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Ayala R, Fernández RA, García‐Gutiérrez V, Alvarez‐Larrán A, Osorio S, Sánchez‐Pina JM, Carreño‐Tarragona G, Álvarez N, Gómez‐Casares MT, Duran A, Gorrochategi J, Hernández‐Boluda JC, Martínez‐López J. Janus kinase inhibitor ruxolitinib in combination with nilotinib and prednisone in patients with myelofibrosis (RuNiC study): A phase Ib, multicenter study. EJHAEM 2023; 4:401-409. [PMID: 37206258 PMCID: PMC10188506 DOI: 10.1002/jha2.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 05/21/2023]
Abstract
This phase Ib, non-randomized, open-label study evaluates the safety and tolerability of ruxolitinib in combination with nilotinib and prednisone in patients with naïve or ruxolitinib-resistant myelofibrosis (MF). A total of 15 patients with primary or secondary MF received the study treatment; 13 patients had received prior ruxolitinib treatment (86.7%). Eight patients completed seven cycles (53.3%) and six patients completed twelve cycles of treatment (40%). All the patients experienced at least one adverse event (AE) during the study (the most common AEs were hyperglycemia, asthenia, and thrombocytopenia), and 14 patients registered at least one treatment-related AE (the most common treatment-related AEs were hyperglycemia (22.2%; three grade 3 cases). Five treatment-related serious AEs (SAEs) were reported in two patients (13.3%). No deaths were registered throughout the study. No dose-limiting toxicity was observed. Four out of fifteen (27%) patients experienced a 100% spleen size reduction at Cycle 7, and two additional patients achieved a >50% spleen size reduction, representing an overall response rate of 40% at Cycle 7. In conclusion, the tolerability of this combination was acceptable, and hyperglycemia was the most frequent treatment-related AE. Ruxolitinib in combination with nilotinib and prednisone showed relevant clinical activity in patients with MF. This trial was registered with EudraCT Number 2016-005214-21.
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Affiliation(s)
- Rosa Ayala
- Haematological Malignancies Clinical Research UnitHospital Universitario 12 de Octubre, Universidad Complutense, CNIO, CIBERONCMadridSpain
| | | | | | | | - Santiago Osorio
- Hematology Department Hospital General UGregorio MarañónMadridSpain
| | | | | | - Noemi Álvarez
- Department of Translational HematologyResearch Institute Hospital 12 de Octubre (i+12)MadridSpain
| | | | - Antonia Duran
- Hematology Department Hospital Universitario Son EspasesPalma de MallorcaSpain
| | | | | | - Joaquín Martínez‐López
- Haematological Malignancies Clinical Research UnitHospital Universitario 12 de Octubre, Universidad Complutense, CNIO, CIBERONCMadridSpain
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2
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Sargas C, Ayala R, Larráyoz MJ, Chillón MC, Carrillo-Cruz E, Bilbao-Sieyro C, Prados de la Torre E, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Gil C, Bernal T, Bergua JM, Algarra L, Tormo M, Martínez-Sánchez P, Soria E, Serrano J, Alonso-Domínguez JM, García-Boyero R, Amigo ML, Herrera-Puente P, Sayas MJ, Lavilla-Rubira E, Martínez-López J, Calasanz MJ, García-Sanz R, Pérez-Simón JA, Gómez-Casares MT, Sánchez-García J, Barragán E, Montesinos P. Molecular Landscape and Validation of New Genomic Classification in 2668 Adult AML Patients: Real Life Data from the PETHEMA Registry. Cancers (Basel) 2023; 15:cancers15020438. [PMID: 36672386 PMCID: PMC9856266 DOI: 10.3390/cancers15020438] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Next-Generation Sequencing (NGS) implementation to perform accurate diagnosis in acute myeloid leukemia (AML) represents a major challenge for molecular laboratories in terms of specialization, standardization, costs and logistical support. In this context, the PETHEMA cooperative group has established the first nationwide diagnostic network of seven reference laboratories to provide standardized NGS studies for AML patients. Cross-validation (CV) rounds are regularly performed to ensure the quality of NGS studies and to keep updated clinically relevant genes recommended for NGS study. The molecular characterization of 2856 samples (1631 derived from the NGS-AML project; NCT03311815) with standardized NGS of consensus genes (ABL1, ASXL1, BRAF, CALR, CBL, CEBPA, CSF3R, DNMT3A, ETV6, EZH2, FLT3, GATA2, HRAS, IDH1, IDH2, JAK2, KIT, KRAS, MPL, NPM1, NRAS, PTPN11, RUNX1, SETBP1, SF3B1, SRSF2, TET2, TP53, U2AF1 and WT1) showed 97% of patients having at least one mutation. The mutational profile was highly variable according to moment of disease, age and sex, and several co-occurring and exclusion relations were detected. Molecular testing based on NGS allowed accurate diagnosis and reliable prognosis stratification of 954 AML patients according to new genomic classification proposed by Tazi et al. Novel molecular subgroups, such as mutated WT1 and mutations in at least two myelodysplasia-related genes, have been associated with an adverse prognosis in our cohort. In this way, the PETHEMA cooperative group efficiently provides an extensive molecular characterization for AML diagnosis and risk stratification, ensuring technical quality and equity in access to NGS studies.
