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Urgessa F, Lengiso B, Tsegaye A, Gebremedhin A, Abdella F, Tadesse F, Radich J, Nigussie H, Kuru Gerbaba T. Hematological, clinical, cytogenetic and molecular profiles of confirmed chronic myeloid leukemia patients at presentation at a tertiary care teaching hospital in Addis Ababa, Ethiopia: a cross-sectional study. BMC Cancer 2024; 24:530. [PMID: 38664756 PMCID: PMC11046892 DOI: 10.1186/s12885-024-12282-x] [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: 01/23/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In low-income countries there is insufficient evidence on hematological, clinical, cytogenetic and molecular profiles among new CML patients. Therefore, we performed this study among newly confirmed CML patients at Tikur Anbesa Specialized Hospital (TASH), Ethiopia. OBJECTIVE To determine the hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at tertiary care teaching hospital in Addis Ababa, Ethiopia. METHODS A facility-based cross-sectional study was conducted to evaluate hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at TASH from August 2021 to December 2022. A structured questionnaire was used to collect the patients' sociodemographic information, medical history and physical examination, and blood samples were also collected for hematological, cytogenetic and molecular tests. Descriptive statistics were used to analyze the sociodemographic, hematological, clinical, cytogenetic and molecular profiles of the study participants. RESULTS A total of 251 confirmed new CML patients were recruited for the study. The majority of patients were male (151 [60.2%]; chronic (CP) CML, 213 [84.7%]; and had a median age of 36 years. The median (IQR) WBC, RBC, HGB and PLT counts were 217.7 (155.62-307.4) x103/µL, 3.2 (2.72-3.6) x106/µL, 9.3 (8.2-11) g/dl and 324 (211-499) x 103/µL, respectively. All patients had leukocytosis, and 92.8%, 95.6% and 99.2% of the patients developed anemia, hyperleukocytosis and neutrophilia, respectively. Fatigue, abdominal pain, splenomegaly and weight loss were the common signs and symptoms observed among CML patients. Approximately 86.1% of the study participants were Philadelphia chromosome positive (Ph+) according to fluorescence in situ hybridization (FISH). P210, the major breakpoint protein, transcript was detected by both qualitative polymerase chain reaction (PCR) and quantitative real time polymerase chain reaction (PCR). CONCLUSION During presentation, most CML patients presented with hyperleukocytosis, neutrophilia and anemia at TASH, Addis Ababa. Fatigue, abdominal pain, splenomegaly and weight loss were the most common signs and symptoms observed in the CML patients. Most CML patients were diagnosed by FISH, and p120 was detected in all CML patients diagnosed by PCR. The majority of CML patients arrive at referral center with advanced signs and symptoms, so better to decentralize the service to peripheral health facilities.
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MESH Headings
- Humans
- Male
- Cross-Sectional Studies
- Female
- Ethiopia/epidemiology
- Adult
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Hospitals, Teaching
- Middle Aged
- Young Adult
- Adolescent
- Tertiary Care Centers/statistics & numerical data
- Aged
- Cytogenetic Analysis
- Fusion Proteins, bcr-abl/genetics
- Tertiary Healthcare
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Affiliation(s)
- Fekadu Urgessa
- Medical Laboratory Sciences Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Cellular and Molecular Biology Department, College of Natural and Computational Sciences, Addis Ababa University, Addis, Ababa, Ethiopia.
| | - Boki Lengiso
- Medical Laboratory Sciences Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Medical Laboratory Sciences Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amha Gebremedhin
- Internal Medicine Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fozia Abdella
- Internal Medicine Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fisihatsion Tadesse
- Internal Medicine Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Helen Nigussie
- Cellular and Molecular Biology Department, College of Natural and Computational Sciences, Addis Ababa University, Addis, Ababa, Ethiopia
| | - Teklu Kuru Gerbaba
- Cellular and Molecular Biology Department, College of Natural and Computational Sciences, Addis Ababa University, Addis, Ababa, Ethiopia
- Microbix Biosystems Inc, Mississauga, ON, Canada
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Kwaśnik P, Zaleska J, Link-Lenczowska D, Zawada M, Wysogląd H, Ochrem B, Bober G, Wasilewska E, Hus I, Szarejko M, Prejzner W, Grzybowska-Izydorczyk O, Klonowska-Szymczyk A, Mędraś E, Kiełbus M, Sacha T, Giannopoulos K. High Level of CD8 +PD-1 + Cells in Patients with Chronic Myeloid Leukemia Who Experienced Loss of MMR after Imatinib Discontinuation. Cells 2024; 13:723. [PMID: 38667336 PMCID: PMC11048908 DOI: 10.3390/cells13080723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Treatment-free remission (TFR) is achieved in approximately half of chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors. The mechanisms responsible for TFR maintenance remain elusive. This study aimed to identify immune markers responsible for the control of residual CML cells early in the TFR (at 3 months), which may be the key to achieving long-term TFR and relapse-free survival (RFS) after discontinuation of imatinib. Our study included 63 CML patients after imatinib discontinuation, in whom comprehensive analysis of changes in the immune system was performed by flow cytometry, and changes in the BCR::ABL1 transcript levels were assessed by RQ-PCR and ddPCR. We demonstrated a significant increase in the percentage of CD8+PD-1+ cells in patients losing TFR. The level of CD8+PD-1+ cells is inversely related to the duration of treatment and incidence of deep molecular response (DMR) before discontinuation. Analysis of the ROC curve showed that the percentage of CD8+PD-1+ cells may be a significant factor in early molecular recurrence. Interestingly, at 3 months of TFR, patients with the e13a2 transcript had a significantly higher proportion of the PD-1-expressing immune cells compared to patients with the e14a2. Our results suggest the important involvement of CD8+PD-1+ cells in the success of TFR and may help in identifying a group of patients who could successfully discontinue imatinib.
