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Yang Y, Wang L, Peng Y, Nie X, Yan R, Peng X. Analysis of the occurrence and liver function characteristics of arsenic-associated liver injury during the treatment of pediatric patients with acute promyelocytic leukemia. Ann Hematol 2024:10.1007/s00277-024-05954-y. [PMID: 39167181 DOI: 10.1007/s00277-024-05954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/15/2024] [Indexed: 08/23/2024]
Abstract
Liver injury during arsenic treatment for acute promyelocytic leukemia was previously reported in adults, but not comprehensively in children until now. This study aims to investigate liver injury in pediatric patients with APL, changes in liver function during treatment, and compare the effects of Arsenic trioxide (ATO) and Realgar-Indigo naturalis formula (RIF) on liver function. One hundred and eighty-six patients with 3076 patient tests were analyzed, who were enrolled in the Chinese Children's Leukemia Group (CCLG)-APL2016 Protocol database between November 2016 and November 2018 in 38 hospitals across China(ChiCTR-OIN-17011227). Twenty of 164 patients (12.2%) suffered from liver injury after treatment with arsenic. In addition, sixteen (80%) cases of liver injury occurred during the induction period of treatment. What's not disheartening was that 18 (90%) cases of liver injury were transient, occurring at a median time of 17 days after exposure to arsenic. More importantly, the risk of liver injury associated with RIF was not higher than that associated with ATO (RR = 0.854, 95% CI: 0.292-2.495). Otherwise, the ALP of 18 cases of liver injury was not higher than the ULN of ALP. Thus, the incidence of liver injury associated with arsenic in pediatric patients with APL was similar to that in adult patients and the risk of liver injury associated with RIF was not higher than that associated with ATO. Since ALP was not higher in pediatric APL patients with liver injury, further research is needed to explore whether ALP is an index of liver injury in children.
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Affiliation(s)
- Yuxuan Yang
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Linya Wang
- Hematology Center, National Key Discipline of Pediatric Hematology, National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yaguang Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Xiaolu Nie
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Ruohua Yan
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China.
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2
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Jebanesan DZP, Illangeswaran RSS, Rajamani BM, Vidhyadharan RT, Das S, Bijukumar NK, Balakrishnan B, Mathews V, Velayudhan SR, Balasubramanian P. Inhibition of NRF2 signaling overcomes acquired resistance to arsenic trioxide in FLT3-mutated Acute Myeloid Leukemia. Ann Hematol 2024; 103:1919-1929. [PMID: 38630133 DOI: 10.1007/s00277-024-05742-8] [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: 11/04/2023] [Accepted: 04/01/2024] [Indexed: 05/14/2024]
Abstract
De novo acute myeloid leukemia (AML) patients with FMS-like tyrosine kinase 3 internal tandem duplications (FLT3-ITD) have worse treatment outcomes. Arsenic trioxide (ATO) used in the treatment of acute promyelocytic leukemia (APL) has been reported to be effective in degrading the FLT3 protein in AML cell lines and sensitizing non-APL AML patient samples in-vitro. We have previously reported that primary cells from FLT3-ITD mutated AML patients were sensitive to ATO in-vitro compared to other non-M3 AML and molecular/pharmacological inhibition of NF-E2 related factor 2 (NRF2), a master regulator of antioxidant response improved the chemosensitivity to ATO and daunorubicin even in non FLT3-ITD mutated cell lines and primary samples. We examined the effects of molecular/pharmacological suppression of NRF2 on acquired ATO resistance in the FLT3-ITD mutant AML cell line (MV4-11-ATO-R). ATO-R cells showed increased NRF2 expression, nuclear localization, and upregulation of bonafide NRF2 targets. Molecular inhibition of NRF2 in this resistant cell line improved ATO sensitivity in vitro. Digoxin treatment lowered p-AKT expression, abrogating nuclear NRF2 localization and sensitizing cells to ATO. However, digoxin and ATO did not sensitize non-ITD AML cell line THP1 with high NRF2 expression. Digoxin decreased leukemic burden and prolonged survival in MV4-11 ATO-R xenograft mice. We establish that altering NRF2 expression may reverse acquired ATO resistance in FLT3-ITD AML.
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Affiliation(s)
- Daniel Zechariah Paul Jebanesan
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India
- Manipal Academy of Higher Education, Manipal, India
| | | | - Bharathi M Rajamani
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India
| | | | - Saswati Das
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India
| | - Nayanthara K Bijukumar
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India
| | - Balaji Balakrishnan
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India
- Department of Integrative Biology, School of BioSciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Vikram Mathews
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India
| | - Shaji R Velayudhan
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India
- Adjunct Scientist, Centre for Stem Cell Research, A Unit of InStem Bengaluru, CMC Campus, Vellore, India
| | - Poonkuzhali Balasubramanian
- Department of Hematology, Christian Medical College Vellore-Ranipet Campus, Tamil Nadu, Vellore, 632517, India.
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Yan M, Wang H, Wei R, Li W. Arsenic trioxide: applications, mechanisms of action, toxicity and rescue strategies to date. Arch Pharm Res 2024; 47:249-271. [PMID: 38147202 DOI: 10.1007/s12272-023-01481-y] [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: 03/11/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
Arsenical medicine has obtained its status in traditional Chinese medicine for more than 2,000 years. In the 1970s, arsenic trioxide was identified to have high efficacy and potency for the treatment of acute promyelocytic leukemia, which promoted many studies on the therapeutic effects of arsenic trioxide. Currently, arsenic trioxide is widely used to treat acute promyelocytic leukemia and various solid tumors through various mechanisms of action in clinical practice; however, it is accompanied by a series of adverse reactions, especially cardiac toxicity. This review presents a comprehensive overview of arsenic trioxide from preclinical and clinical efficacy, potential mechanisms of action, toxicities, and rescue strategies for toxicities to provide guidance or assistance for the clinical application of arsenic trioxide.
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Affiliation(s)
- Meng Yan
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China.
| | - Hao Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Rui Wei
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
- Pharmacy Department, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenwen Li
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
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Yu S, Ge Z, Chen W, Han J. Pyrrolidine Dithiocarbamate Enhances the Cytotoxic Effect of Arsenic Trioxide on Acute Promyelocytic Leukemia Cells. Comb Chem High Throughput Screen 2023; 26:2067-2076. [PMID: 36694317 DOI: 10.2174/1386207326666230123155944] [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: 07/02/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND More than 95% patients with acute promyelocytic leukemia (APL) carry the PML-RARα fusion oncoprotein. Arsenic trioxide (ATO) is an efficacious therapeutic agent for APL, and the mechanism involves the binding with PML and degradation of PML-RARα protein. Pyrrolidine dithiocarbamate (PDTC) demonstrates the function of facilitating the cytotoxic effect of ATO. PURPOSE To investigate whether PDTC is potential to enhance the cytotoxic effect of ATO to APL cells by acting on PML-RARα oncoproteins. METHODS Inhibitory effects of drugs on cell viability were examined by CCK-8 test, and apoptosis was evaluated by flow cytometry. Western blotting and immunofluorescence assays were used to explore the mechanism. RESULTS PDTC improved the effect of ATO on inhibiting proliferation of NB4 cells in vitro. Further, PDTC-ATO promoted apoptosis and cell cycle arrest in NB4 cells. The expression of caspase- 3 and Bcl-2 was reduced in PDTC-ATO-treated NB4 cells, while cleaved caspase-3 and Bax was up-regulated. Furthermore, less PML-RARα expression were found in PDTC-ATO-treated NB4 cells than that in NB4 cells treated with ATO singly. Laser confocal microscopy showed that protein colocalization of PML and RARα was disrupted more significantly by PDTC-ATO treatment than that with ATO monotherapy. CONCLUSION In conclusion, PDTC enhanced the cytotoxic effect of ATO on APL, and the mechanism was, at least in part, related to the promotion of ATO-induced degradation of PML-RARα fusion protein via forming a complex PDTC-ATO.
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Affiliation(s)
- Simin Yu
- Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhuowang Ge
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weixiang Chen
- General Department of Chongming Branch, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinbin Han
- Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Abele M, Müller SL, Schleicher S, Hartmann U, Döring M, Queudeville M, Lang P, Handgretinger R, Ebinger M. Arsenic trioxide in pediatric cancer - a case series and review of literature. Pediatr Hematol Oncol 2021; 38:471-485. [PMID: 33635158 DOI: 10.1080/08880018.2021.1872748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Arsenic trioxide (ATO) has become an established component of treatment protocols for acute promyelocytic leukemia (APL) with excellent efficacy and no relevant sustained toxicity. Part of its action has been attributed to the inhibition of Hedgehog signaling (Hh) which enables a possible therapeutic approach as many pediatric tumor entities have been associated with increased Hh activity. We retrospectively analyzed 31 patients with refractory and relapsed pediatric cancer who were treated with ATO at the University Children's Hospital of Tuebingen. Additionally a literature review on the clinical and preclinical use of ATO in pediatric cancer treatment was performed.ATO alone as well as combinations with other drugs have proven effective in vitro and in mouse models of various pediatric malignancies. However, only few data on the clinical use of ATO in pediatric patients besides APL exist. In our patient sample, ATO was overall well tolerated in the treatment of various pediatric cancers, even in combination with other cytostatic drugs. Due to distinct tumor entities, differently progressed disease stages and varying co-medication, no clear statement can be made regarding the efficacy of ATO treatment. However, patients with proven Hh activation in molecular tumor profiling surpassed all other patients, who received ATO in an experimental treatment setting, in terms of survival. As molecular profiling of tumors increases and enhanced Hh activity can be detected at an early stage, ATO might expand its clinical use to other pediatric malignancies beyond APL depending on further clinical studies.
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Affiliation(s)
- Michael Abele
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Sara-Lena Müller
- Clinic for Anaesthesiology, Critical Care, Emergency Medicine and Pain Management, Klinikum Ludwigsburg, Germany
| | - Sabine Schleicher
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Michaela Döring
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Manon Queudeville
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Ebinger
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
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Chen X, Fan S, Zhao Y, Zhou J. Gene mutations in acute promyelocytic leukemia early death in patients treated with arsenic trioxide alone. Clin Transl Oncol 2021; 23:2171-2180. [PMID: 33942222 DOI: 10.1007/s12094-021-02625-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE APL patients have recurrent alterations in FLT3, WT1, NRAS and KRAS. Gene mutations have a strong potential for involvement in pathogenesis and may have potential effects on the clinical manifestations. Gene mutations may even be associated with early death (ED) in APL patients. However, there is little published information on mutations in APL patients and whether they are attributed to early death. METHODS In this study, we retrospectively analyzed the clinical data and gene mutations of 134 de novo APL patients. We detected the gene mutations by next-generation sequencing (NGS) to investigate the genetic predictors of early death in APL patients. According to the number of gene mutations per patient, the 134 APL patients were divided into three groups. All patients received arsenic trioxide (ATO) alone as induction therapy. The clinical data and gene mutations were compared and analyzed. RESULTS A total of 134 APL patients were involved in the study. The clinical data of sex, WBC, PT, and DD, UA, and LDH level were significantly different between the three groups (P = 0.000, P = 0.000, P = 0.009, P = 0.020, P = 0.030, P = 0.001 and P = 0.014, respectively). Meanwhile, among them, the Sanz risk stratification and early death rate were significantly different (P = 0.001). The early death rate was 10.4%, and the median time to early death was 6.6 days (range 2-15 days). For the next-generation sequencing, a mean of 1.28 ± 1.06 mutations per patient was detected (range: 0-5). The univariate and the multivariate regression analysis showed that age > 50[HR = 1.666, CI (1.027-2.702), P = 0.039], high WBC count [HR = 4.702, CI (1.026-21.543), P = 0.046] and low ALB levels [HR = 4.547, CI (1.088-18.995), P = 0.038] were independent risk factors for early death in APL patients. Furthermore, Kaplan-Meier survival analysis, univariate analysis, and the multivariate regression analysis showed that patients with multiple gene mutations [HR = 2.258, CI (1.115-4.571), P = 0.024], KRAS [HR = 5.136, CI (1.356-19.455), P = 0.016] and/or GATA2 [HR = 4.070, CI (1.287-12.877), P = 0.017] have a significantly higher early death rate. CONCLUSION The results of this investigation show that both molecular markers and clinical variables should be used as potential predictors for early death in APL patients. Our results suggested that age > 50, high WBC count, low ALB levels, and the presence of multiple gene mutations, KRAS and/or GATA2 at the time of diagnosis were independent risk factors for early death in APL patients. For these patients, clinicians should be more cautious during the course of induction treatment.
