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Padmakumar A, Thankamony P, Vasudevan JA, Gopinath P, Chandraprabha VR, Devi ARTV, Anitha GRJ, Sreelatha MM, Padmakumar D, Sreedharan H. Double Philadelphia chromosome: a rare and sole abnormality in pediatric B-acute lymphoblastic leukemia. 3 Biotech 2024; 14:75. [PMID: 38371902 PMCID: PMC10866820 DOI: 10.1007/s13205-024-03935-6] [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: 08/19/2022] [Accepted: 12/04/2023] [Indexed: 02/20/2024] Open
Abstract
The present study describes a 7-year-old male child who had attended the Pediatric Oncology Clinic of the Regional Cancer Centre, Thiruvananthapuram, Kerala, India, and was pathologically confirmed to have B-Acute Lymphoblastic Leukemia (B-ALL). Conventional cytogenetics analysis at diagnosis showed the presence of a double Philadelphia chromosome and the karyotype of the case was 47, XY, t(9;22)(q34;q11.2), + der(22)t(9;22). FISH, done as a molecular confirmation of the translocation, t(9;22)(q34;q11.2), and this case showed an additional fusion signal that confirms the presence of double Ph. As far as we are aware, this represents the initial and only occurrence of an abnormality report regarding the double Philadelphia chromosome in pediatric B-ALL within India. The double Philadelphia chromosome in B-ALL has a very poor prognosis despite aggressive treatment with chemotherapy. This study reveals the importance of conventional and molecular cytogenetic analysis in risk stratification and prognosis prediction of pediatric B-ALL. The risk stratification based on the conventional and molecular cytogenetic analysis may be taken into consideration for deciding the treatment strategy for each patient.
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Affiliation(s)
- Amritha Padmakumar
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
| | | | | | - Preethi Gopinath
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
| | - Vineetha Radhakrishnan Chandraprabha
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
| | - Akhila Raj Thampirajan Vimala Devi
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
| | - Geetha Raj John Anitha
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
| | - Mahitha Mohanan Sreelatha
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
| | - Devipriya Padmakumar
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
| | - Hariharan Sreedharan
- Laboratory of Cytogenetics and Molecular Diagnostics, Division of Cancer Research, Regional Cancer Centre, University of Kerala, Thiruvananthapuram, India
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Maia Moço L, Fraga A, Maia I, Almeida M. Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Children: A Retrospective Cohort Study at a Pediatric Oncology Center. Cureus 2024; 16:e54154. [PMID: 38496108 PMCID: PMC10940871 DOI: 10.7759/cureus.54154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objective Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL Ph+) is quite rare among pediatric patients. Its management has undergone significant changes in the past few years, leading to some variability in how it is approached. At the Portuguese Oncology Institute of Porto (IPOP), a tertiary oncological center, the standard of care has been aligned with the guidelines proposed by the European intergroup study of post-induction treatment of ALL Ph+ (EsPhALL). In this study, we aimed to examine the experience and outcomes related to the treatment of pediatric patients with ALL Ph+ at IPOP. Methods This retrospective cohort study involved pediatric patients diagnosed with ALL Ph+ at IPOP between January 2008 and December 2022 and analyzed their outcomes. Results A total of 14 patients were included. IKFZ1 was altered in five patients (out of nine in whom it was searched). Five patients were treated according to EsPhALL 2004, which involved starting imatinib later in a discontinuous manner [resulting in both five-year overall survival (OS) and progression-free survival (PFS) of 60%]. The EsPhALL 2010 (preconizing a continuous imatinib regimen instead) was employed in three patients, with a five-year OS and PFS of 66.7%. All children mentioned above received cranial irradiation therapy (CRT). Finally, six were treated according to the EsPhALL 2015, which stopped including CRT in its backbone. The five-year OS was 100%, whereas every patient progressed with an increase in BCR::ABL1 levels greater than 1-log. Moreover, until 2015, all patients had been recommended to undergo allogeneic hematopoietic stem cell transplantation (alloHSCT). However, since 2015, alloHSCT has been exclusively reserved for relapsed/refractory (R/R) disease or poor responders with positive measurable residual disease (MRD). In total, alloHSCT was performed in nine patients. Conclusions Although initially associated with a poor prognosis, the ALL Ph+ paradigm is drastically shifting. Further studies will hopefully clarify the outcomes in this population and help understand the role of central nervous system (CNS) prophylaxis, alloHSCT, and MRD quantification.
