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Oh I, Hatano K, Ikeda T, Toda Y, Minakata D, Kawaguchi S, Morita K, Yamamoto C, Ashizawa M, Sato K, Kameda K, Gomyo A, Misaki Y, Kawamura S, Kimura S, Kobayashi H, Sato H, Nakasone H, Ohmine K, Fujiwara S, Kako S, Kanda Y. Phase 2 trial of induction with dasatinib and consolidation with hyper-CVAD plus dasatinib followed by allografting for Ph-positive acute lymphoblastic leukemia in adults. Leuk Res 2024; 137:107438. [PMID: 38278044 DOI: 10.1016/j.leukres.2024.107438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/20/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Affiliation(s)
- Iekuni Oh
- Department of Hematology, Yuai Memorial Hospital, Koga 306-0232, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Shinichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Kazuaki Kameda
- Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Ayumi Gomyo
- Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Yukiko Misaki
- Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Shunto Kawamura
- Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Shunichi Kimura
- Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Hiroyuki Kobayashi
- Department of Hematology, Nasu Red Cross Hospital, Tochigi 324-8686, Japan
| | - Hiroyuki Sato
- Department of Hematology, Saitama Red Cross Hospital, Saitama 330-8553, Japan
| | - Hideki Nakasone
- Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Shinichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Shinichi Kako
- Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 329-0498, Japan; Division of Hematology, Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan.
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2
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Muacevic A, Adler JR, Miranda CJ, Gravina M. Ponatinib-Induced Cerebrovascular Accident (CVA). Cureus 2022; 14:e32383. [PMID: 36632247 PMCID: PMC9829188 DOI: 10.7759/cureus.32383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Ponatinib is a highly potent tyrosine kinase inhibitor shown to have excellent outcomes in the treatment of acute and chronic leukemias. Despite its high efficacy, ponatinib has been shown to carry an increased risk for cardiovascular adverse events, not attributable to a known mechanism. We present a case of a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) who developed a cerebrovascular condition while receiving maintenance therapy with the lowest treatment dose of ponatinib for a prolonged duration.
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3
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Wu C, Zeng M, Chen Y, Wu Y. Tyrosine kinase inhibitors and reduced-dose chemotherapy for adult Philadelphia chromosome-positive acute lymphoblastic leukemia. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:1032-1040. [PMID: 36083141 DOI: 10.1080/16078454.2022.2119344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives: To compare the outcomes of tyrosine kinase inhibitors (TKIs) in combination with reduced-dose chemotherapy with those of standard induction chemotherapy, as well as the outcomes between chemotherapy and transplantation, in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL).Methods: We retrospectively reviewed cases of Ph+ ALL treated with TKIs and combination chemotherapy. The patients were allocated to either the TKIs with reduced-dose chemotherapy group or the TKIs with standard chemotherapy group. In additions, patients were further stratified into either the transplant group or the non-transplant group.Results: The complete remission rate (88.7% vs. 83.9%, p = 0.372), major molecular response (58.9% vs. 56.0%, p = 0.750), molecular complete response (20.5% vs. 22.0%, p = 0.891), and early mortality rate (3.2% vs. 3.5%, p = 0.922) were similar between the TKIs with reduced-dose chemotherapy group and the TKIs with standard chemotherapy group. The proportions of lung infections, bloodstream infections, patients with >21 days of hospitalization, the total costs, transfusion costs, and antimicrobial costs were higher in the standard chemotherapy group than in the TKIs with reduced-dose chemotherapy group. The 3-year overall survival rates (59.0% [95% CI, 46.6-74.7%] vs. 38.4% [95% CI, 29.9-49.4%]) and disease-free survival rates (48.6% [95% CI, 34.2-69.1%] vs. 32.0% [95% CI, 23.5-43.7%]) were significantly better in the transplant group than in the non-transplant group.Conclusion: An induction regimen combining TKIs with reduced-dose chemotherapy and transplantation during the first complete remission remains a suitable and effective option for patients with Ph+ ALL.
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Affiliation(s)
- Chunping Wu
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Mengting Zeng
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yuanzhong Chen
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yong Wu
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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4
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Daghri S, Bendari M, Belmoufid N, Yahyaoui A, Ahnach M. An Unusual Presentation of Extramedullary Relapse Following Blinatumomab in Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia. Cureus 2022; 14:e23262. [PMID: 35449608 PMCID: PMC9013240 DOI: 10.7759/cureus.23262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
In adult patients, extramedullary relapse (EMR) in B-acute lymphoblastic leukemia (B-ALL) has a pejorative prognosis, especially after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Blinatumomab, a bispecific CD3/CD19 antibody, is approved for relapsed/refractory acute lymphoblastic leukemia (ALL) and has proven its efficacy with good complete response (CR) rates and molecular responses in several trials. Unusual sites of relapse following treatment with blinatumomab for ALL are rarely reported. We describe the case of a 23-year-old male with B-ALL characterized as Philadelphia chromosome-positive without extramedullary lesions at diagnosis. He benefited from a matched-related donor allo-HSCT at first remission. A relapse in the bone marrow and central nervous system was diagnosed four months later. A treatment with blinatumomab was initiated with the obtention of CR after one cycle. During the third cycle of blinatumomab, multiple sites of EMR occurred initially with a painless swelling appearing in the areolas and the nipples, followed by bilateral testicular hypertrophy and moderate paraplegia. A diagnosis of leukemic infiltration on the areola-nipple complex was made by cytological analysis of the fine-needle aspiration of the left areola. The analysis of bone marrow was normal, but molecular BCR-ABL was positive. Systemic chemotherapy with hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and cycles of blinatumomab with nilotinib was initiated in association with intrathecal chemotherapy and whole-brain radiation therapy. Clinical, molecular, and central nervous remissions were obtained. We report this case to describe multiple sites of EMR of B-ALL with atypical breast infiltration in an adult male patient following treatment with blinatumomab.
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5
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Song F, Xu J, Dixon J, Yue F. Analysis of Hi-C Data for Discovery of Structural Variations in Cancer. Methods Mol Biol 2022; 2301:143-161. [PMID: 34415534 PMCID: PMC9890901 DOI: 10.1007/978-1-0716-1390-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Structural variations (SVs) are large genomic rearrangements that can be challenging to identify with current short read sequencing technology due to various confounding factors such as existence of genomic repeats and complex SV structures. Hi-C breakfinder is the first computational tool that utilizes the technology of high-throughput chromatin conformation capture assay (Hi-C) to systematically identify SVs, without being interfered by regular confounding factors. SVs change the spatial distance of genomic regions and cause discontinuous signals in Hi-C, which are difficult to analyze by routine informatics practice. Here we provide step-by-step guidance for how to identify SVs using Hi-C data and how to reconstruct Hi-C maps in the presence of SVs.
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Affiliation(s)
- Fan Song
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Bioinformatics and Genomics Graduate Program, Huck Institutes of the Life Sciences, Penn State University, State College, PA, USA
| | - Jie Xu
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jesse Dixon
- Peptide Biology Lab, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Feng Yue
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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6
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Lyu M, Jiang E, He Y, Yang D, Ma Q, Pang A, Zhai W, Wei J, Huang Y, Zhang G, Zhang R, Feng S, Han M. Comparison of autologous and allogeneic stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. ACTA ACUST UNITED AC 2021; 26:65-74. [PMID: 33402056 DOI: 10.1080/16078454.2020.1868783] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: To analyze the outcomes of patients who received autologous stem cell transplantation (auto-SCT), matched sibling donor stem cell transplantation (MSD-SCT) and haploidentical stem cell transplantation (haplo-SCT) and provide the basis for the choice of transplantation method in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Methods: We retrospectively investigated the outcomes of 119 adult patients with Ph+ ALL in our center. The overall survival (OS) rate, leukemia-free survival (LFS) rate, cumulative incidence of relapse (CIR) rate, non-relapse mortality (NRM) rate and the impact of achievement of complete molecular response (CMR) within 3 months and sustaining CMR up to transplantation (s3CMR) on transplantation method were explored. Results: The estimated OS, LFS, CIR and NRM rates at 3 years were not significantly different among three groups (p = 0.960, 0.917, 0.375 and 0.096, respectively). For the 65 patients who achieved s3CMR, there was no significant difference in OS (84.5% vs 72.5% vs 100%, p = 0.374), LFS (75.2% vs 64.5% vs 83.3%, p = 0.668), CIR (17.2% vs 8.1% vs 16.7%, p = 0.583) and NRM (3.1% vs 23.4% vs 0%, p = 0.055) among auto-SCT group, MSD-SCT group and haplo-SCT group. However, in patients who did not achieve s3CMR, auto-SCT recipients tended to have higher CIR (60% vs 33.2% vs 24.0%, p = 0.013) than the allo-HSCT group. Conclusions: Auto-SCT with maintenance therapy after HSCT appears to be an attractive treatment option for patients with Ph+ ALL especially for those whose s3CMR was kept up to transplantation. For non-s3CMR patients, allogeneic transplantation may be more effective from lower relapse.
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Affiliation(s)
- Mengnan Lyu
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Erlie Jiang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yi He
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Donglin Yang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Qiaoling Ma
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Aiming Pang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Weihua Zhai
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jialin Wei
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yong Huang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Guixin Zhang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Rongli Zhang
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Sizhou Feng
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Mingzhe Han
- National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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7
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Li X, Ping N, Wang Y, Xu X, Gao L, Zeng Z, Zhang L, Zhang Z, Xie Y, Ruan C, Wu D, Jin Z, Chen S. Case Report: A Case With Philadelphia Chromosome Positive T-Cell Lymphoblastic Lymphoma and a Review of Literature. Front Oncol 2021; 10:584149. [PMID: 33552960 PMCID: PMC7857119 DOI: 10.3389/fonc.2020.584149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
Philadelphia chromosome positive (Ph+) in T-lineage acute lymphoproliferative tumors is a rare event in both children and adults. In particular, it has not been reported in T-cell lymphoblastic lymphoma(T-LBL) yet. Here, we describe a patient with Ph+ T-LBL for both cytogenetic abnormality and BCR-ABL1 fusion transcript. Moreover, we review the published cases of Ph+ T-cell acute lymphoblastic leukemia (T-ALL) in the literature and summarize their clinical characteristics, management, and prognosis.
