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Masetti R, Baccelli F, Leardini D, Locatelli F. Venetoclax: a new player in the treatment of children with high-risk myeloid malignancies? Blood Adv 2024; 8:3583-3595. [PMID: 38701350 DOI: 10.1182/bloodadvances.2023012041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
ABSTRACT Venetoclax selectively inhibits B-cell lymphoma 2 (BCL-2) and restores apoptotic signaling of hematologic malignant cells. Venetoclax, in combination with hypomethylating and low-dose cytotoxic agents, has revolutionized the management of older patients affected by acute myeloid leukemia (AML) and that of patients unfit to receive intensive chemotherapy. In a single phase 1 pediatric trial conducted on relapsed or refractory AML, the combination of venetoclax and intensive chemotherapy was shown to be safe and yielded promising response rates. In addition, several retrospective studies in children with AML reported that venetoclax, when combined with hypomethylating agents and cytotoxic drugs, seems to be a safe and efficacious bridge to transplant. The promising results on the use of venetoclax combinations in advanced myelodysplastic syndromes (MDS) and therapy-related MDS/AML have also been reported in small case series. This review summarizes the available current knowledge about venetoclax use in childhood high-risk myeloid neoplasms and discusses the possible integration of BCL-2 inhibition in the current treatment algorithm of these children. It also focuses on specific genetic subgroups potentially associated with response in preclinical and clinical studies.
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Affiliation(s)
- Riccardo Masetti
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Baccelli
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Davide Leardini
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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van Weelderen RE, Harrison CJ, Klein K, Jiang Y, Abrahamsson J, Alonzo T, Aplenc R, Arad-Cohen N, Bart-Delabesse E, Buldini B, De Moerloose B, Dworzak MN, Elitzur S, Fernández Navarro JM, Gamis A, Gerbing RB, Goemans BF, de Groot-Kruseman HA, Guest E, Ha SY, Hasle H, Kelaidi C, Lapillonne H, Leverger G, Locatelli F, Miyamura T, Norén-Nyström U, Polychronopoulou S, Rasche M, Rubnitz JE, Stary J, Tierens A, Tomizawa D, Zwaan CM, Kaspers GJL. Optimized cytogenetic risk-group stratification of KMT2A-rearranged pediatric acute myeloid leukemia. Blood Adv 2024; 8:3200-3213. [PMID: 38621200 PMCID: PMC11225675 DOI: 10.1182/bloodadvances.2023011771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
ABSTRACT A comprehensive international consensus on the cytogenetic risk-group stratification of KMT2A-rearranged (KMT2A-r) pediatric acute myeloid leukemia (AML) is lacking. This retrospective (2005-2016) International Berlin-Frankfurt-Münster Study Group study on 1256 children with KMT2A-r AML aims to validate the prognostic value of established recurring KMT2A fusions and additional cytogenetic aberrations (ACAs) and to define additional, recurring KMT2A fusions and ACAs, evaluating their prognostic relevance. Compared with our previous study, 3 additional, recurring KMT2A-r groups were defined: Xq24/KMT2A::SEPT6, 1p32/KMT2A::EPS15, and 17q12/t(11;17)(q23;q12). Across 13 KMT2A-r groups, 5-year event-free survival probabilities varied significantly (21.8%-76.2%; P < .01). ACAs occurred in 46.8% of 1200 patients with complete karyotypes, correlating with inferior overall survival (56.8% vs 67.9%; P < .01). Multivariable analyses confirmed independent associations of 4q21/KMT2A::AFF1, 6q27/KMT2A::AFDN, 10p12/KMT2A::MLLT10, 10p11.2/KMT2A::ABI1, and 19p13.3/KMT2A::MLLT1 with adverse outcomes, but not those of 1q21/KMT2A::MLLT11 and trisomy 19 with favorable and adverse outcomes, respectively. Newly identified ACAs with independent adverse prognoses were monosomy 10, trisomies 1, 6, 16, and X, add(12p), and del(9q). Among patients with 9p22/KMT2A::MLLT3, the independent association of French-American-British-type M5 with favorable outcomes was confirmed, and those of trisomy 6 and measurable residual disease at end of induction with adverse outcomes were identified. We provide evidence to incorporate 5 adverse-risk KMT2A fusions into the cytogenetic risk-group stratification of KMT2A-r pediatric AML, to revise the favorable-risk classification of 1q21/KMT2A::MLLT11 to intermediate risk, and to refine the risk-stratification of 9p22/KMT2A::MLLT3 AML. Future studies should validate the associations between the newly identified ACAs and outcomes and unravel the underlying biological pathogenesis of KMT2A fusions and ACAs.
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Affiliation(s)
- Romy E. van Weelderen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christine J. Harrison
- Leukemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, United Kingdom
| | - Kim Klein
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yilin Jiang
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jonas Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, Salgrenska University Hospital, Gothenburg, Sweden
| | - Todd Alonzo
- Division of Biostatistics, University of Southern California, Los Angeles, CA
| | - Richard Aplenc
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Nira Arad-Cohen
- Department of Pediatric Hematology-Oncology, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Emmanuelle Bart-Delabesse
- Institut Universitaire du Cancer Toulouse-Oncopole, Laboratoire d’Hématologie secteur Génétique des Hémopathies, Toulouse, France
| | - Barbara Buldini
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Department of Maternal and Child Health, Padua University, Padua, Italy
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Michael N. Dworzak
- Department of Pediatrics, St. Anna Children’s Hospital, Medical University of Vienna & St. Anna Children’s Cancer Research Institute, Vienna, Austria
| | - Sarah Elitzur
- Department of Pediatric Hematology and Oncology, Schneider Children’s Medical Center & Tel Aviv University, Tel Aviv, Israel
| | | | - Alan Gamis
- Department of Hematology and Oncology, Children’s Mercy Hospital, Kansas City, MO
| | | | - Bianca F. Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Hester A. de Groot-Kruseman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- DCOG, Dutch Childhood Oncology Group, Utrecht, The Netherlands
| | - Erin Guest
- Department of Hematology and Oncology, Children’s Mercy Hospital, Kansas City, MO
| | - Shau-Yin Ha
- Department of Pediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon Bay, Hong Kong
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Charikleia Kelaidi
- Department of Pediatric Hematology and Oncology, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Hélène Lapillonne
- Department of Pediatric Hematology and Oncology, Hôpital Armand Trousseau, Paris, France
| | - Guy Leverger
- Department of Pediatric Hematology and Oncology, Hôpital Armand Trousseau, Paris, France
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome, Italy
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Mareike Rasche
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Jeffrey E. Rubnitz
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anne Tierens
- Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Daisuke Tomizawa
- Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - C. Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Gertjan J. L. Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Li JN, Chen YJ, Fan Z, Li QR, Liao LH, Ke ZY, Li Y, Wang LN, Yang CY, Luo XQ, Tang YL, Zhang XL, Huang LB. Intensive chemotherapy with dual induction and ALL-like consolidation for childhood acute myeloid leukemia: a respective report from multiple centers in China. Ther Adv Hematol 2024; 15:20406207241256894. [PMID: 38828002 PMCID: PMC11143855 DOI: 10.1177/20406207241256894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 05/07/2024] [Indexed: 06/05/2024] Open
Abstract
Background Pediatric acute myeloid leukemia (AML) has poor prognosis and high rate of relapse and mortality, and exploration of new treatment options is still critically needed. Objectives To summarize the outcome of our new treatment strategies for pediatric AML, which is characterized by dual induction and acute lymphoblastic leukemia (ALL) elements consolidation. Design Retrospective, single-arm study. Methods From July 2012 to December 2019, an intensive chemotherapy protocol was used for newly diagnosed children with AML, which contains dual induction, three courses of consolidations based on high-dose cytarabine, and two courses of consolidations composed of high-dose methotrexate, vincristine, asparaginase, and mercaptopurine (ALL-like elements). Blasts were monitored by bone marrow smears at intervals, and two lumbar punctures were performed during chemotherapy. We retrospectively analyzed the efficacy and safety of this study. The last follow-up was on 26 May 2023. Results A total of 70 pediatric AMLs were included. The median age at diagnosis was 6.7 (0.5-16.0) years. The median initial WBC count was 23.74 × 109/L, 11 of whom ⩾100 × 109/L. After dual induction, there were 62 cases of complete remission (CR), 5 cases of partial remission, and 3 cases of nonremission. The CR rate was 88.57%. The median follow-up time was 5.8 (0.2-9.4) years, the 5-year overall survival was 78.2% ± 5%, the event-free survival (EFS) was 71.2% ± 5.6%, and the cumulative recurrence rate was 27.75%. The 5-year EFS of patients with initial WBC < 100 × 109/L (n = 59) and ⩾100 × 109/L (n = 11) were 76.4% ± 5.7% and 45.5% ± 15% (p = 0.013), respectively. A total of 650 hospital infections occurred. The main causes of infection were respiratory tract infection (26.92%), septicemia (18.46%), stomatitis (11.85%), and skin and soft-tissue infection (10.46%). Conclusion This intensive treatment protocol with dual induction and ALL-like elements is effective and safe for childhood AML. Initial WBC ⩾ 100 × 109/L was the only independent risk factor in this cohort. Trial registration It is a retrospective study, and no registration on ClinicalTrials.gov.
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Affiliation(s)
- Jia-Nan Li
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Jun Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Fan
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiao-Ru Li
- Department of Pediatrics, Zhongshan People’s Hospital, Zhongshan, China
| | - Liu-Hua Liao
- Department of Pediatrics, Huizhou Central People’s Hospital, Huizhou, China
| | - Zhi-Yong Ke
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Li
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Na Wang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cui-Yun Yang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xue-Qun Luo
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan-Lai Tang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xiao-Li Zhang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou 510080, China
| | - Li-Bin Huang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou 510080, China
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Hu GH, Zhang XH, Wang Y, Xu LP, Hou XL, Cheng YF, Huang XJ. The prognosis of haploidentical hematopoietic stem cell transplantation in infants and patients under 3 years old with acute leukemia. Clin Transplant 2024; 38:e15247. [PMID: 38375911 DOI: 10.1111/ctr.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients <3 years of age remains controversial. Data on haploidentical donor (HID) transplants in this age group is limited. PATIENTS AND METHODS We retrospectively analyzed the prognosis of 97 patients with acute leukemia aged <3 years who underwent HID transplantation at our institute. RESULTS With a median follow-up of 45 months, the 3-year disease-free survival (DFS), overall survival (OS), and 3-year cumulative incidence rate of treatment-related mortality were 69.3% (95% confidence interval (CI): 59.9%-78.7%), 74.2% (95% CI: 65.2%-83.2%), and 3.6% (95% CI: 0.9%-9.7%) in all 97 patients, respectively. The 3-year DFS and OS rate in patients diagnosed <1 year and patients diagnosed ≥1 year were comparable: 77.8% (95% CI: 62.2%-93.4%) versus 66.3% (95% CI: 55.0%-77.6%, p = .253) and 82.5% (95% CI: 66.3-98.7%) versus 72.8% (95% CI: 61.9%-83.7%, p = .153), respectively. At the last follow-up, 23 patients had died, and 20 had died of relapse. Multivariate analysis revealed that positive pre-HSCT flow cytometric minimal residual disease (hazard ratio 5.605, p = .000) and AML-M7 expression (hazard ratio 2.906, p = .014) were independent adverse prognostic variables for relapse. CONCLUSIONS HID transplantation is potent and safe for infants and young patients with acute leukemia. Relapse is the primary cause of treatment failure.
