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Cummins K, Gill S. Chimeric Antigen Receptor T Cells in Acute Myeloid Leukemia. Hematol Oncol Clin North Am 2023; 37:1125-1147. [PMID: 37442676 DOI: 10.1016/j.hoc.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Up to 30% of patients with acute myeloid leukemia (AML) who undergo chimeric antigen receptor (CAR) T-cell therapy have evidence of response, although trials are highly heterogeneous. These responses are rarely deep or durable. CD123, CD33, and CLL-1 have emerged as the most common targets for CAR T cells in AML. CAR T cells against myeloid antigens cause myeloablation as well as cytokine release syndrome, although neurotoxicity is rarely seen. Future efforts should focus on AML-specific antigen discovery or engineering, and on further enhancing the activity of CAR T cells.
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Affiliation(s)
- Katherine Cummins
- Peter MacCallum Cancer Centre, University of Melbourne, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Saar Gill
- Division of Hematology-Oncology, University of Pennsylvania Perelman School of Medicine, 8-101 Smilow Center for Translational Research, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Lalayanni C, Demosthenous C, Iskas M, Kelaidi C, Papathanasiou M, Syrigou A, Athanasiadou A, Papalexandri A, Batsis I, Vardi A, Polychronopoulou S, Sakellari I. Adolescents and young adults (AYA) with acute myeloid leukemia (AML): real-world long-term results and age-specific outcomes. Leuk Lymphoma 2022; 63:3128-3137. [PMID: 36002396 DOI: 10.1080/10428194.2022.2113527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Opposing acute lymphoblastic leukemia, sparse data about AYAs with acute myeloid leukemia (AML) is available. Overall, 125 AYAs (age 10-35 years) treated during the last two decades were evaluated and compared to 385 older patients. CBF leukemia was more frequent in AYAs (21.6% vs. 8%, p < 0.001); however, many presented high-risk features. AYAs showed improved complete remission rate (CR, 80% vs. 65%, p = 0.01), lower cumulative incidence of relapse and TRM and longer survival (5 year-OS 53% vs. 24%, p < 0.0001), observed mainly in intermediate-risk karyotype. Adolescents displayed even better outcomes (5 year-OS 69%). AlloHCT in CR1 was beneficial for nonadolescent AYAs (5 year-OS 66.7% vs. 44.4% without HCT, p = 0.04). Among 50 APL patients, 19 AYAs experienced better outcomes than older, mainly attributed to reduced treatment-related mortality (TRM, 5% vs. 19%, p = 0.1). We observed an important (>10%) survival gain for AYAs during the last decade. However, AYAs have still unmet needs to obtain optimal cure rates.
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Affiliation(s)
- Chrysavgi Lalayanni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Michail Iskas
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Charikleia Kelaidi
- Department of Pediatric Hematology and Oncology Aghia, Sophia Children's Hospital, Athens, Greece
| | - Maria Papathanasiou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Antonia Syrigou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | | | - Ioannis Batsis
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Anna Vardi
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology and Oncology Aghia, Sophia Children's Hospital, Athens, Greece
| | - Ioanna Sakellari
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
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3
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He P, Liang J, Zhang W, Lin S, Wu H, Li Q, Xu X, Ji C. Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia: An Overview of Systematic Reviews. Int J Clin Pract 2022; 2022:1828223. [PMID: 36277468 PMCID: PMC9568333 DOI: 10.1155/2022/1828223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) has become the main treatment for acute myeloid leukemia (AML) and has been studied in many systematic reviews (SRs), but strong conclusions have not been drawn yet. OBJECTIVE This study aimed to summarize and critically evaluate the methodological and evidence quality of SRs and meta-analysis on this topic. METHODS PubMed, Embase, the Cochrane Library, and Web of Science were searched for SRs/meta-analyses regarding HSCT for AML. Two reviewers assessed the quality of SRs/meta-analyses in line with AMSTAR-2 and evaluated the strength of evidence quality with the grading of the evaluation system (GRADE) for concerned outcomes independently. RESULTS 12 SR/Meta articles were included, and the AMSTAR-2 scale showed that the quality grade of all articles was low or very low. GRADE results showed 29 outcomes, 2 of which were high, 12 were moderate, and 15 were low. Limitations and inconsistency were the most important factors leading to degradation, followed by imprecision and publication bias. Allo-SCT had better OS and DFS benefits than auto-SCT and significantly reduced the relapse in intermediate-risk AML/CR1 patients. Auto-SCT was associated with lower TRM than allo-SCT but generally had higher relapse. The results should be confirmed further for the low or moderate evidence quality. CONCLUSION Current SRs show that allo-SCT in the treatment of AML might improve the OS, RFS, and DFS. Auto-SCT has significantly lower TRM but higher RR. Whether bone marrow transplantation is superior to nonmyeloablative chemotherapy remains to be evaluated. Meanwhile, the quality of methodology needs to be further improved. The intensity of evidence was uneven, and the high-quality evidence of outcomes was lacking. Considering the limitations of our overview, more rigorous and scientific studies are needed to fully explore the efficacy of different interventions of HSCT in AML, and clinicians should be more cautious in the treatment.