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Affiliation(s)
- Xiaotong Chen
- The first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengjin Fan
- The first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanqiu Zhao
- The first Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin Zhou
- The first Affiliated Hospital of Harbin Medical University, Harbin, China.
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miR-139-5p Regulates the Proliferation of Acute Promyelocytic Leukemia Cells by Targeting MNT. JOURNAL OF ONCOLOGY 2021; 2021:5522051. [PMID: 33953744 PMCID: PMC8064781 DOI: 10.1155/2021/5522051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
Acute promyelocytic leukemia (APL) patients with progressive leukocytosis are more likely to have various complications and poor outcomes. However, the regulatory roles of microRNAs in the leukocytosis of APL have not been clarified. Our study aims to evaluate the effects of miRNAs on leukocytosis during induction therapy of APL patients and explore its potential mechanisms. During induction treatment, patients with white blood cell count higher than 10 × 109/L were divided into leukocytosis group and others were nonleukocytosis group. Using microarray assays, we found that miR-139-5p was significantly downregulated in the leukocytosis group. Elevated expression of miR-139-5p inhibited the proliferation of NB4 cells by arresting the cell cycle and inducing apoptosis. We further identified that MNT was a target of miR-139-5p. miR-139-5p significantly inhibited the proliferation, invasion, and migration function of NB4 cells through targeting MNT. Strategies for regulating miR-139-5p or MNT expression might provide new therapeutic approaches for progressive leukocytosis in APL.
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Hamidou M, Néel A, Poupon J, Amoura Z, Ebbo M, Sibilia J, Viallard JF, Gaborit B, Volteau C, Hardouin JB, Hachulla E, Rieger F. Safety and efficacy of low-dose intravenous arsenic trioxide in systemic lupus erythematosus: an open-label phase IIa trial (Lupsenic). Arthritis Res Ther 2021; 23:70. [PMID: 33658052 PMCID: PMC7927234 DOI: 10.1186/s13075-021-02454-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Lupus animal model has shown that arsenic trioxide (ATO), a treatment of acute promyelocytic leukaemia, could be effective in SLE. This is the first clinical study to determine the safety and efficacy of a short course of intravenous ATO in patients with active SLE. METHODS This phase IIa, open-label, dose-escalating study enrolled 11 adult SLE patients with a non-organ threatening disease, clinically active despite conventional therapy. Patients received 10 IV infusions of ATO within 24 days. The first group received 0.10 mg/kg per injection, with dose-escalating to 0.15 mg/kg in a second group, and to 0.20 mg/kg in a third group. The primary endpoint was the occurrence of adverse events (AEs) and secondary endpoints were the number of SLE Responder Index 4 (SRI-4) responders at week 24 and reduction of corticosteroid dosage. In an exploratory analysis, we collected long-term data for safety and attainment of lupus low disease activity state (LLDAS). RESULTS Four serious AEs occurred (grade 3 neutropenia, osteitis, neuropathy), 2 of which were attributable to ATO (neutropenia in the 2 patients treated with mycophenolate). Two patients suffered a severe flare during the last 4 weeks of the trial. At W24, five patients among 10 were SRI-4 responders. Overall, mean corticosteroid dosage decreased from 11.25 mg/day at baseline to 6 mg/day at W24 (P < 0.01). In the long term, 6 patients attained LLDAS at W52, which continued at last follow-up (median LLDAS duration 3 years, range 2-4). CONCLUSIONS A short course of ATO has an acceptable safety profile in SLE patients and encouraging efficacy. TRIAL REGISTRATION ClinicalTrials.gov, NCT01738360 registered 30 November 2012.
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Affiliation(s)
- Mohamed Hamidou
- Department of Internal Medicine, CHU Nantes, Nantes Université, Nantes, France.
| | - Antoine Néel
- Department of Internal Medicine, CHU Nantes, Nantes Université, Nantes, France
| | - Joel Poupon
- Department of Biological Toxicology, AP-HP, Lariboisière Hospital, University Paris VII, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine 2, Centre National de Référence pour le Lupus, Institut E3M, Hôpital Pitié-Salpétrière, Paris, France
| | - Mikael Ebbo
- Service de Médecine Interne, Aix Marseille Univ, APHM, CNRS, INSERM, CIML, Hôpital de la Timone, Marseille, France
| | - Jean Sibilia
- Department of Rheumatology, University of Strasbourg, Strasbourg, France
| | | | - Benjamin Gaborit
- Department of Internal Medicine, CHU Nantes, Nantes Université, Nantes, France
| | - Christelle Volteau
- Plateforme de Méthodologie et Biostatistiques, CHU Nantes, Université de Nantes, Nantes, France
| | | | - Eric Hachulla
- Department of Internal Medicine, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), University of Lille, Lille, France
| | - François Rieger
- MEDSENIC, SAS, a company with CNRS participation, Strasbourg, France
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Li SY, Lu Y, Liu HC, Gang EJ, Le J, Qian SY, Tang SH, Si T, Pei RZ. Arsenic trioxide and all-trans retinoic acid in the treatment of children with newly diagnosed acute promyelocytic leukemia. Leuk Lymphoma 2021; 62:1267-1270. [PMID: 33439058 DOI: 10.1080/10428194.2020.1856832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shuang-Yue Li
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Ying Lu
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | | | - Eun Ji Gang
- Department of Pediatrics, Division of Hematology and Oncology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jing Le
- Department of Hematology, Ningbo Medical Centre Lihuili Hospital, Ningbo, China
| | - Su-Ying Qian
- Department of Hematology, Hwa Mei hospital, University of Chinese Academy of Science (Ningbo No. 2 Hospital), Ningbo, China
| | - Shan-Hao Tang
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Ting Si
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Ren-Zhi Pei
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
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Gurnari C, Voso MT, Girardi K, Mastronuzzi A, Strocchio L. Acute Promyelocytic Leukemia in Children: A Model of Precision Medicine and Chemotherapy-Free Therapy. Int J Mol Sci 2021; 22:ijms22020642. [PMID: 33440683 PMCID: PMC7826974 DOI: 10.3390/ijms22020642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
Acute promyelocytic leukemia (APL) represents a paradigm of precision medicine. Indeed, in the last decades, the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) completely revolutionized the therapeutic approach to this previously highly fatal disorder. This entirely chemotherapy-free treatment, which provided excellent survival rates, has been initially validated in adults and, recently, translated in the pediatric setting. This review summarizes currently available data on the use of ATRA and ATO combination in pediatric APL, providing a particular focus on peculiar issues and challenges, such as the occurrence of pseudotumor cerebri and death during induction (early death), as well as the advantage offered by the ATO/ATRA combination in sparing long-term sequelae.
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Affiliation(s)
- Carmelo Gurnari
- Department of Pediatric Hemato-Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.G.); (K.G.); (A.M.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
- Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
- Laboratorio di Neuro-Oncoematologia, Fondazione Santa Lucia, 00179 Rome, Italy
| | - Katia Girardi
- Department of Pediatric Hemato-Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.G.); (K.G.); (A.M.)
| | - Angela Mastronuzzi
- Department of Pediatric Hemato-Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.G.); (K.G.); (A.M.)
| | - Luisa Strocchio
- Department of Pediatric Hemato-Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.G.); (K.G.); (A.M.)
- Correspondence:
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The Potential of Lonidamine in Combination with Chemotherapy and Physical Therapy in Cancer Treatment. Cancers (Basel) 2020; 12:cancers12113332. [PMID: 33187214 PMCID: PMC7696079 DOI: 10.3390/cancers12113332] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The unique characteristics of tumor energy metabolism (highly dependent on aerobic glycolysis, namely, the Warburg effect) make it an interesting and attractive target for drug discovery. Radio- and chemoresistance are closely associated with the Warburg effect. Lonidamine (LND), as a glycolytic inhibitor, although having low anticancer activity when used alone, exhibits selectivity to various tumors, and its adverse effects do not overlap when combined with other chemotherapeutic drugs. Therefore, LND may be very promising as a sensitizer of tumors to chemotherapeutic agents and physical therapies. This review summarizes the advance of LND in combination with chemotherapy and physical therapy over the past several decades, as well as the promising LND derivative adjudin (ADD). The underlying sensitizing mechanisms were also analyzed and discussed, which may contribute to an improved therapeutic effect in future clinical cancer treatment. Abstract Lonidamine (LND) has the ability to resist spermatogenesis and was first used as an anti-spermatogenic agent. Later, it was found that LND has a degree of anticancer activity. Currently, LND is known to target energy metabolism, mainly involving the inhibition of monocarboxylate transporter (MCT), mitochondrial pyruvate carrier (MPC), respiratory chain complex I/II, mitochondrial permeability transition (PT) pore, and hexokinase II (HK-II). However, phase II clinical studies showed that LND alone had a weak therapeutic effect, and the effect was short and reversible. Interestingly, LND does not have the common side effects of traditional chemotherapeutic drugs, such as alopecia and myelosuppression. In addition, LND has selective activity toward various tumors, and its toxic and side effects do not overlap when combined with other chemotherapeutic drugs. Therefore, LND is commonly used as a chemosensitizer to enhance the antitumor effects of chemotherapeutic drugs based on its disruption of energy metabolism relating to chemo- or radioresistance. In this review, we summarized the combination treatments of LND with several typical chemotherapeutic drugs and several common physical therapies, such as radiotherapy (RT), hyperthermia (HT), and photodynamic therapy (PDT), and discussed the underlying mechanisms of action. Meanwhile, the development of novel formulations of LND in recent years and the research progress of LND derivative adjudin (ADD) as an anticancer drug were also discussed.
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12
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Gasparovic L, Weiler S, Higi L, Burden AM. Incidence of Differentiation Syndrome Associated with Treatment Regimens in Acute Myeloid Leukemia: A Systematic Review of the Literature. J Clin Med 2020; 9:E3342. [PMID: 33081000 PMCID: PMC7603213 DOI: 10.3390/jcm9103342] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022] Open
Abstract
Differentiation syndrome (DS) is a potentially fatal adverse drug reaction caused by the so-called differentiating agents such as all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), used for remission induction in the treatment of the M3 subtype of acute myeloid leukemia (AML), acute promyelocytic leukemia (APL). However, recent DS reports in trials of isocitrate dehydrogenase (IDH)-inhibitor drugs in patients with IDH-mutated AML have raised concerns. Given the limited knowledge of the incidence of DS with differentiating agents, we conducted a systematic literature review of clinical trials with reports of DS to provide a comprehensive overview of the medications associated with DS. In particular, we focused on the incidence of DS reported among the IDH-inhibitors, compared to existing ATRA and ATO therapies. We identified 44 published articles, encompassing 39 clinical trials, including 6949 patients. Overall, the cumulative incidence of DS across all treatment regimens was 17.7%. Incidence of DS was notably lower in trials with IDH-inhibitors (10.4%) compared to other regimens, including ATRA and/or ATO (15.4-20.6%). Compared to other therapies, the median time to onset was four times longer with IDH-inhibitors (48 vs. 11 days). Treating oncologists should be mindful of this potentially fatal adverse drug reaction, as we expect the current trials represent an underestimation of the actual incidence.