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Affiliation(s)
- Guan-Hua Hu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Xin-Lin Hou
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yi-Fei Cheng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Chinese Academic of Medical Sciences, Beijing, China
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Lee JH, Ju HY, Hyun JK, Kim SJ, Cho HW, Lee JK, Lee JW, Sung KW, Yoo KH. Treatment outcome and prognostic factors in relapsed pediatric acute myeloid leukemia. Blood Res 2023; 58:181-186. [PMID: 37926557 PMCID: PMC10758629 DOI: 10.5045/br.2023.2023152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
Background Despite improved outcomes for pediatric patients with acute myeloid leukemia (AML), the prognosis for relapse remains poor. This study aimed to examine the clinical factors associated with prognosis in relapsed pediatric AML. Methods We conducted a chart review of pediatric patients with AML who experienced their first relapse and received treatment at our institution between 2008 and 2019. Risk stratification at diagnosis was performed according to the definition suggested by the ongoing AML 2012 study in Korea, and the clinical factors associated with prognosis were analyzed. Results A total of 27 pediatric patients with relapsed AML were identified. The 5-year overall survival (OS) and event-free survival (EFS) rates were 32.9% and 32.9%, respectively. A duration ≥12 months from diagnosis to relapse had a favorable impact on survival outcomes (5-yr OS, 64.0% vs. 15.7%; P=0.007). Patients who achieved complete remission (CR) after 1 course of chemotherapy following relapse (N=15) had a 5-year OS rate of 59.3%, while none of the other patients survived (P<0.0001). Additionally, the 5-year OS differed significantly based on the risk group at initial diagnosis (62.3% [favorable and intermediate prognosis groups, N=11] vs. 13.3% [poor prognosis group, N=15]; P=0.014). Conclusion Patients with a longer duration of CR before relapse, who achieved CR following 1 course of reinduction chemotherapy, and were in the favorable or intermediate prognosis group at diagnosis demonstrated better outcomes. These findings emphasize the importance of tailoring treatment strategies based on the expected prognosis at relapse in pediatric patients with AML.
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Affiliation(s)
- Jung Hwan Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Kyung Hyun
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Kyung Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cell & Gene Therapy Institute, Samsung Medical Center, Seoul, Korea
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Tang L, Huang Z, Mei H, Hu Y. Immunotherapy in hematologic malignancies: achievements, challenges and future prospects. Signal Transduct Target Ther 2023; 8:306. [PMID: 37591844 PMCID: PMC10435569 DOI: 10.1038/s41392-023-01521-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 08/19/2023] Open
Abstract
The immune-cell origin of hematologic malignancies provides a unique avenue for the understanding of both the mechanisms of immune responsiveness and immune escape, which has accelerated the progress of immunotherapy. Several categories of immunotherapies have been developed and are being further evaluated in clinical trials for the treatment of blood cancers, including stem cell transplantation, immune checkpoint inhibitors, antigen-targeted antibodies, antibody-drug conjugates, tumor vaccines, and adoptive cell therapies. These immunotherapies have shown the potential to induce long-term remission in refractory or relapsed patients and have led to a paradigm shift in cancer treatment with great clinical success. Different immunotherapeutic approaches have their advantages but also shortcomings that need to be addressed. To provide clinicians with timely information on these revolutionary therapeutic approaches, the comprehensive review provides historical perspectives on the applications and clinical considerations of the immunotherapy. Here, we first outline the recent advances that have been made in the understanding of the various categories of immunotherapies in the treatment of hematologic malignancies. We further discuss the specific mechanisms of action, summarize the clinical trials and outcomes of immunotherapies in hematologic malignancies, as well as the adverse effects and toxicity management and then provide novel insights into challenges and future directions.
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Affiliation(s)
- Lu Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China
| | - Zhongpei Huang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China.
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China.
- Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China.
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China.
- Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
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Tomizawa D, Tsujimoto SI. Risk-Stratified Therapy for Pediatric Acute Myeloid Leukemia. Cancers (Basel) 2023; 15:4171. [PMID: 37627199 PMCID: PMC10452723 DOI: 10.3390/cancers15164171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Acute Myeloid Leukemia (AML) is the second most common type of leukemia in children. Recent advances in high-resolution genomic profiling techniques have uncovered the mutational landscape of pediatric AML as distinct from adult AML. Overall survival rates of children with AML have dramatically improved in the past 40 years, currently reaching 70% to 80% in developed countries. This was accomplished by the intensification of conventional chemotherapy, improvement in risk stratification using leukemia-specific cytogenetics/molecular genetics and measurable residual disease, appropriate use of allogeneic hematopoietic stem cell transplantation, and improvement in supportive care. However, the principle therapeutic approach for pediatric AML has not changed substantially for decades and improvement in event-free survival is rather modest. Further refinements in risk stratification and the introduction of emerging novel therapies to contemporary therapy, through international collaboration, would be key solutions for further improvements in outcomes.
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Affiliation(s)
- Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children’s Cancer Center, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Shin-Ichi Tsujimoto
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan;
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8
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van Weelderen RE, Klein K, Harrison CJ, Jiang Y, Abrahamsson J, Arad-Cohen N, Bart-Delabesse E, Buldini B, De Moerloose B, Dworzak MN, Elitzur S, Fernández Navarro JM, Gerbing RB, Goemans BF, de Groot-Kruseman HA, Guest E, Ha SY, Hasle H, Kelaidi C, Lapillonne H, Leverger G, Locatelli F, Masetti R, Miyamura T, Norén-Nyström U, Polychronopoulou S, Rasche M, Rubnitz JE, Stary J, Tierens A, Tomizawa D, Zwaan CM, Kaspers GJ. Measurable Residual Disease and Fusion Partner Independently Predict Survival and Relapse Risk in Childhood KMT2A-Rearranged Acute Myeloid Leukemia: A Study by the International Berlin-Frankfurt-Münster Study Group. J Clin Oncol 2023; 41:2963-2974. [PMID: 36996387 PMCID: PMC10414713 DOI: 10.1200/jco.22.02120] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/22/2022] [Accepted: 02/01/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE A previous study by the International Berlin-Frankfurt-Münster Study Group (I-BFM-SG) on childhood KMT2A-rearranged (KMT2A-r) AML demonstrated the prognostic value of the fusion partner. This I-BFM-SG study investigated the value of flow cytometry-based measurable residual disease (flow-MRD) and evaluated the benefit of allogeneic stem-cell transplantation (allo-SCT) in first complete remission (CR1) in this disease. METHODS A total of 1,130 children with KMT2A-r AML, diagnosed between January 2005 and December 2016, were assigned to high-risk (n = 402; 35.6%) or non-high-risk (n = 728; 64.4%) fusion partner-based groups. Flow-MRD levels at both end of induction 1 (EOI1) and 2 (EOI2) were available for 456 patients and were considered negative (<0.1%) or positive (≥0.1%). End points were 5-year event-free survival (EFS), cumulative incidence of relapse (CIR), and overall survival (OS). RESULTS The high-risk group had inferior EFS (30.3% high risk v 54.0% non-high risk; P < .0001), CIR (59.7% v 35.2%; P < .0001), and OS (49.2% v 70.5%; P < .0001). EOI2 MRD negativity was associated with superior EFS (n = 413; 47.6% MRD negativity v n = 43; 16.3% MRD positivity; P < .0001) and OS (n = 413; 66.0% v n = 43; 27.9%; P < .0001), and showed a trend toward lower CIR (n = 392; 46.1% v n = 26; 65.4%; P = .016). Similar results were obtained for patients with EOI2 MRD negativity within both risk groups, except that within the non-high-risk group, CIR was comparable with that of patients with EOI2 MRD positivity. Allo-SCT in CR1 only reduced CIR (hazard ratio, 0.5 [95% CI, 0.4 to 0.8]; P = .00096) within the high-risk group but did not improve OS. In multivariable analyses, EOI2 MRD positivity and high-risk group were independently associated with inferior EFS, CIR, and OS. CONCLUSION EOI2 flow-MRD is an independent prognostic factor and should be included as risk stratification factor in childhood KMT2A-r AML. Treatment approaches other than allo-SCT in CR1 are needed to improve prognosis.
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Affiliation(s)
- Romy E. van Weelderen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim Klein
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christine J. Harrison
- Leukemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, United Kingdom
| | - Yilin Jiang
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jonas Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, Salgrenska University Hospital, Gothenburg, Sweden
| | - Nira Arad-Cohen
- Pediatric Hemato-Oncology Department, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Emmanuelle Bart-Delabesse
- IUC Toulouse-Oncopole, Laboratoire d’Hématologie secteur Génétique des Hémopathies, Toulouse, France
| | - Barbara Buldini
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, Padua University, Padua, Italy
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Michael N. Dworzak
- St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, and St Anna Children's Cancer Research Institute, Vienna, Austria
| | - Sarah Elitzur
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center and Tel Aviv University, Tel Aviv, Israel
| | | | - Robert B. Gerbing
- Department of Statistics, The Children's Oncology Group, Monrovia, California
| | - Bianca F. Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Hester A. de Groot-Kruseman
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- DCOG, Dutch Childhood Oncology Group, Utrecht, the Netherlands
| | - Erin Guest
- Children's Mercy Kansas City, Kansas City, MO
| | - Shau-Yin Ha
- Department of Pediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Henrik Hasle
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Charikleia Kelaidi
- Department of Pediatric Hematology and Oncology, Aghia Sophia Children's Hospital, Athens, Greece
| | - Hélène Lapillonne
- Pediatric Hematology and Oncology Department, Hôpital Armand Trousseau, Paris, France
| | - Guy Leverger
- Pediatric Hematology and Oncology Department, Hôpital Armand Trousseau, Paris, France
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology, Aghia Sophia Children's Hospital, Athens, Greece
| | - Mareike Rasche
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - Jeffrey E. Rubnitz
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, University Hospital Motol and 2 Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anne Tierens
- Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - C. Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gertjan J.L. Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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9
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Testi AM, Moleti ML, Angi A, Bianchi S, Barberi W, Capria S. Pediatric Autologous Hematopoietic Stem Cell Transplantation: Safety, Efficacy, and Patient Outcomes. Literature Review. Pediatric Health Med Ther 2023; 14:197-215. [PMID: 37284518 PMCID: PMC10239625 DOI: 10.2147/phmt.s366636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
Autologous stem cell transplantation (auto-HSCT) is a part of the therapeutic strategy for various oncohematological diseases. The auto-HSCT procedure enables hematological recovery after high-dose chemotherapy, otherwise not tolerable, by the infusion of autologous hematopoietic stem cells. Unlike allogeneic transplant (allo-HSCT), auto-HSCT has the advantage of lacking acute-graft-versus-host disease (GVHD) and prolonged immunosuppression, however, these advantages are counterbalanced by the absence of graft-versus-leukemia. Moreover, in hematological malignancies, the autologous hematopoietic stem cell source may be contaminated by neoplastic cells, leading to disease reappearance. In recent years, allogeneic transplant-related mortality (TRM) has progressively decreased, almost approaching auto-TRM, and many alternative donor sources are available for the majority of patients eligible for transplant procedures. In adults, the role of auto-HSCT compared to conventional chemotherapy (CT) in hematological malignancies has been well defined in many extended randomized trials; however, such trials are lacking in pediatric cohorts. Therefore, the role of auto-HSCT in pediatric oncohematology is limited, in both first- and second-line therapies and still remains to be defined. Nowadays, the accurate stratification in risk groups, according to the biological characteristics of the tumors and therapy response, and the introduction of new biological therapies, have to be taken into account in order to assign auto-HSCT a precise role in the therapeutic strategies, also considering that in the developmental age, auto-HSCT has a clear advantage over allo-HSCT, in terms of late sequelae, such as organ damage and second neoplasms. The purpose of this review is to report the results obtained with auto-HSCT in the different pediatric oncohematological diseases, focusing on the most significant literature data in the context of the various diseases and discussing this data in the light of the current therapeutic landscape.