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Affiliation(s)
- Peijie He
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, Binwen Road 548#, China
| | - Juan Liang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, Binwen Road 548#, China
| | - Wanjun Zhang
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Youdian Road 46#, China
| | - Shengyun Lin
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Youdian Road 46#, China
| | - Hanting Wu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, Binwen Road 548#, China
| | - Qiushuang Li
- Clinical Evaluation Center, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Youdian Road 46#, China
| | - Xiujuan Xu
- Critical Care Department, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Conghua Ji
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, Binwen Road 548#, China
- Clinical Evaluation Center, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Youdian Road 46#, China
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Allogeneic transplant can abrogate the risk of relapse in the patients of first remission acute myeloid leukemia with detectable measurable residual disease by next-generation sequencing. Bone Marrow Transplant 2020; 56:1159-1170. [PMID: 33279940 DOI: 10.1038/s41409-020-01165-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 11/09/2022]
Abstract
In patients with acute myeloid leukemia (AML) consolidation treatment options are between allogeneic hematopoietic stem cell transplantation (HCT) and chemotherapy, based on disease risk at the time of initial presentation and age. Measurable residual disease (MRD) following induction chemotherapy could be incorporated as a useful parameter for treatment decisions. The present study evaluated treatment outcomes according to the next-generation sequencing (NGS)-based MRD status and the type of consolidation therapy in patients with normal karyotype (NK)-AML. By sequencing 278 paired samples collected at diagnosis and first remission (CR1), we identified 361 mutations in 124 patients at diagnosis and tracked these at CR1. After excluding mutations associated with age-related clonal hematopoiesis, 82 mutations in 50 of the 124 patients (40.3%) were detected at CR1. Survival benefit was observed in favor of allogeneic HCT over chemotherapy consolidation in the MRDpos subgroup with respect to overall survival (HR 0.294, p = 0.003), relapse-free survival (HR 0.376, p = 0.015) and cumulative incidence of relapse (HR 0.279, p = 0.004) in multivariate analysis, but not in the MRDneg subgroup. In summary, these data support allogeneic HCT in NK-AML patients with detectable MRD by NGS in CR1. Randomized clinical trials will be required to confirm this observation.
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Zheng Z, Zhu Y, Li X, Hu W, Jiang J. Impact of marital status during diagnosis on cancer-caused specific survival in acute myeloid leukemia patients: a case-control and population-based study. Oncotarget 2017; 8:62666-62680. [PMID: 28977979 PMCID: PMC5617539 DOI: 10.18632/oncotarget.16989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/28/2017] [Indexed: 12/27/2022] Open
Abstract
Objective This study investigated the impact of marital status on cancer-caused specific mortality among acute myeloid leukemia (AML) patients in the United States. Methods We used the Surveillance, Epidemiology and End Results program to identify 50,825 patients who had their clinical and follow-up information available and were diagnosed for AML between the years 1988 and 2015. The univariate and multivariable Cox regression models were used to analyze the patient data, and to minimize the group differences due to covariates between groups, a 1:1 propensity score matching was used in subsequent subgroup analysis. Results Our study demonstrated that married patients were less likely to die due to AML after adjusting for demographic and clinicopathological variables, than patients with variable unmarried status. Further analysis indicated that widowed, divorced and never married status correlated with poor cancer-cause specific survival than being married in almost all subgroups after being adjusted for the aforementioned variables (P<0.05). However, the difference between married and separated was not apparent. Moreover, similar survival analysis results were also observed in the 1:1 matched subgroups of marital status, but they displayed varied prognostic factors between them. The association of survival benefit with marriage in AML was consistent with the published survival benefit of conventional therapeutic approaches. Conclusion Overall, our study concluded that unmarried AML patients were at greater risk of cancer-specific mortality than married, and thus indicated that physicians should focus on health care strategies that target social support, in order to reduce the cancer-specific mortality in unmarried patients.
