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Teppert K, Yonezawa Ogusuku IE, Brandes C, Herbel V, Winter N, Werchau N, Khorkova S, Wöhle C, Jelveh N, Bisdorf K, Engels B, Schaser T, Anders K, Künkele A, Lock D. CAR'TCR-T cells co-expressing CD33-CAR and dNPM1-TCR as superior dual-targeting approach for AML treatment. MOLECULAR THERAPY. ONCOLOGY 2024; 32:200797. [PMID: 38601972 PMCID: PMC11004219 DOI: 10.1016/j.omton.2024.200797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
Acute myeloid leukemia (AML), a fast-progressing hematological malignancy affecting myeloid cells, is typically treated with chemotherapy or hematopoietic stem cell transplantation. However, approximately half of the patients face relapses and 5-year survival rates are poor. With the goal to facilitate dual-specificity, boosting anti-tumor activity, and minimizing the risk for antigen escape, this study focused on combining chimeric antigen receptor (CAR) and T cell receptor (TCR) technologies. CAR'TCR-T cells, co-expressing a CD33-CAR and a transgenic dNPM1-TCR, revealed increased and prolonged anti-tumor activity in vitro, particularly in case of low target antigen expression. The distinct transcriptomic profile suggested enhanced formation of immunological synapses, activation, and signaling. Complete elimination of AML xenografts in vivo was only achieved with a cell product containing CAR'TCR-T, CAR-T, and TCR-T cells, representing the outcome of co-transduction with two lentiviral vectors encoding either CAR or TCR. A mixture of CAR-T and TCR-T cells, without CAR'TCR-T cells, did not prevent progressive tumor outgrowth and was comparable to treatment with CAR-T and TCR-T cells individually. Overall, our data underscore the efficacy of co-expressing CAR and transgenic TCR in one T cell, and might open a novel therapeutic avenue not only for AML but also other malignancies.
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Affiliation(s)
- Karin Teppert
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | | | | | - Vera Herbel
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | - Nora Winter
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | - Niels Werchau
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | | | - Christian Wöhle
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | - Nojan Jelveh
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | - Kevin Bisdorf
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | - Boris Engels
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | - Thomas Schaser
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
| | - Kathleen Anders
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10178 Berlin, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Annette Künkele
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10178 Berlin, Germany
- German Cancer Consortium (DKTK), 10117 Berlin, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Dominik Lock
- Miltenyi Biotec B.V. & Co. KG, 51429 Bergisch Gladbach, Germany
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Balta B, Gebreyohannis T, Tachbele E. Survival and predictors of mortality among acute leukemia patients on follow-up in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5-year retrospective cohort study. Cancer Rep (Hoboken) 2023; 6:e1890. [PMID: 37783566 PMCID: PMC10598244 DOI: 10.1002/cnr2.1890] [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: 02/28/2023] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Although Ethiopia has more than 78% of leukemia cases and a significant burden of the disease, the survival of leukemia patients in the country is poorly recognized. The purpose of this study was to assess the survival and predictors of acute leukemia patients. METHODS A 5-year retrospective cohort study was conducted including all acute Leukemia patients who visited Tikur Anbessa Specialized Hospital between January 2015 and December 2019. Data were retrieved from patient's medical records between March and April 2020. Using SPSS version 25, the Kaplan-Meier curve and Cox regression models were employed to analyze the data. RESULTS A total of 119 patients with acute leukemia were retrospectively evaluated for 60 months, having 196 person-years of risk. About 46 deaths (38.7%) were recorded over the follow-up period, giving a mortality incidence rate of 23.5 (95% CL:18-52) per 100 person-years. The median survival time was 35 months (95% CI, 28.3-41.7). At 60 months of follow-up, the predicted overall survival rate after diagnosis for acute leukemia was 21%. The adjusted hazard ratio for acute leukemia subtypes (aHR:4.9, 95% CI:2.3-10.4), history of relapse (aHR:3.9, 95% CI:1.0-7.9), participant age (aHR:1.25, 95% CI:1-1.75), hepatomegaly (aHR:2.7, 95% CI:1.36-5.36), and splenomegaly (aHR:2.29, 95% CI:1.2-4.4). CONCLUSION The 5-year overall survival rate was found to be 21%. The finding was remarkably lower than other published reports. Survival among acute leukemia patients was significantly associated with older age, history of relapse, hepatomegaly, splenomegaly, as well as certain subtypes. Therefore, improving early detection and initiation of treatment for all acute leukemia patients is necessary in order to improve patient's survival status.
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Affiliation(s)
- Bargude Balta
- Department of NursingHawassa University Comprehensive Specialized HospitalHawassaEthiopia
| | | | - Erdaw Tachbele
- College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
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Fiedler W, Montesinos P, Schliemann C, Middeke J, Vasu S, Scholz CW, Esteve J, Mondal S, Rüter B, Burkard U, Osswald A, Blum W. An open-label, phase I/II trial to determine the maximum tolerated dose and investigate safety, pharmacokinetics and efficacy of BI 836858, an unconjugated anti-CD33 monoclonal antibody, in combination with decitabine in patients with acute myeloid leukemia. Haematologica 2022; 107:2977-2982. [PMID: 36005556 PMCID: PMC9713566 DOI: 10.3324/haematol.2022.281128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Christoph Schliemann
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Sumithira Vasu
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Christian W. Scholz
- Department of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Jordi Esteve
- Hematology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Shoubhik Mondal
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Björn Rüter
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach/Riss, Germany and
| | - Ute Burkard
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach/Riss, Germany and
| | - Annika Osswald
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach/Riss, Germany and
| | - William Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA,W. BLUM -
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Martínez-Cuadrón D, Serrano J, Mariz J, Gil C, Tormo M, Martínez-Sánchez P, Rodríguez-Arbolí E, García-Boyero R, Rodríguez-Medina C, Martínez-Chamorro C, Polo M, Bergua J, Aguiar E, Amigo ML, Herrera P, Alonso-Domínguez JM, Bernal T, Espadana A, Sayas MJ, Algarra L, Vidriales MB, Vasconcelos G, Vives S, Pérez-Encinas MM, López A, Noriega V, García-Fortes M, Chillón MC, Rodríguez-Gutiérrez JI, Calasanz MJ, Labrador J, López JA, Boluda B, Rodríguez-Veiga R, Martínez-López J, Barragán E, Sanz MA, Montesinos P. Characteristics and Outcomes of Adult Patients in the PETHEMA Registry with Relapsed or Refractory FLT3-ITD Mutation-Positive Acute Myeloid Leukemia. Cancers (Basel) 2022; 14:cancers14112817. [PMID: 35681796 PMCID: PMC9179309 DOI: 10.3390/cancers14112817] [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: 03/23/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
This retrospective study investigated outcomes of 404 patients with relapsed/refractory (R/R) FMS-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) acute myeloid leukemia (AML) enrolled in the PETHEMA registry, pre-approval of tyrosine kinase inhibitors. Most patients (63%) had received first-line intensive therapy with 3 + 7. Subsequently, patients received salvage with intensive therapy (n = 261), non-intensive therapy (n = 63) or supportive care only (n = 80). Active salvage therapy (i.e., intensive or non-intensive therapy) resulted in a complete remission (CR) or CR without hematological recovery (CRi) rate of 42%. More patients achieved a CR/CRi with intensive (48%) compared with non-intensive (19%) salvage therapy (p < 0.001). In the overall population, median overall survival (OS) was 5.5 months; 1- and 5-year OS rates were 25% and 7%. OS was significantly (p < 0.001) prolonged with intensive or non-intensive salvage therapy compared with supportive therapy, and in those achieving CR/CRi versus no responders. Of 280 evaluable patients, 61 (22%) had an allogeneic stem-cell transplant after they had achieved CR/CRi. In conclusion, in this large cohort study, salvage treatment approaches for patients with FLT3-ITD mutated R/R AML were heterogeneous. Median OS was poor with both non-intensive and intensive salvage therapy, with best long-term outcomes obtained in patients who achieved CR/CRi and subsequently underwent allogeneic stem-cell transplant.
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Affiliation(s)
- David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
- Correspondence: ; Tel.: +34-96-1244925
| | - Josefina Serrano
- Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica Córdoba (IMIBIC), 14004 Córdoba, Spain;
| | - José Mariz
- IPO (Istituto Portugues Oncologia), 4200-072 Porto, Portugal;
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Mar Tormo
- Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - Pilar Martínez-Sánchez
- Hospital Universitario 12 de Octubre, Complutense University, i+12, CNIO, 28041 Madrid, Spain; (P.M.-S.); (J.M.-L.)
| | | | | | | | | | - Marta Polo
- Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Juan Bergua
- Hospital San Pedro Alcántara, 10003 Cáceres, Spain;
| | | | - María L. Amigo
- Hospital General Universitario Morales Meseguer, 30008 Murcia, Spain;
| | - Pilar Herrera
- Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | | | - Teresa Bernal
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain;
| | - Ana Espadana
- Hospital de Coimbra, 3400-091 Coimbra, Portugal;
| | - María J. Sayas
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain;
| | - Lorenzo Algarra
- Hospital General Universitario de Albacete, 02006 Albacete, Spain;
| | - María B. Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.B.V.); (M.C.C.)
| | | | - Susana Vives
- ICO-Hospital Germans Trias i Pujol, Badalona, José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | | | | | - Víctor Noriega
- Complejo Hospitalario Universitario A Coruña, 15006 La Coruna, Spain;
| | | | - María C. Chillón
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.B.V.); (M.C.C.)
| | | | | | | | - Juan A. López
- Complejo Hospitalario Ciudad de Jaén, 23007 Jaén, Spain;
| | - Blanca Boluda
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Rebeca Rodríguez-Veiga
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Complutense University, i+12, CNIO, 28041 Madrid, Spain; (P.M.-S.); (J.M.-L.)