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Affiliation(s)
- Xuewei Li
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Department of Thrombosis and Hemostasis, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Nana Ping
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yong Wang
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Department of Thrombosis and Hemostasis, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Xiaoyu Xu
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Department of Thrombosis and Hemostasis, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Lijuan Gao
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Department of Thrombosis and Hemostasis, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Zhao Zeng
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China
| | - Ling Zhang
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China
| | - Zhibo Zhang
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China
| | - Yiyu Xie
- Department of Internal Medicine, Yale New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States
| | - Changgeng Ruan
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Department of Thrombosis and Hemostasis, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Department of Thrombosis and Hemostasis, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Zhengming Jin
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Suning Chen
- Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.,Department of Thrombosis and Hemostasis, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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8
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Farweez BAT, Kassim NA, Abdelfataah MF, Hassan NM, Hassnien DEA, El-Sakhawy YN. Clinical impact of early minimal residual disease detection at day 15 in precursor B-childhood acute lymphoblastic leukemia: an Egyptian experience. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2020. [DOI: 10.1186/s43042-020-00065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chromosomal abnormalities in childhood acute lymphoblastic leukemia (ALL) are well-established prognostic markers and useful tools for minimal residual disease (MRD) assessment. This study aimed to stratify high-risk precursor B-childhood ALL (pre-B-ALL) patients according to standard prognostic factors (age and total leucocytic count), fluorescence in situ hybridization (FISH) analysis for these cytogenetic abnormalities [t (9;22) BCR/ABL, t(1;19)TCF3/PBX1, and 11q23 MLL gene rearrangement], and MRD status at day 15. Besides, we aimed to demonstrate the relation of these prognostic factors (standard and cytogenetic risk groups) to patients’ outcome at day 15 of induction therapy as well as exploring the impact of early MRD assessment during remission induction compared to other prognostic factors together with the ability to tailor investigations as needed especially in places with limited health resources without compromising the outcome. Seventy-two newly-diagnosed Egyptian children with pre-B-ALL, aged 6 months to 15.5 years, registered from February 2016 to February 2018 were included. They were treated according to the modified Children’s Oncology Group (COG) protocol. Patients were classified into (a) standard and high-risk groups according to standard prognostic factors. (b) Patients with the studied cytogenetic abnormalities and patients without the studied cytogenetic abnormalities. (c) Good outcome (negative MRD) and bad outcome (positive MRD) groups according to day 15 MRD status.
Results
The studied cytogenetic abnormalities were identified in 22.2% of patients, all of them were in the high-risk group, and 75% of them had a bad outcome (positive MRD) at day 15 of induction therapy.
Conclusion
Patients with favorable presenting features (standard risk) and undetectable MRD after 2 weeks remission induction therapy would not be in need to advanced molecular studies, while these studies should be considered for patients with high-risk presenting features and high levels of MRD after 2 weeks remission induction therapy. Therefore, this could provide a cost-effective guideline in countries suffering from financial challenges without affecting the outcome
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9
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Xing C, Xu W, Shi Y, Zhou B, Wu D, Liang B, Zhou Y, Gao S, Feng J. CD9 knockdown suppresses cell proliferation, adhesion, migration and invasion, while promoting apoptosis and the efficacy of chemotherapeutic drugs and imatinib in Ph+ ALL SUP‑B15 cells. Mol Med Rep 2020; 22:2791-2800. [PMID: 32945456 PMCID: PMC7453647 DOI: 10.3892/mmr.2020.11350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 06/26/2020] [Indexed: 11/06/2022] Open
Abstract
Philadelphia chromosome‑positive acute lymphoblastic leukemia (Ph+ ALL) is regarded as a prognostically unfavorable subgroup, as this ALL subgroup has an increased risk of relapse/refractory disease. CD9, which belongs to the tetraspanin membrane proteins, is implicated in several pathological processes, including tumor progression. However, the role of CD9 in the pathogenesis of Ph+ ALL and the potential benefit of applying CD9‑targeted RNA interference strategies for treatment of Ph+ ALL require further investigation. The aim of the present study was to determine the effects of CD9 on leukemic cell progression and the efficacy of therapeutic agents in Ph+ ALL cells, in addition to assessing the in vitro anti‑leukemia activity of CD9‑targeted RNA interference in Ph+ ALL cells. In the present study, a lentiviral short hairpin RNA (shRNA) expression vector targeting CD9 gene in Ph+ ALL SUP‑B15 cells was constructed. The present results demonstrated that treatment of SUP‑B15 cells with lentiviral‑mediated shRNA against CD9 decreased CD9 mRNA and protein expression compared with the shControl cells transduced with a blank vector. In addition, CD9 knockdown could suppress cell proliferation, adhesion, migration and invasion, and promote apoptosis and the efficacy of chemotherapeutic drugs (such as vincristine, daunorubicin, cyclophosphamide and dexamethasone) and the tyrosine kinase inhibitor imatinib in SUP‑B15 cells. Furthermore, CD9 knockdown suppressed cell proliferation and promoted apoptosis in SUP‑B15 cells via a p53‑dependent pathway. These findings suggested that gene silencing of CD9 using a shRNA‑expressing lentivirus vector may provide a promising treatment for Ph+ ALL.
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Affiliation(s)
- Chongyun Xing
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Wanling Xu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yifen Shi
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Bin Zhou
- Laboratory of Internal Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Dijiong Wu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Bin Liang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuhong Zhou
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Shenmeng Gao
- Laboratory of Internal Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Jianhua Feng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
- Department of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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10
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[Comparison of autologous versus matched sibling donor stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:373-378. [PMID: 32536133 PMCID: PMC7342073 DOI: 10.3760/cma.j.issn.0253-2727.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
目的 比较自体造血干细胞移植(auto-HSCT)和同胞全相合造血干细胞移植(MSD-HSCT)治疗费城染色体阳性急性淋巴细胞白血病(Ph+ ALL)的疗效,为患者移植方式的选择提供依据。 方法 回顾性总结2008年1月至2017年12月于中国医学科学院血液病医院行auto-HSCT(31例)及MSD-HSCT(47例)的78例Ph+ ALL患者的临床特征,比较不同移植方式患者的总生存(OS)率、无白血病生存(LFS)率、累积复发率(CIR)及非复发死亡率(NRM),并观察是否3个月内实现完全分子学缓解并持续至移植(s3CMR)条件下不同移植方式对预后的影响。 结果 auto-HSCT组、MSD-HSCT组粒细胞植入的中位时间分别为12(10~29)d、14(11~24)d(P=0.006),血小板植入的中位时间分别为17.5(10~62)d、17(10~33)d(P=0.794)。MSD-HSCT组中,Ⅱ~Ⅳ度和Ⅲ~Ⅳ度急性移植物抗宿主病(GVHD)的发生率分别为27.7%(13/47)和8.5%(4/47),局限型和广泛型慢性GVHD的发生率为17.0%(8/47)和12.8%(6/47)。auto-HSCT组、MSD-HSCT组3年CIR、NRM、LFS率差异均无统计学意义(P值均>0.05)。在达到s3CMR的44例患者中,auto-HSCT组和MSD-HSCT组的3年OS率[(84.0±8.6)%对(78.0±8.7)%,P=0.612]、LFS率[(70.3±10.3)%对(68.2±10.1)%,P=0.970]、CIR[(24.9±10.0)%对(14.4±8.0)%,P=0.286]和NRM[(4.7±4.7)%对(17.4±8.1)%,P=0.209]差异均无统计学意义;未达到s3CMR的34例患者中,auto-HSCT组与MSD-HSCT组相比,3年CIR明显升高[(80.0±14.7)%对(39.6±10.9)%,P=0.057]。 结论 对于化疗后达s3CMR的Ph+ ALL患者,auto-HSCT是一种有效的巩固治疗选择,与MSD-HSCT疗效相当;对于未达到s3CMR的患者,MSD-HSCT复发率更低。
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Santana-Bejarano UF, Bobadilla-Morales L, Mendoza-Maldonado L, Torres-Anguiano E, Brukman-Jiménez SA, Barba-Barba CC, Corona-Rivera JR, Corona-Rivera A. In vitro effect of curcumin in combination with chemotherapy drugs in Ph + acute lymphoblastic leukemia cells. Oncol Lett 2019; 17:5224-5240. [PMID: 31186739 DOI: 10.3892/ol.2019.10204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/29/2018] [Indexed: 12/19/2022] Open
Abstract
Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), is characterized by the t(9;22)(q34q11) that generates the BCR-ABL protein with uncontrolled tyrosine kinase activity. Recently, a connection between BCR-ABL signaling with NF-κB activation mediated by CK2 has been hypothesized. Approximately 95% of patients with Ph+ ALL have the BCR-ABLp190 isoform, which causes aggressive leukemia with a high rate of chemotherapy resistance. Therefore, the use of compounds that could improve the efficacy of chemotherapy drugs is of particular interest. Curcumin is an active chemical in turmeric with antineoplastic potential; it regulates protein-kinases by modulating downstream molecular pathways. The present study evaluated the effect of curcumin in combination with the chemotherapeutic drugs vincristine, imatinib and daunorubicin in the human OP-1 cell line. Several doses of the chemotherapy drugs were examined, and the effects were evaluated following 12, 24 and 48 h of exposure. The interaction between the chemotherapy drugs and curcumin was determined by the dose-effect curve, which generated a combination index (CI); these data were represented in isobolograms. In addition, the individual effect of each drug was compared with its effect in combination with curcumin on cell viability, apoptosis degree, NF-κB activation and gene expression changes. The present study observed that curcumin potentiates the efficacy of vincristine and imatinib, generating an additive/synergistic effect in a dose- and time-dependent manner. These combinations significantly increased the apoptosis degree, decreased the activation of NF-κB and the expression of its regulated genes. Conversely treatment with daunorubicin + curcumin combination produced an antagonistic/additive effect in a dose-dependent manner, and this combination significantly increased the apoptosis degree. However, this effect seems not to be associated with NF-κB activity, as no significant changes were observed in its activation or in the expression of the genes that it regulates. The results of the present study demonstrate that curcumin may be used as an adjuvant agent for chemotherapy in patients with Ph+ ALL.
