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Zhang C, Gao D, Wang X, Sun X, Yan Y, Yang Y, Zhang J, Yan J. Effectiveness of chemotherapy using bortezomib combined with homoharringtonine and cytarabine in refractory or relapsed acute myeloid leukemia: a phase II, multicenter, prospective clinical trial. Front Oncol 2023; 13:1142449. [PMID: 37664023 PMCID: PMC10472935 DOI: 10.3389/fonc.2023.1142449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background Refractory/relapsed acute myeloid leukemia (R/R AML) has unsatisfactory outcomes even after allogeneic hematopoietic stem cell transplantation. Long-term survival is mainly influenced by complete remission (CR) rates after induction therapies. Objectives To investigate CR/CR with incomplete hematologic recovery (CRi) rates and adverse events with a new induction therapy (bortezomib, homoharringtonine, and cytarabine [BHA]) for patients with R/R AML. Methods We enrolled 21 patients with R/R AML (median age, 42 [range, 30-62] years), who received BHA for remission induction (bortezomib, 1.3 mg/m2/day on days 1 and 4; homoharringtonine, 4 mg/m2/day for 5 days, and cytarabine, 1.5 g/m2/day for 5 days). CR and adverse events were assessed. Results After one course of BHA, the CR/CRi and partial remission rates were 38.1% and 14.3%, respectively, with an overall response rate (ORR) of 52.4% in 21 patients. 9 of 21 patients harbored FLT3-ITD or FLT3-TKD mutations, and achieved either CR/CRi or ORR of 66.7% (P=0.03) by comparison with that in R/R AML without FLT3 mutation. After induction therapy, consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation led to a one-year overall survival of 27.8% in all patients. One-year relapse-free survival was 50% in 8 patients who had achieved CR/CRi after one course of BHA. During induction, non-hematologic adverse events (grade 3/4) commonly were infection (90.5%), hypokalemia (14.4%), hypocalcemia (14.3%), and mucositis (9.5%). In patients achieving CR, the median time to neutrophil count >0.5×109/L and time to platelet count >20×109/L were 15 (13-17) days and 13 (13-18) days, respectively. Conclusion BHA chemotherapy regimen was safe and tolerable to serve as an induction therapy for R/R AML, particularly with FLT3 mutation. The higher CR/CRi rate will give a clue to determine a potentialeffectiveness of BHA for AML patients carrying FLT3 mutation in a further investigation. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2000029841.
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Affiliation(s)
- Chengtao Zhang
- Department of Hematology, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, The Second Hospital of Dalian Medical University, Dalian, China
| | - Da Gao
- Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xiaohong Wang
- Department of Hematology, The ChaoYang Central Hospital, Liaoning, China
| | - Xiuli Sun
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan Yan
- Department of Hematology, Bayannur Hospital, Bayannur, Inner Mongolia, China
| | - Yan Yang
- Department of Hematology, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jingjing Zhang
- Department of Hematology, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jinsong Yan
- Department of Hematology, Liaoning Key Laboratory of Hematopoietic Stem Cell Transplantation and Translational Medicine, Liaoning Medical Center for Hematopoietic Stem Cell Transplantation, The Second Hospital of Dalian Medical University, Dalian, China
- Blood Stem Cell Transplantation Institute of Dalian Medical University, Dalian, China
- Pediatric Oncology and Hematology Center of the Second Hospital of Dalian Medical University, Dalian, China
