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Langdon K, Cosentino S, Wawryk O. Superiority of anthracycline-free treatment in standard-risk acute promyelocytic leukemia: A systematic review and comparative epidemiological analysis. Cancer Rep (Hoboken) 2024; 7:e2035. [PMID: 38507294 PMCID: PMC10953833 DOI: 10.1002/cnr2.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Recent advances in the treatment of acute promyelocytic leukemia (APML) have seen unprecedented improvements in patient outcomes. However, such rapid growth in understanding often leads to uncertainty regarding superiority among candidate treatment regimens, especially when further scrutinized from an epidemiological perspective. AIMS The aim of this systematic review with epidemiological analysis was to identify and compare commonly utilized protocols for standard-risk APML with a particular focus on complete remission (CR), overall/disease-free survival (DFS), and reported adverse events. METHODS AND RESULTS Medline, Scopus, and CINAHL were interrogated to identify studies utilizing all-trans retinoic acid (ATRA) in addition to arsenic trioxide (ATO) and/or anthracyclines such as idarubicin (IDA) in the treatment of de-novo APML. After collation of studies, an epidemiological analysis was subsequently performed to compare protocols with regards to outcomes of interest using number needed to benefit (NNB) and number needed to harm (NNH) measures. Seventeen articles, describing 12 distinct trials, were included in the analysis. These trials made use of three unique protocols; CR rates were 94%-100% for ATO/ATRA regimens, 95%-96% for ATO/ATRA/anthracycline regimens, and 89%-94% for ATRA/anthracycline regimens. Epidemiological analysis demonstrated NNB for CR was 9.09 (ATO/ATRA vs. ATRA/IDA) and 20.00 (ATO/ATRA vs. ATO/ATRA/IDA), NNH for neutropenia was -3.45 (ATO/ATRA vs. ATRA/IDA), and NNH for infection was -3.13 (ATO/ATRA vs. ATRA/IDA) and -1.89 (ATO/ATRA vs. ATO/ATRA/IDA). CONCLUSION The ATO/ATRA regimen is superior to chemotherapy-containing protocols at inducing remission and promoting survival in patients with APML. The regimen is better tolerated than the proposed alternatives with fewer adverse events. Future research opportunities include quantifying APML epidemiology and pursuing oral arsenic as an option for simplification of therapeutic protocols.
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Affiliation(s)
- Kane Langdon
- College of Medicine and DentistryJames Cook UniversityCairnsQueenslandAustralia
- Division of MedicineCairns Base HospitalCairnsQueenslandAustralia
- Division of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Stevie Cosentino
- Division of MedicineCairns Base HospitalCairnsQueenslandAustralia
| | - Olivia Wawryk
- Division of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
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2
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AlDawood Z, Bin Morya M, Alrajhi AM, Alfayez M, AlSwayyed AF, AlShehry N. First report of acute promyelocytic leukemia in a patient with Wilson's disease: contemporary discussion of a management challenge. Hematology 2023; 28:2252649. [PMID: 37642434 DOI: 10.1080/16078454.2023.2252649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Zainab AlDawood
- Department of Hematology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Marwa Bin Morya
- Department of Hematology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah M Alrajhi
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, AlFaisal University, Riyadh, Saudi Arabia
| | - Mansour Alfayez
- Department of Hematology, King Faisal Specialist Hospital and Research center, Riyadh, Saudi Arabia
| | - Azizah F AlSwayyed
- Hematopathology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawal AlShehry
- Department of Hematology, King Fahad Medical City, Riyadh, Saudi Arabia
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3
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Kong FC, Qi L, Zhou YL, Yu M, Huang WF, Li F. Chidamide, Decitabine, Cytarabine, Aclarubicin, and Granulocyte Colony-stimulating Factor Therapy for Patients with Relapsed/Refractory Acute Myeloid Leukemia: A Retrospective Study from a Single-Center. Curr Med Sci 2023; 43:1151-1161. [PMID: 38057538 DOI: 10.1007/s11596-023-2805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 09/19/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Preclinical evidence and clinical trials have suggested synergistic effects of epigenetic modifiers in combination with cytotoxic agents for the treatment of leukemia. However, their efficacy in patients with relapsed/refractory acute myeloid leukemia (R/R AML) remains unclear. METHODS Clinical data of R/R AML patients who received a CDCAG regimen (chidamide, decitabine, cytarabine, aclarubicin, and granulocyte colony-stimulating factor) from July 1, 2018 to October 31, 2021 at our center were retrospectively assessed, and the safety and efficacy of the CDCAG regimen were evaluated. Patients were followed up until November 30, 2021, with a median follow-up of 21.6 months (95% CI: 10.0-33.2 months). RESULTS A total of 67 patients were enrolled. Two patients died within 3 weeks after the initiation, and therefore only 65 patients underwent the assement for clinical response and survival. It was found that 56.9% patients achieved complete remission with a median overall survival (OS) of 9.6 months. The median OS of responders was 25.9 months, while that of non-responders was 5.0 months (P<0.0001). Patients with gene mutations had a superior overall response rate (ORR) (80.4% vs. 45.5%, P=0.043) compared to those without gene mutations. The presence of DNA methyltransferase 3 A (DNMT3A), ten-eleven translocation-2 (TET2), and isocitrate dehydrogenase 1/2 (IDH1/2) mutations did not affect the response rate (88.2% vs. 68.9%, P=0.220) and reflected a better OS (not attained vs. 9.0 months, P=0.05). The most common non-hematologic adverse events were pulmonary infection (73.1%), followed by febrile neutropenia (23.9%) and sepsis (19.4%). CONCLUSIONS The CDCAG regimen was effective and well-tolerated in R/R AML patients, increasing the potential for allogeneic hematopoietic stem cell transplantation. Moreover, patients with DNMT3A, TET2, and IDH1/2 mutations might benefit from this regimen.
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Affiliation(s)
- Fan-Cong Kong
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Clinical Research Center for Hematologic Diseases, Nanchang, 330006, China
| | - Ling Qi
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Clinical Research Center for Hematologic Diseases, Nanchang, 330006, China
| | - Yu-Lan Zhou
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Clinical Research Center for Hematologic Diseases, Nanchang, 330006, China
| | - Min Yu
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Clinical Research Center for Hematologic Diseases, Nanchang, 330006, China
| | - Wen-Feng Huang
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Fei Li
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
- Jiangxi Clinical Research Center for Hematologic Diseases, Nanchang, 330006, China.
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4
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Zimmer M, Kadia T. Approach to the Older Patient with Acute Myeloid Leukemia. Curr Oncol Rep 2023; 25:1203-1211. [PMID: 37688738 DOI: 10.1007/s11912-023-01450-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE OF REVIEW This study aims to review the challenges of treating AML in older patients, the spectrum of genomic aberrancies in this cohort, and discuss treatment options for newly diagnosed AML in this patient population. RECENT FINDINGS Greater understanding of biological underpinnings of AML and availability of newer, effective, targeted therapies have allowed us to move away from intensification of chemotherapy, to prioritize better tolerability while still maintaining efficacy. Increasing knowledge of the genomic complexity and adverse karyotypes in older AML patients drives the need for ongoing investigations of targeted and lower-intensity therapies in the frontline, relapsed/refractory setting, and post-remission.
