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Huang X, Liu Y, Liu R, Zou X, Yang H. The efficacy and adverse events of arsenic trioxide for the patients with myelodysplastic syndrome: a systematic review and component network meta-analysis. Hematology 2023; 28:2274149. [PMID: 37908176 DOI: 10.1080/16078454.2023.2274149] [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: 04/14/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Arsenic trioxide (ATO) might be effective for myelodysplastic syndrome (MDS) by apoptosis induction and demethylation. But ATO has not been widely recommended for small sample and conflicting conclusion of existing trials. This review aimed to systematically evaluate the efficacy of regimens containing ATO for the MDS and explore optimal combination. METHOD Randomized clinical trials (RCTs) about ATO regimens were retrieved from China National Knowledge Infrastructure, Embase and PubMed. With odds ratio (OR) as the effect size, network meta-analysis (NMA) and component network meta-analysis (CNMA) were conducted by R and 'netmeta' package, after study selection, quality assessment and data extraction. RESULT Thirty-night RCTs were included with a total of 2125 patients, including 1235 treated by ATO containing regimen. With support therapy alone as reference, no inconsistency and heterogeneity were observed. Although NMA did not demonstrate better efficacy of ATO alone, the result of CNMA indicated that ATO was effective in the improvement of overall remission (ORR) [OR = 2.09(1.61, 2.71)] and complete remission (CR) [OR = 1.66(1.25, 2.21)]. Five ATO-containing regimens reported could effectively improve ORR, some of them benefit in CR or hematological improvement (HI) as well. ATO + Traditional Chinese Medicine (TCM), ATO + Thalidomide (T)+TCM, ATO + Chemotherapy (Chem)+T + TCM were regarded as the optimal combination, which improved both ORR, CR and HI in theory. ATO did not increase the risk of common adverse events compared to supportive therapy [(OR = 0.90(0.67, 1.21)]. CONCLUSION ATO may be an effective and well-tolerant option for patients with myelodysplastic syndrome.
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Affiliation(s)
- Xiaohua Huang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, People's Republic of China
| | - Yuan Liu
- The First Clinical Medicine College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, People's Republic of China
| | - Ruixuan Liu
- The First Clinical Medicine College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, People's Republic of China
| | - Xiaoqiu Zou
- Department of Traditional Chinese Medicine, Guangzhou Liwan Maternal and Child Health Hospital, Guangzhou, People's Republic of China
| | - Hongyong Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, People's Republic of China
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2
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Comorbidities and malignancies negatively affect survival in myelodysplastic syndromes: a population-based study. Blood Adv 2021; 5:1344-1351. [PMID: 33656535 DOI: 10.1182/bloodadvances.2020003381] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/02/2021] [Indexed: 11/20/2022] Open
Abstract
Population-based studies that contain detailed clinical data on patients with myelodysplastic syndrome (MDS) are scarce. This study focused on the real-world overall survival (OS) of MDS patients in association with comorbidities, specifically malignancies. An observational population-based study using the HemoBase registry was performed, including all patients with MDS diagnosed between 2005 and 2017 in Friesland, a Dutch province. Detailed information about diagnosis, patient characteristics, previous treatment of malignancies, and comorbidities according to the Charlson Comorbidity Index (CCI) was collected from electronic health records. Patients were followed up until June 2019. Kaplan-Meier plots and Cox regression analyses were used to study survival differences. In the 291 patients diagnosed with MDS, the median OS was 25.3 months (95% confidence interval [CI], 20.3-30.2). OS was significantly better for patients with CCI score <4, age <65 years, female sex, and low-risk MDS. Fifty-seven patients (20%) had encountered a prior malignancy (excluding nonmelanoma skin cancer), and a majority (38 patients; 67%) were therapy related. Both therapy-related and secondary MDSs were associated with worse OS (hazard ratio, 1.51; 95% CI, 1.02-2.23 and 1.58; 95% CI, 0.95-2.65, respectively), as compared with de novo MDS patients (P = .04). Patients in remission at time of MDS diagnosis had a similar median OS compared with patients with de novo MDS (25.5 vs 28.3 months). This population-based study involving all newly diagnosed MDS patients over a 13-year period in Friesland showed that multiple comorbidities, including previous malignancies, are associated with shorter OS. OS was not related to the use of radiotherapy or chemotherapy.
