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Li ZF, Feng JK, Zhao XC, Liu W, Gu SA, Li R, Lu YL, Mao RJ, Xia LL, Dong LL, Zhang LW, Ruan JY, Liu J, Li GF, Li T, Sun R, Qiu SL, Zheng ZZ, Dong T. The Extract of Pinellia Ternata-Induced Apoptosis of Leukemia Cells by Regulating the Expression of Bax, Bcl-2 and Caspase-3 Protein Expression in Mice. Transplant Proc 2023; 55:2232-2240. [PMID: 37777366 DOI: 10.1016/j.transproceed.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 10/02/2023]
Abstract
The study aims to lessen the monetary burden on patients and society by decreasing the price of proprietary drugs used in leukemia therapy. Flow cytometry, reverse transcription polymerase chain reaction, western blot, and a patient-derived xenograft mouse model were used to confirm the therapeutic effect of Pinellia ternata extract on leukemia. Three types of leukemia cells (K562, HL-60, and C8166 cell lines) were found to undergo early apoptosis (P ≤ .05) after being exposed to P. ternata extract, as measured by flow cytometry. Reverse transcription polymerase chain reaction results showed that P. ternata extract at both middle (300 μg/mL) and high (500 μg/mL) concentrations was able to down-regulate Bcl-2 and upregulate mRNA expression of Bax and caspase-3. In the patient-derived xenograft mouse model formed by BALB/c-nu/nu nude mice, immunohistochemistry indicated that P. ternata extract effectively suppressed the proliferation of leukemia cells. Therefore, P. ternata extract at 300 μg/mL and 500 μg/mL could effectively inhibit myeloid and lymphocytic leukemia cell proliferation and promote leukemia cell apoptosis by regulating Bax/Bcl-2 and caspase-3.
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Affiliation(s)
- Zheng-Fa Li
- Department of Hematology, Department of Laboratory of the First People's Hospital of Yunnan Province (Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan, China
| | - Jia-Kun Feng
- Department of Hematology, Department of Laboratory of the First People's Hospital of Yunnan Province (Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan, China
| | - Xiao-Chen Zhao
- Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Wei Liu
- Department of Hematology, Department of Laboratory of the First People's Hospital of Yunnan Province (Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan, China
| | - Shi-An Gu
- Department of Hematology, Department of Laboratory of the First People's Hospital of Yunnan Province (Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan, China
| | - Rui Li
- Department of Hematology, Department of Laboratory of the First People's Hospital of Yunnan Province (Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan, China
| | - Yang-Liu Lu
- Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Rui-Jiao Mao
- Department of Hematology, Department of Laboratory of the First People's Hospital of Yunnan Province (Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan, China
| | - Li-Ling Xia
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Lu-Lu Dong
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Li-Wen Zhang
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Jing-Yan Ruan
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Jiao Liu
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Guang-Fen Li
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Tao Li
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Rong Sun
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | - Shui-Lan Qiu
- Department of Hematology, Department of Pathology of Yunnan New Kun Hua Hospital, Kunming, Yunnan, China
| | | | - Ting Dong
- Department of Hematology, Department of Laboratory of the First People's Hospital of Yunnan Province (Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan, China.
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Muchtar E, Vidal L, Ram R, Gafter-Gvili A, Shpilberg O, Raanani P. The role of maintenance therapy in acute promyelocytic leukemia in the first complete remission. Cochrane Database Syst Rev 2013:CD009594. [PMID: 23543579 DOI: 10.1002/14651858.cd009594.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) is the most curable type of leukemia. A consensus exists regarding the need for administration of both induction and consolidation treatments, albeit using different approaches. However, there is conflicting evidence for the role of maintenance treatment in APL patients. OBJECTIVES To examine the efficacy and safety of maintenance therapy in APL patients and to establish the optimal regimen for maintenance. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (January 1966 to July 2012), LILACS (1982 to July 2012), relevant conference proceedings (2000 to 2012) and databases of ongoing and unpublished trials. SELECTION CRITERIA Randomized controlled trials assessing maintenance treatment in patients with newly diagnosed APL in first complete remission (CR) following induction or induction and consolidation therapy. DATA COLLECTION AND ANALYSIS Two review authors assessed the quality of trials and extracted data. We estimated and pooled hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI) using the fixed-effect model. If significant heterogeneity was present we explored potential causes for such heterogeneity and if not found we used also the random-effects model. MAIN RESULTS We included 10 randomized controlled trials enrolling 2072 patients in the systematic review, and conducted