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The Proportional Relationship Between Pretransplant WT1 mRNA Levels and Risk of Mortality After Allogeneic Hematopoietic Cell Transplantation in Acute Myeloid Leukemia Not in Remission. Transplantation 2020; 103:2201-2210. [PMID: 30801534 DOI: 10.1097/tp.0000000000002662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between the expression levels of Wilms' tumor-1 gene (WT1) mRNA in peripheral blood before allogeneic hematopoietic cell transplantation (allo-HCT) and risk of mortality in acute myeloid leukemia (AML) patients in noncomplete remission (non-CR) remains quite elusive. METHODS We retrospectively assessed the impact of the pretransplant WT1 mRNA level on survival after allo-HCT in non-CR AML patients. RESULTS A total of 125 AML patients, including 46 non-CR patients (36.8%), were analyzed. On multivariate analysis of non-CR AML patients, WT1 mRNA ≥5000 copies/μg RNA was significantly related to increased risk of mortality (hazard ratio, 2.7; 95% confidence interval, 1.3-5.5; P = 0.008). Furthermore, in the entire cohort, log10-transformed WT1 mRNA before allo-HCT was found to be significantly associated with the increased risk of mortality irrespective of whether the disease status was CR or non-CR, using Akaike's information criterion. As the pretransplant WT1 mRNA level elevated, the hazard ratio of mortality monotonically increased in a nonlinear manner regardless of remission status, suggesting that WT1 mRNA level in peripheral blood might reflect tumor burden. CONCLUSIONS This study demonstrated that the pretransplant WT1 mRNA level was a powerful prognostic factor in allo-HCT even for non-CR AML patients, and there may be a WT1 mRNA threshold in non-CR patients for benefiting from allo-HCT.
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Transplant-related complications are impediments to the success of allogeneic hematopoietic stem cell transplantation for adult T cell leukemia patients in non-complete remission. Bone Marrow Transplant 2019; 55:233-241. [PMID: 31534195 PMCID: PMC7091703 DOI: 10.1038/s41409-019-0669-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 08/02/2019] [Accepted: 08/12/2019] [Indexed: 11/08/2022]
Abstract
Outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with adult T cell leukemia/lymphoma (ATL) are not satisfactory, particularly in patients in non-complete remission at transplantation (Pt-non-CR). We conducted a regional retrospective study in the ATL endemic area of Okinawa, Japan. Of 62 ATL patients, 21 received allo-HSCT in CR and 41 in non-CR. The 3-year overall survival (3yOS) rate and median survival time for the whole cohort was 25.6% and 7.7 months, respectively. The 3yOS of Pt-non-CR was significantly lower than that of patients in CR (Pt-CR) (16.8% vs. 43.6%, P = 0.005). Transplant-related mortality (TRM) was significantly higher in Pt-non-CR than in Pt-CR (46.3% vs. 15.7%, P = 0.025), while there was no significant difference in disease-associated mortality (DAM) between Pt-non-CR and Pt-CR. Multivariable analysis for Pt-non-CR revealed that poor performance status (poor-PS) and higher sIL-2R level (high sIL-2R) adversely affected OS. Poor-PS was associated with higher TRM, but not with higher DAM in Pt-non-CR. High sIL-2R did not affect TRM or DAM in Pt-non-CR. Overall, high TRM rates rather than DAM contribute to the poor outcomes of Pt-non-CR, suggesting that not only disease control but also management of transplant-related complications is required for allo-HSCT in ATL patients.