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Affiliation(s)
- Lucia Gasparovic
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland; (L.G.); (S.W.); (L.H.)
| | - Stefan Weiler
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland; (L.G.); (S.W.); (L.H.)
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, 8032 Zurich, Switzerland
| | - Lukas Higi
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland; (L.G.); (S.W.); (L.H.)
| | - Andrea M. Burden
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland; (L.G.); (S.W.); (L.H.)
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13
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Zhang L, Zhu XF. [How I treat children with acute promyelocytic leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:793-797. [PMID: 33190434 PMCID: PMC7656076 DOI: 10.3760/cma.j.issn.0253-2727.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- L Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - X F Zhu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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14
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Cosio T, Di Prete M, Campione E. Arsenic Trioxide, Itraconazole, All-Trans Retinoic Acid and Nicotinamide: A Proof of Concept for Combined Treatments with Hedgehog Inhibitors in Advanced Basal Cell Carcinoma. Biomedicines 2020; 8:E156. [PMID: 32545245 PMCID: PMC7344956 DOI: 10.3390/biomedicines8060156] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
The treatment of advanced basal cell carcinoma has seen a progressive evolution in recent years following the introduction of Hedgehog pathway inhibitors. However, given the burden of mutations in the tumor microenvironment and lack of knowledge for the follow-up of advanced basal cell carcinoma, we are proposing a possible synergistic therapeutic application. Our aim is to underline the use of arsenic trioxide, itraconazole, all-trans-retinoic acid and nicotinamide as possible adjuvant therapies either in advanced not responding basal cell carcinoma or during follow-up based on Hedgehog pathway. We have analyzed the rational use of these drugs as a pivotal point to block neoplasm progression, modulate epigenetic modification and prevent recurrences.
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Affiliation(s)
- Terenzio Cosio
- Department of Dermatology, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy;
| | - Monia Di Prete
- Anatomic Pathology Unit, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy;
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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15
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Sobh A, Loguinov A, Yazici GN, Zeidan RS, Tagmount A, Hejazi NS, Hubbard AE, Zhang L, Vulpe CD. Functional Profiling Identifies Determinants of Arsenic Trioxide Cellular Toxicity. Toxicol Sci 2020; 169:108-121. [PMID: 30815697 DOI: 10.1093/toxsci/kfz024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Arsenic exposure is a worldwide health concern associated with an increased risk of skin, lung, and bladder cancer but arsenic trioxide (AsIII) is also an effective chemotherapeutic agent. The current use of AsIII in chemotherapy is limited to acute promyelocytic leukemia (APL). However, AsIII was suggested as a potential therapy for other cancer types including chronic myeloid leukemia (CML), especially when combined with other drugs. Here, we carried out a genome-wide CRISPR-based approach to identify modulators of AsIII toxicity in K562, a human CML cell line. We found that disruption of KEAP1, the inhibitory partner of the key antioxidant transcription factor Nrf2, or TXNDC17, a thioredoxin-like protein, markedly increased AsIII tolerance. Loss of the water channel AQP3, the zinc transporter ZNT1 and its regulator MTF1 also enhanced tolerance to AsIII whereas loss of the multidrug resistance protein ABCC1 increased sensitivity to AsIII. Remarkably, disruption of any of multiple genes, EEFSEC, SECISBP2, SEPHS2, SEPSECS, and PSTK, encoding proteins involved in selenocysteine metabolism increased resistance to AsIII. Our data suggest a model in which an intracellular interaction between selenium and AsIII may impact intracellular AsIII levels and toxicity. Together this work revealed a suite of cellular components/processes which modulate the toxicity of AsIII in CML cells. Targeting such processes simultaneously with AsIII treatment could potentiate AsIII in CML therapy.
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Affiliation(s)
- Amin Sobh
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida.,Department of Nutritional Sciences & Toxicology, Comparative Biochemistry Program, University of California, Berkeley, Berkeley, California
| | - Alex Loguinov
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Gulce Naz Yazici
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida.,Department of Histology and Embryology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Rola S Zeidan
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Abderrahmane Tagmount
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Nima S Hejazi
- Division of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California.,Center for Computational Biology, University of California, Berkeley, Berkeley, California
| | - Alan E Hubbard
- Division of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Luoping Zhang
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Chris D Vulpe
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida.,Department of Nutritional Sciences & Toxicology, Comparative Biochemistry Program, University of California, Berkeley, Berkeley, California
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16
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Prieto-Conde MI, Jiménez C, García-Álvarez M, Ramos F, Medina A, Cuello R, Balanzategui A, Alonso JM, Sarasquete ME, Queizán JA, Alcoceba M, Bárez A, Puig N, Cantalapiedra A, Gutiérrez NC, García-Sanz R, González-Díaz M, Chillón MC. Identification of relapse-associated gene mutations by next-generation sequencing in low-risk acute myeloid leukaemia patients. Br J Haematol 2020; 189:718-730. [PMID: 32124426 DOI: 10.1111/bjh.16420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022]
Abstract
Recommended genetic categorization of acute myeloid leukaemias (AML) includes a favourable-risk category, but not all these patients have good prognosis. Here, we used next-generation sequencing to evaluate the mutational profile of 166 low-risk AML patients: 30 core-binding factor (CBF)-AMLs, 33 nucleophosmin (NPM1)-AMLs, 4 biCEBPα-AMLs and 101 acute promyelocytic leukaemias (APLs). Functional categories of mutated genes differed among subgroups. NPM1-AMLs showed frequent variations in DNA-methylation genes (DNMT3A, TET2, IDH1/2) (79%), although without prognostic impact. Within this group, splicing-gene mutations were an independent factor for relapse-free (RFS) and overall survival (OS). In CBF-AML, poor independent factors for RFS and OS were mutations in RAS pathway and cohesin genes, respectively. In APL, the mutational profile differed according to the risk groups. High-risk APLs showed a high mutation rate in cell-signalling genes (P = 0·002), highlighting an increased incidence of FLT3 internal tandem duplication (ITD) (65%, P < 0·0001). Remarkably, in low-risk APLs (n = 28), NRAS mutations were strongly correlated with a shorter five-year RFS (25% vs. 100%, P < 0·0001). Overall, a high number of mutations (≥3) was the worst prognostic factor RFS (HR = 2·6, P = 0·003). These results suggest that gene mutations may identify conventional low-risk AML patients with poor prognosis and might be useful for better risk stratification and treatment decisions.
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Affiliation(s)
- María Isabel Prieto-Conde
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Cristina Jiménez
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - María García-Álvarez
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Fernando Ramos
- Department of Hematology, Hospital Virgen Blanca de León, León, Spain
| | - Alejandro Medina
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Rebeca Cuello
- Department of Hematology, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Ana Balanzategui
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - José M Alonso
- Department of Hematology, Hospital Río Carrión de Palencia, Palencia, Spain
| | - Maria Eugenia Sarasquete
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | | | - Miguel Alcoceba
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Abelardo Bárez
- Department of Hematology, Hospital Nuestra Señora de Sonsoles de Ávila, Avila, Spain
| | - Noemí Puig
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | | | - Norma C Gutiérrez
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Ramón García-Sanz
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - Marcos González-Díaz
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
| | - María Carmen Chillón
- Department of Hematology, IBSAL, CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), University Hospital of Salamanca, Salamanca, Spain
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17
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Gong XZ. Chinese Medicine Might Be A Promising Way for A Solution to Arsenic Nephrotoxicity. Chin J Integr Med 2020; 26:83-87. [PMID: 31997235 DOI: 10.1007/s11655-019-3210-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2019] [Indexed: 11/25/2022]
Abstract
Arsenic from environmental contamination is a risk factor for kidney disease, and the clinical use of arsenic also triggers a new concern that the potential kidney damage caused by exposure to clinical doses of arsenic trivalent. So far, the undergoing mechanisms contributing to arsenic nephrotoxicity mostly remain unclear, and universally accepted methods for preventing this complication are limited too. Ancient Chinese medical scientists recognized the toxicity of arsenic long ago, and there were some records of Chinese herbs against arsenic poisoning in ancient books of Chinese medicine. In the past decade, several herbal formulations, as well as some potentially active compounds extracted from Chinese herbs, have been employed to prevent arsenic nephrotoxicity both in vivo and in vitro and showed better therapeutic effects. The present paper thus summarizes and discusses these Chinese medicine methods in preventing such a public health problem. In addition, we call for large, well-designed, randomized, and controlled clinical trials to be performed to further assess the efficacy and safety of these potential methods of Chinese medicine against arsenic nephrotoxicity.
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Affiliation(s)
- Xue-Zhong Gong
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China.
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18
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Czogała M, Pawińska-Wa Sikowska K, Ksia Żek T, Sikorska-Fic B, Matysiak M, Rodziewicz-Konarska A, Chybicka A, Skalska-Sadowska J, Wachowiak J, Muszyńska-Rosłan K, Krawczuk-Rybak M, Grabowski D, Kowalczyk J, Zielezińska K, Urasiński T, Tomaszewska R, Szczepański T, Karpińska-Derda I, Woszczyk M, Pohorecka J, Karolczyk G, Młynarski W, Mycko K, Badowska W, Skoczeń S, Balwierz W. Treatment Outcome and the Genetic Characteristics of Acute Promyelocytic Leukemia in Children in Poland From 2005 to 2018. Front Pediatr 2020; 8:86. [PMID: 32266181 PMCID: PMC7100382 DOI: 10.3389/fped.2020.00086] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of the study was to analyze the treatment outcome and genetic characteristics of acute promyelocytic leukemia (APL) in children in Poland from 2005 to 2018. Methods: All 41 patients diagnosed with APL in Poland during the analysis period were eligible for the study. In period I (2005-2015), 33 patients were treated with chemotherapy and all-trans retinoic acid (ATRA), and in period II (2015-2018), 3 patients (high risk) received induction chemotherapy with ATRA and arsenic trioxide (ATO), and 5 patients (standard risk) received ATRA and ATO without chemotherapy. Results: Probability of 5-years overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS) was 0.819 ± 0.069, 0.831 ± 0.063, and 0.961 ± 0.037, respectively, in the whole cohort. Four (11%) early deaths were observed. One patient died of severe infection in the course of disease progression. Relapse occurred in one patient, who died finally because of disease progression. All events occurred in the patients from period I. Variant APL was identified in one patient (successfully treated with chemotherapy with ATRA) and complex translocation in one patient (the only patient with relapse). Additional chromosomal aberrations were found in 26% of patients and FLT3-ITD mutation was detected in 44% of patients; none of those changes influenced clinical outcome. Conclusion: Treatment outcome in the analyzed group is similar to the results reported by other study groups. The main cause of death was coagulation disorders in the early stage of disease. Early, accurate diagnosis followed by specific treatment enables the reduction in the number of early deaths.
