Retrospective study of Dana Farber Consortium Protocol in newly diagnosed Egyptian adolescents and young adults with acute lymphoblastic leukemia: Tanta experience

BM-MSCs display altered gene expression profiles in B-cell acute lymphoblastic leukemia niches and exert pro-proliferative effects via overexpression of IFI6

BACKGROUND

The tumor microenvironment (TME) is a supportive environment responsible for promoting the growth and proliferation of tumor cells. Current studies have revealed that the bone marrow mesenchymal stem cells (BM-MSCs), a type of crucial stromal cells in the TME, can promote the malignant progression of tumors. However, in the adult B-cell acute lymphoblastic leukemia (B-ALL) microenvironment, it is still uncertain what changes in BM-MSCs are induced by leukemia cells.

METHODS

In this study, we mimicked the leukemia microenvironment by constructing a BM-MSC-leukemia cell co-culture system. In vitro cell experiments, in vivo mouse model experiments, lentiviral transfection and transcriptome sequencing analysis were used to investigate the possible change of BM-MSCs in the leukemia niche and the potential factors in BM-MSCs that promote the progression of leukemia.

RESULTS

In the leukemia niche, the leukemia cells reduced the MSCs' capacity to differentiate towards adipogenic and osteogenic subtypes, which also promoted the senescence and cell cycle arrest of the MSCs. Meanwhile, compared to the mono-cultured MSCs, the gene expression profiles of MSCs in the leukemia niche changed significantly. These differential genes were enriched for cell cycle, cell differentiation, DNA replication, as well as some tumor-promoting biofunctions including protein phosphorylation, cell migration and angiogenesis. Further, interferon alpha-inducible protein 6 (IFI6), as a gene activated by interferon, was highly expressed in leukemia niche MSCs. The leukemia cell multiplication was facilitated evidently by IFI6 both in vitro and in vivo. Mechanistically, IFI6 might promote leukemia cell proliferation by stimulating SDF-1/CXCR4 axis, which leads to the initiation of downstream ERK signaling pathway. As suggested by further RNA sequencing analysis, the high IFI6 level in MSCs somewhat influenced the gene expression profile and biological functions of leukemia cells.

CONCLUSIONS

BM-MSCs in the leukemia niche have varying degrees of changes in biological characteristics and gene expression profiles. Overexpression of IFI6 in BM-MSCs could be a key factor in promoting the proliferation of B-ALL cells, and this effect might be exerted through the SDF-1/CXCR4/ERK signal stimulation. Targeting IFI6 or related signaling pathways might be an important measure to reduce the leukemia cell proliferation.

Evaluation of liver function tests to identify hepatotoxicity among acute lymphoblastic leukemia patients who are receiving chemotherapy induction

The effect of induction chemotherapy on liver function in patients with acute lymphoblastic leukemia is not well documented in Ethiopia. This study assessed hepatotoxicity in patients with acute lymphoblastic leukemia who were undergoing induction chemotherapy in Ethiopia. A 1-month cohort study was undertaken in forty patients with acute lymphoblastic leukemia, with measurements taken at the baseline, second, and fourth weeks. A Log 10 transformation was done because of the skewed distribution of liver function tests. Descriptive statistics such as mean and proportion were calculated. A mixed model ANOVA and Bonferroni post hoc test were computed. A p value < 0.05 was declared to determine statistical significance. Clinically significant hepatotoxicity was observed in 15% of patients. Mild liver injury occurred in 5% of patients. The mean of all liver function tests increased significantly from pre-induction to post-induction. ALT levels were significantly higher in patients who received blood transfusions, but not in those who did not. Regardless of other factors, ALP level in children is significantly higher than in adults, although total bilirubin in adults is higher than in children. A significant proportion of patients had hepatotoxicity. During chemotherapy induction, the mean of all liver function tests rose significantly, but this elevation of serum liver function tests may be transient. Chemotherapy drugs should be given without causing a significant alteration in serum liver function tests. Continuous monitoring of patients should be required.

The Effect of Chemotherapy Induction Therapy on the Pancreas in Patients with Acute Lymphoblastic Leukemia

Background

The effect of chemotherapy induction on the pancreatic in patients with acute lymphoblastic leukemia is not described in Ethiopia. The study determined the chemotherapy drug-induced pancreatitis in patients with acute lymphoblastic leukemia.

Method

A preexperimental study (pretest and posttests) was conducted in forty patients with acute lymphoblastic leukemia. For some skewed data, a log transformation was computed. The back transformation was then calculated. Descriptive statistics and a mixed-model ANOVA were used to analyze the data. A post hoc Bonferroni test was used. A p value < 0.05 was declared statistically significant.

Results

In this study, no clinically significant acute pancreatitis occurred. Elevated amylase and lipase levels, indicating grade 2 acute pancreatitis, were observed in 25% and 17.5% of patients, respectively. Amylase enzyme levels in children differed significantly from preinduction to the second week of induction (p = 0.001) and fourth week of induction (p = 0.001), as well as between the second and fourth weeks of induction (p = 0.033), but adults' amylase enzyme levels did not differ significantly (p = 0.2). Lipase levels in adults are nearly identical in all three measures, implying that there is no statistically significant difference (p = 0.775). However, the level of lipase enzyme in children was significantly higher from baseline to two and four weeks of induction (p = 0.007) but not between two and four weeks of induction (p = 0.129).

Conclusion

Clinically significant acute pancreatitis did not occur, but patients experienced mild (grade 2) acute pancreatitis. Amylase and lipase enzymes responded significantly to chemotherapy induction in children. Chemotherapy drugs should be given without altering pancreatic enzymes, specifically in children.