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MESH Headings
- Humans
- Imatinib Mesylate/therapeutic use
- Imatinib Mesylate/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/drug effects
- Female
- Male
- Middle Aged
- Adult
- Programmed Cell Death 1 Receptor/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Aged
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Young Adult
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Affiliation(s)
- Paulina Kwaśnik
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
| | - Joanna Zaleska
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
| | - Dorota Link-Lenczowska
- Department of Hematology Diagnostics, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Magdalena Zawada
- Department of Hematology Diagnostics, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Hubert Wysogląd
- Department of Hematology, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Bogdan Ochrem
- Department of Hematology, Jagiellonian University Hospital in Kraków, 30-688 Kraków, Poland
| | - Grażyna Bober
- Department of Hematooncology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, 40-032 Katowice, Poland
| | - Ewa Wasilewska
- Department of Hematology, Medical University of Białystok, 15-276 Białystok, Poland
| | - Iwona Hus
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Monika Szarejko
- Department of Hematology and Transplantology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Witold Prejzner
- Department of Hematology and Transplantology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | | | | | - Ewa Mędraś
- Department of Hematology, Neoplastic Blood Disorders and Bone Marrow Transplantation in Wrocław, 50-367 Wrocław, Poland
| | - Michał Kiełbus
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
| | - Tomasz Sacha
- Chair of Hematology, Jagiellonian University Medical College in Kraków, 31-501 Kraków, Poland
| | - Krzysztof Giannopoulos
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland; (P.K.)
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Li Y, Zhang Y, Meng X, Chen S, Wang T, Zhang L, Ma X. Chronic myeloid leukemia with two rare fusion gene transcripts of atypical BCR::ABL: A case report and literature review. Medicine (Baltimore) 2024; 103:e36728. [PMID: 38241589 PMCID: PMC10798786 DOI: 10.1097/md.0000000000036728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024] Open
Abstract
RATIONALE Imatinib is a standard treatment for Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML), but its efficacy in rare BCR::ABL variants is underexplored. PATIENT CONCERNS A 67-year-old woman was admitted to the Second Affiliated Hospital of Xi'an Jiaotong University in March 2022 due to elevated white blood cells. DIAGNOSIS Karyotype analysis revealed clonal abnormalities involving the variant t(9;22) and positive results for atypical BCR::ABL variants (e14a3 and e13a3). The clinical diagnosis was CML, chronic phase, Ph+, with rare BCR::ABL-e13a3- and BCR::ABL-e14a3-positive findings. INTERVENTION The patient was administered daily imatinib mesylate (400 mg). OUTCOMES After 4 weeks, a swift molecular response was observed: BCR::ABL-e13a3 transcript level at 2.82 × 10-1 (28.24%), and BCR::ABL-e14a3 transcript level at 4.68 × 10-1 (46.76%). Within 3 months, a complete cytogenetic response was achieved, with a Ph chromosome ratio of 0. Early molecular response was evident as BCR::ABL-e13a3 transcript level reached 5.11 × 10-3 (0.51%), and BCR::ABL-e14a3 transcript level at 6.26 × 10-3 (0.63%). The imatinib mesylate treatment continued without significant toxicity. LESSONS This case emphasizes the potential effectiveness of imatinib mesylate in managing rare BCR::ABL fusion gene variants of CML. Screening for these atypical variants is advised for suspected CML patients who test negative for common BCR::ABL fusion gene variants. The presented case underscores the positive outcomes achieved with imatinib treatment for a patient with rare BCR::ABL variants, contributing valuable insights for the management of similar cases. Screening for unusual fusion gene variants should be a consideration in CML diagnosis for comprehensive treatment strategies.
