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Tao T, Cen J, Xu C, Chen Y, Cao Y, Gong Y, Zhu M, Chen S, Zhang Q, Yao L. Identification of concurrent STAT3::RARA and RARA::STAT5b fusions in a variant APL case. Mol Carcinog 2024; 63:558-562. [PMID: 38153216 DOI: 10.1002/mc.23672] [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: 10/30/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Acute promyelocytic leukemia (APL) with typically PML::RARA fusion gene caused by t (15;17) (q22; q12) was distinguished from other types of acute myeloid leukemia. In a subset of patients with APL, t (15;17) (q22;q21) and PML::RARA fusion cannot be detected. In this report, we identified the coexistence of STAT3::RARA and RARA::STAT5b fusions for the first time in a variant APL patient lacking t (15;17)(q22;q21)/PML::RARA fusion. Then, this patient was resistant to all-trans retinoic acid combined arsenic trioxide chemotherapy. Accurate detection of RARA gene partners is crucial for variant APL, and effective therapeutic regime is urgently needed.
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Affiliation(s)
- Tingting Tao
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Jiannong Cen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Chao Xu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Yan Chen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Yanglin Cao
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Yanlei Gong
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Mingqing Zhu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Suning Chen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
| | - Qike Zhang
- Department of Haematology, Gansu Provincial People's Hospital, Lanzhou, People's Republic of China
| | - Li Yao
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and Hemostasis, Department of Haematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, People's Republic of China
- Division of Haematolgy, Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People's Republic of China
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2
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Liu FS, Huang HL. Case report: One case of acute myeloid leukemia M3 with atypical morphology. Front Oncol 2024; 14:1341840. [PMID: 38567145 PMCID: PMC10985165 DOI: 10.3389/fonc.2024.1341840] [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] [Received: 11/21/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Acute promyelocytic leukemia (APL) is a type of acute myeloid leukemia. About 2% of APL is characterized by atypical rearrangements. Here we reported one APL case with atypical manifestations and morphology. A 35-year-old woman patient, mainly due to fatigue, poor appetite for over 10 days and intermittent fever for 3 days. combined with the results of flow cytometry, fusion gene and chromosome, the patient was diagnosed as AML-M3 with atypical morphology. Double induction therapy with retinoic acid and arsenous acid was immediately administrated. Idarubicin was administrated on the 18th day. A re-examination was performed in the 5th week, both the blood routine test and myelogram showed normal results, and the fusion gene turned negative, indicating complete remission. When atypical morphology occurs, peripheral blood POX staining may be performed to check the abnormal cells. Flow cytometry, chromosome analysis, and fusion gene analysis are also required for further diagnosis.
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Affiliation(s)
| | - Hua-Liang Huang
- Department of Laboratory, Inner Mongolia Baogang Hospital, Baotou, China
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3
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Yokoyama Y. Risk factors and remaining challenges in the treatment of acute promyelocytic leukemia. Int J Hematol 2024:10.1007/s12185-023-03696-7. [PMID: 38386203 DOI: 10.1007/s12185-023-03696-7] [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: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/23/2024]
Abstract
The treatment of acute promyelocytic leukemia (APL) has evolved with the introduction of all-trans retinoic acid (ATRA) and subsequent arsenic trioxide (ATO), particularly in standard-risk APL with an initial white blood cell count (WBC) < 10,000/μL, where a high cure rate can now be achieved. However, for some patients with risk factors, early death or relapse remains a concern. Insights from the analysis of patients treated with ATRA and chemotherapy have identified risk factors such as WBC, surface antigens, complex karyotypes, FLT3 and other genetic mutations, p73 isoforms, variant rearrangements, and drug resistance mutations. However, in the ATRA + ATO era, the significance of these risk factors is changing. This article provides a comprehensive review of APL risk factors, taking into account the treatment approach, and explores the challenges associated with APL treatments.
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Affiliation(s)
- Yasuhisa Yokoyama
- Department of Hematology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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4
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Stone M, Lilley CM, Tang G, Loghavi S, Mirza KM. Phenotypic clues that predict underlying cytogenetic/genetic abnormalities in myeloid malignancies: A contemporary review. Cytopathology 2023; 34:530-541. [PMID: 37522274 DOI: 10.1111/cyt.13280] [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: 06/06/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
Precise subclassification of myeloid malignancies per the World Health Organization (WHO) classification system and the International Consensus Classification of Myeloid Neoplasms and Acute Leukaemias (ICC) requires investigation and documentation of the presence of cytogenetic and/or molecular genetic changes. These ancillary studies not only help in diagnosis, but also the prognosis of disease; however, they take time to be completed. In contrast, morphological evaluation of material from the blood and bone marrow specimens of cases where myeloid malignancies are suspected is usually completed quickly. Cytomorphological assessment may predict genetic changes and can be helpful in triaging acuity. This is especially true in haematological emergencies such as acute promyelocytic leukaemia (APL), where prompt APL-specific therapy can be life changing. Similarly, some morphological clues may help identify core binding factor leukaemias where a diagnosis of acute myeloid leukaemia (AML) could be rendered without reaching the 20% blast cutoff with immediate treatment-decision implications, or even a subset of cases of AML with FLT3 ITD/NPM1 mutation(s) which show characteristic features. Even though FISH/cytogenetics and/or PCR are still required for establishing the final diagnosis, evaluation for the presence of specific cytomorphological features that help predict genetic changes can be a useful tool to help guide early therapy.
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Affiliation(s)
- Michael Stone
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cullen M Lilley
- Department of Pathology and Laboratory Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Guilin Tang
- Department of Hematopathology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanam Loghavi
- Department of Hematopathology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Kamran M Mirza
- Department of Pathology and Laboratory Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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5
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Liu X, Zhang L, Yang Y, Yin W, Liu Y, Luo C, Zhang R, Long Z, Jiang Y, Wang B. CD71-mediated liposomal arsenic-nickel complex combined with all-trans retinoic acid for the efficacy of acute promyelocytic leukemia. Asian J Pharm Sci 2023; 18:100826. [PMID: 37583710 PMCID: PMC10423880 DOI: 10.1016/j.ajps.2023.100826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/09/2023] [Accepted: 06/09/2023] [Indexed: 08/17/2023] Open
Abstract
Clinically, arsenic trioxide (ATO) was applied to the treatment of acute promyelocytic leukemia (APL) as a reliable and effective frontline drug. However, the administration regimen of AsⅢ was limited due to its fast clearance, short therapeutic window and toxicity as well. Based on CD71 overexpressed on APL cells, in present study, a transferrin (Tf)-modified liposome (LP) was established firstly to encapsulate AsⅢ in arsenic-nickel complex by nickel acetate gradient method. The AsⅢ-loaded liposomes (AsLP) exhibited the feature of acid-sensitive release in vitro. Tf-modified AsLP (Tf-AsLP) were specifically taken up by APL cells and the acidic intracellular environment triggered liposome to release AsⅢ which stimulated reactive oxygen species level and caspase-3 activity. Tf-AsLP prolonged half-life of AsⅢ in blood circulation, lowered systemic toxicity, and promoted apoptosis and induced cell differentiation at lesion site in vivo. Considering that ATO combined with RA is usually applied as the first choice in clinic for APL treatment to improve the therapeutic effect, accordingly, a Tf-modified RA liposome (Tf-RALP) was designed to reduce the severe side effects of free RA and assist Tf-AsLP for better efficacy. As expected, the tumor inhibition rate of Tf-AsLP was improved significantly with the combination of Tf-RALP on subcutaneous tumor model. Furthermore, APL orthotopic NOD/SCID mice model was established by 60CO irradiation and HL-60 cells intravenously injection. The effect of co-administration (Tf-AsLP + Tf-RALP) was also confirmed to conspicuous decrease the number of leukemia cells in the circulatory system and prolong the survival time of APL mice by promoting the APL cells' apoptosis and differentiation in peripheral blood and bone marrow. Collectively, Tf-modified acid-sensitive AsLP could greatly reduce the systemic toxicity of free drug. Moreover, Tf-AsLP combined with Tf-RALP could achieve better efficacy. Thus, transferrin-modified AsⅢ liposome would be a novel clinical strategy to improve patient compliance, with promising translation prospects.
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Affiliation(s)
- Xiao Liu
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
| | - Lili Zhang
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yueying Yang
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
| | - Weiwei Yin
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
| | - Yunhu Liu
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
| | - Chunyi Luo
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
| | - Ruizhe Zhang
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
| | - Zhiguo Long
- Department of Hematology, Shanghai Pudong Hospital, Fudan University, Shanghai 201399, China
| | - Yanyan Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201023, China
| | - Bing Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
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Borkovskaia A, Bogacheva S, Konyukhova T, Dadakhanova E, Gaskova M, Soldatkina O, Dubrovina M, Popov A, Mikhailova E, Inushkina E, Kazanov M, Matveev E, Novichkova G, Maschan M, Maschan A, Olshanskaya Y, Zerkalenkova E. Molecular Heterogeneity of Pediatric AML with Atypical Promyelocytes Accumulation in Children—A Single Center Experience. Genes (Basel) 2023; 14:genes14030675. [PMID: 36980947 PMCID: PMC10048084 DOI: 10.3390/genes14030675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Acute promyelocytic leukemia (APL) pathogenesis is based on RARA gene translocations, which are of high importance in the diagnosis of and proper therapy selection for APL. However, in some cases acute myeloid leukemia (AML) demonstrates APL-like morphological features such as atypical promyelocytes accumulation. This type of AML is characterized by the involvement of other RAR family members or completely different genes. In the present study, we used conventional karyotyping, FISH and high-throughput sequencing in a group of 271 de novo AML with atypical promyelocytes accumulation. Of those, 255 cases were shown to carry a typical chromosomal translocation t(15;17)(q24;q21) with PML::RARA chimeric gene formation (94.1%). Other RARA-positive cases exhibited cryptic PML::RARA fusion without t(15;17)(q24;q21) (1.8%, n = 5) and variant t(5;17)(q35;q21) translocation with NPM1::RARA chimeric gene formation (1.5%, n = 4). However, 7 RARA-negative AMLs with atypical promyelocytes accumulation were also discovered. These cases exhibited TBL1XR1::RARB and KMT2A::SEPT6 fusions as well as mutations, e.g., NPM1 insertion and non-recurrent chromosomal aberrations. Our findings demonstrate the genetic diversity of AML with APL-like morphological features, which is of high importance for successful therapy implementation.
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Affiliation(s)
- Aleksandra Borkovskaia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Sofia Bogacheva
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Tatiana Konyukhova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Elina Dadakhanova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Marina Gaskova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Olga Soldatkina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Maria Dubrovina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Alexander Popov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Ekaterina Mikhailova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Evgenia Inushkina
- Moscow Regional Oncology Hospital, Karbisheva Str. 6, 143900 Balashikha, Russia
| | - Marat Kazanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
- Institute for Information Transmission Problems (the Kharkevich Institute, RAS), Bolshoy Karetny per. 19, bld. 1, 127051 Moscow, Russia
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard 30, bld. 1, 121205 Moscow, Russia
| | - Evgeniy Matveev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
- Institute for Information Transmission Problems (the Kharkevich Institute, RAS), Bolshoy Karetny per. 19, bld. 1, 127051 Moscow, Russia
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard 30, bld. 1, 121205 Moscow, Russia
| | - Galina Novichkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Michael Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Alexey Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Yulia Olshanskaya
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
| | - Elena Zerkalenkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samora Maschela Str. 1, 117998 Moscow, Russia
- Correspondence:
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Iyer SG, Elias L, Stanchina M, Watts J. The treatment of acute promyelocytic leukemia in 2023: Paradigm, advances, and future directions. Front Oncol 2023; 12:1062524. [PMID: 36741714 PMCID: PMC9889825 DOI: 10.3389/fonc.2022.1062524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
The transformation of acute promyelocytic leukemia (APL) from an often fatal to highly curable cancer with long-term survival exceeding 90% is one of the greatest and most inspiring successes in oncology. A deeper understanding of the pathogenesis of APL heralded the introduction of highly effective therapies targeting the mutant protein that drives the disease, leading to the chemotherapy-free approach to cure almost all patients. In this review, we discuss the paradigm of treatment of APL in 2023, reinforce the high risk of early death without prompt initiation of treatment at first clinical suspicion, and dedicate a special focus to novel agents and future directions to improve cure rates and quality of life in patients affected by APL.