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Affiliation(s)
- Markie Zimmer
- Division of Hematology/Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Tapan Kadia
- Department of Leukemia, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 428, Houston, TX, 77030, USA.
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Akagi Y, Yamashita Y, Kosako H, Furuya Y, Hosoi H, Mushino T, Murata S, Nishikawa A, Tamura S, Nakao T, Sonoki T. Administration of combined venetoclax and azacitidine in a patient with acute myeloid leukemia and multiple comorbidities undergoing dialysis: A case report. EJHAEM 2023; 4:841-843. [PMID: 37601888 PMCID: PMC10435694 DOI: 10.1002/jha2.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 08/22/2023]
Abstract
Patients with acute myeloid leukemia (AML) who have comorbidities have limited treatment options, thereby resulting in poor prognosis. Venetoclax, a specific B-cell lymphoma-2 inhibitor, has recently been approved for AML in combination with hypomethylating agents; however, only one report has described its use in patients undergoing dialysis. Herein, we report the effectiveness of combined venetoclax and azacitidine in a 73-year-old man with AML undergoing dialysis and who was ineligible for standard therapies. The safety of venetoclax and azacitidine in patients undergoing dialysis has been reported, and their combination may be a feasible option for patients with AML undergoing dialysis.
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Affiliation(s)
- Yuina Akagi
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
- Department of HematologyNaga Municipal HospitalWakayamaJapan
| | - Yusuke Yamashita
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
- Department of HematologyNaga Municipal HospitalWakayamaJapan
| | - Hideki Kosako
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Yoshiaki Furuya
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
- Department of HematologyNaga Municipal HospitalWakayamaJapan
| | - Hiroki Hosoi
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Toshiki Mushino
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Shogo Murata
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Akinori Nishikawa
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Shinobu Tamura
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Taisei Nakao
- Department of HematologyNaga Municipal HospitalWakayamaJapan
- Department of Internal MedicineNaga Municipal HospitalWakayamaJapan
| | - Takashi Sonoki
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
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6
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Kuron D, Pohlmann A, Angenendt L, Kessler T, Mesters R, Berdel WE, Stelljes M, Lenz G, Schliemann C, Mikesch JH. Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis. Ann Hematol 2023; 102:755-760. [PMID: 36749402 PMCID: PMC9998561 DOI: 10.1007/s00277-023-05111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
Intensive chemotherapy is the backbone of induction treatment in patients with acute myeloid leukemia (AML). However, AML patients with concomitant cardiac disease may not be eligible for anthracycline-based therapies. In a small cohort of patients, we have previously shown that anthracycline-free, amsacrine-based chemotherapy TAA (thioguanine, cytarabine, amsacrine) may be as effective as cytarabine/daunorubicin for induction therapy in these patients. In this systematic retrospective single-center analysis, we documented the outcome of 31 patients with significant cardiac comorbidities including coronary heart disease or cardiomyopathy receiving TAA as induction chemotherapy. Median (range) ejection fraction (EF) was 48% (30-67%) in this cohort. Patients with EF below 30% were considered unfit for intensive induction therapy. Event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS) were 1.61, 5.46, and 13.6 months respectively. Poor outcome was primarily related to a high early mortality rate within the first 30 days of therapy, mainly caused by infectious complications. TAA cannot be recommended as a substitute of standard induction for AML patients with significant concomitant cardiac disease. In the era of novel agents, alternative strategies (e.g., hypomethylating agents plus venetoclax) should be considered when anthracycline-based regimens are not suitable.
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Affiliation(s)
- David Kuron
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany. .,Current Affiliation: Department of Medicine II, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Alexander Pohlmann
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Linus Angenendt
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Torsten Kessler
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Rolf Mesters
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Matthias Stelljes
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | | | - Jan-Henrik Mikesch
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
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7
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Intravoxel incoherent motion diffusion-weighted MRI of renal parenchyma and its clinical significance in patients with untreated acute leukemia: a pilot study. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1363-1371. [PMID: 36763120 DOI: 10.1007/s00261-023-03829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To evaluate quantitative parameters derived from intravoxel incoherent motion diffusion-weighted MRI (IVIM) of renal parenchyma in patients with untreated acute leukemia (AL) and analyze its prognostic significance and probable pathological mechanism. METHODS From March 2019 to November 2021, 67 newly diagnosed AL patients and 67 healthy controls matched in age and sex were recruited. All participants underwent IVIM in the kidneys, and D, D*, f, standard ADC values were measured. The differences of all parameters between AL and controls were analyzed. The relationship between imaging parameters and estimated glomerular filtration rate (eGFR) was studied. Univariable and multivariable analyses were performed to investigate prognostic significance of possible indicators. RESULTS The f and D value of renal medulla and D value of renal cortex in AL patients were lower than those in the healthy control group (t = - 2.173, t = - 3.463, t = - 2.030, respectively, all P < 0.05). The cortical f, cortical standard ADC, medullary f, and medullary standard ADC were correlated with the eGFR (r = 0.524, r = 0.401, r = 0.415, r = 0.325, respectively, all P < 0.05) in patients with AL. A medullary f value ≤ 9.51% (hazard ratio: 0.282; 95% confidence interval: 0.110, 0.719; P = 0.008) was associated with overall survival in a multivariable analysis. CONCLUSION The f and standard ADC values in renal parenchyma were the probable imaging markers of renal function in patients with newly diagnosed de novo AL. Lower renal medullary f value was a potential independent predictor for overall survival.
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8
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Edahiro T, Ureshino H, Chishaki R, Fujino K, Mino T, Yoshida T, Fukushima N, Ichinohe T. Successful combination treatment with azacitidine and venetoclax for a patient with acute myeloid leukemia undergoing hemodialysis. Leuk Lymphoma 2022; 63:3511-3512. [PMID: 36098247 DOI: 10.1080/10428194.2022.2123230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Taro Edahiro
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Ureshino
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ren Chishaki
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Keita Fujino
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuji Mino
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tetsumi Yoshida
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Noriyasu Fukushima
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.,Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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9
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Limratchapong C, Sophark P, Vachvanichsanong P, McNeil EB, Chotsampancharoen T. Acute kidney injury and childhood acute myeloid leukemia. Pediatr Nephrol 2022; 37:2765-2770. [PMID: 35257241 DOI: 10.1007/s00467-022-05506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) appears to be particularly common in children with acute myeloid leukemia (AML), although the epidemiology data on this patient population is sparse. The objective of this study was to assess the prevalence and factors associated with AKI in childhood AML during chemotherapy treatment. METHODS The medical records of 112 children aged under 15 years diagnosed with AML who received chemotherapy in a major tertiary-care referral center in southern Thailand were reviewed. Logistic regression was used to identify factors associated with AKI. RESULTS Fifty-six (50%) children had AKI events. The median time from AML diagnosis to the first AKI was 29.5 days (interquartile range: 11.0-92.8) and the median follow-up time was 10.9 months (interquartile range: 3.6-31.1). Age at diagnosis ≥ 10 years (OR 2.75, 95% CI 1.09-6.93), glomerular filtration rate < 90 mL/min/1.73 m2 at AML diagnosis (OR 7.58, 95% CI 1.89-30.5), and septic shock (OR 22.0, 95% CI 4.63-104.3) were independently associated with AKI. CONCLUSIONS Childhood AML has a high rate of kidney injury with 50% having AKI. Age ≥ 10 years at diagnosis, impaired kidney function before treatment, and septic shock were strongly associated with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Chompoonut Limratchapong
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand
| | - Praewa Sophark
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand
| | - Prayong Vachvanichsanong
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand
| | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Thirachit Chotsampancharoen
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand.