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Affiliation(s)
- Yuxin Li
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yilin Zhang
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xin Meng
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Sheping Chen
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ting Wang
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Longjin Zhang
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaorong Ma
- Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Iezza M, Cortesi S, Ottaviani E, Mancini M, Venturi C, Monaldi C, De Santis S, Testoni N, Soverini S, Rosti G, Cavo M, Castagnetti F. Prognosis in Chronic Myeloid Leukemia: Baseline Factors, Dynamic Risk Assessment and Novel Insights. Cells 2023; 12:1703. [PMID: 37443737 PMCID: PMC10341256 DOI: 10.3390/cells12131703] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The introduction of tyrosine kinase inhibitors (TKIs) has changed the treatment paradigm of chronic myeloid leukemia (CML), leading to a dramatic improvement of the outcome of CML patients, who now have a nearly normal life expectancy and, in some selected cases, the possibility of aiming for the more ambitious goal of treatment-free remission (TFR). However, the minority of patients who fail treatment and progress from chronic phase (CP) to accelerated phase (AP) and blast phase (BP) still have a relatively poor prognosis. The identification of predictive elements enabling a prompt recognition of patients at higher risk of progression still remains among the priorities in the field of CML management. Currently, the baseline risk is assessed using simple clinical and hematologic parameters, other than evaluating the presence of additional chromosomal abnormalities (ACAs), especially those at "high-risk". Beyond the onset, a re-evaluation of the risk status is mandatory, monitoring the response to TKI treatment. Moreover, novel critical insights are emerging into the role of genomic factors, present at diagnosis or evolving on therapy. This review presents the current knowledge regarding prognostic factors in CML and their potential role for an improved risk classification and a subsequent enhancement of therapeutic decisions and disease management.
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Affiliation(s)
- Miriam Iezza
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
| | - Sofia Cortesi
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
| | - Emanuela Ottaviani
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.O.); (M.M.); (C.V.)
| | - Manuela Mancini
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.O.); (M.M.); (C.V.)
| | - Claudia Venturi
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.O.); (M.M.); (C.V.)
| | - Cecilia Monaldi
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
| | - Sara De Santis
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
| | - Nicoletta Testoni
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.O.); (M.M.); (C.V.)
| | - Simona Soverini
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
| | - Gianantonio Rosti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS “Dino Amadori”, 47014 Meldola, Italy;
| | - Michele Cavo
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.O.); (M.M.); (C.V.)
| | - Fausto Castagnetti
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy; (S.C.); (C.M.); (S.D.S.); (N.T.); (S.S.); (M.C.); (F.C.)
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.O.); (M.M.); (C.V.)
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Lee H, Seo J, Shin S, Lee ST, Choi JR. Development and validation of sensitive BCR::ABL1 fusion gene quantitation using next-generation sequencing. Cancer Cell Int 2023; 23:106. [PMID: 37248544 DOI: 10.1186/s12935-023-02938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND BCR::ABL1 fusion has significant prognostic value and is screened for chronic myeloid leukemia (CML) disease monitoring as a part of routine molecular testing. To overcome the limitations of the current standard real-time quantitative polymerase chain reaction (RQ-PCR), we designed and validated a next-generation sequencing (NGS)-based assay to quantify BCR::ABL1 and ABL1 transcript copy numbers. METHODS After PCR amplification of the target sequence, deep sequencing was performed using an Illumina Nextseq 550Dx sequencer and in-house-designed bioinformatics pipeline. The Next-generation Quantitative sequencing (NQ-seq) assay was validated for its analytical performance, including precision, linearity, and limit of detection, using serially diluted control materials. A comparison with conventional RQ-PCR was performed with 145 clinical samples from 77 patients. RESULTS The limit of detection of the NQ-seq was the molecular response (MR) 5.6 [BCR::ABL1 0.00028% international scale (IS)]. The NQ-seq exhibited excellent precision and linear range from MR 2.0 to 5.0. The IS value from the NQ-seq was highly correlated with conventional RQ-PCR. CONCLUSIONS We conclude that the NQ-seq is an effective tool for monitoring BCR::ABL1 transcripts in CML patients with high sensitivity and reliability. Prospective assessment of the unselected large series is required to validate the clinical impact of this NGS-based monitoring strategy.
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Affiliation(s)
- Hyeonah Lee
- Department of Laboratory Medicine, Graduate School of Medical Science, Brain Korea 21 PLUS Project, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jieun Seo
- Department of Genetics, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA.