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Affiliation(s)
- Sunil Girish Iyer
- Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Laila Elias
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michele Stanchina
- Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Justin Watts
- Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
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At What Point Are Long-Term (>5 Years) Survivors of APL Safe? A Study from the SEER Database. Cancers (Basel) 2023; 15:cancers15030575. [PMID: 36765533 PMCID: PMC9913725 DOI: 10.3390/cancers15030575] [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] [Received: 11/24/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) is a highly curable cancer, but it is not clear whether it is also necessary to monitor long-term toxicity in "cured" patients who survive for more than five years, which is critical to ensuring maximum survival in APL patients. METHODS A total of 1952 APL 5-year survivors and 5973 non-APL acute myeloid leukemia (AML) 5-year survivors were included from the Surveillance, Epidemiology, and End Results (SEER) database. The standardized mortality ratio (SMR) was calculated to measure the risk of death. Cumulative mortality is calculated as the incidence of specific causes of death under competing risk events. RESULTS The SMR of all causes of death in >5-year survivors of APL was higher than that of the general population only at 60-119 months (SMR, 1.41). This was mainly because a significant increase in mortality from AML (SMR, 87.67) and second malignant neoplasms (SMNs) (SMR, 1.56) was found only at 60-119 months. However, there was no higher risk of death from non-cancer-related disease in >5-year survivors of APL than that of the general population (SMR, 0.89). The SMR of all-cause deaths in >5-year survivors of non-APL AML decreased year by year and was no higher than that of the general population until after 216 months. The cumulative incidence of AML-related death, SMN-related death, and non-cancer-related death was significantly lower in APL patients than in non-APL AML patients throughout the follow-up period. CONCLUSIONS Compared with the general population, the risk of death of patients with APL was higher within 5 to 10 years but not higher over 10 years. Therefore, we believe that long-term survivors of APL are safe after 10 years.
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Naicker W, Kloppers J, van Rooyen FC, van Marle A, Barrett C. Acute promyelocytic leukaemia: A central South African experience. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.4102/sajo.v6i0.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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10
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Chen L, Zhu H, Zhu Y, Jin W, Dong F, Li J, Hu J, Chen Q, Wang K, Li J. Case Report: Successful therapy with all-trans retinoic acid combined with chemotherapy followed by hematopoietic stem cell transplantation for acute promyelocytic leukemia carrying the BCOR-RARA fusion gene. Front Oncol 2022; 12:1013046. [PMID: 36212492 PMCID: PMC9539026 DOI: 10.3389/fonc.2022.1013046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is characterized by the balanced translocation of chromosomes 15 and 17, resulting in the formation of PML-RARA fusion gene. More than 98% of APL have PML-RARA fusion, and less than 2% have other types of RARA gene partners, which named variant APL (vAPL). In the present study, we reported a vAPL with BCOR-RARA, which was the third case of BCOR-RARA APL published. The patient achieved complete remission (CR) with all-trans retinoic acid (ATRA) monotherapy, and molecular CR with ATRA plus standard chemotherapy. After that, he underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and ATRA maintenance and maintained a molecular CR status. This case provided valuable insights into the accurate identification of vAPL. Moreover, ATRA combined with chemotherapy followed by allo-HSCT was suggested as an optimal choice for those vAPL patients who had a high risk of relapse.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Junmin Li
- *Correspondence: Junmin Li, ; Kankan Wang,
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Guarnera L, Ottone T, Fabiani E, Divona M, Savi A, Travaglini S, Falconi G, Panetta P, Rapanotti MC, Voso MT. Atypical Rearrangements in APL-Like Acute Myeloid Leukemias: Molecular Characterization and Prognosis. Front Oncol 2022; 12:871590. [PMID: 35494081 PMCID: PMC9039303 DOI: 10.3389/fonc.2022.871590] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023] Open
Abstract
Acute promyelocytic leukemia (APL) accounts for 10–15% of newly diagnosed acute myeloid leukemias (AML) and is typically caused by the fusion of promyelocytic leukemia with retinoic acid receptor α (RARA) gene. The prognosis is excellent, thanks to the all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) combination therapy. A small percentage of APLs (around 2%) is caused by atypical transcripts, most of which involve RARA or other members of retinoic acid receptors (RARB or RARG). The diagnosis of these forms is difficult, and clinical management is still a challenge for the physician due to variable response rates to ATRA and ATO. Herein we review variant APL cases reported in literature, including genetic landscape, incidence of coagulopathy and differentiation syndrome, frequent causes of morbidity and mortality in these patients, sensitivity to ATRA, ATO, and chemotherapy, and outcome. We also focus on non-RAR rearrangements, complex rearrangements (involving more than two chromosomes), and NPM1-mutated AML, an entity that can, in some cases, morphologically mimic APL.
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Affiliation(s)
- Luca Guarnera
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Tiziana Ottone
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Santa Lucia Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuro-Oncohematology, Rome, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Department of Biomedicine and Prevention, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Mariadomenica Divona
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Arianna Savi
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Serena Travaglini
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Giulia Falconi
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Paola Panetta
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Maria Cristina Rapanotti
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.,Santa Lucia Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuro-Oncohematology, Rome, Italy
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12
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Asadbeigi S, Zhou Y. Interdisciplinary Quality Improvement Led by the Molecular Pathology Laboratory Expedites Diagnosis of Acute Promyelocytic Leukemia. Am J Clin Pathol 2022; 157:381-389. [PMID: 34546330 DOI: 10.1093/ajcp/aqab137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Acute promyelocytic leukemia (APL) requires emergent treatment while definitive laboratory results are pending. Following the death of a patient whose diagnosis was delayed, we sought to improve our institution's workflow by using the EPIDEM (Exploration, Promotion, Implementation, Documentation, Evaluation, Modification) quality improvement model. METHODS APL is confirmed by identifying translocation t(15;17)(q24;q21) PML-RARA by using either molecular or cytogenetic methods on peripheral blood or bone marrow specimens. We used the EPIDEM model to decrease the turnaround time (TAT) of molecular diagnosis by improving communication and developing reflex testing. We additionally compared 32 APL cases against a control group of 18 suspected APL cases. RESULTS Our review of 687 multiplex polymerase chain reaction orders and 33 PML-RARA orders (January 2012 to April 2021) showed an initial TAT decrease from 4.48 days to 2.71 days (P < .0001), which further decreased to 0.64 days (P < .0001) after implementation of the PML-RARA qualitative assay. Compared with patients suspected of having APL, patients with confirmed APL had higher dimerized plasmin fragment D (P = .0145), lower fibrinogen (P ≤ .0001), and lower WBC (P ≤ .0001). CONCLUSIONS By using the EPIDEM model, with its emphasis on local context, culture, and resources, improved communication and workflow changes enabled us to reduce the time needed to diagnose APL to 0.64 days and identify potential locally derived screening cutoffs.
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Affiliation(s)
- Sepideh Asadbeigi
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Yaolin Zhou
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pathology and Laboratory Medicine, Eastern Carolina University, Greenville, NC, USA
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13
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A novel coexistence of Tetrasomy 8 and FLT3-ITD along with variant 3 way translocation t(4;17;15) in acute promyelocytic leukemia: Case study and literature review. Cancer Genet 2022; 262-263:111-117. [PMID: 35219054 DOI: 10.1016/j.cancergen.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/23/2022]
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14
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Huang Q, Wang T, Xiong Y, Qu L, Yin Q, Zou W. Safety and efficacy of Compound Huangdai Tablets combined with all-trans retinoic acid for treatment of acute promyelocytic leukemia: Clinical evidence and potential mechanisms. CHINESE HERBAL MEDICINES 2022; 14:154-165. [PMID: 36120125 PMCID: PMC9476755 DOI: 10.1016/j.chmed.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/29/2020] [Accepted: 03/26/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the safety and efficacy of Compound Huangdai Tablets (Realgar-Indigo Naturalis formula, RIF) combined with all-trans retinoic acid (ATRA) to treat acute promyelocytic leukemia (APL). Methods This study was registered in PROSPERO (CRD42018108118). The relevant literatures on RIF treatment of APL were systematically searched in the following databases: China National Knowledge Infrastructure, Wanfang, VIP Medical Information System, Chinese Biomedical Database, EMBASE, Cochrane Library, and PubMed. The quality of the included studies was evaluated and Review Manager 5.3 software and Stata 13.0 software were used to perform the Meta-analysis. In addition, this study used the method of network pharmacology to conduct a preliminary exploration of the mechanism of RIF on APL. Results The study included 12 studies involving 775 APL patients. The Meta-analysis showed that there was no significant difference (P > 0.05) between the RIF group and the arsenic trioxide (ATO) group for primary outcomes, secondary outcomes apart from liver dysfunction. The incidence of liver dysfunction (P = 0.006) in the RIF group were significantly lower than those in the ATO group. In addition, the cost of maintenance therapy in the RIF group was significantly lower (P < 0.05) than the ATO group. Besides, the active ingredients in RIF mainly act on targets proteins such as ACHE, NCOA2, RXRA, and then play a role in the treatment of APL through regulating multiple molecular mechanisms, such as TP53 regulates transcription of cell cycle genes, nuclear receptor transcription pathway. Conclusion There was no significant difference in efficacy of oral RIF combined with ATRA compared with intravenous ATO combined with ATRA for the treatment of APL. The oral RIF exposed patients to less risk, offered more convenience and had lower prices. RIF can treat APL by multi-target and multi-pathway interventions that inducing apoptosis of APL cells and inhibiting the proliferation of APL cells, and so on. Therefore, oral RIF in the treatment of APL is worthy of further research and development.