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Affiliation(s)
- Leonardo Maia Moço
- Hematology and Bone Marrow Transplantation, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
| | - Ana Fraga
- Pediatric Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
| | - Iris Maia
- Pediatric Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
| | - Marta Almeida
- Pediatric Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
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Moles E, Howard CB, Huda P, Karsa M, McCalmont H, Kimpton K, Duly A, Chen Y, Huang Y, Tursky ML, Ma D, Bustamante S, Pickford R, Connerty P, Omari S, Jolly CJ, Joshi S, Shen S, Pimanda JE, Dolnikov A, Cheung LC, Kotecha RS, Norris MD, Haber M, de Bock CE, Somers K, Lock RB, Thurecht KJ, Kavallaris M. Delivery of PEGylated liposomal doxorubicin by bispecific antibodies improves treatment in models of high-risk childhood leukemia. Sci Transl Med 2023; 15:eabm1262. [PMID: 37196067 DOI: 10.1126/scitranslmed.abm1262] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
High-risk childhood leukemia has a poor prognosis because of treatment failure and toxic side effects of therapy. Drug encapsulation into liposomal nanocarriers has shown clinical success at improving biodistribution and tolerability of chemotherapy. However, enhancements in drug efficacy have been limited because of a lack of selectivity of the liposomal formulations for the cancer cells. Here, we report on the generation of bispecific antibodies (BsAbs) with dual binding to a leukemic cell receptor, such as CD19, CD20, CD22, or CD38, and methoxy polyethylene glycol (PEG) for the targeted delivery of PEGylated liposomal drugs to leukemia cells. This liposome targeting system follows a "mix-and-match" principle where BsAbs were selected on the specific receptors expressed on leukemia cells. BsAbs improved the targeting and cytotoxic activity of a clinically approved and low-toxic PEGylated liposomal formulation of doxorubicin (Caelyx) toward leukemia cell lines and patient-derived samples that are immunophenotypically heterogeneous and representative of high-risk subtypes of childhood leukemia. BsAb-assisted improvements in leukemia cell targeting and cytotoxic potency of Caelyx correlated with receptor expression and were minimally detrimental in vitro and in vivo toward expansion and functionality of normal peripheral blood mononuclear cells and hematopoietic progenitors. Targeted delivery of Caelyx using BsAbs further enhanced leukemia suppression while reducing drug accumulation in the heart and kidneys and extended overall survival in patient-derived xenograft models of high-risk childhood leukemia. Our methodology using BsAbs therefore represents an attractive targeting platform to potentiate the therapeutic efficacy and safety of liposomal drugs for improved treatment of high-risk leukemia.
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Affiliation(s)
- Ernest Moles
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- Australian Centre for Nanomedicine, Faculty of Engineering, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Christopher B Howard
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia 4072, Australia
| | - Pie Huda
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia 4072, Australia
| | - Mawar Karsa
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Hannah McCalmont
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Kathleen Kimpton
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Alastair Duly
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Yongjuan Chen
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Yizhou Huang
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Melinda L Tursky
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital Sydney, Sydney 2010, Australia
- St Vincent's Centre for Applied Medical Research (AMR), Sydney 2010, Australia
- St Vincent Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - David Ma
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital Sydney, Sydney 2010, Australia
- St Vincent's Centre for Applied Medical Research (AMR), Sydney 2010, Australia
- St Vincent Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Sonia Bustamante
- Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney 2052, Australia
| | - Russell Pickford
- Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney 2052, Australia
| | - Patrick Connerty
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Sofia Omari
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Christopher J Jolly
- School of Biomedical Sciences, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
| | - Swapna Joshi
- School of Biomedical Sciences, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
| | - Sylvie Shen
- School of Biomedical Sciences, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
| | - John E Pimanda
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
- School of Biomedical Sciences, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- Department of Haematology, Prince of Wales Hospital, Sydney 2031, Australia
| | - Alla Dolnikov
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Laurence C Cheung
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, Western Australia 6009, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia 6102, Australia
| | - Rishi S Kotecha
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, Western Australia 6009, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia 6102, Australia
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia 6009, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
- University of New South Wales Centre for Childhood Cancer Research, UNSW Sydney, Sydney 2052, Australia
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Charles E de Bock
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Klaartje Somers
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| | - Kristofer J Thurecht
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia 4072, Australia
- Centre for Advanced Imaging, ARC Training Centre for Innovation in Biomedical Imaging Technologies, University of Queensland, St Lucia 4072, Australia
| | - Maria Kavallaris
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney 2052, Australia
- Australian Centre for Nanomedicine, Faculty of Engineering, UNSW Sydney, Sydney 2052, Australia
- School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney 2052, Australia
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