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Affiliation(s)
- Claudia Sargas
- Grupo Acreditado de Investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - María José Larráyoz
- CIMA LAB Diagnostics, Departamento de Bioquímica y Genética, Universidad de Navarra, 31008 Pamplona, Spain
| | - María Carmen Chillón
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer–IBMCC (USAL–CSIC), 37007 Salamanca, Spain
| | - Estrella Carrillo-Cruz
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | - Cristina Bilbao-Sieyro
- Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Esther Prados de la Torre
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | - David Martínez-Cuadrón
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Blanca Boluda
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto Universitario (IUOPA), Instituto de Investigación del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | | | - Lorenzo Algarra
- Hospital Universitario General de Albacete, 02006 Albacete, Spain
| | - Mar Tormo
- Hospital Clínico Universitario–INCLIVA, 46010 Valencia, Spain
| | - Pilar Martínez-Sánchez
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | - Josefina Serrano
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | | | | | - María Luz Amigo
- Hospital Universitario Morales Messeguer, 30008 Murcia, Spain
| | | | | | | | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, National Cancer Research Center, Complutense University, 28041 Madrid, Spain
| | - María José Calasanz
- CIMA LAB Diagnostics, Departamento de Bioquímica y Genética, Universidad de Navarra, 31008 Pamplona, Spain
| | - Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer–IBMCC (USAL–CSIC), 37007 Salamanca, Spain
| | - José Antonio Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC/CIBERONC), Universidad de Sevilla, 41013 Sevilla, Spain
| | | | - Joaquín Sánchez-García
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), 14004 Córdoba, Spain
| | - Eva Barragán
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
- Servicio Análisis Clínicos, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-961-244589
| | - Pau Montesinos
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), 46026 Valencia, Spain
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
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3
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Villar S, Ariceta B, Agirre X, Urribarri AD, Ayala R, Martínez-Cuadrón D, Bergua JM, Vives S, Algarra L, Tormo M, Martínez P, Serrano J, Simoes C, Herrera P, Calasanz MJ, Alfonso-Piérola A, Paiva B, Martínez-López J, San Miguel JF, Prósper F, Montesinos P. The transcriptomic landscape of elderly acute myeloid leukemia identifies B7H3 and BANP as a favorable signature in high-risk patients. Front Oncol 2022; 12:1054458. [PMID: 36505804 PMCID: PMC9729799 DOI: 10.3389/fonc.2022.1054458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
Acute myeloid leukemia (AML) in the elderly remains a clinical challenge, with a five-year overall survival rate below 10%. The current ELN 2017 genetic risk classification considers cytogenetic and mutational characteristics to stratify fit AML patients into different prognostic groups. However, this classification is not validated for elderly patients treated with a non-intensive approach, and its performance may be suboptimal in this context. Indeed, the transcriptomic landscape of AML in the elderly has been less explored and it might help stratify this group of patients. In the current study, we analyzed the transcriptome of 224 AML patients > 65 years-old at diagnosis treated in the Spanish PETHEMA-FLUGAZA clinical trial in order to identify new prognostic biomarkers in this population. We identified a specific transcriptomic signature for high-risk patients with mutated TP53 or complex karyotype, revealing that low expression of B7H3 gene with high expression of BANP gene identifies a subset of high-risk AML patients surviving more than 12 months. This result was further validated in the BEAT AML cohort. This unique signature highlights the potential of transcriptomics to identify prognostic biomarkers in in elderly AML.