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Affiliation(s)
- Uriel Francisco Santana-Bejarano
- Cytogenetics and Genomics Laboratory, Human Genetics Institute 'Dr. Enrique Corona Rivera', Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,PhD Program in Molecular Biology and Human Genetics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México
| | - Lucina Bobadilla-Morales
- Cytogenetics and Genomics Laboratory, Human Genetics Institute 'Dr. Enrique Corona Rivera', Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,PhD Program in Molecular Biology and Human Genetics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,Cytogenetics Unit, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco 44340, México
| | - Lucero Mendoza-Maldonado
- Cytogenetics and Genomics Laboratory, Human Genetics Institute 'Dr. Enrique Corona Rivera', Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,PhD Program in Molecular Biology and Human Genetics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México
| | - Elizabeth Torres-Anguiano
- Cytogenetics and Genomics Laboratory, Human Genetics Institute 'Dr. Enrique Corona Rivera', Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,PhD Program in Molecular Biology and Human Genetics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México
| | - Sinhue Alejandro Brukman-Jiménez
- Cytogenetics and Genomics Laboratory, Human Genetics Institute 'Dr. Enrique Corona Rivera', Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,PhD Program in Molecular Biology and Human Genetics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México
| | - Cesar Cenobio Barba-Barba
- Cytogenetics Unit, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco 44340, México
| | - Jorge Román Corona-Rivera
- Cytogenetics and Genomics Laboratory, Human Genetics Institute 'Dr. Enrique Corona Rivera', Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,PhD Program in Molecular Biology and Human Genetics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México
| | - Alfredo Corona-Rivera
- Cytogenetics and Genomics Laboratory, Human Genetics Institute 'Dr. Enrique Corona Rivera', Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,PhD Program in Molecular Biology and Human Genetics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco 44340, México.,Cytogenetics Unit, Dr. Juan I. Menchaca Civil Hospital of Guadalajara, Guadalajara, Jalisco 44340, México
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Chelapareddy LR, Sen S. Philadelphia Translocation in MDS: A Case Report and a Brief Review of the Literature Looking at Its Prevalence, Disease Progression, and Treatment Options. Case Rep Hematol 2018; 2018:5865321. [PMID: 30595928 PMCID: PMC6282134 DOI: 10.1155/2018/5865321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/17/2018] [Accepted: 11/08/2018] [Indexed: 11/27/2022] Open
Abstract
Myelodysplastic syndrome (MDS) is a group of clonal disorders characterized by ineffective and dysplastic hematopoiesis in the bone marrow with variable risk of progression to leukemia. MDS is characterized by specific karyotypic and molecular abnormalities. The t(9 : 22) Philadelphia translocation is not a common abnormality found in MDS, and it is not included in the prognostic indices for germline mutations. There are no definitive treatment guidelines for these patients either. Here, we reviewed previously reported cases of MDS with the Philadelphia translocation with a goal to determine their prognosis and treatment options, specifically the tyrosine kinase inhibitors (TKIs).
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Affiliation(s)
| | - Sandeep Sen
- SSM Health St. Mary's Hospital, St. Louis, Missouri 63117, USA
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13
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Wang D, Shi R, Wang Q, Li J. Extramedullary relapse of acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation treated by CAR T-cell therapy: a case report. Onco Targets Ther 2018; 11:6327-6332. [PMID: 30319272 PMCID: PMC6167997 DOI: 10.2147/ott.s164430] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Philadelphia chromosome-positive (Ph-positive) acute leukemia (ALL) accounts for around one quarter of adult cases of ALL and is usually associated with poor prognosis. The patients still encounter a high rate of relapse even after they receive hematopoietic stem cell transplantation (HSCT). HSCT is considered the established therapy and best option for many malignant ALL cases, however, disease relapse remains the main reason of failure. In recent years, chimeric antigen receptor (CAR) T-cell therapy has become a promising treatment for patients with advanced blood cancers. Here, we report a rare case of a Ph-positive ALL patient with extramedullary relapse in her cervix after receiving allogeneic HSCT. Given the unsatisfactory response to chemotherapy, tyrosine kinase inhibitor (TKI) treatment, and HSCT transplantation, she had received CD19+ CAR T-cell therapy 8 months earlier. The following ultrasound check indicated that her cervix relapse went through significant remission with almost undetectable tumor mass. This case strongly supports the efficacy of CAR T-cell therapy on adult ALL with extramedullary relapse.
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Affiliation(s)
- Dongmei Wang
- Department of Hematology, Harrison International Peace Hospital, Hengshui, Hebei 053000, People's Republic of China,
| | - Rui Shi
- Department of Hematology, Harrison International Peace Hospital, Hengshui, Hebei 053000, People's Republic of China,
| | - Qinglong Wang
- Hebei Senlangbio Technology Co., Ltd, Shijiazhuang, Hebei 050000, People's Republic of China,
| | - Jianqiang Li
- Hebei Senlangbio Technology Co., Ltd, Shijiazhuang, Hebei 050000, People's Republic of China,
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Coccaro N, Anelli L, Zagaria A, Casieri P, Tota G, Orsini P, Impera L, Minervini A, Minervini CF, Cumbo C, Parciante E, Carluccio P, Brunetti C, Specchia G, Albano F. Droplet Digital PCR Is a Robust Tool for Monitoring Minimal Residual Disease in Adult Philadelphia-Positive Acute Lymphoblastic Leukemia. J Mol Diagn 2018; 20:474-482. [DOI: 10.1016/j.jmoldx.2018.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/13/2018] [Accepted: 03/09/2018] [Indexed: 12/16/2022] Open
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15
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Ruiz-Moreno C, Jimenez-Del-Rio M, Sierra-Garcia L, Lopez-Osorio B, Velez-Pardo C. Vitamin E synthetic derivate-TPGS-selectively induces apoptosis in jurkat t cells via oxidative stress signaling pathways: implications for acute lymphoblastic leukemia. Apoptosis 2018; 21:1019-32. [PMID: 27364951 DOI: 10.1007/s10495-016-1266-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
D-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) is a water-soluble derivative of natural vitamin E commonly used as a drug delivery agent. Recently, TPGS alone has been reported to induce cell death in lung, breast and prostate cancer. However, the effect of TPGS on cancer cell viability remains unclear. Thus, this study was aimed to evaluate the cytotoxic effect of TPGS on human periphral blood lymphocytes (PBL) and on T cell acute lymphocytic leukemia (ALL) Jurkat clone E6-1 cells and its possible mechanism of action. PBL and Jurkat cells were treated with TPGS (10, 20, 40, 60, and 80 μM), and morphological changes in the cell nucleus, mitochondrial membrane potential (ΔΨm), and intracellular reactive oxygen species levels were determined by immune-fluorescence microscopy and flow cytometry. Cellular apoptosis markers were also evaluated by immunocytochemistry. In this study, TPGS induced apoptotic cell death in Jurkat cells, but not in PBL, in a dose-response manner with increasing nuclear DNA fragmentation, increasing cell cycle arrest, and decreasing ΔΨm. Additionally, TPGS increased dichlorofluorescein fluorescence intensity, indicative of H2O2 production, in a dose-independent fashion. TPGS increased DJ-1 Cys(106)-sulfonate, as a marker of intracellular stress and induced the activation of NF-κB, p53 and c-Jun transcription factors. Additionally, it increased the expression of apoptotic markers Bcl-2 related pro-apoptotic proteins Bax and PUMAand activated caspase-3. The antioxidant N-acetyl-L-cysteine and known pharmacological inhibitors protected the cells from the TPGS induced effects. In conclusion, TPGS selectively induces apoptosis in Jurkat cells through two independent but complementary H2O2-mediated signaling pathways. Our findings support the use of TPGS as a potential treatment for ALL.
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Affiliation(s)
- Cristian Ruiz-Moreno
- Neuroscience Research Group, Faculty of Medicine, Medical Research Institute, University of Antioquia, Calle 70 N° 52-21, and Calle 62 #52-59, Building 1, Room 412, SIU, P. O. Box 1226, Medellín, Colombia
| | - Marlene Jimenez-Del-Rio
- Neuroscience Research Group, Faculty of Medicine, Medical Research Institute, University of Antioquia, Calle 70 N° 52-21, and Calle 62 #52-59, Building 1, Room 412, SIU, P. O. Box 1226, Medellín, Colombia
| | - Ligia Sierra-Garcia
- Material Science Group, Faculty of Chemistry, University of Antioquia, Calle 70 N° 52-21, and Calle 62 #52-59, Building 1, Room 310, SIU, P. O. Box 1226, Medellin, Colombia
| | - Betty Lopez-Osorio
- Material Science Group, Faculty of Chemistry, University of Antioquia, Calle 70 N° 52-21, and Calle 62 #52-59, Building 1, Room 310, SIU, P. O. Box 1226, Medellin, Colombia
| | - Carlos Velez-Pardo
- Neuroscience Research Group, Faculty of Medicine, Medical Research Institute, University of Antioquia, Calle 70 N° 52-21, and Calle 62 #52-59, Building 1, Room 412, SIU, P. O. Box 1226, Medellín, Colombia.
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16
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Reckel S, Gehin C, Tardivon D, Georgeon S, Kükenshöner T, Löhr F, Koide A, Buchner L, Panjkovich A, Reynaud A, Pinho S, Gerig B, Svergun D, Pojer F, Güntert P, Dötsch V, Koide S, Gavin AC, Hantschel O. Structural and functional dissection of the DH and PH domains of oncogenic Bcr-Abl tyrosine kinase. Nat Commun 2017; 8:2101. [PMID: 29235475 PMCID: PMC5727386 DOI: 10.1038/s41467-017-02313-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022] Open
Abstract
The two isoforms of the Bcr-Abl tyrosine kinase, p210 and p190, are associated with different leukemias and have a dramatically different signaling network, despite similar kinase activity. To provide a molecular rationale for these observations, we study the Dbl-homology (DH) and Pleckstrin-homology (PH) domains of Bcr-Abl p210, which constitute the only structural differences to p190. Here we report high-resolution structures of the DH and PH domains and characterize conformations of the DH-PH unit in solution. Our structural and functional analyses show no evidence that the DH domain acts as a guanine nucleotide exchange factor, whereas the PH domain binds to various phosphatidylinositol-phosphates. PH-domain mutants alter subcellular localization and result in decreased interactions with p210-selective interaction partners. Hence, the PH domain, but not the DH domain, plays an important role in the formation of the differential p210 and p190 Bcr-Abl signaling networks.
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Affiliation(s)
- Sina Reckel
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Charlotte Gehin
- Structural and Computational Biology Unit, European Molecular Biology Laboratory (EMBL), 69117, Heidelberg, Germany
| | - Delphine Tardivon
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Sandrine Georgeon
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Tim Kükenshöner
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Frank Löhr
- Institute of Biophysical Chemistry, Goethe University Frankfurt, 60438, Frankfurt, Germany
| | - Akiko Koide
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, 10016, USA
- Department of Medicine, New York University School of Medicine, New York, NY, 10016, USA
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, 10016, USA
| | - Lena Buchner
- Institute of Biophysical Chemistry, Goethe University Frankfurt, 60438, Frankfurt, Germany
| | - Alejandro Panjkovich
- European Molecular Biology Laboratory (EMBL), Hamburg Outstation, 22607, Hamburg, Germany
| | - Aline Reynaud
- Protein Crystallography Core Facility, School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Sara Pinho
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Barbara Gerig
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Dmitri Svergun
- European Molecular Biology Laboratory (EMBL), Hamburg Outstation, 22607, Hamburg, Germany
| | - Florence Pojer
- Protein Crystallography Core Facility, School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Peter Güntert
- Institute of Biophysical Chemistry, Goethe University Frankfurt, 60438, Frankfurt, Germany
- Laboratory of Physical Chemistry, ETH Zürich, 8093, Zürich, Switzerland
- Graduate School of Science, Tokyo Metropolitan University, Tokyo, 192-0397, Japan
| | - Volker Dötsch
- Institute of Biophysical Chemistry, Goethe University Frankfurt, 60438, Frankfurt, Germany
| | - Shohei Koide
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, 10016, USA
- Department of Medicine, New York University School of Medicine, New York, NY, 10016, USA
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, 10016, USA
| | - Anne-Claude Gavin
- Structural and Computational Biology Unit, European Molecular Biology Laboratory (EMBL), 69117, Heidelberg, Germany
| | - Oliver Hantschel
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland.
