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Lao Z, Lam KY, Cheung YMC, Teng CL, Radhakrishnan V, Bhurani D, Ko BS, Goh YT. Recommendations for the treatment and management of adult B-Cell acute lymphoblastic leukemia in Asia-Pacific: Outcomes from a pilot initiative. Asia Pac J Clin Oncol 2024; 20:325-334. [PMID: 38148287 DOI: 10.1111/ajco.14041] [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: 03/06/2023] [Revised: 09/27/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
The outcomes of adult B-cell acute lymphoblastic leukemia (ALL) remain poor. Recent advancements in the field of leukemia research show potential for improved patient care. However, the adoption of research findings into clinical practice is fraught with practice- and country-specific challenges. The continued addition of new findings warrants critical evaluation for the feasibility of incorporation into clinical practice. A uniform set of evidence-based guidelines can favorably assist physicians in making optimal clinical decisions. Such a resource may also serve as a reference point for strategic planning of initiatives aimed at addressing critical barriers in the optimal management of B-cell ALL. This initiative was undertaken to seek a collaborative perspective and understand the existing challenges. Concordance-based recommendations were outlined through a systematic discussion on various aspects of treatment and management of adult B-cell ALL. The outcomes and experiences gained from this exercise will serve as a foundation for future efforts encompassing the more granular aspects of the management of B-cell ALL across the Asia-Pacific region.
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Affiliation(s)
- Zhentang Lao
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Kwong Yok Lam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Yuk Man Carol Cheung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Chieh-Lin Teng
- Department of Medicine, Division of Hematology/Medical Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Vivek Radhakrishnan
- Division of Haematology Oncology and Haematopoietic Cell Transplantation, Tata Medical Center, Kolkata, India
| | - Dinesh Bhurani
- Department of Hematology and Bone Marrow Transplant, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Bor-Sheng Ko
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
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2
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Jonart LM, Ostergaard J, Brooks A, Fitzpatrick G, Chen L, Gordon PM. CXCR4 antagonists disrupt leukaemia-meningeal cell adhesion and attenuate chemoresistance. Br J Haematol 2023; 201:459-469. [PMID: 36535585 PMCID: PMC10121760 DOI: 10.1111/bjh.18607] [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: 09/19/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
The effective prophylaxis and treatment of central nervous system (CNS) involvement in acute lymphoblastic leukaemia (ALL) remains a significant clinical challenge. Developing novel and more effective CNS-directed therapies has been hampered, in part, by our limited understanding of the leukaemia niche in the CNS relative to the bone marrow. Accordingly, defining the molecular and cellular components critical for the establishment and maintenance of the CNS leukaemia niche may lead to new therapeutic opportunities. In prior work we showed that direct intercellular interactions between leukaemia and meningeal cells enhance leukaemia chemoresistance in the CNS. Herein, we show that the CXCR4/CXCL12 chemokine axis contributes to leukaemia-meningeal cell adhesion. Importantly, clinically tested CXCR4 antagonists, which are likely to cross the blood-brain and blood-cerebral spinal fluid barriers and penetrate the CNS, effectively disrupted leukaemia-meningeal cell adhesion. Moreover, by disrupting these intercellular interactions, CXCR4 antagonists attenuated leukaemia chemoresistance in leukaemia-meningeal cell co-culture experiments and enhanced the efficacy of cytarabine in targeting leukaemia cells in the meninges in vivo. This work identifies the CXCR4/CXCL12 axis as an important regulator of intercellular interactions within the CNS leukaemia niche and supports further testing of the therapeutic efficacy of CXCR4 antagonists in overcoming CNS niche-mediated chemoresistance.
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Affiliation(s)
- Leslie M Jonart
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason Ostergaard
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Athena Brooks
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Garrett Fitzpatrick
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Liam Chen
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Peter M Gordon
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
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Jabbour E, Short NJ, Jain N, Haddad FG, Welch MA, Ravandi F, Kantarjian H. The evolution of acute lymphoblastic leukemia research and therapy at MD Anderson over four decades. J Hematol Oncol 2023; 16:22. [PMID: 36927623 PMCID: PMC10018889 DOI: 10.1186/s13045-023-01409-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
Progress in the research and therapy of adult acute lymphoblastic leukemia (ALL) is accelerating. This analysis summarizes the data derived from the clinical trials conducted at MD Anderson between 1985 and 2022 across ALL subtypes. In Philadelphia chromosome-positive ALL, the addition of BCR::ABL1 tyrosine kinase inhibitors (TKIs) to intensive chemotherapy since 2000, improved outcomes. More recently, a chemotherapy-free regimen with blinatumomab and ponatinib resulted in a complete molecular remission rate of 85% and an estimated 3-year survival rate of 90%, potentially reducing the role of, and need for allogeneic stem cell transplantation (SCT) in remission. In younger patients with pre-B Philadelphia chromosome-negative ALL, the integration of blinatumomab and inotuzumab into the frontline therapy has improved the estimated 3-year survival rate to 85% across all risk categories. Our future strategy is to evaluate the early integration of both immunotherapy agents, inotuzumab and blinatumomab, with low-dose chemotherapy (dose-dense mini-Hyper-CVD-inotuzumab-blinatumomab) into the frontline setting followed by CAR T cells consolidation in high-risk patients, without any further maintenance therapy. In older patients, using less intensive chemotherapy (mini-Hyper-CVD) in combination with inotuzumab and blinatumomab has improved the 5-year survival rate to 50%. Among patients ≥ 65-70 years, the mortality in complete remission (CR) is still high and is multifactorial (old age, death in CR with infections, development of myelodysplastic syndrome or acute myeloid leukemia). A chemotherapy-free regimen with inotuzumab and blinatumomab is being investigated. The assessment of measurable residual disease (MRD) by next-generation sequencing (NGS) is superior to conventional assays, with early MRD negativity by NGS being associated with the best survival. We anticipate that the future therapy in B-ALL will involve less intensive and shorter chemotherapy regimens in combination with agents targeting CD19 (blinatumomab), CD20, and CD22 (inotuzumab). The optimal timing and use of CAR T cells therapy may be in the setting of minimal disease, and future trials will assess the role of CAR T cells as a consolidation among high-risk patients to replace allogeneic SCT. In summary, the management of ALL has witnessed significant progress during the past four decades. Novel combination regimens including newer-generation BCR::ABL1 TKIs and novel antibodies are questioning the need and duration of intensive chemotherapy and allogeneic SCT.
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Affiliation(s)
- Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA.
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA
| | - Fadi G Haddad
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA
| | - Mary Alma Welch
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA
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Arabi S, Yousefian S, Kavosh A, Mansourian M, Nematollahi P. The prognostic significance of hematogones in childhood B-cell acute lymphoblastic leukemia. Pediatr Blood Cancer 2023; 70:e30138. [PMID: 36495254 DOI: 10.1002/pbc.30138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent studies have demonstrated hematogones (HGs) expansion to be associated with favorable outcomes in hematological diseases, especially in patients with acute myeloid leukemia and patients undergoing hematopoietic stem cell transplantation. Acute lymphoblastic leukemia (ALL) is the most common form of cancer in children. As of now, minimal residual disease (MRD) remains the most compelling independent prognostic factor in childhood ALL. There is need for more prognostic tools for evaluating relapse risk. PROCEDURE The goal of this study was to assess the prognostic value of HGs on relapse-free survival (RFS) and overall survival (OS) in childhood ALL. In this prospective cohort study, a total of 122 subjects with definitive diagnosis of precursor B lymphoblastic leukemia were evaluated. Flow cytometric HG detection was performed in bone marrow aspirates after induction and consolidation therapy. RESULTS The median follow-up period of patients was 35.5 ± 9.4 (SD) months. Patients who had at least 1.0% HGs had a significantly better RFS (p = .023). Moreover, univariate and multivariate analyses confirmed that positive HGs were independently associated with longer RFS (unadjusted model: hazard ratio = 0.33, 95% CI = 0.12-0.91, p = .031; adjusted model: hazard ratio = 0.30, 95% CI = 0.11-0.82, p = .020). CONCLUSIONS Along with the role of MRD, our study shows the significance of HGs as an independent prognostic factor. The results indicate the independent prognostic value of HGs on RFS after adjustment for other prognostic factors, and can be beneficial for risk stratification and treatment modifications amongst pediatric B-cell ALL patients.
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Affiliation(s)
- Sina Arabi
- Applied Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Yousefian
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aryan Kavosh
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.,Biomedical Engineering Research Centre (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona, Barcelona, Spain
| | - Pardis Nematollahi
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Cancer Prevention Research Center, Omid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Iacobucci I, Witkowski MT, Mullighan CG. Single-cell analysis of acute lymphoblastic and lineage-ambiguous leukemia: approaches and molecular insights. Blood 2023; 141:356-368. [PMID: 35926109 PMCID: PMC10023733 DOI: 10.1182/blood.2022016954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 01/31/2023] Open
Abstract
Despite recent progress in identifying the genetic drivers of acute lymphoblastic leukemia (ALL), prognosis remains poor for those individuals who experience disease recurrence. Moreover, acute leukemias of ambiguous lineage lack a biologically informed framework to guide classification and therapy. These needs have driven the adoption of multiple complementary single-cell sequencing approaches to explore key issues in the biology of these leukemias, including cell of origin, developmental hierarchy and ontogeny, and the molecular heterogeneity driving pathogenesis, progression, and therapeutic responsiveness. There are multiple single-cell techniques for profiling a specific modality, including RNA, DNA, chromatin accessibility and methylation; and an expanding range of approaches for simultaneous analysis of multiple modalities. Single-cell sequencing approaches have also enabled characterization of cell-intrinsic and -extrinsic features of ALL biology. In this review we describe these approaches and highlight the extensive heterogeneity that underpins ALL gene expression, cellular differentiation, and clonal architecture throughout disease pathogenesis and treatment resistance. In addition, we discuss the importance of the dynamic interactions that occur between leukemia cells and the nonleukemia microenvironment. We discuss potential opportunities and limitations of single-cell sequencing for the study of ALL biology and treatment responsiveness.
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Affiliation(s)
- Ilaria Iacobucci
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, TN
| | - Matthew T. Witkowski
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Charles G. Mullighan
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, TN
- Hematological Malignancies Program, St Jude Children’s Research Hospital, Memphis, TN
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Optimum Methotrexate Exposure in Patients With Suspected or Confirmed CNS Invasive Hematological Malignancies: A Systematic Critical Review. Ther Drug Monit 2023; 45:287-292. [PMID: 35971672 DOI: 10.1097/ftd.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/13/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND METHODS The present review aims to evaluate the current state-of-the-art dosing regimens of high-dose (HD) and intrathecal methotrexate (MTX) using therapeutic drug monitoring (TDM) to optimize its therapeutic response and minimize associated toxicity, particularly in the central nervous system (CNS). RESULTS MTX is administered systemically in a HD regimen (>1 g/m 2 ) for the treatment of various hematological neoplasms. HD-MTX treatment becomes complicated by marked interindividual drug elimination variability. TDM is specified to manage this high variability. Approximately 3%-7% of adults with acute lymphoblastic leukemia are diagnosed with CNS involvement, and the incidence of CNS relapse in patients, despite receiving prophylaxis, ranges from 5% to 10%. HD-MTX penetrates the blood-brain barrier and can be administered intrathecally, making this drug an important component of chemotherapy regimens for patients with hematologic malignancies involving the CNS or those at high risk of CNS relapse. CONCLUSIONS The major evidence found was that an MTX area under the curve target between 1000 and 1100 μmol hour -1 L is associated with better clinical outcomes. However, there seems to be a clinical gap in the prospective validation of HD and IT MTX management to optimize clinical outcomes and minimize toxicity, using the relationship between exposure level (area under the curve MTX) and optimal response to MTX, at systemic and CNS exposure.