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Affiliation(s)
- Qianqian Huang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Tao Wang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yan Xiong
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Liping Qu
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Qiaozhi Yin
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Wenjun Zou
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
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15
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Cicconi L, Testi AM, Montesinos P, Rego E, Zhu HH, Takahashi H, Dworzak M, Estey E, Schwarer A, Esteve J, Annibali O, Castelli R, Mirabile M, Angelini M, Lazarevic V, Kumar J, Avvisati G, Gurnari C, Locatelli F, Voso MT, Sanz MA, Lo-Coco F, Abla O. Characteristics and outcome of acute myeloid leukemia with uncommon retinoic acid receptor-alpha (RARA) fusion variants. Blood Cancer J 2021; 11:167. [PMID: 34657125 PMCID: PMC8520532 DOI: 10.1038/s41408-021-00561-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Laura Cicconi
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy. .,UOSD Ematologia, ASL Roma 1, Rome, Italy.
| | - Anna Maria Testi
- Department of Translational and Precision Medicine and Hematology, 'Sapienza' University, Rome, Italy
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnico la Fe, València, Spain
| | - Eduardo Rego
- Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - Hong Hu Zhu
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | | | - Michael Dworzak
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Elihu Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anthony Schwarer
- Department of Hematology and Oncology, Eastern School, Monash University, Melbourne, VIC, Australia
| | - Jordi Esteve
- Servicio de Hematología, Instituto Clínic de Enfermedades Hematológicas y Oncológicas, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ombretta Annibali
- Hematology and Stem Cells Transplantation Unit, University Campus Bio-Medico, Rome, Italy
| | - Roberto Castelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milano, Italy
| | - Milena Mirabile
- HematologyUnit, Ospedale di Civitanova Marche, Macerata, Italy
| | | | - Vladimir Lazarevic
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Jeevan Kumar
- Department of Clinical Haematology and BMT Tata Medical Center, Kolkata, India
| | - Giuseppe Avvisati
- Hematology and Stem Cells Transplantation Unit, University Campus Bio-Medico, Rome, Italy
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology, IRCCS Ospedale Pediatrico Bambino Gesu, Rome, Italy.,Department of Pediatrics, Sapienza, University of Rome, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Miguel Angel Sanz
- Department of Hematology, Hospital Universitari i Politècnico la Fe, València, Spain
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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16
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King D, Foucar CE, Ma V, Benitez L, Perissinotti AJ, Marini BL, Robinson D, Bhave RR, Bixby D. Identification of variant APL translocations PRKAR1A-RARα and ZBTB16-RARα (PLZF-RARα) through the MI-ONCOSEQ platform. Cancer Genet 2021; 258-259:57-60. [PMID: 34534739 DOI: 10.1016/j.cancergen.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 07/21/2021] [Accepted: 08/22/2021] [Indexed: 01/01/2023]
Abstract
The cornerstone of management in patients with acute promyelocytic leukemia (APL) is early diagnosis and prompt initiation of treatment with an all-trans retinoic acid (ATRA)-based regimen. Identification of the t(15;17)(PML-RARA) chromosomal translocation through conventional cytogenetics fluorescence in-situ hybridization (FISH) or detection of the promyelocytic leukemia-retinoic acid receptor alpha (PML-RARα) fusion through RT-PCR represent the current standard of care for diagnosing APL. However, about 1-2% of patients with APL have a variant translocation involving other fusion partners with RARα besides PML. These patients present a unique diagnostic and clinical challenge in that conventional cytogenetics in addition to FISH and/or RT-PCR for PML-RARα may fail to identify these clinically relevant genetic lesions leading to an inappropriate diagnosis and treatment. We present two cases of patients who had APL with variant translocations whose bone marrow specimens were sent to the University of Michigan for enrollment in the MI-ONCOSEQ study (HUM00067928) after standard testing failed to identify PML-RARα or t(15;17) despite a phenotypic concern for this diagnosis. In these two patients, whole exome and transcriptome profiling via the MI-ONCOSEQ platform identified a PRKAR1A-RARα fusion in one patient and ZBTB16-RARα fusion in another patient. These cases illustrate the utility of whole exome and transcriptome profiling in diagnosing variant translocations in patients in whom there is a high clinical suspicion for APL based on hematopathology review.
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Affiliation(s)
- Darren King
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Charles E Foucar
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Vincent Ma
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lydia Benitez
- Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Bernard L Marini
- Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Dan Robinson
- Michigan Center for Translational Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rupali Roy Bhave
- Division of Hematology and Medical Oncology, Wake Forrest University, Winston-Salem, North Carolina, USA
| | - Dale Bixby
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
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17
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Courville EL, Shantzer L, Vitzthum von Eckstaedt HC, Mellot H, Keng M, Sen J, Morris A, Williams E, El Chaer F. Variant Acute Promyelocytic Leukemia Presenting Without Auer Rods Highlights the Need for Correlation with Cytogenetic Data in Leukemia Diagnosis. Lab Med 2021; 53:95-99. [PMID: 34268555 DOI: 10.1093/labmed/lmab051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Variant acute promyelocytic leukemia (vAPL) is a rare leukemia characterized by rearrangement between RARα and a non-PML partner gene. This type of leukemia can be difficult to recognize by histomorphologic evaluation, particularly in patients with few or no Auer rods, and by flow cytometry, but it can be identified by distinct cytogenetic features. Herein, we report on a patient with vAPL with t(11;17)(q23;q21) who presented an initial diagnostic challenge. Detailed flow cytometry findings are presented for this rare entity. Our case study also presents novel treatment (chemotherapy in combination with venetoclax) chosen based on mechanistic data from preclinical studies.
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Affiliation(s)
- Elizabeth L Courville
- Department of Pathology, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Lindsey Shantzer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | | | - Holly Mellot
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Michael Keng
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Jeremy Sen
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Amy Morris
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Eli Williams
- Department of Pathology, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
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18
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Jokar MH, Sedighi S, Moradzadeh M. A comparative study of anti-leukemic effects of kaempferol and epigallocatechin-3-gallate (EGCG) on human leukemia HL-60 cells. AVICENNA JOURNAL OF PHYTOMEDICINE 2021; 11:314-323. [PMID: 34290963 PMCID: PMC8264220 DOI: 10.22038/ajp.2021.17604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Acute promyelocytic leukemia (APL) is among the most threatening hematological malignant cancers. Defects in cell growth and apoptotic pathways lead to the pathogenesis of the disease as well as its resistance to therapy; therefore, it is a good model for examining pro-apoptotic agents. The present study compared the molecular mechanism induced by kaempferol and epigallocatechin gallate (EGCG) as well as all-trans retinoic acid (ATRA), in HL-60 leukemia cells during five days. MATERIALS AND METHODS Cell viability was determined by resazurin assay following treatment with ATRA (10 µM), EGCG, and kaempferol (12.5-100 µM), and apoptosis was detected by the ANX V/PI kit. Moreover, the levels of genes involved in apoptosis (PI3K, AKT, BCL2, BAX, P21, PTEN, CASP3, CASP8, and CASP9) and multi-drug resistance (MDR, ABCB1 and ABCC1) were assessed by using real-time PCR test. RESULTS Based on the findings, kaempferol decreased cell viability and increased apoptosis in HL60 cells more than EGCG. Apoptosis was induced via extrinsic and intrinsic pathways in HL60 cells by kaempferol and EGCG. In addition, kaempferol and EGCG increased apoptosis and inhibited MDR in a concentration- and time-dependent manner. CONCLUSION Kaempferol at high concentrations can be taken into consideration for treating patients with APL as compared with EGCG.
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Affiliation(s)
- Mohammad Hassan Jokar
- Golestan Rheumatology Research Center, Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
- Equal first author
| | - Sima Sedighi
- Golestan Rheumatology Research Center, Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
- Equal first author
| | - Maliheh Moradzadeh
- Golestan Rheumatology Research Center, Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
- Corresponding Author: Tel: +981732239791, Fax: +981732239791,
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19
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Abstract
The genetic basis for pediatric acute myeloid leukemia (AML) is highly heterogeneous, often involving the cooperative action of characteristic chromosomal rearrangements and somatic mutations in progrowth and antidifferentiation pathways that drive oncogenesis. Although some driver mutations are shared with adult AML, many genetic lesions are unique to pediatric patients, and their appropriate identification is essential for patient care. The increased understanding of these malignancies through broad genomic studies has begun to risk-stratify patients based on their combinations of genomic alterations, a trend that will enable precision medicine in this population.
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Affiliation(s)
- Bryan Krock
- Caris Life Sciences, 4610 South 44th Place, Phoenix, AZ, USA
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20
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Ayatollahi H, Kanesbi M, Jarahi L, Sheikhi M. Comparison of differences in blood laboratory results between acute promyelocytic leukemia and acute promyelocytic leukemia+FLT3-internal tandem duplication patients. IRAQI JOURNAL OF HEMATOLOGY 2021. [DOI: 10.4103/ijh.ijh_52_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Matyskiela ME, Zhu J, Baughman JM, Clayton T, Slade M, Wong HK, Danga K, Zheng X, Labow M, LeBrun L, Lu G, Chamberlain PP, Thompson JW. Cereblon Modulators Target ZBTB16 and Its Oncogenic Fusion Partners for Degradation via Distinct Structural Degrons. ACS Chem Biol 2020; 15:3149-3158. [PMID: 33206504 DOI: 10.1021/acschembio.0c00674] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is a growing interest in using targeted protein degradation as a therapeutic modality in view of its potential to expand the druggable proteome. One avenue to using this modality is via molecular glue based Cereblon E3 Ligase Modulating Drug compounds. Here, we report the identification of the transcription factor ZBTB16 as a Cereblon neosubstrate. We also report two new Cereblon modulators, CC-3060 and CC-647, that promote ZBTB16 degradation. Unexpectedly, CC-3060 and CC-647 target ZBTB16 for degradation by primarily engaging distinct structural degrons on different zinc finger domains. The reciprocal fusion proteins, ZBTB16-RARα and RARα-ZBTB16, which cause a rare acute promyelocytic leukemia, contain these same structural degrons and can be targeted for proteasomal degradation with Cereblon modulator treatment. Thus, a targeted protein degradation approach via Cereblon modulators may represent a novel therapeutic strategy in acute promyelocytic leukemia where ZBTB16/RARA rearrangements are critical disease drivers.
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Affiliation(s)
- Mary E Matyskiela
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Jinyi Zhu
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Joshua M Baughman
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Thomas Clayton
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Michelle Slade
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Hon Kit Wong
- Bristol Myers Squibb CompanyCambridgeMassachusetts02140United States
| | - Kristina Danga
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Xinde Zheng
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Mark Labow
- Bristol Myers Squibb CompanyCambridgeMassachusetts02140United States
| | - Laurie LeBrun
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | - Gang Lu
- Bristol Myers Squibb Company, San Diego, California 92121, United States
| | | | - Joel W Thompson
- Bristol Myers Squibb Company, San Diego, California 92121, United States
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22
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Lenzi L, Lee-Jones L, Mostofa MA, de Andrade DP, Ribeiro RC, Figueiredo BC. Second Primary Malignancy after Acute Promyelocytic Leukemia: A Population-Based Study. Cancers (Basel) 2020; 12:E3610. [PMID: 33287098 PMCID: PMC7761603 DOI: 10.3390/cancers12123610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022] Open
Abstract
Acute promyelocytic leukemia (APL), is now highly curable with treatment approaches that include all-trans retinoic acid (ATRA). The high incidence of APL in the Hispanics suggests an association with genetic variants in this population. Information on second primary malignancies (SPMs) in patients with APL is limited. The Surveillance, Epidemiology, and End Results (SEER) database was used to interrogate whether the rate of SPMs in patients with APL was associated with ethnicity and/or ATRA treatment. Between 2000 and 2016, 116 cases of SPM were diagnosed among 4019 patients with APL. The mean age at diagnosis of primary APL was 53.9 years (±15.7 years), and the mean age at diagnosis of SPMs was 59.0 years (±14.5 years). Comparisons with 3774 APL survivors who did not develop SPMs revealed that age ≥40 years at diagnosis of APL (p < 0.001) and non-Hispanic white ethnicity (p = 0.025) were associated with SPMs in APL survivors. Salivary gland, liver, and soft tissue malignancies were significantly more common in patients with primary APL than in individuals with non-APL malignancies. A risk analysis comparing patients who had APL with patients who had non-APL AML suggests that SPMs after APL is associated with ATRA treatment. Therefore, patient follow-up after APL should focus on early diagnosis of SPMs.
