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Abdallah AM, Hafez H, Madney Y, Ahmed S, Yassin D, Salem S, Yousry R, Abdel-Azim H, Lehmann L, Elhaddad A. Predictive value of early molecular response to tyrosine kinase inhibitors in pediatric patients with chronic myeloid leukemia. Leuk Lymphoma 2024; 65:1024-1027. [PMID: 38513148 DOI: 10.1080/10428194.2024.2331625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
MESH Headings
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/adverse effects
- Child
- Adolescent
- Treatment Outcome
- Female
- Prognosis
- Male
- Child, Preschool
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Tyrosine Kinase Inhibitors
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Affiliation(s)
- Aya M Abdallah
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
| | - Hanafy Hafez
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Youssef Madney
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sonia Ahmed
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Dina Yassin
- Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sherine Salem
- Department of Clinical Pathology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Rodina Yousry
- Department of Research, Children's Cancer Hospital (CCHE 57357), Cairo, Egypt
| | - Hisham Abdel-Azim
- Cancer Center, Children Hospital and Medical Center, Loma Linda University, Loma Linda, CA, USA
| | - Leslie Lehmann
- Pediatric Stem Cell Transplantation Unit, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alaa Elhaddad
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Chen H, Wen Y, Zeng Y, Lin L, Sun B, Zhu H, He H, Wang X, Zou W, Zheng C, Zheng L, Huang J, Pang L, Huang J, Zhang Y, Lin H, Liu Z, Zhu W, Wang Q, Zhou X, Liu X, Qu H, Liu Z, Du X, Xu N. Patient Versus Physician Perspective in the Management of Chronic Myeloid Leukemia During Treatment with Tyrosine Kinase Inhibitors. Oncol Ther 2024; 12:131-145. [PMID: 38104036 PMCID: PMC10881939 DOI: 10.1007/s40487-023-00255-2] [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: 09/01/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is a chronic disease with treatment-free remission (TFR) increasingly regarded as a feasible goal of treatment. However, various factors may influence adherence to international guidelines for CML management. This study aimed to compare the reporting of care between patients with CML and their treating doctors. METHODS Parallel patient and physician online surveys were conducted between September 22, 2021, and March 15, 2022, which focused on the perceptions of 1882 adult patients with CML and 305 physicians regarding tyrosine kinase inhibitor (TKI) treatment options, monitoring and toxicities, TFR, and challenges faced. RESULTS Among the enrolled patients, 69.9% received first-line imatinib treatment, 18.6% received nilotinib, and 4.7% received dasatinib. Among the patients treated with imatinib, 36.7% switched to other TKIs due to imatinib resistance/intolerance (71.1%), exploration of more potent TKIs to achieve TFR (8.9%), and treating physicians' recommendation (14.0%), with a median duration of initial treatment of 14 months [interquartile range (IQR) 6-36]. Most (91.8%) physicians agreed that the breakpoint cluster region-Abelson 1 (BCR::ABL1) transcript level should be assessed every 3 months, but only 42.7% of individuals committed to 3-monthly testing and only 17.8% strictly followed their treating physicians' recommendation. Half of the patients aimed for TFR; however, just 45.2% of physicians considered TFR as one of the top three goals for their patients. The major concern in obtaining TFR was patients' adherence. Fatigue was often distressing for patients with TKIs, while physicians were more concerned about platelet and neutrophil counts. A total of 12% and 20.8% of patients reported moderate/severe anxiety and depression, respectively, while only 53.7% of physicians had concerns about their patients' mental health. During the coronavirus disease 2019 (COVID-19) pandemic, 69.2% of patients reported a reduction in their income. Among these patients, 61.8% maintained their current treatment, while 7.3% switched to cheaper alternatives or discontinued treatment, with over 80% of these patients belonging to the low-income group. CONCLUSIONS Overcoming challenges in patient-physician communication and treatment access is key to improving disease management and quality of life, especially for patients with low income. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05092048.