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10
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Fodil S, Chevret S, Rouzaud C, Valade S, Rabian F, Mariotte E, Raffoux E, Itzykson R, Boissel N, Sébert M, Adès L, Zafrani L, Azoulay E, Lengliné E. Post-remission outcomes in AML patients with high hyperleukocytosis and inaugural life-threatening complications. PLoS One 2022; 17:e0270744. [PMID: 35797337 PMCID: PMC9262217 DOI: 10.1371/journal.pone.0270744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Patients with hyperleukocytic (HL) acute myeloid leukemia (AML) are at higher risk of early death. Initial management of these patients is challenging, not fully codified and heterogenous. Retrospective studies showed that several symptomatic measures might decrease early death rate but long-term data are scarce. We aimed to analyze whether the therapeutic measures carried out urgently at diagnosis may influence the outcome among HL AML patients having achieved who survived inaugural complications. Methods We retrospectively reviewed all medical charts from patients admitted to Saint-Louis Hospital between January, 1st 1997 and December, 31st 2018 with newly diagnosed AML and white blood cell (WBC) count above 50x109/L. Outcome measures were cumulative incidence of relapse (CIR), treatment-related mortality (TRM) defined as relapse-free death, and overall survival. Univariate and multivariate analyses were performed using Cox proportional hazards models. Results A total of 184 patients with HL AML in complete remission (CR) were included in this study. At 2 years after CR. 62.5% of patients were alive, at 5 years, cumulated incidence of relapse was 55.8%. We found that every therapeutic measure, including life-sustaining therapies carried out in the initial phase of the disease, did not increase the relapse risk. The use of hydroxyurea for more than 4 days was associated with a higher risk of relapse. At the end of the study, 94 patients (51.1%) were still alive including 23 patients out of 44 aged less than 60 yo that were able to return to work. Conclusion We show that the use of emergency measures including life sustaining therapies does not come at the expense of a higher risk of relapse or mortality, except in the case of prolonged use of hydroxyurea. Patients with HL AML should be able to benefit from all available techniques, regardless of their initial severity.
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Affiliation(s)
- Sofiane Fodil
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- Sorbonne Université, Paris, France
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, Paris, France
| | - Camille Rouzaud
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Florence Rabian
- Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Emmanuel Raffoux
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Raphael Itzykson
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Nicolas Boissel
- Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Marie Sébert
- Hématologie Seniors, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- Université de Paris and INSERM U944, Paris, France
| | - Lionel Adès
- Hématologie Seniors, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- Université de Paris and INSERM U944, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Etienne Lengliné
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- * E-mail:
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11
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Sheshadri A, Goizueta AA, Shannon VR, London D, Garcia-Manero G, Kantarjian HM, Ravandi-Kashani F, Kadia TM, Konopleva MY, DiNardo CD, Pierce S, Zarifa A, Albittar AA, Zhong LL, Akhmedzhanov FO, Arain MH, Alfayez M, Alotaibi A, Altan M, Naing A, Mendoza TR, Godoy MCB, Shroff G, Kim ST, Faiz SA, Kontoyiannis DP, Khawaja F, Jennings K, Daver NG. Pneumonitis after immune checkpoint inhibitor therapies in patients with acute myeloid leukemia: A retrospective cohort study. Cancer 2022; 128:2736-2745. [PMID: 35452134 PMCID: PMC9232977 DOI: 10.1002/cncr.34229] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI), combined with hypomethylating agents, can be used to treat acute myeloid leukemia (AML), but this strategy results in a high rate of pneumonitis. The authors sought to determine risk factors for pneumonitis development and whether pneumonitis increased mortality. METHODS The authors conducted a retrospective review of 258 AML patients who received ICI-containing regimens from 2016 to 2018. A multidisciplinary adjudication committee diagnosed pneumonia and pneumonitis by reviewing symptoms, imaging, microbiology, and response to therapies. To measure risk factors for pneumonitis and mortality, multivariate Cox proportional hazards models were constructed. Pneumonia, pneumonitis, and disease progression were modeled as a time-dependent variable and incorporated a standard risk set modifying variables into the models. RESULTS Thirty patients developed pneumonitis (12%). Of these, 17 had partial or complete resolution, whereas 13 patients died from pneumonitis. Increasing age (hazard ratio [HR], 1.04 per year; 95% confidence interval [CI], 1.00-1.08), and baseline shortness of breath increased pneumonitis risk (HR, 2.51; 95% CI, 1.13-5.55). Female sex (HR, 0.33; 95% CI, 0.15-0.70) and increasing platelet count (HR, 0.52 per log-unit increase; 95% CI, 0.30-0.92) decreased pneumonitis risk. In adjusted models, ICI-related pneumonitis significantly increased mortality (HR, 2.84; 95% CI, 1.84-4.37). CONCLUSIONS ICI-related pneumonitis occurs at a high rate in AML patients and increases mortality. LAY SUMMARY Immune checkpoint inhibitors (ICIs) remove inhibitory signals that reduce T-cell function and allow T-cells to better attack cancer cells. In acute myeloid leukemia (AML), the effectiveness of ICIs is limited in part by inflammation of the lung, called pneumonitis. This study reviewed 258 patients with AML who received ICIs and identified 30 patients who developed pneumonitis, nearly half of whom died. Older age and baseline shortness of breath increased pneumonitis risk, whereas female sex and higher baseline platelet counts decreased pneumonitis risk. Pneumonitis increased mortality by nearly 3-fold. This work highlights the significant harm imposed by pneumonitis after ICI therapies.
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Affiliation(s)
- Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alberto A Goizueta
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David London
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi-Kashani
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marina Y Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abdulrazzak Zarifa
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aya A Albittar
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Linda L Zhong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fechukwu O Akhmedzhanov
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muhammad H Arain
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mansour Alfayez
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmad Alotaibi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Myrna C B Godoy
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Girish Shroff
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sang T Kim
- Department of Rheumatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fareed Khawaja
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naval G Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Walsh LR, Yuan C, Boothe JT, Conway HE, Mindiola-Romero AE, Barrett-Campbell OO, Yerrabothala S, Lansigan F. Acute myeloid leukemia with hepatic infiltration presenting as obstructive jaundice. Leuk Res Rep 2021; 15:100251. [PMID: 34141563 PMCID: PMC8184649 DOI: 10.1016/j.lrr.2021.100251] [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: 01/12/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 12/11/2022] Open
Abstract
Acute myeloid leukemia can present as cholestasis with obstructive jaundice. Extramedullary leukemia infiltration of liver can delay initiation of chemotherapy. Hydroxyurea may be employed as a temporizing measure for effects of hyperleukocytosis.