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Affiliation(s)
- Luana Lenzi
- Departamento de Análises Clínicas, Universidade Federal do Paraná, Curitiba, Paraná 80210-170, Brazil;
- Life Sciences Department, Manchester Metropolitan University, Manchester M1 5GD, UK; (L.L.-J.); (M.A.M.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná 80250-060, Brazil;
| | - Lisa Lee-Jones
- Life Sciences Department, Manchester Metropolitan University, Manchester M1 5GD, UK; (L.L.-J.); (M.A.M.)
| | - Maruf A. Mostofa
- Life Sciences Department, Manchester Metropolitan University, Manchester M1 5GD, UK; (L.L.-J.); (M.A.M.)
| | - Diancarlos P. de Andrade
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná 80250-060, Brazil;
- Pele Pequeno Principe Research Institute, Faculdades Pequeno Príncipe, Curitiba, Paraná 80230-020, Brazil
| | - Raul C. Ribeiro
- Leukemia and Lymphoma Division, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Bonald C. Figueiredo
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná 80250-060, Brazil;
- Pele Pequeno Principe Research Institute, Faculdades Pequeno Príncipe, Curitiba, Paraná 80230-020, Brazil
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC), Curitiba, Paraná 80030-110, Brazil
- Departamento de Saúde Coletiva, Universidade Federal do Paraná, Curitiba, Paraná 80060-240, Brazil
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23
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Emde B, Kreher H, Bäumer N, Bäumer S, Bouwes D, Tickenbrock L. Microfluidic-Based Detection of AML-Specific Biomarkers Using the Example of Promyelocyte Leukemia. Int J Mol Sci 2020; 21:ijms21238942. [PMID: 33255664 PMCID: PMC7728129 DOI: 10.3390/ijms21238942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023] Open
Abstract
A microfluidic assay for the detection of promyelocytic leukemia (PML)-retinoic acid receptor α (RARα) fusion protein was developed. This microfluidic-based system can be used for rapid personalized differential diagnosis of acute promyelocyte leukemia (APL) with the aim of early initiation of individualized therapy. The fusion protein PML-RARα occurs in 95% of acute promyelocytic leukemia cases and is considered as diagnostically relevant. The fusion protein is formed as a result of translocation t(15,17) and is detected in the laboratory by fluorescence in situ hybridization (FISH) or reverse transcriptase polymerase chain reaction (RT-PCR). Diagnostic methods require many laboratory steps with specialized staff. The developed microfluidic assay includes a sandwich enzyme-linked immunosorbent assay (ELISA) system for PML-RARα on surface of magnetic microparticles in a microfluidic chip. A rapid detection of PML-RARα in cell lysates is achieved in less than one hour. A biotinylated PML-antibody on the surface of magnetic streptavidin coated microparticles is used as capture antibody. The bound translocation product is detected by a RARα antibody conjugated with horseradish peroxidase and the substrate QuantaRed. The analysis is performed in microfluidic channels which involves automated liquid processing with stringent washing and short incubation times. The results of the developed assay show that cell lysates of PML-RARα-positive cells (NB-4) can be clearly distinguished from PML-RARα-negative cells (HL-60, MV4-11).
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MESH Headings
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/isolation & purification
- Granulocyte Precursor Cells/metabolism
- Granulocyte Precursor Cells/pathology
- Humans
- In Situ Hybridization, Fluorescence/methods
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Microfluidics/methods
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/isolation & purification
- Precision Medicine
- Promyelocytic Leukemia Protein/genetics
- Retinoic Acid Receptor alpha/genetics
- Translocation, Genetic/genetics
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Affiliation(s)
- Benedikt Emde
- Department Hamm 1, Hamm-Lippstadt University of Applied Science, 59063 Hamm, Germany;
- Correspondence: ; Tel.: +49-(0)2381-8789-443
| | - Heike Kreher
- Micronit GmbH, 44263 Dortmund, Germany; (H.K.); (D.B.)
| | - Nicole Bäumer
- Department of Medicine A, Hematology and Oncology, University of Muenster, 48149 Muenster, Germany; (N.B.); (S.B.)
| | - Sebastian Bäumer
- Department of Medicine A, Hematology and Oncology, University of Muenster, 48149 Muenster, Germany; (N.B.); (S.B.)
| | | | - Lara Tickenbrock
- Department Hamm 1, Hamm-Lippstadt University of Applied Science, 59063 Hamm, Germany;
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Satlsar ES, Mosleh M, Mehrpouri M. CD9 Is a Very Helpful Marker for Discriminating AML-M3 from HLA-DR-Negative Non-M3 AML. Turk J Haematol 2020; 37:287-289. [PMID: 32517420 PMCID: PMC7702646 DOI: 10.4274/tjh.galenos.2020.2020.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Esmaeil Shahabi Satlsar
- Guilan University of Medical Sciences,School of Paramedical Sciences, Clinical Laboratory Sciences Department, Rasht, Iran,Thakhte Tavous Pathobiology Laboratory, Flow Cytometry Department, Tehran, Iran
| | - Mohammad Mosleh
- Shahid Beheshti University of Medical Sciences, Hematology and Blood Banking Department, School of Paramedical Sciences, Tehran, Iran
| | - Mahdieh Mehrpouri
- Alborz University of Medical Sciences, School of Paramedical Sciences Clinical Laboratory Sciences Department, Karaj, Iran
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Abstract
Acute myeloid leukemia (AML) is a clinically, morphologically, and genetically heterogeneous disorder. Like many malignancies, the genomic landscape of pediatric AML has been mapped recently through sequencing of large cohorts of patients. Much has been learned about the biology of AML through studies of specific recurrent genetic lesions. Further, genetic lesions have been linked to specific clinical features, response to therapy, and outcome, leading to improvements in risk stratification. Lastly, targeted therapeutic approaches have been developed for the treatment of specific genetic lesions, some of which are already having a positive impact on outcomes. While the advances made based on the discoveries of sequencing studies are significant, much work is left. The biologic, clinical, and prognostic impact of a number of genetic lesions, including several seemingly unique to pediatric patients, remains undefined. While targeted approaches are being explored, for most, the efficacy and tolerability when incorporated into standard therapy is yet to be determined. Furthermore, the challenge of how to study small subpopulations with rare genetic lesions in an already rare disease will have to be considered. In all, while questions and challenges remain, precisely defining the genomic landscape of AML, holds great promise for ultimately leading to improved outcomes for affected patients.
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Affiliation(s)
- Shannon E Conneely
- Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Avenue, Feigin Tower, Suite 1025, Houston, TX, 77030, USA
| | - Rachel E Rau
- Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Avenue, Feigin Tower, Suite 1025, Houston, TX, 77030, USA.
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26
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Wang L, Yan X, He J. Does acute promyelocytic leukemia patient with the STAT5B/RARa fusion gene respond well to decitabine?: A case report and literature review. Medicine (Baltimore) 2020; 99:e22923. [PMID: 33120845 PMCID: PMC7581092 DOI: 10.1097/md.0000000000022923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Most acute promyelocytic leukemia (APL) patients respond to all-trans-retinoic acid (ATRA)and have a good prognosis. However, variants APL who carry PLZF/RARа, STAT5B/RARа, and STAT3/RARа are insensitive to ATRA and have poor prognoses. The standard treatment for variants APL is still unclear due to the small sample size. PATIENT CONCERNS Here we reported a Chinese male who was admitted to our hospital with the complaint of rib pain, dyspnea, and fever (37.5°C). Blood tests showed leukopenia (1.83 × 10/L), anemia (hemoglobin 73 g/L), and thrombocytopenia (54 × 10/L). Prothrombin time and activated partial thromboplastin time were normal. DIAGNOSES The patient was diagnosed as STAT5b-RARa-positive APL based on the clinical and laboratory findings. INTERVENTIONS ATRA was used immediately for induction treatment, then he was treated with ATRA + arsenic trioxide and got the severe cardiac insufficiency. Subsequently, consolidation chemotherapy was added with ATRA + Huangdai tablets + idarubicin and decitabine, cytarabine, aclamycin (DCAG). OUTCOMES The patient relapsed soon after his first molecular complete remission (CRm), fortunately, he got a second CRm with DCAG. He has survived for more than 9 months and remains CRm, now he is looking for a suitable donor to prepare for hematopoietic stem cell transplantation (HSCT). LESSONS APL patients with STAT5B-RARa is not only resistant to ATRA, but also to conventional combination chemotherapy such as daunorubicin and cytarabine/idarubicin and cytarabine or other regimens. Relapse and extramedullary infiltration is common, HSCT is a effective treatment, and the best time for HSCT is after the first CR. It should be noted that this patient got CRm with DCAG after relapse, so the role of decitabine in APL with STAT5B-RARa needs to be considered.
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Jiang XW, Chen SZ, Zhu XY, Xu XX, Liu Y. Development and validation of a droplet digital PCR assay for the evaluation of PML-RARα fusion transcripts in acute promyelocytic leukemia. Mol Cell Probes 2020; 53:101617. [PMID: 32585184 DOI: 10.1016/j.mcp.2020.101617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
Abstract
Acute promyelocytic leukemia (APL) is an aggressive disease that requires prompt treatment. Promyelocytic leukemia protein-retinoic acid receptor α (PML-RARα) fusion genes resulting from reciprocal translocation are considered a molecular basis for diagnosing APL. Moreover, PML-RARα fusion gene testing is an essential tool for monitoring the response to therapy via minimal residual disease and providing a diagnosis before rapid disease progression in APL. The present study developed a novel droplet digital PCR (ddPCR) assay to rapidly detect two PML-RARα variants (bcr1 and bcr3) and compared its limit of detection (LOD) with quantitative PCR (qPCR). It was demonstrated that the LOD of ddPCR for PML-RARα reached 0.001%, and the evaluation of high copy number samples of PML-RARα by ddPCR correlated well with qPCR. Furthermore, clinical sample testing with ddPCR found that 34 and 24% samples were bcr-1-positive and bcr3-positive, respectively. However, according to qPCR, 30% of the samples were bcr1-positive and 20% were bcr3-positive. In addition, the concordance rate between ddPCR and qPCR reaction was 86%. While monitoring minimal residual disease, the PML-RARα mutation rate of three patients who recovered well decreased to 0.34%. However, one patient who was bcr3-positive and relapsed had a mutation rate of 13% while in remission, indicating that the bcr3 isoform may be an adverse prognostic factor affecting recovery. Therefore, the present results suggested that this novel ddPCR assay may be useful for monitoring and evaluating the treatment effects and prognosis of APL.
