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Tiong IS, Wall M, Bajel A, Kalro A, Fleming S, Roberts AW, Thiagarajah N, Chua CC, Latimer M, Yeung D, Marlton P, Johnston A, Enjeti A, Fong CY, Cull G, Larsen S, Kennedy G, Schwarer A, Kipp D, Ramanathan S, Verner E, Tiley C, Morris E, Hahn U, Moore J, Taper J, Purtill D, Warburton P, Stevenson W, Murphy N, Tan P, Beligaswatte A, Mutsando H, Hertzberg M, Shortt J, Szabo F, Dunne K, Wei AH. How comparable are patient outcomes in the "real-world" with populations studied in pivotal AML trials? Blood Cancer J 2024; 14:54. [PMID: 38531863 DOI: 10.1038/s41408-024-00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 03/28/2024] Open
Abstract
Despite an increasing desire to use historical cohorts as "synthetic" controls for new drug evaluation, limited data exist regarding the comparability of real-world outcomes to those in clinical trials. Governmental cancer data often lacks details on treatment, response, and molecular characterization of disease sub-groups. The Australasian Leukaemia and Lymphoma Group National Blood Cancer Registry (ALLG NBCR) includes source information on morphology, cytogenetics, flow cytometry, and molecular features linked to treatment received (including transplantation), response to treatment, relapse, and survival outcome. Using data from 942 AML patients enrolled between 2012-2018, we assessed age and disease-matched control and interventional populations from published randomized trials that led to the registration of midostaurin, gemtuzumab ozogamicin, CPX-351, oral azacitidine, and venetoclax. Our analyses highlight important differences in real-world outcomes compared to clinical trial populations, including variations in anthracycline type, cytarabine intensity and scheduling during consolidation, and the frequency of allogeneic hematopoietic cell transplantation in first remission. Although real-world outcomes were comparable to some published studies, notable differences were apparent in others. If historical datasets were used to assess the impact of novel therapies, this work underscores the need to assess diverse datasets to enable geographic differences in treatment outcomes to be accounted for.
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Affiliation(s)
- Ing Soo Tiong
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Meaghan Wall
- Monash University, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Akash Kalro
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Andrew W Roberts
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | | | - Chong Chyn Chua
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
- The Northern Hospital, Epping, VIC, Australia
| | - Maya Latimer
- Canberra Hospital, Garran, ACT, Australia
- ACT Pathology, Garran, ACT, Australia
- Australian National University, Canberra, ACT, Australia
| | - David Yeung
- Royal Adelaide Hospital, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Paula Marlton
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | | | - Anoop Enjeti
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | | | - Gavin Cull
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Stephen Larsen
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | | | | | | | - Campbell Tiley
- Gosford Hospital, Gosford, NSW, Australia
- University of Newcastle, Callaghan, NSW, Australia
| | - Edward Morris
- Townsville University Hospital, Douglas, QLD, Australia
| | - Uwe Hahn
- Royal Adelaide Hospital, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Woodville South, SA, Australia
- SA Pathology, Adelaide, SA, Australia
| | - John Moore
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - John Taper
- Nepean Hospital, Kingswood, NSW, Australia
| | - Duncan Purtill
- PathWest Laboratory Medicine, Nedlands, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | - William Stevenson
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | - Peter Tan
- Royal Perth Hospital, Perth, WA, Australia
| | - Ashanka Beligaswatte
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders University, Bedford Park, SA, Australia
| | | | | | - Jake Shortt
- Monash University, Melbourne, VIC, Australia
- Monash Medical Centre, Clayton, VIC, Australia
| | | | - Karin Dunne
- Australasian Leukaemia and Lymphoma Group (ALLG), Melbourne, VIC, Australia
| | - Andrew H Wei
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Royal Melbourne Hospital, Parkville, VIC, Australia.
- The University of Melbourne, Melbourne, VIC, Australia.