We present the case of a 55-year-old woman who presented with laboratory studies concerning for acute myeloid leukemia (AML) as well as obstructive cholestasis. In similar previously reported cases, concerns of chemotherapy toxicity exacerbated by liver dysfunction or concerns of untreated, concurrent cholecystitis in a neutropenic patient often delay initiation of chemotherapy for full medical workup. At admission, our patient was started on the cytoreductive agent hydroxyurea. By day 10 of her medical workup, her liver function had improved with total bilirubin levels normalizing. At that time, full-dose 7 + 3 induction with cytarabine and daunorubicin was then initiated.
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Affiliation(s)
- Landis R Walsh
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Chaofan Yuan
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - James T Boothe
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Heather E Conway
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Andres E Mindiola-Romero
- Department of Pathology & Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Odeth O Barrett-Campbell
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Swaroopa Yerrabothala
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Frederick Lansigan
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
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13
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Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper. Blood Adv 2021; 4:762-775. [PMID: 32097461 DOI: 10.1182/bloodadvances.2019000955] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/13/2020] [Indexed: 12/16/2022] Open
Abstract
The incidence of acute myeloid leukemia (AML) increases with age. Intensive induction chemotherapy containing cytarabine and an anthracycline has been part of the upfront and salvage treatment of AML for decades. Anthracyclines are associated with a significant risk of cardiotoxicity (especially anthracycline-related left ventricular dysfunction [ARLVD]). In the older adult population, the higher prevalence of cardiac comorbidities and risk factors may further increase the risk of ARLVD. In this article of the Young International Society of Geriatric Oncology group, we review the prevalence of ARLVD in patients with AML and factors predisposing to ARLVD, focusing on older adults when possible. In addition, we review the assessment of cardiac function and management of ARLVD during and after treatment. It is worth noting that only a minority of clinical trials focus on alternative treatment strategies in patients with mildly declined left ventricular ejection fraction or at a high risk for ARLVD. The limited evidence for preventive strategies to ameliorate ARLVD and alternative strategies to anthracycline use in the setting of cardiac comorbidities are discussed. Based on extrapolation of findings from younger adults and nonrandomized trials, we recommend a comprehensive baseline evaluation of cardiac function by imaging, cardiac risk factors, and symptoms to risk stratify for ARLVD. Anthracyclines remain an appropriate choice for induction although careful risk-stratification based on cardiac disease, risk factors, and predicted chemotherapy-response are warranted. In case of declined left ventricular ejection fraction, alternative strategies should be considered.
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14
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Tollkuci E, Tran T, Myers R. Gilteritinib administration in a hemodialysis patient. J Oncol Pharm Pract 2020; 27:1255-1257. [PMID: 33175659 DOI: 10.1177/1078155220973259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gilteritinib is a multitargeted tyrosine kinase inhibitor (TKI) approved by the Food and Drug Administration (FDA) for acute myeloid leukemia (AML) with a FMS-related tyrosine kinase 3 (FLT3) mutation. The pharmacokinetics of gilteritinib in the setting of severe renal impairment (creatinine clearance [CrCl] 15-29 mL/min utilizing Cockcroft-Gault method) and end-stage renal disease are unknown. Gilteritinib is primarily metabolized by the liver through the CYP3A4 enzyme and is eliminated in both the feces and urine. Its excretion is primarily through the fecal route, accounting for 64.5% of the recovered dose. Only about 16.4% of the recovered dose has been detected in the urine of human subjects. CASE REPORT We describe our patient case documenting the administration of gilteritinib in the setting of end-stage renal disease (ESRD) and hemodialysis (HD).Management and Outcomes: Our patient was initiated on single agent gilteritinib 120 mg by mouth once daily for relapse FLT3-TDK positive AML. Treatment course was complicated by pancytopenia, neutropenic fever, and staphylococcus lugdunensis bacteremia requiring temporary interruption of therapy. DISCUSSION Given that gilteritinib is metabolized by the liver and eliminated primarily in the feces, one does not expect an increase in toxicity related to impaired renal function. Although this report describes the successful utilization of gilteritinib, caution should be exercised when administering in patient populations with end organ disease, and patient comorbidities should be taken into account.
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Affiliation(s)
- Eris Tollkuci
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.,Division of Pharmacy, Rush University Medical Center, Chicago, IL, USA
| | - Tiffany Tran
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca Myers
- Division of Pharmacy, Rush University Medical Center, Chicago, IL, USA
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15
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Ma BB, Zhang TJ, Wang CZ, Xu ZJ, Zhou JD, Gu Y, Ma JC, Deng ZQ, Lin J, Qian J. Methylation-independent CRIP1 expression is a potential biomarker affecting prognosis in cytogenetically normal acute myeloid leukemia. Am J Transl Res 2020; 12:4840-4852. [PMID: 33042393 PMCID: PMC7540098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
Abnormal expression of CRIP1 has been identified in numerous solid tumors. However, CRIP1 expression and its regulation are little known in acute myeloid leukemia (AML). The purpose of this study was to evaluate the expression and regulation of CRIP1 and the clinical implications of CRIP1 aberration in AML. Real-time quantitative PCR was carried out to detect the level of CRIP1 expression in 138 AML patients and 38 controls. CRIP1 methylation was detected by methylation-specific PCR and bisulfite sequencing PCR. Five public available AML datasets from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were further analyzed. The level of CRIP1 expression was up-regulated in AML patients compared with controls (P = 0.045). CRIP1 high patients had a significantly lower complete remission (CR) rate than CRIP1 low patients (P = 0.020). CRIP1 high group had a shorter overall survival (OS) and leukemia-free survival (LFS) than CRIP1 low group in cytogenetically normal AML (CN-AML) patients (P = 0.007 and 0.012, respectively). Multivariate analysis further confirmed that high CRIP1 expression was an independent risk factor for LFS in CN-AML patients (P = 0.005). However, we found that CRIP1 expression was not associated with the status of its promoter, which was nearly fully unmethylated both in controls and AML patients. Furthermore, our results were validated using the published GEO datasets and TCGA datasets. Our findings suggest that high CRIP1 expression is independently related with unfavorable prognosis in CN-AML.