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Saeam Shin
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Dxome Co. Ltd, 8, Seongnam-daero 331beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jong Rak Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Dxome Co. Ltd, 8, Seongnam-daero 331beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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Dey S, Basu S, Shah S, Bhattacharyya D, Gupta PP, Acharjee M, Roychoudhury S, Nath S. Deep sequencing reveals the spectrum of BCR-ABL1 mutations upon front-line therapy resistance in chronic myeloid leukemia: An Eastern-Indian cohort study. Cancer Treat Res Commun 2022; 33:100635. [PMID: 36155130 DOI: 10.1016/j.ctarc.2022.100635] [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: 08/17/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
The course of clinical management in chronic myeloid leukemia (CML) often faces a road-block in the form of front-line (imatinib) therapy resistance. Subsequently, several hotspot mutations were clinically validated in the kinase domain (KD) of BCR-ABL1, in deterring imatinib sensitivity and further, made targeted by next-generation tyrosine-kinase-inhibitor (TKI) drugs. Identifying KD mutations, occurring even at low frequencies, became pertinent here. Globally, cohorts from different origins were tested and the mutational spectra were mapped to categorize clinical management as well as related pathological features of CML. Moreover, targeted deep sequencing could reveal the mutational landscape more efficiently than the less sensitive Sanger sequencing method. However, no such efforts were reported from Eastern Indian cohorts of imatinib-resistant CML-sufferers. This study assessed a prospective study cohort of imatinib-resistant CML cases from Eastern India. Following dissecting the molecular and clinical parameters, the mutational spectrum was comparatively examined using conventional Sanger and next-generation deep sequencing method. This cohort showed a prevalence of e14a2-p210 variant of BCR-ABL1 and acquired resistance against imatinib, while the disease was mostly confined in its chronic phase. Together with a few common hotspot mutations identified in this cohort, deep sequencing revealed cases with a candidate mutation, otherwise undetermined by Sanger method. Also, cases with a second low frequency mutation were identified upon applying deep sequencing. Along with highlighting a few aspects of CML biology employing an Eastern-Indian cohort, this data could mark the immense importance of deep sequencing to contribute in the clinical management of CML upon front-line therapy resistance.
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MESH Headings
- Humans
- Cohort Studies
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- High-Throughput Nucleotide Sequencing/methods
- Imatinib Mesylate/pharmacology
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Mutation
- Prospective Studies
- India
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Affiliation(s)
- Samya Dey
- Department of Basic and Translational Research, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India
| | - Soumi Basu
- Department of Basic and Translational Research, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India; Department of Molecular Genetics and Cell Biology, University of Nebraska Medical Center, Omaha, USA
| | - Shahena Shah
- Department of Basic and Translational Research, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India
| | - Debmalya Bhattacharyya
- Department of Hemato-oncology, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India
| | - Partha Pratim Gupta
- Department of Hemato-oncology, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India
| | - Mahasweta Acharjee
- Department of Basic and Translational Research, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India
| | - Susanta Roychoudhury
- Department of Basic and Translational Research, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India; CSIR-Indian Institute of Chemical Biology, CN-06, CN Block, Sector V, Kolkata 700091, India
| | - Somsubhra Nath
- Department of Basic and Translational Research, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, 700063, India; Institute of Health Sciences, Presidency University, Plot No. DG/02/02, Premises No. 14-0358, Action Area-ID, New Town, Kolkata, 700156, India.
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Saugues S, Lambert C, Daguenet E, Ansah HJ, Turhan A, Huguet F, Guerci-Bresler A, Tchirkov A, Hamroun D, Hermet E, Pereira B, Berger MG. Real-world therapeutic response and tyrosine kinase inhibitor discontinuation in chronic phase-chronic myeloid leukemia: data from the French observatory. Ann Hematol 2022; 101:2241-2255. [PMID: 36040480 DOI: 10.1007/s00277-022-04955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
Abstract
Guidelines for tyrosine kinase inhibitor (TKI)-treated chronic phase-chronic myeloid leukemia (CML) management are essentially based on data from clinical research trials; however, real-world data should be valuable for optimizing such recommendations. Here, we analyzed the data collected in the French CML Observatory database, a multicenter real-world cohort (n = 646), using a first-line "intention-to-treat" analysis strategy. This cohort included patients treated with first-line imatinib (n = 484), nilotinib (n = 103), dasatinib (n = 17), imatinib and interferon (n = 9), or second-generation (2G)-TKIs and interferon (n = 29). The cumulative incidence of major molecular response (MMR), MR4, MR4.5 and MR5 confirmed the faster response kinetics with 2G-TKIs. Multivariate analysis identified being a woman and residual disease at month 6 as the main predictive factors of deep molecular response (DMR). Moreover, 30% of patients met the criteria for treatment discontinuation (5 years of treatment and ≥ 2 years of DMR), but only 38% of them stopped treatment. Among the 92 patients who actually discontinued treatment due to optimal response, 31.5% relapsed (48% of them after > 6 months of TKI discontinuation). Multivariate analysis identified age and TKI duration as factors positively correlated with treatment-free remission maintenance. Late (> 6 months) relapses were more frequent in patients with the e14a2 BCR::ABL transcript. Relapse rate was higher in patients who stopped TKI before than after 5 years of treatment (52.6% vs 26%; p = 0.040). These results advocate caution concerning early treatment withdrawal, including in patients receiving 2G-TKIs. This still recruiting database is a valuable source of information for the real-world follow-up of patients with CML.