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Affiliation(s)
- Anna Maria Testi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Maria Luisa Moleti
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Alessia Angi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Simona Bianchi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Walter Barberi
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | - Saveria Capria
- Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
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10
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Masetti R, Muratore E, Gori D, Prete A, Locatelli F. Response to: meta-analysis on allogeneic transplant for treating pediatric patients with acute myeloid leukemia in first remission: reanalysis of primary data. Ann Hematol 2023:10.1007/s00277-023-05219-0. [PMID: 37060463 DOI: 10.1007/s00277-023-05219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Riccardo Masetti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Edoardo Muratore
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatric Bambino Gesù, Sapienza, University of Rome, Rome, Italy
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11
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Messori A, Hyeraci G. Meta-analysis on allogeneic transplant for treating pediatric patients with acute myeloid leukemia in first remission: reanalysis of primary data. Ann Hematol 2023; 102:1603-1605. [PMID: 36877260 DOI: 10.1007/s00277-023-05101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Andrea Messori
- Centro Operativo and HTA Committee, Regione Toscana, Viale Alderotti 26/N, 50136, Florence, Italy.
| | - Giulia Hyeraci
- Centro Operativo and HTA Committee, Regione Toscana, Viale Alderotti 26/N, 50136, Florence, Italy
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12
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Aid Z, Robert E, Lopez CK, Bourgoin M, Boudia F, Le Mene M, Riviere J, Baille M, Benbarche S, Renou L, Fagnan A, Thirant C, Federici L, Touchard L, Lecluse Y, Jetten A, Geoerger B, Lapillonne H, Solary E, Gaudry M, Meshinchi S, Pflumio F, Auberger P, Lobry C, Petit A, Jacquel A, Mercher T. High caspase 3 and vulnerability to dual BCL2 family inhibition define ETO2::GLIS2 pediatric leukemia. Leukemia 2023; 37:571-579. [PMID: 36585521 PMCID: PMC10583253 DOI: 10.1038/s41375-022-01800-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
Pediatric acute myeloid leukemia expressing the ETO2::GLIS2 fusion oncogene is associated with dismal prognosis. Previous studies have shown that ETO2::GLIS2 can efficiently induce leukemia development associated with strong transcriptional changes but those amenable to pharmacological targeting remained to be identified. By studying an inducible ETO2::GLIS2 cellular model, we uncovered that de novo ETO2::GLIS2 expression in human cells led to increased CASP3 transcription, CASP3 activation, and cell death. Patient-derived ETO2::GLIS2+ leukemic cells expressed both high CASP3 and high BCL2. While BCL2 inhibition partly inhibited ETO2::GLIS2+ leukemic cell proliferation, BH3 profiling revealed that it also sensitized these cells to MCL1 inhibition indicating a functional redundancy between BCL2 and MCL1. We further show that combined inhibition of BCL2 and MCL1 is mandatory to abrogate disease progression using in vivo patient-derived xenograft models. These data reveal that a transcriptional consequence of ETO2::GLIS2 expression includes a positive regulation of the pro-apoptotic CASP3 and associates with a vulnerability to combined targeting of two BCL2 family members providing a novel therapeutic perspective for this aggressive pediatric AML subgroup.
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Affiliation(s)
- Zakia Aid
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Elie Robert
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Cécile K Lopez
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France.
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France.
- Wellcome Trust-MRC Cambridge Stem Cell Institute, Cambridge, UK.
- Department of Haematology, University of Cambridge, Cambridge, UK.
| | - Maxence Bourgoin
- Team "Myeloid Malignancies and Multiple Myeloma", Université Côte d'Azur, INSERM U1065/C3M, 06204, Nice, France
| | - Fabien Boudia
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Melchior Le Mene
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Julie Riviere
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Marie Baille
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Salima Benbarche
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
| | - Laurent Renou
- Unité de Recherche (UMR)-E008 Stabilité Génétique, Cellules Souches et Radiations, Team Niche and Cancer in Hematopoiesis, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Université de Paris-Université Paris-Saclay, Fontenay-aux-Roses, 92260, France
| | - Alexandre Fagnan
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Cécile Thirant
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Laetitia Federici
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Laure Touchard
- Unité Mixte de Service - Analyse Moléculaire Modélisation et Imagerie de la maladie Cancéreuse (UMS AMMICA), Gustave Roussy Cancer Campus, 94800, Villejuif, France
| | - Yann Lecluse
- Unité Mixte de Service - Analyse Moléculaire Modélisation et Imagerie de la maladie Cancéreuse (UMS AMMICA), Gustave Roussy Cancer Campus, 94800, Villejuif, France
| | - Anton Jetten
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Birgit Geoerger
- Gustave Roussy Cancer Campus, Pediatric and Adolescent Oncology Department, INSERM U1015, Université Paris Saclay, 94800, Villejuif, France
| | - Hélène Lapillonne
- Pediatric Hematology and Oncology Department, Armand Trousseau Hospital, AP-HP, Sorbonne University, UMRS_938, CONECT-AML, 75012, Paris, France
| | - Eric Solary
- INSERM U1287, Gustave Roussy Cancer Campus, 94800, Villejuif, France
| | - Muriel Gaudry
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Françoise Pflumio
- Unité de Recherche (UMR)-E008 Stabilité Génétique, Cellules Souches et Radiations, Team Niche and Cancer in Hematopoiesis, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Université de Paris-Université Paris-Saclay, Fontenay-aux-Roses, 92260, France
- OPALE Carnot Institute, The Organization for Partnerships in Leukemia, 75010, Paris, France
| | - Patrick Auberger
- Team "Myeloid Malignancies and Multiple Myeloma", Université Côte d'Azur, INSERM U1065/C3M, 06204, Nice, France
- OPALE Carnot Institute, The Organization for Partnerships in Leukemia, 75010, Paris, France
| | - Camille Lobry
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France
- INSERM U944, CNRS UMR7212, Institut de Recherche Saint Louis and Université de Paris, 75010, Paris, France
| | - Arnaud Petit
- Gustave Roussy Cancer Campus, Pediatric and Adolescent Oncology Department, INSERM U1015, Université Paris Saclay, 94800, Villejuif, France
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Arnaud Jacquel
- Team "Myeloid Malignancies and Multiple Myeloma", Université Côte d'Azur, INSERM U1065/C3M, 06204, Nice, France.
| | - Thomas Mercher
- INSERM U1170, Gustave Roussy Cancer Campus, Université Paris Saclay, PEDIAC program, 94800, Villejuif, France.
- Equipe labellisée Ligue Nationale Contre le Cancer, 75013, Paris, France.
- OPALE Carnot Institute, The Organization for Partnerships in Leukemia, 75010, Paris, France.
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13
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Karlsson L, Cheuk D, De Moerloose B, Hasle H, Jahnukainen K, Juul-Dam KL, Kaspers G, Kovalova Z, Lausen B, Nyström UN, Palle J, Pronk CJ, Saks K, Tierens A, Zeller B, Abrahamsson J. Characteristics and outcome of primary resistant disease in paediatric acute myeloid leukaemia. Br J Haematol 2023; 201:757-765. [PMID: 36762836 DOI: 10.1111/bjh.18685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Abstract
A significant proportion of events in paediatric acute myeloid leukaemia (AML) are caused by resistant disease (RD). We investigated clinical and biological characteristics in 66 patients with RD from 1013 children with AML registered and treated according to the NOPHO-AML 93, NOPHO-AML 2004, DB AML-01 and NOPHO-DBH AML 2012 protocols. Risk factors for RD were age10 years or older and a white-blood-cell count (WBC) of 100 × 109 /L or more at diagnosis. The five-year overall survival (OS) was 38% (95% confidence interval [CI]: 28%-52%). Of the 63 children that received salvage therapy with chemotherapy, 59% (N = 37) achieved complete remission (CR) with OS 57% (95% CI: 42%-75%) compared to 12% (95% CI: 4%-35%) for children that did not achieve CR. Giving more than two salvage chemotherapy courses did not increase CR rates. OS for all 43 patients receiving allogeneic haematopoietic stem cell transplantation (HSCT) was 49% (95% CI: 36%-66%). Those achieving CR and proceeding to HSCT had an OS of 56% (95% CI: 41%-77%, N = 30). This study showed that almost 40% of children with primary resistant AML can be cured with salvage therapy followed by HSCT. Children that did not achieve CR after two salvage courses with chemotherapy did not benefit from additional chemotherapy.
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Affiliation(s)
- Lene Karlsson
- Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Cheuk
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hong Kong, China
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsi Jahnukainen
- New Children's hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Gertjan Kaspers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands
| | - Zanna Kovalova
- Department of Paediatric Oncology/Haematology, Children's Clinical University Hospital, Riga, Latvia
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Josefine Palle
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Kadri Saks
- Department of Paediatrics, SA Tallinna Lastehaigla, Tallinn, Estonia
| | - Anne Tierens
- Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Bernward Zeller
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Jonas Abrahamsson
- Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Ye Q, Ying Q, Dai Q, Liao C, Xiao G. Tumor-suppressing effects of miR-381-3p in pediatric acute myeloid leukemia via ROCK1 downregulation. Funct Integr Genomics 2023; 23:43. [PMID: 36658407 DOI: 10.1007/s10142-022-00950-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
MicroRNA (miR)-381-3p is the newly discovered tumor-associated miRNA, which is frequently associated with diverse human malignancies; but, it is still unknown about its effect on acute myeloid leukemia (AML) in children. This work focused on exploring miR-381-3p's effect on childhood AML and identifying the possible mechanisms facilitating new treatment development. Using qRT-PCR analysis, miR-381-3p expression remarkably reduced in pediatric AML patients and AML cell lines (HL-60 and U937). Following transfection of miR-381-3p mimic or inhibitor into HL-60 and U937 cells, we conducted MTT assay to evaluate cell proliferation, flow cytometry (FCM) to measured cell apoptosis and cell cycle, whereas Transwell assays to detect cell invasion and migration. Our results demonstrated that miR-381-3p overexpression remarkably repressed cell growth, invasion and migration; additionally, miR-381-3p overexpression resulted in arrest of cell cycle and enhanced cell apoptosis. In contrast, miR-381-3p knockdown led to an opposite effect. Moreover, we predicted miR-381's target gene and validated it by luciferase reporter assay and TargetScan, separately. We identified miR-381-3p's binding site in ROCK1 3'-UTR. As revealed by Western-blot (WB) assay, miR-381-3p overexpression notably suppressed ROCK1 level. Moreover, restoring ROCK1 expression abolished miR-381-3p's inhibition on cell proliferation, invasion and migration. Data in this work indicated the role of miR-381-3p as the tumor suppressor within pediatric AML by targeting ROCK1. Therefore, miR-381-3p might serve as a potential therapeutic target for the treatment of pediatric AML.
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Affiliation(s)
- Qidong Ye
- Department of Pediatrics, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, No. 59 Liuting Street, Ningbo, 315000, Zhejiang Province, People's Republic of China.
| | - Qianqian Ying
- Department of Pediatrics, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, No. 59 Liuting Street, Ningbo, 315000, Zhejiang Province, People's Republic of China
| | - Qiaoyan Dai
- Department of Pediatrics, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, No. 59 Liuting Street, Ningbo, 315000, Zhejiang Province, People's Republic of China
| | - Cong Liao
- Department of Pediatrics, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, No. 59 Liuting Street, Ningbo, 315000, Zhejiang Province, People's Republic of China
| | - Gang Xiao
- Department of Pediatrics, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, No. 59 Liuting Street, Ningbo, 315000, Zhejiang Province, People's Republic of China
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15
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Evaluating the prognostic value of CD56 in pediatric acute myeloid leukemia. BMC Cancer 2022; 22:1339. [PMID: 36544113 PMCID: PMC9768963 DOI: 10.1186/s12885-022-10460-3] [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] [Received: 04/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many cytogenetic changes and gene mutations are associated with acute myeloid leukemia (AML) survival outcomes. CD56 is related to poor prognosis when expressed in adult AML patients. However, the prognostic value of CD56 in children with AML has rarely been reported. In this research, we aimed to evaluate the prognostic value of CD56 in childhood AML. METHODS The present retrospective study included 145 newly diagnosed pediatric patients with de novo AML (excluding AML-M3) in two hospitals between January 2015 and April 2021. RESULTS The total median (range) age was 75 (8-176) months, and the median follow-up time was 35 months. No significant difference in the 3-year overall survival rate was noted between the CD56-positive and CD56-negative groups (67.0% vs. 79.3%, P = 0.157) who received chemotherapy. However, among high-risk patients, the CD56-positive group had a worse overall survival rate and event-free survival rate (P < 0.05). Furthermore, among high-risk patients, the CD56-positive group had higher relapse and mortality rates than the CD56-negative group (P < 0.05). CONCLUSIONS CD56 represents a potential factor of poor prognosis in specific groups of children with AML and should be considered in the risk stratification of the disease. Given the independent prognostic value of CD56 expression, we should consider integrating this marker with some immunophenotypic or cytogenetic abnormalities for comprehensive analysis.