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3
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Sekeres MA, Watts J, Radinoff A, Sangerman MA, Cerrano M, Lopez PF, Zeidner JF, Campelo MD, Graux C, Liesveld J, Selleslag D, Tzvetkov N, Fram RJ, Zhao D, Bell J, Friedlander S, Faller DV, Adès L. Randomized phase 2 trial of pevonedistat plus azacitidine versus azacitidine for higher-risk MDS/CMML or low-blast AML. Leukemia 2021; 35:2119-2124. [PMID: 33483617 PMCID: PMC8257476 DOI: 10.1038/s41375-021-01125-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/24/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Mikkael A Sekeres
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Justin Watts
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Montserrat Arnan Sangerman
- Institut Català d'Oncologia-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet, Barcelona, Spain
| | - Marco Cerrano
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Turin, Italy
| | - Patricia Font Lopez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Joshua F Zeidner
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Maria Diez Campelo
- University Hospital of Salamanca, IBSAL Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Carlos Graux
- Department of Hematology, Université Catholique de Louvain, CHU UCL Namur (Godinne site), Yvoir, Belgium
| | - Jane Liesveld
- The James P Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | | | - Nikolay Tzvetkov
- MHAT Dr. Georgi Stranski, Clinic of Haematology, Pleven, Bulgaria
| | - Robert J Fram
- Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Dan Zhao
- Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Jill Bell
- Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Sharon Friedlander
- Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Douglas V Faller
- Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Lionel Adès
- AP-HP, Hôpital Saint Louis, Paris, France.,University of Paris, and INSERM U944, Paris, France
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4
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Capizzello A, Tatsiou Z, Prassopoulos P. Upper extremity pleomorphic dermal sarcoma in a patient with chronic myelomonocytic leukemia. Hippokratia 2019; 23:181-185. [PMID: 32742171 PMCID: PMC7377586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pleomorphic dermal sarcoma is a potentially high-grade cutaneous spindle cell tumor that closely resembles atypical fibroxanthoma in the superficial, dermal aspects but with adverse pathological features. Chronic inflammation, as several autoimmune disorders are co-associated with chronic myelomonocytic leukemia. CASE DESCRIPTION We report here an 84-year-old male patient with swelling lump on the upper third of the left arm. Previously he suffered from a type I chronic myelomonocytic leukemia. Based on the initial ultrasound-guided biopsy of the lesion, the histopathological examination revealed an atypical fibroxanthoma. A wide local excision was performed and the diagnosis was revised to pleomorphic dermal sarcoma by the pathologist, based on the currently accepted criteria. Adjuvant radiotherapy was performed. CONCLUSION Differentiating between atypical fibroxanthoma and pleomorphic dermal sarcoma is pivotal. A partial sampling of the skin lesion poses a significant pitfall, as important diagnostic features cannot be assessed. Immunosuppression seems to be involved in the pathogenesis of chronic myelomonocytic leukemia and pleomorphic dermal sarcomas, because of the advanced patient age. HIPPOKRATIA 2019, 23(4): 181-185.