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Affiliation(s)
- Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
| | - Katarzyna Pawińska-Wa Sikowska
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
| | - Teofila Ksia Żek
- Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland.,Department of Medical Genetics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Sikorska-Fic
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Matysiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Rodziewicz-Konarska
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, Wroclaw, Poland
| | - Alicja Chybicka
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Medical University of Wroclaw, Wroclaw, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Dominik Grabowski
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Karolina Zielezińska
- Department of Pediatrics, Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hematology and Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Renata Tomaszewska
- Department of Pediatrics Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Szczepański
- Department of Pediatrics Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | | | - Mariola Woszczyk
- Department of Pediatrics, Hematology and Oncology, City Hospital, Chorzów, Poland
| | - Joanna Pohorecka
- Paediatric Department of Hematology and Oncology, Regional Polyclinic Hospital in Kielce, Kielce, Poland
| | - Grażyna Karolczyk
- Paediatric Department of Hematology and Oncology, Regional Polyclinic Hospital in Kielce, Kielce, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Mycko
- Department of Pediatrics and Hematology and Oncology, Province Children's Hospital, Olsztyn, Poland
| | - Wanda Badowska
- Department of Pediatrics and Hematology and Oncology, Province Children's Hospital, Olsztyn, Poland
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.,Department of Pediatric Oncology and Hematology, University Children Hospital, Krakow, Poland
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19
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Garcia Spezza E, Brethon B, Petit A, Mazingue F, Gandemer V, Boissel N, Carausu L, Reguerre Y, Leverger G, Ducassou S. Tolerance to arsenic trioxide combined with all-trans-retinoic acid in children with acute promyelocytic leukaemia in France. Br J Haematol 2019; 188:170-173. [PMID: 31808943 DOI: 10.1111/bjh.16364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emmanuel Garcia Spezza
- Department of Pediatric Hematology and Oncology, Félix Guyon Hospital, Réunion Island, France
| | - Benoit Brethon
- Department of Pediatric Hematology, Robert Debre Hospital, APHP, Paris, France
| | - Arnaud Petit
- Department of Pediatric Hematology Oncology, Inserm, Centre de Recherche Saint Antoine, CRSA, AP-HP, Hôpital Trousseau, Sorbone Université, Paris, France
| | | | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France
| | - Nicolas Boissel
- Adolescent and Young Adult Hematology Unit, APHP, Saint-Louis Hospital, Paris, France
| | - Liana Carausu
- Department of Pediatric Hematology and Oncology, CHRU, Brest, France
| | - Yves Reguerre
- Department of Pediatric Hematology and Oncology, Félix Guyon Hospital, Réunion Island, France
| | - Guy Leverger
- Department of Pediatric Hematology Oncology, Inserm, Centre de Recherche Saint Antoine, CRSA, AP-HP, Hôpital Trousseau, Sorbone Université, Paris, France
| | - Stephane Ducassou
- Unité Inserm U1218, University of Bordeaux, Bordeaux, France.,Department of Pediatric Hematology and Oncology, Children's Hospital, CHU Bordeaux, Bordeaux, France
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20
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Testi AM, Pession A, Diverio D, Grimwade D, Gibson B, de Azevedo AC, Moran L, Leverger G, Elitzur S, Hasle H, van der Werff ten Bosch J, Smith O, De Rosa M, Piciocchi A, Lo Coco F, Foà R, Locatelli F, Kaspers GJL. Risk-adapted treatment of acute promyelocytic leukemia: results from the International Consortium for Childhood APL. Blood 2018; 132:405-412. [PMID: 29789356 DOI: 10.1182/blood-2018-03-836528] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/15/2018] [Indexed: 11/20/2022] Open
Abstract
Pediatric acute promyelocytic leukemia (APL) can be cured with all-trans retinoic acid (ATRA) and anthracycline. However, most published trials have employed high cumulative doses of anthracyclines. Here, we report the outcome of newly diagnosed APL patients enrolled in the International Consortium for Childhood APL (ICC-APL-01) trial, which reduced anthracycline exposure but extended that of ATRA. The study recruited 258 children/adolescents with molecularly/cytogenetically proven APL. Patients were stratified into standard-risk (SR) and high-risk (HR) groups according to baseline white blood cell counts (<10 × 109/L or ≥10 × 109/L); both groups received identical induction treatment with ATRA and 3 doses of idarubicin. Two or 3 blocks of consolidation therapy were administered to SR and HR patients, respectively, while maintenance therapy with low-dose chemotherapy and ATRA cycles was given to all patients for 2 years. The cumulative dose of daunorubicin equivalent anthracyclines in SR and HR patients was lower than that of previous studies (355 mg/m2 and 405 mg/m2, respectively). Hematologic remission was obtained in 97% of patients; 8 children died of intracranial hemorrhage in the first 2 weeks following diagnosis. Five-year overall and event-free survival for the whole cohort were 94.6% and 79.9%, respectively; they were 98.4% and 89.4% in SR patients and 84.3% and 74.2% in HR patients (P = .002 and P = .043, respectively). These data demonstrate that extended use of ATRA coupled to a risk-adapted consolidation can achieve high cure rates in childhood APL and limit anthracycline exposure. The trial was registered at www.clinicaltrials.gov as EudractCT 2008-002311-40.
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Affiliation(s)
- Anna Maria Testi
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Andrea Pession
- Department of Pediatrics, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Daniela Diverio
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - David Grimwade
- Division of Genetics and Molecular Medicine, King's College, London, United Kingdom
| | - Brenda Gibson
- Department of Paediatric Haematology, Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Lorena Moran
- Grupo Argentino de Tratamiento de la Leucemia Aguda, Buenos Aires, Argentina
| | - Guy Leverger
- Assistance Publique-Hôpitaux de Paris, Hospital Armand Trousseau, Sorbonne Universitè, Paris, France
| | - Sarah Elitzur
- Pediatric Hematology-Oncology, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Owen Smith
- Department of Paediatric Hematology/Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | | | - Alfonso Piciocchi
- Gruppo Italiano Malattie Ematologiche dell'Adulto Foundation, Rome, Italy
| | - Francesco Lo Coco
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Robin Foà
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
- Department of Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gertjan J L Kaspers
- Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands; and
- Dutch Childhood Oncology Group, The Hague, The Netherlands
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21
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Acute Promyelocytic Leukemia in Children: A Single Centre Experience from Turkey. Mediterr J Hematol Infect Dis 2018; 10:e2018045. [PMID: 30002801 PMCID: PMC6039079 DOI: 10.4084/mjhid.2018.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/21/2018] [Indexed: 11/08/2022] Open
Abstract
Background and objectives Acute promyelocytic leukemia (APL), is a distinct subtype of acute myeloid leukemia (AML) characterized by a tendency to hemorrhage and excellent response to all-trans retinoic acid (ATRA). In this retrospective study, we aimed to determine the incidence, clinical symptoms, toxicities, and outcome of children with APL in our center. Methods We retrospectively reviewed the medical records of children (age < 18 years) diagnosed with APL in our pediatric hematology department between January 2006-December 2016. Results Pediatric APL represents 20.5% of AML cases in this cohort. Most of the cases presented as classical M3, albeit hypogranular variant was described in 12% of the cohort. Patients with hypogranular variant APL were differed from classical APL by co-expression of CD2 and CD34. About ¾ of APL patients had hemorrhagic findings at admission or the induction treatment. Severe bleeding manifested as intracranial hemorrhage was present in three patients and intracranial arterial thrombosis was present in one. Six patients showed side effects of ATRA such as pseudotumor cerebri, differentiation syndrome resulting in dilated cardiomyopathy, and pulmonary infiltrates. Five-year overall survival (OS) and early death rate were found to be 82.5% and 12% respectively. Conclusions A high frequency (20.5%) of APL was noted among children with AML in this single-center study. The overall mortality rate was 17.5%. Since the induction death rate was 12% and life-threatening bleeding was the primary problem, awareness and urgent treatment are critical factors to reduce early losses.
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22
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Arsenic speciation in hair and nails of acute promyelocytic leukemia (APL) patients undergoing arsenic trioxide treatment. Talanta 2018; 184:446-451. [DOI: 10.1016/j.talanta.2018.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 01/10/2023]
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Song L, Qiao G, Xu Y, Ma L, Jiang W. Role of non-coding RNAs in cardiotoxicity of chemotherapy. Surg Oncol 2018; 27:526-538. [PMID: 30217315 DOI: 10.1016/j.suronc.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023]
Abstract
The long-time paradoxical situation of non-coding RNAs (ncRNAs) has been terminated for they emerge as executive at full spectrum of gene expression and translation. More recently, it has been demonstrated that some ncRNAs apparently are associated with chemotherapy, causing cardiotoxicity, which taint long-term recovery of patients in growing body of evidence. The current review focused on up-to-date knowledge on regulation change and molecular signaling of ncRNAs, at mean time evaluate their potentials as diagnostic biomarkers or therapeutic targets to monitor and protect cardio function.
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Affiliation(s)
- Lina Song
- Department of Oncology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guanglei Qiao
- Department of Oncology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingjie Xu
- Department of Cardiology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lijun Ma
- Department of Oncology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Weihua Jiang
- Department of Oncology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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24
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Management of patients with acute promyelocytic leukemia. Leukemia 2018; 32:1277-1294. [DOI: 10.1038/s41375-018-0139-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 01/10/2023]
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25
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Zhang L, Zou Y, Chen Y, Guo Y, Yang W, Chen X, Wang S, Liu X, Ruan M, Zhang J, Liu T, Liu F, Qi B, An W, Ren Y, Chang L, Zhu X. Role of cytarabine in paediatric acute promyelocytic leukemia treated with the combination of all-trans retinoic acid and arsenic trioxide: a randomized controlled trial. BMC Cancer 2018; 18:374. [PMID: 29615003 PMCID: PMC5883545 DOI: 10.1186/s12885-018-4280-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background The combination of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) has been suggested to be safe and effective for adult acute promyelocytic leukaemia (APL). As of 2010, the role of cytarabine (Ara-C) in APL was controversial. The aim of this study was to test the efficacy and safety of ATRA and ATO in paediatric APL patients. Also, we assessed whether Ara-C could be omitted in ATO and ATRA- based trials in children. Methods We performed a randomized controlled trial in paediatric APL patients (≤14 years of age) in our hospital from May 2010 to December 2016. All of the patients were assigned to receive ATRA plus ATO for induction followed by one course of idarubicin (IDA) and ATO (28 days). The patients were then randomly assigned to receive two courses of daunorubicin (DNR, no- Ara-C group) or DNR + Ara-C (Ara-C group). All of the patients were followed with maintenance therapy with oral ATRA, 6-mercaptopurine, and methotrexate for 1.5 years. Results Among the 66 patients, 43 were male and 23 were female. All of the patients achieved complete remission (CR) with the exception of one who gave up the treatment. During induction therapy, all toxicity events were reversed after appropriate management. Thirty patients in the Ara-C group underwent 57 courses of treatment, and 35 patients in the no-Ara-C group underwent 73 courses of treatment. No significant differences in age, genders, white blood cell counts, haemoglobin levels, and platelet counts were found between the Ara-C and no-Ara-c groups. Greater myelosuppression and sepsis were observed in the Ara-C group during the consolidation courses. No patient died at consolidation, and only one patient relapsed. No differences were found in event-free survival, disease-free survival and overall survival between the two groups. Additionally, our analysis of the arsenic levels in the plasma, urine, hair and nails of the patients indicated that no significant accumulation of arsenic occurred after ATO was discontinued for 12 months. Conclusions Overall, ATO and ATRA are safe and effective for paediatric APL patients and Ara-C could be omitted when ATO is used for two courses. Trial registration ClinicalTrials.gov (NCT01191541, retrospectively registered on 18 August 2010).
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Affiliation(s)
- Li Zhang
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Yao Zou
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Yumei Chen
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Ye Guo
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Wenyu Yang
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Xiaojuan Chen
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Shuchun Wang
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Xiaoming Liu
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Min Ruan
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Jiayuan Zhang
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Tianfeng Liu
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Fang Liu
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Benquan Qi
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Wenbin An
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Yuanyuan Ren
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Lixian Chang
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China
| | - Xiaofan Zhu
- State Key Laboratory of Experimental Hematology, Department of Paediatrics Haematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China.