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
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Beaton M, Peterson GJ, O'Brien K. Acute Myeloid Leukemia: Advanced Practice Management From Presentation to Cure. J Adv Pract Oncol 2020; 11:836-844. [PMID: 33489424 PMCID: PMC7810269 DOI: 10.6004/jadpro.2020.11.8.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Acute myeloid leukemia (AML) is the most common acute leukemia in adults, diagnosed in approximately 21,450 individuals annually in the US with nearly 11,000 deaths attributable to this disease (National Cancer Institute, 2020). Acute myeloid leukemia is a disease of the elderly, with the average age of diagnosis being 68 years old (Kouchkovsky & Abdul-Hay, 2016). It is a heterogeneous disease with widely varying presentations but universally carries a poor prognosis in the majority of those affected. Unfortunately, the 5-year overall survival rate remains poor, at less than 5% in patients over 65 years of age (Thein, Ershler, Jemal, Yates, & Baer, 2013). The landscape of AML is beginning to change, however, as new and improved treatments are emerging. Advanced practitioners (APs) are often involved in the care of these complex patients from the time of initial symptoms through diagnosis, treatment, and potentially curative therapy. It is vitally important for APs to understand and be aware of the various presentations, initial management strategies, diagnostic workup, and treatment options for patients with AML, especially in the elderly population, which until recently had few treatment options. This Grand Rounds article highlights the common presenting signs and symptoms of patients with AML in the hospital, including a discussion of the upfront clinical stability issues, oncologic emergencies, diagnostic evaluation, and current treatment options for elderly patients and those with poor performance status.
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Jiang L, Meng W, Yu G, Yin C, Wang Z, Liao L, Meng F. MicroRNA-144 targets APP to regulate AML1/ETO + leukemia cell migration via the p-ERK/c-Myc/MMP-2 pathway. Oncol Lett 2019; 18:2034-2042. [PMID: 31423275 DOI: 10.3892/ol.2019.10477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 12/04/2018] [Indexed: 12/30/2022] Open
Abstract
Extramedullary infiltration (EMI) is common in patients with acute myeloid leukemia (AML) and is closely associated with the prognosis of disease. We previously reported that patients carrying the AML1/ETO (A/E) fusion gene and expressing the amyloid precursor protein (APP) tended to develop EMI, and had a poor prognosis. In the present study, the relapse-free survival (RFS) time and overall survival (OS) time were significantly lower in patients with EMI. The results demonstrated that the EMI incidence was significantly higher (P<0.05), while the RFS and OS rates were significantly lower (P<0.05), in patients with high APP expression. Kasumi-1 cells, which are A/E+, and the APP gene were used as the in vitro cell model to detect the mechanism of action in detail. Following the knockdown of APP expression, cell migration was significantly reduced (P<0.05). Furthermore, western blotting demonstrated that the protein expression of phosphorylated extracellular-signal-regulated kinase (p-ERK), matrix metalloproteinase-2 (MMP-2) and c-Myc was markedly reduced following interference of APP, while the expression of CXCR4 and MMP-9 was not altered. Kasumi-1 cells were co-cultured with p-ERK or c-Myc inhibitors and demonstrated that the APP/p-ERK/c-Myc/MMP-2 pathway was involved in signal transduction and regulation of cell migration. MicroRNA-144 (miR-144) mimics and transfected Kasumi-1 cells were generated. Reverse transcription-quantitative polymerase chain reaction and western blotting demonstrated that miR-144 was a negative regulator of APP. Taken together, the findings of the present study suggest that miR-144 negatively targets the APP gene and regulates cell migration via the APP/p-ERK/c-Myc/MMP-2 pathway.