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Mathews V, Korula A, Chakrapani A, Bhurani D, Bhattacharyya J, Sengar M, Malhotra P, Boyella PK, Singh PK, Ganesan P, Dhawan R, Melinkeri S, Damodar S, Dolai TK, Radhakrishnan V. Management of B-cell lineage acute lymphoblastic leukemia: expert opinion from an Indian panel via Delphi consensus method. Front Oncol 2023; 13:1171568. [PMID: 37168381 PMCID: PMC10166232 DOI: 10.3389/fonc.2023.1171568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Currently, there are no guidelines for the management of B-cell lineage acute lymphoblastic leukemia (B-ALL) from an Indian perspective. The diagnostic workup, monitoring, and treatment of B-ALL vary among different physicians and institutes. Objective To develop evidence-based practical consensus recommendations for the management of B-ALL in Indian settings. Methods Modified Delphi consensus methodology was considered to arrive at a consensus. An expert scientific committee of 15 experts from India constituted the panel. Clinically relevant questions belonging to three major domains were drafted for presentation and discussion: (i) diagnosis and risk assignment; (ii) frontline treatment; and (iii) choice of therapy (optimal vs. real-world practice) in relapsed/refractory (R/R) settings. The questionnaire was shared with the panel members through an online survey platform. The level of consensus was categorized into high (≥ 80%), moderate (60%-79%), and no consensus (< 60%). The process involved 2 rounds of discussion and 3 rounds of Delphi survey. The questions that received near or no consensus were discussed during virtual meetings (Delphi rounds 1 and 2). The final draft of the consensus was emailed to the panel for final review. Results Experts recommended morphologic assessment of peripheral blood or bone marrow, flow cytometric immunophenotyping, and conventional cytogenetic analysis in the initial diagnostic workup. Berlin-Frankfurt-Münster (BFM)-based protocol is the preferred frontline therapy in pediatric and adolescent and young adult patients with B-ALL. BFM/German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia-based regimen is suggested in adult patients with B-ALL. Immunotherapy (blinatumomab or inotuzumab ozogamicin) followed by allogeneic hematopoietic cell transplantation (allo-HCT) is the optimal choice of therapy that would yield the best outcomes if offered in the first salvage in patients with R/R B-ALL. In patients with financial constraints or prior allo-HCT (real-world practice) at first relapse, standard-intensive chemotherapy followed by allo-HCT may be considered. For subsequent relapses, chimeric antigen receptor T-cell therapy or palliative care was suggested as the optimal choice of therapy. Conclusion This expert consensus will offer guidance to oncologists/clinicians on the management of B-ALL in Indian settings.
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Affiliation(s)
- Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
- *Correspondence: Vikram Mathews,
| | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Dinesh Bhurani
- Department of Hemato-Oncology & Bone Marrow Transplant (BMT) Unit, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Jina Bhattacharyya
- Department of Clinical Hematology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Manju Sengar
- Medical Oncology Department, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Nehru Hospital, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pavan Kumar Boyella
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Centre, Hyderabad, Telangana, India
| | - Pawan Kumar Singh
- Haemato-Oncology & Bone Marrow Transplant (BMT), B.L. Kapur (BLK)-Max Center for Bone Marrow Transplant, BLK-Max Superspeciality Hospital, New Delhi, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Rishi Dhawan
- Clinical Hematology, All India Institute of Medical Sciences, Delhi, India
| | - Sameer Melinkeri
- Department of Hematology, Deenanath Mangeshkar Hospital & Research Center, Pune, India
| | - Sharat Damodar
- Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
| | - Tuphan Kanti Dolai
- Department of Haematology, Nil Ratan Sarkar (NRS) Medical College and Hospital, Kolkata, India
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Antonio-Andres G, Martinez-Ruiz GU, Morales-Martinez M, Jiménez-Hernandez E, Martinez-Torres E, Lopez-Perez TV, Estrada-Abreo LA, Patino-Lopez G, Juarez-Mendez S, Davila-Borja VM, Huerta-Yepez S. Transcriptional Regulation of Yin-Yang 1 Expression through the Hypoxia Inducible Factor-1 in Pediatric Acute Lymphoblastic Leukemia. Int J Mol Sci 2022; 23:ijms23031728. [PMID: 35163649 PMCID: PMC8835886 DOI: 10.3390/ijms23031728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/04/2022] Open
Abstract
Yin-Yang transcription factor 1 (YY1) is involved in tumor progression, metastasis and has been shown to be elevated in different cancers, including leukemia. The regulatory mechanism underlying YY1 expression in leukemia is still not understood. Bioinformatics analysis reveal three Hypoxia-inducible factor 1-alpha (HIF-1α) putative binding sites in the YY1 promoter region. The regulation of YY1 by HIF-1α in leukemia was analyzed. Mutation of the putative YY1 binding sites in a reporter system containing the HIF-1α promoter region and CHIP analysis confirmed that these sites are important for YY1 regulation. Leukemia cell lines showed that both proteins HIF-1α and YY1 are co-expressed under hypoxia. In addition, the expression of mRNA of YY1 was increased after 3 h of hypoxia conditions and affect several target genes expression. In contrast, chemical inhibition of HIF-1α induces downregulation of YY1 and sensitizes cells to chemotherapeutic drugs. The clinical implications of HIF-1α in the regulation of YY1 were investigated by evaluation of expression of HIF-1α and YY1 in 108 peripheral blood samples and by RT-PCR in 46 bone marrow samples of patients with pediatric acute lymphoblastic leukemia (ALL). We found that the expression of HIF-1α positively correlates with YY1 expression in those patients. This is consistent with bioinformatic analyses of several databases. Our findings demonstrate for the first time that YY1 can be transcriptionally regulated by HIF-1α, and a correlation between HIF-1α expression and YY1 was found in ALL clinical samples. Hence, HIF-1α and YY1 may be possible therapeutic target and/or biomarkers of ALL.
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Affiliation(s)
- Gabriela Antonio-Andres
- Unidad de Investigación en Enfermedades Oncológicas, Hospital Infantil de México, Federico Gómez, Mexico City 06720, Mexico; (G.A.-A.); (M.M.-M.); (E.M.-T.); (T.V.L.-P.)
| | - Gustavo U. Martinez-Ruiz
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | - Mario Morales-Martinez
- Unidad de Investigación en Enfermedades Oncológicas, Hospital Infantil de México, Federico Gómez, Mexico City 06720, Mexico; (G.A.-A.); (M.M.-M.); (E.M.-T.); (T.V.L.-P.)
| | - Elva Jiménez-Hernandez
- Servicio de Hemato-Oncología, Hospital Infantil de Moctezuma, Mexico City 15530, Mexico;
| | - Estefany Martinez-Torres
- Unidad de Investigación en Enfermedades Oncológicas, Hospital Infantil de México, Federico Gómez, Mexico City 06720, Mexico; (G.A.-A.); (M.M.-M.); (E.M.-T.); (T.V.L.-P.)
| | - Tania V. Lopez-Perez
- Unidad de Investigación en Enfermedades Oncológicas, Hospital Infantil de México, Federico Gómez, Mexico City 06720, Mexico; (G.A.-A.); (M.M.-M.); (E.M.-T.); (T.V.L.-P.)
- Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico City 03940, Mexico
| | - Laura A. Estrada-Abreo
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México, Federico Gómez, Mexico City 06720, Mexico; (L.A.E.-A.); (G.P.-L.)
| | - Genaro Patino-Lopez
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México, Federico Gómez, Mexico City 06720, Mexico; (L.A.E.-A.); (G.P.-L.)
| | - Sergio Juarez-Mendez
- Laboratorio de Oncología Experimental, Instituto Nacional de Pediatría, S.S.A., Mexico City 04530, Mexico; (S.J.-M.); (V.M.D.-B.)
| | - Víctor M. Davila-Borja
- Laboratorio de Oncología Experimental, Instituto Nacional de Pediatría, S.S.A., Mexico City 04530, Mexico; (S.J.-M.); (V.M.D.-B.)
| | - Sara Huerta-Yepez
- Unidad de Investigación en Enfermedades Oncológicas, Hospital Infantil de México, Federico Gómez, Mexico City 06720, Mexico; (G.A.-A.); (M.M.-M.); (E.M.-T.); (T.V.L.-P.)
- Correspondence: ; Tel.: +52-55-52289917 (ext. 4401); Fax: +52-55-44349663
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Rajakumar SA, Grandal I, Minden MD, Hitzler JK, Guidos CJ, Danska JS. Targeted blockade of immune mechanisms inhibit B precursor acute lymphoblastic leukemia cell invasion of the central nervous system. Cell Rep Med 2021; 2:100470. [PMID: 35028611 PMCID: PMC8714910 DOI: 10.1016/j.xcrm.2021.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/05/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
Acute lymphoblastic leukemia (ALL) dissemination to the central nervous system (CNS) is a challenging clinical problem whose underlying mechanisms are poorly understood. Here, we show that primary human ALL samples injected into the femora of immunodeficient mice migrate to the skull and vertebral bone marrow and provoke bone lesions that enable passage into the subarachnoid space. Treatment of leukemia xenografted mice with a biologic antagonist of receptor activator of nuclear factor κB ligand (RANKL) blocks this entry route. In addition to erosion of cranial and vertebral bone, samples from individuals with B-ALL also penetrate the blood-cerebrospinal fluid barrier of recipient mice. Co-administration of C-X-C chemokine receptor 4 (CXCR4) and RANKL antagonists attenuate both identified routes of entry. Our findings suggest that targeted RANKL and CXCR4 pathway inhibitors could attenuate routes of leukemia blast CNS invasion and provide benefit for B-ALL-affected individuals.
