou, China; Hematological Institute of Guizhou Province, Guizhou, China
| | - Ping Liu
- Department of Haematology, Affiliated Hospital of Guizhou Medical University, Guizhou, China; Hematological Institute of Guizhou Province, Guizhou, China
| | - Dan Ma
- Department of Haematology, Affiliated Hospital of Guizhou Medical University, Guizhou, China; Hematological Institute of Guizhou Province, Guizhou, China; Guizhou Province Hematopoietic Stem Cell Transplantation Centre and Key Laboratory of Hematological Disease Diagnostic and Treatment Centre, Guizhou, China
| | - Siyu Zhang
- Department of Pharmacy, Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Ming Ni
- Department of Haematology, Affiliated Hospital of Guizhou Medical University, Guizhou, China; Hematological Institute of Guizhou Province, Guizhou, China; Guizhou Province Hematopoietic Stem Cell Transplantation Centre and Key Laboratory of Hematological Disease Diagnostic and Treatment Centre, Guizhou, China
| | - Qin Fang
- Department of Pharmacy, Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Jishi Wang
- Department of Haematology, Affiliated Hospital of Guizhou Medical University, Guizhou, China; Hematological Institute of Guizhou Province, Guizhou, China; Guizhou Province Hematopoietic Stem Cell Transplantation Centre and Key Laboratory of Hematological Disease Diagnostic and Treatment Centre, Guizhou, China.
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19
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Zhong J, Yu X, Zhang X. Comparison of Overall Survival Between De Novo and Secondary Acute Lymphoblastic Leukemia Patients of Different Ages. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e622-e627. [PMID: 32565127 DOI: 10.1016/j.clml.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the overall survival (OS) between de novo and secondary acute lymphoblastic leukemia (ALL) patients in different age groups after chemotherapy. PATIENTS AND METHODS Data from 8305 ALL patients undergoing chemotherapy from the Surveillance, Epidemiology, and End Results (SEER) database during 1975 to 2015 were included in this study, of which 7454 (80.11%) were in the de novo ALL group, and 851 (19.89%) were in the secondary ALL (sALL) group. Propensity matching was used before comparison of OS between the two groups. RESULTS Female ALL patients had a lower risk of death than male (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.88-0.98; P < .01). The mortality of black patients was higher than in white patients (HR, 1.29; 95% CI, 1.18-1.42; P < .001). Patients aged 45-75 years (HR, 1.82; 95% CI, 1.72-1.94; P < .001) and ≥ 75 years (HR, 3.85; 95% CI, 3.52-4.23; P < .001) had a higher risk of death. Separated/divorced (HR, 1.21; 95% CI, 1.10-1.34; P < .001) and widowed (HR, 1.35; 95% CI, 1.21-1.51; P < .001) patients had a higher risk of death than single patients. sALL patients had a higher risk of death than de novo ALL patients (HR, 1.21; 95% CI, 1.12-1.30; P < .001). The mean age of the de novo ALL group was lower than in the sALL group (51.05 vs. 60.25; P < .001) after the propensity score was matched, and the 1-, 2-, 3-, 4-, and 5-year OS of the de novo ALL group were higher than that of the sALL group aged 18-75 years (P < .001). CONCLUSION The survival rate of ALL decreased with increased age. Patients with sALL had poorer OS than de novo patients aged 18-75 years.
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Affiliation(s)
- Jiansheng Zhong
- Department of Hematology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, PR China.