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16
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Gao X, Fan S, Zhang X. MiR-1306-5p promotes cell proliferation and inhibits cell apoptosis in acute myeloid leukemia by downregulating PHF6 expression. Leuk Res 2022; 120:106906. [DOI: 10.1016/j.leukres.2022.106906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
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17
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Allogeneic hematopoietic stem cell transplantation for pediatric acute myeloid leukemia in first complete remission: a meta-analysis. Ann Hematol 2022; 101:2497-2506. [PMID: 36038660 PMCID: PMC9546991 DOI: 10.1007/s00277-022-04965-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/19/2022] [Indexed: 11/01/2022]
Abstract
Identification of pediatric patients with acute myeloid leukemia (AML) candidates to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1) is still a matter of debate. Currently, transplantation is reserved to patients considered at high risk of relapse based on cytogenetics, molecular biology, and minimal residual disease (MRD) assessment. However, no randomized clinical trial exists in the literature comparing transplantation with other types of consolidation therapy. Here, we provide an up-to-date meta-analysis of studies comparing allo-HSCT in CR1 with chemotherapy alone as a post-remission treatment in high-risk pediatric AML. The literature search strategy identified 10 cohorts from 9 studies performing as-treated analysis. The quantitative synthesis showed improved overall survival (OS) (relative risk, 1.15; 95% confidence interval [CI], 1.06-1.24; P = 0.0006) and disease-free survival (relative risk, 1.31; 95% CI, 1.17-1.47; P = 0.0001) in the allo-HSCT group, with increased relapse rate in the chemotherapy group (relative risk, 1.26; 95% CI, 1.07-1.49; P = 0.006). Sensitivity analysis including prospective studies alone and excluding studies that reported the comparison only on intermediate-risk patients confirmed the benefit of allo-HSCT on OS. Further research should focus on individualizing allo-HSCT indications based on molecular stratification and MRD monitoring.
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18
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Restivo GA, Mussolin L, D’Angelo P, Zin A, Pigazzi M, Carraro E, D’Amore ESG, Pillon M, Farruggia P. Extranodal Biphenotypic Non-Hodgkin Lymphoma of the Popliteal Cavity: A Case Report and Review of Literature. Diagnostics (Basel) 2022; 12:diagnostics12071649. [PMID: 35885553 PMCID: PMC9323538 DOI: 10.3390/diagnostics12071649] [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] [Received: 04/30/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 11/20/2022] Open
Abstract
Primary soft-tissue lymphoma (PSTL) is a rare extranodal non-Hodgkin lymphoma, characterized by a mass growing within soft-tissue, which is connective tissue, adipose tissue, and skeletal muscle. Here, we describe a case of biphenotypic lymphoblastic lymphoma arising from soft tissue of the popliteal fossa in an 11-year-old boy. A pediatric review about PSTL revealed that anaplastic large cell lymphoma is the most common histological type and a biphenotypic lymphoblastic lymphoma has not yet been reported in childhood. Lymphoma should always be considered in patients presenting with a soft-tissue mass, and a comprehensive immunohistochemical evaluation, including B-cell, T-cell, and myeloid markers, is needed to make a correct diagnosis and establish the most suitable treatment.
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Affiliation(s)
- Giulia A. Restivo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Lara Mussolin
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
- Institute of Pediatric Research-Fondazione Città della Speranza, 35127 Padova, Italy;
| | - Paolo D’Angelo
- Department of Pediatric Hemato-Oncology, ARNAS Ospedali Civico, G. Di Cristina, 90127 Palermo, Italy; (P.D.); (P.F.)
| | - Angelica Zin
- Institute of Pediatric Research-Fondazione Città della Speranza, 35127 Padova, Italy;
| | - Martina Pigazzi
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
| | - Elisa Carraro
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
| | | | - Marta Pillon
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
| | - Piero Farruggia
- Department of Pediatric Hemato-Oncology, ARNAS Ospedali Civico, G. Di Cristina, 90127 Palermo, Italy; (P.D.); (P.F.)
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19
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Molecular Measurable Residual Disease Assessment before Hematopoietic Stem Cell Transplantation in Pediatric Acute Myeloid Leukemia Patients: A Retrospective Study by the I-BFM Study Group. Biomedicines 2022; 10:biomedicines10071530. [PMID: 35884834 PMCID: PMC9313005 DOI: 10.3390/biomedicines10071530] [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] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a curative post-remission treatment in patients with acute myeloid leukemia (AML), but relapse after transplant is still a challenging event. In recent year, several studies have investigated the molecular minimal residual disease (qPCR-MRD) as a predictor of relapse, but the lack of standardized protocols, cut-offs, and timepoints, especially in the pediatric setting, has prevented its use in several settings, including before HSCT. Here, we propose the first collaborative retrospective I-BFM-AML study assessing qPCR-MRD values in pretransplant bone marrow samples of 112 patients with a diagnosis of AML harboring t(8;21)(q22; q22)RUNX1::RUNX1T1, or inv(16)(p13q22)CBFB::MYH11, or t(9;11)(p21;q23)KMT2A::MLLT3, or FLT3-ITD genetic markers. We calculated an ROC cut-off of 2.1 × 10−4 that revealed significantly increased OS (83.7% versus 57.1%) and EFS (80.2% versus 52.9%) for those patients with lower qPCR-MRD values. Then, we partitioned patients into three qPCR-MRD groups by combining two different thresholds, 2.1 × 10−4 and one lower cut-off of 1 × 10−2, and stratified patients into low-, intermediate-, and high-risk groups. We found that the 5-year OS (83.7%, 68.6%, and 39.2%, respectively) and relapse-free survival (89.2%, 73.9%, and 67.9%, respectively) were significantly different independent of the genetic lesion, conditioning regimen, donor, and stem cell source. These data support the PCR-based approach playing a clinical relevance in AML transplant management.
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20
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High-Risk Acute Myeloid Leukemia: A Pediatric Prospective. Biomedicines 2022; 10:biomedicines10061405. [PMID: 35740427 PMCID: PMC9220202 DOI: 10.3390/biomedicines10061405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Pediatric acute myeloid leukemia is a clonal disorder characterized by malignant transformation of the hematopoietic stem cell. The incidence and the outcome remain inferior when compared to pediatric ALL, although prognosis has improved in the last decades, with 80% overall survival rate reported in some studies. The standard therapeutic approach is a combined cytarabine and anthracycline-based regimen followed by consolidation with allogeneic stem cell transplantation (allo-SCT) for high-risk AML and allo-SCT for non-high-risk patients only in second complete remission after relapse. In the last decade, several drugs have been used in clinical trials to improve outcomes in pediatric AML treatment.
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21
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da Silva Selistre L, Renard C, Bacchetta J, Goutagny MP, Hu J, Carla de Souza V, Bertrand Y, Dubourg L, Domenech C. Teenagers and young adults with a past of allogenic hematopoietic stem cell transplantation are at significant risk of chronic kidney disease. Pediatr Nephrol 2022; 37:1365-1375. [PMID: 34735600 DOI: 10.1007/s00467-021-05319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Allogenic hematopoietic stem cell transplantation (aHSCT) remains the treatment of choice for some malignant hemopathies in children, albeit with the risk of long-term consequences, including chronic kidney disease (CKD). METHODS In our single tertiary referral center, we retrospectively assessed the long-term renal outcome in a cohort of children and adolescents who had undergone aHSCT for malignant hemopathies between 2003 and 2017. We distinguished glomerular and tubular dysfunctions and assessed the accuracy of the most common formula(s) to estimate glomerular filtration rate (GFR) during standard clinical follow-up. RESULTS Among the 166 patients who had received aHSCT, 61 underwent kidney functional assessment 1 to 10 years post-transplantation. Twenty-seven patients (44.3%) had a CKD with glomerular impairment, including 20 patients with a GFR < 90 mL/min/1.73 m2, and among these, 5 patients < 60 mL/min/1.73 m2. Patients with tubular signs had a significantly higher baseline GFR: 112 mL/min/1.73 m2 [100; 120] versus 102 [99.0; 112.5] for patients without kidney involvement, and 76 [61; 86] for patients with CKD (p < 0.01). Schwartz, CKiDU25, and EKFC formulas significantly overestimated mGFR, with a P30% ≤ 30%, which could lead to overlooking CKD diagnosis in this population. No patient reached kidney failure. CONCLUSIONS In conclusion, our study shows that CKD represents an important long-term sequela for children and adolescents who undergo aHSCT for malignant hemopathies, either with glomerular dysfunction or with the more insidious tubular dysfunction which could potentially impact growth. These patients could benefit from specialized long-term nephrology follow-up. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Luciano da Silva Selistre
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Universidade de Caxias Do Sul, Programa de Pós Graduação Em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias Do Sul, Caxias do Sul, Brazil
| | - Cécile Renard
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Justine Bacchetta
- Centre de Référence Des Maladies Rénales Rares, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie-Pierre Goutagny
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Julie Hu
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Vandréa Carla de Souza
- Universidade de Caxias Do Sul, Programa de Pós Graduação Em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias Do Sul, Caxias do Sul, Brazil
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Carine Domenech
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France.
- Faculté de Médecine Et de Maïeutique Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France.
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052, CNRS 5286, Université Lyon 1, Lyon, France.
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22
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Childhood acute myeloid leukemia with 5q deletion and HNRNPH1-MLLT10 fusion: the first case report. Blood Adv 2022; 6:3162-3166. [PMID: 35139176 PMCID: PMC9131903 DOI: 10.1182/bloodadvances.2021006383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 12/30/2022] Open
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23
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Tregnago C, Benetton M, Da Ros A, Borella G, Longo G, Polato K, Francescato S, Biffi A, Pigazzi M. Novel Compounds Synergize With Venetoclax to Target KMT2A-Rearranged Pediatric Acute Myeloid Leukemia. Front Pharmacol 2022; 12:820191. [PMID: 35153769 PMCID: PMC8830338 DOI: 10.3389/fphar.2021.820191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
In pediatric acute myeloid leukemia (AML), fusions involving lysine methyltransferase 2A (KMT2A) are considered hallmarks of aggressive AML, for whom the development of targeted specific therapeutic agents to ameliorate classic chemotherapy and obtain a complete eradication of disease is urgent. In this study, we investigated the antiapoptotic proteins in a cohort of 66 pediatric AML patients, finding that 75% of the KMT2A-r are distributed in Q3 + Q4 quartiles of BCL-2 expression, and KMT2A-r have statistically significant high levels of BCL-2, phospho-BCL-2 S70, and MCL-1, indicating a high anti-apoptotic pathway activation. In an attempt to target it, we tested novel drug combinations of venetoclax, a B-cell lymphoma-2 (BCL-2) inhibitor, in KMT2A-MLLT3, for being the most recurrent, and KMT2A-AFDN, for mediating the worst prognosis, rearranged AML cell lines. Our screening revealed that both the bromodomain and extra-terminal domain (BET) inhibitor, I-BET151, and kinase inhibitor, sunitinib, decreased the BCL-2 family protein expression and significantly synergized with venetoclax, enhancing KMT2A-r AML cell line death. Blasts t (6; 11) KMT2A-AFDN rearranged, both from cell lines and primary samples, were shown to be significantly highly responsive to the combination of venetoclax and thioridazine, with the synergy being induced by a dramatic increase of mitochondrial depolarization that triggered blast apoptosis. Finally, the efficacy of novel combined drug treatments was confirmed in KMT2A-r AML cell lines or ex vivo primary KMT2A-r AML samples cultured in a three-dimensional system which mimics the bone marrow niche. Overall, this study identified that, by high-throughput screening, the most KMT2A-selective drugs converged in different but all mitochondrial apoptotic network activation, supporting the use of venetoclax in this AML setting. The novel drug combinations here unveiled provide a rationale for evaluating these combinations in preclinical studies to accelerate the introduction of targeted therapies for the life-threatening KMT2A-AML subgroup of pediatric AML.
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Affiliation(s)
- Claudia Tregnago
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Maddalena Benetton
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Ambra Da Ros
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Giulia Borella
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Giorgia Longo
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Katia Polato
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Samuela Francescato
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Alessandra Biffi
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
| | - Martina Pigazzi
- Pediatric Haematology-Oncology and Hematopoietic Cell and Gene Therapy Division, Woman and Child Health Department, University-Hospital of Padova, Padova, Italy
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24
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Pediatric Acute Myeloid Leukemia—Past, Present, and Future. J Clin Med 2022; 11:jcm11030504. [PMID: 35159956 PMCID: PMC8837075 DOI: 10.3390/jcm11030504] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 02/06/2023] Open
Abstract
This review reports about the main steps of development in pediatric acute myeloid leukemia (AML) concerning diagnostics, treatment, risk groups, and outcomes. Finally, a short overview of present and future approaches is given.