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Affiliation(s)
- Sandrine Saugues
- Hématologie Biologique, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France.,Equipe d'Accueil EA7453 CHELTER, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Céline Lambert
- Secteur Biométrie et Médico-économie, DRCI, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Elisabeth Daguenet
- Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | | | - Ali Turhan
- Inserm U935 - Service d'Hématologie, Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre, France
| | - Françoise Huguet
- Hématologie, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | | | - Andreï Tchirkov
- Secteur Biométrie et Médico-économie, DRCI, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.,Cytogénétique Médicale, CHU Estaing, Clermont-Ferrand, France
| | - Dalil Hamroun
- Direction de La Recherche Et de L'Innovation, CHRU de Montpellier, Montpellier, France
| | - Eric Hermet
- Hématologie Clinique Adulte, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Secteur Biométrie et Médico-économie, DRCI, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Marc G Berger
- Hématologie Biologique, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France. .,Equipe d'Accueil EA7453 CHELTER, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. .,Hématologie Clinique Adulte, CHU Clermont-Ferrand, Clermont-Ferrand, France.
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8
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Su Y, Kuo M, Chen T, Wang M, Yang Y, Ma M, Lin T, Lin T, Chang H, Teng CJ, Hsiao P, Chen C, Wang P, Shih L. Comparison of molecular responses and outcomes between
BCR‐ABL1
e14a2 and e13a2 transcripts in chronic myeloid leukemia. Cancer Sci 2022; 113:3518-3527. [PMID: 35869805 PMCID: PMC9530867 DOI: 10.1111/cas.15501] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Several studies have compared the molecular responses between e14a2 and e13a2 BCR::ABL1 transcripts in chronic myeloid leukemia (CML) patients treated with front‐line imatinib, but there were very limited studies on nilotinib or dasatinib‐treated patients. We retrospectively analyzed the molecular responses in 1124 CML patients with the e14a2 or e13a2 transcript receiving front‐line imatinib, nilotinib or dasatinib treatment. Patients with the e14a2 transcript had higher optimal response rates than those with the e13a2 transcript at 12 months in the imatinib‐treated group, and 6 and 12 months in the nilotinib‐treated group. The optimal response rates were not significantly different between the two transcripts in the dasatinib‐treated group at landmark molecular responses. With a median follow‐up time of 48.4 months, higher cumulative incidences of BCR::ABL1 International Scale ≤1% and major molecular response were observed in patients with the e14a2 rather than the e13a2 transcript receiving front‐line imatinib or nilotinib treatment, but not in dasatinib‐treated patients. The progression‐free survival and overall survival did not differ between the two transcripts in all three treatment groups. In view of the speed and depth of molecular responses, BCR::ABL1 transcript subtypes might provide helpful information in selecting a front‐line tyrosine kinase inhibitor for individual young patients with future potential treatment‐free remission.
