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Craddock CF, Houlton AE, Quek LS, Ferguson P, Gbandi E, Roberts C, Metzner M, Garcia-Martin N, Kennedy A, Hamblin A, Raghavan M, Nagra S, Dudley L, Wheatley K, McMullin MF, Pillai SP, Kelly RJ, Siddique S, Dennis M, Cavenagh JD, Vyas P. Outcome of Azacitidine Therapy in Acute Myeloid Leukemia Is not Improved by Concurrent Vorinostat Therapy but Is Predicted by a Diagnostic Molecular Signature. Clin Cancer Res 2017; 23:6430-6440. [PMID: 28765326 DOI: 10.1158/1078-0432.ccr-17-1423] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/30/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Azacitidine (AZA) is a novel therapeutic option in older patients with acute myeloid leukemia (AML), but its rational utilization is compromised by the fact that neither the determinants of clinical response nor its mechanism of action are defined. Co-administration of histone deacetylase inhibitors, such as vorinostat (VOR), is reported to improve the clinical activity of AZA, but this has not been prospectively studied in patients with AML.Experimental Design: We compared outcomes in 259 adults with AML (n = 217) and MDS (n = 42) randomized to receive either AZA monotherapy (75 mg/m2 × 7 days every 28 days) or AZA combined with VOR 300 mg twice a day on days 3 to 9 orally. Next-generation sequencing was performed in 250 patients on 41 genes commonly mutated in AML. Serial immunophenotyping of progenitor cells was performed in 47 patients.Results: Co-administration of VOR did not increase the overall response rate (P = 0.84) or overall survival (OS; P = 0.32). Specifically, no benefit was identified in either de novo or relapsed AML. Mutations in the genes CDKN2A (P = 0.0001), IDH1 (P = 0.004), and TP53 (P = 0.003) were associated with reduced OS. Lymphoid multipotential progenitor populations were greatly expanded at diagnosis and although reduced in size in responding patients remained detectable throughout treatment.Conclusions: This study demonstrates no benefit of concurrent administration of VOR with AZA but identifies a mutational signature predictive of outcome after AZA-based therapy. The correlation between heterozygous loss of function CDKN2A mutations and decreased OS implicates induction of cell-cycle arrest as a mechanism by which AZA exerts its clinical activity. Clin Cancer Res; 23(21); 6430-40. ©2017 AACR.
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Affiliation(s)
- Charles F Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
| | - Aimee E Houlton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Lynn Swun Quek
- MRC Molecular Haematology Unit and Centre for Haematology, Weatherall Institute of Molecular Medicine, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Paul Ferguson
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Emma Gbandi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Corran Roberts
- Centre for Statistics in Medicine, Oxford, United Kingdom
| | - Marlen Metzner
- MRC Molecular Haematology Unit and Centre for Haematology, Weatherall Institute of Molecular Medicine, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Natalia Garcia-Martin
- MRC Molecular Haematology Unit and Centre for Haematology, Weatherall Institute of Molecular Medicine, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Alison Kennedy
- MRC Molecular Haematology Unit and Centre for Haematology, Weatherall Institute of Molecular Medicine, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Angela Hamblin
- MRC Molecular Haematology Unit and Centre for Haematology, Weatherall Institute of Molecular Medicine, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Manoj Raghavan
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Louise Dudley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | | | - Srinivas P Pillai
- University Hospitals of North Midlands, Stoke on Trent, United Kingdom
| | | | - Shamyla Siddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Michael Dennis
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jamie D Cavenagh
- Department of Haemato-Oncology, St Bartholomew's Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - Paresh Vyas
- MRC Molecular Haematology Unit and Centre for Haematology, Weatherall Institute of Molecular Medicine, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
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Main C, Wilson JS, Stevens SP, Houlton AE, English M, Kearns PR, Phillips B, Pizer B, Wilne S, Wheatley K. The role of high-dose myeloablative chemotherapy with haematopoietic stem cell transplantation (HSCT) in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:168. [PMID: 26589619 PMCID: PMC4654793 DOI: 10.1186/s13643-015-0155-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The objective of the study is to conduct a systematic review to compare the effects of high-dose chemotherapy (HDCT) with autologous haematopoietic stem cell transplantation (HSCT) versus standard-dose chemotherapy (SDCT) in children with malignant central nervous system (CNS) tumours. METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Ten electronic databases will be searched, along with citation searching and reference checking. Studies assessing the effects of HDCT with HSCT in children with CNS tumours will be included. The outcomes are survival (overall, progression-free, event-free, disease-free), response rates, short- and long-term adverse events and health-related quality of life (HRQoL). Two reviewers will independently screen and select randomised and non-randomised controlled trials and controlled and uncontrolled observational studies for inclusion. Quality assessment will be tailored to the different study designs. Where possible data will be summarised using combined estimates of effect for the hazard ratio for survival outcomes and the risk ratio for response rates. A fixed effect model will be used; sub-group analyses and meta-regression will be used to explore potential sources of heterogeneity between studies. DISCUSSION Given the poor prognosis of malignant brain tumours in children in terms of survival and quality of life, this review will help guide clinical practice by summarising the current evidence on the use of high-dose myeloblative chemotherapy with stem cell support in children with CNS tumours.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Aimee E Houlton
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Bob Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK.
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK.
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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Bradbury C, Houlton AE, Akiki S, Gregg R, Rindl M, Khan J, Ward J, Khan N, Griffiths M, Nagra S, Hills R, Burnett A, Russell N, Vyas P, Grimwade D, Craddock C, Freeman SD. Prognostic value of monitoring a candidate immunophenotypic leukaemic stem/progenitor cell population in patients allografted for acute myeloid leukaemia. Leukemia 2014; 29:988-91. [PMID: 25425198 PMCID: PMC4391965 DOI: 10.1038/leu.2014.327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- C Bradbury
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - A E Houlton
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S Akiki
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - R Gregg
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - M Rindl
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - J Khan
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - J Ward
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - N Khan
- Department of Clinical Immunology, University of Birmingham, Birmingham, UK
| | - M Griffiths
- West Midlands Regional Genetics Laboratory, Birmingham Women's Hospital, Birmingham, UK
| | - S Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - R Hills
- Department of Haematology, Cardiff University, Cardiff, UK
| | - A Burnett
- Department of Haematology, Cardiff University, Cardiff, UK
| | - N Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - P Vyas
- 1] MRC Molecular Haematology Unit, WIMM, University of Oxford, Oxford, UK [2] Department of Haematology, Radcliffe Hospitals NHS Trust, Oxford, UK
| | - D Grimwade
- 1] Department of Medical & Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK [2] Department of Haematology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - C Craddock
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S D Freeman
- 1] Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK [2] Department of Clinical Immunology, University of Birmingham, Birmingham, UK
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