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Affiliation(s)
- A Capizzello
- Department of Radiation Oncology, AHEPA University Hospital, Thessaloniki, Greece
| | - Z Tatsiou
- Department of Anatomical Pathology, General Hospital of Kavala, Kavala, Greece
| | - P Prassopoulos
- Department of Radiology, AHEPA University Hospital, Thessaloniki, Greece
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5
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Woo J, Choi DR, Storer BE, Yeung C, Halpern AB, Salit RB, Sorror ML, Woolston DW, Monahan T, Scott BL, Deeg HJ. Impact of clinical, cytogenetic, and molecular profiles on long-term survival after transplantation in patients with chronic myelomonocytic leukemia. Haematologica 2019; 105:652-660. [PMID: 31289199 PMCID: PMC7049334 DOI: 10.3324/haematol.2019.218677] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is a heterogeneous group of clonal hematopoietic malignancies with variable clinical and molecular features. We analyzed long-term results of allogeneic hematopoietic cell transplantation in patients with CMML and determined clinical and molecular risk factors associated with outcomes. Data from 129 patients, aged 7-74 (median 55) years, at various stages of the disease and transplanted from related or unrelated donors were analyzed. Using a panel of 75 genes somatic mutations present before hematopoietic cell transplantation were identified In 52 patients. The progression-free survival rate at 10 years was 29%. The major cause of death was relapse (32%), which was significantly associated with adverse cytogenetics (hazard ratio, 3.77; P=0.0002), CMML Prognostic Scoring System (hazard ratio, 14.3, P=0.01), and MD Anderson prognostic scores (hazard ratio, 9.4; P=0.005). Mortality was associated with high-risk cytogenetics (hazard ratio, 1.88; P=0.01) and high Hematopoietic Cell Transplantation Comorbidity Index (score ≥4: hazard ratio, 1.99; P=0.01). High overall mutation burden (≥10 mutations: hazard ratio, 3.4; P=0.02), and ≥4 mutated epigenetic regulatory genes (hazard ratio 5.4; P=0.003) were linked to relapse. Unsupervised clustering of the correlation matrix revealed distinct high-risk groups with unique associations of mutations and clinical features. CMML with a high mutation burden appeared to be distinct from high-risk groups defined by complex cytogenetics. New transplant strategies must be developed to target specific disease subgroups, stratified by molecular profiling and clinical risk factors.
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Affiliation(s)
- Janghee Woo
- Fred Hutchinson Cancer Research Center.,University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Cecilia Yeung
- Fred Hutchinson Cancer Research Center.,University of Washington School of Medicine, Seattle, WA, USA
| | - Anna B Halpern
- Fred Hutchinson Cancer Research Center.,University of Washington School of Medicine, Seattle, WA, USA
| | - Rachel B Salit
- Fred Hutchinson Cancer Research Center.,University of Washington School of Medicine, Seattle, WA, USA
| | - Mohamed L Sorror
- Fred Hutchinson Cancer Research Center.,University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Bart L Scott
- Fred Hutchinson Cancer Research Center.,University of Washington School of Medicine, Seattle, WA, USA
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center .,University of Washington School of Medicine, Seattle, WA, USA
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6
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Diagnosis and Treatment of Chronic Myelomonocytic Leukemias in Adults: Recommendations From the European Hematology Association and the European LeukemiaNet. Hemasphere 2018; 2:e150. [PMID: 31723789 PMCID: PMC6745959 DOI: 10.1097/hs9.0000000000000150] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is a disease of the elderly, and by far the most frequent overlap myelodysplastic/myeloproliferative neoplasm in adults. Aside from the chronic monocytosis that remains the cornerstone of its diagnosis, the clinical presentation of CMML includes dysplastic features, cytopenias, excess of blasts, or myeloproliferative features including high white blood cell count or splenomegaly. Prognosis is variable, with several prognostic scoring systems reported in recent years, and treatment is poorly defined, with options ranging from watchful waiting to allogeneic stem cell transplantation, which remains the only curative therapy for CMML. Here, we present on behalf of the European Hematology Association and the European LeukemiaNet, evidence- and consensus-based guidelines, established by an international group of experts, from Europe and the United States, for standardized diagnostic and prognostic procedures and for an appropriate choice of therapeutic interventions in adult patients with CMML.