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Activation of the basal cell carcinoma pathway in a patient with CNS HGNET-BCOR diagnosis: consequences for personalized targeted therapy. Oncotarget 2018; 7:83378-83391. [PMID: 27825128 PMCID: PMC5347776 DOI: 10.18632/oncotarget.13092] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/19/2016] [Indexed: 01/01/2023] Open
Abstract
High grade neuroepithelial tumor of the central nervous system with BCOR alteration (CNS HGNET-BCOR) is a recently described new tumor entity with a dismal prognosis. The objective of this study was to identify and validate pathways deregulated in CNS HGNET-BCOR as basis for targeted therapy approaches. We characterized the BCOR alteration in a pediatric patient with CNS HGNET-BCOR diagnosis by Sanger sequencing and demonstrated an elevated BCOR expression by qRT-PCR and western blot. By whole transcriptome sequencing and Ingenuity Pathway Analysis, we identified the activation of the Sonic Hedgehog (SHH) and of the WNT signaling pathway in two different regions of the primary tumor and of one inoculation metastasis compared to normal brain. We validated the activation of the SHH and of the WNT pathway by qRT-PCR analysis of GLI1 and AXIN2 respectively. GLI1 and AXIN2 were upregulated in the primary tumor and in two inoculation metastases compared to normal brain. Mutational analysis of SMO, PTCH1 and SUFU, three key components of the SHH pathway, revealed a Single Nucleotide Polymorphism (SNP) in PTCH1 (rs357564). We tested the effect of the GLI-inhibitor arsenic trioxide (ATO) on a short-term cell culture isolated from the metastasis. ATO was able to reduce the viability of the cells with an IC50 of 1.3 μM. In summary, these results provide functional evidence of altered BCOR expression and homogeneous coactivation of both the SHH and WNT signaling pathways, building the basis for potential novel therapeutic approaches for patients with a CNS HGNET-BCOR diagnosis.
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Klein K, de Haas V, Kaspers GJL. Clinical challenges in de novo pediatric acute myeloid leukemia. Expert Rev Anticancer Ther 2018; 18:277-293. [DOI: 10.1080/14737140.2018.1428091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Klein
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Valérie de Haas
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Conyers R, Costello B, La Gerche A, Tripaydonis A, Burns C, Ludlow L, Lange P, Ekert P, Mechinaud F, Cheung M, Martin M, Elliot D. Chemotherapy‐related cardiotoxicity: are Australian practitioners missing the point? Intern Med J 2017; 47:1166-1172. [DOI: 10.1111/imj.13481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/13/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Rachel Conyers
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Ben Costello
- The Baker IDI Institute The Alfred Hospital Melbourne Victoria Australia
| | - Andre La Gerche
- The Baker IDI Institute The Alfred Hospital Melbourne Victoria Australia
| | - Anne Tripaydonis
- Melbourne Medical School Melbourne University Melbourne Victoria Australia
| | - Charlotte Burns
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Louise Ludlow
- Children's Cancer Centre, Tissue Bank Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Peter Lange
- Department of General Medicine The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Paul Ekert
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Francoise Mechinaud
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Michael Cheung
- Cardiology Unit, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Michelle Martin
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - David Elliot
- Cardiac Development Laboratory Murdoch Children's Research Institute Melbourne Victoria Australia
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Kutny MA, Alonzo TA, Gerbing RB, Wang YC, Raimondi SC, Hirsch BA, Fu CH, Meshinchi S, Gamis AS, Feusner JH, Gregory JJ. Arsenic Trioxide Consolidation Allows Anthracycline Dose Reduction for Pediatric Patients With Acute Promyelocytic Leukemia: Report From the Children's Oncology Group Phase III Historically Controlled Trial AAML0631. J Clin Oncol 2017; 35:3021-3029. [PMID: 28767288 PMCID: PMC5590801 DOI: 10.1200/jco.2016.71.6183] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Children's Oncology Group AAML0631 trial for newly diagnosed pediatric acute promyelocytic leukemia (APL) was a phase III historically controlled trial to determine the survival of patients receiving arsenic trioxide (ATO) consolidation and reduced doses of anthracyclines. Patients and Methods Patients age 2 to 21 years with de novo APL confirmed by PML-RARα polymerase chain reaction were stratified as standard risk (SR) or high risk (HR) on the basis of diagnostic WBC count. All patients received all-trans retinoic acid (ATRA) during induction, each consolidation course, and maintenance. All patients received two cycles of ATO therapy during consolidation 1, an additional two (SR) or three (HR) consolidation courses that included high-dose cytarabine and anthracycline, and maintenance therapy comprising ATRA, oral methotrexate, and mercaptopurine. Results One hundred one patients (66 SR and 35 HR) were evaluable for outcome. The 3-year overall survival was 94%, and event-free survival (EFS) was 91%. For SR and HR patients with APL, the overall survival was 98% versus 86% ( P = .003), and EFS was 95% versus 83% ( P = .03), respectively. The EFS for SR patients in AAML0631 was noninferior to that of patients in the AIDA 0493 historical control, which used a significantly higher anthracycline dose and did not include ATO consolidation. Relapse risk for patients in AAML0631 from end consolidation 1 (after ATO treatment) was only 4% at 3 years and did not differ significantly between SR and HR patients. Conclusion ATO consolidation cycles were well tolerated in pediatric patients with APL and allowed significant reduction in cumulative anthracycline doses while maintaining excellent survival and a low relapse risk for both SR and HR patients with APL.
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Affiliation(s)
- Matthew A. Kutny
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Todd A. Alonzo
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Robert B. Gerbing
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Yi-Cheng Wang
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Susana C. Raimondi
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Betsy A. Hirsch
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Cecilia H. Fu
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Soheil Meshinchi
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - Alan S. Gamis
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - James H. Feusner
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
| | - John J. Gregory
- Matthew A. Kutny, University of Alabama at Birmingham, Birmingham, AL; Todd A. Alonzo, University of Southern California; Cecilia H. Fu, Children’s Hospital Los Angeles, Los Angeles; Robert B. Gerbing and Yi-Cheng Wang, Children’s Oncology Group, Monrovia; James H. Feusner, Children’s Hospital and Research Center Oakland, Oakland, CA; Susana C. Raimondi, St Jude Children’s Research Hospital, Memphis, TN; Betsy A. Hirsch, University of Minnesota Medical Center-Fairview, Minneapolis, MN; Soheil Meshinchi, Fred Hutchinson Cancer Research Center, Seattle, WA; Alan S. Gamis, Children’s Mercy Hospitals and Clinics, Kansas City, MO; and John J. Gregory Jr, Goryeb Children’s Hospital, Morristown, NJ
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Hecht A, Doll S, Altmann H, Nowak D, Lengfelder E, Röllig C, Ehninger G, Spiekermann K, Hiddemann W, Weiß C, Hofmann WK, Nolte F, Platzbecker U. Validation of a Molecular Risk Score for Prognosis of Patients With Acute Promyelocytic Leukemia Treated With All-trans Retinoic Acid and Chemotherapy-containing Regimens. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:889-896.e5. [PMID: 28923666 DOI: 10.1016/j.clml.2017.08.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Although treatment of acute promyelocytic leukemia (APL) has evolved dramatically during the past decades, especially with the introduction of all-trans retinoic acid, risk stratification remains an important issue. To date, relapse risk can be predicted by leukocyte and platelet counts only. In the present report, we present a validation study on 3 candidate genes and a newly developed molecular risk score for APL in 2 independent patient cohorts. PATIENTS AND METHODS An integrative risk score combining the expression levels of BAALC, ERG, and WT1 was calculated for 79 de novo APL patients from the original cohort and 76 de novo APL patients from a validation cohort. Gene expression analysis was executed the same for both cohorts, and the results regarding the effect on patient outcomes were compared. RESULTS The expression levels of BAALC, ERG, and WT1 were similar in both cohorts compared with the healthy controls. The relapse and survival rates were not different between the low- and high-risk patients according to the Sanz score. However, application of the molecular risk score on the validation cohort distinctly discriminated patients according to their risk of relapse and death just as in the original APL cohort, although single gene analyses could not reproduce the negative prognostic impact. CONCLUSION The analysis clearly validated the prognostic effect of the integrative risk score on the outcome in APL patients. The value was further empowered because the single gene analyses did not show similar results. Whether the integrative risk score retains its prognostic power in the chemotherapy-free setting should be investigated further.
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Affiliation(s)
- Anna Hecht
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany.
| | - Seraphina Doll
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Heidi Altmann
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Daniel Nowak
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Eva Lengfelder
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Gerhard Ehninger
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Wolfgang Hiddemann
- Department of Hematology/Oncology, University of Munich, Munich, Germany
| | - Christel Weiß
- Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Florian Nolte
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Uwe Platzbecker
- Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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31
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Creutzig U, Dworzak MN, Bochennek K, Faber J, Flotho C, Graf N, Kontny U, Rossig C, Schmid I, von Stackelberg A, Mueller JE, von Neuhoff C, Reinhardt D, von Neuhoff N. First experience of the AML-Berlin-Frankfurt-Münster group in pediatric patients with standard-risk acute promyelocytic leukemia treated with arsenic trioxide and all-trans retinoid acid. Pediatr Blood Cancer 2017; 64. [PMID: 28111878 DOI: 10.1002/pbc.26461] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/07/2016] [Accepted: 12/25/2016] [Indexed: 11/10/2022]
Abstract
Recently, studies in adults with acute promyelocytic leukemia (APL) showed high cure rates in low-risk patients treated with all-trans retinoid acid (ATRA) and arsenic trioxide (ATO), while toxicities were significantly reduced compared to the standard treatment with ATRA and chemotherapy. Here we report about first experience with 11 pediatric patients with low-risk APL treated with ATRA and ATO. All patients stayed in molecular remission. All suffered from hyperleukocytosis. Two patients experienced reversible severe side effects. One suffered from osteonecroses at both femurs, seizures, as well as posterior reversible encephalopathy syndrome, the other patient had an abducens paresis.
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Affiliation(s)
- Ursula Creutzig
- Department of Pediatric Hematology/Oncology, Hannover Medical School, Children's Hospital, Hannover, Germany
| | - Michael N Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Konrad Bochennek
- Division for Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Flotho
- Division of Pediatric Hematology/Oncology, University Medical Center, Freiburg, Germany
| | - Norbert Graf
- Department of Pediatric Oncology/Hematology, Saarland University, Homburg, Germany
| | - Udo Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, Dr. von Hauner Children`s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Arend von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité University Medical Center Berlin, Berlin, Germany
| | - Jans-Enno Mueller
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Christine von Neuhoff
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Nils von Neuhoff
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
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Abstract
Acute promyelocytic leukaemia (APML) is a subtype of leukaemia arising from a distinct reciprocal translocation involving chromosomes 15 and 17, which results in the PML-RARA fusion gene. Over the past three decades, APML has been transformed from a highly fatal disease to a highly curable one. This drastic improvement is because of the introduction of a new treatment strategy with all-trans retinoic acid and, more recently, arsenic trioxide. The revolutionary treatment of APML has also paved the way for a new cancer treatment, which is genetically targeted therapy. In this review, we look into this amazing journey of transformation and provide recent advances in the management of APML.