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Affiliation(s)
- Yi‐Jiun Su
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou Taoyuan Taiwan
| | - Ming‐Chung Kuo
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou Taoyuan Taiwan
- Chang Gung University School of Medicine Taoyuan Taiwan
| | - Tsai‐Yun Chen
- National Cheng Kung University Hospital Tainan Taiwan
| | - Ming‐Chung Wang
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Kaohsiung Kaohsiung Taiwan
| | - Youngsen Yang
- Division of Hematology‐Oncology, Department of Internal Medicine, Taichung Veterans General Hospital Taichung Taiwan
- Internal Medicine, College of Medicine China Medical University Taichung Taiwan
| | - Ming‐Chun Ma
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Kaohsiung Kaohsiung Taiwan
| | - Tung‐Liang Lin
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou Taoyuan Taiwan
| | - Tung‐Huei Lin
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou Taoyuan Taiwan
| | - Hung Chang
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou Taoyuan Taiwan
| | - Chieh‐Lin Jerry Teng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital Taichung Taiwan
- Department of Life Science Tunghai University Taichung Taiwan
- School of Medicine Chung Shan Medical University Taichung Taiwan
| | | | - Chih‐Cheng Chen
- Chang Gung University School of Medicine Taoyuan Taiwan
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Chiayi Chiayi Taiwan
| | - Po‐Nan Wang
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou Taoyuan Taiwan
| | - Lee‐Yung Shih
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou Taoyuan Taiwan
- Chang Gung University School of Medicine Taoyuan Taiwan
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9
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Sacha T, Szczepanek E, Dumnicka P, Góra-Tybor J, Niesiobędzka-Krężel J, Prejzner W, Wasilewska E, Kłoczko J, Ciepłuch H, Makowska W, Patkowska E, Wasilewska J, Bober G, Kopera M, Wichary R, Kroll-Balcerzak R, Gromek T, Wach M, Rudkowska-Kazanowska A, Świniarska M, Paczkowska E, Biernat M, Joks M, Oller M, Kasza R, Kostyra A, Gil J, Grzybowska-Izydorczyk O. The Outcomes of Ponatinib Therapy in Patients With Chronic Myeloid Leukemia Resistant or Intolerant to Previous Tyrosine Kinase Inhibitors, Treated in Poland Within the Donation Program. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:405-415. [PMID: 34933827 DOI: 10.1016/j.clml.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) have greatly improved the treatment outcome for most patients with chronic myeloid leukemia (CML). Ponatinib is a new pan-inhibitor of TK active in resistant CML. This study aimed to evaluate the efficacy and safety of ponatinib in patients suffering from CML. PATIENTS AND METHODS This multicenter, non-randomized, observational, retrospective study evaluated the efficacy and safety of ponatinib administered in adult CML patients in any disease phase, including those with a detected ABL T315I mutation, which were resistant or intolerant to previous-generation TKIs. The study comprised 43 patients benefiting from the ponatinib donation program who were treated in 16 Polish centers. RESULTS For patients who started treatment with ponatinib in chronic phase (CP) (n = 23) and in accelerated phase (AP) (n = 3) the median time on ponatinib was 19.5 months (range: 1.0-35.4), and 31.7 months (range: 31.0-34.1), respectively. All these patients were in CP after 1 month of treatment and at the end of observation - none of them progressed to AP or blastic phase (BP) during the study, meaning that progression-free survival was 100% at the end of observation (35.4 months). The estimated 2-year survival in this group of patients was 84%. For all 43 patients, median survival was not reached (lower quartile 6.3 months), and estimated 2-year survival was 60%. CONCLUSION Our analysis confirmed ponatinib efficacy in a significant proportion of patients heavily pre-treated with TKIs achieving durable responses in both CP and AP/BP CML groups.
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Affiliation(s)
- Tomasz Sacha
- Department of Hematology, Jagiellonian University Medical College, Krakow, Poland.
| | - Elżbieta Szczepanek
- Department of Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Góra-Tybor
- Department of Hematology, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Joanna Niesiobędzka-Krężel
- Department of Hematology, Transplantation and Internal Medicine, University Clinical Center of the Medical University of Warsaw, Poland
| | - Witold Prejzner
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Wasilewska
- Department of Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Janusz Kłoczko
- Department of Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Hanna Ciepłuch
- Department of Hematology, Copernicus Regional Oncology Centre, Gdansk, Poland
| | - Wioletta Makowska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Elżbieta Patkowska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Joanna Wasilewska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Grażyna Bober
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Małgorzata Kopera
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Ryszard Wichary
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Renata Kroll-Balcerzak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Gromek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Małgorzata Wach
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Anna Rudkowska-Kazanowska
- Department of Hematology and Cancer Prevention, School of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
| | - Magdalena Świniarska
- Department of Hematology and Transplantology, Pomeranian Medical University, Szczecin, Poland
| | - Edyta Paczkowska
- Department of General Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Monika Biernat
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Joks
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Oller
- Department of Hematology, Copernicus Regional Oncology Centre, Gdansk, Poland
| | - Renata Kasza
- Department of Hematology, Zamosc Hospital, Zamosc, Poland
| | | | - Justyna Gil
- Department of Hematooncology, Oncology Centre of the Podkarpackie Province, Brzozow, Poland
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10
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Benchikh S, Bousfiha A, El Hamouchi A, Soro SGC, Malki A, Nassereddine S. Chronic myeloid leukemia: cytogenetics and molecular biology’s part in the comprehension and management of the pathology and treatment evolution. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00248-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
Chronic myelogenous leukemia (CML) is a type of blood cancer that affects hematopoietic stem cells and is often characterized by the presence of the Philadelphia chromosome. The Philadelphia chromosome encodes for a protein with high tyrosine kinase activity which acts as a tumorigenic factor.
Main body
This review article reports an update on the pathophysiology of CML and highlights the role of cytogenetic and molecular biology in screening, diagnosis, therapeutic monitoring as well as evaluating patients’ response to treatment. Additionally, these genetic tests allow identifying additional chromosomal abnormalities (ACA) and BCR-ABL tyrosine kinase domain mutations in intolerant or resistant patients. Thus, therapeutic advances have enabled this pathology to become manageable and almost curable in its clinical course. The scientific literature search used in the synthesis of this paper was carried out in the PubMed database, and the figures were generated using online software named BioRender.