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Affiliation(s)
- Hong Chen
- Department of Hematology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Da Dao North, Guangzhou, 510515, Guangdong, China
| | - Yan Wen
- Department of Hematology, Yunnan Hematology Hospital, First People' Hospital of Yunnan, Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yun Zeng
- Department of Hematology, First Affiliated Hospital of Kunming Medical University, Hematology Research Center of Yunnan Province, Kunming, China
| | - Lie Lin
- Department of Hematology, Hainan General Hospital, Haikou, China
| | - Bihong Sun
- Department of Hematology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hongqian Zhu
- Department of Hematology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Huiqing He
- Department of Hematology, Zhongshan People's Hospital, Zhongshan, China
| | - Xiaotao Wang
- Department of Hematology, Guilin Medical University Affiliated Hospital, Guilin, China
| | - Waiyi Zou
- Department of Hematology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Caifeng Zheng
- Department of Hematology, Shenzhen Bao An People's Hospital, Shenzhen, China
| | - Liling Zheng
- Department of Hematology, The Second People's Hospital of Guangdong Province, Guangzhou, China
| | - Jinxiong Huang
- Department of Hematology, Liuzhou People's Hospital, Liuzhou, China
| | - Liping Pang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jixian Huang
- Department of Hematology, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Yuming Zhang
- Department of Hematology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haiqing Lin
- Department of Hematology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Zelin Liu
- Department of Hematology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Wanshou Zhu
- Department of Hematology, Gaozhou People's Hospital, Gaozhou, China
| | - Qiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Da Dao North, Guangzhou, 510515, Guangdong, China
| | - Xuan Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Da Dao North, Guangzhou, 510515, Guangdong, China
| | - Xiaoli Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Da Dao North, Guangzhou, 510515, Guangdong, China
| | - Hong Qu
- Department of Hematology, Panyu Central Hospital, Guangzhou, China
| | - Zhenfang Liu
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuang Yong Road, Nanning, 530021, Guangxi, China.
| | - Xin Du
- Department of Hematology and Shenzhen Bone Marrow Transplantation Public Service Platform, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen University School of Medicine, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China.
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Da Dao North, Guangzhou, 510515, Guangdong, China.
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3
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Scott MT, Liu W, Mitchell R, Clarke CJ, Kinstrie R, Warren F, Almasoudi H, Stevens T, Dunn K, Pritchard J, Drotar ME, Michie AM, Jørgensen HG, Higgins B, Copland M, Vetrie D. Activating p53 abolishes self-renewal of quiescent leukaemic stem cells in residual CML disease. Nat Commun 2024; 15:651. [PMID: 38246924 PMCID: PMC10800356 DOI: 10.1038/s41467-024-44771-9] [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: 10/24/2022] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Whilst it is recognised that targeting self-renewal is an effective way to functionally impair the quiescent leukaemic stem cells (LSC) that persist as residual disease in chronic myeloid leukaemia (CML), developing therapeutic strategies to achieve this have proved challenging. We demonstrate that the regulatory programmes of quiescent LSC in chronic phase CML are similar to that of embryonic stem cells, pointing to a role for wild type p53 in LSC self-renewal. In support of this, increasing p53 activity in primitive CML cells using an MDM2 inhibitor in combination with a tyrosine kinase inhibitor resulted in reduced CFC outputs and engraftment potential, followed by loss of multilineage priming potential and LSC exhaustion when combination treatment was discontinued. Our work provides evidence that targeting LSC self-renewal is exploitable in the clinic to irreversibly impair quiescent LSC function in CML residual disease - with the potential to enable more CML patients to discontinue therapy and remain in therapy-free remission.
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Affiliation(s)
- Mary T Scott
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Wei Liu
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Rebecca Mitchell
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Cassie J Clarke
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Ross Kinstrie
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Felix Warren
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Hassan Almasoudi
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Thomas Stevens
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Karen Dunn
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - John Pritchard
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Mark E Drotar
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Alison M Michie
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Heather G Jørgensen
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - David Vetrie
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK.