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25
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Varotto E, Munaretto E, Stefanachi F, Della Torre F, Buldini B. Diagnostic challenges in acute monoblastic/monocytic leukemia in children. Front Pediatr 2022; 10:911093. [PMID: 36245718 PMCID: PMC9554480 DOI: 10.3389/fped.2022.911093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Acute monoblastic/monocytic leukemia (AMoL), previously defined as M5 according to FAB classification, is one of the most common subtypes of Acute Myeloid Leukemia (AML) in children, representing ~15-24% of all pediatric AMLs. Currently, the characterization of monocytic-lineage neoplasia at diagnosis includes cytomorphology, cytochemistry, immunophenotyping by multiparametric flow cytometry, cytogenetics, and molecular biology. Moreover, measurable residual disease (MRD) detection is critical in recognizing residual blasts refractory to chemotherapy. Nonetheless, diagnosis and MRD detection may still be challenging in pediatric AMoL since the morphological and immunophenotypic features of leukemic cells potentially overlap with those of normal mature monocytic compartment, as well as differential diagnosis can be troublesome, particularly with Juvenile Myelomonocytic Leukemia and reactive monocytosis in infants and young children. A failure or delay in diagnosis and inaccuracy in MRD assessment may worsen the AMoL prognosis. Therefore, improving diagnosis and monitoring techniques is mandatory to stratify and tailor therapies to the risk profile. This Mini Review aims to provide an updated revision of the scientific evidence on pediatric AMoL diagnostic tools.
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Affiliation(s)
- Elena Varotto
- Pediatric Hematology Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, Padua University, Padua, Italy
| | - Eleonora Munaretto
- Pediatric Hematology Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, Padua University, Padua, Italy
| | - Francesca Stefanachi
- Pediatric Hematology Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, Padua University, Padua, Italy
| | - Fiammetta Della Torre
- Pediatric Hematology Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, Padua University, Padua, Italy
| | - Barbara Buldini
- Pediatric Hematology Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, Padua University, Padua, Italy
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26
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Monosomal karyotype as an adverse risk factor for inferior survivals in children with acute myeloid leukemia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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27
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Gut microbiome in pediatric acute leukemia: from predisposition to cure. Blood Adv 2021; 5:4619-4629. [PMID: 34610115 PMCID: PMC8759140 DOI: 10.1182/bloodadvances.2021005129] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/25/2021] [Indexed: 01/02/2023] Open
Abstract
The gut microbiome (GM) has emerged as a key factor in the genesis and progression of many diseases. The intestinal bacterial composition also influences treatment-related side effects and even the efficacy of oncological therapies. Acute leukemia (AL) is the most common cancer among children and the most frequent cause of cancer-related death during childhood. Outcomes have improved considerably over the past 4 decades, with the current long-term survival for acute lymphoblastic leukemia being ∼90%. However, several acute toxicities and long-term sequelae are associated with the multimodal therapy protocols applied in these patients. Specific GM configurations could contribute to the multistep developmental hypothesis for leukemogenesis. Moreover, GM alterations occur during the AL therapeutic course and are associated with treatment-related complications, especially during hematopoietic stem cell transplantation. The GM perturbation could last even after the removal of microbiome-modifying factors, like antibiotics, chemotherapeutic drugs, or alloimmune reactions, contributing to several health-related issues in AL survivors. The purpose of this article is to provide a comprehensive review of the chronological changes of GM in children with AL, from predisposition to cure. The underpinning biological processes and the potential interventions to modulate the GM toward a potentially health-promoting configuration are also highlighted.
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28
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Porcù E, Benetton M, Bisio V, Da Ros A, Tregnago C, Borella G, Zanon C, Bordi M, Germano G, Manni S, Campello S, Rao DS, Locatelli F, Pigazzi M. The long non-coding RNA CDK6-AS1 overexpression impacts on acute myeloid leukemia differentiation and mitochondrial dynamics. iScience 2021; 24:103350. [PMID: 34816103 PMCID: PMC8591413 DOI: 10.1016/j.isci.2021.103350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022] Open
Abstract
Patients with acute myeloid leukemia (AML) carrying high-risk genetic lesions or high residual disease levels after therapy are particularly exposed to the risk of relapse. Here, we identified the long non-coding RNA CDK6-AS1 able to cluster an AML subgroup with peculiar gene signatures linked to hematopoietic cell differentiation and mitochondrial dynamics. CDK6-AS1 silencing triggered hematopoietic commitment in healthy CD34+ cells, whereas in AML cells the pathological undifferentiated state was rescued. This latter phenomenon derived from RUNX1 transcriptional control, responsible for the stemness of hematopoietic precursors and for the block of differentiation in AML. By CDK6-AS1 silencing in vitro, AML mitochondrial mass decreased with augmented pharmacological sensitivity to mitochondria-targeting drugs. In vivo, the combination of tigecycline and cytarabine reduced leukemia progression in the AML-PDX model with high CDK6-AS1 levels, supporting the concept of a mitochondrial vulnerability. Together, these findings uncover CDK6-AS1 as crucial in myeloid differentiation and mitochondrial mass regulation. CDK6-AS1 acts in concert with CDK6 High CDK6-AS1 levels trigger RUNX1 early differentiation arrest in myeloid cells CDK6-AS1 controls mitochondrial mass of AML blasts CDK6-AS1 levels impact on mitochondrial-targeted agents sensitivity
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Affiliation(s)
- Elena Porcù
- Pediatric Hematology, Oncology and Hematopoietic Cell&Gene Therapy Division of Women's and Children's Health Department, University-Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Maddalena Benetton
- Pediatric Hematology, Oncology and Hematopoietic Cell&Gene Therapy Division of Women's and Children's Health Department, University-Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Valeria Bisio
- Pediatric Hematology, Oncology and Hematopoietic Cell&Gene Therapy Division of Women's and Children's Health Department, University-Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Ambra Da Ros
- Pediatric Hematology, Oncology and Hematopoietic Cell&Gene Therapy Division of Women's and Children's Health Department, University-Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Claudia Tregnago
- Pediatric Hematology, Oncology and Hematopoietic Cell&Gene Therapy Division of Women's and Children's Health Department, University-Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Giulia Borella
- Pediatric Hematology, Oncology and Hematopoietic Cell&Gene Therapy Division of Women's and Children's Health Department, University-Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Carlo Zanon
- Pediatric Onco-Hematology, Stem Cell Transplant and Gene Therapy Laboratory, Istituto di Ricerca Pediatrica - Città della Speranza, 35127 Padova, Italy
| | - Matteo Bordi
- Department of Biology, University of Rome Tor Vergata, 00133 Rome, Italy.,Department of Pediatric Hemato-Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, 00143 Rome, Italy
| | - Giuseppe Germano
- Pediatric Onco-Hematology, Stem Cell Transplant and Gene Therapy Laboratory, Istituto di Ricerca Pediatrica - Città della Speranza, 35127 Padova, Italy
| | - Sabrina Manni
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, and Veneto Institute of Molecular Medicine (VIMM), 35129 Padova, Italy
| | - Silvia Campello
- Department of Biology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Dinesh S Rao
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Sapienza University of Rome, 00165 Roma, Italy
| | - Martina Pigazzi
- Pediatric Hematology, Oncology and Hematopoietic Cell&Gene Therapy Division of Women's and Children's Health Department, University-Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy.,Pediatric Onco-Hematology, Stem Cell Transplant and Gene Therapy Laboratory, Istituto di Ricerca Pediatrica - Città della Speranza, 35127 Padova, Italy
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29
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Schmidt MP, Colita A, Ivanov AV, Coriu D, Miron IC. Outcomes of patients with Down syndrome and acute leukemia: A retrospective observational study. Medicine (Baltimore) 2021; 100:e27459. [PMID: 34622870 PMCID: PMC8500660 DOI: 10.1097/md.0000000000027459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Children with Down syndrome (DS) have a higher risk of developing acute leukemia than do those without DS. There are few studies in the literature about outcome, survival, and difficulties of treating patients with DS and acute leukemia in a developing country. This study aimed to analyze the outcome, response to treatment, survival, treatment complications, and causes of death in patients with DS and acute leukemia compared with those in patients with acute leukemia without DS diagnosed in the same period of time.We conducted a retrospective observational analysis including a cohort of 21 patients with DS and acute leukemia diagnosed between 2009 and 2018 in 3 hemato-oncology centers (2 pediatric centers and 1 adult hematology center). A group of patients with DS-acute lymphoblastic leukemia (DS-ALL) was analyzed and compared with a group of 165 patients with acute lymphoblastic leukemia without DS, and a group of patients with DS-acute myeloid leukemia (DS-AML) was analyzed and compared with a group of 50 patients with acute myeloid leukemia without DS, which was diagnosed during the same period of time (2009-2018) and treated under similar conditions in terms of both treatment protocols and economic resources.The overall survival rates in children with DS-ALL and DS-AML were 35.7% and 57.1%, respectively (P = .438). The overall survival rate was significantly worse in children with DS-ALL than in those with acute lymphoblastic leukemia without DS (35.71% vs 75.80%, P = .001). We noted that treatment-related mortality in the patients with DS-ALL was high (50%) (infections and toxicities related to chemotherapy); this result was significantly different from that for patients with leukemia without DS (P < .0001). The relapse rate was higher in patients with DS-ALL but not significantly higher than that in patients without DS (P = .13).In contrast, the overall survival rate was better for patients with DS-AML than for those with acute myeloid leukemia without DS (57.1% vs 45.1%, P = .47).Because of the particularities of the host, we suggest that DS-ALL and DS-AML should be considered as independent diseases and treated according to specific protocols with therapy optimization per the minimal residual disease.
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Affiliation(s)
| | - Anca Colita
- Fundeni Clinical Institut - Pediatrics Department, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca-Viorica Ivanov
- “Sf Maria” Children's Hospital-Hemato-Oncology Department, Iasi, Romania
- “Grigore T Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Daniel Coriu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Fundeni Clinical Institut-Hematology Department, Bucharest, Romania
| | - Ingrith-Crenguta Miron
- “Sf Maria” Children's Hospital-Hemato-Oncology Department, Iasi, Romania
- “Grigore T Popa” University of Medicine and Pharmacy, Iasi, Romania
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30
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Skou AS, Juul-Dam KL, Hansen M, Lausen B, Stratmann S, Holmfeldt L, Aggerholm A, Nyvold CG, Ommen HB, Hasle H. Measurable Residual Disease Monitoring of SPAG6, ST18, PRAME, and XAGE1A Expression in Peripheral Blood May Detect Imminent Relapse in Childhood Acute Myeloid Leukemia. J Mol Diagn 2021; 23:1787-1799. [PMID: 34600138 DOI: 10.1016/j.jmoldx.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022] Open
Abstract
Overexpressed genes may be useful for monitoring of measurable residual disease (MRD) in patients with childhood acute myeloid leukemia (AML) without a leukemia-specific target. The normal expression of five leukemia-associated genes (SPAG6, ST18, MSLN, PRAME, XAGE1A) was defined in children without hematologic disease (n = 53) and children with suspected infection (n = 90). Gene expression at AML diagnosis (n=50) and during follow-up (n = 21) was compared with child-specific reference values. At diagnosis, 34/50 children (68%) had high expression of at least one of the five genes, and so did 16/31 children (52%) without a leukemia-specific target. Gene expression was quantified in 110 peripheral blood (PB) samples (median, five samples/patient; range, 1 to 10) during follow-up in 21 patients with high expression at diagnosis. All nine patients with PB sampling performed within 100 days of disease recurrence displayed overexpression of SPAG6, ST18, PRAME, or XAGE1A at a median of 2 months (range, 0.6 to 9.6 months) before hematologic relapse, whereas MSLN did not reach expression above normal prior to hematologic relapse. Only 1 of 130 (0.8%) follow-up analyses performed in 10 patients in continuous complete remission had transient expression above normal. SPAG6, ST18, PRAME, and XAGE1A expression in PB may predict relapse in childhood AML patients and facilitate MRD monitoring in most patients without a leukemia-specific target.