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17
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Igwe IJ, Yang D, Merchant A, Merin N, Yaghmour G, Kelly K, Ramsingh G. The presence of Philadelphia chromosome does not confer poor prognosis in adult pre-B acute lymphoblastic leukaemia in the tyrosine kinase inhibitor era - a surveillance, epidemiology, and end results database analysis. Br J Haematol 2017; 179:618-626. [PMID: 29047122 DOI: 10.1111/bjh.14953] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/06/2017] [Indexed: 01/04/2023]
Abstract
The BCR-ABL1 fusion gene is caused by a translocation between chromosomes 9 and 22, resulting in an abnormal chromosome 22 (Philadelphia chromosome; Ph). Prior to the introduction of tyrosine kinase inhibitors (TKI), the presence of BCR-ABL1 conferred a poor prognosis in patients with acute lymphoblastic leukaemia (ALL). We compared the survival of Ph+ and Ph-ALL during the period when TKIs were universally available in the US for Ph+ALL, using a Surveillance, Epidemiology, and End Results (SEER) Database analysis. A total of 2694 patients with pre-B ALL (206 Ph+ALL; 2488 Ph-ALL) aged ≥18 years, who were diagnosed between 2010 and 2014, were identified in SEER registries. The median overall survival (OS) was 32 months in Ph+ALL (95% confidence interval [CI] 18 months-not reached) and 27 months (95% CI 24-30 months) in Ph-ALL (Log-rank test P-value 0·34). Older age was associated with worse prognosis in both Ph+ALL and Ph-ALL. Age-adjusted OS was inferior in Hispanics and African-Americans compared to non-Hispanic whites. Survival of pre-B ALL shows continued improvement with time. Philadelphia chromosome status does not confer poor prognosis in pre-B ALL in the TKI era: prognostic factors in pre-B ALL should be re-evaluated in the light of this finding.
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Affiliation(s)
- Igwe J Igwe
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Dongyun Yang
- Biostatistics Core, Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Akil Merchant
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Noah Merin
- Blood and Marrow Transplant Program, Cedar-Sinai Medical Center, Los Angeles, CA, USA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kevin Kelly
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Giridharan Ramsingh
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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18
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Reckel S, Hantschel O. Bcr-Abl: one kinase, two isoforms, two diseases. Oncotarget 2017; 8:78257-78258. [PMID: 29108223 PMCID: PMC5667957 DOI: 10.18632/oncotarget.20874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- Sina Reckel
- Oliver Hantschel: Swiss Institute for Experimental Cancer Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Oliver Hantschel
- Oliver Hantschel: Swiss Institute for Experimental Cancer Research, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Ruxolitinib/nilotinib cotreatment inhibits leukemia-propagating cells in Philadelphia chromosome-positive ALL. J Transl Med 2017; 15:184. [PMID: 28854975 PMCID: PMC5577751 DOI: 10.1186/s12967-017-1286-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022] Open
Abstract
Background As one of the major treatment obstacles in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL), relapse of Ph+ALL may result from the persistence of leukemia-propagating cells (LPCs). Research using a xenograft mouse assay recently determined that LPCs were enriched in the CD34+CD38−CD58− fraction in human Ph+ALL. Additionally, a cohort study demonstrated that Ph+ALL patients with a LPCs phenotype at diagnosis exhibited a significantly higher cumulative incidence of relapse than those with the other cell phenotypes even with uniform front-line imatinib-based therapy pre- and post-allotransplant, thus highlighting the need for novel LPCs-based therapeutic strategies. Methods RNA sequencing (RNA-Seq) and real-time quantitative polymerase chain reaction (qRT-PCR) were performed to analyze the gene expression profiles of the sorted LPCs and other cell fractions from patients with de novo Ph+ALL. In order to assess the effects of the selective BCR–ABL and/or Janus kinase (JAK)2 inhibition therapy by the treatment with single agents or a combination of ruxolitinib and imatinib or nilotinib on Ph+ALL LPCs, drug-induced apoptosis of LPCs was investigated in vitro, as well as in vivo using sublethally irradiated and anti-CD122-conditioned NOD/SCID xenograft mouse assay. Moreover, western blot analyses were performed on the bone marrow cells harvested from the different groups of recipient mice. Results RNA-Seq and qRT-PCR demonstrated that JAK2 was more highly expressed in the sorted LPCs than in the other cell fractions in de novo Ph+ALL patients. Combination treatment with a selective JAK1/JAK2 inhibitor (ruxolitinib) and nilotinib more effectively eliminated LPCs than either therapy alone or both in vitro and in humanized Ph+ALL mice by reducing phospho-CrKL and phospho-JAK2 activities at the molecular level. Conclusions In summary, this pre-clinical study provides a scientific rationale for simultaneously targeting BCR–ABL and JAK2 activities as a promising anti-LPCs therapeutic approach for patients with de novo Ph+ALL.
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Abstract
Acute lymphoblastic leukemia (ALL) is characterized by a great biological and clinical heterogeneity. Despite most adult patients enter complete hematologic remission after induction therapy only 40% survive five or more years. Over the last 20 years, the definition of an accurate biologic leukemia profile and the minimal residual disease evaluation in addition to conventional risk criteria led to a significant improvement for the risk stratification. The alterations of the oncosuppressor gene TP53, including deletions, sequence mutations and defect in its expression due to regulatory defects, define a new important predictor of adverse outcome. More recently, new drugs have been developed with the aim of targeting p53 protein itself or its regulatory molecules, such as Mdm2, and restoring the pathway functionality. Therefore, TP53 alterations should be considered in the diagnostic work-up to identify high risk ALL patients in need of intensive treatment strategies or eligible for new innovative targeted therapies.
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Affiliation(s)
- Silvia Salmoiraghi
- a Hematology and Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy
| | - Alessandro Rambaldi
- a Hematology and Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy.,b Department of Hematology-Oncology , University of Milan , Milan , Italy
| | - Orietta Spinelli
- a Hematology and Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy
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21
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Aref S, Mohamed T, Fouda M, El-Aziz SA, Hamid DA. Clinicopathological impact of CD20 expression in childhood B cell precursor acute lymphoblastic leukemia (BCP-ALL). COMPARATIVE CLINICAL PATHOLOGY 2017; 26:943-949. [DOI: 10.1007/s00580-017-2469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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22
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Dai Y, Shuai X, Kuang P, Wang L, Liu T, Niu T. Philadelphia chromosome with acute myeloid leukemia and concurrent large B cell lymphoma of different origins: A case report. Oncol Lett 2017; 13:1189-1193. [PMID: 28454232 PMCID: PMC5403225 DOI: 10.3892/ol.2017.5578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/03/2016] [Indexed: 02/05/2023] Open
Abstract
Philadelphia chromosome with de novo acute myeloid leukemia (Ph + AML) arising from t(9;22) is an uncommon occurrence. Ph + AML is known to respond poorly to conventional chemotherapy. To the best of our knowledge, simultaneous diagnosis of de novo Ph + AML and lymphoma in a single patient has not yet been reported. The present study reports the case of a 37-year-old female patient who presented with bone pain, fever and lymphadenopathy, and was diagnosed as Ph + AML with concurrent diffuse large B cell lymphoma. Combined chemotherapy regimen covering AML and lymphoma was administered, achieving short-term response. However, the therapy soon failed and the patient succumbed to the disease. The present study reports the first case of Ph + AML occurring concurrently with diffuse large B cell lymphoma, and discusses certain differences between Ph + AML and chronic myelogenous leukemia in the myeloid blast crisis phase, as well as the appropriate therapeutic modalities for Ph + AML. In addition, the potential association between Ph + AML and diffuse large B cell lymphoma in this patient was investigated.
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Affiliation(s)
- Yang Dai
- Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiao Shuai
- Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Pu Kuang
- Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lin Wang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ting Liu
- Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ting Niu
- Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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23
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Nicolini FE, Basak GW, Kim DW, Olavarria E, Pinilla-Ibarz J, Apperley JF, Hughes T, Niederwieser D, Mauro MJ, Chuah C, Hochhaus A, Martinelli G, DerSarkissian M, Duh MS, McGarry LJ, Kantarjian HM, Cortes JE. Overall survival with ponatinib versus allogeneic stem cell transplantation in Philadelphia chromosome-positive leukemias with the T315I mutation. Cancer 2017; 123:2875-2880. [PMID: 28387926 PMCID: PMC5573914 DOI: 10.1002/cncr.30558] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/05/2016] [Accepted: 12/13/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Effective treatment options for patients with chronic myeloid leukemia (CML) or Philadelphia‐positive (Ph+) acute lymphoblastic leukemia (ALL) who have the threonine to isoleucine mutation at codon 315 (T315I) are few. The objective of this study was to compare overall survival (OS) between patients with CML and those with Ph+ ALL who received treatment with ponatinib versus allogeneic stem cell transplantation (allo‐SCT). METHODS A post hoc, retrospective, indirect comparison of OS among patients who received single‐agent ponatinib in the Ponatinib Ph+ ALL and CML Evaluation (PACE) trial with those who underwent allo‐SCT as reported to the European Bone Marrow Transplant registry, stratified by CML disease phase and Ph+ ALL, was conducted. Kaplan‐Meier survival curves and multivariate Cox proportional‐hazards models were used to compare OS between intervention groups, adjusting for time from diagnosis to intervention, age, sex, and geographic region; 24‐month and 48‐month OS rates and median OS were reported. RESULTS After adjustment for potential confounders, 24‐month and 48‐month OS rates were significantly higher in patients with chronic‐phase CML (CP‐CML) who received ponatinib compared with those who underwent allo‐SCT (24 months: 84% vs 60.5%, respectively; P = .004; 48 months: 72.7% vs 55.8%, respectively; P = .013), with a hazard ratio (HR) of 0.37 (95% confidence interval [CI], 0.16‐0.84; P = .017). In patients who had accelerated‐phase CML, OS rates were not significantly different between the groups (HR, 0.90; 95% CI, 0.20‐4.10; P = .889). In patients who had blast‐crisis CML and those with Ph+ ALL, ponatinib was associated with shorter OS compared with allo‐SCT (blast‐crisis CML: HR, 2.29 [95% CI, 1.08‐4.82; P = .030]; Ph+ ALL: HR, 2.77 [95% CI, 0.73‐10.56; P = .146]). CONCLUSIONS Although allo‐SCT remains an important treatment option for patients with T315I‐positive advanced CML and Ph+ ALL, ponatinib represents a valuable alternative for patients with T315I‐positive CP‐CML. Cancer 2017;123:2875–80. © 2017 American Cancer Society. In patients who have chronic‐phase chronic myeloid leukemia (CML) with the Philadelphia chromosome threonine to isoleucine mutation at codon 315, single‐agent ponatinib is associated with significantly longer overall survival compared with allogenic stem cell transplantation. In those who have accelerated‐phase CML, blast‐crisis CML, and Philadelphia chromosome‐positive acute lymphoblastic leukemia with the T315I mutation, single‐agent ponatinib is associated with similar or shorter overall survival compared with stem cell transplantation.
