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Tang X, Mai H, Wang L, Chen S, Chen F, Li T, Liu Y, Zhou G, Liu S, Wang Y, Liu S, Fu X, Wen F. Diagnostic significance of cerebrospinal fluid flow cytometry in Chinese children with B lineage acute lymphoblastic leukemia. BMC Pediatr 2024; 24:204. [PMID: 38519960 PMCID: PMC10958868 DOI: 10.1186/s12887-024-04684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Central nervous system leukemia (CNSL) is one of the major causes of the poor prognosis of childhood leukemia. We aimed to compare the sensitivity of cytomorphology (CM) and flow cytometry (FCM) in diagnosing CNSL, emphasizing the importance of FCM in the diagnosis process. METHODS One-hundred-sixty-five children with newly diagnosed B-cell Acute Lymphoblastic Leukemia (B-cell ALL) were included in this study. Cerebrospinal fluid (CSF) samples were taken for routine CSF analysis, CM analysis, and FCM examination. Computed tomography scans and/or magnetic resonance imaging were performed at diagnosis. Patients with CNS2, CNS3, and traumatic lumbar puncture (TLP) at diagnosis received two additional courses of triple intrathecal injections during induction treatment. We compared the sensitivity of FCM and CM in the diagnosis of children with CNSL. RESULTS One hundred and twenty-eight (77.58%) CSF samples were negative by either CM or FCM (CM-/FCM-), four (2.42%) were positive by both CM and FCM (CM+/FCM+), and thirty-three (20%) displayed a single positive finding by FCM (CM-/FCM+) (p = 0.044). By adding two intrathecal injections in the induction treatment, ten children with TLP+ had no CNS relapse, like those with TLP-. However, compared to CNS1 and TLP, the event-free survival (EFS) did not significantly improve in patients with CNS2 and CNS3. Moreover, CNSL status was associated with worse 3-year EFS (p < 0.05). CONCLUSIONS We have validated that FCM is more accurate in stratifying the status of the CNS compared to CM analysis. However, to improve the EFS rate of childhood leukemia, it is necessary to combine CM examination, FCM, and cranial imaging for the early diagnosis of CNSL.
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Affiliation(s)
- Xue Tang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
- Department of Hematology and Oncology, Shenzhen Children's Hospital of China Medical University, Shenzhen, China
| | - Huirong Mai
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Lulu Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Shiyang Chen
- Department of Laboratory Medicine, Shenzhen Children's Hospital, Shenzhen, China
| | - Fen Chen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Tonghui Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Yi Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Guichi Zhou
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Shilin Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Ying Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Sixi Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China
| | - Xiaoying Fu
- Department of Laboratory Medicine, Shenzhen Children's Hospital, Shenzhen, China.
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, No.7019 Yitian Road, Futian District, Shenzhen, China.
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Kidoguchi K, Ureshino H, Kizuka-Sano H, Yamaguchi K, Katsuya H, Kubota Y, Ando T, Miura M, Takahashi N, Kimura S. Efficacy and safety of ponatinib for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: a case series from a single institute. Int J Hematol 2021; 114:199-204. [PMID: 33907977 DOI: 10.1007/s12185-021-03156-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022]
Abstract
Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL) is an aggressive leukemia that occurs in 20-40% of adult patients. Ph + ALL is caused by the Philadelphia chromosome (Ph), which consists of a t(9;22)(q34;q11) reciprocal translocation leading to the formation of a BCR-ABL1 fusion gene. The disease is treated with targeted therapy comprising ABL1 tyrosine kinase inhibitors (TKIs). Ponatinib is a third generation TKI that demonstrates higher binding affinity for ABL1 than first/second generation TKIs. Although intensive combined immunotherapy with ponatinib greatly improves the prognosis of Ph + ALL, the safety and efficacy profiles of ponatinib in Japanese patients are unclear. This retrospective study investigated five cases of Ph + ALL at a single institute to evaluate safety and efficacy profiles. Three patients achieved a deep molecular response (DMR) following combined intensive treatment with ponatinib as induction chemotherapy. Four patients received consolidative allogenic stem cell transplantation (allo-SCT) during their first complete response. Three of the four experienced early relapse within 100 days; they subsequently received ponatinib, and one of the three achieved a DMR. No patient experienced severe cardiovascular events. This case series suggests that ponatinib at a concentration of least 30 mg exhibits anti-leukemia effects in Japanese patients with Ph + ALL.
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Affiliation(s)
- Keisuke Kidoguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroshi Ureshino
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Haruna Kizuka-Sano
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kyosuke Yamaguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroo Katsuya
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yasushi Kubota
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.,Department of Transfusion Medicine, Saga University Hospital, Saga, Japan
| | - Toshihiko Ando
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masatomo Miura
- Department of Pharmacy, Akita University Hospital, Akita, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Tanimura K, Yamasaki K, Okuhiro Y, Hira K, Nitani C, Okada K, Fujisaki H, Matsumoto K, Hara J. Monitoring Ponatinib in a Child with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia. Case Rep Oncol 2021; 14:24-28. [PMID: 33776678 PMCID: PMC7983555 DOI: 10.1159/000511071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 01/06/2023] Open
Abstract
Ponatinib is a third-generation tyrosine kinase inhibitor (TKI) reported to show a higher efficacy for adult Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) than other TKIs. However, few studies describe ponatinib for pediatric Ph+ALL; therefore, the efficacy, safety, and optimal dosage have not been determined. Here, we report a 3-year-old girl with Ph+ALL treated by a ponatinib-containing regimen with therapeutic drug monitoring in the plasma and cerebrospinal fluid (CSF). In our case, a ponatinib-containing regimen was able to keep minimal residual disease negative, and the pharmacokinetics (PKs) of plasma ponatinib resembled that previously reported in adults. Penetration to the CSF was extremely limited. Thus, ponatinib was feasible and effective for a child with Ph+ALL, although the plasma concentration of ponatinib varied significantly throughout the treatment. The appropriate dosage should be confirmed in a prospective trial, including a detailed PK study.
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Affiliation(s)
- Kazuki Tanimura
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Kai Yamasaki
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Yuki Okuhiro
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Kota Hira
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Chika Nitani
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Keiko Okada
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Hiroyuki Fujisaki
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Kana Matsumoto
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Junichi Hara
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
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