| | - Eva Barragán
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Miguel A. Sanz
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
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Emerging CAR T Cell Strategies for the Treatment of AML. Cancers (Basel) 2022; 14:cancers14051241. [PMID: 35267549 PMCID: PMC8909045 DOI: 10.3390/cancers14051241] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Chimeric antigen receptors (CARs) targeting CD19 have emerged as a new treatment for hematological malignancies. As a “living therapy”, CARs can precisely target and eliminate tumors while proliferating inside the patient’s body. Various preclinical and clinical studies are ongoing to identify potential CAR-T cell targets for acute myeloid leukemia (AML). We shed light on the continuing efforts of CAR development to overcome tumor escape, exhaustion, and toxicities. Furthermore, we summarize the recent progress of a range of putative targets exploring this unmet need to treat AML. Lastly, we discuss the advances in preclinical models that built the foundation for ongoing clinical trials. Abstract Engineered T cells expressing chimeric antigen receptors (CARs) on their cell surface can redirect antigen specificity. This ability makes CARs one of the most promising cancer therapeutic agents. CAR-T cells for treating patients with B cell hematological malignancies have shown impressive results. Clinical manifestation has yielded several trials, so far five CAR-T cell therapies have received US Food and Drug Administration (FDA) approval. However, emerging clinical data and recent findings have identified some immune-related toxicities due to CAR-T cell therapy. Given the outcome and utilization of the same proof of concept, further investigation in other hematological malignancies, such as leukemias, is warranted. This review discusses the previous findings from the pre-clinical and human experience with CAR-T cell therapy. Additionally, we describe recent developments of novel targets for adoptive immunotherapy. Here we present some of the early findings from the pre-clinical studies of CAR-T cell modification through advances in genetic engineering, gene editing, cellular programming, and formats of synthetic biology, along with the ongoing efforts to restore the function of exhausted CAR-T cells through epigenetic remodeling. We aim to shed light on the new targets focusing on acute myeloid leukemia (AML).
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Ma J, Ge Z. Recent advances of targeted therapy in relapsed/refractory acute myeloid leukemia. Bosn J Basic Med Sci 2021; 21:409-421. [PMID: 33577442 PMCID: PMC8292864 DOI: 10.17305/bjbms.2020.5485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 12/22/2022] Open
Abstract
Despite advances in the understanding of disease pathobiology, treatment for relapsed or refractory acute myeloid leukemia (R/R AML) remains challenging. The prognosis of R/R AML remains extremely poor despite chemotherapy and bone marrow transplants. Discoveries on recurrent and novel genetic mutations, such as FLT3-ITD and IDH1/IDH2, critical signaling pathways, and unique molecular markers expressed on the surface of leukemic cells have been under investigation for the management of R/R AML. Other than monoclonal antibodies, diabodies, and triabodies are new targeted therapies developed in recent years and will be the new direction of immunotherapy. Targeted agents combined intensive regimens can be viable options for salvage therapy and as bridges to allogeneic transplant. Future directions will focus on novel, efficient and targeted combinations, low-toxicity maintenance, and individualized precision strategies. Here, we review the major recent advances of targeted therapies in the treatment of R/R AML.
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Affiliation(s)
- Jiale Ma
- Department of Hematology, Zhongda Hospital, School of Medicine, Southeast University, Institute of Hematology Southeast University, Nanjing, China; Department of Hematology, Xuzhou Central Hospital, Xuzhou, China
| | - Zheng Ge
- Department of Hematology, Zhongda Hospital, School of Medicine, Southeast University, Institute of Hematology Southeast University, Nanjing, China
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7
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CD33 Expression and Gentuzumab Ozogamicin in Acute Myeloid Leukemia: Two Sides of the Same Coin. Cancers (Basel) 2021; 13:cancers13133214. [PMID: 34203180 PMCID: PMC8268215 DOI: 10.3390/cancers13133214] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Roughly 85–90% of adult and pediatric acute myeloid leukemia (AML) are CD33-positive. Gemtuzumab ozogamicin (GO), a humanized murine IgG4 anti-CD33 antibody, is the first target therapy approved in AML therapeutic scenario. This review focuses on current biological information and clinical data from several studies investigating the use of GO in patients with AML. Over the years, flow cytometry, cytogenetics, molecular techniques, and genotyping studies of CD33 SNPs have provided a comprehensive analysis of promising biomarkers for GO responses and have potentially helped to identify subgroups of patients that may benefit from GO addition to standard chemotherapies. Increased understanding of molecular mutations, altered intracellular pathways, and their potential relationship with CD33 expression may open new therapeutic landscapes based on combinatorial regimens in an AML scenario. Abstract Acute myeloid leukemia (AML), the most frequent acute leukemia in adults, has been historically treated with infusional cytarabine (ara-c) + daunorubicin (3 + 7) for at least 40 years. The first “target therapy” to be introduced was the monoclonal anti-CD33 gemtuzumab ozogamicin (GO) in 2004. Unfortunately, in 2010 it was voluntarily withdrawn from the market both for safety reasons related to potential liver toxicity and veno-occlusive disease (VOD) and because clinical studies failed to confirm the clinical benefit during induction and maintenance. Seven years later, GO was re-approved based on new data, including insights into its mechanism of action on its target receptor CD33 expressed on myeloid cells. The present review focuses on current biological information and clinical data from several studies investigating GO. Cytogenetic, molecular, and immunophenotypic data are now able to predict the potential positive advantages of GO, with the exception of high-risk AML patients who do not seem to benefit. GO can be considered a ‘repurposed drug’ that could be beneficial for some patients with AML, mostly in combination with new drugs already approved or currently in testing.
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8
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Tabata R, Chi S, Yuda J, Minami Y. Emerging Immunotherapy for Acute Myeloid Leukemia. Int J Mol Sci 2021; 22:1944. [PMID: 33669431 PMCID: PMC7920435 DOI: 10.3390/ijms22041944] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 12/12/2022] Open
Abstract
Several immune checkpoint molecules and immune targets in leukemic cells have been investigated. Recent studies have suggested the potential clinical benefits of immuno-oncology (IO) therapy against acute myeloid leukemia (AML), especially targeting CD33, CD123, and CLL-1, as well as immune checkpoint inhibitors (e.g., anti-PD (programmed cell death)-1 and anti-CTLA4 (cytotoxic T-lymphocyte-associated protein 4) antibodies) with or without conventional chemotherapy. Early-phase clinical trials of chimeric antigen receptor (CAR)-T or natural killer (NK) cells for relapsed/refractory AML showed complete remission (CR) or marked reduction of marrow blasts in a few enrolled patients. Bi-/tri-specific antibodies (e.g., bispecific T-cell engager (BiTE) and dual-affinity retargeting (DART)) exhibited 11-67% CR rates with 13-78% risk of cytokine-releasing syndrome (CRS). Conventional chemotherapy in combination with anti-PD-1/anti-CTLA4 antibody for relapsed/refractory AML showed 10-36% CR rates with 7-24 month-long median survival. The current advantages of IO therapy in the field of AML are summarized herein. However, although cancer vaccination should be included in the concept of IO therapy, it is not mentioned in this review because of the paucity of relevant evidence.
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Affiliation(s)
- Rikako Tabata
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (R.T.); (S.C.); (J.Y.)
- Department of Hematology, Kameda Medical Center, Kamogawa 296-8602, Japan
| | - SungGi Chi
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (R.T.); (S.C.); (J.Y.)
| | - Junichiro Yuda
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (R.T.); (S.C.); (J.Y.)
| | - Yosuke Minami
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (R.T.); (S.C.); (J.Y.)