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Affiliation(s)
- Bei-Bei Ma
- Department of Hematology, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
| | - Ting-Juan Zhang
- Department of Hematology, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
| | - Cui-Zhu Wang
- Department of Oncology, Hai’an People’s Hospital Affiliated to Nantong UniversityNantong, Jiangsu, People’s Republic of China
| | - Zi-Jun Xu
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- The Key Lab of Precision Diagnosis and Treatment of Zhenjiang CityZhenjiang, Jiangsu, People’s Republic of China
| | - Jing-Dong Zhou
- Department of Hematology, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
| | - Yu Gu
- Department of Hematology, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
| | - Ji-Chun Ma
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- The Key Lab of Precision Diagnosis and Treatment of Zhenjiang CityZhenjiang, Jiangsu, People’s Republic of China
| | - Zhao-Qun Deng
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- The Key Lab of Precision Diagnosis and Treatment of Zhenjiang CityZhenjiang, Jiangsu, People’s Republic of China
| | - Jiang Lin
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- The Key Lab of Precision Diagnosis and Treatment of Zhenjiang CityZhenjiang, Jiangsu, People’s Republic of China
| | - Jun Qian
- Department of Hematology, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
- Laboratory Center, Affiliated People’s Hospital of Jiangsu UniversityZhenjiang, Jiangsu, People’s Republic of China
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16
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Li Q, Huang JC, Liao DY, Wu Y. Chidamide plus decitabine synergistically induces apoptosis of acute myeloid leukemia cells by upregulating PERP. Am J Transl Res 2020; 12:3461-3475. [PMID: 32774712 PMCID: PMC7407678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
Acute myeloid leukemia (AML) is a malignant clonal disease that originates from hematopoietic stem cells. Because AML has a generally unsatisfactory long-term prognosis, new therapeutic options are required. To this end, we explored the effects of chidamide and decitabine alone or in combination on the AML cell lines THP-1, MV4-11, HL60, and Kasumi-1. Notably, the two drugs exhibited a synergistic effect against these cell lines. Similarly, we also found potential synergistic effects in primary cells of relapsed/refractory (r/r) AML. A transcriptome sequencing analysis performed to elucidate the underlying molecular mechanism revealed differentially expressed genes and regulatory pathways, particularly with regard to apoptosis, when comparing cells subjected to single and combination treatments. We identified PERP as a downstream target gene of the transcription factors P53 and P63, and it was expressed at considerably higher levels in combination-treated cells relative to monotherapy-treated cells. We further used a lentivirus-mediated small interfering RNA to inhibit the endogenous expression of PERP in AML cell lines and observed a significant increase in cell proliferation. Collectively, our results demonstrate, for the first time, the role of PERP in the response of AML to a combination drug regimen, providing a new potential treatment protocol and target in this context.
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Affiliation(s)
- Qing Li
- Department of Hematology and Hematology Research Laboratory, West China Hospital, Sichuan UniversityChengdu, Sichuan, P. R. China
| | - Jing-Cao Huang
- Department of Hematology and Hematology Research Laboratory, West China Hospital, Sichuan UniversityChengdu, Sichuan, P. R. China
| | - Dian-Ying Liao
- Department of Pathology, West China Hospital, Sichuan UniversityChengdu, Sichuan, P. R. China
| | - Yu Wu
- Department of Hematology and Hematology Research Laboratory, West China Hospital, Sichuan UniversityChengdu, Sichuan, P. R. China
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17
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Li J, Li W, Niu J, Song X, Wu W, Gong T, Zheng R, Ting-Fang Shih T, Li W, Zhou XJ. Intravoxel Incoherent Motion Diffusion-weighted MRI of Infiltrated Marrow for Predicting Overall Survival in Newly Diagnosed Acute Myeloid Leukemia. Radiology 2020; 295:155-161. [PMID: 32068504 DOI: 10.1148/radiol.2020191693] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Acute myeloid leukemia (AML) features relatively low overall survival (OS). Intravoxel incoherent motion (IVIM) diffusion-weighted MRI separates tissue microcapillary perfusion and diffusivity and may have potential for helping to assess prognosis in infiltrated marrow disease apart from solid tumor. Thus, a study of overall survival would contribute to clarifying the value of IVIM for assessing long-term prognosis in AML. Purpose To determine whether the IVIM-derived parameters of infiltrated bone marrow may be associated with OS in newly diagnosed AML. Materials and Methods This prospective study enrolled participants with newly diagnosed AML between July 2014 to March 2016 consecutively. Participants underwent MRI of the lumbar spine by using an IVIM sequence. Participant clinical characteristics and OS were collected. The median of follow-up period was 20 months (range, 1-56 months). The IVIM parameters (pseudoperfusion fraction, f; diffusion coefficient, D; and pseudodiffusion coefficient, D*) were obtained. A nonparametric log-rank test was used to identify the threshold of IVIM parameters for OS. Univariable Kaplan-Meier and multivariable Cox proportional hazards regression analyses were performed to investigate prognostic significance of possible indicators. Results Fifty-three participants (mean age, 42 years ± 17; 30 men) were evaluated. Nonparametric log-rank test results showed that the thresholds of f and D values for OS were 31.0% and 0.2 × 10-3 mm2/sec, respectively. Univariable analyses indicated that high f value (>31.0%) and low D value (≤0.2 × 10-3 mm2/sec) were associated with shorter OS (P = .003 and .01, respectively). An f value greater than 31.0% (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.6; P = .046) was associated with OS, independent of clinical confounders (age, karyotype, and white blood cell counts) in a multivariable analysis. Conclusion Pseudoperfusion fraction and diffusion coefficient from intravoxel incoherent motion diffusion-weighted MRI may be viable prognosis predictors of newly diagnosed acute myeloid leukemia. © RSNA, 2020.
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Affiliation(s)
- Jianting Li
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Wenjin Li
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Jinliang Niu
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Xiaoli Song
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Wenqi Wu
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Tong Gong
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Rong Zheng
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Tiffany Ting-Fang Shih
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Weiguo Li
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
| | - Xiaohong Joe Zhou
- From the Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China (J.L., R.Z.); Departments of Stomatology (Wenjin Li) and Radiology (J.N., X.S., W.W.), 2nd Hospital, Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China 030001; Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China (T.G.); Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (T.T.F.S.); Department of Radiology, Northwestern University, Chicago, Ill (Weiguo Li); and Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois at Chicago, Chicago, Ill (X.J.Z.)
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A rare case of acute myeloid leukemia with ARHGEF12 (LARG, 11q23.3) and MAPRE1 (EB1, 20q11.21) fusion gene in an elderly patient. REV ROMANA MED LAB 2020. [DOI: 10.2478/rrlm-2020-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Introduction. We report one elderly patient diagnosed with a rare subtype of acute myeloid leukemia (AML) and also with a very rare fusion gene involving ARHGEF12 (LARG, 11q23.3) and MAPRE1 (EB1, 20q11.21) genes.
Material and methods. Clinical examination and routine analysis were performed including peripheral blood smear, immunophenotyping of the peripheral blood by flow cytometry and several molecular analyses.
Results. Peripheral blood smear showed 80% blasts with round and some with convoluted nuclei, with basophilic cytoplasm, identified as monoblast and the majority of cells as promonocytes. Peripheral blood immunophenotyping was consistent with monocytic differentiation. Molecular analysis was negative for FLT3 ITD, FLT3 D835, NPM1, and DNMT3A R882 mutations. Multiplex ligation-dependent probe amplification revealed no copy number aberration. Ligation-dependent reverse transcription polymerase chain reaction (LD-RT-PCR) analysis identified the presence of one gene fusion between ARHGEF12 (LARG, 11q23.3) and MAPRE1 (EB1, 20q11.21) genes. The patient had no significant comorbidities, the renal function was normal and Eastern Cooperative Oncology Group performance status was 2 at diagnosis and 1 after treatment. She was treated with decitabine. She became transfusion independent and a reduction of the number of blasts was obtained.
Conclusions. The outcome of our AML patient was favorable but other patients with fusion genes involving ARHGEF12 (LARG, 11q23.3) and MAPRE1 (EB1, 20q11.21) should be reported, contributing to a better characterization of the disease, to monitor the minimal residual disease and in the end to more targeted treatment options. LD-RT-PCR represent a valuable multiplex technique for fusion gene analysis.