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Affiliation(s)
- Anne-Sofie Skou
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Kristian L Juul-Dam
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Hansen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Svea Stratmann
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Linda Holmfeldt
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Anni Aggerholm
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte G Nyvold
- Hematology-Pathology Research Laboratory, Research Unit for Hematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Hans B Ommen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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31
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The Role of Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Leukemia. J Clin Med 2021; 10:jcm10173790. [PMID: 34501237 PMCID: PMC8432223 DOI: 10.3390/jcm10173790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/08/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) offers potentially curative treatment for many children with high-risk or relapsed acute leukemia (AL), thanks to the combination of intense preparative radio/chemotherapy and the graft-versus-leukemia (GvL) effect. Over the years, progress in high-resolution donor typing, choice of conditioning regimen, graft-versus-host disease (GvHD) prophylaxis and supportive care measures have continuously improved overall transplant outcome, and recent successes using alternative donors have extended the potential application of allotransplantation to most patients. In addition, the importance of minimal residual disease (MRD) before and after transplantation is being increasingly clarified and MRD-directed interventions may be employed to further ameliorate leukemia-free survival after allogeneic HSCT. These advances have occurred in parallel with continuous refinements in chemotherapy protocols and the development of targeted therapies, which may redefine the indications for HSCT in the coming years. This review discusses the role of HSCT in childhood AL by analysing transplant indications in both acute lymphoblastic and acute myeloid leukemia, together with current and most promising strategies to further improve transplant outcome, including optimization of conditioning regimen and MRD-directed interventions.
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32
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NPM1 Mutational Status Underlines Different Biological Features in Pediatric AML. Cancers (Basel) 2021; 13:cancers13143457. [PMID: 34298672 PMCID: PMC8304368 DOI: 10.3390/cancers13143457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Nucleophosmin (NPM1) is a nucleocytoplasmic shuttling protein, predominantly located in the nucleolus, that regulates a multiplicity of different biological processes. NPM1 localization in the cell is finely tuned by specific signal motifs, with two tryptophan residues (Trp) being essential for the nucleolar localization. In acute myeloid leukemia (AML), several NPM1 mutations have been reported, all resulting in cytoplasmic delocalization, but the putative biological and clinical significance of different variants are still debated. We explored HOXA and HOXB gene expression profile in AML patients and found a differential expression between NPM1 mutations inducing the loss of two (A-like) Trp residues and those determining the loss of one Trp residue (non-A-like). We thus expressed NPM1 A-like- or non-A-like-mutated vectors in AML cell lines finding that NPM1 partially remained in the nucleolus in the non-A-like NPM1-mutated cells. As a result, only in A-like-mutated cells we detected HOXA5, HOXA10, and HOXB5 hyper-expression and p14ARF/p21/p53 pathway deregulation, leading to reduced sensitivity to the treatment with either chemotherapy or Venetoclax, as compared to non-A-like cells. Overall, we identified that the NPM1 mutational status mediates crucial biological characteristics of AML cells, providing the basis for further sub-classification and, potentially, management of this subgroup of patients.
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Abstract
Minimal or measurable residual disease (MRD) after therapy is the most important independent prognostic factor in acute myeloid leukemia. MRD measured by multiparametric flow cytometry and real-time quantitative polymerase chain reaction has been integrated into risk stratification and used to guide future treatment strategies. Recent technological advances have allowed the application of the novel molecular method, high-throughput sequencing, in MRD detection in clinical practice to improve sensitivity and specificity. Randomized studies are needed to address outstanding issues, including the optimal methods and timing of MRD testing and interlaboratory standardization to facilitate comparisons, to further improve MRD-directed interventions.
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Affiliation(s)
- Xueyan Chen
- Hematopathology, SCCA G7800, 825 Eastlake Ave E., Seattle, WA 98109, USA
| | - Sindhu Cherian
- Hematopathology, SCCA G7800, 825 Eastlake Ave E., Seattle, WA 98109, USA.
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34
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Egan G, Chopra Y, Mourad S, Chiang KY, Hitzler J. Treatment of acute myeloid leukemia in children: A practical perspective. Pediatr Blood Cancer 2021; 68:e28979. [PMID: 33844444 DOI: 10.1002/pbc.28979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/17/2021] [Accepted: 02/07/2021] [Indexed: 12/17/2022]
Abstract
Pediatric acute myeloid leukemia (AML) is a heterogeneous disease that requires a multifaceted treatment approach. Although outcomes for low-risk AML have improved significantly over recent decades, high-risk AML continues to be associated with an adverse prognosis. Recent advances in molecular diagnostics, risk stratification, and supportive care have contributed to improvements in outcomes in pediatric AML. Targeted approaches, for example, the use of tyrosine kinase inhibitors to treat FLT3-ITD AML, offer promise and are currently undergoing clinical investigation in pediatric patients. New approaches to hematopoietic stem cell transplantation, including the use of haploidentical donors, are significantly expanding donor options for patients with high-risk AML. This review provides an overview of recent advances in the treatment of pediatric AML that are likely to have clinical impact and reshape the standard of care.
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Affiliation(s)
- Grace Egan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yogi Chopra
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie Mourad
- Division of Haematology/Oncology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Kuang-Yueh Chiang
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Johann Hitzler
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
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35
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Abstract
The genetic basis for pediatric acute myeloid leukemia (AML) is highly heterogeneous, often involving the cooperative action of characteristic chromosomal rearrangements and somatic mutations in progrowth and antidifferentiation pathways that drive oncogenesis. Although some driver mutations are shared with adult AML, many genetic lesions are unique to pediatric patients, and their appropriate identification is essential for patient care. The increased understanding of these malignancies through broad genomic studies has begun to risk-stratify patients based on their combinations of genomic alterations, a trend that will enable precision medicine in this population.
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Affiliation(s)
- Bryan Krock
- Caris Life Sciences, 4610 South 44th Place, Phoenix, AZ, USA
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36
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Cytogenetic risk groups for childhood acute myeloid leukemia based on survival analysis in a cancer referral hospital from Perú. ACTA ACUST UNITED AC 2021; 41:302-313. [PMID: 34214271 PMCID: PMC8382291 DOI: 10.7705/biomedica.5747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Indexed: 12/27/2022]
Abstract
Introduction: Acute myeloid leukemia is a heterogeneous disorder characterized by immature myeloid cell proliferation. Cytogenetic analysis has revealed the presence of chromosomal aberrations important to patient prognosis.
Objective: To determine cytogenetic risk groups of pediatric patients with acute myeloid leukemia according to overall survival.
Materials and methods: In this cross-sectional observational study, the clinical records of pediatric patients diagnosed with de novo acute myeloid leukemia admitted to the Instituto Nacional de Enfermedades Neoplásicas between 2001 and 2011 with cytogenetic analysis of bone marrow were included. Cytogenetic risk groups were established according to the criteria of the Medical Research Council. Overall survival curves were generated with the Kaplan-Meier method and compared using the Mantel-Cox test and Cox regression with the software R, version 3.3.2.
Results: A total of 130 patients were included, 68 males (52.3%) and 62 females (47.7%), most of them with subtype M2 (33%). The average age was 7.7 years (range: 0-15 years). Chromosomal aberrations were observed in 60.8% of the patients, the most frequent of which was the translocation t(8;21). According to the overall survival analysis, two cytogenetic risk groups were established: favorable and unfavorable.
Conclusion: Two groups of cytogenetic risk were determined: high (or unfavorable) and standard (favorable).
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37
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Lim K, Thompson-Peach C, Thomas D. Neonatal heel prick mass spectrometry identifies metabolic predictors of AML latency. Leuk Res 2021; 109:106644. [PMID: 34175567 DOI: 10.1016/j.leukres.2021.106644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 12/22/2022]
Abstract
Ongoing research efforts that consider cancer as a disease of dramatically altered cellular metabolism have accelerated interest in snapshot metabolomics in various human tissues. In this issue of Leukemia Research, Petrick et al performed metabolomic analysis on newborn blood spots and found a number of unexpected ceramide and sphingolipid compounds that may play a role in the development and latency of pediatric acute myeloid leukemia (AML). The chemical complexity and range of cellular metabolites massively exceeds the relatively limited building blocks of the transcriptome or the proteome and has high potential to find novel leukemia-specific macromolecular synthesis pathways, metabolic vulnerabilities and biomarkers.
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Affiliation(s)
- Kelly Lim
- Adelaide Medical School, The University of Adelaide, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Chloe Thompson-Peach
- Adelaide Medical School, The University of Adelaide, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Daniel Thomas
- Adelaide Medical School, The University of Adelaide, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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38
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Chen X, Wang X, Dou H, Yang Z, Bi J, Huang Y, Lu L, Yu J, Bao L. Cytogenetic and mutational analysis and outcome assessment of a cohort of 284 children with de novo acute myeloid leukemia reveal complex karyotype as an adverse risk factor for inferior survival. Mol Cytogenet 2021; 14:27. [PMID: 34011412 PMCID: PMC8136172 DOI: 10.1186/s13039-021-00547-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is rare in children. Although complex karyotype (CK) defined as ≥ 3 cytogenetic abnormalities is an adverse risk factor in adult AML, its prognostic impact on childhood AML remains to be determined. Results We studied the prevalence, cytogenetic and mutational features, and outcome impact of CK in a cohort of 284 Chinese children with de novo AML. Thirty-four (12.0%) children met the criteria for CK-AML with atypical CK being more frequent than typical CK featured with -5/5q-, -7/7q-, and/or 17p aberration. Mutational prevalence was low and co-occurrence mutants were uncommon. Children with CK-AML showed shorter overall survival (OS) (5-year OS: 26.7 ± 10.6% vs. 37.5 ± 8.6%, p = 0.053) and event-free survival (EFS) (5-year EFS: 26.7 ± 10.6% vs. 38.8 ± 8.6%, p = 0.039) compared with those with intermediate-risk genetics. Typical CK tended to correlate with a decreased OS than atypical CK (5-year OS: 0 vs. 33 ± 12.7%.; p = 0.084), and CK with ≥ 5 cytogenetic aberrations was associated with an inferior survival compared with CK with ≤ 4 aberrations (5-year OS: 13.6 ± 11.7% vs. 50.0 ± 18.6%; p = 0.040; 5-year EFS: 13.6 ± 11.7% vs. 50.0 ± 18.6%; p = 0.048). Conclusion Our results demonstrate CK as an adverse risk factor for reduced survival in childhood AML. Our findings shed light on the cytogenetic and mutational profile of childhood CK-AML and would inform refinement of risk stratification in childhood AML to improve outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13039-021-00547-0.
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Affiliation(s)
- Xi Chen
- Center for Clinical Molecular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xingjuan Wang
- Center for Reproductive Medicine, Baoji Maternal and Child Health Hospital, Shanxi, China
| | - Hu Dou
- Department of Clinical Laboratory, Key Laboratory of Pediatrics in Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenzhen Yang
- Department of Clinical Laboratory, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Junqin Bi
- Department of Laboratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi Huang
- Chongqing Key Laboratory of Child Infection and Immunity, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Ling Lu
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Yu
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshang 2nd Road, Chongqing, 400014, China.
| | - Liming Bao
- Department of Pathology, School of Medicine, University of Colorado Anschutz Medical Campus, 12705 E. Montview Boulevard, Suite 400, Aurora, CO, 80045, USA.
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Thioridazine requires calcium influx to induce MLL-AF6-rearranged AML cell death. Blood Adv 2021; 4:4417-4429. [PMID: 32931582 DOI: 10.1182/bloodadvances.2020002001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/12/2020] [Indexed: 01/25/2023] Open
Abstract
In pediatric acute myeloid leukemia (AML), intensive chemotherapy and allogeneic hematopoietic stem cell transplantation are the cornerstones of treatment in high-risk cases, with severe late effects and a still high risk of disease recurrence as the main drawbacks. The identification of targeted, more effective, safer drugs is thus desirable. We performed a high-throughput drug-screening assay of 1280 compounds and identified thioridazine (TDZ), a drug that was highly selective for the t(6;11)(q27;q23) MLL-AF6 (6;11)AML rearrangement, which mediates a dramatically poor (below 20%) survival rate. TDZ induced cell death and irreversible progress toward the loss of leukemia cell clonogenic capacity in vitro. Thus, we explored its mechanism of action and found a profound cytoskeletal remodeling of blast cells that led to Ca2+ influx, triggering apoptosis through mitochondrial depolarization, confirming that this latter phenomenon occurs selectively in t(6;11)AML, for which AF6 does not work as a cytoskeletal regulator, because it is sequestered into the nucleus by the fusion gene. We confirmed TDZ-mediated t(6;11)AML toxicity in vivo and enhanced the drug's safety by developing novel TDZ analogues that exerted the same effect on leukemia reduction, but with lowered neuroleptic effects in vivo. Overall, these results refine the MLL-AF6 AML leukemogenic mechanism and suggest that the benefits of targeting it be corroborated in further clinical trials.