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Affiliation(s)
- Franck E Nicolini
- Hematology Department, Lyon South-Pierre-Bénite Hospital Center and Unit 1052, National Institute of Health and Medical Research Lyon Cancer Research Center/Léon Berard Center, Lyon, France
| | - Grzegorz W Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dong-Wook Kim
- Leukemia Research Institute, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eduardo Olavarria
- Department of Haematology, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | | | - Jane F Apperley
- Department of Haematology, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Timothy Hughes
- Department of Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dietger Niederwieser
- Department of Haematology and Medical Oncology, University of Leipzig, Leipzig, Germany
| | - Michael J Mauro
- Department of Leukemia, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles Chuah
- Department of Haematology, Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Andreas Hochhaus
- Clinic and Polyclinic for Internal Medicine II, Division of Hematology and Oncology, Jena University Hospital, Jena, Germany
| | | | | | | | | | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge E Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Efficacy and prognostic factors of imatinib plus CALLG2008 protocol in adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia. Front Med 2017; 11:229-238. [PMID: 28349299 DOI: 10.1007/s11684-017-0506-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/24/2016] [Indexed: 12/11/2022]
Abstract
A CALLG2008 protocol was developed by the Chinese Acute Lymphoblastic Leukemia Cooperative Group for adult acute lymphoblastic leukemia (ALL). We retrospectively analyzed 153 newly diagnosed adult patients with Philadelphia chromosome (Ph)-positive ALL enrolled into imatinib (400 mg/d) plus CALLG2008 regimen between 2009 and 2015. The median age was 40 years (range, 18-68 years), with 81 (52.3%) males. The overall hematologic complete remission (CR) rate was 96.7% after induction. With a median follow-up of 24.2 months, the estimated 3-year overall survival (OS) and event-free survival (EFS) rates were 49.5%(95%confidence interval (CI): 38.5%-59.5%) and 49.2% (95% CI: 38.3%-59.2%), respectively. Fifty-eight (36 with haploidentical donor) patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first CR. Among the patients in CR1 after induction, both the 3-year OS and EFS were significantly better in the allo-HSCT group than in the without allo-HSCT group (73.2%, 95% CI: 58.3%-83.5% vs. 22.2%, 95% CI: 8.7%-39.6% and 66.5%, 95% CI: 50.7%-78.2% vs. 16.1%, 95% CI: 5.1%-32.7%, respectively). Multivariate analysis showed that allo-HSCT and achievement of major molecular response were associated with favorable OS or EFS independently. Interestingly, in the allo-HSCT cohort, the donor type (haploidentical versus matched donors) had no significant impact on EFS or OS. All these results suggested that imatinib plus CALLG2008 was an effective protocol for Ph-positive ALL. Haploidentical donors can also be a reasonable alternative expedient donor pool.
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25
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Reckel S, Hamelin R, Georgeon S, Armand F, Jolliet Q, Chiappe D, Moniatte M, Hantschel O. Differential signaling networks of Bcr-Abl p210 and p190 kinases in leukemia cells defined by functional proteomics. Leukemia 2017; 31:1502-1512. [PMID: 28111465 PMCID: PMC5508078 DOI: 10.1038/leu.2017.36] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 12/31/2022]
Abstract
The two major isoforms of the oncogenic Bcr–Abl tyrosine kinase, p210 and p190, are expressed upon the Philadelphia chromosome translocation. p210 is the hallmark of chronic myelogenous leukemia, whereas p190 occurs in the majority of B-cell acute lymphoblastic leukemia. Differences in protein interactions and activated signaling pathways that may be associated with the different diseases driven by p210 and p190 are unknown. We have performed a quantitative comparative proteomics study of p210 and p190. Strong differences in the interactome and tyrosine phosphoproteome were found and validated. Whereas the AP2 adaptor complex that regulates clathrin-mediated endocytosis interacts preferentially with p190, the phosphatase Sts1 is enriched with p210. Stronger activation of the Stat5 transcription factor and the Erk1/2 kinases is observed with p210, whereas Lyn kinase is activated by p190. Our findings provide a more coherent understanding of Bcr–Abl signaling, mechanisms of leukemic transformation, resulting disease pathobiology and responses to kinase inhibitors.
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Affiliation(s)
- S Reckel
- ISREC Foundation Chair in Translational Oncology, Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - R Hamelin
- Proteomics Core Facility, School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - S Georgeon
- ISREC Foundation Chair in Translational Oncology, Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - F Armand
- Proteomics Core Facility, School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Q Jolliet
- Proteomics Core Facility, School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - D Chiappe
- Proteomics Core Facility, School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - M Moniatte
- Proteomics Core Facility, School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - O Hantschel
- ISREC Foundation Chair in Translational Oncology, Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
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26
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Major molecular response prior to allogeneic hematopoietic stem cell transplantation predicts better outcome in adult Philadelphia-positive acute lymphoblastic leukemia in first remission. Bone Marrow Transplant 2017; 52:470-472. [DOI: 10.1038/bmt.2016.307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Philadelphia Chromosome in an Infant With Pro-B Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2017; 39:79-80. [PMID: 27820127 DOI: 10.1097/mph.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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BCR-ABL-specific T-cell therapy in Ph+ ALL patients on tyrosine-kinase inhibitors. Blood 2016; 129:582-586. [PMID: 27927646 DOI: 10.1182/blood-2016-07-731091] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/29/2016] [Indexed: 12/21/2022] Open
Abstract
Although the emergence of bone marrow (BM)-resident p190BCR-ABL-specific T lymphocytes has been correlated with hematologic and cytogenetic remissions in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) undergoing maintenance tyrosine-kinase inhibitor treatment, little is known about the possibility of culturing these cells ex vivo and using them in T-cell therapy strategies. We investigated the feasibility of expanding/priming p190BCR-ABL-specific T cells in vitro by stimulation with dendritic cells pulsed with p190BCR-ABL peptides derived from the BCR-ABL junctional region and alternative splicing, and of adoptively administering them to patients with relapsed disease. We report on the feasibility of producing clinical-grade BCR-ABL-specific cytotoxic T lymphocytes (CTLs), endowed with antileukemia activity, from Ph+ ALL patients and healthy donors. We treated 3 patients with Ph+ ALL with autologous or allogeneic p190BCR-ABL-specific CTLs. No postinfusion toxicity was observed, except for a grade II skin graft-versus-host disease in the patient treated for hematologic relapse. All patients achieved a molecular or hematologic complete remission (CR) after T-cell therapy, upon emergence of p190BCR-ABL-specific T cells in the BM. Our results show that p190BCR-ABL-specific CTLs are capable of controlling treatment-refractory Ph+ ALL in vivo, and support the development of adoptive immunotherapeutic approaches with BCR-ABL CTLs in Ph+ ALL.
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29
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BCR-ABL1 gene rearrangement as a subclonal change in ETV6-RUNX1-positive B-cell acute lymphoblastic leukemia. Blood Adv 2016; 1:132-138. [PMID: 29296806 DOI: 10.1182/bloodadvances.2016000463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022] Open
Abstract
We report here on a case of ETV6-RUNX1-positive B-cell acute lymphoblastic leukemia (B-ALL) that has acquired a BCR-ABL1 gene rearrangement as a subclonal change. The 19-year-old female patient presented with B symptoms, pancytopenia, and circulating blasts. The bone marrow aspirate was hypercellular and was infiltrated by an immature blast population that was confirmed as B-ALL by flow cytometry. Sequential fluorescent in situ hybridization was performed on the patient's leukemic cells, which were shown to contain both ETV6-RUNX1 and BCR-ABL1 gene rearrangements. The majority of nuclei (85%) showed only the ETV6-RUNX1 gene rearrangement; however, an additional 10% also showed a variant BCR-ABL1 gene rearrangement, indicating the ETV6-RUNX1 gene rearrangement was the primary change. A review of the literature has shown that acquisition of a BCR-ABL1 gene rearrangement as a secondary change in B-ALL is a very rare occurrence, and the effect it may have on prognosis is uncertain in the modern therapy age.
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30
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Alsadeq A, Fedders H, Vokuhl C, Belau NM, Zimmermann M, Wirbelauer T, Spielberg S, Vossen-Gajcy M, Cario G, Schrappe M, Schewe DM. The role of ZAP70 kinase in acute lymphoblastic leukemia infiltration into the central nervous system. Haematologica 2016; 102:346-355. [PMID: 27686375 DOI: 10.3324/haematol.2016.147744] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
Central nervous system infiltration and relapse are poorly understood in childhood acute lymphoblastic leukemia. We examined the role of zeta-chain-associated protein kinase 70 in preclinical models of central nervous system leukemia and performed correlative studies in patients. Zeta-chain-associated protein kinase 70 expression in acute lymphoblastic leukemia cells was modulated using short hairpin ribonucleic acid-mediated knockdown or ectopic expression. We show that zeta-chain-associated protein kinase 70 regulates CCR7/CXCR4 via activation of extracellular signal-regulated kinases. High expression of zeta-chain-associated protein kinase 70 in acute lymphoblastic leukemia cells resulted in a higher proportion of central nervous system leukemia in xenografts as compared to zeta-chain-associated protein kinase 70 low expressing counterparts. High zeta-chain-associated protein kinase 70 also enhanced the migration potential towards CCL19/CXCL12 gradients in vitro CCR7 blockade almost abrogated homing of acute lymphoblastic leukemia cells to the central nervous system in xenografts. In 130 B-cell precursor acute lymphoblastic leukemia and 117 T-cell acute lymphoblastic leukemia patients, zeta-chain-associated protein kinase 70 and CCR7/CXCR4 expression levels were significantly correlated. Zeta-chain-associated protein kinase 70 expression correlated with central nervous system disease in B-cell precursor acute lymphoblastic leukemia, and CCR7/CXCR4 correlated with central nervous system involvement in T-cell acute lymphoblastic leukemia patients. In multivariate analysis, zeta-chain-associated protein kinase 70 expression levels in the upper third and fourth quartiles were associated with central nervous system involvement in B-cell precursor acute lymphoblastic leukemia (odds ratio=7.48, 95% confidence interval, 2.06-27.17; odds ratio=6.86, 95% confidence interval, 1.86-25.26, respectively). CCR7 expression in the upper fourth quartile correlated with central nervous system positivity in T-cell acute lymphoblastic leukemia (odds ratio=11.00, 95% confidence interval, 2.00-60.62). We propose zeta-chain-associated protein kinase 70, CCR7 and CXCR4 as markers of central nervous system infiltration in acute lymphoblastic leukemia warranting prospective investigation.