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Su XH, Yao JF, Zhang GX, He Y, Wei JL, Ma QL, Yang DL, Huang Y, Zhai WH, Liang C, Li G, Chen X, Feng SZ, Han MZ, Jiang EL. [Allogeneic hematopoietic stem cell transplantation for treatment of refractory and relapsed acute myeloid leukemia: outcomes and prognostic factors]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:1024-1030. [PMID: 29365394 PMCID: PMC7342196 DOI: 10.3760/cma.j.issn.0253-2727.2017.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
目的 评价异基因造血干细胞移植(allo-HSCT)治疗难治/复发急性髓系白血病(AML)的疗效,并对预后相关因素进行分析。 方法 回顾性分析allo-HSCT治疗99例难治/复发AML患者总体生存(OS)率、无病生存(DFS)率、移植物抗宿主病(GVHD)发生率、移植相关死亡率(TRM)及复发率,并分析影响预后的危险因素。 结果 全部99例患者中男59例,女40例,中位年龄为35(6~58)岁,均接受清髓性预处理。所有患者中性粒细胞均达植入标准,中位植活时间为14(9~25)d。移植后100 d Ⅱ~Ⅳ度急性GVHD累积发生率为27.3%(95% CI 18.9%~36.3%);2年慢性GVHD累积发生率为33.9%(95%CI 24.6%~43.5%),其中广泛型慢性GVHD累积发生率为9.3%(95%CI 4.5%~16.1%)。移植后3年OS、DFS、TRM率分别为45.0%(95%CI 34.6%~55.4%)、45.0%(95%CI 34.8%~55.2%)、19.7%(95%CI 12.4%~28.3%),复发率为36.6%(95%CI 26.9%~46.4%)。多因素分析显示,影响OS的独立危险因素包括移植前未缓解[P=0.009,HR=2.21(95%CI 1.22~4.04)]、初诊WBC>50×109/L[P=0.024,HR=2.11(95%CI 1.11~4.02)]、供者年龄>35岁[P=0.031,HR=1.96(95%CI 1.06~3.60)]、移植后未发生慢性GVHD[P=0.008,HR=0.38(95%CI 0.18~0.78)]。根据移植前危险因素(移植前未缓解、初诊WBC>50×109/L、供者年龄>35岁)进行危险度分组,具有0、1、2~3个危险因素患者的3年OS率分别为75.0%、46.9%、15.4%(χ2=26.873,P<0.001)。 结论 allo-HSCT是挽救性治疗难治/复发AML的有效手段,复发是影响生存的主要原因。移植前缓解状态、发病时WBC水平、供者年龄及移植后是否发生慢性GVHD是难治/复发AML患者allo-HSCT预后的独立影响因素。
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Affiliation(s)
- X H Su
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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Fraccaroli A, Prevalsek D, Fritsch S, Haebe S, Bücklein V, Schulz C, Hubmann M, Stemmler HJ, Ledderose G, Hausmann A, Schmid C, Tischer J. Sequential HLA-haploidentical transplantation utilizing post-transplantation cyclophosphamide for GvHD prophylaxis in high-risk and relapsed/refractory AML/MDS. Am J Hematol 2018; 93:1524-1531. [PMID: 30194866 DOI: 10.1002/ajh.25281] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 12/13/2022]
Abstract
This study evaluates the role of sequential therapy in HLA-haploidentical transplantation (haplo-HSCT) of high-risk, relapsed/refractory AML/MDS. We analyzed the course of 33 adults with active disease at time of transplantation (AML n = 30; MDS n = 3; median age 58 years, range: 32-71). Sequential therapy consisted of cytoreductive chemotherapy (FLAMSA n = 21; clofarabine n = 12) applied shortly prior to reduced intensity conditioning for T-cell-replete haplo-HSCT using post-transplantation cyclophosphamide as GvHD prophylaxis. No graft rejection was observed. Complete remission at day +30 was achieved in 97% of patients. CI of acute GvHD grade II-IV and chronic GvHD was 24% (no grade IV) and 23%, respectively. NRM at 1 and 3 years was 15%, each. Severe regimen-related toxicities (grade III-IV) were observed in 58%, predominantly involving the gastrointestinal tract (diarrhea 48%, mucositis 15%, transient elevation of transaminases 18%). Probability of relapse at 1 and 3 years was 28% and 35%. At a median follow-up of 36 months, the estimated 1- and 3-year overall survival was 56% and 48%. Disease-free survival was 49% and 40%, respectively. At 3 years, GvHD and relapse-free survival (GRFS) was 24% while chronic GvHD and relapse-free survival (CRFS) was 29%. Thus, our results indicate that sequential haplo-HSCT is an effective salvage treatment providing high anti-leukemic activity, favorable tolerance, and acceptable toxicity in patients suffering from advanced AML/MDS.