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19
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How I treat acute myeloid leukemia in the era of new drugs. Blood 2020; 135:85-96. [DOI: 10.1182/blood.2019001239] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
AbstractThe acute myeloid leukemia (AML) treatment landscape has changed substantially since 2017. New targeted drugs have emerged, including venetoclax to target B-cell lymphoma 2, midostaurin and gilteritinib to target FLT3, and ivosidenib and enasidenib to target mutant isocitrate dehydrogenase 1 and 2, respectively. Other additions include reapproval of gemtuzumab ozogomycin to target CD33, glasdegib to target the hedgehog pathway, and a liposomal formulation of daunorubicin and cytarabine (CPX-351). Genomically heterogeneous AML has a tendency to evolve, particularly under selective treatment pressure. For decades, treatment decisions have largely centered around chemotherapy drug intensity. Physicians now have access to an increasing number of drugs with novel mechanisms of action and distinctive side-effect profiles. Key issues faced by hematologists in this era of new drugs include (1) the timely identification of actionable mutations at diagnosis and at relapse; (2) deciding which drug to use among several therapeutic options; and (3) increasing awareness of how to anticipate, mitigate, and manage common complications associated with these new agents. This article will use 3 case presentations to discuss some of the new treatment challenges encountered in AML management, with the goal of providing practical guidance to aid the practicing physician.
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Abstract
OBJECTIVE To describe the interdisciplinary management of acute leukemias across the continuum of care. DATA SOURCE Literature review and experiential knowledge. CONCLUSION Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.
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Affiliation(s)
- Sandra Kurtin
- The University of Arizona Cancer Center, Tucson, AZ.
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Anti-leukemic effects of simvastatin on NRASG12D mutant acute myeloid leukemia cells. Mol Biol Rep 2019; 46:5859-5866. [DOI: 10.1007/s11033-019-05019-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 08/01/2019] [Indexed: 11/27/2022]
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Das AA, Medlock J, Liang H, Nees D, Allsup DJ, Madden LA, Paunov VN. Bioimprint aided cell recognition and depletion of human leukemic HL60 cells from peripheral blood. J Mater Chem B 2019. [DOI: 10.1039/c9tb00679f] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report a large scale preparation of bioimprints of layers of cultured leukemic HL60 cells which can perform cell shape and size recognition from a mixture with peripheral blood mononuclear cells (PBMCs).
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Affiliation(s)
- Anupam A.K. Das
- Department of Chemistry and Biochemistry
- University of Hull
- Hull
- UK
| | - Jevan Medlock
- Department of Chemistry and Biochemistry
- University of Hull
- Hull
- UK
| | - He Liang
- Department of Chemistry and Biochemistry
- University of Hull
- Hull
- UK
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Tollkuci E, Seddon A, Geswein L, Mulseh M. Midostaurin administration in two hemodialysis patients. J Oncol Pharm Pract 2018; 25:1285-1288. [PMID: 30253726 DOI: 10.1177/1078155218801067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Midostaurin is a multitargeted tyrosine kinase inhibitor approved by the Food and Drug Administration for FMS-related tyrosine kinase 3-positive acute myeloid leukemia in combination with standard daunorubicin and cytarabine induction and high-dose cytarabine consolidation. The pharmacokinetics of midostaurin in the setting of severe renal impairment (creatinine clearance [CrCl] 15-29 mL/min utilizing Cockcroft-Gault method) and end-stage renal disease are unknown. Midostaurin is primarily metabolized by the liver through the CYP3A4 enzyme with fecal excretion accounting for 95% of the dose (4% recovered as unchanged drug). Only 5% of the parent drug is found in the urine. This is the first case report documenting the administration of midostaurin in two patients with end-stage renal disease on HD. Given the limited excretion of both active and inactive metabolites of midostaurin in the urine, one does not expect an increase in toxicity related to impaired drug excretion. Although this report describes the likely successful utilization of midostaurin, caution should be exercised when administering in patient populations with end organ disease. Medical history, concomitant comorbidities, and goals of therapy should be taken into account.
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Affiliation(s)
- Eris Tollkuci
- 1 College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.,2 Division of Pharmacy, Rush University Medical Center, Chicago, IL, USA
| | - Amanda Seddon
- 2 Division of Pharmacy, Rush University Medical Center, Chicago, IL, USA.,3 College of Pharmacy, Midwestern University, Downers Grove, IL, USA
| | - Laura Geswein
- 2 Division of Pharmacy, Rush University Medical Center, Chicago, IL, USA
| | - Musa Mulseh
- 3 College of Pharmacy, Midwestern University, Downers Grove, IL, USA
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24
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Kumar SK, Rajkumar SV. The multiple myelomas — current concepts in cytogenetic classification and therapy. Nat Rev Clin Oncol 2018; 15:409-421. [DOI: 10.1038/s41571-018-0018-y] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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25
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Tan D, Lee JH, Chen W, Shimizu K, Hou J, Suzuki K, Nawarawong W, Huang SY, Sang Chim C, Kim K, Kumar L, Malhotra P, Chng WJ, Durie B. Recent advances in the management of multiple myeloma: clinical impact based on resource-stratification. Consensus statement of the Asian Myeloma Network at the 16th international myeloma workshop. Leuk Lymphoma 2018; 59:2305-2317. [PMID: 29390932 DOI: 10.1080/10428194.2018.1427858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Predicated on our improved understanding of the disease biology, we have seen remarkable advances in the management of multiple myeloma over the past few years. Recently approved drugs have radically transformed the treatment paradigm and improved survivals of myeloma patients. The progress has necessitated revision of the diagnostic criteria, risk-stratification and response definition. The huge disparities in economy, healthcare infrastructure and access to novel drugs among different Asian countries will hinder the delivery of optimum myeloma care to patients managed in resource-constrained environments. In the light of the tremendous recent changes and evolution in myeloma management, it is timely that the resource-stratified guidelines from the Asian Myeloma Network be revised to provide updated recommendations for Asia physicians practicing under various healthcare reimbursement systems. This review will highlight the most recent advances and our recommendations on how they could be integrated in both resource-abundant and resource-constrained facilities.