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Affiliation(s)
- Sujeetha A. Rajakumar
- Program in Genetics and Genome Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ildiko Grandal
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
| | - Mark D. Minden
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A8, Canada
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Johann K. Hitzler
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
- Department of Pediatrics, Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Cynthia J. Guidos
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jayne S. Danska
- Program in Genetics and Genome Biology, The Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
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10
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Other (Non-CNS/Testicular) Extramedullary Localizations of Childhood Relapsed Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma-A Report from the ALL-REZ Study Group. J Clin Med 2021; 10:jcm10225292. [PMID: 34830574 PMCID: PMC8621955 DOI: 10.3390/jcm10225292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Children with other extramedullary relapse of acute lymphoblastic leukemia are currently poorly characterized. We aim to assess the prevalence and the clinical, therapeutic and prognostic features of extramedullary localizations other than central nervous system or testis in children with relapse of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) treated on a relapsed ALL protocol. PATIENTS AND METHODS Patients with relapse of ALL and LBL, treated according to the multicentric ALL-REZ BFM trials between 1983 and 2015, were analyzed for other extramedullary relapse (OEMR) of the disease regarding clinical features, treatment and outcome. Local treatment/irradiation has been recommended on an individual basis and performed only in a minority of patients. RESULTS A total of 132 out of 2323 (5.6%) patients with ALL relapse presented with an OEMR (combined bone marrow relapse n = 78; isolated extramedullary relapse n = 54). Compared to the non-OEMR group, patients with OEMR had a higher rate of T-immunophenotype (p < 0.001), a higher rate of LBL (p < 0.001) and a significantly different distribution of time to relapse, i.e., more very early and late relapses compared to the non-OEMR group (p = 0.01). Ten-year probabilities of event-free survival (pEFS) and overall survival (pOS) in non-OEMR vs. OEMR were 0.38 ± 0.01 and 0.32 ± 0.04 (p = 0.0204) vs. 0.45 ± 0.01 and 0.37 ± 0.04 (p = 0.0112), respectively. OEMRs have been classified into five subgroups according to the main affected compartment: lymphatic organs (n = 32, 10y-pEFS 0.50 ± 0.09), mediastinum (n = 35, 10y-pEFS 0.11 ± 0.05), bone (n = 12, 0.17 ± 0.11), skin and glands (n = 21, 0.32 ± 0.11) and other localizations (n = 32, 0.41 ± 0.09). Patients with OEMR and T-lineage ALL/LBL showed a significantly worse 10y-pEFS (0.15 ± 0.04) than those with B-Precursor-ALL (0.49 ± 0.06, p < 0.001). Stratified into standard risk (SR) and high risk (HR) groups, pEFS and pOS of OEMR subgroups were in the expected range whereas the mediastinal subgroup had a significantly worse outcome. Subsequent relapses involved more frequently the bone marrow (58.4%) than isolated extramedullary compartments (41.7%). In multivariate Cox regression, OEMR confers an independent prognostic factor for inferior pEFS and pOS. CONCLUSION OEMR is adversely related to prognosis. However, the established risk classification can be applied for all subgroups except mediastinal relapses requiring treatment intensification. Generally, isolated OEMR of T-cell-origin needs an intensified treatment including allogeneic stem cell transplantation (HSCT) as a curative approach independent from time to relapse. Local therapy such as surgery and irradiation may be of benefit in selected cases. The indication needs to be clarified in further investigations.
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11
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Liu S, Cui Q, Dai H, Song B, Cui W, Xue S, Qiu H, Miao M, Jin Z, Li C, Fu C, Wang Y, Sun A, Chen S, Zhu X, Wu D, Tang X. Early T-Cell Precursor Acute Lymphoblastic Leukemia and T/Myeloid Mixed Phenotype Acute Leukemia Possess Overlapping Characteristics and Both Benefit From CAG-Like Regimens and Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:481.e1-481.e7. [PMID: 33785365 DOI: 10.1016/j.jtct.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/18/2022]
Abstract
Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) and T-lymphoid/myeloid mixed phenotype acute leukemia (T/M-MPAL) are closely related entities and remain a therapeutic challenge. In this study, we characterized the clinical features of 43 ETP-ALL and 41 T/M-MPAL patients and compared clinical outcomes and safety between cytarabine, aclarubicin, and granulocyte colony-stimulating factor (CAG)-like regimens in 34 patients and conventional ALL regimens in 50 patients. In our series, ETP-ALL and T/M-MPAL showed similar biological characteristics, immunophenotypes, genomic alterations, and outcomes. The complete remission (CR) rate and minimal residual disease (MRD)-negative CR rate of CAG-like regimens were significantly higher compared with conventional ALL regimens (CAG-like: 80.0% and 59.7%, respectively; P = .039; ALL: 51.4% and 31.3%, respectively; P = .048). Overall, 90.0% of cases (18/20) achieved CR using combined decitabine and CAG-like regimens. Additionally, CAG-like regimens had lower rates of grade 3 or 4 infection (18.8% vs. 38.2%; P = .059) and grade 1 or 2 hepatotoxicity (37.5% vs. 60.0%; P = .043) than conventional ALL regimens. The 38 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the first CR (CR1) had better overall survival (OS) and leukemia-free survival (LFS) than the 11 patients who underwent allo-HSCT in the second CR (CR2) or in no remission (median OS not reached vs. 7.6 months, P = .0004; median LFS not reached vs. 11.6 months, P = .0008). There was a significant difference in 3-year OS (95.7% vs. 52.5%; P = .0039) and LFS (95.8% vs. 43.5%; P = .0003) after allo-HSCT between pre-transplant MRD-negative and MRD-positive patients. The median OS for patients without allo-HSCT was 32.1 months in the CAG-like group compared with 12.1 months in the non-CAG-like group (P = .019). These findings suggest that ETP-ALL and T/M-MPAL possess overlapping characteristics and CAG-like regimens improve their clinical outcomes.
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Affiliation(s)
- Sining Liu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Qingya Cui
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Haiping Dai
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Baoquan Song
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Wei Cui
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Shengli Xue
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Huiying Qiu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Miao Miao
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Zhengming Jin
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Caixia Li
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Chengcheng Fu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Ying Wang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Aining Sun
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Suning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaming Zhu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
| | - Xiaowen Tang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
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12
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Brown P, Inaba H, Annesley C, Beck J, Colace S, Dallas M, DeSantes K, Kelly K, Kitko C, Lacayo N, Larrier N, Maese L, Mahadeo K, Nanda R, Nardi V, Rodriguez V, Rossoff J, Schuettpelz L, Silverman L, Sun J, Sun W, Teachey D, Wong V, Yanik G, Johnson-Chilla A, Ogba N. Pediatric Acute Lymphoblastic Leukemia, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 18:81-112. [PMID: 31910389 DOI: 10.6004/jnccn.2020.0001] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Advancements in technology that enhance our understanding of the biology of the disease, risk-adapted therapy, and enhanced supportive care have contributed to improved survival rates. However, additional clinical management is needed to improve outcomes for patients classified as high risk at presentation (eg, T-ALL, infant ALL) and who experience relapse. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for pediatric ALL provide recommendations on the workup, diagnostic evaluation, and treatment of the disease, including guidance on supportive care, hematopoietic stem cell transplantation, and pharmacogenomics. This portion of the NCCN Guidelines focuses on the frontline and relapsed/refractory management of pediatric ALL.
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Affiliation(s)
- Patrick Brown
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Hiroto Inaba
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Colleen Annesley
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Susan Colace
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Mari Dallas
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Kara Kelly
- Roswell Park Comprehensive Cancer Center
| | | | | | | | - Luke Maese
- Huntsman Cancer Institute at the University of Utah
| | - Kris Mahadeo
- The University of Texas MD Anderson Cancer Center
| | | | | | | | - Jenna Rossoff
- Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Laura Schuettpelz
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Weili Sun
- City of Hope National Medical Center
| | - David Teachey
- Abramson Cancer Center at the University of Pennsylvania
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13
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Morales-Martinez M, Lichtenstein A, Vega MI. Function of Deptor and its roles in hematological malignancies. Aging (Albany NY) 2021; 13:1528-1564. [PMID: 33412518 PMCID: PMC7834987 DOI: 10.18632/aging.202462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
Deptor is a protein that interacts with mTOR and that belongs to the mTORC1 and mTORC2 complexes. Deptor is capable of inhibiting the kinase activity of mTOR. It is well known that the mTOR pathway is involved in various signaling pathways that are involved with various biological processes such as cell growth, apoptosis, autophagy, and the ER stress response. Therefore, Deptor, being a natural inhibitor of mTOR, has become very important in its study. Because of this, it is important to research its role regarding the development and progression of human malignancies, especially in hematologic malignancies. Due to its variation in expression in cancer, it has been suggested that Deptor can act as an oncogene or tumor suppressor depending on the cellular or tissue context. This review discusses recent advances in its transcriptional and post-transcriptional regulation of Deptor. As well as the advances regarding the activities of Deptor in hematological malignancies, its possible role as a biomarker, and its possible clinical relevance in these malignancies.
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Affiliation(s)
- Mario Morales-Martinez
- Molecular Signal Pathway in Cancer Laboratory, UIMEO, Oncology Hospital, Siglo XXI National Medical Center, IMSS, México City, México
| | - Alan Lichtenstein
- Department of Medicine, Hematology-Oncology Division, Greater Los Angeles VA Healthcare Center, UCLA Medical Center, Jonsson Comprehensive Cancer Center, Los Angeles, CA 90024, USA
| | - Mario I Vega
- Molecular Signal Pathway in Cancer Laboratory, UIMEO, Oncology Hospital, Siglo XXI National Medical Center, IMSS, México City, México.,Department of Medicine, Hematology-Oncology Division, Greater Los Angeles VA Healthcare Center, UCLA Medical Center, Jonsson Comprehensive Cancer Center, Los Angeles, CA 90024, USA
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14
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Gupta S, Aitken J, Bartels U, Bhakta N, Bucurenci M, Brierley JD, De Camargo B, Chokunonga E, Clymer J, Coza D, Fraser C, Fuentes-Alabi S, Gatta G, Gross T, Jakab Z, Kohler B, Kutluk T, Moreno F, Nakata K, Nur S, Parkin DM, Penberthy L, Pole J, Poynter JN, Pritchard-Jones K, Ramirez O, Renner L, Steliarova-Foucher E, Sullivan M, Swaminathan R, Van Eycken L, Vora T, Frazier AL. Development of paediatric non-stage prognosticator guidelines for population-based cancer registries and updates to the 2014 Toronto Paediatric Cancer Stage Guidelines. Lancet Oncol 2020; 21:e444-e451. [PMID: 32888473 DOI: 10.1016/s1470-2045(20)30320-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022]
Abstract
Population-based cancer registries (PBCRs) generate measures of cancer incidence and survival that are essential for cancer surveillance, research, and cancer control strategies. In 2014, the Toronto Paediatric Cancer Stage Guidelines were developed to standardise how PBCRs collect data on the stage at diagnosis for childhood cancer cases. These guidelines have been implemented in multiple jurisdictions worldwide to facilitate international comparative studies of incidence and outcome. Robust stratification by risk also requires data on key non-stage prognosticators (NSPs). Key experts and stakeholders used a modified Delphi approach to establish principles guiding paediatric cancer NSP data collection. With the use of these principles, recommendations were made on which NSPs should be collected for the major malignancies in children. The 2014 Toronto Stage Guidelines were also reviewed and updated where necessary. Wide adoption of the resultant Paediatric NSP Guidelines and updated Toronto Stage Guidelines will enhance the harmonisation and use of childhood cancer data provided by PBCRs.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
| | | | - Ute Bartels
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nickhill Bhakta
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - James D Brierley
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada
| | - Beatriz De Camargo
- Research Centre, National Cancer Institute National Cancer Institute, Rio de Janeiro, Brazil
| | | | - Jessica Clymer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Dana Coza
- Romanian National Child Cancer Registry, Constanta, Romania
| | - Chris Fraser
- Department of Oncology, Children's Health Queensland Hospital, South Brisbane, QLD, Australia
| | | | | | - Thomas Gross
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest, Hungary
| | - Betsy Kohler
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Tezer Kutluk
- Department of Paediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Turkey
| | | | - Kayo Nakata
- Cancer Control Centre, Osaka International Cancer Institute, Osaka, Japan
| | - Sari Nur
- Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Jawa Barat, Indonesia
| | - D M Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Lynne Penberthy
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Jason Pole
- Pediatric Group of Ontario, Toronto, ON, Canada
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | | | - Oscar Ramirez
- Centro Médico Imbanaco, Cali, Valle del Cauca, Colombia
| | - Lorna Renner
- University of Ghana School of Medicine, Accra, Ghana
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michael Sullivan
- Faculty of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | | | - Tushar Vora
- Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A L Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
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15
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Fridlyand DM, Keller FG, Sabnis HS, Patterson BC, Gadde JA, Peragallo JH, Biousse V, Wechsler DS. Very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor. Pediatr Hematol Oncol 2020; 37:438-444. [PMID: 32299275 DOI: 10.1080/08880018.2020.1751754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Involvement of the pituitary gland by leukemic infiltration is exceedingly rare. Here, we describe a very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor and review the literature for previously reported cases. Our female patient presented 13 years after completion of therapy for B-ALL with headache, amenorrhea, galactorrhea and a pituitary mass. Subsequent studies revealed recurrence of her leukemia, and the pituitary lesion resolved after induction chemotherapy. Our case highlights the importance of considering leukemic infiltrate in the differential diagnosis of pituitary mass, particularly in a patient with a history of hematologic malignancy, sparing unnecessary surgical intervention and informing endocrine evaluation. In addition, the case also highlights difficulties with characterizing this recurrence as a very late relapse or clonal evolution of the original leukemia.