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Affiliation(s)
- Alessia Fraccaroli
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Dusan Prevalsek
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Susanne Fritsch
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Sarah Haebe
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Veit Bücklein
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Christoph Schulz
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Max Hubmann
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Hans-Joachim Stemmler
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Georg Ledderose
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Andreas Hausmann
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Christoph Schmid
- Department of Hematology and Oncology, Hospital Augsburg, Ludwig-Maximilians University, Munich, Germany
| | - Johanna Tischer
- Department of Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
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Yoshida S, Henzan H, Ueno T, Shimakawa T, Matsuo Y, Kuriyama T, Saito N, Kawano I, Numata A, Takase K, Iino T, Eto T. The Confirmation of Safety for the Intensified Conditioning Regimens: A Retrospective Study of Allogeneic Hematopoietic Stem Cell Transplantation for Non-Remission Hematological Malignant Diseases. Int J Hematol Oncol Stem Cell Res 2018; 12:123-131. [PMID: 30233774 PMCID: PMC6141425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: The prognosis of allogeneic hematopoietic stem cell transplantation (HSCT) for non-remission hematological malignant diseases is usually unfavorable. The most uncontrollable factor is residual disease or relapse. To overcome this problem, intensified conditioning regimens- sequential and/or additional chemotherapy to the standard regimen- could be effective. However, increasing the intensity of conditioning might also lead to more complications. Materials and Methods: We retrospectively analyzed 81 patients with non-remission disease who received allogeneic HSCT in our institution between 2007 and 2011. Results: 55.6% in 36 myeloablative conditioning patients and 46.7% in 45 reduced-intensity conditioning patients received intensified conditioning. The 5-year probability of overall survival was 35.0% and 17.1% in the standard and intensified group, respectively (p=0.027). Relapse mortality was 30% in the standard regimen group and 36.6% in the intensified regimen group (p=0.54). Transplant-related mortality (TRM) at 30 and 100 days was 5%, 17.1% (p=0.086) and 27.5%, 34.2% (p=0.52) in the standard and intensified group, respectively. There was no difference in TRM between the 2 groups at 30 days and 100 days. Conclusion: The results of the study confirm the safety of the intensified conditioning regimen. Meanwhile, it could be considered as one of the few methods available to reduce the tumor burden before HSCT for refractory malignant diseases.
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Affiliation(s)
- Shuro Yoshida
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Hideho Henzan
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Toshiyuki Ueno
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Yayoi Matsuo
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Takuro Kuriyama
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Noriyuki Saito
- Department of Hematology, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Ichiro Kawano
- Hematology and Oncology Division, Japan Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Akihiko Numata
- Department of Medicine and Biosystemic Science, Kyushu University, Fukuoka, Japan
| | - Ken Takase
- Department of Hematology, National Hospital Organization Kyushu Medical Hospital, Fukuoka, Japan
| | - Tadafumi Iino
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
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Abstract
Acute leukemias are hematologic malignancies with aggressive behavior especially in adult population. With the introduction of new gene expression and sequencing technologies there have been advances in the knowledge of the genetic landscape of acute leukemias. A more detailed analysis allows for the identification of additional alterations in epigenetic regulators that have a profound impact in cellular biology without changes in DNA sequence. These epigenetic alterations disturb the physiological balance between gene activation and gene repression and contribute to aberrant gene expression, contributing significantly to the leukemic pathogenesis and maintenance. We review epigenetic changes in acute leukemia in relation to what is known about their mechanism of action, their prognostic role and their potential use as therapeutic targets, with important implications for precision medicine.