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Affiliation(s)
- Chin-Hin Ng
- National University Cancer Institute, Singapore, Singapore
| | - Wee-Joo Chng
- National University Cancer Institute, Singapore, Singapore
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Huang D, Yang Y, Sun J, Dong X, Wang J, Liu H, Lu C, Chen X, Shao J, Yan J. Annexin A2-S100A10 heterotetramer is upregulated by PML/RARα fusion protein and promotes plasminogen-dependent fibrinolysis and matrix invasion in acute promyelocytic leukemia. Front Med 2017; 11:410-422. [PMID: 28687976 DOI: 10.1007/s11684-017-0527-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/08/2017] [Indexed: 02/08/2023]
Abstract
Aberrant expression of annexin A2-S100A10 heterotetramer (AIIt) associated with PML/RARα fusion protein causes lethal hyperfibrinolysis in acute promyelocytic leukemia (APL), but the mechanism is unclear. To facilitate the investigation of regulatory association between ANXA2 and promyelocytic leukemia/retinoic acid receptor a (PML/RARα) fusion protein, this work was performed to determine the transcription start site of ANXA2 promoter with rapid amplification of 5'-cDNA ends analysis. Zinc-induced U937/PR9 cells expressed PML/RARα fusion protein, and resultant increases in ANXA2 transcripts and translational expressions of both ANXA2 and S100A10, while S100A10 transcripts remained constitutive. The transactivation of ANXA2 promoter by PML/RARα fusion protein was 3.29 ± 0.13 fold higher than that by control pSG5 vector or wild-type RARα. The overexpression of ANXA2 in U937 transfected with full-length ANXA2 cDNA was associated with increased S100A10 subunit, although S100A10 transcripts remained constitutive. The tPA-dependent initial rate of plasmin generation (IRPG) in zinc-treated U937/PR9 increased by 2.13-fold, and cell invasiveness increased by 27.6%. Antibodies against ANXA2, S100A10, or combination of both all remarkably inhibited the IRPG and invasiveness in U937/PR9 and NB4. Treatment of zinc-induced U937/PR9 or circulating APL blasts with all-trans retinoic acid (ATRA) significantly reduced cell surface ANXA2 and S100A10 and associated reductions in IRPG and invasiveness. Thus, PML/RARα fusion protein transactivated the ANXA2 promoter to upregulate ANXA2 and accumulate S100A10. Increased AIIt promoted IRPG and invasiveness, both of which were partly abolished by antibodies against ANXA2 and S100A10 or by ATRA.
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Affiliation(s)
- Dan Huang
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Yan Yang
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Jian Sun
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Xiaorong Dong
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Jiao Wang
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Hongchen Liu
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Chengquan Lu
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Environmental Health and Toxicology, School of Public Health, Dalian Medical University, Dalian, 116044, China
| | - Xueyu Chen
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China
| | - Jing Shao
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Environmental Health and Toxicology, School of Public Health, Dalian Medical University, Dalian, 116044, China.
| | - Jinsong Yan
- Dalian Key Laboratory of Hematology, Liaoning Hematopoietic Stem Cell Transplantation Medical Center, Department of Hematology of the Second Hospital of Dalian Medical University, Dalian, 116027, China.
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Duan X, Li T, Han X, Ren J, Chen P, Li H, Gong S. The antitumor effect of arsenic trioxide on hepatocellular carcinoma is enhanced by andrographolide. Oncotarget 2017; 8:90905-90915. [PMID: 29207612 PMCID: PMC5710893 DOI: 10.18632/oncotarget.18677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/02/2017] [Indexed: 12/25/2022] Open
Abstract
High concentrations of arsenic trioxide (As2O3) are used to treat acute promyelocytic leukemia and solid tumors, with negative side effects to normal cells. Andrographolide is a traditional Chinese medicine that exerts anti-cancer, anti-inflammatory, anti-virus, and anti-diabetic effects. Here, we tested the effects of combined andrographolide with As2O3 against hepatocellular carcinoma (HCC). We found that by increasing apoptosis, andrographolide synergistically enhanced the anti-tumor effects of As2O3 in HepG2 cells in vitro and in vivo. Furthermore, results from our microarray assays and experiments with mouse xenografts showed that EphB4 was downregulated by the combination of As2O3 plus andrographolide. These findings suggest that the combination of andrographolide and As2O3 could yield therapeutic benefits in the treatment of HCC.
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Affiliation(s)
- Xuhua Duan
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Tengfei Li
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Pengfei Chen
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Hao Li
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Shaojun Gong
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
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Ghosh S, Mishra R, Biswas S, Bhadra RK, Mukhopadhyay PK. α-Lipoic Acid Mitigates Arsenic-Induced Hematological Abnormalities in Adult Male Rats. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:242-250. [PMID: 28533572 PMCID: PMC5429492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Arsenic toxicity is a major global health problem and exposure via contaminated drinking water has been associated with hematological and other systemic disorders. The present investigation has been conducted in adult male rats to evaluate the protective ability of α-lipoic acid (ALA) against such hematological disorders. METHODS Twenty-four adult male Wister rats (b.wt.130±10g) were grouped and accordingly group I (control) received the normal diet, group II (treated) was given arsenic orally for 28 consecutive days as arsenic trioxide (3 mg/kgbw/rat/day) whereas group III (supplemented) received the same dose of arsenic along with ALA (25 mg/kgbw/rat/day) as oral supplement. Hematological profile, plasma oxidant/antioxidant status, and erythrocyte morphology were assessed. Statistical analysis was done by one-way ANOVA using SPSS software (version 16.0). RESULTS Arsenic exposure caused reduction of erythrocyte (P=0.021), leucocyte (P<0.001), and hemoglobin (P=0.031) associated with echinocytic transformation as evidenced by light and scanning electron microscopic studies. The other significantly altered parameters include increased mean corpuscular volume (P=0.041) and lymphocytopenia (P<0.001) with insignificant neutropenia and eosinophilia. Altered serum oxidative balance as evidenced by decreased TAS (P<0.001) and increased TOS (P<0.001) with OSI (P<0.001) was also noted. The dietary supplementation of ALA has a beneficial effect against the observed (P<0.05) arsenic toxicities. It brings about the protection by restoring the hematological redox and inflammatory status near normal in treated rats. Arsenic-induced morphological alteration of erythrocytes was also partially attenuated by ALA supplementation. CONCLUSION It is concluded that arsenicosis is associated with hematological alterations and ALA co-supplementation can partially alleviate these changes in an experimental male rat model.
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Affiliation(s)
- Sonali Ghosh
- Department of Biological Sciences, Presidency University, Kolkata, India
| | - Raghwendra Mishra
- Department of Biological Sciences, Presidency University, Kolkata, India,Department of Physiology, University of Calcutta, Kolkata, India
| | - Sagnik Biswas
- Department of Biological Sciences, Presidency University, Kolkata, India
| | - Rupak K Bhadra
- Department of Infectious Diseases & Immunology, CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Prabir K Mukhopadhyay
- Department of Biological Sciences, Presidency University, Kolkata, India,Correspondence: Prabir K. Mukhopadhyay, PhD; Department of Biological Sciences, Presidency University, 86/1 College Street, Kolkata-700073, India Tel: +91 943 3160257
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36
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McCulloch D, Brown C, Iland H. Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives. Onco Targets Ther 2017; 10:1585-1601. [PMID: 28352191 PMCID: PMC5359123 DOI: 10.2147/ott.s100513] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) with a unique morphological appearance, associated coagulopathy and canonical balanced translocation of genetic material between chromosomes 15 and 17. APL was first described as a distinct subtype of AML in 1957 by Dr Leif Hillestad who recognized the pattern of an acute leukemia associated with fibrinolysis, hypofibrinogenemia and catastrophic hemorrhage. In the intervening years, the characteristic morphology of APL has been described fully with both classical hypergranular and variant microgranular forms. Both are characterized by a balanced translocation between the long arms of chromosomes 15 and 17, [t(15;17)(q24;q21)], giving rise to a unique fusion gene PML-RARA and an abnormal chimeric transcription factor (PML-RARA), which disrupts normal myeloid differentiation programs. The success of current treatments for APL is in marked contrast to the vast majority of patients with non-promyelocytic AML. The overall prognosis in non-promyelocytic AML is poor, and although there has been an improvement in overall survival in patients aged <60 years, only 30%-40% of younger patients are still alive 5 years after diagnosis. APL therapy has diverged from standard AML therapy through the empirical discovery of two agents that directly target the molecular basis of the disease. The evolution of treatment over the last 4 decades to include all-trans retinoic acid and arsenic trioxide, with chemotherapy limited to patients with high-risk disease, has led to complete remission in 90%-100% of patients in trials and rates of overall survival between 86% and 97%.
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Affiliation(s)
- Derek McCulloch
- Institute of Hematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Christina Brown
- Institute of Hematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Harry Iland
- Institute of Hematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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37
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Abstract
The outcome for children with acute myeloid leukemia (AML) has improved significantly over the past 30 years, with complete remission and overall survival rates exceeding 90 and 60%, respectively, in recent clinical trials. However, these improvements have not been achieved by the introduction of new agents. Instead, intensification of standard chemotherapy, more precise risk classification, improvements in supportive care, and the use of minimal residual disease to monitor response to therapy have all contributed to this success. Nevertheless, novel therapies are needed, as the cure rates for many subtypes of childhood AML remain unacceptably low. Here, we briefly review advances in our understanding of the biology and genetics of AML, the results of recent clinical trials, and current recommendations for the treatment of children with AML.
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Affiliation(s)
- Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA. .,Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA.
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38
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Jiang YH, Chen YJ, Wang C, Lan YF, Yang C, Wang QQ, Hussain L, Maimaitiying Y, Islam K, Naranmandura H. Phenylarsine Oxide Can Induce the Arsenite-Resistance Mutant PML Protein Solubility Changes. Int J Mol Sci 2017; 18:ijms18020247. [PMID: 28125064 PMCID: PMC5343784 DOI: 10.3390/ijms18020247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/17/2022] Open
Abstract
Arsenic trioxide (As2O3) has recently become one of the most effective drugs for treatment of patient with acute promyelocytic leukemia (APL), and its molecular mechanism has also been largely investigated. However, it has been reported that As2O3 resistant patients are frequently found in relapsed APL after consolidation therapy, which is due to the point mutations in B-box type 2 motifs of promyelocytic leukemia (PML) gene. In the present study, we for the first time establish whether organic arsenic species phenylarsine oxide (PAO) could induce the mutant PML-IV (A216V) protein solubility changes and degradation. Here, three different PML protein variants (i.e., PML-IV, PML-V and mutant PML-A216V) were overexpressed in HEK293T cells and then exposed to PAO in time- and dose-dependent manners. Interestingly, PAO is found to have potential effect on induction of mutant PML-IV (A216V) protein solubility changes and degradation, but no appreciable effects were found following exposure to high concentrations of iAsIII, dimethylarsinous acid (DMAIII) and adriamycin (doxorubicin), even though they cause cell death. Our current data strongly indicate that PAO has good effects on the mutant PML protein solubility changes, and it may be helpful for improving the therapeutic strategies for arsenic-resistant APL treatments in the near future.
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Affiliation(s)
- Yu Han Jiang
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
- Department of Marine Science, Ocean College, Zhejiang University, Hangzhou 310058, China.
| | - Ye Jia Chen
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Chao Wang
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
| | - Yong Fei Lan
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
| | - Chang Yang
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Qian Qian Wang
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China.
| | - Liaqat Hussain
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Yasen Maimaitiying
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Khairul Islam
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
| | - Hua Naranmandura
- Department of Toxicology, School of Medicine and Public health, Zhejiang University, Hangzhou 310058, China.
- Department of Marine Science, Ocean College, Zhejiang University, Hangzhou 310058, China.