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Affiliation(s)
- Diana M Fridlyand
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frank G Keller
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Himalee S Sabnis
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Briana C Patterson
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Judith A Gadde
- Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason H Peragallo
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel S Wechsler
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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16
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Samra B, Jabbour E, Ravandi F, Kantarjian H, Short NJ. Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions. J Hematol Oncol 2020; 13:70. [PMID: 32503572 PMCID: PMC7275444 DOI: 10.1186/s13045-020-00905-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
Recent years have witnessed major advances that have improved outcome of adults with acute lymphoblastic leukemia (ALL). The emergence of the concept of measurable residual disease has fine-tuned our prognostic models and guided our treatment decisions. The treatment paradigms of ALL have been revolutionized with the advent of tyrosine kinase inhibitors targeting BCR-ABL1, monoclonal antibodies targeting CD20 (rituximab), antibody-drug conjugates targeting CD22 (inotuzumab ozogamicin), bispecific antibodies (blinatumomab), and CD19 chimeric antigen receptor T cell therapy (tisagenlecleucel). These highly effective new agents are allowing for novel approaches that reduce reliance on intensive cytotoxic chemotherapy and hematopoietic stem cell transplantation in first remission. This comprehensive review will focus on the recent advances and future directions in novel therapeutic strategies in adult ALL.
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Affiliation(s)
- Bachar Samra
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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17
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Truong H, Sierzchulski AG, Schram S, Litzow M, Hogan WJ. Systemic methotrexate absorption in a patient receiving intrathecal chemotherapy for acute lymphoblastic leukemia. Leuk Lymphoma 2019; 61:993-995. [PMID: 31833433 DOI: 10.1080/10428194.2019.1702184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Huong Truong
- Inpatient Hematology/Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Susan Schram
- Inpatient Hematology, Mayo Clinic, Rochester, MN, USA
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18
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Jonart LM, Ebadi M, Basile P, Johnson K, Makori J, Gordon PM. Disrupting the leukemia niche in the central nervous system attenuates leukemia chemoresistance. Haematologica 2019; 105:2130-2140. [PMID: 31624109 PMCID: PMC7395284 DOI: 10.3324/haematol.2019.230334] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
Protection from acute lymphoblastic leukemia relapse in the central nervous system (CNS) is crucial to survival and quality of life for leukemia patients. Current CNS-directed therapies cause significant toxicities and are only partially effective. Moreover, the impact of the CNS microenvironment on leukemia biology is poorly understood. In this study we showed that leukemia cells associated with the meninges of xenotransplanted mice, or co-cultured with meningeal cells, exhibit enhanced chemoresistance due to effects on both apoptosis balance and quiescence. From a mechanistic standpoint, we found that leukemia chemoresistance is primarily mediated by direct leukemia-meningeal cell interactions and overcome by detaching the leukemia cells from the meninges. Next, we used a co-culture adhesion assay to identify drugs that disrupted leukemia-meningeal adhesion. In addition to identifying several drugs that inhibit canonical cell adhesion targets we found that Me6TREN (Tris[2-(dimethylamino)ethyl]amine), a novel hematopoietic stem cell-mobilizing compound, also disrupted leukemia-meningeal adhesion and enhanced the efficacy of cytarabine in treating CNS leukemia in xenotransplanted mice. This work demonstrates that the meninges exert a critical influence on leukemia chemoresistance, elucidates mechanisms of relapse beyond the well-described role of the blood-brain barrier, and identifies novel therapeutic approaches for overcoming chemoresistance.
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Affiliation(s)
- Leslie M Jonart
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Maryam Ebadi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Patrick Basile
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Kimberly Johnson
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Jessica Makori
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Peter M Gordon
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota .,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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19
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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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20
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Youlden DR, Gupta S, Frazier AL, Moore AS, Baade PD, Valery PC, Green AC, Aitken JF. Stage at diagnosis for children with blood cancers in Australia: Application of the Toronto Paediatric Cancer Stage Guidelines in a population-based national childhood cancer registry. Pediatr Blood Cancer 2019; 66:e27683. [PMID: 30803139 DOI: 10.1002/pbc.27683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/22/2018] [Accepted: 11/26/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Information on stage at diagnosis for childhood blood cancers is essential for surveillance but is not available on a population basis in most countries. Our aim was to apply the internationally endorsed Toronto Paediatric Cancer Stage Guidelines to children (<15 years) with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin lymphoma (HL), or non-Hodgkin lymphoma (NHL) and to assess differences in survival by stage at diagnosis. PROCEDURE Stage was defined by extent of involvement of the central nervous system (CNS) for ALL and AML and using the Ann Arbor and St Jude-Murphy systems for HL and NHL, respectively. The study cohort was drawn from the population-based Australian Childhood Cancer Registry, consisting of children diagnosed with one of these four blood cancers between 2006 and 2014 with follow-up to 2015. Five-year observed survival was estimated from the Kaplan-Meier method. RESULTS Stage was assigned to 2201 of 2351 eligible patients (94%), ranging from 85% for AML to 95% for ALL, HL, and NHL. Survival following ALL varied from 94% (95% CI = 93%-95%) for CNS1 disease to 89% (95% CI = 79%-94%) for CNS2 (P = 0.07), whereas for AML there was essentially no difference in survival between CNS- (77%) and CNS+ disease (78%; P = 0.94). Nearly all children with HL survived for five years. There was a trend (P = 0.04) toward worsening survival with higher stage for NHL. CONCLUSIONS These results provide the first population-wide picture of the distribution and outcomes for childhood blood cancers in Australia by extent of disease at diagnosis and provide a baseline for future comparisons.
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Affiliation(s)
- Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Andrew S Moore
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.,Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.,UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adèle C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester Institute and Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, United Kingdom
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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21
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Rubagumya F, Xu MJ, May L, Driscoll C, Uwizeye FR, Shyirambere C, Larrabee K, Fehr AE, Gilbert UD, Muhayimana C, Hategekimana V, Elmore S, Mpunga T, Moore M, Shulman LN, Lehmann L. Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda. J Glob Oncol 2018; 4:1-11. [PMID: 30241148 PMCID: PMC6180843 DOI: 10.1200/jgo.2017.009290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Children with acute lymphoblastic leukemia (ALL) in low-income countries have
disproportionately lower cure rates than those in high-income countries. At
Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with
ALL with the first arm of the Hunger Protocol, a graduated-intensity method
tailored for resource-limited settings. This article provides the first
published outcomes, to our knowledge, of patients with ALL treated with this
protocol. Methods This is a retrospective descriptive study of patients with ALL enrolled at
BCCOE from July 1, 2012 to June 30, 2014; data were collected through
December 31, 2015. Descriptive statistics were used to calculate patient
demographics, disease characteristics, and outcomes; event-free survival was
assessed at 2 years using the Kaplan-Meier method. Results Forty-two consecutive patients with ALL were included. At the end of the
study period, 19% (eight) were alive without evidence of relapse: three
completed treatment and five were continuing treatment. Among the remaining
patients, 71% (30) had died and 10% (four) were lost to follow-up. A total
of 83% (25) of the deaths were disease related, 3% (one) treatment-related,
and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%),
considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if
lost to follow-up is censored. Conclusion As expected, relapse was the major cause of failure with this low-intensity
regimen. However, toxicity was acceptably low, and BCCOE has decided to
advance to intensity level 2. These results reflect the necessity of a
data-driven approach and a continual improvement process to care for complex
patients in resource-constrained settings.
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Affiliation(s)
- Fidel Rubagumya
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Mary Jue Xu
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Leana May
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Caitlin Driscoll
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Frank Regis Uwizeye
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Cyprien Shyirambere
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Katherine Larrabee
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Alexandra E Fehr
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Umuhizi Denis Gilbert
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Clemence Muhayimana
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Vedaste Hategekimana
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Shekinah Elmore
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Tharcisse Mpunga
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Molly Moore
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Lawrence N Shulman
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Leslie Lehmann
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
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Tawfik B, Brown L, Fuda F, Chen W, Niu S, Sailors J, Sadeghi N. Utility and proposed algorithm of CSF flow cytometry in hematologic malignancies. Ann Hematol 2018; 97:1707-1716. [DOI: 10.1007/s00277-018-3336-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/08/2018] [Indexed: 01/26/2023]
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Prolonged Survival of Acute Lymphoblastic Leukemia with Intrathecal Treatments for Isolated Central Nervous System Relapse. Case Rep Hematol 2018; 2018:8765285. [PMID: 29651352 PMCID: PMC5830976 DOI: 10.1155/2018/8765285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 12/20/2022] Open
Abstract
Acute lymphoblastic leukemia is commonly cured when diagnosed in the pediatric population. It portends a poorer prognosis if present in adult patients. Although adults frequently achieve complete remission, relapse rates are substantial, particularly among the elderly and high-risk populations. In the absence of prophylactic intrathecal chemotherapy, more than half of patients may develop CNS involvement or relapse, which is associated with significant risk for systemic illness. This report describes a patient with acute lymphoblastic leukemia with repeated isolated CNS relapses. This case should remind clinicians that isolated CNS disease in the absence of systemic recurrence could successfully respond to intrathecal therapy and offer patients a favorable quality of life.
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24
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Jalaeikhoo H, Rajaeinejad M, Keyhani M, Zokaasadi M, Dehghani Firoozabadi MM. Effectiveness of modified hyper-CVAD chemotherapy regimen in the treatment of adult acute lymphoblastic leukemia: a retrospective experience. Cancer Med 2018; 7:594-599. [PMID: 29383863 PMCID: PMC5852350 DOI: 10.1002/cam4.1328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 11/23/2022] Open
Abstract
Several chemotherapy regimens have been developed for the treatment of acute lymphoblastic leukemia (ALL), but relapse still presents the most common obstacles to attaining long‐term survival. The hyper‐CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and prednisolone)/HD MTX and Ara‐C (high‐dose methotrexate and cytarabine) chemotherapy regimen was first started in the MD Anderson Cancer Center as an intensive regimen for adult patients with ALL. The purpose of this study was to evaluate the effectiveness of a modified hyper‐CVAD protocol. We used hyper‐CVAD as consolidation/maintenance after remission induction with daunorubicin, vincristine, and prednisolone (and cyclophosphamide for T‐cell ALL only) rather than standard hyper‐CVAD in order to reduce treatment complications. This study was conducted as a retrospective review of medical records of ALL patients at 501 army hospital, Tehran, Iran, from 2005 to 2015. Three hundred and one patients underwent modified hyper‐CVAD chemotherapy regimen. Complete remission and overall survival (OS) rates were measured as primary endpoints. Two hundred and forty‐six (81.7%) reached complete remission (CR) during the first 6 months of treatment, and 55 patients (18.3%) did not reach CR. The 5‐year OS rate was 51.8% (95% CI (confidence interval): 45.1–57.8%). Modified hyper‐CVAD regimen is an efficient intensive chemotherapy regimen for consolidation/maintenance of adults with newly diagnosed ALL and has an acceptable 5‐year overall that is comparable to standard hyper‐CVAD regimen.