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Cruz-Rodriguez N, Combita AL, Enciso LJ, Raney LF, Pinzon PL, Lozano OC, Campos AM, Peñaloza N, Solano J, Herrera MV, Zabaleta J, Quijano S. Prognostic stratification improvement by integrating ID1/ID3/IGJ gene expression signature and immunophenotypic profile in adult patients with B-ALL. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2017; 36:37. [PMID: 28245840 PMCID: PMC5331651 DOI: 10.1186/s13046-017-0506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/21/2017] [Indexed: 01/25/2023]
Abstract
Background Survival of adults with B-Acute Lymphoblastic Leukemia requires accurate risk stratification of patients in order to provide the appropriate therapy. Contemporary techniques, using clinical and cytogenetic variables are incomplete for prognosis prediction. Methods To improve the classification of adult patients diagnosed with B-ALL into prognosis groups, two strategies were examined and combined: the expression of the ID1/ID3/IGJ gene signature by RT-PCR and the immunophenotypic profile of 19 markers proposed in the EuroFlow protocol by Flow Cytometry in bone marrow samples. Results Both techniques were correlated to stratify patients into prognostic groups. An inverse relationship between survival and expression of the three-genes signature was observed and an immunophenotypic profile associated with clinical outcome was identified. Markers CD10 and CD20 were correlated with simultaneous overexpression of ID1, ID3 and IGJ. Patients with simultaneous expression of the poor prognosis gene signature and overexpression of CD10 or CD20, had worse Event Free Survival and Overall Survival than patients who had either the poor prognosis gene expression signature or only CD20 or CD10 overexpressed. Conclusion By utilizing the combined evaluation of these two immunophenotypic markers along with the poor prognosis gene expression signature, the risk stratification can be significantly strengthened. Further studies including a large number of patients are needed to confirm these findings. Electronic supplementary material The online version of this article (doi:10.1186/s13046-017-0506-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nataly Cruz-Rodriguez
- Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC), Instituto Nacional de Cancerología, Bogotá, Colombia.,Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia.,Programa de Doctorado en Ciencias Biológicas, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Alba L Combita
- Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC), Instituto Nacional de Cancerología, Bogotá, Colombia. .,Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia. .,Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Leonardo J Enciso
- Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC), Instituto Nacional de Cancerología, Bogotá, Colombia.,Grupo de Hemato-Oncología, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Lauren F Raney
- Department of Pediatrics, Pediatric Hematology-Oncology Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Paula L Pinzon
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Olga C Lozano
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Alba M Campos
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Julio Solano
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Jovanny Zabaleta
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sandra Quijano
- Hospital Universitario San Ignacio, Bogotá, Colombia. .,Grupo de Inmunobiología y Biología Celular, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia.
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Jaiswal SR, Zaman S, Chakrabarti A, Sen S, Mukherjee S, Bhargava S, Ray K, O'Donnell PV, Chakrabarti S. Improved Outcome of Refractory/Relapsed Acute Myeloid Leukemia after Post-Transplantation Cyclophosphamide-Based Haploidentical Transplantation with Myeloablative Conditioning and Early Prophylactic Granulocyte Colony-Stimulating Factor–Mobilized Donor Lymphocyte Infusions. Biol Blood Marrow Transplant 2016; 22:1867-1873. [DOI: 10.1016/j.bbmt.2016.07.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/21/2016] [Indexed: 11/15/2022]
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10