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Affiliation(s)
- Ameera Alsadeq
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Henning Fedders
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Christian Vokuhl
- Kiel Pediatric Tumor Registry, Department of Pediatric Pathology, University Medical Center Schleswig-Holstein, Germany
| | - Nele M Belau
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Tim Wirbelauer
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Steffi Spielberg
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Michaela Vossen-Gajcy
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gunnar Cario
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Martin Schrappe
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Denis M Schewe
- Department of General Pediatrics, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
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Renzi D, Marchesi F, De Angelis G, Elia L, Salvatorelli E, Gumenyuk S, Palombi F, Pisani F, Romano A, Spadea A, Papa E, Canfora M, Arcese W, Mengarelli A. Ponatinib Induces a Persistent Molecular Response and Graft-versus-Host Disease/Graft-versus-Leukemia Effect in a Patient with Philadelphia-Positive Acute Lymphoblastic Leukemia with a T315I Mutation following Early Relapse after Allogeneic Transplant. Chemotherapy 2016; 62:58-61. [DOI: 10.1159/000448750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 11/19/2022]
Abstract
We describe the case of a patient with a Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL) treated with dasatinib plus steroids as the first-line therapy who achieved a molecular complete remission and then underwent a matched, unrelated donor allogeneic transplant. Five months after the transplant, he experienced a disease relapse with an T315I mutation, which was resistant to salvage chemotherapy. Once the details of the T315I mutation were acquired, we initiated ponatinib treatment at a standard dosage and observed a rapid decrease of minimal residual disease (MRD) at molecular assessment. The bone marrow evaluation after 2, 3, 6, 10 and 13 months was negative for MRD. After starting ponatinib, the patient experienced a skin graft-versus-host disease (GVHD), whereas no occurrence of GVHD was observed after transplant, suggesting that the efficacy of ponatinib could be related not only to the direct antileukemic effect, but also to its ability to promote an indirect graft-versus-leukemia effect. Ponatinib was well tolerated but a thyroid dysfunction mimicking a cardiovascular toxicity was observed and solved with hormonal substitutive treatment.
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32
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Churchman ML, Evans K, Richmond J, Robbins A, Jones L, Shapiro IM, Pachter JA, Weaver DT, Houghton PJ, Smith MA, Lock RB, Mullighan CG. Synergism of FAK and tyrosine kinase inhibition in Ph + B-ALL. JCI Insight 2016; 1:86082. [PMID: 27123491 DOI: 10.1172/jci.insight.86082] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BCR-ABL1+ B progenitor acute lymphoblastic leukemia (Ph+ B-ALL) is an aggressive disease that frequently responds poorly to currently available therapies. Alterations in IKZF1, which encodes the lymphoid transcription factor Ikaros, are present in over 80% of Ph+ ALL and are associated with a stem cell-like phenotype, aberrant adhesion molecule expression and signaling, leukemic cell adhesion to the bone marrow stem cell niche, and poor outcome. Here, we show that FAK1 is upregulated in Ph+ B-ALL with further overexpression in IKZF1-altered cells and that the FAK inhibitor VS-4718 potently inhibits aberrant FAK signaling and leukemic cell adhesion, potentiating responsiveness to tyrosine kinase inhibitors, inducing cure in vivo. Thus, targeting FAK with VS-4718 is an attractive approach to overcome the deleterious effects of FAK overexpression in Ph+ B-ALL, particularly in abrogating the adhesive phenotype induced by Ikaros alterations, and warrants evaluation in clinical trials for Ph+ B-ALL, regardless of IKZF1 status.
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Affiliation(s)
- Michelle L Churchman
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kathryn Evans
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, New South Wales, Sydney, Australia
| | - Jennifer Richmond
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, New South Wales, Sydney, Australia
| | - Alissa Robbins
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, New South Wales, Sydney, Australia
| | - Luke Jones
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, New South Wales, Sydney, Australia
| | | | | | | | - Peter J Houghton
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, New South Wales, Sydney, Australia
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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33
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Wang J, Zhang Y, Zu Y, Li Z, Li M, Song Y. [Characteristics and clinical outcome of T315I mutation in Philadelphia chromosome-positive acute lymphoblastic leukemia and chronic myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:110-4. [PMID: 27014979 PMCID: PMC7348199 DOI: 10.3760/cma.j.issn.0253-2727.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
目的 分析伴T315I突变的Ph染色体阳性急性淋巴细胞白血病(Ph+ALL)和慢性髓性白血病(CML)的特征及疗效。 方法 收集2014年3月至2015年6月于郑州大学附属肿瘤医院行ABL激酶区突变检测并对酪氨酸激酶抑制剂(TKI)耐药的23例Ph+ ALL患者和95例CML患者的临床资料。采用R显带法进行染色体分析,实时定量PCR方法检测BCR-ABL融合基因,TRIzol法提取总RNA,直接测序法检测ABL激酶区突变。 结果 ABL激酶区突变发生率在TKI耐药Ph+ ALL和CML中分别为60.9%(14/23)、41.1%(39/95),其中T315I突变发生率分别为34.8%(8/23)和5.3%(5/95),差异具有统计学意义(χ2=13.586,P<0.01)。CML慢性期患者ABL激酶区突变发生率为38.8%(19/49),加速期、急变期分别为47.1%(8/17)、41.4%(12/29),差异无统计学意义(χ2=0.360,P=0.835)。Ph+ ALL、CML患者自开始TKI治疗至发生T315I突变的中位时间分别为10和19个月,T315I突变发生至死亡或随访终止的中位时间分别为2和3个月,中位血液学缓解持续时间分别为10和16个月,中位总生存时间分别为13和42个月。 结论 Ph+ ALL较CML更易出现T315I突变,但两者自开始TKI治疗至发生T315I突变的中位时间相近,在现有方案治疗下,两者血液学缓解持续时间、总生存时间相近。
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Affiliation(s)
- Juan Wang
- Department of Hematology, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
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Hussaini M. Biomarkers in Hematological Malignancies: A Review of Molecular Testing in Hematopathology. Cancer Control 2016; 22:158-66. [PMID: 26068760 DOI: 10.1177/107327481502200206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Molecular interrogation of genetic information has transformed our understanding of disease and is now routinely integrated into the workup and monitoring of hematological malignancies. In this article, a brief but comprehensive review is presented of state-of-the-art testing in hematological disease. METHODS The primary medical literature and standard textbooks in the field were queried and reviewed to assess current practices and trends for molecular testing in hematopathology by disease. RESULTS Pertinent materials were summarized under appropriate disease categories. CONCLUSION Molecular testing is well entrenched in the diagnostic and therapeutic pathways for hematological malignancies, with rapid growth and insights emerging following the integration of next-generation sequencing into the clinical workflow.
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Affiliation(s)
- Mohammad Hussaini
- Department of Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Deshpande PA, Srivastava VM, Mani S, Anandhan S, Meena J, Abraham A, Viswabandya A, George B, Srivastava A, Mathews V, Balasubramanian P. Atypical BCR-ABL1 fusion transcripts in adult B-acute lymphoblastic leukemia, including a novel fusion transcript-e8a1. Leuk Lymphoma 2016; 57:2481-4. [PMID: 26942999 DOI: 10.3109/10428194.2016.1151512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Prashant A Deshpande
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Vivi M Srivastava
- b Cytogenetics Unit , Christian Medical College , Vellore , Tamil Nadu , India
| | - Sathya Mani
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | | | - J Meena
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Aby Abraham
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Auro Viswabandya
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Biju George
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Alok Srivastava
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Vikram Mathews
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
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Leoni V, Biondi A. Tyrosine kinase inhibitors in BCR-ABL positive acute lymphoblastic leukemia. Haematologica 2015; 100:295-9. [PMID: 25740105 DOI: 10.3324/haematol.2015.124016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Veronica Leoni
- Paediatric Haematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM", San Gerardo Hospital, Monza, Italy
| | - Andrea Biondi
- Paediatric Haematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM", San Gerardo Hospital, Monza, Italy
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Shojaee S, Caeser R, Buchner M, Park E, Swaminathan S, Hurtz C, Geng H, Chan LN, Klemm L, Hofmann WK, Qiu YH, Zhang N, Coombes KR, Paietta E, Molkentin J, Koeffler HP, Willman CL, Hunger SP, Melnick A, Kornblau SM, Müschen M. Erk Negative Feedback Control Enables Pre-B Cell Transformation and Represents a Therapeutic Target in Acute Lymphoblastic Leukemia. Cancer Cell 2015; 28:114-28. [PMID: 26073130 PMCID: PMC4565502 DOI: 10.1016/j.ccell.2015.05.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 02/05/2015] [Accepted: 05/12/2015] [Indexed: 11/20/2022]
Abstract
Studying mechanisms of malignant transformation of human pre-B cells, we found that acute activation of oncogenes induced immediate cell death in the vast majority of cells. Few surviving pre-B cell clones had acquired permissiveness to oncogenic signaling by strong activation of negative feedback regulation of Erk signaling. Studying negative feedback regulation of Erk in genetic experiments at three different levels, we found that Spry2, Dusp6, and Etv5 were essential for oncogenic transformation in mouse models for pre-B acute lymphoblastic leukemia (ALL). Interestingly, a small molecule inhibitor of DUSP6 selectively induced cell death in patient-derived pre-B ALL cells and overcame conventional mechanisms of drug-resistance.