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9
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Uy GL, Aldoss I, Foster MC, Sayre PH, Wieduwilt MJ, Advani AS, Godwin JE, Arellano ML, Sweet KL, Emadi A, Ravandi F, Erba HP, Byrne M, Michaelis L, Topp MS, Vey N, Ciceri F, Carrabba MG, Paolini S, Huls GA, Jongen-Lavrencic M, Wermke M, Chevallier P, Gyan E, Récher C, Stiff PJ, Pettit KM, Löwenberg B, Church SE, Anderson E, Vadakekolathu J, Santaguida M, Rettig MP, Muth J, Curtis T, Fehr E, Guo K, Zhao J, Bakkacha O, Jacobs K, Tran K, Kaminker P, Kostova M, Bonvini E, Walter RB, Davidson-Moncada JK, Rutella S, DiPersio JF. Flotetuzumab as salvage immunotherapy for refractory acute myeloid leukemia. Blood 2021; 137:751-762. [PMID: 32929488 PMCID: PMC7885824 DOI: 10.1182/blood.2020007732] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
Approximately 50% of acute myeloid leukemia (AML) patients do not respond to induction therapy (primary induction failure [PIF]) or relapse after <6 months (early relapse [ER]). We have recently shown an association between an immune-infiltrated tumor microenvironment (TME) and resistance to cytarabine-based chemotherapy but responsiveness to flotetuzumab, a bispecific DART antibody-based molecule to CD3ε and CD123. This paper reports the results of a multicenter, open-label, phase 1/2 study of flotetuzumab in 88 adults with relapsed/refractory AML: 42 in a dose-finding segment and 46 at the recommended phase 2 dose (RP2D) of 500 ng/kg per day. The most frequent adverse events were infusion-related reactions (IRRs)/cytokine release syndrome (CRS), largely grade 1-2. Stepwise dosing during week 1, pretreatment dexamethasone, prompt use of tocilizumab, and temporary dose reductions/interruptions successfully prevented severe IRR/CRS. Clinical benefit accrued to PIF/ER patients showing an immune-infiltrated TME. Among 30 PIF/ER patients treated at the RP2D, the complete remission (CR)/CR with partial hematological recovery (CRh) rate was 26.7%, with an overall response rate (CR/CRh/CR with incomplete hematological recovery) of 30.0%. In PIF/ER patients who achieved CR/CRh, median overall survival was 10.2 months (range, 1.87-27.27), with 6- and 12-month survival rates of 75% (95% confidence interval [CI], 0.450-1.05) and 50% (95% CI, 0.154-0.846). Bone marrow transcriptomic analysis showed that a parsimonious 10-gene signature predicted CRs to flotetuzumab (area under the receiver operating characteristic curve = 0.904 vs 0.672 for the European LeukemiaNet classifier). Flotetuzumab represents an innovative experimental approach associated with acceptable safety and encouraging evidence of activity in PIF/ER patients. This trial was registered at www.clinicaltrials.gov as #NCT02152956.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cytokine Release Syndrome/chemically induced
- Cytokine Release Syndrome/drug therapy
- Dose-Response Relationship, Immunologic
- Drug Administration Schedule
- Drug Resistance, Neoplasm
- Female
- Follow-Up Studies
- Hematopoiesis/drug effects
- Humans
- Immunotherapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Male
- Maximum Tolerated Dose
- Middle Aged
- Nausea/chemically induced
- Protein Interaction Maps
- Salvage Therapy
- Survival Rate
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Affiliation(s)
- Geoffrey L Uy
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Peter H Sayre
- Division of Hematology and Blood and Marrow Transplantation, University of California San Francisco, San Francisco, CA
| | | | - Anjali S Advani
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Kendra L Sweet
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Ashkan Emadi
- Marlene & Stewart Greenebaum Cancer, School of Medicine, University of Maryland, Baltimore, MD
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harry P Erba
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Centre, Durham, NC
| | - Michael Byrne
- Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Laura Michaelis
- Division of Hematology/Oncology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI
| | - Max S Topp
- Medizinische Klinik Und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Norbert Vey
- Hematologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Matteo Giovanni Carrabba
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Stefania Paolini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology L. and A. Seràgnoli, University of Bologna, Bologna, Italy
| | - Gerwin A Huls
- Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Martin Wermke
- Universitätsklinikum Carl Gustav Carus an der Technische Universität, Dresden, Germany
| | - Patrice Chevallier
- Institut Universitaire du Cancer Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Gyan
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Christian Récher
- Hôpital Bretonneau, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | | | - Kristen M Pettit
- Michigan Medicine Bone Marrow Transplant and Leukemia, C. S. Mott Children's Hospital, Ann Arbor, MI
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Jayakumar Vadakekolathu
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Michael P Rettig
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | | | | | - Kuo Guo
- MacroGenics Inc, Rockville, MD
| | | | | | | | | | | | | | | | | | | | - Sergio Rutella
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
- Centre for Health, Ageing and Understanding Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - John F DiPersio
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
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Goldenson BH, Goodman AM, Ball ED. Gemtuzumab ozogamicin for the treatment of acute myeloid leukemia in adults. Expert Opin Biol Ther 2020; 21:849-862. [PMID: 32990476 DOI: 10.1080/14712598.2021.1825678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Treatment of acute myeloid leukemia (AML) has changed dramatically in the past ten years with the approval of targeted agents, the first of which was the anti-CD33 antibody-drug conjugate gemtuzumab ozogamicin (GO). Despite withdrawal from the market after accelerated approval, GO was reapproved and now has a well-established role in treating select AML patients. CD33 has proven to be an important target for drug development in AML as evidenced by the improvement in survival with GO treatment. AREAS COVERED The review summarizes the development of GO, its mechanism of action, initial studies and approval, withdrawal from the market, and subsequent reapproval after the results of several large randomized studies became available. We also provide an overview of its current role in the treatment landscape of AML. EXPERT OPINION Multiple phase 3 trials with GO have established a significant benefit with GO in induction therapy for favorable risk AML. Additional studies support the use of GO in relapsed/refractory AML and APL. Despite the withdrawal of GO from the market after initial approval, GO has proven to improve survival of select AML patients when added to induction chemotherapy and in relapsed disease.
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Affiliation(s)
- Benjamin H Goldenson
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, La Jolla, California, USA
| | - Aaron M Goodman
- Department of Medicine, Division of Blood and Marrow Transplantation, University of California, San Diego, La Jolla, California, USA
| | - Edward D Ball
- Department of Medicine, Division of Blood and Marrow Transplantation, University of California, San Diego, La Jolla, California, USA
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11
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Penel-Page M, Plesa A, Girard S, Marceau-Renaut A, Renard C, Bertrand Y. Association of fludarabin, cytarabine, and fractioned gemtuzumab followed by hematopoietic stem cell transplantation for first-line refractory acute myeloid leukemia in children: A single-center experience. Pediatr Blood Cancer 2020; 67:e28305. [PMID: 32307866 DOI: 10.1002/pbc.28305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Acute myeloid leukemia (AML) is a rare disease in children, with only 50% to 60% event-free survival. Among patients with AML, 10% do not respond to first-line chemotherapy. There is no recommendation concerning second-line treatments. Gemtuzumab ozogamicin (GO) is a monoclonal antibody targeting CD33, linked to calicheamicin. We report the efficacy and tolerance of a salvage regimen of fludarabin, cytarabine, and GO (FLA-GO) in patients refractory to first-line treatment. METHODS Eight patients (median age 14.5 years), who had more than 2% minimal residual disease (MRD) by flow cytometry (MRD flow), received gemtuzumab 3 mg/m² on days 1, 4, 7, associated with cytarabine 2000 mg/m² and fludarabin 30 mg/m² on days 1 to 5. RESULTS Six patients achieved complete remission (CR) (blast count morphology ≤5 × 10-2 , CR-MRD flow <1 × 10-3 for four patients). Five patients received a second course. We observed 11 episodes of febrile neutropenia, including 6 septicemias without complication. There was no fungal infection or toxic death. Two patients received granulocyte colony stimulating factor. One patient had partial platelet recovery; one, prolonged pancytopenia. All patients received hematopoietic stem cell transplantation (HSCT). We observed five mild-to-severe sinusoidal obstruction syndromes during HSCT procedures, particularly in patients who did not receive defibrotide prophylaxis. At the date of last contact (median follow-up: 58 months; range: 22-78), six patients were in continuous CR with negative MRD. Two patients died of post-HSCT relapse. CONCLUSION FLA-GO is a good salvage regimen for pediatric refractory AML, with significant but acceptable toxicity. HSCT is mandatory to achieve sustained CR in these patients.
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Affiliation(s)
- Mathilde Penel-Page
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France.,Claude Bernard University - Lyon 1, Lyon, France
| | - Adriana Plesa
- Laboratory of Hematology, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Girard
- Laboratory of Hematology, Center of Biology and Pathology East, Hospices Civils de Lyon, Lyon, France
| | | | - Cécile Renard
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France.,Claude Bernard University - Lyon 1, Lyon, France
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12
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Fractionated gemtuzumab ozogamicin in association with high dose chemotherapy: a bridge to allogeneic stem cell transplantation in refractory and relapsed acute myeloid leukemia. Bone Marrow Transplant 2019; 55:452-460. [PMID: 31554931 DOI: 10.1038/s41409-019-0690-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/16/2022]
Abstract
Optimization of the salvage regimen is required to improve prognosis in primary refractory or relapsed acute myeloid leukemia (AML). In fit patients, a bridge to allogeneic transplant is the primary purpose of salvage. We tested the combination of fractionated gemtuzumab ozogamicin with cytarabine and mitoxantrone (MYLODAM schema) with primary endpoint of efficacy and safety. We also attempted to define predictive factors for survival and response after salvage. We included 58 patients with a median age at salvage of 56 years. The overall response rate was 67%. Leukemia-free survival (LFS) and overall survival (OS) at 2 years was 36% (95% CI: 23-49) and 54% (95% CI: 39-68), respectively. Treatment-related mortality was 7%. Three veno-occlusive diseases (SOS/VOD) occurred during salvage. In the allogeneic group of 28 patients (48%), LFS and OS at 2 years was 57 % (95% CI: 36.3-77.5) and 69 % (95% CI: 49.3-88.7), respectively. Incidences of nonrelapse mortality, grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD were 16%, 40%, and 45%, respectively. A GO-based intensive regimen is a viable option for salvage therapy and a feasible schedule as a bridge to allogeneic transplant.
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13
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Fostvedt LK, Hibma JE, Masters JC, Vandendries E, Ruiz-Garcia A. Pharmacokinetic/Pharmacodynamic Modeling to Support the Re-approval of Gemtuzumab Ozogamicin. Clin Pharmacol Ther 2019; 106:1006-1017. [PMID: 31070776 PMCID: PMC6852000 DOI: 10.1002/cpt.1500] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/13/2019] [Indexed: 11/07/2022]
Abstract
Gemtuzumab ozogamicin (Mylotarg; Pfizer, New York, NY) was the first antibody-drug conjugate to be approved for CD33-positive acute myeloid leukemia (AML). However, it was voluntarily withdrawn from the US market due to lack of clinical benefit in the confirmatory phase III trial. In 2012, several investigator cooperative studies using a different dosing regimen showed efficacy, but pharmacokinetic (PK) data were not collected in these trials. Through simulation of expected concentrations for new dosing regimens, PK/pharmacodynamic modeling was able to support the safety and efficacy of these regimens. Significant exposure-response relationships were found for the attainment of complete remission with and without platelet recovery, attainment of blast-free status, the time course of myelosuppression, several grade ≥ 3 hepatic adverse events, and veno-occlusive disease. Gemtuzumab ozogamicin received full approval by the US Food and Drug Administration (FDA) in September 2017 for newly diagnosed and relapsed AML in adult patients and relapsed AML in pediatric patients aged 2-17 years.