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7
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Liu H, Cheng J, Zhao L, Xu Q, Xue M, Zhang S, Liu B. Outcome of patient with high-risk chronic myelomonocytic leukemia, treated with decitabine prior to transformation to acute myeloid leukemia: A case report. Oncol Lett 2018; 15:7132-7138. [PMID: 29731877 PMCID: PMC5921036 DOI: 10.3892/ol.2018.8236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 01/29/2018] [Indexed: 11/23/2022] Open
Abstract
The present study describes a patient with high-risk chronic myelomonocytic leukemia (CMML), for whom decitabine therapy achieved partial remission, prior to a sudden transformation to acute myeloid leukemia (AML) and an inferior outcome. The 53-year-old male reported easily bruising for 5 months. Examination indicated a diagnosis of CMML. Chromosome analysis identified a 48, XY, +8, +21 karyotype, classifying the patient as high-risk, according to a clinical/molecular CPSS (CPSS-Mol) model. Gene sequencing detected a mutation in DNA methyltransferase 3α, which is relatively rarely identified in CMML and has recently been reported to have an independent prognostic impact on overall survival time. Partial remission was achieved with decitabine treatment, and hematologic improvement was observed subsequent to 2 cycles of treatment. However, a sudden transformation to AML led to fatality of the patient. This case suggests that decitabine may be an effective therapeutic for high-risk CMML; however, the response may be temporary, and the ultimate outcome may be extremely poor. Therefore, novel treatment strategies of CMML, including combination therapies with decitabine, or targeted drugs, including Janus kinase inhibitors or granulocyte-macrophage colony stimulating factor monoclonal antibodies, require investigation.
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Affiliation(s)
- Huan Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Juan Cheng
- Department of Hematology, The First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Long Zhao
- Department of Hematology, The First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Qian Xu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Mingming Xue
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Shuling Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Bei Liu
- Department of Hematology, The First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
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8
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Robinson TM, Prince GT, Thoburn C, Warlick E, Ferguson A, Kasamon YL, Borrello IM, Hess A, Smith BD. Pilot trial of K562/GM-CSF whole-cell vaccination in MDS patients. Leuk Lymphoma 2018; 59:2801-2811. [PMID: 29616857 DOI: 10.1080/10428194.2018.1443449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic stem cell malignancies. Currently, approved drugs are given with non-curative intent as the only known cure is allogeneic bone marrow transplantation, which relies on the donor's immune system driving an allogeneic effect. Previous efforts to harness the endogenous immune system have been less successful. We present the results of a pilot study of K562/GM-CSF (GVAX) whole-cell vaccination in MDS patients. The primary objective of safety was met as there were no serious adverse events. One patient had a decrease in transfusion requirements and another demonstrated hematologic improvement suggesting a signal for clinical activity. In vitro correlative studies indicated biological effects on immune cells following vaccination. Although only a pilot study, results are encouraging that an immunotherapeutic approach with a whole-cell vaccine may be feasible in MDS patients.
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Affiliation(s)
- Tara M Robinson
- a Department of Medical Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Gabrielle T Prince
- a Department of Medical Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Chris Thoburn
- b Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Erica Warlick
- c Department of Medicine , University of Minnesota Medical Center , St. Paul/Minneapolis , MN , USA
| | - Anna Ferguson
- a Department of Medical Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Yvette L Kasamon
- a Department of Medical Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Ivan M Borrello
- a Department of Medical Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Allan Hess
- a Department of Medical Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - B Douglas Smith
- a Department of Medical Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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9
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Thomay K, Behrens YL, Lentes J, Wittner N, Wittig V, Rothe D, Steinemann D, Schlegelberger B, Göhring G. Octasomy 21 in a patient with secondary AML after CMML: the role of acquired NRAS mutations in triggering aneuploidy. Leuk Lymphoma 2018; 59:2478-2481. [PMID: 29384408 DOI: 10.1080/10428194.2018.1427861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kathrin Thomay
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
| | - Yvonne Lisa Behrens
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
| | - Jana Lentes
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
| | - Nicole Wittner
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
| | - Verena Wittig
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
| | - Doreen Rothe
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
| | - Doris Steinemann
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
