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Haumschild R, Kennerly-Shah J, Barbarotta L, Zeidan AM. Clinical activity, pharmacokinetics, and pharmacodynamics of oral hypomethylating agents for myelodysplastic syndromes/neoplasms and acute myeloid leukemia: A multidisciplinary review. J Oncol Pharm Pract 2024; 30:721-736. [PMID: 38509812 PMCID: PMC11118786 DOI: 10.1177/10781552241238979] [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: 09/22/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To review the pharmacokinetic (PK)-pharmacodynamic (PD) profiles, disease setting, dosing, and safety of oral and parenteral hypomethylating agents (HMAs) for the treatment of myelodysplastic syndromes/neoplasms (MDS) and acute myeloid leukemia (AML), and to provide a multidisciplinary perspective on treatment selection and educational needs relating to HMA use. DATA SOURCES Clinical and real-world data for parenteral decitabine and azacitidine and two oral HMAs: decitabine-cedazuridine (DEC-C) for MDS and azacitidine (CC-486) for AML maintenance therapy. DATA SUMMARY Differences in the PK-PD profiles of oral and parenteral HMA formulations have implications for their potential toxicities and planned use. Oral DEC-C (decitabine 35 mg and cedazuridine 100 mg) has demonstrated equivalent systemic area under the concentration-time curve (AUC) exposure to a 5-day regimen of intravenous (IV) decitabine 20 mg/m2 and showed no significant difference in PD. The AUC equivalence of oral DEC-C and IV decitabine means that these regimens can be treated interchangeably (but must not be substituted within a cycle). Oral azacitidine has a distinct PK-PD profile versus IV or subcutaneous azacitidine, and the formulations are not bioequivalent or interchangeable owing to differences in plasma time-course kinetics and exposures. Clinical trials are ongoing to evaluate oral HMA combinations and novel oral HMAs, such as NTX-301 and ASTX030. CONCLUSIONS Treatment with oral HMAs has the potential to improve quality of life, treatment adherence, and disease outcomes versus parenteral HMAs. Better education of multidisciplinary teams on the factors affecting HMA treatment selection may help to improve treatment outcomes in patients with MDS or AML.
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Affiliation(s)
- Ryan Haumschild
- Emory University Hospital Midtown and Winship Cancer Institute, Atlanta, GA, USA
| | - Julie Kennerly-Shah
- The James Cancer Hospital and Solove Research Institute, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Lisa Barbarotta
- Smilow Cancer Hospital at Yale New Haven, New Haven, CT, USA
| | - Amer M. Zeidan
- Yale School of Medicine and Yale Cancer Center, Yale University, New Haven, CT, USA
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Nannya Y, Tobiasson M, Sato S, Bernard E, Ohtake S, Takeda J, Creignou M, Zhao L, Kusakabe M, Shibata Y, Nakamura N, Watanabe M, Hiramoto N, Shiozawa Y, Shiraishi Y, Tanaka H, Yoshida K, Kakiuchi N, Makishima H, Nakagawa M, Usuki K, Watanabe M, Imada K, Handa H, Taguchi M, Kiguchi T, Ohyashiki K, Ishikawa T, Takaori-Kondo A, Tsurumi H, Kasahara S, Chiba S, Naoe T, Miyano S, Papaemanuil E, Miyazaki Y, Hellström-Lindberg E, Ogawa S. Postazacitidine clone size predicts long-term outcome of patients with myelodysplastic syndromes and related myeloid neoplasms. Blood Adv 2023; 7:3624-3636. [PMID: 36989067 PMCID: PMC10365941 DOI: 10.1182/bloodadvances.2022009564] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 03/30/2023] Open
Abstract
Azacitidine is a mainstay of therapy for myelodysplastic syndrome (MDS)-related diseases. The purpose of our study is to elucidate the effect of gene mutations on hematological response and overall survival (OS), particularly focusing on their posttreatment clone size. We enrolled a total of 449 patients with MDS or related myeloid neoplasms. They were analyzed for gene mutations in pretreatment (n = 449) and posttreatment (n = 289) bone marrow samples using targeted-capture sequencing to assess the impact of gene mutations and their posttreatment clone size on treatment outcomes. In Cox proportional hazard modeling, multihit TP53 mutation (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.42-2.91; P < .001), EZH2 mutation (HR, 1.71; 95% CI, 1.14-2.54; P = .009), and DDX41 mutation (HR, 0.33; 95% CI, 0.17-0.62; P < .001), together with age, high-risk karyotypes, low platelets, and high blast counts, independently predicted OS. Posttreatment clone size accounting for all drivers significantly correlated with International Working Group (IWG) response (P < .001, using trend test), except for that of DDX41-mutated clones, which did not predict IWG response. Combined, IWG response and posttreatment clone size further improved the prediction of the original model and even that of a recently proposed molecular prediction model, the molecular International Prognostic Scoring System (IPSS-M; c-index, 0.653 vs 0.688; P < .001, using likelihood ratio test). In conclusion, evaluation of posttreatment clone size, together with the pretreatment mutational profile as well as the IWG response play a role in better prognostication of azacitidine-treated patients with myelodysplasia.