Conclusion
The role of cytogenetic and molecular biology is crucial for the diagnosis and medical monitoring of patients. In-depth knowledge of molecular mechanisms of the BCR-ABL kinase facilitated the development of new targeted therapies that have improved the vital prognosis in patients. However, the emergence of ACA and new mutations resistant to tyrosine kinase inhibitors constitutes a real challenge in the quest for adequate therapy.
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11
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Chen K, Ruan Y, Tian K, Xiong P, Xia N, Li J, Huang W, Cao F, Chen Q. Impact of BCR-ABL1 Transcript Type on Outcome in Chronic Myeloid Leukemia Patients Treated With Tyrosine Kinase Inhibitors: A Pairwise and Bayesian Network Meta-Analysis. Front Oncol 2022; 12:841546. [PMID: 35223524 PMCID: PMC8867088 DOI: 10.3389/fonc.2022.841546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the impact of BCR-ABL1 transcript type on outcome in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs). METHODS PubMed, Embase and Cochrane library were systematically searched for relevant studies. Outcomes assessed were: major molecular response (MMR) at 6, 12, 18 and 60 months, deep molecular response (DMR) at 6, 12, 18 and 60 months, event-free survival (EFS), progression-free survival (PFS), overall survival (OS) and treatment-free remission (TFR). Odds ratios (ORs) and hazard ratios (HRs) were estimated and pooled using a random effect model. RESULTS A total of 16 retrospective cohort studies involving 5,411 patients were included in this study. Compared with e13a2 transcripts, there was a statistically significant advantage for patients with e14a2 (alone or with co-expressed e13a2) in terms of MMR and DMR at 6, 12 and 18 months. This benefit was sustained up to 5 years for patients with e14a2 transcripts (OR 1.60, 1.23-2.07 and 2.21, 1.71-2.87, respectively), but not for patients with both transcripts. The expression of e14a2 also improved EFS (HR 0.71, 0.53-0.94) and OS (HR 0.76, 0.57-1.00) throughout treatment period. Importantly, having e14a2 transcripts were associated with a higher rate of TFR (OR 2.94, 1.70-5.08) in CML patients attempting TKI discontinuation. Bayesian network meta-analysis showed that e14a2 had the highest probability to be the most favorable transcript type for all outcomes, followed by both and e13a2. CONCLUSIONS The expression of e14a2 had a positive impact on MMR, DMR, EFS, OS and TFR. We suggest that in the future, the e14a2 transcript can be added to the list of prognostic factors to guide clinical decisions in treating CML. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO/#myprospero], identifier PROSPERO (CRD42021288440).
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Affiliation(s)
- Kangkang Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Yingying Ruan
- Department of General Practice, Shaoxing People's Hospital, Shaoxing, China
| | - Kewei Tian
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Peisheng Xiong
- Immunization Program Section, Zhanggong District Center for Disease Control and Prevention, Ganzhou, China
| | - Nan Xia
- The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jin Li
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Wen Huang
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Feiyan Cao
- Emergency Department, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Qifeng Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
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12
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[Combination of socio-demographic and clinical co-variates for predicting treatment responses and outcomes in patients with chronic myeloid leukemia in the chronic phase]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:54-62. [PMID: 35231994 PMCID: PMC8980668 DOI: 10.3760/cma.j.issn.0253-2727.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To explore the impacts of socio-demographic and clinical co-variates on treatment responses and outcomes in patients with chronic myeloid leukemia in the chronic phase (CML-CP) receiving tyrosine kinase inhibitor (TKI) and identified the predictive models for them. Methods: Data of newly diagnosed adult patients with CML-CP receiving first-line TKI and having complete socio-demographic data and clinical information were reviewed. Cox model was used to identify the independent variables associated with complete cytogenetic response (CCyR) , major molecular response (MMR) , molecular response 4 (MR(4)) and molecular response 4.5 (MR(4.5)) , as well as failure-free survival (FFS) , progression-free survival (PFS) , overall survival (OS) and CML-related OS. Results: A total of 1414 CML-CP patients treated with first-line imatinib (n=1176) , nilotinib (n=170) or dasatinib (n=68) were reviewed. Median age was 40 (18-83) years and 873 patients (61.7% ) were males. Result of the multivariate analysis showed that lower educational level (P<0.001-0.070) and EUTOS long-term survival intermediate or high-risk (P<0.001-0.009) were significantly associated with lower cumulative incidences of CCyR, MMR, MR(4) and MR(4.5), as well as the inferior FFS, PFS, OS and CML-related OS. In addition, those who were males, from rural households, had white blood cells (WBC) ≥120×10(9)/L, hemoglobin (HGB) <115 g/L and treated with first-line imatinib had significantly lower cumulative incidences of cytogenetic and/or molecular responses. Being single, divorced or widowed, having, rural household registration, WBC≥120×10(9)/L, HGB<15 g/L, and comorbidity (ies) was significantly associated with inferior FFS, PFS, OS, and/or CML-related OS. Thereafter, the patients were classified into several subgroups using the socio-demographic characteristics and clinical variables by cytogenetic and molecular responses, treatment failure and disease progression, as well as overall survival and CML-related OS, respectively. There were significant differences in treatment responses and outcomes among the subgroups (P<0.001) . Conclusion: Except for clinical co-variates, socio-demographic co-variates significantly correlated with TKI treatment responses and outcomes in CML-CP patients. Models established by the combination of independent socio-demographic and clinical co-variates could effectively predict the responses and outcome.
