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Ai H, Chao NJ, Rizzieri DA, Huang X, Spitzer TR, Wang J, Guo M, Keating A, Krakow EF, Blaise D, Ma J, Wu D, Reagan J, Gergis U, Duarte RF, Chaudhary PM, Hu K, Yu C, Sun Q, Fuchs E, Cai B, Huang Y, Qiao J, Gottlieb D, Schultz KR, Liu M, Chen X, Chen W, Wang J, Zhang X, Li J, Huang H, Sun Z, Li F, Yang L, Zhang L, Li L, Liu K, Jin J, Liu Q, Liu D, Gao C, Fan C, Wei L, Zhang X, Hu L, Zhang W, Tian Y, Han W, Zhu J, Xiao Z, Zhou D, Zhang B, Jia Y, Zhang Y, Wu X, Shen X, Lu X, Zhan X, Sun X, Xiao Y, Wang J, Shi X, Zheng B, Chen J, Ding B, Wang Z, Zhou F, Zhang M, Zhang Y, Sun J, Xia B, Chen B, Ma L. Expert consensus on microtransplant for acute myeloid leukemia in elderly patients -report from the international microtransplant interest group. Heliyon 2023; 9:e14924. [PMID: 37089296 PMCID: PMC10119710 DOI: 10.1016/j.heliyon.2023.e14924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Recent studies have shown that microtransplant (MST) could improve outcome of patients with elderly acute myeloid leukemia (EAML). To further standardize the MST therapy and improve outcomes in EAML patients, based on analysis of the literature on MST, especially MST with EAML from January 1st, 2011 to November 30th, 2022, the International Microtransplant Interest Group provides recommendations and considerations for MST in the treatment of EAML. Four major issues related to MST for treating EAML were addressed: therapeutic principle of MST (1), candidates for MST (2), induction chemotherapy regimens (3), and post-remission therapy based on MST (4). Others included donor screening, infusion of donor cells, laboratory examinations, and complications of treatment.
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Characterization of the Newly Established Homoharringtonine- (HHT-) Resistant Cell Lines and Mechanisms of Resistance. JOURNAL OF ONCOLOGY 2022; 2022:2813938. [PMID: 36081671 PMCID: PMC9448541 DOI: 10.1155/2022/2813938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/22/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
Homoharringtonine- (HHT-) based HHT, aclarubicin, and cytarabine (HAA) induction regimen is the first-line therapy for nonelder acute myeloid leukemia (AML) patients in China. However, drug resistance is a new challenge, and little attention has been devoted to excavating resistant mechanisms. This study used the classic method to construct six HHT-resistant cell lines with a gradually increasing resistance index (RI) to discover HHT drug resistance mechanisms dynamically. After HHT resistance, the cell growth rate decreased, cell cycle delayed, and P-glycoprotein (p-gp, CD243) expression levels increased. Furthermore, we explored the changes in transcriptomics between HHT-sensitive and HHT-resistant cells using RNA-sequence. Through Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology (GO), and hub gene analyses, we found that immune activity, especially G-protein coupled receptor (GPR) and related molecules, may mediate HHT resistance. Moreover, Calcitonin Receptor-Like (CALCRL) and G Protein Subunit Alpha I1 (GNAI1), which belong to GPRs, were stimulated in HHT-resistant cell strains in vitro and vivo, indicating that they may play a critical role in HHT resistance. In addition, these two genes have prognostic significance for AML patients. Taken together, we successfully constructed HHT-resistant cell lines with dynamic RIs and explored the resistance mechanisms, which will help identify new drugs for HHT-resistant AML patients.