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Affiliation(s)
- Yasuhito Nannya
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Division of Hematopoietic Disease Control, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Magnus Tobiasson
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
- Division of Hematology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Shinya Sato
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- Japan Adult Leukemia Study Group, Japan
| | - Elsa Bernard
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - June Takeda
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Maria Creignou
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
- Division of Hematology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lanying Zhao
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Kusakabe
- Department of Hematology, University of Tsukuba, Tsukuba, Japan
| | - Yuhei Shibata
- Department of Hematology, Gifu Municipal Hospital, Gifu, Japan
| | - Nobuhiko Nakamura
- Department of Hematology & Infectious Disease, Gifu University Hospital, Gifu, Japan
| | - Mizuki Watanabe
- Department of Hematology and Oncology, Kyoto University, Kyoto, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yusuke Shiozawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuichi Shiraishi
- Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Hiroko Tanaka
- Department of Integrated Data Science, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Yoshida
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuyuki Kakiuchi
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Makishima
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Nakagawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Mitsumasa Watanabe
- Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kazunori Imada
- Department of Hematology, Japan Red Cross Osaka Hospital, Osaka, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University, Gunma, Japan
| | - Masataka Taguchi
- Department of Hematology, Sasebo City General Hospital, Nagasaki, Japan
| | - Toru Kiguchi
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Kazuma Ohyashiki
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | | | - Hisashi Tsurumi
- Department of Hematology & Infectious Disease, Gifu University Hospital, Gifu, Japan
| | - Senji Kasahara
- Department of Hematology, Gifu Municipal Hospital, Gifu, Japan
| | - Shigeru Chiba
- Department of Hematology, University of Tsukuba, Tsukuba, Japan
| | - Tomoki Naoe
- Japan Adult Leukemia Study Group, Japan
- Nagoya Medical Center, Aichi, Japan
| | - Satoru Miyano
- Department of Integrated Data Science, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Elli Papaemanuil
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- Japan Adult Leukemia Study Group, Japan
| | - Eva Hellström-Lindberg
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
- Division of Hematology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
- Institute for the Advanced Study of Human Biology, Kyoto University, Kyoto, Japan
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Bouwstra R, van Meerten T, Bremer E. CD47‐SIRPα blocking‐based immunotherapy: Current and prospective therapeutic strategies. Clin Transl Med 2022; 12:e943. [PMID: 35908284 PMCID: PMC9339239 DOI: 10.1002/ctm2.943] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 01/22/2023] Open
Abstract
Background The CD47‐signal regulatory protein alpha (SIRPα) ‘don't eat me’ signalling axis is perhaps the most prominent innate immune checkpoint to date. However, from initial clinical trials, it is evident that monotherapy with CD47‐SIRPα blocking has a limited therapeutic effect at the maximum tolerated dose. Furthermore, treatment is associated with severe side effects, most notably anaemia, that are attributable to the ubiquitous expression of CD47. Nevertheless, promising clinical responses have been reported upon combination with the tumour‐targeting antibody rituximab or azacytidine, although toxicity issues still hamper clinical application. Main body Here, we discuss the current state of CD47‐SIRPα blocking therapy with a focus on limitations of current strategies, such as depletion of red blood cells. Subsequently, we focus on innovations designed to overcome these limitations. These include novel antibody formats designed to selectively target CD47 on tumour cells as well as tumour‐targeted bispecific antibodies with improved selectivity. In addition, the rationale and outcome of combinatorial approaches to improve the therapeutic effect of CD47 blockade are discussed. Such combinations include those with tumour‐targeted opsonizing antibodies, systemic therapy, epigenetic drugs, other immunomodulatory T‐cell‐targeted therapeutics or dual immunomodulatory CD47 bispecific antibodies. Conclusion With these advances in the design of CD47‐SIRPα‐targeting therapeutic strategies and increasing insight into the mechanism of action of this innate checkpoint, including the role of adaptive immunity, further advances in the clinical application of this checkpoint can be anticipated.