| | - Xiaoyang Yu
- Department of Clinical Laboratory, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, PR China
| | - Xing Zhang
- Department of Hematology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, PR China
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20
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Zhong Q, Li BH, Zhu QQ, Zhang ZM, Zou ZH, Jin YH. The Top 100 Highly Cited Original Articles on Immunotherapy for Childhood Leukemia. Front Pharmacol 2019; 10:1100. [PMID: 31611792 PMCID: PMC6769078 DOI: 10.3389/fphar.2019.01100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/26/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Childhood leukemia is one of the most common cancers in children. As a potential treatment for leukemia, immunotherapy has become a new research hotspot. This research aimed at exploring the status and trends of current researches on immunotherapy for childhood leukemia through bibliometric analysis. Methods: The Institute for Scientific Information Web of Science core collection database was searched for articles on immunotherapy and childhood leukemia using a computer. Time period for retrieval was from the beginning of the database to June 15, 2019. The top 100 highly cited articles were selected to extract their information on publication year, authors, title, publication journal, number of citations, author’s affiliations, country, and so on. These general information and bibliometric data were collected for analysis. VOSviewer software was used to generate a figure for keywords’ co-occurrence network and a figure for researcher’s coauthorship network that visualized reference and cooperation patterns for different terms in the 100 articles. Results: The number of citations in the top 100 articles ranged from 17 to 471. These articles were published in 52 different publications. The top four journals in terms of the number of our selected articles were Leukemia (11 articles), Blood (10 articles), Bone Marrow Transplantation (6 articles), and Clinical Cancer Research. The most frequently nominated author was T. Klingebiel from Goethe University Frankfurt, and of the top 100 articles, 12 listed his name. These top 100 articles were published after the year 2000. Most of these articles were original (67%). The United States and Germany were the major countries researching immunotherapy for childhood leukemia and made significant contributions to the combat against the disease. Adoptive immunotherapy and stem cell transplantation appeared more frequently in keywords. Conclusions: This study analyzed the top 100 highly cited articles on immunotherapy for childhood leukemia and provided insights into the features and research hotspots of the articles on this issue.
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Affiliation(s)
- Qing Zhong
- Department of Pediatrics, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Qi-Qi Zhu
- Department of Pediatrics, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Zhi-Min Zhang
- Department of Pediatrics, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Zhi-Hao Zou
- Department of Pediatrics, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China
| | - Ying-Hui Jin
- Department of Pediatrics, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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21
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Lennmyr E, Karlsson K, Ahlberg L, Garelius H, Hulegårdh E, Izarra AS, Joelsson J, Kozlowski P, Moicean A, Tomaszewska-Toporska B, Lübking A, Hallböök H. Survival in adult acute lymphoblastic leukaemia (ALL): A report from the Swedish ALL Registry. Eur J Haematol 2019; 103:88-98. [PMID: 31074910 PMCID: PMC6851994 DOI: 10.1111/ejh.13247] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES As new, effective therapies emerge for acute lymphoblastic leukaemia (ALL), the results of clinical trials need to relate to standard of care. METHODS We used the population-based Swedish ALL Registry to evaluate characteristics, treatment and long-term outcome in 933 patients with diagnosis between 1997 and 2015. RESULTS The median age was 53 years. The frequency of Philadelphia (Ph)-positive leukaemia was 34% of examined B-ALL with a peak incidence at 50-59 years. Five-year overall survival (OS) improved between 1997-2006 and 2007-2015; in patients 18-45 years from 50% (95% CI 43-57) to 65% (95% CI 58-72), 46-65 years from 25% (95% CI 18-32) to 46% (95% CI 37-55) and >65 years from 7% (95% CI 2.6-11) to 11% (95% CI 5.9-16) (P < 0.05). Men with Ph-neg B-ALL 46-65 years had inferior OS compared with women (P < 0.01). Standardised mortality ratio was 5.7 (95% CI 5.0-6.3) for patients who survived 5 years from diagnosis. In multivariable analysis, Ph-positive disease was not associated with impaired prognosis but with lower risk of death in 2007-2015. CONCLUSIONS In a population-based cohort, OS has improved in adult ALL, especially for Ph-positive disease but for middle-aged men with Ph-negative B-ALL outcome was poor. Cure without late toxicity or relapse is still desired.
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Affiliation(s)
- Emma Lennmyr
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Karlsson
- Department of Haematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden
| | - Lucia Ahlberg
- Department of Haematology, University Hospital of Linköping, Linköping, Sweden
| | - Hege Garelius
- Department of Medicine, Section of Haematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Erik Hulegårdh
- Department of Medicine, Section of Haematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Antonio S Izarra
- Department of Haematology, Cancer Centre, University Hospital of Umeå, Umeå, Sweden
| | - Joel Joelsson
- Division of Haematology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Piotr Kozlowski
- Department of Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Andreea Moicean
- Department of Medicine, Central Hospital Skövde, Skövde, Sweden
| | | | - Anna Lübking
- Department of Haematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden
| | - Helene Hallböök
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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