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Affiliation(s)
- Xi-Wen Jiang
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China.
| | - Si-Ze Chen
- Central Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China; The Precise Therapy Engineering Technology Research Cente of Guangdong Province for Esophageal Cancer, Guangzhou, 510080, China
| | - Xiao-Ya Zhu
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China
| | - Xiao-Xie Xu
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China
| | - Yue Liu
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, 510080, China; The Medicine and Biological Engineering Technology Research Center of the Ministry of Health, Guangzhou, 510080, China
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Balbuena-Merle RI, Tormey CA, DiAdamo A, Rinder HM, Siddon AJ. Monocytic Acute Myeloid Leukemias with KM2TA Translocations to Chromosome 17q that May Clinically Mimic Acute Promyelocytic Leukemia. Lab Med 2020; 52:290-296. [PMID: 32984885 DOI: 10.1093/labmed/lmaa078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Acute promyelocytic leukemia (APL) with variant RARA translocation, eg, t(11;17), is not sensitive to all-trans retinoic acid and requires distinct chemotherapy. However, there are some leukemic entities that may mimic aspects of the clinical and/or laboratory picture of APL and cause confusion because of karyotype nomenclature. Therefore, recognition of such entities may be of therapeutic and prognostic significance. METHODS We present 2 cases of acute myeloid leukemia (AML) with t(11;17) that were clinically concerning for APL based primarily on clinical presentation but were ultimately diagnosed as AML with monocytic differentiation. RESULTS Both leukemias harbored KMT2A translocations, one located near but not involving RARA and the other with SEPT9. CONCLUSION In leukemias that clinically and/or immunophenotypically mimic APL, identification of specific gene translocations can lead to the correct diagnosis and may carry therapeutic/prognostic implications.
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Affiliation(s)
- Raisa I Balbuena-Merle
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.,Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Henry M Rinder
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.,Internal Medicine (Hematology), Yale University School of Medicine, New Haven, Connecticut
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
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29
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PML-RARA Fusion Transcripts Detectable 8 Months prior to Promyelocytic Blast Crisis in Chronic Myeloid Leukemia. Case Rep Hematol 2020; 2020:8830595. [PMID: 32953185 PMCID: PMC7481999 DOI: 10.1155/2020/8830595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 11/21/2022] Open
Abstract
Promyelocytic blast crisis arising from chronic myeloid leukemia (CML) is rare. We present a 40-year-old male who developed promyelocytic blast crisis 17 months after CML diagnosis, confirmed by the presence of the t(15;17) and t(9;22) translocations in the leukemic cells. Preserved nucleic acids from routine BCR-ABL1 testing provided a unique opportunity to evaluate clonal progression over time. Retrospective analysis demonstrated PML-RARA fusion transcripts were first detectable 8 months prior to blast crisis presentation. A review of 21 cases of promyelocytic blasts crisis published in the literature reveals a male predominance with earlier age at onset as compared to females. Interestingly, TKI therapy during chronic phase did not impact the time interval between diagnosis and promyelocytic blast crisis. Treatment with standard acute promyelocytic leukemia regimens provides more favorable outcomes with complete molecular remission. Although rare, it is important to consider a promyelocytic blast crisis when evaluating for transformation of CML due to its effective treatment with specific therapies.
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30
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Cela I, Di Matteo A, Federici L. Nucleophosmin in Its Interaction with Ligands. Int J Mol Sci 2020; 21:E4885. [PMID: 32664415 PMCID: PMC7402337 DOI: 10.3390/ijms21144885] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
Nucleophosmin (NPM1) is a mainly nucleolar protein that shuttles between nucleoli, nucleoplasm and cytoplasm to fulfill its many functions. It is a chaperone of both nucleic acids and proteins and plays a role in cell cycle control, centrosome duplication, ribosome maturation and export, as well as the cellular response to a variety of stress stimuli. NPM1 is a hub protein in nucleoli where it contributes to nucleolar organization through heterotypic and homotypic interactions. Furthermore, several alterations, including overexpression, chromosomal translocations and mutations are present in solid and hematological cancers. Recently, novel germline mutations that cause dyskeratosis congenita have also been described. This review focuses on NPM1 interactions and inhibition. Indeed, the list of NPM1 binding partners is ever-growing and, in recent years, many studies contributed to clarifying the structural basis for NPM1 recognition of both nucleic acids and several proteins. Intriguingly, a number of natural and synthetic ligands that interfere with NPM1 interactions have also been reported. The possible role of NPM1 inhibitors in the treatment of multiple cancers and other pathologies is emerging as a new therapeutic strategy.
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Affiliation(s)
- Ilaria Cela
- Center for Advanced Studies and Technology (CAST), University of Chieti “G. d’Annunzio”, Via Polacchi, 66100 Chieti, Italy;
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti “G. d’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy
| | - Adele Di Matteo
- Institute of Molecular Biology and Pathology (IBPM) of the CNR, c/o “Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Roma, Italy;
| | - Luca Federici
- Center for Advanced Studies and Technology (CAST), University of Chieti “G. d’Annunzio”, Via Polacchi, 66100 Chieti, Italy;
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti “G. d’Annunzio”, Via dei Vestini 31, 66100 Chieti, Italy
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31
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Yapor L, Zahid M, Shrestha N, Walck R, Schreiber Z, Adrish M. Case report: An unusual presentation of acute promyelocytic leukemia in a middle aged female mimicking dengue infection. Medicine (Baltimore) 2020; 99:e21011. [PMID: 32590818 PMCID: PMC7328946 DOI: 10.1097/md.0000000000021011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/27/2020] [Accepted: 05/29/2020] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Acute promyelocytic leukemia (APL) is an uncommon subtype of acute myeloid leukemia (AML). M3v phenotype is a less common presentation of APL and these patients usually present with leukocytosis and abnormal promyelocytes that are characterized by sparse granulation and are less likely to have faggot cells with multiple Auer rods. Distinguishing M3v phenotype from acute febrile illness can be challenging as the diagnosis relies on examination of peripheral smear. PATIENT CONCERNS Fifty-seven-year-old female who presented after recent trip to Dominican Republic for high grade fever and gum bleeding. She was exposed to patients with Dengue fever during her stay. At presentation, patient had leukocytosis, thrombocytopenia, and urinalysis showing bacteria and white cell. She was started on treatment for urinary tract infection. Patient remained febrile and thrombocytopenia worsened. On day 2, flow cytometry of the peripheral smear showed 43% medium sized blasts. Fluorescence in situ hybridization was positive for promyelocytic leukemia/retinoic acid receptor alpha. DIAGNOSES The patient was diagnosed with APL. INTERVENTIONS Patient was started on treatment with all-trans retinoic acid and arsenic trioxide along with supportive care OUTCOMES:: Patient had a favorable clinical response and her symptoms subsided. LESSONS Flow cytometry of the peripheral smear is key to diagnosis of suspected APL. One must maintain high suspicion for this life-threatening condition as early diagnosis saves lives.
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Affiliation(s)
- Laura Yapor
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY
| | - Maleeha Zahid
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY
| | - Nikee Shrestha
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY
| | - Randee Walck
- American University of the Caribbean, Jordan Dr, Sint Maarten, FL
| | - Zwi Schreiber
- Division of Hematology, Department of Medicine, Bronx Care Health System, Affiliated With Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY
| | - Muhammad Adrish
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, Affiliated With Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY
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32
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Sobas M, Talarn-Forcadell MC, Martínez-Cuadrón D, Escoda L, García-Pérez MJ, Mariz J, Mela-Osorio MJ, Fernández I, Alonso-Domínguez JM, Cornago-Navascués J, Rodríguez-Macias G, Amutio ME, Rodríguez-Medina C, Esteve J, Sokół A, Murciano-Carrillo T, Calasanz MJ, Barrios M, Barragán E, Sanz MA, Montesinos P. PLZF-RAR α, NPM1-RAR α, and Other Acute Promyelocytic Leukemia Variants: The PETHEMA Registry Experience and Systematic Literature Review. Cancers (Basel) 2020; 12:cancers12051313. [PMID: 32455804 PMCID: PMC7281281 DOI: 10.3390/cancers12051313] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/23/2022] Open
Abstract
It has been suggested that 1–2% of acute promyelocytic leukemia (APL) patients present variant rearrangements of retinoic acid receptor alpha (RARα) fusion gene, with the promyelocytic leukaemia zinc finger (PLZF)/RARα being the most frequent. Resistance to all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) has been suggested in PLZF/RARα and other variant APLs. Herein, we analyze the incidence, characteristics, and outcomes of variant APLs reported to the multinational PETHEMA (Programa para el Tratamiento de Hemopatias Malignas) registry, and we perform a systematic review in order to shed light on strategies to improve management of these extremely rare diseases. Of 2895 patients with genetically confirmed APL in the PETHEMA registry, 11 had variant APL (0.4%) (9 PLZF-RARα and 2 NPM1-RARα), 9 were men, with median age of 44.6 years (3 months to 76 years), median leucocytes (WBC) 16.8 × 109/L, and frequent coagulopathy. Eight patients were treated with ATRA plus chemotherapy-based regimens, and 3 with chemotherapy-based. As compared to previous reports, complete remission and survival was slightly better in our cohort, with 73% complete remission (CR) and 73% survival despite a high relapse rate (43%). After analyzing our series and performing a comprehensive and critical review of the literature, strong recommendations on appropriate management of variant APL are not possible due to the low number and heterogeneity of patients reported so far.
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Affiliation(s)
- Marta Sobas
- Blood Neoplasms and Bone Marrow Transplantation, Department of Hematology, Wroclaw Medical University, 50-367 Wrocław, Poland;
| | | | - David Martínez-Cuadrón
- Department of Hematology, Hospital Universitari I Politècnic La Fe, 46-009 Valencia, Spain; (D.M.-C.); (M.A.S.)
- CIBERONC Instituto de Salud Carlos III, 28-020 Madrid, Spain;
| | - Lourdes Escoda
- Hospital of Tarragona “Joan XXIII”, Hematology-ICO, 43-005 Tarragona, Spain; (M.C.T.-F.); (L.E.)
| | | | - Jose Mariz
- Department of Hematology, Istituto Portugues de Oncologi IPO, 4200-072 Porto, Portugal;
| | - María J. Mela-Osorio
- Fundaleu, Department of Hematology, Buenos Aires 1114, Argentina; (M.J.M.-O.); (I.F.)
| | - Isolda Fernández
- Fundaleu, Department of Hematology, Buenos Aires 1114, Argentina; (M.J.M.-O.); (I.F.)
| | - Juan M. Alonso-Domínguez
- Department of Hematology, University Hospital Universitario Fundacion Jimenez Diaz IIS-FJD, 28-040 Madrid, Spain; (J.M.A.-D.); (J.C.-N.)
| | - Javier Cornago-Navascués
- Department of Hematology, University Hospital Universitario Fundacion Jimenez Diaz IIS-FJD, 28-040 Madrid, Spain; (J.M.A.-D.); (J.C.-N.)
| | | | - María E. Amutio
- Department of Hematology, Hospital de Cruces, 48-903 Barakaldo, Spain;
| | - Carlos Rodríguez-Medina
- Department of Hematology, Hospital Universitario Dr. Negrin, 35-010 Las Palmas de Gran Canaria, Spain;
| | - Jordi Esteve
- Department of Hematology, Hospital Clinic, 08-036 Barcelona, Spain;
| | - Agnieszka Sokół
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, 50-367 Wrocław, Poland;
| | | | - María J. Calasanz
- Department of Hematology, Clinica Universitaria de Navarra, 31-008 Pamplona, Spain;
| | - Manuel Barrios
- Department of Hematology, Hospital Carlos Haya, 29-014 Málaga, Spain;
| | - Eva Barragán
- CIBERONC Instituto de Salud Carlos III, 28-020 Madrid, Spain;
- Department of Molecular Biology Laboratory, Hospital Universitari I Politècnic La Fe, 46-009 Valencia, Spain
| | - Miguel A. Sanz
- Department of Hematology, Hospital Universitari I Politècnic La Fe, 46-009 Valencia, Spain; (D.M.-C.); (M.A.S.)