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Affiliation(s)
- Renée Bouwstra
- Department of Hematology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Tom van Meerten
- Department of Hematology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Edwin Bremer
- Department of Hematology University Medical Center Groningen University of Groningen Groningen The Netherlands
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Leisch M, Pfeilstöcker M, Stauder R, Heibl S, Sill H, Girschikofsky M, Stampfl-Mattersberger M, Tinchon C, Hartmann B, Petzer A, Schreder M, Kiesl D, Vallet S, Egle A, Melchardt T, Piringer G, Zebisch A, Machherndl-Spandl S, Wolf D, Keil F, Drost M, Greil R, Pleyer L. Adverse Events in 1406 Patients Receiving 13,780 Cycles of Azacitidine within the Austrian Registry of Hypomethylating Agents-A Prospective Cohort Study of the AGMT Study-Group. Cancers (Basel) 2022; 14:cancers14102459. [PMID: 35626063 PMCID: PMC9140081 DOI: 10.3390/cancers14102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Azacitidine is thus far the only drug shown to prolong overall survival and is, therefore, the recommended (backbone) treatment in patients diagnosed with myelodysplastic syndromes, chronic myelomonocytic leukemia and acute myeloid leukemia who are not eligible for intensive chemotherapy. Detailed reports on adverse events are often lacking. We performed a thorough analysis of the adverse events that occur during treatment with azacitidine in the largest cohort of patients treated with this drug published so far. We also compared the frequency of adverse events documented in our cohort to published data from randomized clinical trials with an azacitidine monotherapy arm. Adverse event documentation in the Austrian Registry was high. Hematologic adverse events occurred at a similar rate compared to published trials, whereas gastrointestinal toxicities were significantly less commonly reported. Our data complement results from clinical trials with real-world evidence and form a reference for future combination strategies with azacitidine. Abstract Background: Azacitidine is the treatment backbone for patients with acute myeloid leukemia, myelodysplastic syndromes and chronic myelomonocytic leukemia who are considered unfit for intensive chemotherapy. Detailed reports on adverse events in a real-world setting are lacking. Aims: To analyze the frequency of adverse events in the Austrian Registry of Hypomethylating agents. To compare real-world data with that of published randomized clinical trials. Results: A total of 1406 patients uniformly treated with a total of 13,780 cycles of azacitidine were analyzed. Hematologic adverse events were the most common adverse events (grade 3–4 anemia 43.4%, grade 3–4 thrombopenia 36.8%, grade 3–4 neutropenia 36.1%). Grade 3–4 anemia was significantly more common in the Registry compared to published trials. Febrile neutropenia occurred in 33.4% of patients and was also more common in the Registry than in published reports. Other commonly reported adverse events included fatigue (33.4%), pain (29.2%), pyrexia (23.5%), and injection site reactions (23.2%). Treatment termination due to an adverse event was rare (5.1%). Conclusion: The safety profile of azacitidine in clinical trials is reproducible in a real-world setting. With the use of prophylactic and concomitant medications, adverse events can be mitigated and azacitidine can be safely administered to almost all patients with few treatment discontinuations.