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Affiliation(s)
- Hasan Jalaeikhoo
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
| | - Mohsen Rajaeinejad
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
| | - Manoutchehr Keyhani
- Hematology and Oncology Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zokaasadi
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
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Marathe BM, Mostafa HH, Vogel P, Pascua PNQ, Jones JC, Russell CJ, Webby RJ, Govorkova EA. A pharmacologically immunosuppressed mouse model for assessing influenza B virus pathogenicity and oseltamivir treatment. Antiviral Res 2017; 148:20-31. [PMID: 29100887 DOI: 10.1016/j.antiviral.2017.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 01/19/2023]
Abstract
Immunocompromised patients are highly susceptible to influenza virus infections. Although neuraminidase inhibitor (NAI) therapy has proved effective in these patients, the treatment regimens require optimization, which can be partly addressed via animal models. Here, we describe a pharmacologically immunosuppressed mouse model for studying the pathogenesis of influenza B viruses and evaluating the efficacy of antiviral treatment. We modeled clinical regimens for dexamethasone and cyclophosphamide to immunosuppress BALB/c mice that were then inoculated with B/Phuket/3073/2013 (Yamagata lineage) or B/Brisbane/60/2008 (BR/08, Victoria lineage) virus. Although both viruses caused morbidity and mortality in immunosuppressed mice, BR/08 was more virulent, consistently inducing greater morbidity and 100% lethality in mice inoculated with at least 103 TCID50/mouse. The replication of both viruses was prolonged in the lungs of immunosuppressed mice, but the extent of pulmonary inflammation in these mice was markedly less than that in immunocompetent animals. Most of the examined cytokines, including IFN-γ, IL-1β, and RANTES, were significantly decreased in the lungs of immunosuppressed mice, as compared to immunocompetent animals, until at least 10 days post-infection. Treatment with the NAI oseltamivir for 8 or 16 days increased the mean survival time and reduced virus spread in the lungs of immunosuppressed mice challenged with a lethal dose of BR/08 but did not completely provide protection or decrease the virus titers. Our data suggests that the synergy of the viral load and aberrant immune responses is a key contributor to the severity of infection, as well as the limited efficacy of oseltamivir, which in immunosuppressed mice curtails virus release without clearing infected cells.
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Affiliation(s)
- Bindumadhav M Marathe
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Heba H Mostafa
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Peter Vogel
- Veterinary Pathology Core, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Philippe Noriel Q Pascua
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jeremy C Jones
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Charles J Russell
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Richard J Webby
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Elena A Govorkova
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Wolach O, Amitai I, DeAngelo DJ. Current challenges and opportunities in treating adult patients with Philadelphia-negative acute lymphoblastic leukaemia. Br J Haematol 2017; 179:705-723. [PMID: 29076138 DOI: 10.1111/bjh.14916] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Significant advances have been made in recent years in the field of Philadelphia-negative acute lymphoblastic leukaemia (ALL). New insights into the biology and genetics of ALL as well as novel clinical observations and new drugs are changing the way we diagnose, risk-stratify and treat adult patients with ALL. New genetic subtypes and alterations refine risk stratification and uncover new actionable therapeutic targets. The incorporation of more intensive, paediatric and paediatric-inspired approaches for young adults seem to have a positive impact on survival in this population. Minimal residual disease at different time points can assist in tailoring risk-adapted interventions for patients based on individual response. Finally, novel targeted approaches with monoclonal antibodies, immunotherapies and small molecules are moving through clinical development and entering the clinic. The aim of this review is to consolidate the abundance of emerging data and to review and revisit the concepts of risk-stratification, choice of induction and post-remission strategies as well as to discuss and update the approach to specific populations with ALL, such as young adult, elderly/unfit and relapsed/refractory patients with ALL.
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Affiliation(s)
- Ofir Wolach
- Institute of Haematology, Davidoff Cancer Centre, Beilinson Hospital, Rabin Medical Centre, Petah-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Irina Amitai
- Institute of Haematology, Davidoff Cancer Centre, Beilinson Hospital, Rabin Medical Centre, Petah-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Dass J, Dayama A, Mishra PC, Mahapatra M, Seth T, Tyagi S, Pati HP, Saxena R. Higher rate of central nervous system involvement by flow cytometry than morphology in acute lymphoblastic leukemia. Int J Lab Hematol 2017. [PMID: 28649769 DOI: 10.1111/ijlh.12694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) is diagnosed traditionally by cytopathology (CP) of the cerebrospinal fluid (CSF). Role of flow cytometry (FC) to diagnose CNS involvement has not been extensively investigated. METHODS We aimed to detect CNS involvement in 42 ALL patients (33 B-ALL, nine T-ALL) at diagnosis by FC and comparing it with CP and to correlate it with known risk factors for CNS disease like Lactate dehydrogenase (LDH). A receiver operating characteristic curve was used to determine the cutoff of LDH to predict CSF involvement. For the analysis of categorical/quantitative variables, Fisher's exact test was used. For the analysis of continuous variables, Mann-Whitney test was used. A P value of <.05 was taken as significant. RESULTS CP and FC were positive in five (11.9%) and 11 patients (26.14%) respectively with FC detecting a significantly higher level of involvement (P=.001). All CP-positive cases were FC positive. A LDH value of >472 U/L had a sensitivity of 61% and specificity of 62.5% for diagnosis of CSF involvement by FC. CONCLUSIONS CSF FC detects CNS disease in ALL patients at diagnosis at a rate double than CP alone and is statistically associated with an elevated LDH level. It should be incorporated in the evaluation of CSF to detect CNS involvement.
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Affiliation(s)
- J Dass
- Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
| | - A Dayama
- Department of Hematology, Fortis Memorial Research Institute, Gurgaon, India
| | - P C Mishra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - M Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - T Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - S Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - H P Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - R Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
BACKGROUND Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes. OBJECTIVES Objectives were to compare neurocognitive abilities to age-adjusted standardized norms, examine change over time in neurocognitive abilities, and establish neurocognitive predictors of academic outcomes. METHODS Seventy-one children were followed over the course of therapy. Cognitive abilities were assessed during induction when the child was in remission (baseline) and annually for 3 years (years 1, 2, and 3). Reading and mathematics abilities were assessed at year 3. RESULTS Fine motor dexterity was significantly below age-adjusted norms at all data points but showed improvement over time. Baseline visual-motor integration was within the reference range but significantly declined by year 3, and mean scores at years 2 and 3 were significantly below age-adjusted norms. Verbal short-term memory was significantly below age-adjusted norms at all assessments. Visual-motor integration predicted reading and mathematics abilities. Verbal short-term memory predicted reading abilities, and visual short-term memory predicted mathematics abilities. CONCLUSIONS Central nervous system-directed therapy is associated with specific neurocognitive problems. Visual-spatial skills and verbal and visual short-term memory predict academic outcomes. IMPLICATIONS FOR PRACTICE Early assessment of visual-spatial perception and short-term memory can identify children at risk of academic problems. Children who are at risk of academic problems could benefit from a school-based individual educational program and/or educational intervention.
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Gossai NP, Gordon PM. The Role of the Central Nervous System Microenvironment in Pediatric Acute Lymphoblastic Leukemia. Front Pediatr 2017; 5:90. [PMID: 28491865 PMCID: PMC5405081 DOI: 10.3389/fped.2017.00090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/10/2017] [Indexed: 12/11/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer in children. While survival rates for ALL have improved, central nervous system (CNS) relapse remains a significant cause of treatment failure and treatment-related morbidity. Accordingly, there is a need to identify more efficacious and less toxic CNS-directed leukemia therapies. Extensive research has demonstrated a critical role of the bone marrow (BM) microenvironment in leukemia development, maintenance, and chemoresistance. Moreover, therapies to disrupt mechanisms of BM microenvironment-mediated leukemia survival and chemoresistance represent new, promising approaches to cancer therapy. However, in direct contrast to the extensive knowledge of the BM microenvironment, the unique attributes of the CNS microenvironment that serve to make it a leukemia reservoir are not yet elucidated. Recent work has begun to define both the mechanisms by which leukemia cells migrate into the CNS and how components of the CNS influence leukemia biology to enhance survival, chemoresistance, and ultimately relapse. In addition to providing new insight into CNS relapse and leukemia biology, this area of investigation will potentially identify targetable mechanisms of leukemia chemoresistance and self-renewal unique to the CNS environment that will enhance both the durability and quality of the cure for ALL patients.
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Affiliation(s)
- Nathan P Gossai
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Peter M Gordon
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA.,University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
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Feng SR, Chen ZX, Cen JN, Shen HJ, Wang YY, Yao L. [Critical roles of matrix metalloproteinases secreted by leukemic cells in the pathogenesis of central nervous system leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:1070-1076. [PMID: 28088972 PMCID: PMC7348488 DOI: 10.3760/cma.j.issn.0253-2727.2016.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
目的 观察白血病细胞分泌的基质金属蛋白酶(MMP)-2和MMP-9对脑微血管内皮细胞(BMVEC)紧密连接蛋白ZO-1、claudin-5、occludin表达及对血脑屏障(BBB)通透性的影响,探讨MMP-2和MMP-9在中枢神经系统白血病(CNSL)发病机制中的作用。 方法 ①实时定量PCR检测SHI-1、HL-60、U937细胞MMP-2、MMP-9基因的转录水平;明胶酶谱法检测细胞培养上清中MMP-2和MMP-9蛋白表达;体外穿膜实验观察各白血病细胞株的侵袭能力。②将原代人BMVEC接种于铺有Matrigel胶和纤维黏连蛋白包被的Transwell小室系统中,建立体外BBB模型。将蛋白酶抑制剂GM6001处理或未处理的SHI-1、HL-60、U937细胞或MMP-2/MMP-9基因沉默的SHI-1细胞接种于BBB模型的Transwell小室上层与BMVEC共培养,倒置相差显微镜观察BMVEC的形态变化,激光共聚焦显微镜观察紧密连接蛋白ZO-1、claudin-5和occludin的表达,计算白血病细胞的穿膜率。 结果 ①SHI-1细胞表达较高转录水平的MMP-2和MMP-9及酶活性,且侵袭能力强于HL-60、U937细胞(P< 0.01)。②与HL-60、SHI-1和U937细胞共培养后,融合致密的BMVEC之间出现间隙、细胞呈单个生长,紧密连接蛋白ZO-1、claudin-5和occludin的表达明显下调,各白血病细胞均不同程度地穿过体外BBB进入Transwell小室下层。其中SHI-1细胞对BMVEC的形态改变及3种紧密连接蛋白的下调最为明显,穿膜率最高。GM6001明显抑制白血病细胞分泌MMP-2和MMP-9,使BMVEC的形态有所恢复,同时上调ZO-1、claudin-5和occludin的表达,降低了BBB的通透性。③用siRNA分别沉默MMP-2和MMP-9基因后,SHI-1细胞分泌MMP-2和MMP-9被抑制,SHI-1细胞穿膜率较沉默前分别下降43.64%和57.30%(P<0.01),ZO-1、claudin-5和occludin表达上调。 结论 白血病细胞株分泌的MMP-2和MMP-9能通过降解BMVEC紧密连接蛋白ZO-1、claudin-5和occludin而破坏BBB。
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Affiliation(s)
| | - Z X Chen
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Olmos-Jiménez R, Díaz-Carrasco MS, Galera-Miñarro A, Pascual-Gazquez JF, Espuny-Miró A. Evaluation of standardized triple intrathecal therapy toxicity in oncohematological pediatric patients. Int J Clin Pharm 2016; 39:126-132. [PMID: 27933487 DOI: 10.1007/s11096-016-0408-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
Background The administration of triple intrathecal therapy with methotrexate, cytarabine and a corticosteroid for the prophylaxis and treatment of neoplastic cell infiltration in the central nervous system in hematological malignancies is a widespread practice. There is limited information available about its toxicity profile. Several factors related to intrathecal preparation can affect toxicity. Thus, it was decided to standardize intrathecal chemotherapy, trying to obtain the best toxicity profile. Objective To assess the toxicity of a standardized triple intrathecal chemotherapy in oncohematological pediatric patients and to establish risk factors of toxicity. Setting Oncohematological pediatric unit from a tertiary hospital in Spain. Methods Prospective, descriptive and observational study in which all the administrations of standardized triple intrathecal chemotherapy in pediatric patients were registered. Main outcome measure Toxicity of the intrathecal therapy was recorded and possible risk factors were assessed. Results A total of 269 administrations of triple intrathecal chemotherapy were registered in 41 patients (mean age = 6.6 ± 3.9 years). In 16.7% of the procedures, an adverse event was reported (total number of adverse events = 61). 47.5% were grade 1, 47.5% grade 2 and 4.9% grade 3. The administration of intrathecal chemotherapy inpatient and patient age ≥3 years were risk factors of toxicity in the multivariate analysis. Conclusions The administration of standardized triple intrathecal chemotherapy is related to a low frequency of toxicity and most of the adverse events registered were mild/moderate. The detection of adverse effects was significantly greater in children with age greater than or equal to three years and in hospitalized patients.