- CIBERONC Instituto de Salud Carlos III, 28-020 Madrid, Spain;
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari I Politècnic La Fe, 46-009 Valencia, Spain; (D.M.-C.); (M.A.S.)
- CIBERONC Instituto de Salud Carlos III, 28-020 Madrid, Spain;
- Correspondence:
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Donoso-Bustamante V, Borrego EA, Schiaffino-Bustamante Y, Gutiérrez DA, Millas-Vargas JP, Fuentes-Retamal S, Correa P, Carrillo I, Aguilera RJ, Miranda D, Chávez-Báez I, Pulgar R, Urra FA, Varela-Ramírez A, Araya-Maturana R. An acylhydroquinone derivative produces OXPHOS uncoupling and sensitization to BH3 mimetic ABT-199 (Venetoclax) in human promyelocytic leukemia cells. Bioorg Chem 2020; 100:103935. [PMID: 32454391 DOI: 10.1016/j.bioorg.2020.103935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022]
Abstract
Since cancer cells have different mitochondrial bioenergetic requirements than non-cancerous cells, therapeutic inhibition of its mitochondrial functionality continues to be an important target for anticancer drug discovery. In this study, a series of acylhydroquinones with different acyl-chain length, and their chlorinated derivatives, in the aromatic ring, synthesized by Fries rearrangement under microwave irradiation, were evaluated for their anticancer activity in two leukemia cell lines. Findings from the primary and secondary screening of the 18 acylhydroquinones, tested at 5 µM on acute promyelocytic leukemia HL-60 and acute lymphoblastic leukemia CEM cells lines, identified an acylchlorohydroquinone (12) with a highly selective anti-proliferative effect toward HL-60 cells. This compound induced S-phase arrest in the cell cycle progression of HL-60 cells with insignificant toxicity on leukemic CEM cells and non-cancerous Hs27 cells. In HL-60 leukemic cells, 12 triggered increased mitochondrial NADH oxidation, increased respiration in presence of oligomycin (state 4o), mitochondrial depolarization, and ROS production, suggesting an uncoupling of OXPHOS. This provoked a metabolic adaptation dependent on AMPK/ACC/autophagy axis, having the mitochondrial β-oxidation a pro-survival role since the combination of 12 and etomoxir, a carnitine palmitoyl-transferase (CPT) inhibitor promoted extensive HL-60 cell death. Finally, 12-induced metabolic stress sensitized to HL-60 cells to cell death by the FDA-approved anti-leukemic drug ABT-199, a BH3 mimetic. Therefore, our results suggest that acylchlorohydroquinone is a promising scaffold in anti-promyelocytic leukemia drug research.
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Affiliation(s)
- Viviana Donoso-Bustamante
- Instituto de Química de Recursos Naturales, Universidad de Talca, Chile; Programa de Investigación Asociativa en Cáncer Gástrico, Universidad de Talca, Chile
| | - Edgar A Borrego
- Border Biomedical Research Center, Department of Biological Sciences, The University of Texas at El Paso, USA
| | | | - Denisse A Gutiérrez
- Border Biomedical Research Center, Department of Biological Sciences, The University of Texas at El Paso, USA
| | - Juan Pablo Millas-Vargas
- Instituto de Química de Recursos Naturales, Universidad de Talca, Chile; Network for Snake Venom Research and Drug Discovery, Santiago, Chile
| | - Sebastián Fuentes-Retamal
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile; Programa de Investigación Asociativa en Cáncer Gástrico, Universidad de Talca, Chile; Network for Snake Venom Research and Drug Discovery, Santiago, Chile
| | - Pablo Correa
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile; Network for Snake Venom Research and Drug Discovery, Santiago, Chile
| | - Ileana Carrillo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Renato J Aguilera
- Border Biomedical Research Center, Department of Biological Sciences, The University of Texas at El Paso, USA
| | - Dante Miranda
- Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago, Chile
| | - Ignacio Chávez-Báez
- Network for Snake Venom Research and Drug Discovery, Santiago, Chile; Laboratorio de Genómica y Genética de Interacciones Biológicas, INTA-Universidad de Chile, Santiago, Chile
| | - Rodrigo Pulgar
- Network for Snake Venom Research and Drug Discovery, Santiago, Chile; Laboratorio de Genómica y Genética de Interacciones Biológicas, INTA-Universidad de Chile, Santiago, Chile
| | - Félix A Urra
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile; Network for Snake Venom Research and Drug Discovery, Santiago, Chile.
| | - Armando Varela-Ramírez
- Border Biomedical Research Center, Department of Biological Sciences, The University of Texas at El Paso, USA.
| | - Ramiro Araya-Maturana
- Instituto de Química de Recursos Naturales, Universidad de Talca, Chile; Network for Snake Venom Research and Drug Discovery, Santiago, Chile.
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Chien N, Varghese C, Green TN, Chan G, Theakston E, Eaddy N, Doocey R, Berkahn L, Hawkins T, Browett PJ, Kalev-Zylinska ML. Treatment outcomes of patients with acute promyelocytic leukaemia between 2000 and 2017, a retrospective, single centre experience. Leuk Res 2020; 93:106358. [PMID: 32380366 DOI: 10.1016/j.leukres.2020.106358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
All-trans retinoic acid (ATRA) and arsenic trioxide (ATO) are effective induction therapy for acute promyelocytic leukaemia (APL). However, early thrombo-haemorrhagic complications and mortality remain high. We aimed to investigate how the timing of ATRA initiation and the inclusion of ATO influence patient outcomes. Clinical records were retrospectively reviewed for all patients treated for APL in a single, tertiary centre during 2000-2017. Among 70 patients with APL, 36 (51.4%) presented with thrombo-haemorrhagic complications, and four (5.8%) died within 30 days. The median time to ATRA initiation was 11.2 (range 0-104) h from the time of admission. Patients requiring more transfusions started on ATRA sooner (P = 0.04). Patients with adverse early events did not start ATRA later (P = 0.99). Nevertheless, patients that required additional tests for diagnosis (PML immunofluorescence or molecular) started on ATRA later (28.5 versus 5.3 h; P < 0.0001), and had more thrombo-haemorrhagic complications (P = 0.04). Long-term survival was actually better in patients who started ATRA later (P = 0.03), which is likely explained by higher proportion of low risk patients in this group. Patients treated with ATO (n = 23) maintained higher fibrinogen levels and required less transfusions during induction (P < 0.05), with no disease-related deaths in this group over a median follow-up time of 37.8 months (interquartile range 44.9 months). In summary, fast ATRA initiation reduces early but not late adverse events in APL patients, and the inclusion of ATO helps further improve both early and late outcomes in APL.
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Affiliation(s)
- Nicole Chien
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Chris Varghese
- Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Taryn N Green
- Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - George Chan
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand; Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand; Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Nicola Eaddy
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Richard Doocey
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Leanne Berkahn
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Timothy Hawkins
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Peter J Browett
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand; Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand; Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Maggie L Kalev-Zylinska
- Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand; Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand.
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35
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Putative promoters within gene bodies control exon expression via TET1‐mediated H3K36 methylation. J Cell Physiol 2020; 235:6711-6724. [DOI: 10.1002/jcp.29566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
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36
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Metabolomics Reveals that Cysteine Metabolism Plays a Role in Celastrol-Induced Mitochondrial Apoptosis in HL-60 and NB-4 Cells. Sci Rep 2020; 10:471. [PMID: 31949255 PMCID: PMC6965619 DOI: 10.1038/s41598-019-57312-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/28/2019] [Indexed: 12/24/2022] Open
Abstract
Recently, celastrol has shown great potential for inducing apoptosis in acute myeloid leukemia cells, especially acute promyelocytic leukaemia cells. However, the mechanism is poorly understood. Metabolomics provides an overall understanding of metabolic mechanisms to illustrate celastrol's mechanism of action. We treated both nude mice bearing HL-60 cell xenografts in vivo and HL-60 cells as well as NB-4 cells in vitro with celastrol. Ultra-performance liquid chromatography coupled with mass spectrometry was used for metabolomics analysis of HL-60 cells in vivo and for targeted L-cysteine analysis in HL-60 and NB-4 cells in vitro. Flow cytometric analysis was performed to assess mitochondrial membrane potential, reactive oxygen species and apoptosis. Western blotting was conducted to detect the p53, Bax, cleaved caspase 9 and cleaved caspase 3 proteins. Celastrol inhibited tumour growth, induced apoptosis, and upregulated pro-apoptotic proteins in the xenograft tumour mouse model. Metabolomics showed that cysteine metabolism was the key metabolic alteration after celastrol treatment in HL-60 cells in vivo. Celastrol decreased L-cysteine in HL-60 cells. Acetylcysteine supplementation reversed reactive oxygen species accumulation and apoptosis induced by celastrol and reversed the dramatic decrease in the mitochondrial membrane potential and upregulation of pro-apoptotic proteins in HL-60 cells. In NB-4 cells, celastrol decreased L-cysteine, and acetylcysteine reversed celastrol-induced reactive oxygen species accumulation and apoptosis. We are the first to identify the involvement of a cysteine metabolism/reactive oxygen species/p53/Bax/caspase 9/caspase 3 pathway in celastrol-triggered mitochondrial apoptosis in HL-60 and NB-4 cells, providing a novel underlying mechanism through which celastrol could be used to treat acute myeloid leukaemia, especially acute promyelocytic leukaemia.
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Mosleh M, Mehrpouri M, Ghaffari S, Saei Z, Agaeipoor M, Jadali F, Satlsar ES, Gholampour R. Report of a new six-panel flow cytometry marker for early differential diagnosis of APL from HLA-DR negative Non-APL leukemia. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:87-92. [DOI: 10.1080/00365513.2019.1700427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Mohammad Mosleh
- Faculty of Paramedical sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Rasad Pathobiology and Genetics Laboratory, Department of Flow Cytometry, Tehran, Iran
| | - Mahdieh Mehrpouri
- Rasad Pathobiology and Genetics Laboratory, Department of Flow Cytometry, Tehran, Iran
| | - Sasan Ghaffari
- Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Cell-based Therapies Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Saei
- Department of Flow Cytometry, Takhte Tavous Pathobiology Laboratory, Tehran, Iran
| | - Mahnaz Agaeipoor
- Department of Flow Cytometry, Takhte Tavous Pathobiology Laboratory, Tehran, Iran
| | - Farzaneh Jadali
- Department of Flow Cytometry, Takhte Tavous Pathobiology Laboratory, Tehran, Iran
| | - Esmaeil Shahabi Satlsar
- Faculty of Paramedical sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Flow Cytometry, Takhte Tavous Pathobiology Laboratory, Tehran, Iran
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38
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Schultz MJ, Blackburn PR, Cogbill CH, Pitel BA, Smadbeck JB, Johnson SH, Vasmatzis G, Rech KL, Sukov WR, Greipp PT, Hoppman NL, Baughn LB, Ketterling RP, Peterson JF. Characterization of a cryptic PML-RARA fusion by mate-pair sequencing in a case of acute promyelocytic leukemia with a normal karyotype and negative RARA FISH studies. Leuk Lymphoma 2019; 61:975-978. [PMID: 31809670 DOI: 10.1080/10428194.2019.1699081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew J Schultz
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patrick R Blackburn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Beth A Pitel
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - James B Smadbeck
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, MN, USA
| | - Sarah H Johnson
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, MN, USA
| | - George Vasmatzis
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Department of Laboratory Medicine and Genomics, Mayo Clinic, Rochester, MN, USA
| | - William R Sukov
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Nicole L Hoppman
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Division of Hematopathology, Department of Laboratory Medicine and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Su L, Kong H, Wu F, Lv H, Wu W, Wang G, Yan X, Wang J, Fang Q. Long non-coding RNA zinc finger antisense 1 functions as an oncogene in acute promyelocytic leukemia cells. Oncol Lett 2019; 18:6331-6338. [PMID: 31807158 PMCID: PMC6876286 DOI: 10.3892/ol.2019.11014] [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: 08/30/2016] [Accepted: 01/03/2019] [Indexed: 12/15/2022] Open
Abstract
Despite progress in the diagnosis and treatment of acute promyelocytic leukemia (APL), its prognosis remains poor. Multiple studies have shown that long non-coding RNAs (lncRNAs) are involved in carcinogenesis and metastasis. The present study assessed the function of the lncRNA zinc finger antisense 1 (ZFAS1) in APL. In a cohort of 33 patients, ZFAS1 was significantly overexpressed compared with the level in healthy controls. To investigate the specific mechanisms of this upregulation, in vitro studies showed that silencing of ZFAS1 by small interfering RNA significantly inhibited cell proliferation in APL cells. Moreover, downregulation of ZFAS1 increased cellular apoptosis, decreased expression of B-cell lymphoma-2 and of induced myeloid leukemia cell differentiation protein Mcl-1, increased the expression of apoptosis regulator BAX and promoted the release of cytochrome c and Diablo homolog mitochondrial into the cytoplasm. In conclusion, these data indicate that ZFAS1 may serve as an oncogene in APL and may thus be a useful target for future clinical management.