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Affiliation(s)
- Michael Leisch
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Michael Pfeilstöcker
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Reinhard Stauder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Sonja Heibl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Heinz Sill
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
| | - Michael Girschikofsky
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Margarete Stampfl-Mattersberger
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, Klinik Donaustadt, 1220 Vienna, Austria
| | - Christoph Tinchon
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department for Hemato-Oncology, LKH Hochsteiermark, 8700 Leoben, Austria
| | - Bernd Hartmann
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine, Landeskrankenhaus Feldkirch, 6800 Feldkirch, Austria
| | - Andreas Petzer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Medical Oncology and Hematology, Internal Medicine I, Ordensklinikum Linz GmbH Barmherzige Schwestern, 4020 Linz, Austria
| | - Martin Schreder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Klinik Ottakring, 1160 Vienna, Austria
| | - David Kiesl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Hematology and Medical Oncology, Kepleruniversitätsklinikum, 4020 Linz, Austria
| | - Sonia Vallet
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, 3500 Krems, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Thomas Melchardt
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Gudrun Piringer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Armin Zebisch
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8036 Graz, Austria
| | - Sigrid Machherndl-Spandl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Dominik Wolf
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Felix Keil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, 6020 Innsbruck, Austria;
| | - Richard Greil
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Lisa Pleyer
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Correspondence:
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Bouchla A, Thomopoulos TP, Papageorgiou SG, Apostolopoulou C, Loucari C, Mpazani E, Pappa V. Predicting outcome in higher-risk myelodysplastic syndrome patients treated with azacitidine. Epigenomics 2021; 13:1129-1143. [PMID: 34291653 DOI: 10.2217/epi-2021-0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
5-Azacitidine (5-AZA) is widely used for the treatment of higher-risk myelodysplastic syndromes. However, response and survival rates vary considerably, while indicated treatment duration remains undefined. For these reasons, factors determining response and survival are of major importance. Clinical, morphological, flow cytometry, cytogenetic and molecular factors are discussed in this review. Biomarkers predictive of response and prognosis, as well as their link to the mode of action of 5-AZA are also addressed, shifting the focus from clinical practice to investigational research. Their use could further improve prognostic classification of 5-AZA treated higher-risk myelodysplastic syndromes in the near future.
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Affiliation(s)
- Anthi Bouchla
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Thomas P Thomopoulos
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Sotirios G Papageorgiou
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Christina Apostolopoulou
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Constantinos Loucari
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Efthimia Mpazani
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
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Papageorgiou SG, Kotsianidis I, Bouchla A, Symeonidis A, Galanopoulos A, Viniou NA, Hatzimichael E, Vassilakopoulos TP, Gogos D, Megalakaki A, Zikos P, Diamantopoulos P, Kourakli A, Giannoulia P, Papoutselis M, Poulakidas E, Arapaki M, Vardi A, Anagnostopoulos A, Mparmparousi D, Papaioannou M, Bouronikou E, Dimou M, Papadaki H, Panayiotidis P, Pappa V. Serum ferritin and ECOG performance status predict the response and improve the prognostic value of IPSS or IPSS-R in patients with high-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia treated with 5-azacytidine: a retrospective analysis of the Hellenic national registry of myelodysplastic and hypoplastic syndromes. Ther Adv Hematol 2020; 11:2040620720966121. [PMID: 33343854 PMCID: PMC7727043 DOI: 10.1177/2040620720966121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background: 5-azacytidine (5-AZA) improves survival of patients with higher-risk myelodysplastic syndromes (MDSs) and oligoblastic acute myeloid leukemia (AML); however, predictive factors for response and outcome have not been consistently studied. Methods: This study of the Hellenic