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Affiliation(s)
- Seyedmehdi Shojaee
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Rebecca Caeser
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA; Department of Haematology, University of Cambridge, Cambridge CB2 0AH, UK
| | - Maike Buchner
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Eugene Park
- Department of Haematology, University of Cambridge, Cambridge CB2 0AH, UK
| | - Srividya Swaminathan
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Christian Hurtz
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Huimin Geng
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lai N Chan
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lars Klemm
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Wolf-Karsten Hofmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg 68167, Germany
| | - Yi Hua Qiu
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Nianxiang Zhang
- Department of Bioinformatics and Computational Biology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Kevin R Coombes
- Department of Bioinformatics and Computational Biology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Jeffery Molkentin
- Howard Hughes Medical Institute and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH 45247, USA
| | - H Phillip Koeffler
- Division of Hematology and Oncology, Cedars Sinai Medical Center, Los Angeles, CA 90095, USA; Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | - Cheryl L Willman
- Department of Pathology, University of New Mexico Cancer Center, Albuquerque, NM 87102, USA
| | - Stephen P Hunger
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Ari Melnick
- Departments of Medicine and Pharmacology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Steven M Kornblau
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Markus Müschen
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
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Anti-leukemic potency of piggyBac-mediated CD19-specific T cells against refractory Philadelphia chromosome-positive acute lymphoblastic leukemia. Cytotherapy 2015; 16:1257-69. [PMID: 25108652 DOI: 10.1016/j.jcyt.2014.05.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/25/2014] [Accepted: 05/30/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND AIMS To develop a treatment option for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+)ALL) resistant to tyrosine kinase inhibitors (TKIs), we evaluated the anti-leukemic activity of T cells non-virally engineered to express a CD19-specific chimeric antigen receptor (CAR). METHODS A CD19.CAR gene was delivered into mononuclear cells from 10 mL of blood of healthy donors through the use of piggyBac-transposons and the 4-D Nucleofector System. Nucleofected cells were stimulated with CD3/CD28 antibodies, magnetically selected for the CD19.CAR, and cultured in interleukin-15-containing serum-free medium with autologous feeder cells for 21 days. To evaluate their cytotoxic potency, we co-cultured CAR T cells with seven Ph(+)ALL cell lines including three TKI-resistant (T315I-mutated) lines at an effector-to-target ratio of 1:5 or lower without cytokines. RESULTS We obtained ∼1.3 × 10(8) CAR T cells (CD4(+), 25.4%; CD8(+), 71.3%), co-expressing CD45RA and CCR7 up to ∼80%. After 7-day co-culture, CAR T cells eradicated all tumor cells at the 1:5 and 1:10 ratios and substantially reduced tumor cell numbers at the 1:50 ratio. Kinetic analysis revealed up to 37-fold proliferation of CAR T cells during a 20-day culture period in the presence of tumor cells. On exposure to tumor cells, CAR T cells transiently and reproducibly upregulated the expression of transgene as well as tumor necrosis factor-related apoptosis-inducing ligand and interleukin-2. CONCLUSIONS We generated a clinically relevant number of CAR T cells from 10 mL of blood through the use of piggyBac-transposons, a 4D-Nulcleofector, and serum/xeno/tumor cell/virus-free culture system. CAR T cells exhibited marked cytotoxicity against Ph(+)ALL regardless of T315I mutation. PiggyBac-mediated CD19-specific T-cell therapy may provide an effective, inexpensive and safe option for drug-resistant Ph(+)ALL.
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Daver N, Thomas D, Ravandi F, Cortes J, Garris R, Jabbour E, Garcia-Manero G, Borthakur G, Kadia T, Rytting M, Konopleva M, Kantarjian H, O'Brien S. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the front-line treatment of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Haematologica 2015; 100:653-61. [PMID: 25682595 DOI: 10.3324/haematol.2014.118588] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/02/2015] [Indexed: 12/12/2022] Open
Abstract
We have previously reported on the efficacy and tolerability of hyper-CVAD regimen (cyclophosphamide, vincristine, Adriamycin, and dexamethasone) and imatinib followed by imatinib-based consolidation/maintenance therapy in 20 patients with newly diagnosed Philadelphia-positive acute lymphoblastic leukemia. Here, we present the 13-year follow up of our study. Fifty-four patients with newly diagnosed Philadelphia-positive acute lymphoblastic leukemia were enrolled: 39 (72%) with de novo disease, 6 (11%) whose disease was primary refractory after induction (without a tyrosine kinase inhibitor), and 9 (17%) in complete remission after one course of induction therapy (without tyrosine kinase inhibitor). Forty-two (93%) of the 45 patients treated for active disease achieved complete remission, one achieved complete remission with incomplete recovery of platelets, one achieved partial remission and one died during induction. Nineteen (35%) patients are alive and 18 are in complete remission. The 5-year overall survival rate for all patients was 43%. Significant negative predictors of overall survival were age over 60 years, p190 molecular transcript, and active disease at enrollment. Sixteen (30%) patients underwent allogeneic stem cell transplantation. Median overall survival was not significantly greater for patients who underwent transplant. Patients with residual molecular disease at three months had improved complete remission duration with transplant. The median time to hematologic recovery and severe toxicities with combination were not significantly different from those observed with conventional chemotherapy. Only one patient discontinued therapy due to toxicity. HyperCVAD chemotherapy and imatinib is an effective regimen for Philadelphia-positive acute lymphoblastic leukemia. Transplant may not be indicated in all patients with Philadelphia-positive acute lymphoblastic leukemia. (clinicaltrials.gov identifier: NCT00038610).
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Affiliation(s)
- Naval Daver
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Deborah Thomas
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jorge Cortes
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Garris
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Tapan Kadia
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Michael Rytting
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Susan O'Brien
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Kong Y, Xu LP, Liu YR, Qin YZ, Sun YQ, Wang Y, Jiang H, Jiang Q, Chen H, Chang YJ, Huang XJ. Presence of CD34(+)CD38(-)CD58(-) leukemia-propagating cells at diagnosis identifies patients at high risk of relapse with Ph chromosome-positive ALL after allo-hematopoietic SCT. Bone Marrow Transplant 2014; 50:348-53. [PMID: 25486581 DOI: 10.1038/bmt.2014.274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 12/30/2022]
Abstract
Relapse of Ph chromosome-positive ALL (Ph(+)ALL) results from the persistence of leukemia-propagating cells (LPCs). In Ph(+)ALL, a xenograft assay recently determined that LPCs are enriched in the CD34(+)CD38(-)CD58(-) fraction. Therefore, the prognostic significance of LPCs in Ph(+)ALL subjects after allogeneic hematopoietic SCT (allo-HSCT) was investigated. A total of 80 consecutive adults with Ph(+)ALL who underwent allo-HSCT were eligible. A multi-parameter flow cytometry analysis examining CD58-FITC/CD10-PE/ CD19-APC-Cy7/CD34-PerCP/CD45-Vioblue/ CD38-APC on gated leukemia BM blasts was performed at diagnosis. Based on the original blast phenotypes, subjects were stratified into the CD34(+)CD38(-)CD58(-)group (N=15) and other phenotype group (N=65). During minimal residual disease monitoring, significantly higher levels of BCR/ABL transcripts were detected in subjects in the CD34(+)CD38(-)CD58(-) group than in other phenotype group, especially at 3 months post HSCT. In addition, CD34(+)CD38(-)CD58(-)LPCs are directly correlated with a higher 3-year cumulative incidence of relapse (CIR) and worse leukemia-free survival (LFS) and OS. Multivariate analyses indicated that presence of CD34(+)CD38(-)CD58(-) LPCs at diagnosis, and BCR-ABL reduction at 3 months post HSCT were independent risk factors for relapse, LFS and OS. Our data suggest that presence of CD34(+)CD38(-)CD58(-) LPCs at diagnosis allows rapid identification of high-risk patients for relapse after allo-HSCT.
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Affiliation(s)
- Y Kong
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - L-P Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y-R Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y-Z Qin
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y-Q Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Q Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y-J Chang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - X-J Huang
- 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China [2] Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
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Marks DI, Alonso L, Radia R. Allogeneic Hematopoietic Cell Transplantation in Adult Patients with Acute Lymphoblastic Leukemia. Hematol Oncol Clin North Am 2014; 28:995-1009. [DOI: 10.1016/j.hoc.2014.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Susceptibility of Ph-positive all to TKI therapy associated with Bcr-Abl rearrangement patterns: a retrospective analysis. PLoS One 2014; 9:e110431. [PMID: 25415187 PMCID: PMC4240579 DOI: 10.1371/journal.pone.0110431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 09/22/2014] [Indexed: 12/14/2022] Open
Abstract
Background Tyrosine kinase inhibitors (TKIs) have demonstrated success in the treatment of acute lymphoblastic leukemia (ALL) in patients that express BCR-ABL rearrangements (Philadelphia chromosome [Ph]). The current study aimed to assess the efficacy of TKIs and prognostic factors in the treatment of adults with Ph+-ALL. Methods In this multicenter retrospective study, the relationship between Ph+-ALL and treatment outcomes among Chinese patients receiving TKI-containing induction/consolidation chemotherapy was examined. A total of 86 Ph+-ALL patients were included and followed for 3.85 (0.43–9.30) years. Overall survival (OS) and event-free survival (EFS) were analyzed. Results A total of 86 Ph+-ALL patients (40 females and 46 males; median age: 34.0 years) were enrolled, including those with BCR/ABL transcripts 190 (n = 52), 210 (n = 25), and 230 (n = 2); BCR/ABL isoform determination was not available for 7 patients. Mortality was influenced by variable BCR/ABL transcripts and TKI administration, and BCR/ABL transcripts, hematopoietic stem cell transplantation (HSCT), and TKI administration were associated with the occurrence of events. The OS rate in the TKI administration group during steady state was significantly higher compared with those patients who did not receive TKI administration (P = 0.008), the EFS rate in the TKI administration group during steady state was significantly higher compared with those patients who did not receive TKIs (P = 0.012), and also higher than those with TKI salvage administration (P = 0.004). BCR/ABL transcripts 210 showed preferable OS and EFS compared with BCR/ABL transcripts 190 and 230 (P<0.05 for each). Conclusions The susceptibility of Ph+-ALL to TKI associated with the patterns of BCR-ABL rearrangement is demonstrated for the first time, thus adding another risk-stratifying molecular prognostic tool for the management of patients with Ph+-ALL.
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Van Neste L, Van Criekinge W. We are all individuals... bioinformatics in the personalized medicine era. Cell Oncol (Dordr) 2014; 38:29-37. [PMID: 25204962 DOI: 10.1007/s13402-014-0195-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/16/2022] Open
Abstract
The medical landscape is evolving at a rapid pace, creating the opportunity for more personalized patient treatment and shifting the way healthcare is approached and thought about. With the availability of (epi)genome-wide, transcriptomic and proteogenomic profiling techniques detailed characterization of a disease at the level of the individual is now possible, offering the opportunity for truly tailored approaches for treatment and patient care. While improvements are still expected, the techniques and the basic analytical tools have reached a state that these can be efficiently deployed in both routine research and clinical practice. Still, some major challenges remain. Notably, holistic approaches, integrating data from several sources, e.g. genomic and epigenomic, will increase the understanding of the underlying biological concepts and provide insight into the causes, effects and effective solutions. However, creating and validating such a knowledge base, potentially for different levels of expertise, and integrating several data points into meaningful information is not trivial.
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Affiliation(s)
- Leander Van Neste
- Department of Pathology, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands,
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Konuma T, Kato S, Ooi J, Oiwa-Monna M, Tojo A, Takahashi S. Myeloablative unrelated cord blood transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia: comparison with other graft sources from related and unrelated donors. Ann Hematol 2014; 94:289-96. [DOI: 10.1007/s00277-014-2195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/14/2014] [Indexed: 11/24/2022]
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Munoz J, Janku F, Cohen PR, Kurzrock R. Erdheim-Chester disease: characteristics and management. Mayo Clin Proc 2014; 89:985-96. [PMID: 24814521 DOI: 10.1016/j.mayocp.2014.01.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 01/14/2023]
Abstract
Erdheim-Chester disease is a rare CD68(+), CD1a(-) non-Langerhans cell histiocytosis with multiorgan involvement. The etiology of Erdheim-Chester disease is unclear; there are no known associated infectious or hereditary genetic abnormalities. However, somatic BRAF mutations have recently been identified in these patients. Historically, the literature regarding the management of Erdheim-Chester disease consisted of case reports and small case series with anecdotal therapeutic responses to agents including, but not limited to, cytotoxic chemotherapy, bone marrow transplantation, cladribine, corticosteroids, IFN-α, the BCR-ABL/KIT inhibitor imatinib mesylate, the IL-1 receptor antagonist anakinra, the TNF-inhibitor infliximab, and recently the BRAF inhibitor vemurafenib. We performed a search of the literature using PubMed with the terms Erdheim Chester disease, without date limitations, including case reports, case series, original articles, and previous review articles. In the absence of large-scale studies, experience-based management prevails. The present review details our approach to the management of patients with Erdheim-Chester disease.