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Affiliation(s)
- Lifang Su
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Hongwei Kong
- Department of Hematopathology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, P.R. China
| | - Fenzhi Wu
- Department of Hematopathology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, P.R. China
| | - Hongjiao Lv
- Department of Hematopathology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, P.R. China
| | - Wenping Wu
- Department of Hematopathology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, P.R. China
| | - Gang Wang
- Department of Hematopathology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, P.R. China
| | - Xuefen Yan
- Department of Hematopathology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, P.R. China
| | - Jiaheng Wang
- Department of Hematopathology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, P.R. China
| | - Qiang Fang
- Intensive Care Unit, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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40
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Noguera NI, Catalano G, Banella C, Divona M, Faraoni I, Ottone T, Arcese W, Voso MT. Acute Promyelocytic Leukemia: Update on the Mechanisms of Leukemogenesis, Resistance and on Innovative Treatment Strategies. Cancers (Basel) 2019; 11:cancers11101591. [PMID: 31635329 PMCID: PMC6826966 DOI: 10.3390/cancers11101591] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022] Open
Abstract
This review highlights new findings that have deepened our understanding of the mechanisms of leukemogenesis, therapy and resistance in acute promyelocytic leukemia (APL). Promyelocytic leukemia-retinoic acid receptor α (PML-RARa) sets the cellular landscape of acute promyelocytic leukemia (APL) by repressing the transcription of RARa target genes and disrupting PML-NBs. The RAR receptors control the homeostasis of tissue growth, modeling and regeneration, and PML-NBs are involved in self-renewal of normal and cancer stem cells, DNA damage response, senescence and stress response. The additional somatic mutations in APL mainly involve FLT3, WT1, NRAS, KRAS, ARID1B and ARID1A genes. The treatment outcomes in patients with newly diagnosed APL improved dramatically since the advent of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). ATRA activates the transcription of blocked genes and degrades PML-RARα, while ATO degrades PML-RARa by promoting apoptosis and has a pro-oxidant effect. The resistance to ATRA and ATO may derive from the mutations in the RARa ligand binding domain (LBD) and in the PML-B2 domain of PML-RARa, but such mutations cannot explain the majority of resistances experienced in the clinic, globally accounting for 5-10% of cases. Several studies are ongoing to unravel clonal evolution and resistance, suggesting the therapeutic potential of new retinoid molecules and combinatorial treatments of ATRA or ATO with different drugs acting through alternative mechanisms of action, which may lead to synergistic effects on growth control or the induction of apoptosis in APL cells.
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Affiliation(s)
- N I Noguera
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
- Santa Lucia Foundation, Unit of Neuro-Oncoematologia, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Rome, Italy.
| | - G Catalano
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
- Santa Lucia Foundation, Unit of Neuro-Oncoematologia, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Rome, Italy.
| | - C Banella
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
- Santa Lucia Foundation, Unit of Neuro-Oncoematologia, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Rome, Italy.
| | - M Divona
- Policlinico Tor vergata, 00133 Rome, Italy.
| | - I Faraoni
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - T Ottone
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
- Santa Lucia Foundation, Unit of Neuro-Oncoematologia, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Rome, Italy.
| | - W Arcese
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
| | - M T Voso
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
- Santa Lucia Foundation, Unit of Neuro-Oncoematologia, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Rome, Italy.
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41
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Ren J, Lu Y, Qian Y, Chen B, Wu T, Ji G. Recent progress regarding kaempferol for the treatment of various diseases. Exp Ther Med 2019; 18:2759-2776. [PMID: 31572524 PMCID: PMC6755486 DOI: 10.3892/etm.2019.7886] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022] Open
Abstract
Kaempferol, also known as kaempferol-3 or kaempferide, is a flavonoid compound that naturally occurs in tea, as well as numerous common vegetables and fruits, including beans, broccoli, cabbage, gooseberries, grapes, kale, strawberries, tomatoes, citrus fruits, brussel sprouts, apples and grapefruit. The present review mainly summarizes the application of kaempferol in treating diseases and the underlying mechanisms that are currently being studied. Due to its anti-inflammatory properties, it may be used to treat numerous acute and chronic inflammation-induced diseases, including intervertebral disc degeneration and colitis, as well as post-menopausal bone loss and acute lung injury. In addition, it has beneficial effects against cancer, liver injury, obesity and diabetes, inhibits vascular endothelial inflammation, protects the cranial nerve and heart function, and may be used for treating fibroproliferative disorders, including hypertrophic scar.
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Affiliation(s)
- Jie Ren
- Center of Chinese Medical Therapy and Systems Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Yifei Lu
- Center of Chinese Medical Therapy and Systems Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Yanhong Qian
- Center of Chinese Medical Therapy and Systems Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Bozhou Chen
- Center of Chinese Medical Therapy and Systems Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Tao Wu
- Center of Chinese Medical Therapy and Systems Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China.,Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
| | - Guang Ji
- Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, P.R. China
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42
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Nadiminti K, Silverman M, Bhagavathi S, Vikas P. t(15; 17) associated with primary myelofibrosis: a case report of an unusual clinical presentation and diagnostic dilemma. Onco Targets Ther 2019; 12:5449-5455. [PMID: 31371984 PMCID: PMC6633400 DOI: 10.2147/ott.s208290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/21/2019] [Indexed: 01/09/2023] Open
Abstract
Background primary myelofibrosis (PMF) is a myeloproliferative neoplasm which is associated with clonal molecular and cytogenetic abnormalities (CA) and varied clinical manifestations. While various CA have been previously described, t(15; 17) has not been reported in association with this condition. Case presentation A 69-year-old male presented with constitutional symptoms, cytopenias and bone marrow biopsy revealed immature blasts with fibrosis. Cytogenetic analysis showed a t(15;17) which initially suggested a diagnosis of acute promyelocytic leukemia (APL). However, flourescence in situ hybridization (FISH) and reverse transcriptase polymerase chain reaction (RT-PCR) studies were negative for transcripts promyelocytic leukemia (PML) gene and retinoic acid receptor alpha (RARA) or PML-RARA fusion. Along with these results, a second review of bone marrow histology, flowcytometry and the detection of a calreticulin gene (CALR) mutation helped with the correct diagnosis of PMF. Patient was then treated with ruxolitinib, a JAK (Janus kinase) 1 and 2 inhibitor, and eventually proceeded to receive a matched unrelated reduced intensity conditioning (RIC) allogeneic stem cell transplantation (ASCT) and has been doing well at the 6-month follow up. Conclusions Our case highlights two points, that the t(15;17) is diagnostic of Acute Promyelocytic Leukemia (APL) in most cases, there are exceptions and it can be associated with other malignancies without causing any APL like features, as noted in this case. Also, that t(15; 17) by itself is never sufficient to diagnose APL without confirmation by other methods and relying solely on cytogenetics without timely confirmatory tests can lead to risks of delay in diagnosis and appropriate management.
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Affiliation(s)
- Kalyan Nadiminti
- Division of Hematology and Blood and Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Margarida Silverman
- Division of Hematology and Blood and Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | | | - Praveen Vikas
- Division of Hematology and Blood and Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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Huynh TT, Sultan M, Vidovic D, Dean CA, Cruickshank BM, Lee K, Loung CY, Holloway RW, Hoskin DW, Waisman DM, Weaver ICG, Marcato P. Retinoic acid and arsenic trioxide induce lasting differentiation and demethylation of target genes in APL cells. Sci Rep 2019; 9:9414. [PMID: 31263158 PMCID: PMC6602962 DOI: 10.1038/s41598-019-45982-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 06/19/2019] [Indexed: 12/11/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is characterized by arrested differentiation of promyelocytes. Patients treated with all-trans retinoic acid (ATRA) alone experience relapse, while patients treated with ATRA and arsenic trioxide (ATO) are often relapse-free. This suggests sustained changes have been elicited by the combination therapy. To understand the lasting effects of the combination therapy, we compared the effects of ATRA and ATO on NB4 and ATRA-resistant NB4-MR2 APL cells during treatment versus post treatment termination. After treatment termination, NB4 cells treated with ATRA or ATO reverted to non-differentiated cells, while combination-treated cells remained terminally differentiated. This effect was diminished in NB4-MR2 cells. This suggests combination treatment induced more permanent changes. Combination treatment induced higher expression of target genes (e.g., transglutaminase 2 and retinoic acid receptor beta), which in NB4 cells was sustained post treatment termination. To determine whether sustained epigenetic changes were responsible, we quantified the enrichment of histone modifications by chromatin immunoprecipitation, and CpG methylation by bisulfite-pyrosequencing. While ATRA and combination treatment induced similar histone acetylation enrichment, combination treatment induced greater demethylation of target genes, which was sustained. Therefore, sustained demethylation of target genes by ATRA and ATO combination treatment is associated with lasting differentiation and gene expression changes.
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Affiliation(s)
- Thomas T Huynh
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Sultan
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Dejan Vidovic
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Cheryl A Dean
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | | | - Kristen Lee
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Chao-Yu Loung
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | - Ryan W Holloway
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - David W Hoskin
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | - David M Waisman
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
- Department of Biochemistry and Molecular Biology, Dalhousie University, Halifax, NS, Canada
| | - Ian C G Weaver
- Department of Pathology, Dalhousie University, Halifax, NS, Canada.
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
- Brain Repair Centre, Dalhousie University, Halifax, NS, Canada.
| | - Paola Marcato
- Department of Pathology, Dalhousie University, Halifax, NS, Canada.
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.