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Affiliation(s)
- Daryl Tan
- a Raffles Cancer Center , Raffles Hospital , Singapore.,b Department of Hematology , Singapore General Hospital , Singapore
| | - Jae Hoon Lee
- c Gil Hospital, Gachon University , Incheon , South Korea
| | - Wenming Chen
- d Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Kazuyuki Shimizu
- e Higashi Nagoya National Hospital , National Hospital Organization , Nagoya , Japan
| | - Jian Hou
- f Department of Haematology , Changzheng Hospital, The Second Military Medical University , Shanghai , China
| | - Kenshi Suzuki
- g Department of Hematology , Japanese Red Cross Medical Center , Tokyo , Japan
| | | | | | - Chor Sang Chim
- j Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Kihyun Kim
- k Samsung Medical Center , Sungkyunkwan University , Seoul , South Korea
| | - Lalit Kumar
- l Department of Medical Oncology , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India
| | - Pankaj Malhotra
- m Department of Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Wee Joo Chng
- n Cancer Science Institute of Singapore , National University of Singapore , Singapore.,o Department of Haematology-Oncology , National University Cancer Institute of Singapore National University Health System , Singapore
| | - Brian Durie
- p Cedars-Sinai Comprehensive Cancer Center , Los Angeles , CA , USA
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Chim CS, Kumar SK, Orlowski RZ, Cook G, Richardson PG, Gertz MA, Giralt S, Mateos MV, Leleu X, Anderson KC. Management of relapsed and refractory multiple myeloma: novel agents, antibodies, immunotherapies and beyond. Leukemia 2018; 32:252-262. [PMID: 29257139 PMCID: PMC5808071 DOI: 10.1038/leu.2017.329] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
Despite enormous advances, management of multiple myeloma (MM) remains challenging. Multiple factors impact the decision to treat or which regimen to use at MM relapse/progression. Recent major randomized controlled trials (RCTs) showed widely varying progression-free survivals (PFS), ranging from a median of 4 months (MM-003) to 23.6 months (ASPIRE). Based on these RCTs, next-generation proteasome inhibitors (carfilzomib and ixazomib), next-generation immunomodulatory agent (pomalidomide), and monoclonal antibodies (elotuzumab and daratumumab) were approved for relapsed and refractory MM. Daratumumab, targeting CD38, has multiple mechanisms of action including modulation of the immunosuppressive bone marrow micro-environment. In addition to the remarkable single agent activity in refractory MM, daratumumab produced deep responses and superior PFS in MM when combined with lenalidomide/dexamethasone, or bortezomib/dexamethasone. Other anti-CD38 antibodies, such as isatuximab and MOR202, are undergoing assessment. Elotuzumab, targeting SLAMF7, yielded superior response rates and PFS when combined with lenalidomide/dexamethasone. New combinations of these next generation novel agents and/or antibodies are undergoing clinical trials. Venetoclax, an oral BH3 mimetic inhibiting BCL2, showed single agent activity in MM with t(11;14), and is being studied in combination with bortezomib/dexamethasone. Selinexor, an Exportin-1 inhibitor, yielded promising results in quad- or penta-refractory MM including patients resistant to daratumumab. Pembrolizumab, an anti-PD1 check-point inhibitor, is being tested in combination with lenalidomide/dexamethasone or pomalidomide/dexamethasone. Chimeric antigen receptor-T cells targeting B-cell maturation antigen have yielded deep responses in RRMM. Finally, salvage autologous stem cell transplantation (ASCT) remains an important treatment in MM relapsing/progressing after a first ASCT. Herein, the clinical trial data of these agents are summarized, cautious interpretation of RCTs highlighted, and algorithm for salvage treatment of relapse/refractory MM proposed.
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Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - S K Kumar
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - R Z Orlowski
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Cook
- Haematology & Myeloma Studies, Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - P G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Gertz
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - S Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M V Mateos
- Department of Haematology, University Hospital of Salamanca, Salamanca, Spain
| | - X Leleu
- Hopital La Mileterie, part of the Academic Hospital of Poitiers (CHU), France
| | - K C Anderson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Pevonedistat, a first-in-class NEDD8-activating enzyme inhibitor, combined with azacitidine in patients with AML. Blood 2018; 131:1415-1424. [PMID: 29348128 DOI: 10.1182/blood-2017-09-805895] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022] Open
Abstract
Pevonedistat (TAK-924/MLN4924) is a novel inhibitor of NEDD8-activating enzyme (NAE) with single-agent activity in relapsed/refractory acute myeloid leukemia (AML). We performed a phase 1b study of pevonedistat (PEV) with azacitidine (AZA) based on synergistic activity seen preclinically. Primary objectives included safety and tolerability, and secondary objectives included pharmacokinetics (PK) and disease response. Patients ≥60 years with treatment-naive AML (unfit for standard induction therapy) received PEV 20 or 30 mg/m2 IV on days 1, 3, and 5 combined with fixed-dose AZA (75 mg/m2 IV/subcutaneously) on days 1 to 5, 8, and 9, every 28 days. The most common treatment-emergent adverse events were constipation (48%), nausea (42%), fatigue (42%), and anemia (39%). In total, 11 deaths were observed and considered unrelated to study therapy by the investigators. Transient elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were dose limiting. The recommended phase 2 dose (RP2D) of PEV in this combination is 20 mg/m2 PEV PK was not altered by the addition of AZA. Overall response rate (ORR) based on an intent-to-treat analysis was 50% (20 complete remissions [CRs], 5 complete remission with incomplete peripheral count recovery, 7 partial remissions [PRs]), with an 8.3-month median duration of remission. In patients receiving ≥6 cycles of therapy (n = 23, 44%), ORR was 83%. In patients with TP53 mutations, the composite CR/PR rate was 80% (4/5). Two of these patients stayed on study for >10 cycles. Baseline bone marrow blast percentage or cytogenetic/molecular risk did not influence ORR. This study was registered at www.clinicaltrials.gov as #NCT01814826.
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Shen Y, He A, Wang F, Bai J, Wang J, Zhao W, Zhang W, Cao X, Chen Y, Liu J, Ma X, Chen H, Feng Y, Yang Y. Granulocyte colony stimulating factor priming chemotherapy is more effective than standard chemotherapy as salvage therapy in relapsed acute myeloid leukemia. Med Clin (Barc) 2017; 151:339-344. [PMID: 29292108 DOI: 10.1016/j.medcli.2017.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/07/2017] [Accepted: 11/02/2017] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND OBJECTIVE To improve the complete remission (CR) rate of newly diagnosed acute myeloid leukemia (AML) patients and alleviate the severe side effects of double induction chemotherapy, we combined a standard regimen with granulocyte colony-stimulating factor (G-CSF) priming chemotherapy to compose a new double induction regimen for AML patients who failed to achieve CR after the first course. PATIENTS AND METHODS Ninety-seven patients with AML who did not achieve CR after the first course of standard chemotherapy were enrolled. Among them, 45 patients received G-CSF priming combined with low-dose chemotherapy during days 20-22 of the first course of chemotherapy, serving as priming group, 52 patients were administered standard chemotherapy again, serving as control group. RESULTS Between the two groups there were no differences in the French-American-British (FAB) classification, risk status, the first course of chemotherapy, blood cell count or blasts percentage of bone marrow before the second course. But the CR rate was significantly higher and the adverse effect was much lower in the priming group than the control group. Cox multivariate regression analysis showed that WBC level before the second course and the selection of the second chemotherapy regimen were two independent factors for long survival of patients. DISCUSSION These results elucidate that standard chemotherapy followed by G-CSF priming new double induction chemotherapy is an effective method for AML patients to improve CR rate and reduce adverse effects.
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Affiliation(s)
- Ying Shen
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Aili He
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China; National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, 710004 Xi'an, Shaanxi, China
| | - Fangxia Wang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Ju Bai
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Jianli Wang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Wanhong Zhao
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Wanggang Zhang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Xingmei Cao
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Yinxia Chen
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Jie Liu
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Xiaorong Ma
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Hongli Chen
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Yuandong Feng
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Yun Yang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China.