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Affiliation(s)
- Raquel Olmos-Jiménez
- Pharmacology Department, Faculty of Medicine, University of Murcia, Campus de Espinardo, 30.071, Murcia, Spain.
| | - María Sacramento Díaz-Carrasco
- Pharmacy Service, Virgen de la Arrixaca Clinical University Hospital, Madrid-Cartagena Road, El Palmar, 30.120, Murcia, Spain
| | - Ana Galera-Miñarro
- Pediatric Oncohematology Department, Pediatric Service, Virgen de la Arrixaca Clinical University Hospital, Madrid-Cartagena Road, El Palmar, 30.120, Murcia, Spain
| | - Juan Francisco Pascual-Gazquez
- Pediatric Oncohematology Department, Pediatric Service, Virgen de la Arrixaca Clinical University Hospital, Madrid-Cartagena Road, El Palmar, 30.120, Murcia, Spain
| | - Alberto Espuny-Miró
- Pharmacology Department, Faculty of Medicine, University of Murcia, Campus de Espinardo, 30.071, Murcia, Spain
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Frishman-Levy L, Izraeli S. Advances in understanding the pathogenesis of CNS acute lymphoblastic leukaemia and potential for therapy. Br J Haematol 2016; 176:157-167. [DOI: 10.1111/bjh.14411] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/15/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Liron Frishman-Levy
- Childhood Leukaemia Research Section; Department of Paediatric Oncology and the Cancer Research Centre; Safra Children Hospital and Sheba Medical Centre; Tel Hashomer Ramat Gan Israel
- Department of Human Genetics and Biochemistry; Tel Aviv University; Tel Aviv Israel
| | - Shai Izraeli
- Childhood Leukaemia Research Section; Department of Paediatric Oncology and the Cancer Research Centre; Safra Children Hospital and Sheba Medical Centre; Tel Hashomer Ramat Gan Israel
- Department of Human Genetics and Biochemistry; Tel Aviv University; Tel Aviv Israel
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Moore IM(K, Merkle CJ, Byrne H, Ross A, Hawkins AM, Ameli SS, Montgomery DW. Effects of Intraventricular Methotrexate on Neuronal Injury and Gene Expression in a Rat Model. Biol Res Nurs 2016; 18:505-14. [DOI: 10.1177/1099800416644780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Central nervous system (CNS)-directed treatment for acute lymphoblastic leukemia, used to prevent disease recurrence in the brain, is essential for survival. Systemic and intrathecal methotrexate, commonly used for CNS-directed treatment, have been associated with cognitive problems during and after treatment. The cortex, hippocampus, and caudate putamen, important brain regions for learning and memory, may be involved in methotrexate-induced brain injury. Objectives of this study were to (1) quantify neuronal degeneration in selected regions of the cortex, hippocampus, and caudate putamen and (2) measure changes in the expression of genes with known roles in oxidant defense, apoptosis/inflammation, and protection from injury. Male Sprague Dawley rats were administered 2 or 4 mg/kg of methotrexate diluted in artificial cerebrospinal fluid (aCSF) or aCSF only into the left cerebral lateral ventricle. Gene expression changes were measured using customized reverse transcription (RT)2 polymerase chain reaction arrays. The greatest percentage of degenerating neurons in methotrexate-treated animals was in the medial region of the cortex; percentage of degenerating neurons in the dentate gyrus and cornu ammonis 3 regions of the hippocampus was also greater in rats treated with methotrexate compared to perfusion and vehicle controls. There was a greater percentage of degenerating neurons in the inferior cortex of control versus methotrexate-treated animals. Eight genes involved in protection from injury, oxidant defense, and apoptosis/inflammation were significantly downregulated in different brain regions of methotrexate-treated rats. To our knowledge, this is the first study to investigate methotrexate-induced injury in selected brain regions and gene expression changes using a rat model of intraventricular drug administration.
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Affiliation(s)
| | | | | | - Adam Ross
- College of Nursing, The University of Arizona, Tucson AZ, USA
| | | | - Sara S. Ameli
- College of Nursing, The University of Arizona, Tucson AZ, USA
| | - David W. Montgomery
- College of Nursing, The University of Arizona, Tucson AZ, USA
- Southern Arizona VA Healthcare System, Tucson AZ, USA
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Xu L, Weng J, Huang X, Zeng C, Chen S, Geng S, Yang L, Wu S, Huang S, Du X, Li Y. Persistent donor derived Vδ4 T cell clones may improve survival for recurrent T cell acute lymphoblastic leukemia after HSCT and DLI. Oncotarget 2016; 7:42943-42952. [PMID: 27356746 PMCID: PMC5189998 DOI: 10.18632/oncotarget.10260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/13/2016] [Indexed: 02/05/2023] Open
Abstract
The outcome for T-cell acute lymphoblastic leukemia (T-ALL) in relapse after hematopoietic stem cell transplantation (HSCT) is quite poor, while, both donor lymphocytes infusion (DLI) and adoptively infusion of γδ T cells in leukemia patients after HSCT have demonstrated good results in prolonging survival time of patients. Here, we reported a T-ALL case who experienced three relapses and received HSCT and DLI with an overall survival (OS) time lasting for more than seven years. Based on our previous identification of a leukemic and reactive clone in this patient, continual γδ T cell repertoire monitoring affirmed that the same Vδ5 leukemic clone existed in most samples from the patient, particularly including a sample taken at the time of the third T-ALL relapse, while it could not be detected in the donor sample. In addition, an identical Vδ4 monoclonal T cell that proliferated in the recipient for several years was confirmed to come from the donor graft, and its expression level significantly increased in third leukemia recurrence. These results indicate that clonally expanded Vδ4 T cells may represent a reconstituted γδ T cell repertoire after HSCT, which also hints to a relatively better outcome for this case. Based on this case study, we recommend DLI should be as a treatment strategy for patients who achieve CR or relapse from HSCT. Moreover, dynamically monitoring the TCR repertoire in patients who receive HSCT will benefit in supervising of malignant clone evolution and residue, identifying T cell clones mediate anti-infection, GvHD or GvL.
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MESH Headings
- Blood Donors
- Clone Cells/immunology
- Clone Cells/metabolism
- Gene Expression/immunology
- Graft vs Host Disease/etiology
- Graft vs Host Disease/immunology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Immunotherapy, Adoptive/methods
- Lymphocyte Transfusion/methods
- Neoplasm Recurrence, Local
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- Survival Analysis
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- T-Lymphocytes/transplantation
- Treatment Outcome
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Affiliation(s)
- Ling Xu
- Institute of Hematology, Jinan University, Guangzhou, China
| | - Jianyu Weng
- Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Huang
- Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chengwu Zeng
- Institute of Hematology, Jinan University, Guangzhou, China
| | - Shaohua Chen
- Institute of Hematology, Jinan University, Guangzhou, China
| | - Suxia Geng
- Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lijian Yang
- Institute of Hematology, Jinan University, Guangzhou, China
| | - Suijing Wu
- Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Suming Huang
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, Florida, USA
| | - Xin Du
- Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yangqiu Li
- Institute of Hematology, Jinan University, Guangzhou, China
- Key Laboratory for Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
- Department of Hematology, First Affiliated Hospital, Jinan University, Guangzhou, China
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Gopalakrishnapillai A, Kolb EA, Dhanan P, Bojja AS, Mason RW, Corao D, Barwe SP. Generation of Pediatric Leukemia Xenograft Models in NSG-B2m Mice: Comparison with NOD/SCID Mice. Front Oncol 2016; 6:162. [PMID: 27446808 PMCID: PMC4921874 DOI: 10.3389/fonc.2016.00162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/15/2016] [Indexed: 01/22/2023] Open
Abstract
Generation of orthotopic xenograft mouse models of leukemia is important to understand the mechanisms of leukemogenesis, cancer progression, its cross talk with the bone marrow microenvironment, and for preclinical evaluation of drugs. In these models, following intravenous injection, leukemic cells home to the bone marrow and proliferate there before infiltrating other organs, such as spleen, liver, and the central nervous system. Moreover, such models have been shown to accurately recapitulate the human disease and correlate with patient response to therapy and prognosis. Thus, various immune-deficient mice strains have been used with or without recipient preconditioning to increase engraftment efficiency. Mice homozygous for the severe combined immune deficiency (SCID) mutation and with non-obese diabetic background (NOD/SCID) have been used in the majority of leukemia xenograft studies. Later, NOD/SCID mice deficient for interleukin 2 receptor gamma chain (IL2Rγ) gene called NSG mice became the model of choice for leukemia xenografts. However, engraftment of leukemia cells without irradiation preconditioning still remained a challenge. In this study, we used NSG mice with null alleles for major histocompatibility complex class I beta2-microglobulin (β2m) called NSG-B2m. This is a first report describing the 100% engraftment efficiency of pediatric leukemia cell lines and primary samples in NSG-B2m mice in the absence of host preconditioning by sublethal irradiation. We also show direct comparison of the engraftment efficiency and growth rate of pediatric acute leukemia cells in NSG-B2m and NOD/SCID mice, which showed 80–90% engraftment efficiency. Secondary and tertiary xenografts in NSG-B2m mice generated by injection of cells isolated from the spleens of leukemia-bearing mice also behaved similar to the primary patient sample. We have successfully engrafted 25 acute lymphoblastic leukemia (ALL) and 5 acute myeloid leukemia (AML) patient samples with distinct cytogenetic characteristics in NSG-B2m mice, with the purpose of generating pediatric ALL and AML xenografts for preclinical evaluation of drugs. Thus, our data support the use of NSG-B2m mouse model for leukemia engraftment and in vivo preclinical drug efficacy studies.