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Perusini MA, Novitzky-Basso I, Atenafu EG, Forrest D, Bence-Bruckler I, Savoie L, Keating MM, Busque L, Delage R, Xenocostas A, Liew E, Laneuville P, Paulson K, Stockley T, Lipton JH, Leber B, Kim DDH. Final report of TKI discontinuation trial with dasatinib for the second attempt of treatment-free remission after failing the first attempt with imatinib: Treatment-free Remission Accomplished by Dasatinib (TRAD) study. Br J Haematol 2023; 203:781-791. [PMID: 37697469 DOI: 10.1111/bjh.19058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 09/13/2023]
Abstract
Multiple studies have reported a significant treatment-free remission (TFR) rate of 50%-60% in patients with chronic myeloid leukaemia (CML) who discontinue tyrosine kinase inhibitor (TKI) therapy. However, the remaining half of these patients still require re-initiation of TKI therapy for leukaemia control. It remains unclear if TKI drugs should be switched for re-therapy in patients who failed the first TFR (TFR1) attempt. Our study attempted to determine whether dasatinib therapy after TFR1 failure post-imatinib discontinuation could improve the likelihood of TFR2. Of 59 patients who lost molecular response after imatinib discontinuation for TFR1, 55 patients (93.2%) were treated with dasatinib, of whom 49 (89.1%) regained MR4.5 or deeper response, with a median time of 1.85 months to achieve MR4.5. Dasatinib was discontinued in 35 patients for TFR2 attempt, of whom 26 patients (74.28%) lost MMR and 6 (17.14%) MR4. Risk factor analysis for the TFR2 after dasatinib discontinuation suggested three significant factors: (1) doubling time of BCR::ABL1 transcript following TFR1 attempt, (2) rapid regaining of molecular response following dasatinib therapy and (3) undetectable BCR::ABL1 transcript prior to TFR2 attempt. The present study showed that dasatinib does not increase the TFR2 rate in general, but a selected group of patients could benefit from this approach.
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Affiliation(s)
- Maria Agustina Perusini
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Igor Novitzky-Basso
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Hematology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Biostatistic Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Donna Forrest
- Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Isabelle Bence-Bruckler
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lynn Savoie
- University of Calgary, Alberta Health Services, Calgary, Alberta, Canada
| | - Mary-Margaret Keating
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lambert Busque
- Hematopoiesis and Aging Research Unit, University of Montreal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Robert Delage
- Centre Universitaire d'Hématologie et d'Oncologie de Québec, CHU de Québec, Hôpital de l'Enfant-Jésus, Quebec City, Quebec, Canada
| | - Anargyros Xenocostas
- Division of Hematology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Elena Liew
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Laneuville
- Division of Hematology, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Tracy Stockley
- Department of Pathology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Hematology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Leber
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Dong Hwan Kim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Hematology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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Pacelli P, Santoni A, Sicuranza A, Abruzzese E, Giai V, Crugnola M, Annunziata M, Galimberti S, Iurlo A, Luciano L, Sorà F, Fava C, Bestoso E, Marzano C, Cartocci A, Defina M, Sammartano V, Cencini E, Raspadori D, Bocchia M. Prospective monitoring of chronic myeloid leukemia patients from the time of TKI discontinuation: the fate of peripheral blood CD26 + leukemia stem cells. Front Pharmacol 2023; 14:1194712. [PMID: 37305536 PMCID: PMC10250640 DOI: 10.3389/fphar.2023.1194712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction: In chronic myeloid leukemia (CML), about half of the patients achieving a deep and stable molecular response with tyrosine kinase inhibitors (TKIs) may discontinue TKI treatment without disease recurrence. As such, treatment-free remission (TFR) has become an ambitious goal of treatment. Given the evidence that deepness and duration of molecular response are necessary but not sufficient requisites for a successful TFR, additional biological criteria are needed to identify CML patients suitable for efficacious discontinuation. Leukemia stem cells (LSCs) are supposed to be the reservoir of the disease. Previously, we demonstrated that residual circulating CD34+/CD38-/CD26+ LSCs were still detectable in a consistent number of CML patients during TFR. Methods: CML LSCs could be easily identified by flow-cytometry as they express the CD34+/CD38-/CD26+ phenotype. In this study, we explored the role of these cells and their correlation with molecular response in a cohort of 109 consecutive chronic phase CML patients prospectively monitored from the time of TKI discontinuation. Results: After a median observation time of 33 months from TKI discontinuation, 38/109 (35%) patients failed TFR after a median time of 4 months, while 71/109 (65%) patients are still in TFR. At TKI discontinuation, peripheral blood CD26+LSCs were undetectable in 48/109 (44%) patients and detectable in 61/109 (56%). No statistically significant correlation between detectable/undetectable CD26+LSCs and the rate of TFR loss was found (p = 0.616). The incidence of TFR loss based on the type of TKI treatment was statistically significant for imatinib treatment compared to that of nilotinib (p = 0.039). Exploring the behavior of CD26+LSCs during TFR, we observed fluctuating values that were very variable between patients, and they were not predictive of TFR loss. Discussion: Up to date, our results confirm that CD26+LSCs are detectable at the time of TKI discontinuation and during TFR. Moreover, at least for the observation median time of the study, the persistence of "fluctuating" values of residual CD26+LSCs does not hamper the possibility to maintain a stable TFR. On the contrary, even patients discontinuing TKI with undetectable CD26+LSCs could undergo TFR loss. Our results suggest that factors other than residual LSCs "burden" playing an active role in controlling disease recurrence. Additional studies evaluating CD26+LSCs' ability to modulate the immune system and their interaction in CML patients with very long stable TFR are ongoing.