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Dombret H, Itzykson R. How and when to decide between epigenetic therapy and chemotherapy in patients with AML. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:45-53. [PMID: 29222236 PMCID: PMC6142607 DOI: 10.1182/asheducation-2017.1.45] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Remission induction with chemotherapy has long been the frontline treatment of acute myeloid leukemia (AML). However, intensive therapy is limited in frail patients by its associated toxicity and higher rates of failure or relapse in patients with chemoresistant disease, such as secondary AML or poor-risk cytogenetics. Frailty and chemoresistance are more frequent in older adults with AML. In recent years, epigenetic therapies with the hypomethylating agents decitabine and azacitidine have been thoroughly explored in AML. The results of two pivotal studies carried out with these agents in older adults with newly diagnosed AML have challenged the role of intensive chemotherapy as the frontline treatment option in this high-risk population. Here, we review the results of treatment with intensive chemotherapy and hypomethylating agents in older patients with AML; discuss the patient- and disease-specific criteria to integrate into treatment decision making; and also, highlight the methodological limitations of cross-study comparison in this population.
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Affiliation(s)
- Hervé Dombret
- Hôpital Saint-Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
| | - Raphael Itzykson
- Hôpital Saint-Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
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Comorbidity, Physical Function, and Quality of Life in Older Adults with Acute Myeloid Leukemia. CURRENT GERIATRICS REPORTS 2017; 6:247-254. [PMID: 29479516 DOI: 10.1007/s13670-017-0227-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose of review To describe the pathology, impact of comorbidities, functional limitations, symptoms, and quality of life (QOL) related to treatment of acute myeloid leukemia (AML) in older adults. Recent findings AML is a rare aggressive hematologic disease that occurs most often in older adults. The prognosis for older patients with AML is markedly worse due to genetic mutations and patient characteristics such as comorbidities and functional limitations. Patient characteristics may influence treatment decisions, as well as impact symptoms, functional ability, health-related outcomes and (QOL). Summary As the population continues to age, the number of people diagnosed with AML is expected to increase. Better management of comorbidities is imperative to improving QOL and other treatment related outcomes. Prospective, longitudinal and multi-site studies are warranted to further understand the interaction between these characteristics on symptoms, outcomes and QOL.
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Karathedath S, Rajamani BM, Musheer Aalam SM, Abraham A, Varatharajan S, Krishnamurthy P, Mathews V, Velayudhan SR, Balasubramanian P. Role of NF-E2 related factor 2 (Nrf2) on chemotherapy resistance in acute myeloid leukemia (AML) and the effect of pharmacological inhibition of Nrf2. PLoS One 2017; 12:e0177227. [PMID: 28505160 PMCID: PMC5432104 DOI: 10.1371/journal.pone.0177227] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/24/2017] [Indexed: 12/30/2022] Open
Abstract
Cytarabine (Ara-C) and Daunorubicin (Dnr) forms the backbone of acute myeloid leukemia (AML) therapy. Drug resistance and toxic side effects pose a major threat to treatment success and hence alternate less toxic therapies are warranted. NF-E2 related factor-2 (Nrf2), a master regulator of antioxidant response is implicated in chemoresistance in solid tumors. However, little is known about the role of Nrf2 in AML chemoresistance and the effect of pharmacological inhibitor brusatol in modulating this resistance. Primary AML samples with high ex-vivo IC50 to Ara-C, ATO, Dnr had significantly high NRF2 RNA expression. Gene-specific knockdown of NRF2 improved sensitivity to these drugs in resistant AML cell lines by decreasing the expression of downstream antioxidant targets of Nrf2 by compromising the cell’s ability to scavenge the ROS. Treatment with brusatol, a pharmacological inhibitor of Nrf2, improved sensitivity to Ara-C, ATO, and Dnr and reduced colony formation capacity. AML cell lines stably overexpressing NRF2 showed increased resistance to ATO, Dnr and Ara-C and increased expression of downstream targets. This study demonstrates that Nrf2 could be an ideal druggable target in AML, more so to the drugs that function through ROS, suggesting the possibility of using Nrf2 inhibitors in combination with chemotherapeutic agents to modulate drug resistance in AML.
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Affiliation(s)
| | | | | | - Ajay Abraham
- Department of Haematology, Christian Medical College, Vellore, India
| | | | - Partha Krishnamurthy
- Department of Pharmacology, Toxicology and Therapeutics, Kansas University Medical Centre, Kansas City, Kansas, United States of America
| | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - Shaji Ramachandran Velayudhan
- Department of Haematology, Christian Medical College, Vellore, India
- Centre for Stem Cell Research, Christian Medical College, Vellore, India
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Muchtar E, Gertz MA. Clinical trials evaluating potential therapies for light chain (AL) amyloidosis. Expert Opin Orphan Drugs 2017; 5:655-663. [PMID: 34567849 PMCID: PMC8460071 DOI: 10.1080/21678707.2017.1341834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The field of systemic amyloidosis is experiencing major advances in diagnostic and prognostic methods coupled with a growing availability in treatment options. AREAS COVERED Treatment of AL amyloidosis traditionally targeted the clonal plasma cells, in order to block further production of amyloidogenic light chains. Currently, a research focus is placed on targeting the already formed amyloid deposits using monoclonal antibodies against epitopes on such deposits. Encouraging results were obtained from the three investigated antibodies: NEOD001, 11-1F4 and anti-SAP, but further validation is required before these antibodies can be commercialized. In this paper, we review the current active clinical research in AL amyloidosis, which includes the monoclonal antibodies targeting amyloid deposits, daratumumab, Venetoclax, doxycycline, green tea, pomalidomide, carfilzomib and ixazomib. EXPERT OPINION Monoclonal antibodies, targeting either the amyloid deposits or the plasma cell compartment will likely be integrated into routine treatment practice given their encouraging results and minimal toxicity in the fragile population of AL amyloidosis. Other therapeutic options hold promise to the field as well, but toxicity will likely challenge their routine use. Early recognition remains the best option for outcome enhancement.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Niscola P, Caravita T, Tatangelo P, Siniscalchi A, de Fabritiis P, Palumbo R. Hematologists and nephrologists working together: moving forward with a new integrated care model for blood-related malignancies? Blood Res 2017; 52:218-219. [PMID: 29043238 PMCID: PMC5641515 DOI: 10.5045/br.2017.52.3.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/17/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Pasquale Niscola
- Hematology Unit, Department of Medical Specialties S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Tommaso Caravita
- Hematology Unit, Department of Medical Specialties S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Paola Tatangelo
- Nephrology Unit, Department of Medical Specialties S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Agostina Siniscalchi
- Hematology Unit, Department of Medical Specialties S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Paolo de Fabritiis
- Hematology Unit, Department of Medical Specialties S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Roberto Palumbo
- Nephrology Unit, Department of Medical Specialties S. Eugenio Hospital (ASL Roma 2), Rome, Italy
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Acute Coronary Syndromes in Patients with Hematological Disorders. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2016. [DOI: 10.1515/jce-2016-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract
Hematological conditions can lead to serious disturbances in blood rheology, being frequently associated with increased systemic inflammation and increased risk of bleeding. The imbalance between coagulation and thrombolytic factors in patients with acute coronary syndromes may lead to undesirable outcomes, and the success of emergency coronary angioplasty or by-pass grafting may be altered by increased bleeding in coagulopathies such as hemophilia. This paper intends to review the present knowledge in the field of acute coronary syndromes in subjects with hematological and onco-hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, von Willebrand disease, hemophilia, polycythemia vera, erythrocyte disorders, myelodysplastic syndrome, leukemia, lymphoma or myeloma.
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