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44
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Peterson JF, He RR, Nayer H, Cuevo RS, Smadbeck JB, Vasmatzis G, Greipp PT, Ketterling RP, Hoppman NL, Baughn LB. Characterization of a rarely reported STAT5B/RARA gene fusion in a young adult with newly diagnosed acute promyelocytic leukemia with resistance to ATRA therapy. Cancer Genet 2019; 237:51-54. [PMID: 31447065 DOI: 10.1016/j.cancergen.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 01/17/2023]
Abstract
The detection of PML/RARA or variant RARA rearrangements is critical for the diagnosis and treatment of patients with newly diagnosed acute promyelocytic leukemia (APL). While most cases of APL harboring the PML/RARA fusion respond to all-trans retinoic acid (ATRA), some variant RARA rearrangements are ATRA insensitive. Herein, we report a 27-year-old male with newly diagnosed, rapidly progressive APL and a rarely described STAT5B/RARA fusion with known resistance to ATRA therapy. While the PML/RARA dual-color dual-fusion fluorescence in situ hybridization (FISH) probe study was negative, the RARA break-apart probe study revealed an atypical RARA rearrangement in 95% of nuclei. A next generation sequencing assay, mate-pair sequencing, was subsequently performed to further characterize the RARA rearrangement and identified the RARA gene fusion partner STAT5B.
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Affiliation(s)
- Jess F Peterson
- Division of Laboratory Medicine and Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, United States.
| | - Rui R He
- Department of Pathology, Inova Fairfax Hospital, Falls Church, VA, United States
| | - Hassan Nayer
- Department of Pathology, Inova Fairfax Hospital, Falls Church, VA, United States
| | - Raymund S Cuevo
- Inova Schar Cancer Institute, Inova Fairfax Hospital, Falls Church, VA, United States
| | - James B Smadbeck
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, MN, United States
| | - George Vasmatzis
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, MN, United States
| | - Patricia T Greipp
- Division of Laboratory Medicine and Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, United States
| | - Rhett P Ketterling
- Division of Laboratory Medicine and Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, United States
| | - Nicole L Hoppman
- Division of Laboratory Medicine and Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, United States
| | - Linda B Baughn
- Division of Laboratory Medicine and Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, United States
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Thomas X. Acute Promyelocytic Leukemia: A History over 60 Years-From the Most Malignant to the most Curable Form of Acute Leukemia. Oncol Ther 2019; 7:33-65. [PMID: 32700196 PMCID: PMC7360001 DOI: 10.1007/s40487-018-0091-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 02/07/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) that is cytogenetically characterized by a balanced reciprocal translocation between chromosomes 15 and 17, which results in the fusion of the promyelocytic leukemia (PML) and retinoic acid receptor alpha (RARα) genes. Because patients with APL present a tendency for severe bleeding, often resulting in an early fatal course, APL was historically considered to be one of the most fatal forms of acute leukemia. However, therapeutic advances, including anthracycline- and cytarabine-based chemotherapy, have significantly improved the outcomes of APL patients. Due to the further introduction of all-trans retinoic acid (ATRA) and-more recently-the development of arsenic trioxide (ATO)-containing regimens, APL is currently the most curable form of AML in adults. Treatment with these new agents has introduced the concept of cure through targeted therapy. With the advent of revolutionary ATRA-ATO combination therapies, chemotherapy can now be safely omitted from the treatment of low-risk APL patients. In this article, we review the six-decade history of APL, from its initial characterization to the era of chemotherapy-free ATRA-ATO, a model of cancer-targeted therapy.
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Affiliation(s)
- Xavier Thomas
- Hospices Civils de Lyon, Hematology Department, Lyon-Sud University Hospital, Pierre Bénite, France.
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Wang X, Wang J, Zhang L. Characterization of atypical acute promyelocytic leukaemia: Three cases report and literature review. Medicine (Baltimore) 2019; 98:e15537. [PMID: 31083206 PMCID: PMC6531224 DOI: 10.1097/md.0000000000015537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/30/2019] [Accepted: 04/09/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE The vast majority of acute promyelocytic leukemia (APL) is characterized with a specific chromosomal translocation t (15, 17) (q22, q21), which fuses PML-RARα leading to a good response to all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). However, there are few cases of atypical APL, including PLZF-RARα, F1P1L1-RARα, STAT5b-RARα, et al. Neither PLZF-RARα nor STAT5b-RARα are sensitive to ATRA and ATO, and the prognosis is poor. PATIENT CONCERNS Here we have 3 cases (PLZF-RARα, n = 2; STAT5b-RARα, n = 1). Case A, A 53-year-old Chinese female had suffered ecchymosis in both legs for 3 days. Case B, A 44 years old male suffered pain from lower limbs and hip. Case C, 52-year-old male patient presented with fever for 3 weeks invalid to antibiotics and gingival bleeding for 1 week. DIAGNOSES With RT-PCR and karyotype, Case A is diagnosed with STAT5b-RARα-positive APL.Case B, C are diagnosed with PLZF-RARα-positive APL. INTERVENTIONS In case A, ATO, and ATRA were used for induction treatment. In Case B, ATO, and chemotherapy with DA were given in the first induction treatment. In Case C, ATRA, and ATO were used immediately, subsequently, chemotherapy was added with DA, ATRA, and CAG combination treatment, and medium-dose cytarabine with daunorubicin were given regularly. OUTCOMES In Case A, the patient refused the following treatment and discharged on day 25. In Case B, the patient got the disseminated intravascular coagulation (DIC).In Case C, the patient has survived for 7 months and remains CR. LESSONS Both STAT5b-RARα-positive APL and PLZF-RARα-positive APL appear to be resistant to both ATRA and ATO, so combined chemotherapy and allo-HSCT should be considered. Since the prognosis and long-term outcome are poor, more clinical trials, and researches should be taken.
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Isoderivative chromosome 17 with multiple copies of RARα-PML fusions and Tp53 deletion in a rare case of APML. Hematol Oncol Stem Cell Ther 2019; 13:248-250. [PMID: 30981688 DOI: 10.1016/j.hemonc.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/23/2019] [Accepted: 02/24/2019] [Indexed: 11/21/2022] Open
Abstract
Acute Promyelocytic Leukemia (APML) is a malignancy of cells in myeloid lineage. It is a neoplasm described by proliferation and accumulation of immature neutrophils called promyelocytes in the bone marrow, inhibiting normal cell production, which results in lower numbers of blood cells circulating the body. A minor but significant proportion of patients with APML harbor complex and cryptic rearrangements. Presence of isoderivative 17 with t(15;17) is very rare. We report a case of adult APML with amplification of RARα/PML fusion protein, a consequence of isoderivative 17 with duplication of normal chromosome 15 and 17 and Tp53 deletion on derivative 17. Immunophenotyping by flow cytometry, presence of pancytopenia and epistaxis helped classify the patient as APML. FISH was used for confirmation of the same and indicated involvement of additional abnormalities.
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Early treatment of acute promyelocytic leukaemia is accurately guided by the PML protein localisation pattern: real-life experience from a tertiary New Zealand centre. Pathology 2019; 51:412-420. [PMID: 30876657 DOI: 10.1016/j.pathol.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/19/2018] [Accepted: 01/05/2019] [Indexed: 01/31/2023]
Abstract
Current guidelines recommend that a rapid test be used to assist diagnosis of acute promyelocytic leukaemia (APL), but the choice of an assay is discretionary. PML immunofluorescence (PML IF) identifies the microparticulate pattern of the PML protein localisation, highly specific for APL. The aim of this study was to evaluate clinical utility of PML IF in a real-life setting based on a retrospective records review for all patients who had PML IF performed in our centre between 2000 and 2017. Final analysis included 151 patients, 70 of whom had APL. PML IF was reported on average 3 days faster than cytogenetics. Compared with genetic results, PML IF showed sensitivity of 96% and specificity of 100%. PML IF accurately predicted APL in four APL cases with cryptic karyotype/FISH and excluded APL in 98% cases tested based on the suspicious immunophenotype alone, 21/28 of whom had mutated NPM1. Results of PML IF influenced decision to start ATRA in 25 (36%) APL patients and led to its termination in six non-APL patients. In conclusion, PML IF is a fast and reliable test that facilitates accurate treatment decisions when APL is suspected. This performance of PML IF remains hard to match in a real-life setting.
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A case of acute myeloid leukemia with promyelocytic features characterized by expression of a novel RARG- CPSF6 fusion. Blood Adv 2019; 2:1295-1299. [PMID: 29891591 DOI: 10.1182/bloodadvances.2017014183] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/13/2018] [Indexed: 12/18/2022] Open
Abstract
Key Points
Novel RARG-CPSF6 fusion in an AML case with promyelocytic features and no evidence of PML-RARA or X-RARA fusion. Gene fusions involving RARG can initiate AML with promyelocytic morphological features.
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Moradzadeh M, Ghorbani A, Erfanian S, Mohaddes ST, Rahimi H, Karimiani EG, Mashkani B, Chiang SC, El-Khamisy SF, Tabarraei A, Sadeghnia HR. Study of the mechanisms of crocetin-induced differentiation and apoptosis in human acute promyelocytic leukemia cells. J Cell Biochem 2019; 120:1943-1957. [PMID: 30203596 DOI: 10.1002/jcb.27489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/25/2018] [Indexed: 01/24/2023]
Abstract
Crocetin, the major carotenoid in saffron, exhibits potent anticancer effects. However, the antileukemic effects of crocetin are still unclear, especially in primary acute promyelocytic leukemia (APL) cells. In the current study, the potential antipromyelocytic leukemia activity of crocetin and the underlying molecular mechanisms were investigated. Crocetin (100 µM), like standard anti-APL drugs, all-trans retinoic acid (ATRA, 10 µM) and As2 O 3 (arsenic trioxide, 50 µM), significantly inhibited proliferation and induced apoptosis in primary APL cells, as well as NB4 and HL60 cells. The effect was associated with the decreased expressions of prosurvival genes Akt and BCL2, the multidrug resistance (MDR) proteins, ABCB1 and ABCC1 and the inhibition of tyrosyl-DNA phosphodiesterase 1 (TDP1), while the expressions of proapoptotic genes CASP3, CASP9, and BAX/BCL2 ratio were significantly increased. In contrast, crocetin at relatively low concentration (10 µM), like ATRA (1 µM) and As 2 O 3 (0.5 µM), induced differentiation of leukemic cells toward granulocytic pattern, and increased the number of differentiated cells expressing CD11b and CD14, while the number of the immature cells expressing CD34 or CD33 was decreased. Furthermore, crocetin suppressed the expression of clinical marker promyelocytic leukemia/retinoic acid receptor-α ( PML/RARα) in NB4 and primary APL cells, and reduced the expression of histone deacetylase 1 ( HDAC1) in all leukemic cells. The results suggested that crocetin can be considered as a candidate for future preclinical and clinical trials of complementary APL treatment.
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Affiliation(s)
- Maliheh Moradzadeh
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Department of New Sciences and Technology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Ghorbani
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saiedeh Erfanian
- Non-Communicable Diseases Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyedeh Tahereh Mohaddes
- Internal Medicine Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Rahimi
- Internal Medicine Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Baratali Mashkani
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shih-Chieh Chiang
- Department of Molecular Biology and Biotechnology, Krebs and Sheffield Institute of Nucleic Acids, University of Sheffield, Sheffield, UK
| | - Sherif F El-Khamisy
- Department of Molecular Biology and Biotechnology, Krebs and Sheffield Institute of Nucleic Acids, University of Sheffield, Sheffield, UK
| | - Alijan Tabarraei
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hamid Reza Sadeghnia
- Department of New Sciences and Technology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Division of Neurocognitive Sciences, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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