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Wang QY, Liu HH, Dong YJ, Liang ZY, Yin Y, Liu W, Wang QY, Wang Q, Sun YH, Xu WL, Han N, Li Y, Ren HY. Low-Dose 5-Aza and DZnep Alleviate Acute Graft- Versus-Host Disease With Less Side Effects Through Altering T-Cell Differentiation. Front Immunol 2022; 13:780708. [PMID: 35281001 PMCID: PMC8907421 DOI: 10.3389/fimmu.2022.780708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Previous studies showed that hypomethylating agents (HMAs) could alleviate acute graft-versus-host disease (aGvHD), but affect engraftment after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The combination of two different HMAs in lower doses might overcome this problem. This study aimed to evaluate the treatment effect of the combination of two HMAs—azacitidine (5-Aza) and histone H3K27 methyltransferase inhibitor 3-deazaneplanocin (DZNep)—for the prophylaxis of aGvHD after allo-HSCT and to explore the possible mechanisms. Methods We first optimized the concentrations of individual and combinational 5-Aza and DZNep treatments to ensure no obvious toxicities on activated T cells by evaluating T-cell proliferation, viability, and differentiation. A mouse model of aGvHD was then established to assess the prophylactic efficacy of 5-Aza, DZNep, and their combination on aGvHD. The immunomodulatory effect on T cells and the hematopoietic reconstruction were assessed. Additionally, RNA sequencing (RNA-seq) was performed to identify the underlying molecular mechanisms. Results Compared with single treatments, the in vitro application of 5-Aza with DZNep could more powerfully reduce the production of T helper type 1 (Th1)/T cytotoxic type 1 (Tc1) cells and increase the production of regulatory T cells (Tregs). In an allo-HSCT mouse model, in vivo administration of 5-Aza with DZNep could enhance the prophylactic effect for aGvHD compared with single agents. The mechanism study demonstrated that the combination of 5-Aza and DZNep in vivo had an enhanced effect to inhibit the production of Th1/Tc1, increase the proportions of Th2/Tc2, and induce the differentiation of Tregs as in vitro. RNA-seq analysis revealed the cytokine and chemokine pathways as one mechanism for the alleviation of aGvHD with the combination of 5-Aza and DZNep. Conclusion The combination of 5-Aza and DZNep could enhance the prophylactic effect for aGvHD by influencing donor T-cell differentiation through affecting cytokine and chemokine pathways. This study shed light on the effectively prophylactic measure for aGvHD using different epigenetic agent combinations.
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Affiliation(s)
- Qing Ya Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Hui Hui Liu
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Yu Jun Dong
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Ze Yin Liang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Yue Yin
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Wei Liu
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Qing Yun Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Qian Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Yu Hua Sun
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Wei Lin Xu
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Na Han
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Yuan Li
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
| | - Han Yun Ren
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, China
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Jiang Y, Southam AD, Trova S, Beke F, Alhazmi B, Francis T, Radotra A, di Maio A, Drayson MT, Bunce CM, Khanim FL. Valproic acid disables the Nrf2 anti-oxidant response in acute myeloid leukaemia cells enhancing reactive oxygen species-mediated killing. Br J Cancer 2022; 126:275-286. [PMID: 34686779 PMCID: PMC8770569 DOI: 10.1038/s41416-021-01570-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We previously demonstrated the in vitro killing of AML cells by the combination of the lipid-lowering agent bezafibrate (BEZ) and the contraceptive hormone medroxyprogesterone acetate (MPA). A phase II trial demonstrated in vivo safety and efficacy of BEZ and MPA (BaP) in elderly, relapsed/refractory AML and high-risk myelodysplastic syndrome (MDS) patients. However, we observed dose-limiting toxicities in a second trial that attempted to improve outcomes via escalation of BaP doses. Thus we sought to identify a third repurposed drug that potentiates activity of low dose BaP (BaP 0.1 mM). METHODS AND RESULTS We demonstrate that addition of a commonly used anti-epileptic, valproic acid (VAL) to low dose BaP (BaP 0.1 mM)(VBaP) enhanced killing of AML cell lines/primary AML cells to levels similar to high dose BaP (BaP 0.5 mM). Similarly, addition of VAL to BaP 0.1 mM enhanced reactive oxygen species (ROS), lipid peroxidation and inhibition of de novo fatty acid synthesis. Overexpression of Nrf2 in K562 and KG1a completely inhibited ROS production and rescued cells from VAL/BaP 0.1 mM/VBaP killing. CONCLUSIONS Given the good safety data of low-dose BaP in elderly/relapsed/refractory AML patients, and that VAL alone is well-tolerated, we propose VBaP as a novel therapeutic combination for AML.