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39
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Sun LY, Wang H, Zhou J. Clinical Implementation of Arsenic Trioxide. CHINESE HERBAL MEDICINES 2016. [DOI: 10.1016/s1674-6384(16)60056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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40
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Abla O, Kutny MA, Testi AM, Feusner JH, Creutzig U, Gregory J, Gibson B, Leverger G, Ribeiro RC, Smith O, Locatelli F, Kaspers G. Management of relapsed and refractory childhood acute promyelocytic leukaemia: recommendations from an international expert panel. Br J Haematol 2016; 175:588-601. [PMID: 27651168 DOI: 10.1111/bjh.14313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Matthew A Kutny
- Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna Maria Testi
- Department of Cellular Biotechnologies and Haematology, Sapienza University of Rome, Rome, Italy
| | - James H Feusner
- Division of Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA, USA
| | - Ursula Creutzig
- Paediatric Haematology/Oncology, Hannover Medical School, Hannover, Germany
| | - John Gregory
- Atlantic Health System, Goryeb Children's Hospital, Morristown, NJ, USA
| | - Brenda Gibson
- Department of Haematology and Oncology, Royal Hospital for Children, Glasgow, UK
| | - Guy Leverger
- Haematology/Oncology, Hôpital Armand Trousseau, Paris, France
| | - Raul C Ribeiro
- Department of Oncology, Division of Leukemia/Lymphoma, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Owen Smith
- Department of Haematology/Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Franco Locatelli
- Department of Paediatric Haematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.,University of Pavia, Pavia, Italy
| | - Gertjan Kaspers
- Paediatric Oncology, VU University Medical Centre, Amsterdam, The Netherlands.,Academy of Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
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41
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Wang QQ, Zhou XY, Zhang YF, Bu N, Zhou J, Cao FL, Naranmandura H. Methylated arsenic metabolites bind to PML protein but do not induce cellular differentiation and PML-RARα protein degradation. Oncotarget 2016. [PMID: 26213848 PMCID: PMC4694856 DOI: 10.18632/oncotarget.4662] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Arsenic trioxide (As2O3) is one of the most effective therapeutic agents used for patients with acute promyelocytic leukemia (APL). The probable explanation for As2O3-induced cell differentiation is the direct targeting of PML-RARα oncoprotein by As2O3, which results in initiation of PML-RARa degradation. However, after injection, As2O3 is rapidly methylated in body to different intermediate metabolites such as trivalent monomethylarsonous acid (MMAIII) and dimethylarsinous acid (DMAIII), therefore, it remains unknown that which arsenic specie is actually responsible for the therapeutic effects against APL. Here we have shown the role of As2O3 (as iAsIII) and its intermediate metabolites (i.e., MMAIII/DMAIII) in NB4 cells. Inorganic iAsIII predominantly showed induction of cell differentiation, while MMAIII and DMAIII specifically showed to induce mitochondria and endoplasmic reticulum-mediated apoptosis, respectively. On the other hand, in contrast to iAsIII, MMAIII showed stronger binding affinity for ring domain of PML recombinant protein, however, could not induce PML protein SUMOylation and ubiquitin/proteasome degradation. In summary, our results suggest that the binding of arsenicals to the ring domain of PML proteins is not associated with the degradation of PML-RARa fusion protein. Moreover, methylated arsenicals can efficiently lead to cellular apoptosis, however, they are incapable of inducing NB4 cell differentiation.
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Affiliation(s)
- Qian Qian Wang
- Department of Toxicology, School of Medicine and Public Health, Zhejiang University, Hangzhou 310058, China.,College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Xin Yi Zhou
- Department of Toxicology, School of Medicine and Public Health, Zhejiang University, Hangzhou 310058, China.,College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yan Fang Zhang
- Department of Toxicology, School of Medicine and Public Health, Zhejiang University, Hangzhou 310058, China.,College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Na Bu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Jin Zhou
- Department of Hematology and Oncology, The First Clinical College of Harbin Medical University, Harbin 150086, China
| | - Feng Lin Cao
- Department of Hematology and Oncology, The First Clinical College of Harbin Medical University, Harbin 150086, China
| | - Hua Naranmandura
- Department of Toxicology, School of Medicine and Public Health, Zhejiang University, Hangzhou 310058, China.,College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
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Phase I and Phase II Objective Response Rates are Correlated in Pediatric Cancer Trials: An Argument for Better Clinical Trial Efficiency. J Pediatr Hematol Oncol 2016; 38:360-6. [PMID: 27164535 PMCID: PMC4925289 DOI: 10.1097/mph.0000000000000583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although many phase I trials report tumor response, formal analysis of efficacy is deferred to phase II. We reviewed paired phase I and II pediatric oncology trials to ascertain the relationship between phase I and II objective response rate (OR%). Single-agent phase I trials were paired with corresponding phase II trials (comparable study drug, dosing schedule, and population). Phase I trials without efficacy data or a matching phase II trial were excluded. OR% was tabulated for all trials, and phase II authors' subjective conclusions regarding efficacy were documented; 35 pairs of trials were analyzed. The correlation between phase I and II OR% was 0.93. Between phase II studies with a "positive" conclusion versus a "negative" one, there was a statistically significant difference in mean phase I OR% (32.0% vs. 4.5%, P<0.001). Thirteen phase II studies were undertaken despite phase I OR% of 0%; only 1 had a "positive" conclusion, and none exceeded OR% of 15%. OR% are highly correlated between phase I and II pediatric oncology trials. Although not a formal measure of drug efficacy, phase I OR% may provide an estimate of phase II response, inform phase II study design, and should be given greater consideration.
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Madan V, Shyamsunder P, Han L, Mayakonda A, Nagata Y, Sundaresan J, Kanojia D, Yoshida K, Ganesan S, Hattori N, Fulton N, Tan KT, Alpermann T, Kuo MC, Rostami S, Matthews J, Sanada M, Liu LZ, Shiraishi Y, Miyano S, Chendamarai E, Hou HA, Malnassy G, Ma T, Garg M, Ding LW, Sun QY, Chien W, Ikezoe T, Lill M, Biondi A, Larson RA, Powell BL, Lübbert M, Chng WJ, Tien HF, Heuser M, Ganser A, Koren-Michowitz M, Kornblau SM, Kantarjian HM, Nowak D, Hofmann WK, Yang H, Stock W, Ghavamzadeh A, Alimoghaddam K, Haferlach T, Ogawa S, Shih LY, Mathews V, Koeffler HP. Comprehensive mutational analysis of primary and relapse acute promyelocytic leukemia. Leukemia 2016; 30:1672-81. [PMID: 27063598 PMCID: PMC4972641 DOI: 10.1038/leu.2016.69] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/12/2016] [Accepted: 03/15/2016] [Indexed: 12/16/2022]
Abstract
Acute promyelocytic leukemia (APL) is a subtype of myeloid leukemia characterized by differentiation block at the promyelocyte stage. Besides the presence of chromosomal rearrangement t(15;17), leading to the formation of PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) fusion, other genetic alterations have also been implicated in APL. Here, we performed comprehensive mutational analysis of primary and relapse APL to identify somatic alterations, which cooperate with PML-RARA in the pathogenesis of APL. We explored the mutational landscape using whole-exome (n=12) and subsequent targeted sequencing of 398 genes in 153 primary and 69 relapse APL. Both primary and relapse APL harbored an average of eight non-silent somatic mutations per exome. We observed recurrent alterations of FLT3, WT1, NRAS and KRAS in the newly diagnosed APL, whereas mutations in other genes commonly mutated in myeloid leukemia were rarely detected. The molecular signature of APL relapse was characterized by emergence of frequent mutations in PML and RARA genes. Our sequencing data also demonstrates incidence of loss-of-function mutations in previously unidentified genes, ARID1B and ARID1A, both of which encode for key components of the SWI/SNF complex. We show that knockdown of ARID1B in APL cell line, NB4, results in large-scale activation of gene expression and reduced in vitro differentiation potential.
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Affiliation(s)
- V Madan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - P Shyamsunder
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - L Han
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - A Mayakonda
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Y Nagata
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - J Sundaresan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - D Kanojia
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - K Yoshida
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Ganesan
- Department of Haematology, Christian Medical College, Vellore, India
| | - N Hattori
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - N Fulton
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - K-T Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - T Alpermann
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - M-C Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - S Rostami
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - J Matthews
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Sanada
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - L-Z Liu
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Y Shiraishi
- Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - S Miyano
- Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - E Chendamarai
- Department of Haematology, Christian Medical College, Vellore, India
| | - H-A Hou
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - G Malnassy
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - T Ma
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Internal Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - M Garg
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - L-W Ding
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Q-Y Sun
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - W Chien
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - T Ikezoe
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - M Lill
- Cedars-Sinai Medical Center, Division of Hematology/Oncology, UCLA School of Medicine, Los Angeles, CA, USA
| | - A Biondi
- Paediatric Haematology-Oncology Department and 'Tettamanti' Research Centre, Milano-Bicocca University, 'Fondazione MBBM', San Gerardo Hospital, Monza, Italy
| | - R A Larson
- Department of Medicine, University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - B L Powell
- Department of Internal Medicine, Section on Hematology and Oncology, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - M Lübbert
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Internal Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - W J Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Hematology-Oncology, National University Cancer Institute of Singapore (NCIS), The National University Health System (NUHS), Singapore, Singapore
| | - H-F Tien
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - A Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - M Koren-Michowitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel Hashomer, Israel
| | - S M Kornblau
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H M Kantarjian
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Nowak
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - W-K Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - H Yang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - W Stock
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - A Ghavamzadeh
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - K Alimoghaddam
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - T Haferlach
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - S Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - L-Y Shih
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - V Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - H P Koeffler
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Cedars-Sinai Medical Center, Division of Hematology/Oncology, UCLA School of Medicine, Los Angeles, CA, USA.,Department of Hematology-Oncology, National University Cancer Institute of Singapore (NCIS), The National University Health System (NUHS), Singapore, Singapore
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Ge F, Zhang Y, Cao F, Li J, Hou J, Wang P, Li H, Xu M, Liu S, Li L, Li X, Wang S, Lv C, Su Y, Zhou J. Arsenic trioxide-based therapy is suitable for patients with psoriasis-associated acute promyelocytic leukemia - A retrospective clinical study. ACTA ACUST UNITED AC 2016; 21:287-94. [PMID: 26871996 DOI: 10.1080/10245332.2015.1115586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Many patients with psoriasis have developed acute promyelocytic leukemia (APL) whereas few reports on psoriasis-associated APL were found in the published literature. This study was aimed to study the etiology, clinical characteristics, and prognosis of psoriasis-associated APL and to map a suitable treatment regime for this condition. METHODS This study retrospectively analyzed the clinical data of 17 patients with psoriasis-associated APL diagnosed and treated in our hospital in the past decade. RESULTS The 17 patients accounted for 8.3% of the total patients diagnosed with de novo APL during the same period in our hospital. Their clinical characteristics of APL were similar to those of general APL. Four patients had a definite history of taking bimolane. All patients received arsenic trioxide (ATO)-based remission induction and postremission treatment. After induction, 15 patients (88%) achieved hematologic complete remission. With a median follow-up of 27 months, the 3-year estimates of overall survival were 77.2% ± 12.4% and the 3-year estimates of event-free survival were 70.6% ± 13.5%. In addition, the ATO-based remission induction and postremission treatment significantly improved psoriasis symptoms in 83 and 85.7% of patients, respectively. Through the final follow-up, no chronic arsenicosis or secondary malignancy was observed. CONCLUSIONS Psoriasis patients are at high risk for APL. The increased risk is most likely associated with the genetic background and bimolane treatment. The ATO-based therapy is especially suitable for patients with psoriasis-associated APL. Our study also brings a new treatment option for psoriasis.