MDS Study Group included 687 consecutive patients with higher-risk MDS and oligoblastic AML treated with 5-AZA. Results: The International Prognostic Scoring System (IPSS) revised version (IPSS-R), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0 or 1 versus ⩾2) and baseline serum ferritin (SF) levels > 520 ng/ml were shown to independently predict response to 5-AZA. In the survival analysis, the IPSS and IPSS-R risk classification systems along with the ECOG PS and SF levels > 520 ng/ml proved to be independent prognosticators for overall survival (OS), as well as for leukemia-free survival (LFS). Next, we built new multivariate models for OS and LFS, incorporating only ECOG PS and SF levels besides IPSS or IPSS-R risk classification systems. Thereby, the new modified IPSS and IPSS-R risk classification systems (H-PSS, H-PSS-R) could each discriminate a low, an intermediate and a high-risk patient group regarding OS and LFS. The H-PSS and H-PSS-R proved to be better predictors of OS than their previous counterparts as well as the French prognostic score, while the most powerful OS predictor was the new, H-PSS-R system. Conclusions: ECOG PS and SF levels > 520 ng/ml independently predict response to 5-AZA, OS and LFS. Their incorporation in the IPSS and IPSS-R scores enhances these scores’ predictive power in 5-AZA-treated higher-risk MDS and oligoblastic AML patients.
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Affiliation(s)
- Sotirios G Papageorgiou
- Consultant of Hematology, Second Department of Internal Medicine and Research Unit, University General Hospital "Attikon", 1 Rimini St., Haidari, Athens, 12462, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anthi Bouchla
- Second Department of Internal Medicine and Research Unit, University General Hospital "Attikon", Haidari, Athens, Greece
| | | | | | | | | | - Theodoros P Vassilakopoulos
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | | | | | | | - Menelaos Papoutselis
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Elias Poulakidas
- "401" Army General Hospital of Athens, Mesogeion and Kanellopoulou 1, Athens, Greece
| | - Maria Arapaki
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Anna Vardi
- Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | - Achilles Anagnostopoulos
- Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | - Despoina Mparmparousi
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Papaioannou
- Hematology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Eleni Bouronikou
- University General Hospital of Larissa, Mezourlo, Larissa, Greece
| | - Maria Dimou
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Papadaki
- University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine and Research Unit, University General Hospital "Attikon", Haidari, Athens, Greece
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7
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Cai L, Zhao X, Ai L, Wang H. Role Of TP53 mutations in predicting the clinical efficacy of hypomethylating therapy in patients with myelodysplastic syndrome and related neoplasms: a systematic review and meta-analysis. Clin Exp Med 2020; 20:361-371. [PMID: 32613269 DOI: 10.1007/s10238-020-00641-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Hypomethylating agents (HMAs) are now a major treatment option for myelodysplastic syndrome (MDS) and related neoplasms, but 50% of patients still do not respond and realize poor outcomes. Mutational predictors of treatment efficacy attract continuous attention. Whether TP53 mutations can be used as predictors of HMA effectiveness has caused heated debate. Therefore, we performed a meta-analysis to investigate the predictive value of TP53 mutations to outcomes of HMA therapy in patients with MDS and related neoplasms. We systematically searched PubMed, Embase, the Cochrane Library, and the WanFang databases (published deadline: September 12, 2019). The primary endpoints were overall response rate (ORR) and overall survival (OS). Odds ratio (OR), hazard ratio (HR), and 95% confidence intervals (CI) were pooled to estimate the association between TP53 mutations and the clinical efficacy of HMAs. Four hundred fifteen papers were found, and 22 papers were included in this meta-analysis (N = 2020 participants). The results showed that the presence of TP53 mutation predicted an increased overall response rate with HMA treatment in the subsets that restricted patients in de novo disease, MDS by WHO (World Health Organization) criteria, or NGS (next-generation sequence) group (P = 0.005, P = 0.003, P = 0.0005, respectively). However, TP53 mutations remained poor factors for OS (P < 0.00001). Collectively, in HMA therapy, TP53 mutations can predict better ORR when setting more refined subgroups, but TP53 mutations still strongly correlated with poor survival in hypomethylating therapy.