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Affiliation(s)
- Luke K Fostvedt
- Pfizer Global Product Development, La Jolla, California, USA
| | | | | | - Erik Vandendries
- Pfizer Global Product Development, Cambridge, Massachusetts, USA
| | - Ana Ruiz-Garcia
- Pfizer Global Product Development, La Jolla, California, USA
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14
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Bahashwan S, Moluçon-Chabrot C, Hermet E, Ravinet A, Douge A, Veronese L, Tchirkov A, Lemal R, Berger MG, Veyrat-Masson R, Tournilhac O, Bay JO, Guièze R. Outcome and impact of post-remission strategy after MIDAM regimen in patients with relapsing or refractory acute myeloid leukemia. Am J Hematol 2019; 94:E32-E35. [PMID: 30370957 DOI: 10.1002/ajh.25332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/06/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Salem Bahashwan
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Cécile Moluçon-Chabrot
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Eric Hermet
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Aurélie Ravinet
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Aurore Douge
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Lauren Veronese
- Clermont Auvergne University; Clermont-Ferrand France
- Cytogenetic Laboratory; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Andrei Tchirkov
- Clermont Auvergne University; Clermont-Ferrand France
- Cytogenetic Laboratory; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Richard Lemal
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Marc G. Berger
- Clermont Auvergne University; Clermont-Ferrand France
- Department of Biology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Richard Veyrat-Masson
- Clermont Auvergne University; Clermont-Ferrand France
- Department of Biology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Olivier Tournilhac
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Jacques-Olivier Bay
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
| | - Romain Guièze
- Clermont Auvergne University; Clermont-Ferrand France
- Unit of Adult Cell Therapy and Clinical Hematology; University Hospital of Clermont-Ferrand; Clermont-Ferrand France
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15
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Targeting cell-bound MUC1 on myelomonocytic, monocytic leukemias and phenotypically defined leukemic stem cells with anti-SEA module antibodies. Exp Hematol 2018; 70:97-108. [PMID: 30593830 DOI: 10.1016/j.exphem.2018.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 01/05/2023]
Abstract
Cell surface molecules aberrantly expressed or overexpressed by myeloid leukemic cells represent potential disease-specific therapeutic targets for antibodies. MUC1 is a polymorphic glycoprotein, the cleavage of which yields two unequal chains: a large extracellular α subunit containing a tandem repeat array bound in a strong noncovalent interaction to a smaller β subunit containing the transmembrane and cytoplasmic domains. Because the α-chain can be released from the cell-bound domains of MUC1, agents directed against the α-chain will not effectively target MUC1+ cells. The MUC1 SEA (a highly conserved protein module so called from its initial identification in a sea urchin sperm protein, in enterokinase, and in agrin) domain formed by the binding of the α and β chains represents a stable structure fixed to the cell surface at all times. DMB-5F3, a partially humanized murine anti-MUC1 SEA domain monoclonal antibody, was used to examine MUC1 expression in acute myeloid leukemia (AML) and was found to bind acute myelomonocytic and monocytic leukemia (AML-M4 and AML-M5) cell lines. We also examined monocytic neoplasms freshly obtained from patients including chronic myelomonocytic leukemia and juvenile myelomonocytic leukemia, which were found to uniformly express MUC1. CD34+/lin-/CD38- or CD38+ presumed leukemic stem cell populations from CD34+ AML and CD34-CD38- or CD38+ populations from CD34- AML were also found to express MUC1, although at low percentages. Based on these studies, we generated an anti-MUC1 immunotoxin to directly gauge the cytotoxic efficacy of targeting AML-bound MUC1. Using single-chain DMB-5F3 fused to recombinant gelonin toxin, the degree of AML cytotoxicity was found to correlate with MUC1 expression. Our data support the use of an anti-MUC1 SEA module-drug conjugates to selectively target and inhibit MUC1-expressing myelomonocytic leukemic cells.
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16
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Compound Zhebei granules combined with chemotherapy for the treatment of refractory acute leukemia: a randomized clinical trial. J TRADIT CHIN MED 2018; 36:606-12. [PMID: 29933528 DOI: 10.1016/s0254-6272(16)30079-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To observe the effect of compound Zhebei granules (CZBG) with chemotherapy in the treatment of refractory acute leukemia. METHODS In this multicenter, double-blind, placebo-controlled clinical trial, we used a central (online)
randomization system to assign 235 patients to two treatment groups. A total of 118 patients received
chemotherapy combined with CZBG (4 g, twice daily) and 117 patients received chemotherapy
plus placebo. The clinical efficacy was evaluated at the end of one chemotherapeutic cycle. RESULTS In the full analysis set, in which deaths due to disease progression were regarded as inefficacy,
the rates of complete remission (CR) and partial remission (CR + PR) were 32.35% and 50.00% ,
respectively, for the chemotherapy combined with CZBG group, and 23.08% and 35.58%, respectively,
for the chemotherapy plus placebo group. There was a statistically significant difference between
the two groups according to a χ2 test (P < 0.05). In the per protocol analysis set (PPS), the CR (33.67%),
CR+PR (52.04%) response rates for the chemotherapy plus CZBG group were significantly different
from the response rates of the control group (CR: 24.24% and CR+PR: 37.37%), respectively (P < 0.05). CONCLUSION CZBG plus chemotherapy can improve the clinical remission rate of refractory acute
leukemia after one just one therapeutic cycle.
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17
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Bertoli S, Tavitian S, Berard E, Gadaud N, Luquet I, Huynh A, Sarry A, Huguet F, Récher C. Outcome of relapsed or refractory acute myeloid leukemia treated with intensive salvage chemotherapy in real life in comparison to intermediate dose cytarabine in phase 3 studies. Leuk Lymphoma 2018; 60:238-241. [PMID: 29893611 DOI: 10.1080/10428194.2018.1464156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sarah Bertoli
- a Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France.,b Faculté de médecine , Université Toulouse III Paul Sabatier , Toulouse , France.,c Cancer Research Center of Toulouse, UMR1037-INSERM, ERL5294 CNRS , Toulouse , France
| | - Suzanne Tavitian
- a Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France
| | - Emilie Berard
- d Service d'Epidemiologie, CHU de Toulouse , Toulouse , France.,e UMR1027, INSERM-Université Toulouse III , Toulouse , France
| | - Noemie Gadaud
- a Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France
| | - Isabelle Luquet
- f Laboratoire d'Hematologie , CHU de Toulouse , Toulouse , France
| | - Anne Huynh
- a Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France
| | - Audrey Sarry
- a Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France
| | - Françoise Huguet
- a Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France
| | - Christian Récher
- a Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France.,b Faculté de médecine , Université Toulouse III Paul Sabatier , Toulouse , France.,c Cancer Research Center of Toulouse, UMR1037-INSERM, ERL5294 CNRS , Toulouse , France
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18
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Megías-Vericat JE, Martínez-Cuadrón D, Sanz MÁ, Montesinos P. Salvage regimens using conventional chemotherapy agents for relapsed/refractory adult AML patients: a systematic literature review. Ann Hematol 2018; 97:1115-1153. [DOI: 10.1007/s00277-018-3304-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/12/2018] [Indexed: 12/26/2022]
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19
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Gemtuzumab Ozogamicin Containing Chemotherapy for Relapsed or Refractory Acute Myeloid Leukemia (AML) in Children. J Pediatr Hematol Oncol 2018; 40:163-168. [PMID: 29240026 DOI: 10.1097/mph.0000000000001010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Paubelle E, Ducastelle-Leprêtre S, Labussière-Wallet H, Nicolini FE, Barraco F, Plesa A, Salles G, Wattel E, Thomas X. Fractionated gemtuzumab ozogamicin combined with intermediate-dose cytarabine and daunorubicin as salvage therapy in very high-risk AML patients: a bridge to reduced intensity conditioning transplant? Ann Hematol 2016; 96:363-371. [DOI: 10.1007/s00277-016-2899-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022]
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22
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Peterlin P, Guillaume T, Delaunay J, Mohty M, Garnier A, Mahe B, Dubruille V, Blin N, Voldoire M, Touzeau C, Chauvin C, Gastinne T, Béné MC, Le Gouill S, Moreau P, Chevallier P. Similarity of fractionated versus single dose(s) of gemtuzumab ozogamicin as part of the MIDAM salvage regimen in relapsed/refractory acute myeloid leukemia patients. Semin Hematol 2016; 53:216-7. [PMID: 27496314 DOI: 10.1053/j.seminhematol.2016.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Pierre Peterlin
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France.