| | | | - Gudrun Göhring
- a Department of Human Genetics , Hannover Medical School , Hannover , Germany
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10
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Hannon M, Wilde L, Nwaoduah N, Kasner M. Chronic myelomonocytic leukemia with central nervous system involvement. Leuk Lymphoma 2018; 59:2267-2268. [PMID: 29322838 DOI: 10.1080/10428194.2017.1422866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michelle Hannon
- a Sidney Kimmel Medical College at Thomas Jefferson University , Philadelphia , PA , USA
| | - Lindsay Wilde
- b Sidney Kimmel Cancer Center of Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | - Nneamaka Nwaoduah
- c Department of Pathology , Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | - Margaret Kasner
- b Sidney Kimmel Cancer Center of Thomas Jefferson University Hospital , Philadelphia , PA , USA
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11
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Duong VH, Padron E, Al Ali NH, Lancet JE, Hall J, Kwok B, Zhang L, Epling-Burnette PK, List AF, Komrokji RS. The prognostic value of circulating myeloblasts in patients with myelodysplastic syndromes. Ann Hematol 2017; 97:247-254. [DOI: 10.1007/s00277-017-3186-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
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12
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Zeidan AM, Hu X, Long JB, Wang R, Ma X, Podoltsev NA, Huntington SF, Gore SD, Davidoff AJ. Hypomethylating agent therapy use and survival in older patients with chronic myelomonocytic leukemia in the United States: A large population-based study. Cancer 2017. [PMID: 28621841 DOI: 10.1002/cncr.30814] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the approval of azacitidine in 2004 and the approval of decitabine in 2006 in the United States for chronic myelomonocytic leukemia (CMML), the overall survival (OS) benefit with hypomethylating agent (HMA) therapy is unclear. METHODS Older adults (age ≥ 66 years) who had been diagnosed with CMML from 2001 to 2011 were selected from the Surveillance, Epidemiology, and End Results-Medicare database, and propensity score matching was used to match patients who had been diagnosed after HMA approval (2007-2011) and had received HMA treatment with patients diagnosed before HMA approval (2001-2003). Cox proportional hazards models with the matched sample were used to assess the change in OS. A second matched cohort of patients who did not receive HMA after approval and patients diagnosed before HMA approval was used to evaluate survival change attributable to other potential differences between the 2 time periods, such as improved supportive care. RESULTS Among 1378 older adults diagnosed with CMML, the median OS was 13 months, and 18.8% received HMAs. In the primary matched analysis, with 225 HMA users diagnosed in 2007-2011 and 395 patients diagnosed in 2001-2003, the median OS times were 17 and 11 months, respectively (hazard ratio, 0.72; 95% confidence interval [CI], 0.58-0.91; P = .005). In a secondary analysis, the risk of death did not differ between 395 propensity score-matched HMA nonusers diagnosed in 2007-2011 and 484 patients diagnosed in 2001-2003 (hazard ratio, 1.09; 95% CI, 0.91-1.32; P = .34). CONCLUSIONS Despite limited evidence, HMAs are commonly used to treat older CMML patients. The use of HMAs was associated with a 28% reduction in the risk of death in adjusted analyses. Improvements in supportive care do not appear to account for temporal improvements in OS. Cancer 2017;123:3754-3762. © 2017 American Cancer Society.
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Affiliation(s)
- Amer M Zeidan
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Xin Hu
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Jessica B Long
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - Nikolai A Podoltsev
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Scott F Huntington
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Steven D Gore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut.,Department of Health Policy and Management, School of Public Health, Yale University, New Haven, Connecticut
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13
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Azacitidine in chronic myelomonocytic leukemia: an effective and manageable approach. Mediterr J Hematol Infect Dis 2014; 6:e2014020. [PMID: 24678397 PMCID: PMC3965718 DOI: 10.4084/mjhid.2014.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/29/2014] [Indexed: 11/23/2022] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is an uncommon neoplastic hematological disorder, typically affecting the elderly, and characterized by a marked clinical heterogeneity and a remarkable propensity for transformation into acute myeloid leukemia. Hypomethylating agents represent the most innovative management approach in this difficult setting. At our institution, between 2010 and 2012, we have treated with azacitidine 10 CMML patients with a median age of 75 (62–86) years. The overall response rate of 70% was achieved without remarkable toxicities; in particular, most therapy-induced side effects were managed on outpatient basis. With a median follow-up of 12,5 (2–27) months, 6 patients are alive, and 4 of them continue to receive the treatment; the median survival from the start of therapy was not reached. In conclusion, also in the light of our encouraging experience, azacitidine can offer new chances of treatment also in the difficult setting of elderly CMML.
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