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Affiliation(s)
- Li Cai
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaoyan Zhao
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lisha Ai
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huafang Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Papageorgiou SG, Kontos CK, Kotsianidis I, Vasilatou D, Symeonidis A, Galanopoulos A, Bouchla A, Hatzimichael E, Repousis P, Zikos P, Viniou NA, Poulakidas E, Vassilakopoulos TP, Diamantopoulos P, Diamantopoulos MA, Mparmparousi D, Bouronikou E, Papadaki H, Panayiotidis P, Pappa V. The outcome of patients with high-risk MDS achieving stable disease after treatment with 5-azacytidine: A retrospective analysis of the Hellenic (Greek) MDS Study Group. Hematol Oncol 2018; 36:693-700. [DOI: 10.1002/hon.2551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Sotirios G. Papageorgiou
- Second Department of Internal Medicine and Research Unit; University General Hospital “Attikon”; Athens Greece
| | - Christos K. Kontos
- Department of Biochemistry and Molecular Biology; University of Athens; Athens Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School; University Hospital of Alexandroupolis; Alexandroupolis Greece
- The Hellenic (Greek) MDS Study Group; Athens Greece
| | - Diamantina Vasilatou
- Second Department of Internal Medicine and Research Unit; University General Hospital “Attikon”; Athens Greece
| | - Argyris Symeonidis
- The Hellenic (Greek) MDS Study Group; Athens Greece
- General University Hospital of Patras; Patras Greece
| | - Athanasios Galanopoulos
- The Hellenic (Greek) MDS Study Group; Athens Greece
- General Hospital of Athens ‘G. Gennimatas’; Athens Greece
| | - Anthi Bouchla
- Second Department of Internal Medicine and Research Unit; University General Hospital “Attikon”; Athens Greece
| | | | | | | | - Nora-Athina Viniou
- The Hellenic (Greek) MDS Study Group; Athens Greece
- First Department of Internal Medicine; National and Kapodistrian University of Athens; Athens Greece
| | | | - Theodoros P. Vassilakopoulos
- Department of Haematology; National and Kapodistrian University of Athens, Laikon General Hospital; Athens Greece
| | - Panagiotis Diamantopoulos
- First Department of Internal Medicine; National and Kapodistrian University of Athens; Athens Greece
| | | | - Despoina Mparmparousi
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | | | - Helen Papadaki
- University General Hospital of Heraklion; Heraklion Greece
| | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine and Research Unit; University General Hospital “Attikon”; Athens Greece
- The Hellenic (Greek) MDS Study Group; Athens Greece
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9
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Papageorgiou SG, Vasilatou D, Kontos CK, Kotsianidis I, Symeonidis A, Galanopoulos AG, Hatzimichael E, Megalakaki A, Poulakidas E, Diamantopoulos P, Vassilakopoulos TP, Zikos P, Papadaki H, Mparmparousi D, Bouronikou E, Panayiotidis P, Viniou NA, Pappa V. The prognostic value of monosomal karyotype (MK) in higher-risk patients with myelodysplastic syndromes treated with 5-Azacitidine: A retrospective analysis of the Hellenic (Greek) Myelodysplastic syndromes Study Group. Am J Hematol 2018; 93:895-901. [PMID: 29659040 DOI: 10.1002/ajh.25111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/08/2022]
Abstract
In this study, we investigated the incidence and prognostic impact of monosomal karyotype (MK) in 405 higher-risk Myelodysplastic Syndromes (MDS) patients treated with 5-AZA. The MK was present in 66 out of 405 (16.3%) patients, most of whom had complex karyotype (CK). MK was strongly associated with CK and the cytogenetic risk defined according to IPSS-R, as well as with high-risk disease, according to IPSS (P = .029), IPSS-R (P < .001), and WPSS (P < .001) classification systems. The overall response rate (ORR) was not different between MK+ and MK- patients (46.6% vs. 46.2%). At 28 months median follow-up, the median duration of response was 11 months in the entire cohort, 9.5 months in MK+ patients and 11 months in MK-patients (P = .024). The estimated median time to transformation to acute myeloid leukemia for MK+ patients was 17 months vs. 23 months for MK- patients (P = .025). The estimated median OS for MK+ patients was 12 months vs. 18 months for MK- patients (P < .001). Multivariate Cox regression analysis revealed that performance status (P < .001), IPSS-R (P < .001), and MK (P = .002) were independently associated with overall survival (OS). In a subgroup consisting of high and very-high risk patients according to IPSS-R, MK- patients showed better OS rates compared to MK+ patients (estimated median OS: 17 months vs. 12 months, P = .002). In conclusion, we found that MK is associated with reduced OS in patients with higher-risk MDS treated with 5-AZA. Furthermore, we showed that in MDS with high or very-high IPSS-R risk score, MK can further distinguish patients with worse outcome.