| | - Thierry Guillaume
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Jacques Delaunay
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Mohamad Mohty
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France; Centre de recherche Saint-Antoine, INSERM, UMRs 938, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Alice Garnier
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Beatrice Mahe
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Viviane Dubruille
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Nicolas Blin
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Maud Voldoire
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Cyrille Touzeau
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Cecile Chauvin
- Centre Hospitalier et Universitaire (CHU), Pharmacie Clinique Oncologique Nantes, France
| | - Thomas Gastinne
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Marie C Béné
- Centre Hospitalier et Universitaire (CHU), Service d'hématologie biologique, Nantes, France
| | - Steven Le Gouill
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Philippe Moreau
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
| | - Patrice Chevallier
- Centre Hospitalier et Universitaire (CHU) de Nantes, Département d'Hématologie Clinique, Centre d׳Investigation Clinique en Cancérologie (CI2C), France
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Bergua JM, Montesinos P, Martinez-Cuadrón D, Fernández-Abellán P, Serrano J, Sayas MJ, Prieto-Fernandez J, García R, García-Huerta AJ, Barrios M, Benavente C, Pérez-Encinas M, Simiele A, Rodríguez-Macias G, Herrera-Puente P, Rodríguez-Veiga R, Martínez-Sánchez MP, Amador-Barciela ML, Riaza-Grau R, Sanz MA. A prognostic model for survival after salvage treatment with FLAG-Ida +/− gemtuzumab-ozogamicine in adult patients with refractory/relapsed acute myeloid leukaemia. Br J Haematol 2016; 174:700-10. [DOI: 10.1111/bjh.14107] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 02/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Juan M. Bergua
- Department of Haematology; Hospital San Pedro de Alcántara; Cáceres Spain
| | - Pau Montesinos
- Department of Haematology; University Hospital La Fe; Valencia Spain
| | | | | | | | - María J. Sayas
- Department of Haematology; Hospital Doctor Peset; Valencia Spain
| | | | - Raimundo García
- Department of Haematology; General Hospital Castellón; Castellón Spain
| | | | - Manuel Barrios
- Department of Haematology; Hospital Carlos Haya; Málaga Spain
| | | | | | | | | | | | | | | | | | | | - Miguel A. Sanz
- Department of Haematology; University Hospital La Fe; Valencia Spain
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Hütter-Krönke ML, Benner A, Döhner K, Krauter J, Weber D, Moessner M, Köhne CH, Horst HA, Schmidt-Wolf IGH, Rummel M, Götze K, Koller E, Petzer AL, Salwender H, Fiedler W, Kirchen H, Haase D, Kremers S, Theobald M, Matzdorff AC, Ganser A, Döhner H, Schlenk RF. Salvage therapy with high-dose cytarabine and mitoxantrone in combination with all-trans retinoic acid and gemtuzumab ozogamicin in acute myeloid leukemia refractory to first induction therapy. Haematologica 2016; 101:839-45. [PMID: 27036160 DOI: 10.3324/haematol.2015.141622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 03/24/2016] [Indexed: 12/29/2022] Open
Abstract
Outcome of patients with primary refractory acute myeloid leukemia remains unsatisfactory. We conducted a prospective phase II clinical trial with gemtuzumab ozogamicin (3 mg/m(2) intravenously on day 1), all-trans retinoic acid (45 mg/m(2) orally on days 4-6 and 15 mg/m(2) orally on days 7-28), high-dose cytarabine (3 g/m(2)/12 h intravenously on days 1-3) and mitoxantrone (12 mg/m(2) intravenously on days 2-3) in 93 patients aged 18-60 years refractory to one cycle of induction therapy. Primary end point of the study was response to therapy; secondary end points included evaluation of toxicities, in particular, rate of sinusoidal obstruction syndrome after allogeneic hematopoietic cell transplantation. Complete remission or complete remission with incomplete blood count recovery was achieved in 47 (51%) and partial remission in 10 (11%) patients resulting in an overall response rate of 61.5%; 33 (35.5%) patients had refractory disease and 3 patients (3%) died. Allogeneic hematopoietic cell transplantation was performed in 71 (76%) patients; 6 of the 71 (8.5%) patients developed moderate or severe sinusoidal obstruction syndrome after transplantation. Four-year overall survival rate was 32% (95% confidence interval 24%-43%). Patients responding to salvage therapy and undergoing allogeneic hematopoietic cell transplantation (n=51) had a 4-year survival rate of 49% (95% confidence intervaI 37%-64%). Patients with fms-like tyrosine kinase internal tandem duplication positive acute myeloid leukemia had a poor outcome despite transplantation. In conclusion, the described regimen is an effective and tolerable salvage therapy for patients who are primary refractory to one cycle of conventional intensive induction therapy. (clinicaltrials.gov identifier: 00143975).
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Affiliation(s)
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital Ulm, Germany
| | - Jürgen Krauter
- Department of Oncology and Hematology, Klinikum Braunschweig, Germany Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany
| | - Daniela Weber
- Department of Internal Medicine III, University Hospital Ulm, Germany
| | - Margit Moessner
- Department of Internal Medicine III, University Hospital Ulm, Germany
| | | | - Heinz A Horst
- Department of Internal Medicine II, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | | | - Mathias Rummel
- Department of Hematology/Oncology, University-hospital Giessen, Germany
| | - Katharina Götze
- Department of Internal Medicine III, Technical University of Munich, Germany
| | - Elisabeth Koller
- Department of Hematology/Oncology, Hanuschkrankenhaus, Wien, Austria
| | - Andreas L Petzer
- Department of Medical Oncology and Hematology, Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | - Hans Salwender
- Department of Hematology/Oncology, Asklepios Klinik Altona, Hamburg, Germany
| | - Walter Fiedler
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heinz Kirchen
- Department of Hematology/Oncology, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Detlef Haase
- Department of Hematology and Oncology, Georg-August-University Hospital of Göttingen, Germany
| | - Stephan Kremers
- Department of Hematology/Oncology, Caritas-Krankenhaus, Lebach, Germany
| | - Matthias Theobald
- Department of Medicine III, Johannes Gutenberg-University Mainz, Germany
| | - Axel C Matzdorff
- Department of Hematology/Oncology, Caritas-Krankenhaus, Saarbrücken, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital Ulm, Germany
| | - Richard F Schlenk
- Department of Internal Medicine III, University Hospital Ulm, Germany
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25
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Kell J. The addition of gemtuzumab ozogamicin to chemotherapy in adult patients with acute myeloid leukemia. Expert Rev Anticancer Ther 2016; 16:377-82. [PMID: 26942450 DOI: 10.1586/14737140.2016.1162099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The treatment of acute myeloid leukaemia has remained largely unchanged for the last 30 years since the advent of combination chemotherapy with cytarabine arabinoside and daunorubicin with remission rates around 70% but with long term survival still only around 40% in young adults. Doses of chemotherapy have been pushed to the limit of toxicity. Gemtuzumab ozogamicin allows additional chemotherapy to be delivered to the leukaemic cells without significantly adding to toxicity since the active agent is coupled to a monoclonal anti-CD33 antibody. It was approved by the FDA in 2000 for the treatment of elderly patients with relapsed CD33 positive AML at a dose of 9mg/m(2) on two days two weeks apart. Almost at once, questions were raised about its safety, with a particular liver signal, and it was voluntarily withdrawn from practice in 2010. Many groups have been examining the role of gemtuzumab ozogamicin in combination with chemotherapy, usually at lower doses than originally recommended, with varying degrees of success and toxicity and gemtuzumab ozogamicin is now entering a period of rehabilitation. Currently it is only commercially available in Japan although it is currently also available in the UK Bloodwise AML18 study.
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Affiliation(s)
- Jonathan Kell
- a Department of Haematology , University Hospital of Wales , Cardiff , UK
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26
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The level of blast CD33 expression positively impacts the effect of gemtuzumab ozogamicin in patients with acute myeloid leukemia. Blood 2016; 127:2157-60. [PMID: 26929274 DOI: 10.1182/blood-2016-01-689976] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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How I treat refractory and early relapsed acute myeloid leukemia. Blood 2015; 126:319-27. [DOI: 10.1182/blood-2014-10-551911] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/02/2015] [Indexed: 12/19/2022] Open
Abstract
AbstractBetween 10% and 40% of newly diagnosed patients with acute myeloid leukemia (AML) do not achieve complete remission with intensive induction therapy and are therefore categorized as primary refractory or resistant. Few of these patients can be cured with conventional salvage therapy. They need to be evaluated regarding eligibility for allogeneic hematopoietic stem cell transplantation (HSCT) as this is currently the treatment with the highest probability of cure. To reduce the leukemia burden prior to transplantation, salvage chemotherapy regimens need to be employed. Whenever possible, refractory/relapsed patients should be enrolled in clinical trials as we do not have highly effective and standardized treatments for this situation. Novel therapies include tyrosine kinase inhibitors, small-molecule inhibitors (eg, for Polo-like kinase 1 and aminopeptidase), inhibitors of mutated isocitrate dehydrogenase (IDH) 1 and IDH2, antibody-based therapies, and cell-based therapies. Although the majority of these therapies are still under evaluation, they are likely to enter clinical practice rapidly as a bridge to transplant and/or in older, unfit patients who are not candidates for allogeneic HSCT. In this review, we describe our approach to refractory/early relapsed AML, and we discuss treatment options for patients with regard to different clinical conditions and molecular profiles.
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Todaro J, Bollmann PW, Rother ET, del Giglio A. Azacitidine and lenalidomide as an alternative treatment for refractory acute myeloid leukemia: a case report. SAO PAULO MED J 2015; 133:271-4. [PMID: 25250799 PMCID: PMC10876374 DOI: 10.1590/1516-3180.2012.6790006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 02/20/2013] [Accepted: 05/08/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Refractory acute myeloid leukemia (AML) is a difficult disease to control with second or third-line chemotherapy regimens. In this report, we describe using azacitidine in combination with lenalidomide as salvage therapy. CASE REPORT 52-year-old female was diagnosed with refractory AML and high-risk cytogenetics: complex monosomal karyotype consisting of t (3, 3) in association with monosomy 7 and del 5q. Morphological remission associated with maintenance of the cytogenetic abnormality of chromosome 3 and disappearance of the abnormalities relating to chromosomes 5 and 7 was achieved after three cycles of combination therapy with azacitidine and lenalidomide. CONCLUSION Azacitidine plus lenalidomide can be a therapeutic option for patients with refractory AML, as illustrated in this case.
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Affiliation(s)
- Juliana Todaro
- MD. Assistant Professor, Discipline of Hematology and Oncology, Faculdade de Medicina do ABC (FMABC), Santo André, and Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
| | - Patrícia Weinschenker Bollmann
- MSc. Assistant Professor, Discipline of Hematology and Oncology, Faculdade de Medicina do ABC (FMABC), Santo André, and Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
| | - Edna Terezinha Rother
- Librarian, Institute of Education and Research, Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
| | - Auro del Giglio
- MD, PhD. Full Professor, Discipline of Hematology and Oncology, Faculdade de Medicina do ABC (FMABC), Santo André, and Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
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29
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Collin JF, Wells JW, Czepulkowski B, Lyne L, Duriez PJ, Banham AH, Mufti GJ, Guinn BA. A novel zinc finger gene, ZNF465, is inappropriately expressed in acute myeloid leukaemia cells. Genes Chromosomes Cancer 2015; 54:288-302. [PMID: 25706801 DOI: 10.1002/gcc.22242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 01/12/2015] [Indexed: 11/08/2022] Open
Abstract
To increase our knowledge of leukaemia-associated antigens, especially in acute myeloid leukaemia (AML) M4, we prepared a phage display cDNA library using mRNA from the bone marrow cells of a patient with AML M4 at diagnosis. We immunoscreened 10(6) pfu with autologous sera and identified an antigen which we named GKT-AML8. The cDNA showed more than 99% similarity to a sequence on 2q21.2 and 95% sequence similarity to a sequence on 19q13.3. These genes were named ZNF465 and ZNF466, respectively, following HUGO Gene Nomenclature Committee (HGNC) guidelines. Expressed sequence tag data suggests that both genes are transcriptionally active. ZNF465 and ZNF466 encode a 5' krüppel associated box domain typical of negative regulators of gene transcription. We have confirmed the translational start site in the +1 frame in a near-Kozak sequence that produces a 102 amino acid polypeptide from ZNF465. The high level of sequence similarity between ZNF465 and ZNF466 makes their transcripts almost indistinguishable by real-time polymerase chain reaction (RT-PCR). However, GKT-AML8 showed most sequence similarity to ZNF465 and no transcript matching the 3' ZNF466 sequence could be detected in patient samples or healthy volunteers. ZNF465/466 expression was detectable in 12/13 AML and 10/14 chronic myeloid leukaemia patients' samples but not in normal donor peripheral blood (0/8) or 0/3 bone marrow samples which had been separated into CD34(+) and CD34(-) samples. The altered expression of ZNF465/466 in patients' samples and its absence in healthy donor haematopoietic samples indicate that ZNF465 is overexpressed in early myeloid disease and as such may represent a promising target for immunotherapy.