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Affiliation(s)
- Ling Jiang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510500, P.R. China
| | - Wei Meng
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Guopan Yu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510500, P.R. China
| | - Changxin Yin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510500, P.R. China
| | - Zhixiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510500, P.R. China
| | - Libin Liao
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510500, P.R. China
| | - Fanyi Meng
- Department of Hematology, Kang Hua Hospital, Dongguan, Guangdong 523080, P.R. China
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Martínez-Cuadrón D, Gil C, Serrano J, Rodríguez G, Pérez-Oteyza J, García-Boyero R, Jiménez-Bravo S, Vives S, Vidriales MB, Lavilla E, Pérez-Simón JA, Tormo M, Colorado M, Bergua J, López JA, Herrera P, Hernández-Campo P, Gorrochategui J, Primo D, Rojas JL, Villoria J, Moscardó F, Troconiz I, Linares Gómez M, Martínez-López J, Ballesteros J, Sanz M, Montesinos P. A precision medicine test predicts clinical response after idarubicin and cytarabine induction therapy in AML patients. Leuk Res 2018; 76:1-10. [PMID: 30468991 DOI: 10.1016/j.leukres.2018.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 01/20/2023]
Abstract
Complete remission (CR) after induction therapy is the first treatment goal in acute myeloid leukemia (AML) patients and has prognostic impact. Our purpose is to determine the correlation between the observed CR/CRi rate after idarubicin (IDA) and cytarabine (CYT) 3 + 7 induction and the leukemic chemosensitivity measured by an ex vivo test of drug activity. Bone marrow samples from adult patients with newly diagnosed AML were included in this study. Whole bone marrow samples were incubated for 48 h in well plates containing IDA, CYT, or their combination. Pharmacological response parameters were estimated using population pharmacodynamic models. Patients attaining a CR/CRi with up to two induction cycles of 3 + 7 were classified as responders and the remaining as resistant. A total of 123 patients fulfilled the inclusion criteria and were evaluable for correlation analyses. The strongest clinical predictors were the area under the curve of the concentration response curves of CYT and IDA. The overall accuracy achieved using MaxSpSe criteria to define positivity was 81%, predicting better responder (93%) than non-responder patients (60%). The ex vivo test provides better yet similar information than cytogenetics, but can be provided before treatment representing a valuable in-time addition. After validation in an external cohort, this novel ex vivo test could be useful to select AML patients for 3 + 7 regimen vs. alternative schedules.
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Affiliation(s)
- David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | | | | | - Susana Vives
- ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | | | | | - Mar Tormo
- Hospital Clínico Universitario, Valencia, Spain
| | | | - Juan Bergua
- Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Miguel Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
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Lu QS, Xu N, Zhou X, Huang JX, Li L, Li YL, Lu ZY, Cao R, Liao LB, Liu XL. Prognostic Significance of Monosomal Karyotype in Adult Patients With Acute Myeloid Leukemia Treated With Risk-Adapted Protocols. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:790-6. [PMID: 26482108 DOI: 10.1016/j.clml.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The monosomal karyotype (MK) is a well-known adverse prognostic factor and has been found to be related to poor outcome in patients with acute myeloid leukemia (AML). However, the outcome in MK-positive AML patients undergoing different therapies has not been well investigated. PATIENTS AND METHODS We retrospectively analyzed clinical and laboratory features in 225 MK-positive AML patients. Clinical outcome of overall survival (OS) and disease-free survival (DFS) was evaluated in patients according to age group and in patients who received different therapy protocols. RESULTS The proportion of MK-positive patients increased along with age. Also, patients who were treated with high-dose cytarabine (HD-Ara-C) as consolidation therapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) demonstrated longer OS and DFS compared to allo-HSCT or HD-Ara-C alone. Patients treated with allo-HSCT alone exhibited longer DFS compared to patients treated with HD-Ara-C alone. No difference in OS was discovered between these 2 single protocols. CONCLUSION MK was associated with a lower complete remission rate. HD-Ara-C therapy followed by allo-HSCT could improve the prognosis of MK-positive AML patients.
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Affiliation(s)
- Qi-Si Lu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Xuan Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Ji-Xian Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Lin Li
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Yu-Ling Li
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Zi-Yuan Lu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Rui Cao
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Li-Bin Liao
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China
| | - Xiao-Li Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou Dadao North Street, Guangzhou, China.
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