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Affiliation(s)
- Sotirios G. Papageorgiou
- Second Department of Internal Medicine and Research Unit; University General Hospital “Attikon”, 1 Rimini St., Haidari; Athens 12462 Greece
| | - Diamantina Vasilatou
- Second Department of Internal Medicine and Research Unit; University General Hospital “Attikon”, 1 Rimini St., Haidari; Athens 12462 Greece
| | - Christos K. Kontos
- Department of Biochemistry and Molecular Biology; National and Kapodistrian University of Athens, Panepistimiopolis; Athens 15701 Greece
| | - Ioannis Kotsianidis
- Department of Hematology; Democritus University of Thrace Medical School, University Hospital of Alexandroupolis; Alexandroupolis Greece
- The Hellenic (Greek) MDS Study Group
| | - Argiris Symeonidis
- The Hellenic (Greek) MDS Study Group
- General University Hospital of Patras, Rio Patron; Patras 26500 Greece
| | - Athanasios G. Galanopoulos
- The Hellenic (Greek) MDS Study Group
- General Hospital of Athens “G. Gennimatas”, Mesogeion 154; Athens 11527 Greece
| | | | | | - Elias Poulakidas
- Mesogeion and Kanellopoulou 1; “401” Army General Hospital of Athens; Athens 11525 Greece
| | | | - Theodoros P. Vassilakopoulos
- Department of Haematology; National and Kapodistrian University of Athens, Laikon General Hospital; Athens Greece
| | - Panagiotis Zikos
- General Hospital of Patras “Agios Andreas”, Tsertidou 1; Patras 26335 Greece
| | - Helen Papadaki
- University General Hospital of Heraklion, Voutes; Heraklion 71110 Greece
| | - Despoina Mparmparousi
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Eleni Bouronikou
- University General Hospital of Larissa, Mezourlo; Larissa 41110 Greece
| | - Panayiotis Panayiotidis
- 1 Propaedeutic Department of Internal Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Nora-Athina Viniou
- The Hellenic (Greek) MDS Study Group
- Mesogeion and Kanellopoulou 1; “401” Army General Hospital of Athens; Athens 11525 Greece
| | - Vassiliki Pappa
- Second Department of Internal Medicine and Research Unit; University General Hospital “Attikon”, 1 Rimini St., Haidari; Athens 12462 Greece
- The Hellenic (Greek) MDS Study Group
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10
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Kourtis A, Adamopoulos PG, Papalois A, Iliopoulos DC, Babis GC, Scorilas A. Quantitative analysis and study of the mRNA expression levels of apoptotic genes BCL2, BAX and BCL2L12 in the articular cartilage of an animal model of osteoarthritis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:243. [PMID: 30069445 DOI: 10.21037/atm.2018.05.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Given that apoptosis of chondrocytes is one of the most important factors related to the pathogenesis of osteoarthritis (OA), the recent research interest adds progress not only to the knowledge of the molecular signals that mediate apoptosis but also to find new therapeutic targets. This study attempts to investigate the differential expression of BCL2 family genes in the articular cartilage of an experimental animal model of OA. Methods In total, 26 New Zealand white rabbits underwent an anterior cruciate ligament transaction, 26 more were subjected to a placebo surgery and 18 specimens constituted the control non-operated group. Thirteen weeks later, samples of cartilage from the osteoarthritic and non-osteoarthritic knees were collected and subjected to analysis of the BCL2, BAX and BCL2L12 gene expression at the mRNA level. Results Installed osteoarthritic alterations of varied intensity and of grade 1 up to grade 5, were confirmed according to the OARSI system. Contrary to the physiologically healthy samples, in the osteoarthritic samples the mRNA expression levels of BAX and BCL2L12 genes were found significantly upregulated by signals which can activate apoptosis. However, the difference between BCL2 mRNA expression levels in healthy and osteoarthritic samples was not supported statistically. Conclusions Since apoptosis is the main feature of the cartilage degeneration in OA, the effective inhibition of apoptosis of chondrocytes can provide novel and interesting therapeutic strategies for the treatment of OA. Therefore, BAX and BCL2L12 are highlighted as potential therapeutic targets in OA.