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Affiliation(s)
- Joseph F Collin
- Department of Haematological Medicine, Guy's, King's and St. Thomas' School of Medicine, King's College London, The Rayne Institute, London, UK
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Chantepie SP, Reboursiere E, Mear JB, Gac AC, Salaun V, Benabed K, Cheze S, Johnsonansah H, Macro M, Vilque JP, Reman O. Gemtuzumab ozogamicin in combination with intensive chemotherapy in relapsed or refractory acute myeloid leukemia. Leuk Lymphoma 2015; 56:2326-30. [PMID: 25393676 DOI: 10.3109/10428194.2014.986478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prognosis of refractory/relapsed acute myeloid leukemia (AML) remains poor. The complete response (CR) rate after relapse is around 25%, with 11% of patients still alive after 5 years. The efficacy and toxicity of fractionated gemtuzumab ozogamicin (fGO; 3 mg/m2, days 1, 4, 7) in combination with intensive chemotherapy were retrospectively evaluated in patients with refractory/relapsed AML. Thirty-six patients (median age 54 years) were included. European LeukemiaNet classification was as follows: favorable (n=6), intermediate-I (n=13), intermediate-II (n=8), adverse (n=9). Median CR duration was 7.16 months (1.63-96.8). The overall response rate was 38.8%, with CR in eight patients (22.2%) and CR with incomplete platelet recovery (CRp) in six patients (16.7%). Two-year overall survival was 26% (95% confidence interval [CI]: 12-42) and 2-year relapse free-survival was 18.5% (95% CI: 6.6-35.0). Salvage therapy with fractionated GO in patients with very high-risk disease produced a 38.8% response rate and may be considered as a bridge therapy to transplant.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jean-Pierre Vilque
- c Department of Hematology , François Baclesse Cancer Center , Caen , France
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31
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Koren-Michowitz M, Maayan H, Apel A, Shem-Tov N, Yerushalmi R, Volchek Y, Avigdor A, Shimoni A, Nagler A. Salvage therapy with ARA-C and gemtuzumab ozogamicin in AML patients relapsing after stem cell transplantation. Ann Hematol 2014; 94:375-8. [DOI: 10.1007/s00277-014-2229-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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Abstract
INTRODUCTION Gemtuzumab ozogamicin (GO) is a combination of calicheamicin and a recombinant humanized IgG4 antibody directed against CD33. From 2000 to 2010, it was approved by the FDA for treatment of relapsed, older patients with CD33(+) acute myeloid leukemia (AML). After withdrawal from the market, several trials have provided new evidence on the safety and clinical efficacy of GO. AREAS COVERED In this review, we discuss pharmacological and clinical aspects of GO. GO was found to show benefit in AML patients as adjunct to intensive chemotherapy when it was given in parallel to induction therapy. The benefit was restricted to patients with a favorable- or an intermediate-risk cytogenetic profile. Higher doses of GO above 6 mg/m(2) per administration were associated with increased toxicity without survival benefit, whereas repetitive doses of 3 mg/m(2) resulting in cumulative doses of 9 mg/m(2) were well tolerated. Predictive markers for response to GO other than the cytogenetic profile and P-glycoprotein activity are still missing. EXPERT OPINION GO as adjunct and in parallel to intensive induction chemotherapy does significantly improve survival end points in AML patients with favorable/intermediate-risk cytogenetics. A dose of 3 mg/m(2) per administration appears safer compared with 6 mg/m(2) and even 9 mg/m(2).
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Affiliation(s)
- Felicitas Thol
- Hannover Medical School, Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation , Carl-Neuberg-Str. 1, 30625, Hannover , Germany
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33
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Guenounou S, Delabesse E, Récher C. Sorafenib plus all-trans retinoic acid for AML patients withFLT3-ITDandNPM1mutations. Eur J Haematol 2014; 93:533-6. [DOI: 10.1111/ejh.12334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Sarah Guenounou
- Service d'Hématologie; Centre Hospitalier Universitaire de Toulouse; Hôpital Purpan; Toulouse France
| | - Eric Delabesse
- Université Toulouse III Paul Sabatier; Toulouse France
- Laboratoire d'Hématologie; Centre Hospitalier Universitaire de Toulouse; Hôpital Purpan; Toulouse France
| | - Christian Récher
- Service d'Hématologie; Centre Hospitalier Universitaire de Toulouse; Hôpital Purpan; Toulouse France
- Université Toulouse III Paul Sabatier; Toulouse France
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Abstract
Survival rates for children with acute myeloid leukemia (AML) exceed 60 % when modern, intensified chemotherapeutic regimens and enhanced supportive care measures are employed. Despite well-recognized improvements in outcomes, primary refractory or relapsed pediatric AML yields significant morbidity and mortality, and improved understanding of this obstinate population along with refined treatment protocols are urgently needed. Although a significant number of patients with refractory or relapsed disease will achieve remission, long-term survival rates remain poor, and efforts to identify therapies which will improve OS are under continuous investigation. The current fundamental goal of such investigation is the achievement of as complete a remission as possible without dose-limiting toxicities, and the progression to hematopoietic stem cell transplantation thereafter. In this review the scope of the problem of relapsed and refractory AML as well as current and emerging chemotherapy options will be discussed.
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35
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Pilorge S, Rigaudeau S, Rabian F, Sarkozy C, Taksin AL, Farhat H, Merabet F, Ghez S, Raggueneau V, Terré C, Garcia I, Renneville A, Preudhomme C, Castaigne S, Rousselot P. Fractionated gemtuzumab ozogamicin and standard dose cytarabine produced prolonged second remissions in patients over the age of 55 years with acute myeloid leukemia in late first relapse. Am J Hematol 2014; 89:399-403. [PMID: 24375467 DOI: 10.1002/ajh.23653] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/02/2013] [Accepted: 12/19/2013] [Indexed: 11/08/2022]
Abstract
Gemtuzumab ozogamicin (fGO), a humanized anti-CD33 monoclonal antibody linked to calicheamicin in combination with intensive chemotherapy gives high response rates in adult acute myeloid leukemia (AML) patients in relapse. However, reduced intensity chemotherapy in combination with fractionated GO has not been tested in aged relapsing patients. Patients from our institution with CD33+ AML aged 55 years or more in first late relapse (≥ 6 months) were proposed participation in a GO compassionate use program. Induction therapy consisted in fractionated GO (fGO; 3 mg/m², days 1, 4, 7) with standard-dose cytarabine (200 mg/m² /day, 7 days). Patients were consolidated with two courses of GO and intermediate dose cytarabine. Twenty-four patients (median age 68 years) received fGO with cytarabine. Median follow-up was 42 months. The response rate was 75%, including complete remission (CR) in 16 patients and CR with incomplete platelet recovery (CRp) in two patients. Two-year overall survival (OS) was 51% (95% CI: 28-69) and 2 years relapse-free survival (RFS) was 51% (95%CI: 25-72). Duration of second CR (CR2) was longer than first CR (CR1) in 9 out of 18 patients. Minimal residual disease (MRD) was negative in evaluable patients in CR2, particularly in NPM1 mutated cases. Toxicity was in line with that of the same fractionated single agent GO schedule. Fractionated GO with low intensity chemotherapy produced high response rates and prolonged CR2 in aged AML patients in first late relapse.