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Affiliation(s)
- Fei Ge
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Yingmei Zhang
- b Central Laboratory , The First Affiliated Hospital, Harbin Medical University , China
| | - Fenglin Cao
- b Central Laboratory , The First Affiliated Hospital, Harbin Medical University , China
| | - Jinmei Li
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Jinxiao Hou
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Ping Wang
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China.,c Department of Neonatology , The First Affiliated Hospital, Harbin Medical University , China
| | - Haitao Li
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Mengyuan Xu
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Shuchuan Liu
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Limin Li
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Xiaoxia Li
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Shuye Wang
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Chengfang Lv
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Yanhua Su
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China
| | - Jin Zhou
- a Department of Hematology , The First Affiliated Hospital, Harbin Medical University , China.,b Central Laboratory , The First Affiliated Hospital, Harbin Medical University , China
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Liu CC, Wang H, Wang WD, Zhu MY, Geng QR, Lu Y. Consolidation therapy of arsenic trioxide alternated with chemotherapy achieves remarkable efficacy in newly diagnosed acute promyelocytic leukemia. Onco Targets Ther 2015; 8:3297-303. [PMID: 26622182 PMCID: PMC4654542 DOI: 10.2147/ott.s92486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Currently, all-trans retinoic acid (ATRA) combined with daunorubicin and ATRA combined with arsenic trioxide (ATO) therapies are considered the standard induction therapy regimens for adult patients newly diagnosed with acute promyelocytic leukemia (APL). However, there is no consensus concerning the optimal consolidation and maintenance therapies after induction therapy. In this study, we explored a new therapeutic strategy for APL that may be simple, effective, and safe. Methods The patients in our study were divided into high white blood cell (WBC) group and low WBC group according to the numeration of leukocytes at the first visit. The low WBC group received ATRA and ATO until complete remission (CR), and the high WBC group received anthracycline, ATRA, and ATO until CR. After achieving hematologic CR, ATO was alternated with chemotherapy for consolidation therapy. Three cycles were completed in the 1st year with no maintenance therapy. The patients were followed for a median of 5 years after their initial treatment. Results After induction therapy, the rate of CR for the 18 patients was 100%. The rate of negativity for the PML/RARα fusion gene following induction therapy was 100%. There was no mortality during the treatment. Both the 5-year event-free survival rate and 5-year overall survival rate were 100%. No relapses occurred during the follow-up period. Conclusion This study proposes a novel treatment for APL that is efficient, well-tolerated, and very simple to perform.
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Affiliation(s)
- Cheng-Cheng Liu
- Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China ; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Hua Wang
- Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China ; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wei-da Wang
- Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China ; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Meng-Yuan Zhu
- Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China ; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Qi-Rong Geng
- Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China ; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yue Lu
- Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China ; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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46
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Shen Y, Fu YK, Zhu YM, Lou YJ, Gu ZH, Shi JY, Chen B, Chen C, Zhu HH, Hu J, Zhao WL, Mi JQ, Chen L, Zhu HM, Shen ZX, Jin J, Wang ZY, Li JM, Chen Z, Chen SJ. Mutations of Epigenetic Modifier Genes as a Poor Prognostic Factor in Acute Promyelocytic Leukemia Under Treatment With All-Trans Retinoic Acid and Arsenic Trioxide. EBioMedicine 2015; 2:563-71. [PMID: 26285909 PMCID: PMC4535155 DOI: 10.1016/j.ebiom.2015.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) is a model for synergistic target cancer therapy using all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), which yields a very high 5-year overall survival (OS) rate of 85 to 90%. Nevertheless, about 15% of APL patients still get early death or relapse. We performed this study to address the possible impact of additional gene mutations on the outcome of APL. METHODS We included a consecutive series of 266 cases as training group, and then validated the results in a testing group of 269 patients to investigate the potential prognostic gene mutations, including FLT3-ITD or -TKD, N-RAS, C-KIT, NPM1, CEPBA, WT1, ASXL1, DNMT3A, MLL (fusions and PTD), IDH1, IDH2 and TET2. RESULTS More high-risk patients (50.4%) carried additional mutations, as compared with intermediate- and low-risk ones. The mutations of epigenetic modifier genes were associated with poor prognosis in terms of disease-free survival in both training (HR = 6.761, 95% CI 2.179-20.984; P = 0.001) and validation (HR = 4.026, 95% CI 1.089-14.878; P = 0.037) groups. Sanz risk stratification was associated with CR induction and OS. CONCLUSION In an era of ATRA/ATO treatment, both molecular markers and clinical parameter based stratification systems should be used as prognostic factors for APL.
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Affiliation(s)
- Yang Shen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Ya-Kai Fu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Yong-Mei Zhu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Yin-Jun Lou
- Zhejiang Institute of Hematology, First Affiliated Hospital, Zhejiang University School of Medicine Peking, China
| | - Zhao-Hui Gu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Jing-Yi Shi
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Bing Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Chao Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | | | - Jiong Hu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Wei-Li Zhao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Jian-Qing Mi
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Li Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Hong-Ming Zhu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Zhi-Xiang Shen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Jie Jin
- Zhejiang Institute of Hematology, First Affiliated Hospital, Zhejiang University School of Medicine Peking, China
| | - Zhen-Yi Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Jun-Min Li
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Zhu Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
| | - Sai-Juan Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine and Collaborative Innovation Center of Systems Biomedicine, SJTU, Shanghai, China
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Abstract
Diagnosis of acute leukemia during pregnancy presents significant medical challenges. Pancytopenia, caused by bone marrow substitution with leukemic cells, impairs maternal and fetal health. Chemotherapeutic agents required to be immediately used to save the mother's life are likely to adversely affect fetal development and outcome, especially if administered at an early gestational stage. Patients diagnosed with acute leukemia during the first trimester are, therefore, recommended to undergo pregnancy termination. At later gestational stages, antileukemic therapy can be administered, although in this case, fetal outcome is still associated with increased incidence of growth restriction and loss. Special attention to the issue of future reproduction, adopting a personalized fertility preservation approach, is required. This article addresses these subjects, presenting women diagnosed with acute myeloid and acute promyelocytic leukemia in pregnancy. The rarity of this event, resulting in insufficient data, emphasizes the need for collaborative efforts to optimize management of this complicated clinical condition.
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Affiliation(s)
- Irit Avivi
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
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Zhang L, Samad A, Pombo-de-Oliveira MS, Scelo G, Smith MT, Feusner J, Wiemels JL, Metayer C. Global characteristics of childhood acute promyelocytic leukemia. Blood Rev 2015; 29:101-25. [PMID: 25445717 PMCID: PMC4379131 DOI: 10.1016/j.blre.2014.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/21/2014] [Accepted: 09/23/2014] [Indexed: 12/29/2022]
Abstract
Acute promyelocytic leukemia (APL) comprises approximately 5-10% of childhood acute myeloid leukemia (AML) cases in the US. While variation in this percentage among other populations was noted previously, global patterns of childhood APL have not been thoroughly characterized. In this comprehensive review of childhood APL, we examined its geographic pattern and the potential contribution of environmental factors to observed variation. In 142 studies (spanning >60 countries) identified, variation was apparent-de novo APL represented from 2% (Switzerland) to >50% (Nicaragua) of childhood AML in different geographic regions. Because a limited number of previous studies addressed specific environmental exposures that potentially underlie childhood APL development, we gathered 28 childhood cases of therapy-related APL, which exemplified associations between prior exposures to chemotherapeutic drugs/radiation and APL diagnosis. Future population-based studies examining childhood APL patterns and the potential association with specific environmental exposures and other risk factors are needed.
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Affiliation(s)
- L Zhang
- School of Public Health, University of California, Berkeley, USA.
| | - A Samad
- School of Public Health, University of California, Berkeley, USA.
| | - M S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program, Research Center-National Institute of Cancer, Rio de Janeiro, Brazil.
| | - G Scelo
- International Agency for Research on Cancer (IARC), Lyon, France.
| | - M T Smith
- School of Public Health, University of California, Berkeley, USA.
| | - J Feusner
- Department of Hematology, Children's Hospital and Research Center Oakland, Oakland, USA.
| | - J L Wiemels
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
| | - C Metayer
- School of Public Health, University of California, Berkeley, USA.
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Kolhe R, Mangaonkar A, Mansour J, Clemmons A, Shaw J, Dupont B, Walczak L, Mondal A, Rojiani A, Jillella A, Kota V. Utility and impact of early t(15;17) identification by Fluorescence In Situ Hybridization (FISH) in clinical decision making for patients in Acute Promyelocytic Leukemia (APL). Int J Lab Hematol 2015; 37:515-20. [PMID: 25639817 DOI: 10.1111/ijlh.12326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Acute Promyelocytic Leukemia (APL) is a curable malignancy with studies showing above 90% survival. However, population-based studies looking at survival suggest that approximately 30% of patients with APL die during induction. Early demonstration of t(15;17) will lead to accurate decision making regarding treatment. The aim of this project was to validate earlier time frames for the Abbott Molecular Vysis LSI promyelocytic leukemia (PML)/ retinoic acid receptor alpha (RARA) fluorescence in situ hybridization (FISH) probe (ASR 6-16 h). METHODS Twenty patients (15 APL cases and five non-APL cases) were selected for validating various hybridization times for the FISH probe. Expected normal signal pattern was two red and two green signals (2R2G), and the most common expected abnormal signal pattern was two fusion (yellow) signals, one red and one green (2F1R1G) and/or one fusion, one red and one green (1F1R1G). RESULTS The specificity of the probe ranged from 84% at 2 h, 86% at 4 h, 84% at 6 h, and 87% for overnight hybridization. The sensitivity increased from 79% at 2 h, 80% at 4 h, 81% at 6 h to 87% for overnight hybridization. CONCLUSION Based on the validation studies, we recommend reading of FISH results at the 4-h incubation mark for a preliminary diagnosis and confirmation with overnight hybridization.
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Affiliation(s)
- R Kolhe
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - A Mangaonkar
- Department of Internal Medicine, Georgia Regents University Cancer Center, Augusta, GA, USA
| | - J Mansour
- Department of Internal Medicine, Georgia Regents University Cancer Center, Augusta, GA, USA
| | - A Clemmons
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - J Shaw
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - B Dupont
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - L Walczak
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - A Mondal
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - A Rojiani
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - A Jillella
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - V Kota
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
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A Multicenter Experience from Lebanon in Childhood and Adolescent Acute Myeloid Leukemia: High rate of Early Death in Childhood Acute Promyelocytic Leukemia. Mediterr J Hematol Infect Dis 2015; 7:e2015012. [PMID: 25574371 PMCID: PMC4283923 DOI: 10.4084/mjhid.2015.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/12/2014] [Indexed: 12/12/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is a disease with marked heterogeneity. Despite major improvement in outcome, it remains a life-threatening malignancy. Demographic and clinical data on pediatric AML is lacking among the Lebanese population. Purpose We aimed to identify clinical, molecular and outcome data in children with AML in Lebanon. Methods A retrospective chart review of children with AML diagnosed in three Lebanese hospitals during the past 8 years was conducted. Results From May 2002 through March 2010, we identified 24 children with AML in Saint George Hospital University Medical Center, University Medical Center Rizk Hospital, and Abou-Jaoude Hospital. Males and females were equally represented; median age at diagnosis was 9 years (range 1–24) and median WBC at diagnosis was 31 × 109/L (range: 2.1–376 × 109/L). Twenty five percent of patients (6 out of 24) had acute promyelocytic leukemia (APL). Karyotype was normal in 33% of patients; t(8;21), inv (16), t(8;9), t(7;11), t(9;11), complex chromosomal abnormality, monosomy 7 and trisomy 8 were the most common cytogenetic abnormalities encountered. Patients were treated on different European and North American protocols. Twelve patients (50%) achieved morphologic CR after cycle 1, 6 of them (50%) had bone marrow relapse within 11 months from diagnosis. Nine patients underwent allogeneic stem cell transplant, and 3 of them are alive at 5 years post-transplant. Early death rate was 16.6% of patients, mainly those with APL and a presenting WBC > 10 × 109/L. Fifty per cent of APL patients had an early death due to DIC despite starting ATRA therapy. Overall, median survival for AML patients who died from disease progression was 25.8 months (range: 1–60 months). Overall disease-free survival was 30.4%. Patients < 10 years of age had a 50% survival rate compared to 0% in patients > 10 years. Conclusions Our report highlights the needs in Lebanon for better supportive care of children with APL, including faster ATRA administration and, aggressive transfusions, easy access to stem cell transplant for high-risk AML patients and the need for a national homogenous treatment strategy for children with AML.
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