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Affiliation(s)
- Yao Jiang
- grid.6572.60000 0004 1936 7486School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Andrew D. Southam
- grid.6572.60000 0004 1936 7486School of Biosciences, University of Birmingham, Birmingham, UK
| | - Sandro Trova
- grid.6572.60000 0004 1936 7486School of Biosciences, University of Birmingham, Birmingham, UK
| | - Flavio Beke
- grid.5335.00000000121885934CRUK Cancer Institute, University of Cambridge, Cambridge, UK
| | - Bader Alhazmi
- grid.6572.60000 0004 1936 7486School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Thomas Francis
- grid.13097.3c0000 0001 2322 6764Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, King’s College London, London, UK
| | - Anshul Radotra
- grid.412570.50000 0004 0400 5079University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry, UK
| | - Alessandro di Maio
- grid.6572.60000 0004 1936 7486School of Biosciences, University of Birmingham, Birmingham, UK
| | - Mark T. Drayson
- grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Chris M. Bunce
- grid.6572.60000 0004 1936 7486School of Biosciences, University of Birmingham, Birmingham, UK
| | - Farhat L. Khanim
- grid.6572.60000 0004 1936 7486School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Adoptive immunotherapy with CB following chemotherapy for patients with refractory myeloid malignancy: chimerism and response. Blood Adv 2021; 4:5146-5156. [PMID: 33091124 DOI: 10.1182/bloodadvances.2020002805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022] Open
Abstract
We conducted a prospective evaluation of cord blood (CB)-derived adoptive cell therapy, after salvage chemotherapy, for patients with advanced myeloid malignancies and poor prognosis. Previously, we reported safety, feasibility, and preliminary efficacy of this approach. We present updated results in 31 patients who received intensive chemotherapy followed by CB infusion and identify predictors of response. To enhance the antileukemic effect, we selected CB units (CBU) with shared inherited paternal antigens and/or noninherited maternal antigens with the recipients. Twenty-eight patients with acute myeloid leukemia (AML), 2 with myelodysplastic syndrome, and 1 in chronic myeloid leukemia myeloid blast crisis were enrolled; 9 had relapsed after allogeneic transplant. Response was defined as <5% blasts in hypocellular bone marrow at 2 weeks after treatment. Thirteen patients (42%) responded; a rate higher than historical data with chemotherapy only. Twelve had CBU-derived chimerism detected; chimerism was a powerful predictor of response (P < .001). CBU lymphocyte content and a prior transplant were associated with chimerism (P < .01). Safety was acceptable: 3 patients developed mild cytokine release syndrome, 2 had grade 1 and 2 had grade 4 graft-versus-host disease. Seven responders and 6 nonresponders (after additional therapy) received subsequent transplant; 5 are alive (follow-up, 5-47 months). The most common cause of death for nonresponders was disease progression, whereas for responders it was infection. CB-derived adoptive cell therapy is feasible and efficacious for refractory AML. Banked CBU are readily available for treatment. Response depends on chimerism, highlighting the graft-versus-leukemia effect of CB cell therapy. This trial was registered at www.clinicaltrials.gov as #NCT02508324.
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D'Angelo CR, Hall A, Woo KM, Kim K, Longo W, Hematti P, Callander N, Kenkre VP, Mattison R, Juckett M. Decitabine induction with myeloablative conditioning and allogeneic hematopoietic stem cell transplantation in high-risk patients with myeloid malignancies is associated with a high rate of infectious complications. Leuk Res 2020; 96:106419. [PMID: 32683127 DOI: 10.1016/j.leukres.2020.106419] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
Patients with high-risk myelodysplastic syndrome or acute myeloid leukemia have an increased risk of death following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Decitabine has minimal non-hematologic toxicity and proven efficacy in myeloid diseases, and post-transplant cyclophosphamide (PTCy) has reduced rates of graft-versus-host-disease (GVHD). We hypothesized that decitabine induction with allo-HSCT and PTCy would improve outcomes in a high-risk myeloid disease population. We performed a phase-II trial of decitabine at 20 mg/m2 for 10 days followed by allo-HSCT using a myeloablative regimen of fludarabine, IV busulfan and 4 Gy total body irradiation with PTCy for GVHD prophylaxis. Twenty patients underwent decitabine induction and 17 patients proceeded to transplant per protocol. Median overall survival from decitabine induction was 210 days (95 % CI 122-not reached). All patients developed grade 4 neutropenia after decitabine, eleven patients (55 %) developed grade 3-4 infections, and 5 cases were fatal. There were 5/20 (25 %) long-term survivors with a median follow-up of 3.6 years. Decitabine induction followed by myeloablative allo-HSCT in a high-risk population was associated with a high risk of infection and mortality related to enhanced immunosuppression. Further exploration of decitabine conditioning on reduced intensity platforms and improved infectious prophylaxis and screening may better mitigate toxicity (ClinicalTrials.gov (NCT01707004)).
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Affiliation(s)
- Christopher R D'Angelo
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aric Hall
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kaitlin M Woo
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Walter Longo
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Peiman Hematti
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Natalie Callander
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vaishalee P Kenkre
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ryan Mattison
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mark Juckett
- Section of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Orfali N, van Besien K. Combining haplo-identical and cord blood stem cell grafts - might the whole be greater than the sum of its parts? Leuk Lymphoma 2020; 61:753-756. [PMID: 32048529 DOI: 10.1080/10428194.2020.1725509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nina Orfali
- Department of Bone Marrow Transplantation, Weill Cornell Medicine, New York, NY, USA
| | - Koen van Besien
- Department of Bone Marrow Transplantation, Weill Cornell Medicine, New York, NY, USA
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