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Cruz-Rodriguez N, Combita AL, Enciso LJ, Quijano SM, Pinzon PL, Lozano OC, Castillo JS, Li L, Bareño J, Cardozo C, Solano J, Herrera MV, Cudris J, Zabaleta J. High expression of ID family and IGJ genes signature as predictor of low induction treatment response and worst survival in adult Hispanic patients with B-acute lymphoblastic leukemia. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2016; 35:64. [PMID: 27044543 PMCID: PMC4820984 DOI: 10.1186/s13046-016-0333-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/22/2016] [Indexed: 12/27/2022]
Abstract
Background B-Acute lymphoblastic leukemia (B-ALL) represents a hematologic malignancy with poor clinical outcome and low survival rates in adult patients. Remission rates in Hispanic population are almost 30 % lower and Overall Survival (OS) nearly two years inferior than those reported in other ethnic groups. Only 61 % of Colombian adult patients with ALL achieve complete remission (CR), median overall survival is 11.3 months and event-free survival (EFS) is 7.34 months. Identification of prognostic factors is crucial for the application of proper treatment strategies and subsequently for successful outcome. Our goal was to identify a gene expression signature that might correlate with response to therapy and evaluate the utility of these as prognostic tool in hispanic patients. Methods We included 43 adult patients newly diagnosed with B-ALL. We used microarray analysis in order to identify genes that distinguish poor from good response to treatment using differential gene expression analysis. The expression profile was validated by real-time PCR (RT-PCT). Results We identified 442 differentially expressed genes between responders and non-responders to induction treatment. Hierarchical analysis according to the expression of a 7-gene signature revealed 2 subsets of patients that differed in their clinical characteristics and outcome. Conclusions Our study suggests that response to induction treatment and clinical outcome of Hispanic patients can be predicted from the onset of the disease and that gene expression profiles can be used to stratify patient risk adequately and accurately. The present study represents the first that shows the gene expression profiling of B-ALL Colombian adults and its relevance for stratification in the early course of disease. Electronic supplementary material The online version of this article (doi:10.1186/s13046-016-0333-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nataly Cruz-Rodriguez
- Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC), Instituto Nacional de Cancerología, Bogotá, Colombia.,Group of Investigation in Biology of Cancer, Instituto Nacional de Cancerología, Calle 1 # 9-85, Bogotá, Colombia.,Programa de Doctorado en Ciencias Biológicas, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Alba L Combita
- Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC), Instituto Nacional de Cancerología, Bogotá, Colombia. .,Group of Investigation in Biology of Cancer, Instituto Nacional de Cancerología, Calle 1 # 9-85, Bogotá, Colombia. .,Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Leonardo J Enciso
- Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC), Instituto Nacional de Cancerología, Bogotá, Colombia.,Grupo de Hemato Oncología, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Sandra M Quijano
- Grupo de Inmunobiología y Biología Celular, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Paula L Pinzon
- Group of Investigation in Biology of Cancer, Instituto Nacional de Cancerología, Calle 1 # 9-85, Bogotá, Colombia
| | - Olga C Lozano
- Group of Investigation in Biology of Cancer, Instituto Nacional de Cancerología, Calle 1 # 9-85, Bogotá, Colombia
| | - Juan S Castillo
- Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC), Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Li Li
- Stanley S. Scott Cancer Center, Center Louisiana State University Health Sciences Center Louisiana Cancer Research Center, 1700 Tulane Ave, Room 909, New Orleans, LA, USA
| | | | | | - Julio Solano
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Jovanny Zabaleta
- Stanley S. Scott Cancer Center, Center Louisiana State University Health Sciences Center Louisiana Cancer Research Center, 1700 Tulane Ave, Room 909, New Orleans, LA, USA. .,Department of Pediatrics, Center Louisiana State University Health Sciences Center Louisiana Cancer Research Center, 1700 Tulane Ave, Room 909, New Orleans, LA, USA.