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40
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Survival Following Relapse in Children with Acute Myeloid Leukemia: A Report from AML-BFM and COG. Cancers (Basel) 2021; 13:cancers13102336. [PMID: 34066095 PMCID: PMC8151466 DOI: 10.3390/cancers13102336] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Acute myeloid leukemia in children remains a difficult disease to cure despite intensive therapies that push the limits of tolerability. Though the intent of initial therapy should be the prevention of relapse, about 30% of all patients experience a relapse. Hence, relapse therapy remains critically important for survival. This retrospective analysis of two large international study groups (COG and BFM) was undertaken to describe the current survival, response rates and clinical features that predict outcomes. We demonstrate that children with relapsed AML may be cured with cytotoxic therapy followed by HSCT. High-risk features at initial diagnosis and early relapse remain prognostic for post-relapse survival. Current response criteria are not aligned with the standards of care for children, nor are the count recovery thresholds meaningful for prognosis in children with relapsed AML. Our data provide a new baseline for future treatment planning and will allow an updated stratification in upcoming studies. Abstract Post-relapse therapy remains critical for survival in children with acute myeloid leukemia (AML). We evaluated survival, response and prognostic variables following relapse in independent cooperative group studies conducted by COG and the population-based AML-BFM study group. BFM included 197 patients who relapsed after closure of the last I-BFM relapse trial until 2017, while COG included 852 patients who relapsed on the last Phase 3 trials (AAML0531, AAML1031). Overall survival at 5 years (OS) was 42 ± 4% (BFM) and 35 ± 2% (COG). Initial high-risk features (BFM 32 ± 6%, COG 26 ± 4%) and short time to relapse (BFM 29 ± 4%, COG 25 ± 2%) predicted diminished survival. In the BFM dataset, there was no difference in OS for patients who had a complete remission with full hematopoietic recovery (CR) following post-relapse re-induction compared to those with partial neutrophil and platelet recovery (CRp and CRi) only (52 ± 7% vs. 63 ± 10%, p = 0.39). Among 90 patients alive at last follow-up, 87 had received a post-relapse hematopoietic stem cell transplant (HSCT). OS for patients with post-relapse HSCT was 54 ± 4%. In conclusion, initial high-risk features and early relapse remain prognostic. Response assessment with full hematopoietic recovery following initial relapse therapy does not predict survival. These data indicate the need for post-relapse risk stratification in future studies of relapse therapies.
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41
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Barresi V, Di Bella V, Andriano N, Privitera AP, Bonaccorso P, La Rosa M, Iachelli V, Spampinato G, Pulvirenti G, Scuderi C, Condorelli DF, Lo Nigro L. NUP-98 Rearrangements Led to the Identification of Candidate Biomarkers for Primary Induction Failure in Pediatric Acute Myeloid Leukemia. Int J Mol Sci 2021; 22:ijms22094575. [PMID: 33925480 PMCID: PMC8123909 DOI: 10.3390/ijms22094575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/17/2022] Open
Abstract
Conventional chemotherapy for acute myeloid leukemia regimens generally encompass an intensive induction phase, in order to achieve a morphological remission in terms of bone marrow blasts (<5%). The majority of cases are classified as Primary Induction Response (PIR); unfortunately, 15% of children do not achieve remission and are defined Primary Induction Failure (PIF). This study aims to characterize the gene expression profile of PIF in children with Acute Myeloid Leukemia (AML), in order to detect molecular pathways dysfunctions and identify potential biomarkers. Given that NUP98-rearrangements are enriched in PIF-AML patients, we investigated the association of NUP98-driven genes in primary chemoresistance. Therefore, 85 expression arrays, deposited on GEO database, and 358 RNAseq AML samples, from TARGET program, were analyzed for “Differentially Expressed Genes” (DEGs) between NUP98+ and NUP98-, identifying 110 highly confident NUP98/PIF-associated DEGs. We confirmed, by qRT-PCR, the overexpression of nine DEGs, selected on the bases of the diagnostic accuracy, in a local cohort of PIF patients: SPINK2, TMA7, SPCS2, CDCP1, CAPZA1, FGFR1OP2, MAN1A2, NT5C3A and SRP54. In conclusion, the integrated analysis of NUP98 mutational analysis and transcriptome profiles allowed the identification of novel putative biomarkers for the prediction of PIF in AML.
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Affiliation(s)
- Vincenza Barresi
- Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, 95123 Catania, Italy; (V.B.); (V.D.B.); (A.P.P.); (G.S.); (C.S.)
| | - Virginia Di Bella
- Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, 95123 Catania, Italy; (V.B.); (V.D.B.); (A.P.P.); (G.S.); (C.S.)
| | - Nellina Andriano
- Cytogenetic-Cytofluorimetric-Molecular Biology Lab, 95123 Catania, Italy; (N.A.); (P.B.); (M.L.R.); (V.I.); (G.P.); (L.L.N.)
- Center of Pediatric Hematology-Oncology, Azienda Policlinico–San Marco, 95123 Catania, Italy
| | - Anna Provvidenza Privitera
- Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, 95123 Catania, Italy; (V.B.); (V.D.B.); (A.P.P.); (G.S.); (C.S.)
| | - Paola Bonaccorso
- Cytogenetic-Cytofluorimetric-Molecular Biology Lab, 95123 Catania, Italy; (N.A.); (P.B.); (M.L.R.); (V.I.); (G.P.); (L.L.N.)
- Center of Pediatric Hematology-Oncology, Azienda Policlinico–San Marco, 95123 Catania, Italy
| | - Manuela La Rosa
- Cytogenetic-Cytofluorimetric-Molecular Biology Lab, 95123 Catania, Italy; (N.A.); (P.B.); (M.L.R.); (V.I.); (G.P.); (L.L.N.)
- Center of Pediatric Hematology-Oncology, Azienda Policlinico–San Marco, 95123 Catania, Italy
| | - Valeria Iachelli
- Cytogenetic-Cytofluorimetric-Molecular Biology Lab, 95123 Catania, Italy; (N.A.); (P.B.); (M.L.R.); (V.I.); (G.P.); (L.L.N.)
- Center of Pediatric Hematology-Oncology, Azienda Policlinico–San Marco, 95123 Catania, Italy
| | - Giorgia Spampinato
- Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, 95123 Catania, Italy; (V.B.); (V.D.B.); (A.P.P.); (G.S.); (C.S.)
| | - Giulio Pulvirenti
- Cytogenetic-Cytofluorimetric-Molecular Biology Lab, 95123 Catania, Italy; (N.A.); (P.B.); (M.L.R.); (V.I.); (G.P.); (L.L.N.)
- Center of Pediatric Hematology-Oncology, Azienda Policlinico–San Marco, 95123 Catania, Italy
| | - Chiara Scuderi
- Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, 95123 Catania, Italy; (V.B.); (V.D.B.); (A.P.P.); (G.S.); (C.S.)
| | - Daniele F. Condorelli
- Department of Biomedical and Biotechnological Sciences, Section of Medical Biochemistry, University of Catania, 95123 Catania, Italy; (V.B.); (V.D.B.); (A.P.P.); (G.S.); (C.S.)
- Correspondence:
| | - Luca Lo Nigro
- Cytogenetic-Cytofluorimetric-Molecular Biology Lab, 95123 Catania, Italy; (N.A.); (P.B.); (M.L.R.); (V.I.); (G.P.); (L.L.N.)
- Center of Pediatric Hematology-Oncology, Azienda Policlinico–San Marco, 95123 Catania, Italy
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Petrick L, Imani P, Perttula K, Yano Y, Whitehead T, Metayer C, Schiffman C, Dolios G, Dudoit S, Rappaport S. Untargeted metabolomics of newborn dried blood spots reveals sex-specific associations with pediatric acute myeloid leukemia. Leuk Res 2021; 106:106585. [PMID: 33971561 PMCID: PMC8275155 DOI: 10.1016/j.leukres.2021.106585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
The etiology of pediatric acute myeloid leukemia (AML) is largely unknown, but evidence for mutations in utero and long latency periods suggests that environmental factors play a role. Therefore, we used untargeted metabolomics of archived newborn dried blood spots (DBS) to investigate neonatal exposures as potential causal risk factors for AML. Untargeted metabolomics profiling was performed on DBS punches from 48 pediatric patients with AML and 46 healthy controls as part of the California Childhood Leukemia Study (CCLS). Because sex disparities are suggested by differences in AML incidence rates, metabolite features associated with AML were identified in analyses stratified by sex. There was no overlap between the 16 predictors of AML in females and 15 predictors in males, suggesting that neonatal metabolomic profiles of pediatric AML risk are sex-specific. In females, four predictors of AML were putatively annotated as ceramides, a class of metabolites that has been linked with cancer cell proliferation. In females, two metabolite predictors of AML were strongly correlated with breastfeeding duration, indicating a possible biological link between this putative protective risk factor and childhood leukemia. In males, a heterogeneous metabolite profile of AML predictors was observed. Replication with larger participant numbers is required to validate findings.
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Affiliation(s)
- Lauren Petrick
- The Institute of Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA.
| | - Partow Imani
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Kelsi Perttula
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, 94720, USA; Department of Health Sciences, California State University East Bay, Hayward, CA, 94542, USA
| | - Yukiko Yano
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Todd Whitehead
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Catherine Metayer
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Courtney Schiffman
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Georgia Dolios
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sandrine Dudoit
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA; Department of Statistics, University of California, Berkeley, CA, 94720, USA
| | - Stephen Rappaport
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, 94720, USA
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43
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Exploiting Clonal Evolution to Improve the Diagnosis and Treatment Efficacy Prediction in Pediatric AML. Cancers (Basel) 2021; 13:cancers13091995. [PMID: 33919131 PMCID: PMC8122278 DOI: 10.3390/cancers13091995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 01/18/2023] Open
Abstract
Despite improvements in therapeutic protocols and in risk stratification, acute myeloid leukemia (AML) remains the leading cause of childhood leukemic mortality. Indeed, the overall survival accounts for ~70% but still ~30% of pediatric patients experience relapse, with poor response to conventional chemotherapy. Thus, there is an urgent need to improve diagnosis and treatment efficacy prediction in the context of this disease. Nowadays, in the era of high throughput techniques, AML has emerged as an extremely heterogeneous disease from a genetic point of view. Different subclones characterized by specific molecular profiles display different degrees of susceptibility to conventional treatments. In this review, we describe in detail this genetic heterogeneity of pediatric AML and how it is linked to relapse in terms of clonal evolution. We highlight some innovative tools to characterize minor subclones that could help to enhance diagnosis and a preclinical model suitable for drugs screening. The final ambition of research is represented by targeted therapy, which could improve the prognosis of pediatric AML patients, as well as to limit the side toxicity of current treatments.
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44
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Zecca M, Ferrari A, Quarello P, Rabusin M, Balduzzi A, Buldini B, Rostagno E, Prete A, Favre C, Massimino M, Biondi A, Porta F, Biffi A, Locatelli F, Pession A, Fagioli F. Childhood cancer in Italy: background, goals, and achievements of the Italian Paediatric Hematology Oncology Association (AIEOP). TUMORI JOURNAL 2021; 107:370-375. [PMID: 33876662 DOI: 10.1177/03008916211007934] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reviews the primary goals and achievements of the Italian Association for Pediatric Hematology-Oncology (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP]), a national cooperative group that has been working for children and adolescents with cancer in Italy since 1975.