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Affiliation(s)
- Sylvain Pilorge
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | - Sophie Rigaudeau
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | - Florence Rabian
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | - Clémentine Sarkozy
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | - Anne L. Taksin
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | - Hassan Farhat
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | - Fathia Merabet
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | - Stéphanie Ghez
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
| | | | - Christine Terré
- Département de Biologie Médicale; Hôpital André Mignot; Le Chesnay France
| | - Isabelle Garcia
- Département de Biologie Médicale; Hôpital André Mignot; Le Chesnay France
| | - Aline Renneville
- Laboratoire d'Hématologie, Centre de Biologie-Pathologie CHRU Lille, Université de Lille; Lille France
| | - Claude Preudhomme
- Laboratoire d'Hématologie, Centre de Biologie-Pathologie CHRU Lille, Université de Lille; Lille France
| | - Sylvie Castaigne
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
- Université Versailles Saint-Quentin-en-Yvelines; Versailles France
| | - Philippe Rousselot
- Service d'Hématologie et d'Oncologie; Hôpital André Mignot; Le Chesnay France
- Université Versailles Saint-Quentin-en-Yvelines; Versailles France
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36
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Intérêt du gemtuzumab ozogamicin dans les leucémies aiguës myéloïdes. Bull Cancer 2014; 101:211-8. [DOI: 10.1684/bdc.2014.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Outcomes of adults with active or progressive hematological malignancies at the time of allo-SCT: a survey from the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC). Bone Marrow Transplant 2013; 49:361-5. [PMID: 24292522 DOI: 10.1038/bmt.2013.186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/11/2013] [Accepted: 09/26/2013] [Indexed: 11/08/2022]
Abstract
Previous data suggested that allo-SCT might be an effective therapy in the setting of chemo-refractory/relapsed diseases because of the potent long-term immune-mediated tumor control. This retrospective study aimed to analyze the outcome of adult patients who received allo-SCT in a chemo-refractory/relapsed status. The series included 840 patients with active or progressive disease at the time of transplant. Median age was 50 years. With a median follow-up of 40 months, 3-year OS, disease-free survival (DFS), and non-relapse mortality rates were 29±2, 23±2, and 30±2%, respectively. At the last follow-up, 252 patients (30%) were still alive (of whom 201 were in CR (24%). In a Cox multivariate analysis, the use of a reduced-intensity conditioning (RIC) before allo-SCT and use of an HLA-identical sibling donor remained independently associated with a better OS (hazard ratio (HR)=0.82; 95% confidence interval (CI), 0.69-0.98, P=0.03; and HR=0.79; 95% CI, 0.66-0.93, P=0.006, respectively). Also, a diagnosis of myelodysplastic syndrome/myeloproliferative disorder, Hodgkin lymphoma and non-Hodgkin lymphoma compared with acute leukemia had a favorable impact on OS (HR=0.55; 95% CI, 0.45-0.68, P<0.0001; HR=0.49; 95% CI, 0.31-0.75, P=0.001; and HR=0.47; 95% CI, 0.35-0.63, P<0.0001, respectively). In conclusion, this study suggests that allo-SCT may be of benefit in some subgroups of patients with active or progressive hematological malignancies at the time of allo-SCT.
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38
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Sarkozy C, Gardin C, Gachard N, Merabet F, Turlure P, Malfuson JV, Pautas C, Micol JB, Thomas X, Quesnel B, Celli-Lebras K, Preudhomme C, Terré C, Fenaux P, Chevret S, Castaigne S, Dombret H. Outcome of older patients with acute myeloid leukemia in first relapse. Am J Hematol 2013; 88:758-64. [PMID: 23749683 DOI: 10.1002/ajh.23498] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/10/2022]
Abstract
To provide data for future drug evaluation, we analyzed the outcome of 393 patients aged 50 years or older (median, 64 years) with AML in first relapse after treatment in recent ALFA trials. Salvage options were retrospectively classified as follows: best supportive care (BSC), low-dose cytarabine (LDAC), gemtuzumab ozogamicin (GO), intensive chemotherapy (ICT), or ICT combined with GO. Second complete remission (CR2) rate was 31% and median post-relapse survival was 6.8 months (0, 17, 42.5, 53, and 80% and 3.2, 5.6, 8.9, 9, and 19.8 months in BSC, LDAC, GO, ICT, and ICT + GO subsets, respectively). Age, performance status, WBC, CR1 duration, and favorable AML karyotype, but not other cytogenetic or molecular features, influenced post-relapse outcome. Multivariate adjustment and propensity score matching showed that intensive salvage (ICT/ICT+GO/GO versus LDAC/BSC) was associated with longer post-relapse survival, at least in patients with CR1 duration ≥12 months (P = 0.001 and 0.0005, respectively). Of interest, GO appeared to be as effective as standard ICT, and ICT + GO combination more effective than standard ICT. In conclusion, older patients with CR1 duration ≥12 months appeared to benefit from intensive salvage and results observed with GO-containing salvage suggest that GO combination studies should be actively pursued in this setting.
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Affiliation(s)
| | - Claude Gardin
- Hematology Department, Hôpital Avicenne, AP-HP; University Paris 13; Bobigny; France
| | - Nathalie Gachard
- Hematology Department, Hôpital Dupuytren; University Limoges; Limoges; France
| | - Fathia Merabet
- Hematology Department, Hôpital Mignot; University Versailles - Saint Quentin; Le Chesnay; France
| | - Pascal Turlure
- Hematology Department, Hôpital Dupuytren; University Limoges; Limoges; France
| | | | - Cécile Pautas
- Hematology Department, Hôpital Henri Mondor, AP-HP; University Paris 12; Créteil; France
| | - Jean-Baptiste Micol
- Hematology Department, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris (AP-HP); University Paris 7; EA 3518; Paris; France
| | - Xavier Thomas
- Hematology Department; Hôpital Lyon Sud; Pierre-Bénite; France
| | - Bruno Quesnel
- Hematology Department, Hôpital Claude Huriez; University Lille; Lille; France
| | - Karine Celli-Lebras
- Hematology Department, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris (AP-HP); University Paris 7; EA 3518; Paris; France
| | - Claude Preudhomme
- Hematology Department, Hôpital Claude Huriez; University Lille; Lille; France
| | - Christine Terré
- Hematology Department, Hôpital Mignot; University Versailles - Saint Quentin; Le Chesnay; France
| | - Pierre Fenaux
- Hematology Department, Hôpital Avicenne, AP-HP; University Paris 13; Bobigny; France
| | - Sylvie Chevret
- Department of Biostatistics, Hôpital Saint-Louis, AP-HP; University Paris 7; Paris; France
| | - Sylvie Castaigne
- Hematology Department, Hôpital Mignot; University Versailles - Saint Quentin; Le Chesnay; France
| | - Hervé Dombret
- Hematology Department, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris (AP-HP); University Paris 7; EA 3518; Paris; France
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Tsunemine H, Takahashi T. Gemtuzumab ozogamicin in the treatment of adult acute myeloid leukemia. Health (London) 2013. [DOI: 10.4236/health.2013.55a002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ara-C, Idarubicine and Gentuzumab Ozogamicin (AIM) as Salvage Treatment in Advanced Acute Myeloid Leukemia Patients. Mediterr J Hematol Infect Dis 2012. [PMID: 23205260 PMCID: PMC3507532 DOI: 10.4084/mjhid.2012.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Long-term survival of relapsed/refractory acute myeloid leukemia (AML) remains a major problem, particularly in patients not eligible for transplantation. We hereby evaluated the feasibility and efficacy of adding Gemtuzumab Ozogamicin to salvage chemotherapy (Ara-C, Idarubicine, Peg-Filgrastim) in relapsed/refractory AML. The main endpoints were: the rate of complete remissions (CR) and the proportion of patients capable of undergoing a stem cell transplant. Fourty-two patients were enrolled. The overall CR rate was 76% and no induction deaths were reported. In 56% of patients, a transplant procedure could be performed. The treatment schedule proved feasible and well tolerated, providing a high CR rate and a useful bridge to transplant.
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Devillier R, Crocchiolo R, Etienne A, Prebet T, Charbonnier A, Fürst S, El-Cheikh J, D'Incan E, Rey J, Faucher C, Blaise D, Vey N. Outcome of relapse after allogeneic stem cell transplant in patients with acute myeloid leukemia. Leuk Lymphoma 2012; 54:1228-34. [PMID: 23082952 DOI: 10.3109/10428194.2012.741230] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although allogeneic stem cell transplant (Allo-SCT) is an effective treatment for high-risk acute myeloid leukemia (AML), relapses remain a major cause of treatment failure. There is currently no standard of care for post-transplant relapse of AML, but the increasing numbers of investigational agents in this setting require a better knowledge of their outcome. We retrospectively evaluated the efficacy of salvage therapies in 54 patients with AML relapsing after Allo-SCT. Twenty-four patients received intensive salvage treatment (17 non-intensive chemotherapy, 13 supportive care). Complete remissions (CRs) were seen only in the group who received intensive salvage (CR rate: 17/24 [71%]). One-year overall survival was 19% (median: 3.4 months) in the whole study group and 33% in the intensive savage group (vs. 7% for patients without intensive salvage, p = 0.004). Factors influencing overall survival (OS) were: time to relapse after Allo-SCT (hazard ratio [HR]: 3.7 [1.6-8.8]) and performance status (PS) at relapse (HR: 2.2 [1.1-4.4]) by multivariate analysis. Our results confirm the poor prognosis of AML relapse after Allo-SCT. In selected patients salvage chemotherapy produces CRs, but these are short lived. Other strategies aiming at modulating immune antileukemic activity have to be developed.
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Pfeiffer T, Schleuning M, Mayer J, Haude KH, Tischer J, Buchholz S, Bunjes D, Bug G, Holler E, Meyer RG, Greinix H, Scheid C, Christopeit M, Schnittger S, Braess J, Schlimok G, Spiekermann K, Ganser A, Kolb HJ, Schmid C. Influence of molecular subgroups on outcome of acute myeloid leukemia with normal karyotype in 141 patients undergoing salvage allogeneic stem cell transplantation in primary induction failure or beyond first relapse. Haematologica 2012; 98:518-25. [PMID: 22983588 DOI: 10.3324/haematol.2012.070235] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Based on molecular aberrations, in particular the NPM1 mutation (NPM1(mut)) and the FLT3 internal tandem duplication (Flt3-ITD), prognostic subgroups have been defined among patients with acute myeloid leukemia with normal karyotype. Whereas these subgroups are known to play an important role in outcome in first complete remission, and also in the indication for allogeneic stem cell transplantation, data are limited on their role after transplantation in advanced disease. To evaluate the role of molecular subgroups of acute myeloid leukemia with normal karyotype after allogeneic stem cell transplantation beyond first complete remission, we analyzed the data from 141 consecutive adults (median age: 51.0 years, range 18.4-69.3 years) who had received an allogeneic transplant either in primary induction failure or beyond first complete remission. A sequential regimen of cytoreductive chemotherapy (fludarabine, high-dose AraC, amsacrine) followed by reduced intensity conditioning (FLAMSA-RIC), was uniformly used for conditioning. After a median follow up of three years, overall survival from transplantation was 64 ± 4%, 53 ± 4% and 44 ± 5% at one, two and four years, respectively. Forty patients transplanted in primary induction failure achieved an encouraging 2-year survival of 69%. Among 101 patients transplanted beyond first complete remission, 2-year survival was 81% among patients with the NPM1(mut)/FLT3(wt) genotype in contrast to 43% in other genotypes. Higher numbers of transfused CD34(+) cells (hazard ratio 2.155, 95% confidence interval 0.263-0.964, P=0.039) and favorable genotype (hazard ratio 0.142, 95% confidence interval: 0.19-0.898, P=0.048) were associated with superior overall survival in multivariate analysis. In conclusion, patients with acute myeloid leukemia with normal karyotype can frequently be rescued after primary induction failure by allogeneic transplantation following FLAMSA-RIC. The prognostic role of NPM1(mut)/FLT3-ITD based subgroups was carried through after allogeneic stem cell transplantation beyond first complete remission.