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Affiliation(s)
- Javier Munoz
- Hematology-Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ.
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), University of Texas MD Anderson Cancer Center, Houston
| | - Philip R Cohen
- Division of Dermatology, University of California, San Diego, San Diego
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, San Diego
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Torelli GF, Peragine N, Raponi S, Pagliara D, De Propris MS, Vitale A, Bertaina A, Barberi W, Moretta L, Basso G, Santoni A, Guarini A, Locatelli F, Foà R. Recognition of adult and pediatric acute lymphoblastic leukemia blasts by natural killer cells. Haematologica 2014; 99:1248-54. [PMID: 24658822 DOI: 10.3324/haematol.2013.101931] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In this study, we aimed to investigate the pathways of recognition of acute lymphoblastic leukemia blasts by natural killer cells and to verify whether differences in natural killer cell activating receptor ligand expression among groups defined by age of patients, or presence of cytogenetic/molecular aberrations correlate with the susceptibility to recognition and killing. We analyzed 103 newly diagnosed acute lymphoblastic leukemia patients: 46 adults and 57 children. Pediatric blasts showed a significantly higher expression of Nec-2 (P=0.03), ULBP-1 (P=0.01) and ULBP-3 (P=0.04) compared to adult cells. The differential expression of these ligands between adults and children was confined to B-lineage acute lymphoblastic leukemia with no known molecular alterations. Within molecularly defined subgroups of patients, a high surface expression of NKG2D and DNAM1 ligands was found on BCR-ABL(+) blasts, regardless of patient age. Accordingly, BCR-ABL(+) blasts proved to be significantly more susceptible to natural killer-dependent lysis than B-lineage blasts without molecular aberrations (P=0.03). Cytotoxic tests performed in the presence of neutralizing antibodies indicated a pathway of acute lymphoblastic leukemia cell recognition in the setting of the Nec-2/DNAM-1 interaction. These data provide a biological explanation of the different roles played by alloreactive natural killer cells in pediatric versus adult acute lymphoblastic leukemia and suggest that new natural killer-based strategies targeting specific subgroups of patients, particularly those BCR-ABL(+), are worth pursuing further.
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Affiliation(s)
- Giovanni F Torelli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
| | - Nadia Peragine
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
| | - Sara Raponi
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
| | - Daria Pagliara
- Department of Pediatric Hematology/Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome
| | - Maria S De Propris
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
| | - Antonella Vitale
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
| | - Alice Bertaina
- Department of Pediatric Hematology/Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome
| | - Walter Barberi
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
| | | | | | - Angela Santoni
- Department of Molecular Medicine, Sapienza University, Rome
| | - Anna Guarini
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome University of Pavia, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome
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UKALLXII/ECOG2993: addition of imatinib to a standard treatment regimen enhances long-term outcomes in Philadelphia positive acute lymphoblastic leukemia. Blood 2013; 123:843-50. [PMID: 24277073 DOI: 10.1182/blood-2013-09-529008] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Philadelphia chromosome positive arm of the UKALLXII/ECOG2993 study for adult acute lymphoblastic leukemia (ALL) enrolled 266 patients between 1993 and 2003 (pre-imatinib cohort). In 2003 imatinib was introduced as a single-agent course following induction (N = 86, late imatinib). In 2005 imatinib was added to the second phase of induction (N = 89, early imatinib). The complete remission (CR) rate was 92% in the imatinib cohort vs 82% in the preimatinib cohort (P = .004). At 4 years, the overall survival (OS) of all patients in the imatinib cohort was 38% vs 22% in the preimatinib cohort (P = .003). The magnitude of the difference between the preimatinib and imatinib cohorts in event-free survival (EFS), OS, and relapse-free survival (RFS) seen in univariate analysis was even greater in the multivariate analysis. In the preimatinib cohort, 31% of those starting treatment achieved hematopoietic stem cell transplant (alloHSCT) compared with 46% in the imatinib cohort. A Cox multivariate analysis taking alloHSCT into account showed a modest additional benefit to imatinib (hazard ratio for EFS = 0.64, 95% confidence interval 0.44-0.93, P = .02), but no significant benefit for OS and RFS. Adding imatinib to standard therapy improves CR rate and long-term OS for adults with ALL. A proportion of the OS benefit derives from the fact that imatinib facilitates alloHSCT. This trial was registered at clinicaltrials.gov as NCT00002514.
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Giebel S, Labopin M, Gorin NC, Caillot D, Leguay T, Schaap N, Michallet M, Dombret H, Mohty M. Improving results of autologous stem cell transplantation for Philadelphia-positive acute lymphoblastic leukaemia in the era of tyrosine kinase inhibitors: a report from the Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation. Eur J Cancer 2013; 50:411-7. [PMID: 24210524 DOI: 10.1016/j.ejca.2013.08.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/12/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Outcome of Philadelphia-positive acute lymphoblastic leukaemia (Ph+ ALL) improved significantly with the introduction of tyrosine kinase inhibitors (TKIs). Autologous stem cell transplantation (ASCT) has never been considered a standard of care in this setting. The aim of our study was to analyse if results of ASCT improved in the era of TKIs. PATIENTS AND METHODS One-hundred and seventy-seven adults with Ph+ ALL treated with ASCT in first complete remission were analysed for the impact of year of transplantation on outcome. Additional analysis was performed including 32 patients for whom detailed data on the use of TKIs and the status of minimal residual disease were collected. RESULTS The probability of the overall survival (OS) at 3 years increased from 16% for transplants performed between 1996 and 2001 to 48% between 2002 and 2006 and 57% between 2007 and 2010 (P<.0001). Leukaemia-free survival (LFS) was 11%, 39% and 52%, respectively (P<.0001). Relapse incidence decreased from 70% to 45% and 45% (P=.01), respectively, while non-relapse mortality was 19%, 15% and 3% (P=.08). In a multivariate analysis, year of ASCT was the only independent factor influencing the risk of treatment failure (hazard ratio (HR)=0.37; P<.001). In a subgroup of 22 patients actually treated with TKIs and being in complete molecular remission at the time of ASCT, the LFS rate at 3 years was 65%. CONCLUSIONS Results of ASCT for Ph+ ALL improved significantly over time. Prospective, innovative studies are needed to verify the role of ASCT in this patient setting.
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Affiliation(s)
- Sebastian Giebel
- Dept. of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Myriam Labopin
- Clinical Haematology and Cellular Therapy Department, Hospital Saint-Antoine, APHP, Paris, France; EBMT ALWP Office, Hospital Saint-Antoine, Paris, France; Universite Pierre et Marie Curie, Paris, France; INSERM UMRs 938, Paris, France
| | - Norbert Claude Gorin
- Clinical Haematology and Cellular Therapy Department, Hospital Saint-Antoine, APHP, Paris, France; EBMT ALWP Office, Hospital Saint-Antoine, Paris, France; Universite Pierre et Marie Curie, Paris, France; INSERM UMRs 938, Paris, France
| | - Denis Caillot
- Centre Hospitalier Universitaire Le Bocage, Dijon, France
| | - Thibaut Leguay
- Centre Hospitalier Universitaire Bordeaux, Hôpital Haut-Leveque, Pessac, France
| | - Nicolaas Schaap
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | - Mohamad Mohty
- Clinical Haematology and Cellular Therapy Department, Hospital Saint-Antoine, APHP, Paris, France; EBMT ALWP Office, Hospital Saint-Antoine, Paris, France; Universite Pierre et Marie Curie, Paris, France; INSERM UMRs 938, Paris, France
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Detection of MRD may predict the outcome of patients with Philadelphia chromosome-positive ALL treated with tyrosine kinase inhibitors plus chemotherapy. Blood 2013; 122:1214-21. [PMID: 23836561 DOI: 10.1182/blood-2012-11-466482] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
From 2001 to 2011, 122 patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia were treated with chemotherapy + imatinib (n = 54) or + dasatinib (n = 68). One hundred fifteen (94%) achieved complete remission (CR) including 101 patients who achieved it with only 1 induction course and had at least 1 minimal residual disease (MRD) assessment; 25 patients underwent an allogeneic stem cell transplant in first CR and were excluded, leaving 76 patients as the subject of this report. MRD monitoring by multiparameter flow cytometry (MFC) and real-time quantitative polymerase chain reaction (PCR) was performed at the end of induction and at ~3-month intervals thereafter. Median age was 54 years (range, 21-84 years). There was no difference in survival by achievement of at least a major molecular response (MMR; BCR-ABL/ABL < 0.1%) at CR (P = .22). Patients achieving MMR at 3, 6, 9, and 12 months had a better survival (P = .02, .04, .05, and .01, respectively). Negative MFC at CR did not predict for improved survival (P = .2). At 3 and 12 months, negative MRD by MFC was associated with improved survival (P = .04 and .001). MRD monitoring by PCR and MFC identifies patients who benefit from treatment intensification in first CR.
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Watanabe A, Chansu S, Ogawa A, Asami K, Imamura M. Prophylactic post-transplant dasatinib administration in a pediatric patient with Philadelphia chromosome-positive acute lymphoblastic leukemia. Pediatr Int 2013; 55:e56-8. [PMID: 23782380 DOI: 10.1111/ped.12019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 09/16/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022]
Abstract
Philadelphia chromosome-positive acute lymphoblastic leukemia has a poor prognosis, even in pediatric patients. Although imatinib-containing chemotherapy can reportedly improve early event-free survival, allogeneic hematopoietic stem cell transplantation is still considered to be the main curative treatment option. Dasatinib, a novel abl tyrosine kinase inhibitor, is being used for the treatment of relapsed or refractory Philadelphia chromosome-positive acute lymphoblastic leukemia and is reported to have excellent efficacy. We used dasatinib after bone marrow transplantation prior to the anticipated relapse for the purpose of prophylaxis against relapse. After discontinuation of dasatinib administration, molecular remission has lasted for 7 months. Although preventive use of dasatinib is as yet uncommon, we consider that dasatinib may eradicate the minimal residual disease and prevent recurrence, and it is feasible to administer and appears to be safe. Further studies are needed to confirm our experience in this case.
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Affiliation(s)
- Akihiro Watanabe
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan.
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