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Affiliation(s)
- Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, University of Torino, Piemonte, Italy
| | - Marco Rabusin
- Institute for Maternal and Child Health, "IRCCS Burlo Garofolo" Trieste, Trieste, Friuli-Venezia Giulia, Italy
| | - Adriana Balduzzi
- Pediatric Department, University of Milano Bicocca, MBBM Foundation, ASST Monza Ospedale San Gerardo, Monza, Lombardia, Italy
| | - Barbara Buldini
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Mother and Child's Health Department, University of Padova, Padova, Veneto, Italy
| | - Elena Rostagno
- Hematology-Oncology Unit, Department of Pediatrics - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arcangelo Prete
- Hematology-Oncology Unit, Department of Pediatrics - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Favre
- Paediatric Haematology/Oncology and HSCT Department, Anna Meyer Children's University Hospital, Firenze, Toscana, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Biondi
- Pediatric Department, University of Milano Bicocca, MBBM Foundation, ASST Monza Ospedale San Gerardo, Monza, Lombardia, Italy
| | - Fulvio Porta
- Pediatric Haematology Oncology and BMT Unit, Ospedale dei Bambini, ASST-Spedali Civili of Brescia, Brescia, Lombardia, Italy
| | - Alessandra Biffi
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Mother and Child's Health Department, University of Padova, Padova, Veneto, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Roma, Lazio, Italy
| | - Andrea Pession
- Hematology-Oncology Unit, Department of Pediatrics - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, University of Torino, Piemonte, Italy
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An Immune Checkpoint-Related Gene Signature for Predicting Survival of Pediatric Acute Myeloid Leukemia. JOURNAL OF ONCOLOGY 2021; 2021:5550116. [PMID: 33986802 PMCID: PMC8079183 DOI: 10.1155/2021/5550116] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 01/04/2023]
Abstract
Objective The aim of this research was to create a new genetic signature of immune checkpoint-associated genes as a prognostic method for pediatric acute myeloid leukemia (AML). Methods Transcriptome profiles and clinical follow-up details were obtained in Therapeutically Applicable Research to Generate Effective Treatments (TARGET), a database of pediatric tumors. Secondary data was collected from the Gene Expression Omnibus (GEO) to test the observations. In univariate Cox regression and multivariate Cox regression studies, the expression of immune checkpoint-related genes was studied. A three-mRNA signature was developed for predicting pediatric AML patient survival. Furthermore, the GEO cohort was used to confirm the reliability. A bioinformatics method was utilized to identify the diagnostic and prognostic value. Results A three-gene (STAT1, BATF, EML4) signature was developed to identify patients into two danger categories depending on their OS. A multivariate regression study showed that the immune checkpoint-related signature (STAT1, BATF, EML4) was an independent indicator of pediatric AML. By immune cell subtypes analyses, the signature was correlated with multiple subtypes of immune cells. Conclusion In summary, our three-gene signature can be a useful tool to predict the OS in AML patients.
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46
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Zangrando A, Cavagnero F, Scarparo P, Varotto E, Francescato S, Tregnago C, Cuccurullo R, Fagioli F, Nigro LL, Masetti R, Putti MC, Rizzari C, Santoro N, Pession A, Pigazzi M, Locatelli F, Basso G, Buldini B. CD56, HLA-DR, and CD45 recognize a subtype of childhood AML harboring CBFA2T3-GLIS2 fusion transcript. Cytometry A 2021; 99:844-850. [PMID: 33811445 PMCID: PMC8451792 DOI: 10.1002/cyto.a.24339] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/08/2021] [Accepted: 03/17/2021] [Indexed: 11/23/2022]
Abstract
The presence of CBFA2T3‐GLIS2 fusion gene has been identified in childhood Acute Myeloid Leukemia (AML). In view of the genomic studies indicating a distinct gene expression profile, we evaluated the role of immunophenotyping in characterizing a rare subtype of AML‐CBFA2T3‐GLIS2 rearranged. Immunophenotypic data were obtained by studying a cohort of 20 pediatric CBFA2T3‐GLIS2‐AML and 77 AML patients not carrying the fusion transcript. Enrolled cases were included in the Associazione Italiana di Ematologia Oncologia Pediatrica (AIEOP) AML trials and immunophenotypes were compared using different statistical approaches. By multiple computational procedures, we identified two main core antigens responsible for the identification of the CBFA2T3‐GLIS2‐AML. CD56 showed the highest performance in single marker evaluation (AUC = 0.89) and granted the most accurate prediction when used in combination with HLA‐DR (AUC = 0.97) displaying a 93% sensitivity and 99% specificity. We also observed a weak‐to‐negative CD45 expression, being exceptional in AML. We here provide evidence that the combination of HLA‐DR negativity and intense bright CD56 expression detects a rare and aggressive pediatric AML genetic lesion improving the diagnosis performance.
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Affiliation(s)
- Andrea Zangrando
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy.,Pediatric Hemato Oncology, Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy
| | - Francesca Cavagnero
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
| | - Pamela Scarparo
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
| | - Elena Varotto
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
| | - Samuela Francescato
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
| | - Claudia Tregnago
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
| | | | - Franca Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Luca Lo Nigro
- Center of Pediatric Hemato-Oncology, Azienda Policlinico-OVE, Catania, Italy
| | - Riccardo Masetti
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Caterina Putti
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
| | - Carmelo Rizzari
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation c/o ASST Monza, Milan, Italy
| | - Nicola Santoro
- Department of Pediatric Hemato-Oncology, University of Bari, Bari, Italy
| | - Andrea Pession
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Martina Pigazzi
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Basso
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy.,Italian Institute for Genomic Medicine, Turin, Italy
| | - Barbara Buldini
- Pediatric Hemato Oncology, Maternal and Child Health Department, University of Padua, Padua, Italy
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47
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Chen W, Yang J, Chen P. Cytogenetic characteristics of and prognosis for acute myeloid leukemia in 107 children. ASIAN BIOMED 2021; 15:79-89. [PMID: 37551405 PMCID: PMC10388776 DOI: 10.2478/abm-2021-0010] [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: 11/21/2022]
Abstract
Background Patients diagnosed with acute myeloid leukemia (AML) in childhood have a poor prognosis. A better understanding of prognostic factors will assist patients and clinicians in making difficult treatment decisions. Objectives To understand further the cytogenetic characteristics of and reassess the prognostic value of cytogenetic abnormalities in childhood AML. Methods Conventional karyotypes of 107 children with AML were analyzed retrospectively. The cases were divided into 4 groups based on genetic rearrangements; namely patients with: t(15;17)/PML-RARA; t(8;21)/RUNX1-RUNX1T1 or inv(16)(p13;q22) and t(16;16)/CBFB-MYH11; -7 or complex karyotypes; normal karyotypes or other cytogenetic changes. Differences in age, sex, leukocyte count, event-free survival (EFS), and overall survival (OS) were analyzed. Results All French-American-British (FAB) subtypes of AML were detected in 107 patients. We successfully cultured 81 of 107 bone marrow specimens, of which 60 cases had abnormal karyotypes. The most common abnormal karyotypes were t(8;21) (17/81 cases), followed by t(15;17) (13/81 cases), -X/Y (10/81 cases). There were no significant differences (P > 0.05) in age, sex, or leukocyte counts between the 4 groups. The differences in 3-year EFS and OS between each pair were significant, except for groups of patients with t(8;21)/RUNX1-RUNX1T1 and patients with normal karyotypes or other cytogenetic changes (P = 0.054). Conclusions Chromosomal abnormalities may provide important prognostic factors for AML in children and be helpful for risk stratification and individual treatment.
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Affiliation(s)
- Wanzi Chen
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
| | - Jinghui Yang
- Fujian Provincial Key Laboratory on Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
| | - Ping Chen
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
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48
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Van Weelderen RE, Klein K, Natawidjaja MD, De Vries R, Kaspers GJ. Outcome of pediatric acute myeloid leukemia (AML) in low- and middle-income countries: a systematic review of the literature. Expert Rev Anticancer Ther 2021; 21:765-780. [PMID: 33779466 DOI: 10.1080/14737140.2021.1895756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Survival rates of pediatric acute myeloid leukemia (AML) in low- and middle-income countries (LMICs) seem extremely poor, and the available literature on the matter is scarce. Accordingly, there is a limited understanding of poor treatment outcomes seen in this population.Areas covered: We provide an overview of the available literature with respect to treatment outcomes of pediatric AML in LMICs yielding poor outcomes compared to high-income countries. Moreover, treatment outcomes vary markedly between LMICs. In addition, there is a wide variation among studies in how treatment outcomes are reported and analyzed.Expert opinion: The substantially inferior treatment outcomes of pediatric AML in LMICs emphasize the unprecedented importance of global initiatives and international collaborations to improve the survival of these patients. A coordinated approach is necessary to carry out country-specific situational analyses. These analyses will result in operational plans on how to structurally implement childhood cancer registries, align healthcare infrastructure, build on capacities, and provide universal health coverage in LMICs. In addition, we strongly recommend that, in the future, LMICs document, analyze, and publish pediatric AML treatment outcomes in a more structured and uniform manner.
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Affiliation(s)
- Romy E Van Weelderen
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Kim Klein
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Meyrina D Natawidjaja
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralph De Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gertjan Jl Kaspers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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49
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Treatment outcomes of pediatric acute myeloid leukemia: a retrospective analysis from 1996 to 2019 in Taiwan. Sci Rep 2021; 11:5893. [PMID: 33723338 PMCID: PMC7960737 DOI: 10.1038/s41598-021-85321-3] [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] [Received: 10/04/2020] [Accepted: 02/28/2021] [Indexed: 11/08/2022] Open
Abstract
Improvement in outcomes of children with acute myeloid leukemia (AML) is attributed to several refinements in clinical management. We evaluated treatment outcomes of Taiwanese pediatric AML patients in the past 20 years. Overall, 860 de novo AML patients aged 0-18 years and registered in the Childhood Cancer Foundation of R.O.C during January 1996-December 2019 were included. Survival analysis was performed to identify factors that improved treatment outcomes. Regardless of treatment modalities used, patients during 2008-2019 had better 5-year event-free survival (EFS) and overall survival (OS) rates than patients during 1996-2007. For patients received the TPOG-AML-97A treatment, only 5-year OS rates were significantly different between patients diagnosed before and after 2008. Patients with RUNX1-RUNX1T1 had similar relapse-free survival rates, but 5-year OS rates were better during 2008-2019. However, the survival of patients who received hematopoietic stem-cell transplantations (HSCT) did not differ significantly before and after 2008. For patients without relapse, the 5-year OS improved during 2008-2019. Non-relapse mortality decreased annually, and cumulative relapse rates were similar. In conclusion, 5-year EFS and OS rates improved during 2008-2019, though intensities of chemotherapy treatments were similar before and after 2008. Non-relapse mortality decreased gradually. Further treatment strategies including more intensive chemotherapy, novel agents' use, identification of high-risk patients using genotyping and minimal residual disease, early intervention of HSCT, and antibiotic prophylaxis can be considered for future clinical protocol designs in Taiwan.
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50
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Second Relapse of Pediatric Patients with Acute Myeloid Leukemia: A Report on Current Treatment Strategies and Outcome of the AML-BFM Study Group. Cancers (Basel) 2021; 13:cancers13040789. [PMID: 33672815 PMCID: PMC7918758 DOI: 10.3390/cancers13040789] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Children with acute myeloid leukemia (AML) experience high relapse rates of about 30%; still, survival rates following the first relapse are encouraging. Hence, it is critically important to examine the consequences of a second relapse; however, little is known about this subgroup of patients. This retrospective population-based analysis intends to describe response, survival and prognostic factors relevant for the survival of children with second relapse of AML. Treatment approaches include many different therapeutic regimens, including palliation and intensive treatment with curative intent (63% of the patients). Survival is poor; however, patients who respond to reinduction attempts can be rescued with subsequent hematopoietic stem cell transplantation. We deciphered risk factors, such as short time interval from first to second relapse below one year as being associated with a poor outcome. This analysis will help to improve future international treatment planning and patient care of children with advanced AML. Abstract Successful management of relapse is critical to improve outcomes of children with acute myeloid leukemia (AML). We evaluated response, survival and prognostic factors after a second relapse of AML. Among 1222 pediatric patients of the population-based AML-Berlin–Frankfurt–Munster (BFM) study group (2004 until 2017), 73 patients met the quality parameters for inclusion in this study. Central review of source documentation warranted the accuracy of reported data. Treatment approaches included palliation in 17 patients (23%), intensive therapy with curative intent (n = 46, 63%) and other regimens (n = 10). Twenty-five patients (35%) received hematopoietic stem cell transplantation (HSCT), 21 of whom (88%) had a prior HSCT. Survival was poor, with a five-year probability of overall survival (pOS) of 15 ± 4% and 31 ± 9% following HSCT (n = 25). Early second relapse (within one year after first relapse) was associated with dismal outcome (pOS 2 ± 2%, n = 44 vs. 33 ± 9%, n = 29; p < 0.0001). A third complete remission (CR) is required for survival: 31% (n = 14) of patients with intensive treatment achieved a third CR with a pOS of 36 ± 13%, while 28 patients (62%) were non-responders (pOS 7 ± 5%). In conclusion, survival is poor but possible, particularly after a late second relapse and an intensive chemotherapy followed by HSCT. This analysis provides a baseline for future treatment planning.
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