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13
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Castagnetti F, Binotto G, Capodanno I, Billio A, Calistri E, Cavazzini F, Crugnola M, Gozzini A, Gugliotta G, Krampera M, Lucchesi A, Merli A, Miggiano MC, Minotto C, Poggiaspalla M, Salvucci M, Scappini B, Tiribelli M, Trabacchi E, Rosti G, Galimberti S, Bonifacio M. Making Treatment-Free Remission (TFR) Easier in Chronic Myeloid Leukemia: Fact-Checking and Practical Management Tools. Target Oncol 2021; 16:823-838. [PMID: 34661826 PMCID: PMC8613078 DOI: 10.1007/s11523-021-00831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
In chronic-phase chronic myeloid leukemia (CML), tyrosine kinase inhibitors (TKIs) are the standard of care, and treatment-free remission (TFR) following the achievement of a stable deep molecular response (DMR) has become, alongside survival, a primary goal for virtually all patients. The GIMEMA CML working party recently suggested that the possibility of achieving TFR cannot be denied to any patient, and proposed specific treatment policies according to the patient's age and risk. However, other international recommendations (including 2020 ELN recommendations) are more focused on survival and provide less detailed suggestions on how to choose first and subsequent lines of treatment. Consequently, some grey areas remain. After literature review, a panel of Italian experts discussed the following controversial issues: (1) early prediction of DMR and TFR: female sex, non-high disease risk score, e14a2 transcript and early MR achievement have been associated with stable DMR, but the lack of these criteria is not sufficient to exclude any patient from TFR; (2) criteria for first and subsequent line therapy choice: a number of patient and drug characteristics have been proposed to make a personalized decision; (3) monitoring of residual disease after discontinuation: after the first 6 months, the frequency of molecular tests can be reduced based on MR4.5 persistence and short turnaround time; (4) prognosis of TFR: therapy and DMR duration are important to predict TFR; although immunological control of CML plays a role, no immunological predictive phenotype is currently available. This guidance is intended as a practical tool to support physicians in decision making.
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Affiliation(s)
- Fausto Castagnetti
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.
| | - Gianni Binotto
- Hematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Atto Billio
- Hematology and Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy
| | | | | | - Monica Crugnola
- Hematology Unit and BMT, Azienda Ospedaliero Universitaria, Parma, Italy
| | - Antonella Gozzini
- Department of Cellular Therapies and Transfusion Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gabriele Gugliotta
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Krampera
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Lucchesi
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Anna Merli
- Hematology Unit, Ospedale Infermi Rimini, AUSL Romagna, Rimini, Italy
| | | | - Claudia Minotto
- Medical Oncology and Onco-Hematology Unit, AULSS 3 Serenissima distretto di Dolo-Mirano, Venice, Italy
| | - Monica Poggiaspalla
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marzia Salvucci
- Hematology Unit, Oncology and Hematology Department, Ospedale Civico, Ravenna, Italy
| | - Barbara Scappini
- Hematology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| | - Elena Trabacchi
- Hematology Unit and BMT Center, Ospedale G. Saliceto, Piacenza, Italy
| | - Gianantonio Rosti
- Scientific Direction, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimiliano Bonifacio
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
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14
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Mughal TI, Psaila B, DeAngelo DJ, Saglio G, Van Etten RA, Radich JP. Interrogating the molecular genetics of chronic myeloproliferative malignancies for personalized management in 2021. Haematologica 2021; 106:1787-1793. [PMID: 33657787 PMCID: PMC8252942 DOI: 10.3324/haematol.2020.267252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tariq I Mughal
- Tufts University Medical Center, Boston, MA, USA; University of Buckingham Medical School, Buckingham.
| | - Bethan Psaila
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford
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