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Affiliation(s)
- Tim Pfeiffer
- Department of Hematology and Oncology, Klinikum Augsburg, Germany
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Tanimoto T, Tsubokura M, Mori J, Pietrek M, Ono S, Kami M. Differences in drug approval processes of 3 regulatory agencies: a case study of gemtuzumab ozogamicin. Invest New Drugs 2012; 31:473-8. [PMID: 22965890 DOI: 10.1007/s10637-012-9877-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/30/2012] [Indexed: 11/29/2022]
Abstract
Major discrepancies concerning risk-benefit assessments and regulatory actions are frequent among regulatory agencies. We explored the differences by scrutinizing a case of gemtuzumab ozogamicin (GO) in patients with acute myeloid leukaemia (AML). Assessment reports of GO were retrieved form the websites of the US Food and Drug Administration (FDA), the European Medicines Agency (EMA) and Japanese regulatory agency, and we also reviewed published clinical trials. While GO was approved by the US FDA under the accelerated approval program in 2000, it was withdrawn from the market in 2010, based on the required post-marketing commitment failure. The EMA refused granting marketing authorization for GO in 2008 on the grounds that there were no randomised controlled trials (RCTs). GO was approved as an orphan drug in Japan in 2005, and the Japanese regulatory authority decided to continue with the approval in 2010 on the condition that post-marketing surveillance is strengthened. Under these situations, promising new results of RCTs appeared in 2011, and the role of GO in AML treatment was refocused worldwide. The stringent regulation may not be suitable in case of an orphan drug of targeted therapy, and more room should be kept to facilitate effective developments of new anti-neoplastic agents.
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Affiliation(s)
- Tetsuya Tanimoto
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, 108-8639, Shirokanedai 4-6-1, Tokyo, Japan.
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Fractionated doses of gemtuzumab ozogamicin combined with 3 + 7 induction chemotherapy as salvage treatment for young patients with acute myeloid leukemia in first relapse. Ann Hematol 2012; 91:1871-7. [DOI: 10.1007/s00277-012-1528-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/12/2012] [Indexed: 02/07/2023]
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Rao AV, Rizzieri DA, DeCastro CM, Diehl LF, Lagoo AS, Moore JO, Gockerman JP. Phase I study of dose dense induction and consolidation with gemtuzumab ozogamicin and high dose cytarabine in older adults with AML. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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O'Brien S, Rizzieri DA, Vey N, Ravandi F, Krug UO, Sekeres MA, Dennis M, Venditti A, Berry DA, Jacobsen TF, Staudacher K, Bergeland T, Giles FJ. Elacytarabine has single-agent activity in patients with advanced acute myeloid leukaemia. Br J Haematol 2012; 158:581-8. [PMID: 22702906 DOI: 10.1111/j.1365-2141.2012.09186.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/03/2012] [Indexed: 01/14/2023]
Abstract
Elacytarabine is a novel cytotoxic nucleoside analogue, independent of nucleoside transporters (e.g. human Equilibrative Nucleoside Transporter 1 [hENT1]) for cell uptake, and mechanisms of action similar to those of cytarabine. This Phase II study assessed the efficacy and safety of elacytarabine in patients with advanced stage acute myeloid leukaemia (AML). Patients received 2000 mg/m(2) per d continuously i.v. during days 1-5 every 3 weeks. Patients were matched by six risk factors with historical controls; remission rate (assessed after 1 or 2 cycles) and 6-month survival were compared. Sixty-one patients, median age 58 years, were enrolled; 52% had five or six risk factors. The remission rate was 18% (95% confidence interval: 9-30%) vs. 4% in controls (P < 0·0001), 6-month survival rate was 43%, median overall survival was 5·3 months (vs. 1·5 months); 10 patients (16%) were referred for stem cell transplantation after treatment. Side effects were predictable and manageable. The most common grade 3/4 non-haematological adverse events were febrile neutropenia, hypokalemia, fatigue, hyponatraemia, dyspnoea and pyrexia. Thirty-day all-cause mortality, after start of treatment, was 13% vs. 25% in controls. Elacytarabine has monotherapy activity in patients with advanced AML. This study provides proof-of-concept that lipid esterification of nucleoside analogues is clinically relevant.
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Affiliation(s)
- Susan O'Brien
- Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX 77230, USA.
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Abstract
CD33, a 67-kDa glycoprotein expressed on the majority of myeloid leukemia cells as well as on normal myeloid and monocytic precursors, has been an attractive target for monoclonal antibody (mAb)-based therapy of acute myeloid leukemia (AML). Lintuzumab, an unconjugated, humanized anti-CD33 mAb, has modest single-agent activity against AML but failed to improve patient outcomes in two randomized trials when combined with conventional chemotherapy. Gemtuzumab ozogamicin, an anti-CD33 mAb conjugated to the antitumor antibiotic calicheamicin, improved survival in a subset of AML patients when combined with standard chemotherapy, but safety concerns led to US marketing withdrawal. The activity of these agents confirms that CD33 remains a viable therapeutic target for AML. Strategies to improve the results of mAb-based therapies for AML include antibody engineering to enhance effector function, use of alternative drugs and chemical linkers to develop safer and more effective drug conjugates, and radioimmunotherapeutic approaches.
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Affiliation(s)
- Joseph G Jurcic
- Department of Medicine, Leukemia Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Ricart AD. Antibody-drug conjugates of calicheamicin derivative: gemtuzumab ozogamicin and inotuzumab ozogamicin. Clin Cancer Res 2012; 17:6417-27. [PMID: 22003069 DOI: 10.1158/1078-0432.ccr-11-0486] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antibody-drug conjugates (ADC) are an attractive approach for the treatment of acute myeloid leukemia and non-Hodgkin lymphomas, which in most cases, are inherently sensitive to cytotoxic agents. CD33 and CD22 are specific markers of myeloid leukemias and B-cell malignancies, respectively. These endocytic receptors are ideal for an ADC strategy because they can effectively carry the cytotoxic payload into the cell. Gemtuzumab ozogamicin (GO, Mylotarg) and inotuzumab ozogamicin consist of a derivative of calicheamicin (a potent DNA-binding cytotoxic antibiotic) linked to a humanized monoclonal IgG4 antibody directed against CD33 or CD22, respectively. Both of these ADCs have a target-mediated pharmacokinetic disposition. GO was the first drug to prove the ADC concept in the clinic, specifically in phase II studies that included substantial proportions of older patients with relapsed acute myeloid leukemia. In contrast, in phase III studies, it has thus far failed to show clinical benefit in first-line treatment in combination with standard chemotherapy. Inotuzumab ozogamicin has shown remarkable clinical activity in relapsed/refractory B-cell non-Hodgkin lymphoma, and it has started phase III evaluation. The safety profile of these ADCs includes reversible myelosuppression (especially neutropenia and thrombocytopenia), elevated hepatic transaminases, and hyperbilirubinemia. There have been postmarketing reports of hepatotoxicity, especially veno-occlusive disease, associated with GO. The incidence is ~2%, but patients who undergo hematopoietic stem cell transplantation have an increased risk. As we steadily move toward the goal of personalized medicine, these kinds of agents will provide a unique opportunity to treat selected patient subpopulations based on the expression of their specific tumor targets.
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Affiliation(s)
- Alejandro D Ricart
- Biotechnology Unit and Oncology Clinical Research, Pfizer Inc., San Diego, California, USA.
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Wang ES, Zeidan A, Tan W, Wilding GE, Ford LA, Wallace PK, Hahn TE, Battiwalla M, McCarthy PL, Wetzler M. Cytoreduction with gemtuzumab ozogamicin and cytarabine prior to allogeneic stem cell transplant for relapsed/refractory acute myeloid leukemia. Leuk Lymphoma 2011; 53:2085-8. [DOI: 10.3109/10428194.2011.603450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hütter ML, Schlenk RF. Gemtuzumab ozogamicin in non-acute promyelocytic acute myeloid leukemia. Expert Opin Biol Ther 2011; 11:1369-80. [PMID: 21810061 DOI: 10.1517/14712598.2011.604630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gemtuzumab ozogamicin (GO) has been used in relapsed, refractory and newly diagnosed acute myeloid leukemia (AML) as a single agent and in combination with intensive chemotherapy. Results of recent Phase III trials have led to its withdrawal in the USA although a beneficial effect of GO in genetically defined AML subgroups was evident. AREAS COVERED This review examines the use of GO as a single agent or in combination with intensive chemotherapy in non-acute promyelocytic AML. The literature search was based on publications on GO indexed in the PubMed electronic database and selected meeting abstracts. GO has shown moderate activity as a single agent but promising activity in combination with intensive chemotherapy in refractory or relapsed AML. Relapsed AML defined molecularly by mutant nucleophosmin-1 without concurrent fms-related tyrosine kinase 3 (FLT3) internal tandem duplication seems to benefit most from GO. In newly diagnosed AML two up-front randomized Phase III trials evaluating GO in induction therapy failed to demonstrate an improvement in response and survival. Again, genetically defined subgroups may benefit. EXPERT OPINION Future challenges of personalized therapy in AML will be to integrate the signals from current subgroup analyses underlining the role of GO in genetically defined AML entities.
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Affiliation(s)
- Marie-Luise Hütter
- University of Ulm, Department of Internal Medicine III, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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