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Affiliation(s)
| | - Panagiotis G Adamopoulos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - George C Babis
- Second Orthopaedic Department, National and Kapodistrian University of Athens Medical School, Konstantopouleio General Hospital, Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
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11
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Adamopoulos PG, Theodoropoulou MC, Scorilas A. Alternative Splicing Detection Tool-a novel PERL algorithm for sensitive detection of splicing events, based on next-generation sequencing data analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:244. [PMID: 30069446 DOI: 10.21037/atm.2018.06.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Next-generation sequencing (NGS) can provide researchers with high impact information regarding alternative splice variants or transcript identifications. However, the enormous amount of data acquired from NGS platforms make the analysis of alternative splicing events hard to accomplish. For this reason, we designed the "Alternative Splicing Detection Tool" (ASDT), an algorithm that is capable of identifying alternative splicing events, including novel ones from high-throughput NGS data. ASDT is available as a PERL script at http://aias.biol.uoa.gr/~mtheo and can be executed on any system with PERL installed. In addition to the detection of annotated and novel alternative splicing events from high-throughput NGS data, ASDT can also analyze the intronic regions of genes, thus enabling the detection of novel cryptic exons residing in annotated introns, extensions of previously annotated exons, or even intron retentions. Consequently, ASDT demonstrates many innovative and unique features that can efficiently contribute to alternative splicing analysis of NGS data.
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Affiliation(s)
- Panagiotis G Adamopoulos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Athens, Greece
| | - Margarita C Theodoropoulou
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Papasiopoulou, Lamia, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Athens, Greece
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12
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Diamantopoulos MA, Tsiakanikas P, Scorilas A. Non-coding RNAs: the riddle of the transcriptome and their perspectives in cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:241. [PMID: 30069443 DOI: 10.21037/atm.2018.06.10] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Non-coding RNAs (ncRNAs) constitute a heterogeneous group of RNA molecules in terms of biogenesis, biological function as well as length and structure. These biological molecules have gained attention recently as a potentially crucial layer of tumor cell progression or regulation. ncRNAs are expressed in a broad spectrum of tumors, and they play an important role not only in maintaining but also in promoting cancer development and progression. Recent discoveries have revealed that ncRNAs may act as key signal transduction mediators in tumor signaling pathways by interacting with RNA or proteins. These results reinforce the hypothesis, that ncRNAs constitute therapeutic targets, and point out their clinical potential as stratification markers. The major purpose of this review is to mention the emergence of the importance of ncRNAs, as molecules which are correlated with cancer, and to discuss their clinical implicit as prognostic diagnostic indicators, biomarkers, and therapeutic targets.
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Affiliation(s)
- Marios A Diamantopoulos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Tsiakanikas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
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