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Affiliation(s)
| | - E Anders Kolb
- Nemours Center for Childhood Cancer Research, A.I. DuPont Hospital for Children , Wilmington, DE , USA
| | - Priyanka Dhanan
- Nemours Center for Childhood Cancer Research, A.I. DuPont Hospital for Children , Wilmington, DE , USA
| | - Aruna Sri Bojja
- Nemours Center for Childhood Cancer Research, A.I. DuPont Hospital for Children , Wilmington, DE , USA
| | - Robert W Mason
- Nemours Center for Childhood Cancer Research, A.I. DuPont Hospital for Children , Wilmington, DE , USA
| | - Diana Corao
- Nemours Center for Childhood Cancer Research, A.I. DuPont Hospital for Children , Wilmington, DE , USA
| | - Sonali P Barwe
- Nemours Center for Childhood Cancer Research, A.I. DuPont Hospital for Children , Wilmington, DE , USA
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A rare case of leptomeningeal carcinomatosis in a patient with uveal melanoma: case report and review of literature. Melanoma Res 2016; 26:481-6. [PMID: 27285292 DOI: 10.1097/cmr.0000000000000274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Uveal melanoma is a rare subtype of melanoma, accounting for only 3-5% of all melanoma cases in the USA. Although fewer than 4% of uveal melanoma patients present with metastasis at diagnosis, approximately half will develop metastasis, more than 90% of which disseminate to the liver. Infrequently, a number of malignancies can lead to leptomeningeal metastases, a devastating and terminal complication. In this case report, we present an exceedingly rare case of a patient with uveal melanoma who developed leptomeningeal carcinomatosis as the sole site of metastasis. After conventional methods to diagnose leptomeningeal carcinomatosis fell short, a diagnosis was confirmed on the basis of identification and genomic analysis of melanoma circulating tumor cells in the cerebrospinal fluid.
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Piovezani Ramos G, Villasboas Bisneto JC, Chen D, Pardanani A. Initial presentation of CNS-restricted acute lymphoblastic B cell leukaemia as peripheral polyneuropathy. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-214645. [PMID: 27095809 DOI: 10.1136/bcr-2016-214645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 58-year-old woman who presented with a 1-month course of progressive lower and upper extremity weakness in addition to binocular diplopia. Diagnostic lumbar puncture revealed atypical lymphoid cells with 28% blasts. Immunophenotype was consistent with B cell acute lymphoblastic leukaemia (B-ALL). Further work up showed no systemic involvement but extensive thoracolumbar-sacral leptomeningeal disease. The patient was treated with several courses of intrathecal and systemic chemotherapy followed by craniospinal irradiation for consolidation. There was initial steady improvement in neurological symptoms and leptomeningeal disease, the latter being ascertained through radiological studies and cerebrospinal fluid examination. After 10 months of response, the patient relapsed with central nervous system (CNS) and systemic disease. B-ALL is a rare precursor lymphoid neoplasm that generally presents with systemic disease. While CNS involvement is not uncommon, isolated involvement of this compartment without systemic disease is exceedingly rare.
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Affiliation(s)
| | | | - Dong Chen
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Safety of liposomal cytarabine CNS prophylaxis in children, adolescent and young adult hematopoietic stem cell transplant recipients with acute leukemia and non-Hodgkin lymphoma. Bone Marrow Transplant 2016; 51:1249-52. [DOI: 10.1038/bmt.2016.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gupta S, Aitken JF, Bartels U, Brierley J, Dolendo M, Friedrich P, Fuentes-Alabi S, Garrido CP, Gatta G, Gospodarowicz M, Gross T, Howard SC, Molyneux E, Moreno F, Pole JD, Pritchard-Jones K, Ramirez O, Ries LAG, Rodriguez-Galindo C, Shin HY, Steliarova-Foucher E, Sung L, Supriyadi E, Swaminathan R, Torode J, Vora T, Kutluk T, Frazier AL. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines. Lancet Oncol 2016; 17:e163-e172. [PMID: 27300676 DOI: 10.1016/s1470-2045(15)00539-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/03/2015] [Accepted: 11/16/2015] [Indexed: 11/16/2022]
Abstract
Population-based cancer registries generate estimates of incidence and survival that are essential for cancer surveillance, research, and control strategies. Although data on cancer stage allow meaningful assessments of changes in cancer incidence and outcomes, stage is not recorded by most population-based cancer registries. The main method of staging adult cancers is the TNM classification. The criteria for staging paediatric cancers, however, vary by diagnosis, have evolved over time, and sometimes vary by cooperative trial group. Consistency in the collection of staging data has therefore been challenging for population-based cancer registries. We assembled key experts and stakeholders (oncologists, cancer registrars, epidemiologists) and used a modified Delphi approach to establish principles for paediatric cancer stage collection. In this Review, we make recommendations on which staging systems should be adopted by population-based cancer registries for the major childhood cancers, including adaptations for low-income countries. Wide adoption of these guidelines in registries will ease international comparative incidence and outcome studies.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Joanne F Aitken
- Cancer Council Queensland, Fortitude Valley, Brisbane, QLD, Australia
| | - Ute Bartels
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Brierley
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Mae Dolendo
- Southern Philippines Medical Center, Bajada, Davao City, Philippines
| | - Paola Friedrich
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | | | | | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCSS Instituto Nazionale dei Tumori, Milan, Italy
| | - Mary Gospodarowicz
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Thomas Gross
- Center for Global Health, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Florencia Moreno
- Argentinian Oncopediatric Registry (ROHA), National Cancer Institute, Buenos Aires, Argentina
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | | | - Oscar Ramirez
- Registro Poblacional de Cancer de Cali, Universidad del Valle, Oficina, Cali, Valle, Colombia
| | - Lynn A G Ries
- SEER Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Hee Young Shin
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Lillian Sung
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eddy Supriyadi
- Pediatric Hematology Oncology Division, Department of Pediatrics, Dr Sardjito Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Julie Torode
- Union for International Cancer Control, Geneva, Switzerland
| | - Tushar Vora
- Tata Memorial Hospital, Parel, Mumbai, India
| | - Tezer Kutluk
- Union for International Cancer Control, Geneva, Switzerland
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
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Cohler C, Jumanne S, Kaijage J, DuBois SG, Scanlan P, Matthay KK. Evaluation and Outcome of Central Nervous System Involvement in Pediatric Acute Lymphoblastic Leukemia in Dar es Salaam, Tanzania. Pediatr Blood Cancer 2016; 63:458-64. [PMID: 26529141 DOI: 10.1002/pbc.25829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/04/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Outcomes for acute lymphoblastic leukemia (ALL) in low-income countries lag far behind high-income countries (HIC). We explored the impact of central nervous system (CNS) involvement on outcome of pediatric patients with ALL in Tanzania. PROCEDURE Comprehensive chart review was performed to characterize CNS involvement, treatment, and outcomes of pediatric patients with ALL at Muhimbili National Hospital in Dar es Salaam, Tanzania between January 1, 2011 and December 31, 2013. RESULTS One hundred fifty-six patients with confirmed ALL had accessible data, and 128 initiated therapy. Sixteen percent of 156 patients had a documented cerebral spinal fluid analysis by cytospin. Seventy patients (45%) had a documented lumbar puncture with intrathecal (IT) therapy within 1 week of diagnosis. Thirteen patients presented with CNS involvement at diagnosis based on cytospin and/or unequivocal symptoms. Twenty-one patients (16%) experienced CNS relapse, three of whom had CNS disease at diagnosis. Median event-free survival (EFS) for all patients was 7.9 months and estimated EFS at 24 months was 31%. For the patients with CNS involvement at diagnosis, the estimated EFS at 24 months was 45%. Only three of 21 patients with CNS relapse were still alive with a median follow up of 3 months. CONCLUSIONS The rate of CNS disease in patients with ALL in Dar es Salaam at diagnosis and relapse was higher than that reported in HIC, and overall survival was lower. Improving outcomes will require further advances including consistent CNS prophylaxis and may include targeting high-risk patients with additional IT treatments.
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Affiliation(s)
- Cheryl Cohler
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | - Shakilu Jumanne
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Jane Kaijage
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Steven G DuBois
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California
| | - Patricia Scanlan
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Katherine K Matthay
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California
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Imaging of Nervous System Involvement in Hematologic Malignancies: What Radiologists Need to Know. AJR Am J Roentgenol 2015; 205:604-17. [DOI: 10.2214/ajr.14.14092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Heidari N, Saki N, De Filippis L, Shahjahani M, Teimouri A, Ahmadzadeh A. Central nervous system niche involvement in the leukemia. Clin Transl Oncol 2015; 18:240-50. [DOI: 10.1007/s12094-015-1370-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 12/25/2022]
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Sung SH, Jang IS. Isolated central nervous system relapse of acute lymphoblastic leukemia. Brain Tumor Res Treat 2014; 2:114-8. [PMID: 25408936 PMCID: PMC4231617 DOI: 10.14791/btrt.2014.2.2.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/04/2014] [Accepted: 08/18/2014] [Indexed: 11/20/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common form of childhood cancer and may exhibit central nervous system (CNS) involvement. Advances in chemotherapy and effective CNS prophylaxis have significantly decreased the incidence of CNS relapse of ALL to 5-10%. Here, we report the case of a patient with isolated CNS relapse of standard risk group pre-B-cell type ALL in an 11-year-old girl, relapsed 3 years after successful completion of chemotherapy. An 11-year-old girl visited our hospital complaining of headache, dizziness, vomiting, and visual field defects. Neurological examination revealed left-side homonymous hemianopsia. Brain magnetic resonance imaging showed a large irregular dural-based sulcal hematoma in the right parietal and occipital lobes. Surgery to remove the hematoma revealed the existence of hematopoietic malignancy after pathologic evaluation. Bone marrow biopsy was subsequently performed but showed no evidence of malignancy.
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Affiliation(s)
- Sang-Hyun Sung
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea
| | - In-Seok Jang
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea
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Winter E, Dal Pizzol C, Locatelli C, Silva AH, Conte A, Chiaradia-Delatorre LD, Nunes RJ, Yunes RA, Creckzynski-Pasa TB. In vitro and in vivo effects of free and chalcones-loaded nanoemulsions: insights and challenges in targeted cancer chemotherapies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10016-35. [PMID: 25264679 PMCID: PMC4210964 DOI: 10.3390/ijerph111010016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 12/19/2022]
Abstract
Several obstacles are encountered in conventional chemotherapy, such as drug toxicity and poor stability. Nanotechnology is envisioned as a strategy to overcome these effects and to improve anticancer therapy. Nanoemulsions comprise submicron emulsions composed of biocompatible lipids, and present a large surface area revealing interesting physical properties. Chalcones are flavonoid precursors, and have been studied as cytotoxic drugs for leukemia cells that induce cell death by different apoptosis pathways. In this study, we encapsulated chalcones in a nanoemulsion and compared their effect with the respective free compounds in leukemia and in non-tumoral cell lines, as well as in an in vivo model. Free and loaded-nanoemulsion chalcones induced a similar anti-leukemic effect. Free chalcones induced higher toxicity in VERO cells than chalcones-loaded nanoemulsions. Similar results were observed in vivo. Free chalcones induced a reduction in weight gain and liver injuries, evidenced by oxidative stress, as well as an inflammatory response. Considering the high toxicity and the side effects induced generally by all cancer chemotherapies, nanotechnology provides some options for improving patients’ life quality and/or increasing survival rates.