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Affiliation(s)
- Paola Pacelli
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Adele Santoni
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Valentina Giai
- Division of Hematology, Città Della Salute e Della Scienza, Turin, Italy
| | - Monica Crugnola
- Ematologia e Centro BMT, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigiana Luciano
- Hematology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Federica Sorà
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmen Fava
- Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Elena Bestoso
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Cristina Marzano
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Marzia Defina
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Vincenzo Sammartano
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Emanuele Cencini
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Donatella Raspadori
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Zheng FY, Wang M, Zhang LP, Jiang Q. [Study progress of tyrosine kinase inhibitor discontinuation in children with chronic myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:174-176. [PMID: 36948878 PMCID: PMC10033271 DOI: 10.3760/cma.j.issn.0253-2727.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Indexed: 03/24/2023]
Affiliation(s)
- F Y Zheng
- Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - M Wang
- Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - L P Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - Q Jiang
- Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China
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7
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Therapy Resistance and Disease Progression in CML: Mechanistic Links and Therapeutic Strategies. Curr Hematol Malig Rep 2022; 17:181-197. [PMID: 36258106 DOI: 10.1007/s11899-022-00679-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Despite the adoption of tyrosine kinases inhibitors (TKIs) as molecular targeted therapy in chronic myeloid leukemia, some patients do not respond to treatment and even experience disease progression. This review aims to give a broad summary of advances in understanding of the mechanisms of therapy resistance, as well as management strategies that may overcome or prevent the emergence of drug resistance. Ultimately, the goal of therapy is the cure of CML, which will also require an increased understanding of the leukemia stem cell (LSC). RECENT FINDINGS Resistance to tyrosine kinase inhibitors stems from a range of possible causes. Mutations of the BCR-ABL1 fusion oncoprotein have been well-studied. Other causes range from cell-intrinsic factors, such as the inherent resistance of primitive stem cells to drug treatment, to mechanisms extrinsic to the leukemic compartment that help CML cells evade apoptosis. There exists heterogeneity in TKI response among different hematopoietic populations in CML. The abundances of these TKI-sensitive and TKI-insensitive populations differ from patient to patient and contribute to response heterogeneity. It is becoming clear that targeting the BCR-ABL1 kinase through TKIs is only one part of the equation, and TKI usage alone may not cure the majority of patients with CML. Considerable effort should be devoted to targeting the BCR-ABL1-independent mechanisms of resistance and persistence of CML LSCs.
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8
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Wang Y, Jiang L, Li B, Zhao Y. Management of Chronic Myeloid Leukemia and Pregnancy: A Bibliometric Analysis (2000-2020). Front Oncol 2022; 12:826703. [PMID: 35321439 PMCID: PMC8934933 DOI: 10.3389/fonc.2022.826703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Given the increasing number and survival rates of reproductive-age patients with chronic myeloid leukemia (CML), several studies aimed to elucidate optimum disease management in pregnancy. This study aimed to use bibliometric analysis to assess focus and reported insights, as well as future trends, in CML and pregnancy research. Methods We extracted all studies related to CML and pregnancy from the Web of Science database from 2001 to 2020. VOS Viewer, CiteSpace, Python, and R-bibliometrix were used for bibliometric analysis, revealing the leading research countries, institutions, and authors, as well as distribution of keywords (frequency greater than five). Results A total of 196 records, published in 137 journals by 1,105 authors from 421 research institutes in 50 countries, were identified for analysis. The United States was the leader in the number of publications. Imperial College London and National Research Center for Hematology were the most influential institutions. In addition, Apperley J, Cortes J, Abruzzese E and Kantarjian H were the leading authors in the field. Keyword analysis identified four research hotspot clusters. Conclusions This study systematically analyzed the progress in CML and pregnancy research in the last 20 years. The present findings suggest that the management of planned and unplanned pregnancies in patients with CML will remain a research focus, as further evidence is required for the development of treatment guidelines.
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Affiliation(s)
- Yue Wang
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqing Jiang
- Department of Medical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Baoxuan Li
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan Zhao
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yan Zhao,
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