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11
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Drew R, Walsh A, Ní Laoi B, Conneally E, Crowley B. BK virus (BKV) plasma dynamics in patients with BKV-associated hemorrhagic cystitis following allogeneic stem cell transplantation. Transpl Infect Dis 2013; 15:276-82. [DOI: 10.1111/tid.12066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 09/20/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Affiliation(s)
- R.J. Drew
- Department of Clinical Microbiology, Sir Patrick Dun Translational Research Laboratory; Trinity College Dublin; Dublin; Ireland
| | - A. Walsh
- Department of Clinical Microbiology; St James's Hospital; Dublin; Ireland
| | - B. Ní Laoi
- Department of Clinical Microbiology; St James's Hospital; Dublin; Ireland
| | - E. Conneally
- Department of Haematology; St James's Hospital; Dublin; Ireland
| | - B. Crowley
- Department of Clinical Microbiology; St James's Hospital; Dublin; Ireland
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12
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Donor compatibility and performance status affect outcome of allogeneic haematopoietic stem cell transplant in patients with relapsed or refractory acute myeloid leukaemia. Ann Hematol 2012; 91:1937-43. [PMID: 22893485 DOI: 10.1007/s00277-012-1551-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/01/2012] [Indexed: 10/28/2022]
Abstract
We retrospectively analysed 78 patients with relapsed (n = 38), primary refractory (n = 34) or untreated (n = 6) acute myeloid leukaemia (AML) who underwent allogeneic HSCT at our Institution between 2002 and 2011, to verify outcome and to identify factors that can affect long-term outcome. Myeloablative conditioning regimens were used in 48 patients (24 siblings, 24 matched unrelated donor (MUD)), while 30 patients (18 siblings, 12 MUD) received reduced-intensity conditioning. Acute graft versus host disease (GVHD) developed in 37 (47 %) patients, while chronic GVHD occurred in 19 of the 65 evaluable patients (29 %). With a median follow-up time of 5 years, 13 of 78 patients (17 %) are alive and in complete remission (CR), while 64 have died. Cause of death was disease recurrence in 37 patients (58 %), infection in ten patients (16 %) and GVHD in six (9 %). One-year non-relapse mortality was 35 %. In multivariate analysis, performance status ≥80 % WHO and a full-matched donor were associated with a better outcome: these two variables allowed for risk stratification, identifying three groups with significantly different survival after transplant (P = 0.0001). Considering post-transplant variables, only CR at recovery and development of cGVHD were correlated with a longer survival. Our data confirm the capacity of allogeneic transplant to prolong survival in a significant proportion of extremely high-risk AML patients.
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13
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Ayremlou P, Razavi SM, Solaymani-Dodaran M, Vakili M, Asadi-Lari M. Demographic and prognostic factors of 455 patients with acute leukemia admitted to two referral hospitals in tehran-iran during ten years (2001-2011). IRANIAN JOURNAL OF CANCER PREVENTION 2012; 5:157-63. [PMID: 25628835 PMCID: PMC4294538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 04/29/2012] [Indexed: 10/25/2022]
Abstract
BACKGROUND Global death toll of Acute Leukemia (AL), as a heterogeneous group of hematopoietic malignancies, is rather high, i.e. almost 74% of 300,000 new cases die every year. This reflects a poor prognosis of this malignancy in most parts of the world, where contemporary and rather complex remedies are not available. There are a few well documented reports about the epidemiologic features of AL at national level in Iran. This retrospective study demonstrates demographic and laboratory features of Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) patients admitted to the main referral oncology hospitals in the ex-Iran University of Medical Sciences in Tehran (Firoozgar and Rasoul-Akram hospitals) during the last decade (2001-2011). METHODS Medical records of all patients admitted to the both hospitals diagnosed with AML and ALL were reviewed during the study period for demographic, biological and clinical characteristics at diagnosis. RESULTS Four-hundred fifty five patients were diagnosed with AML and ALL, who admitted to the both hospitals during ten years, of whom 59.6 % (271 patients) were male. Fifty five percent of patients had AML and 44.6 % had ALL, both significantly dominated in men (p<0.001). AML patients died more significantly (p<0.05) and the most deaths occurred in older patients (p<0.001). Initial WBC count was significantly related to death (p= 0.001), where the least death (13%) occurred in the group with initial WBC between 5-10×10(3)/μL and most of deceased had an initial WBC more than 10×10(3)/μL. Logistic regression showed that age, fever and WBC were significant prognostic factors. CONCLUSION Demographic characteristics of AL patients were almost the same as other global reports. Most deaths occurred in older patients, those who had fever, and patients with higher WBC count at first admission, which warrants more investigations accurately and also improvements in hospital records.
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Affiliation(s)
- Parvin Ayremlou
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Razavi
- Oncopathology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani-Dodaran
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Vakili
- Oncopathology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Oncopathology Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
Mohsen Asadi-Lari, MD, Ph.D;
Associate Professor of Epidemiology
Tel: (+98) 21 81 63 35 78
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