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Affiliation(s)
- Evelyn Winter
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, P.O. Box 476, Florianópolis, SC 88040-900, Brazil; E-Mails: (E.W.) (C.D.P.); (A.H.S.)
| | - Carine Dal Pizzol
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, P.O. Box 476, Florianópolis, SC 88040-900, Brazil; E-Mails: (E.W.) (C.D.P.); (A.H.S.)
| | - Claudriana Locatelli
- Department of Pharmacy, University of West of Santa Catarina, Videira, SC 89560-000, Brazil; E-Mails: (C.L.); (A.C.)
| | - Adny H. Silva
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, P.O. Box 476, Florianópolis, SC 88040-900, Brazil; E-Mails: (E.W.) (C.D.P.); (A.H.S.)
| | - Aline Conte
- Department of Pharmacy, University of West of Santa Catarina, Videira, SC 89560-000, Brazil; E-Mails: (C.L.); (A.C.)
| | - Louise D. Chiaradia-Delatorre
- Department of Chemistry, Federal University of Santa Catarina, P.O. Box 476, Florianópolis, SC 88040-900, Brazil; E-Mails: (L.D.C.-D.); (R.J.N.); (R.A.Y.)
| | - Ricardo J. Nunes
- Department of Chemistry, Federal University of Santa Catarina, P.O. Box 476, Florianópolis, SC 88040-900, Brazil; E-Mails: (L.D.C.-D.); (R.J.N.); (R.A.Y.)
| | - Rosendo A. Yunes
- Department of Chemistry, Federal University of Santa Catarina, P.O. Box 476, Florianópolis, SC 88040-900, Brazil; E-Mails: (L.D.C.-D.); (R.J.N.); (R.A.Y.)
| | - Tânia B. Creckzynski-Pasa
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, P.O. Box 476, Florianópolis, SC 88040-900, Brazil; E-Mails: (E.W.) (C.D.P.); (A.H.S.)
- Author to whom correspondence should be addressed; E-Mails: or ; Tel.: +55-48-3221-2212; Fax: +55-48-3721-9542
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Ma YR, Ma YH. MIP-1α enhances Jurkat cell transendothelial migration by up-regulating endothelial adhesion molecules VCAM-1 and ICAM-1. Leuk Res 2014; 38:1327-31. [PMID: 25245399 DOI: 10.1016/j.leukres.2014.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/30/2014] [Accepted: 08/30/2014] [Indexed: 11/19/2022]
Abstract
The aim of this study is to evaluate the expression of macrophage inflammatory protein-1α (MIP-1α) in Jurkat cells and its effect on transendothelial migration. In the present study, human acute lymphoblastic leukemia Jurkat cells (Jurkat cells) were used as a model of T cells in human T-cell acute lymphoblastic leukemia (T-ALL), which demonstrated significantly higher MIP-1α expression compared with that in normal T-cell controls. The ability of Jurkat cells to cross a human brain microvascular endothelial cell (HBMEC) monolayer was almost completely abrogated by MIP-1α siRNA. In addition, the overexpression of MIP-1α resulted in the up-regulated expression of endothelial adhesion molecules, which enhanced the migration of Jurkat cells through a monolayer of HBMEC. MIP-1α levels in Jurkat cells appeared to be an important factor for its transendothelial migration, which may provide the theoretical basis to understand the mechanisms of brain metastases of T-ALL at cellular and molecular levels.
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Affiliation(s)
- Yi-Ran Ma
- Department of Transfusion, The First Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Ying-Huan Ma
- Department of Cancer, The 436rd Hospital of Chinese People's Liberation Army, Shenyang, Liaoning, China
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Johnson RM, Papp E, Grandal I, Kowalski PE, Nutter L, Wong RCC, Joseph-George AM, Danska JS, Guidos CJ. MuLV-related endogenous retroviral elements and Flt3 participate in aberrant end-joining events that promote B-cell leukemogenesis. Genes Dev 2014; 28:1179-90. [PMID: 24888589 PMCID: PMC4052764 DOI: 10.1101/gad.240820.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
During V(D)J recombination of immunoglobulin genes, p53 and nonhomologous end-joining (NHEJ) suppress aberrant rejoining of DNA double-strand breaks induced by recombinase-activating genes (Rags)-1/2. However, Rag deficiency does not prevent B-cell leukemogenesis in p53/NHEJ mutant mice. Johnson et al. identified a novel class of activating mutations in Flt3 in Rag/p53/NHEJ triple-mutant B-cell leukemias. These mutant Flt3 alleles were created by complex genomic rearrangements with Moloney leukemia virus (MuLV)-related endogenous retroviral (ERV) elements. Mutant Flt3 induced ligand-independent STAT5 phosphorylation and promoted development of clinically aggressive B-cell leukemia. During V(D)J recombination of immunoglobulin genes, p53 and nonhomologous end-joining (NHEJ) suppress aberrant rejoining of DNA double-strand breaks induced by recombinase-activating genes (Rags)-1/2, thus maintaining genomic stability and limiting malignant transformation during B-cell development. However, Rag deficiency does not prevent B-cell leukemogenesis in p53/NHEJ mutant mice, revealing that p53 and NHEJ also suppress Rag-independent mechanisms of B-cell leukemogenesis. Using several cytogenomic approaches, we identified a novel class of activating mutations in Fms-like tyrosine kinase 3 (Flt3), a receptor tyrosine kinase important for normal hematopoiesis in Rag/p53/NHEJ triple-mutant (TM) B-cell leukemias. These mutant Flt3 alleles were created by complex genomic rearrangements with Moloney leukemia virus (MuLV)-related endogenous retroviral (ERV) elements, generating ERV-Flt3 fusion genes encoding an N-terminally truncated mutant form of Flt3 (trFlt3) that was transcribed from ERV long terminal repeats. trFlt3 protein lacked most of the Flt3 extracellular domain and induced ligand-independent STAT5 phosphorylation and proliferation of hematopoietic progenitor cells. Furthermore, expression of trFlt3 in p53/NHEJ mutant hematopoietic progenitor cells promoted development of clinically aggressive B-cell leukemia. Thus, repetitive MuLV-related ERV sequences can participate in aberrant end-joining events that promote development of aggressive B-cell leukemia.
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Affiliation(s)
- Radia M Johnson
- Program in Developmental and Stem Cell Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada; Department of Immunology
| | - Eniko Papp
- Program in Developmental and Stem Cell Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Ildiko Grandal
- Program in Developmental and Stem Cell Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Paul E Kowalski
- Program in Developmental and Stem Cell Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Lauryl Nutter
- Program in Developmental and Stem Cell Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Raymond C C Wong
- The Centre for Applied Genomics, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Ann M Joseph-George
- The Centre for Applied Genomics, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada; Program in Genetics and Genome Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Jayne S Danska
- Department of Immunology, Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Program in Genetics and Genome Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada
| | - Cynthia J Guidos
- Program in Developmental and Stem Cell Biology, Hospital for Sick Children Research Institute, Toronto, Ontario M5G 0A4, Canada; Department of Immunology
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Fozza C, Dore F, Isoni MA, Longu F, Dessì L, Coppola L, Contini S, Longinotti M. Strabismus and diplopia in a patient with acute myeloid leukemia. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:288-90. [PMID: 25006360 PMCID: PMC4085118 DOI: 10.12659/ajcr.890526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/24/2014] [Indexed: 11/12/2022]
Abstract
Patient: Male, 64 Final Diagnosis: Acute myeloid leukemia (AML) Symptoms: — Medication: — Clinical Procedure: — Specialty: —
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Affiliation(s)
- Claudio Fozza
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Fausto Dore
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Francesco Longu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Laura Dessì
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Lorenzo Coppola
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Contini
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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48
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Basu SK, Remick SC, Monga M, Gibson LF. Breaking and entering into the CNS: clues from solid tumor and nonmalignant models with relevance to hematopoietic malignancies. Clin Exp Metastasis 2013; 31:257-67. [PMID: 24306183 DOI: 10.1007/s10585-013-9623-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/01/2013] [Indexed: 12/16/2022]
Abstract
Various malignancies invade the CNS sanctuary site, accounting for the vast majority of CNS neoplastic foci and contributing to significant morbidity as well as mortality. The blood-brain barrier (BBB) exhibits considerable impermeability to chemotherapeutic agents, severely limiting therapeutic options available for patients developing metastatic CNS involvement, accounting for poor outcomes. The mechanisms by which malignant cells breach the highly exclusive BBB and subsequently survive in this unique anatomical site remain poorly understood, with most of the current knowledge stemming from nonmalignant and solid malignancy models. While solid and hematologic malignancies may face different challenges once within the CNS (e.g., solid tumor parenchymal metastasis compared to masses/nodules/leptomeningeal disease in hematologic malignancies), commonality exists in the process of migrating across the BBB from the circulation. Specifically considering this last point, this review aims to survey the current mechanistic knowledge regarding malignant migration across the BBB, necessarily emphasizing the better studied solid tumor and nonmalignant models with the intention of highlighting both the current knowledge gap and additional work required to effectively consider how hematopoietic malignancies breach the CNS.
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Affiliation(s)
- Soumit K Basu
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV, USA,
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Li Q, Wu H, Chen B, Hu G, Huang L, Qin K, Chen Y, Yuan X, Liao Z. SNPs in the TGF-β signaling pathway are associated with increased risk of brain metastasis in patients with non-small-cell lung cancer. PLoS One 2012; 7:e51713. [PMID: 23284751 PMCID: PMC3524120 DOI: 10.1371/journal.pone.0051713] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/05/2012] [Indexed: 02/04/2023] Open
Abstract
Purpose Brain metastasis (BM) from non-small cell lung cancer (NSCLC) is relatively common, but identifying which patients will develop brain metastasis has been problematic. We hypothesized that genotype variants in the TGF-β signaling pathway could be a predictive biomarker of brain metastasis. Patients and Methods We genotyped 33 SNPs from 13 genes in the TGF-β signaling pathway and evaluated their associations with brain metastasis risk by using DNA from blood samples from 161 patients with NSCLC. Kaplan-Meier analysis was used to assess brain metastasis risk; Cox hazard analyses were used to evaluate the effects of various patient and disease characteristics on the risk of brain metastasis. Results The median age of the 116 men and 45 women in the study was 58 years; 62 (39%) had stage IIIB or IV disease. Within 24 months after initial diagnosis of lung cancer, brain metastasis was found in 60 patients (37%). Of these 60 patients, 16 had presented with BM at diagnosis. Multivariate analysis showed the GG genotype of SMAD6: rs12913975 and TT genotype of INHBC: rs4760259 to be associated with a significantly higher risk of brain metastasis at 24 months follow-up (hazard ratio [HR] 2.540, 95% confidence interval [CI] 1.204–5.359, P = 0.014; and HR 1.885, 95% CI 1.086–3.273, P = 0.024), compared with the GA or CT/CC genotypes, respectively. When we analyzed combined subgroups, these rates showed higher for those having both the GG genotype of SMAD6: rs12913975 and the TT genotype of INHBC: rs4760259 (HR 2.353, 95% CI 1.390–3.985, P = 0.001). Conclusions We found the GG genotype of SMAD6: rs12913975 and TT genotype of INHBC: rs4760259 to be associated with risk of brain metastasis in patients with NSCLC. This finding, if confirmed, can help to identify patients at high risk of brain metastasis.
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Affiliation(s)
- Qianxia Li
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huanlei Wu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Bei Chen
- Department of Electrocardiographic Room, Hubei Provincial Tumor Hospital, Wuhan, Hubei Province, China
| | - Guangyuan Hu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Liu Huang
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Kai Qin
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yu Chen
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- * E-mail:
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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Yang A, Ma J, Wu M, Qin W, Zhao B, Shi Y, Jin Y, Xie Y. Aberrant microRNA-182 expression is associated with glucocorticoid resistance in lymphoblastic malignancies. Leuk Lymphoma 2012; 53:2465-73. [DOI: 10.3109/10428194.2012.693178] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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