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Affiliation(s)
- Zhuojun Zheng
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China
| | - Yuandong Zhu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaodong Li
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China.,Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wenwei Hu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China.,Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jingting Jiang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China
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Wang L, Luo L, Gao Z, Liu SF, Liu CJ, Ma DX, Chen JG, Cao WR, Yin AM, Xu JW, Wang SL, Zhuo DJ, Geng B, Zhao SS, Wang FY, Yang N, Guan LX, Gu ZY, Gao CJ. The diagnostic and prognostic value of interleukin-10 in cerebrospinal fluid for central nervous system lymphoma: a meta-analysis. Leuk Lymphoma 2017; 58:2452-2459. [PMID: 28278715 DOI: 10.1080/10428194.2017.1289523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Li Wang
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Lan Luo
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Zhe Gao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shu-Feng Liu
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Cheng-Jun Liu
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - De-Xun Ma
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Ji-Gang Chen
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Wu-Rui Cao
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Ai-Min Yin
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Jia-Wen Xu
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Song-Lei Wang
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Du-Jun Zhuo
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Bin Geng
- Department of Hematology, Laoshan Branch of No. 401 Hospital of Chinese People’s Liberation Army (PLA), Qingdao, China
| | - Sha-Sha Zhao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Fei-Yan Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Nan Yang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Li-Xun Guan
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Zhen-Yang Gu
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Chun-Ji Gao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
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De Kouchkovsky I, Abdul-Hay M. 'Acute myeloid leukemia: a comprehensive review and 2016 update'. Blood Cancer J 2016; 6:e441. [PMID: 27367478 PMCID: PMC5030376 DOI: 10.1038/bcj.2016.50] [Citation(s) in RCA: 778] [Impact Index Per Article: 97.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 12/13/2022] Open
Abstract
Acute myeloid leukemia (AML) is the most common acute leukemia in adults, with an incidence of over 20 000 cases per year in the United States alone. Large chromosomal translocations as well as mutations in the genes involved in hematopoietic proliferation and differentiation result in the accumulation of poorly differentiated myeloid cells. AML is a highly heterogeneous disease; although cases can be stratified into favorable, intermediate and adverse-risk groups based on their cytogenetic profile, prognosis within these categories varies widely. The identification of recurrent genetic mutations, such as FLT3-ITD, NMP1 and CEBPA, has helped refine individual prognosis and guide management. Despite advances in supportive care, the backbone of therapy remains a combination of cytarabine- and anthracycline-based regimens with allogeneic stem cell transplantation for eligible candidates. Elderly patients are often unable to tolerate such regimens, and carry a particularly poor prognosis. Here, we review the major recent advances in the treatment of AML.
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Affiliation(s)
- I De Kouchkovsky
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - M Abdul-Hay
- Department of Medicine, New York University School of Medicine, New York, NY, USA.,Department of Hematology/Oncology, New York University Perlmutter Cancer Center, New York, NY, USA
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Damiani D, Tiribelli M, Geromin A, Cerno M, Zanini F, Michelutti A, Fanin R. ABCG2, Cytogenetics, and Age Predict Relapse after Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia in Complete Remission. Biol Blood Marrow Transplant 2016; 22:1621-1626. [PMID: 27178373 DOI: 10.1016/j.bbmt.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/02/2016] [Indexed: 11/12/2022]
Abstract
Recent studies have shown that ABGG2 protein overexpression in acute myeloid leukemia (AML) may be associated with poor response to therapy and increased relapse risk. Few data are available in patients with AML undergoing allogeneic stem cell transplantation (SCT), particularly when in complete remission (CR). We analyzed 105 patients with AML who underwent allogeneic SCT in CR evaluating the role of ABCG2 and other pretransplantation features on subsequent transplantation outcomes. Factors negatively associated with leukemia-free survival (LFS) were unfavorable cytogenetics (3-year LFS 48% versus 80%, P = .0035) and ABCG2 positivity (65% versus 80%, P = .045). Three-year cumulative incidence of relapse (CIR) in the whole population was 20%; a higher incidence of relapse was associated with adverse cytogenetics (41% versus 16%, P = .018), ABCG2 overexpression (29% versus 15%, P = .04), and, marginally, age > 50 years (30% versus 14%, P = .06). We grouped patients according to the combination of these 3 risk factors: no patient relapsed within 3 years from SCT in the group without risk factors, whereas the 3-year CIR was 12% (95% confidence interval [CI], 2% to 25%) in the group with 1 risk factor and 47% (95% CI, 31% to 70%) in patients with 2 or 3 risk factors (P = .00005). In conclusion, allogeneic SCT does not seem to abrogate the negative prognosis associated with ABCG2 overexpression at diagnosis, specifically in terms of a higher relapse risk. ABCG2, age, and cytogenetics can predict AML relapse after SCT in patients who undergo transplantation while in CR.
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Affiliation(s)
- Daniela Damiani
- Division of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy.
| | - Mario Tiribelli
- Division of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Antonella Geromin
- Division of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Michela Cerno
- Division of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Francesca Zanini
- Division of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Angela Michelutti
- Division of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
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