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Affiliation(s)
- Sara Villar
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain
| | - Beñat Ariceta
- CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Centro de Investigación Médica Aplicada (CIMA) LAB Diagnostics, Universidad de Navarra, Pamplona, Spain,Program of Hematology-Oncology, CIMA, Universidad de Navarra, Pamplona, Spain
| | - Xabier Agirre
- CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Program of Hematology-Oncology, CIMA, Universidad de Navarra, Pamplona, Spain
| | | | - Rosa Ayala
- Hospital Universitario 12 de octubre, Madrid, Spain
| | | | | | - Susana Vives
- ICO Badalona- Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Josefina Serrano
- Hospital Universitario Reina Sofía, Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Catia Simoes
- Program of Hematology-Oncology, CIMA, Universidad de Navarra, Pamplona, Spain
| | | | - Maria José Calasanz
- CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Centro de Investigación Médica Aplicada (CIMA) LAB Diagnostics, Universidad de Navarra, Pamplona, Spain
| | - Ana Alfonso-Piérola
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain
| | - Bruno Paiva
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,Centro de Investigación Médica Aplicada (CIMA) LAB Diagnostics, Universidad de Navarra, Pamplona, Spain
| | | | - Jesús F. San Miguel
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain
| | - Felipe Prósper
- Servicio de Hematología y Terapia Celular, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain,CIBERONC Centro de Investigación Biomédica en Red de Cáncer, Pamplona, Spain,*Correspondence: Felipe Prósper, ; Pau Montesinos,
| | - Pau Montesinos
- Hospital Universitario y Politécnico la Fe, Valencia, Spain,*Correspondence: Felipe Prósper, ; Pau Montesinos,
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4
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Chu X, Zhong L, Dan W, Wang X, Zhang Z, Liu Z, Lu Y, Shao X, Zhou Z, Chen S, Liu B. DNMT3A R882H mutation drives daunorubicin resistance in acute myeloid leukemia via regulating NRF2/NQO1 pathway. Cell Commun Signal 2022; 20:168. [PMID: 36303144 PMCID: PMC9615155 DOI: 10.1186/s12964-022-00978-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND DNA methyltransferase 3A (DNMT3A) often mutate on arginine 882 (DNMT3AR882) in acute myeloid leukemia (AML). AML patients with DNMT3A R882 mutation are usually resistant to daunorubicin treatment; however, the associated mechanism is still unclear. Therefore, it is urgent to investigate daunorubicin resistance in AML patients with DNMT3A R882 mutant. METHOD AML cell lines with DNMT3A-wild type (DNMT3A-WT), and DNMT3A-Arg882His (DNMT3A-R882H) mutation were constructed to investigate the role of DNMT3A R882H mutation on cell proliferation, apoptosis and cells' sensitivity to Danunorubin. Bioinformatics was used to analyze the role of nuclear factor-E2-related factor (NRF2) in AML patients with DNMT3A R882 mutation. The regulatory mechanism of DNMT3A R882H mutation on NRF2 was studied by Bisulfite Sequencing and CO-IP. NRF2 inhibitor Brusatol (Bru) was used to explore the role of NRF2 in AML cells carried DNMT3A R882H mutation. RESULTS AML cells with a DNMT3A R882H mutation showed high proliferative and anti-apoptotic activities. In addition, mutant cells were less sensitive to daunorubicin and had a higher NRF2 expression compared with those in WT cells. Furthermore, the NRF2/NQO1 pathway was activated in mutant cells in response to daunorubicin treatment. DNMT3A R882H mutation regulated the expression of NRF2 via influencing protein stability rather than decreasing methylation of NRF2 promoter. Also, NRF2/NQO1 pathway inhibition improved mutant cells' sensitivity to daunorubicin significantly. CONCLUSION Our findings identified NRF2 as an important player in the regulation of cell apoptosis through which helps mediate chemoresistance to daunorubicin in AML cells with DNMT3A R882H mutation. Targeting NRF2 might be a novel therapeutic approach to treat AML patients with a DNMT3A R882H mutation. Video abstract.
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Affiliation(s)
- Xuan Chu
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Liang Zhong
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Wenran Dan
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Xiao Wang
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Zhonghui Zhang
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Zhenyan Liu
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Yang Lu
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Xin Shao
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Ziwei Zhou
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Shuyu Chen
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Beizhong Liu
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, 402160, China. .,Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China.
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5
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Granowicz EM, Jonas BA. Targeting TP53-Mutated Acute Myeloid Leukemia: Research and Clinical Developments. Onco Targets Ther 2022; 15:423-436. [PMID: 35479302 PMCID: PMC9037178 DOI: 10.2147/ott.s265637] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/07/2022] [Indexed: 12/13/2022] Open
Abstract
TP53 is a key tumor suppressor gene that plays an important role in regulating apoptosis, senescence, and DNA damage repair in response to cellular stress. Although somewhat rare, TP53-mutated AML has been identified as an important molecular subgroup with a prognosis that is arguably the worst of any. Survival beyond one year is rare after induction chemotherapy with or without consolidative allogeneic stem cell transplant. Although response rates have been improved with hypomethylating agents, outcomes remain particularly poor due to short response duration. Improvements in our understanding of AML genetics and biology have led to a surge in novel treatment options, though the clinical applicability of these agents in TP53-mutated disease remains largely unknown. This review will focus on the epidemiology, molecular characteristics, and clinical significance of TP53 mutations in AML as well as emerging treatment options that are currently being studied.
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Affiliation(s)
- Eric M Granowicz
- Department of Internal Medicine, Division of Hematology/Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Brian A Jonas
- Department of Internal Medicine, Division of Hematology/Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
- Correspondence: Brian A Jonas, Department of Internal Medicine, Division of Hematology/Oncology, University of California Davis Comprehensive Cancer Center, 4501 X Street, Suite #3016, Sacramento, CA, 95817, USA, Tel +1 916-734-3772, Fax +1 916-734-7946, Email
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