meta-analysis on nine of them. There was no statistically significant effect on overall survival (OS) in the three main comparisons (HR for any maintenance treatment versus observation 0.79, 95% CI 0.49 to 1.27; HR for all-trans retinoic acid (ATRA)-based maintenance versus non-ATRA based maintenance 1.21, 95% CI 0.73 to 1.98; HR for ATRA alone maintenance versus ATRA and chemotherapy 0.99, 95% CI 0.69 to 1.43). However, disease free survival (DFS) was improved with any maintenance therapy compared to observation (HR 0.59, 95% CI 0.48 to 0.74; 5 trials, 1209 patients) and with ATRA and chemotherapy compared to ATRA alone maintenance (HR for ATRA alone compared to ATRA and chemotherapy 1.38, 95% CI 1.09 to 1.76; 4 trials, 1028 patients). DFS was not improved with ATRA-based regimens compared to non-ATRA based regimens (HR 0.72, 95% CI 0.51 to 1.01; 4 trials, 670 patients). Analysis of clinically relevant adverse events could not be conducted due to paucity of data. Yet, increased reports of grade 3/4 adverse events were noted for any maintenance versus observation and for combined ATRA and chemotherapy versus ATRA alone treatment. The major limitation of this review lies in the variability between the included trials in both maintenance and pre-maintenance parameters. We tried to address this variability and to reduce its potential biases by conducting three separate main comparisons, as outlined above, leaving less statistical power to the presented results. AUTHORS' CONCLUSIONS Maintenance therapy compared to observation in APL patients improved DFS but not OS. Similarly, ATRA and chemotherapy compared to ATRA improved DFS but not OS. In contrast, ATRA based regimens compared to non-ATRA based regimens did not demonstrate a survival benefit. The significance of these findings is limited due to clinical heterogeneity between studies.
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Affiliation(s)
- Eli Muchtar
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, Israel, 49100
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Abstract
Central nervous system (CNS) involvement is rare in acute promyelocytic leukemia (APL). The majority of CNS relapses occur in patients with hyperleukocytosis at presentation, and the optimal management of such patients is still controversial. We describe a 13-year-old boy with APL who developed an isolated CNS relapse after first-line treatment with all-trans retinoic acid and chemotherapy. A second remission was achieved with a regimen consisting of intrathecal chemotherapy, intravenous high-dose cytarabine, and oral 6-mercaptopurine. All-trans retinoic acid was avoided owing to severe complications during initial therapy. The patient remains in molecular remission at 9 months after autologous stem cell transplant. Prognostic factors of CNS relapse in children with APL are needed to define the indications for CNS prophylaxis in this group of patients.
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Tirado CA, Golembiewski-Ruiz V, Horvatinovich J, Moore JO, Buckley PJ, Stenzel TT, Goodman BK. Cytogenetic and molecular analysis of an unusual case of acute promyelocytic leukemia with a t(15;17;17)(q22;q23;q21). CANCER GENETICS AND CYTOGENETICS 2003; 145:31-7. [PMID: 12885460 DOI: 10.1016/s0165-4608(03)00027-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a 52-year-old female with a clinical history of acute myelocytic leukemia, probable acute promyelocytic leukemia (APL). Flow cytometry results were somewhat unusual. Specifically, the promyelocytic population showed partial positivity for antigens not usually expressed in APL (HLA-DR and CD117). The interpretation of these results was that the abnormal population contained a proportion of very early promyeolocytes that had not completely lost all their "precursor" antigens. Cytogenetic analysis of a bone marrow aspirate showed a t(15:17;17)(q22;q23;q21) in all cells analyzed. Fluorescence in situ hybridization (FISH) analysis using the PML-RARA DNA probe showed a positive signal pattern (fusion) in 100% of 200 total interphase and metaphase cells examined, confirming the presence of the PML-RARA rearrangement. Multicolor FISH, which produces 24 colors to differentiate all chromosomes in a single hybridization, was applied. This study confirmed the cytogenetic interpretation of the rearrangement. No material from any other chromosome was detected on the second smaller derivative chromosome 17. Additional studies using the RARA(17q21) break-apart DNA FISH probe showed that 17q21 (RARA) was not rearranged on the derivative chromosome 17 that received the q22-->qter segment from chromosome 15. The RARA locus on the smaller derivative 17 was the allele involved in the fusion in this three-way rearrangement. The signal pattern was consistent in 100% of interphase and metaphase cells scored. This unusual t(15;17;17) prompted us to investigate further using reverse-transcription polymerase chain reaction with primers from the 3' and 5' regions of both the RARA and PML loci. These studies showed that the PML-RARA fusion was present, but the complementary fusion RARA-PML, which is usually detectable, was absent. The patient is responding well to standard treatment protocols.
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Affiliation(s)
- C A Tirado
- Cytogenetics Laboratory, Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
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