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Sobas M, Knopinska-Posluszny W, Piątkowska-Jakubas B, García-Álvarez F, Díez MEA, Caballero M, Martínez-Cuadrón D, Aguiar E, González-Campos J, Garrido A, Algarra L, Salamero O, de la Serna J, Sayas MJ, Perez-Encinas MM, Vives S, Vidriales B, Labrador J, Prado AI, Celebrin L, Mayer J, Brioso J, de Laiglesia A, Bergua JM, Amigo ML, Rodriguez-Medina C, Polo M, Pluta A, Cichocka E, Skarupski M, Sanz MA, Wierzbowska A, Montesinos P. Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience. Ann Hematol 2024; 103:451-461. [PMID: 38110588 PMCID: PMC10799093 DOI: 10.1007/s00277-023-05582-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
The most important challenges in acute promyelocytic leukemia (APL) is preventing early death and reducing long-term events, such as second neoplasms (s-NPLs). We performed a retrospective analysis of 2670 unselected APL patients, treated with PETHEMA "chemotherapy based" and "chemotherapy free" protocols. Only de novo APL patients who achieved complete remission (CR) and completed the three consolidation cycles were enrolled into the analysis. Out of 2670 APL patients, there were 118 (4.4%) who developed s-NPLs with the median latency period (between first CR and diagnosis of s-NPL) of 48.0 months (range 2.8-231.1): 43.3 (range: 2.8-113.9) for s-MDS/AML and 61.7 (range: 7.1-231.1) for solid tumour. The 5-year CI of all s-NPLs was of 4.43% and 10 years of 7.92%. Among s-NPLs, there were 58 cases of s-MDS/AML, 3 cases of other hematological neoplasms, 57 solid tumours and 1 non-identified neoplasm. The most frequent solid tumour was colorectal, lung and breast cancer. Overall, the 2-year OS from diagnosis of s-NPLs was 40.6%, with a median OS of 11.1 months. Multivariate analysis identified age of 35 years (hazard ratio = 0.2584; p < 0.0001) as an independent prognostic factor for s-NPLs. There were no significant differences in CI of s-NPLs at 5 years between chemotherapy-based vs chemotherapy-free regimens (hazard ratio = 1.09; p = 0.932). Larger series with longer follow-up are required to confirm the potential impact of ATO+ATRA regimens to reduce the incidence of s-NPLs after front-line therapy for APL.
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Affiliation(s)
- Marta Sobas
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland.
| | | | | | | | | | - Mar Caballero
- Hospital Insular de Las Palmas, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | - Susana Vives
- Hospital U. Germans Trias i Pujol ICO, Badalona, Spain
| | - Belén Vidriales
- University Hospital of Salamanca (CAUSA/IBSAL) and Center for Biomedical Research in Network of Cancer (CIBERONC), Salamanca, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | | | | | - Jiri Mayer
- University Hospital Brno, Masaryk University, Brno, Czechia
| | | | | | | | | | | | - Marta Polo
- Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Marek Skarupski
- Faculty of Pure and Applied Mathematics, Wrocław University of Science and Technology, Wroclaw, Poland
- Department of Mathematics and Computer Science, Eindhoven University of Technology, 5612, AZ, Eindhoven, The Netherlands
| | - Miguel A Sanz
- Hospital Universitario i Politècnico la Fe, Valencia, Spain
| | | | - Pau Montesinos
- Hospital Universitario i Politècnico la Fe, Valencia, Spain
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Labrador J, Saiz-Rodríguez M, de Miguel D, de Laiglesia A, Rodríguez-Medina C, Vidriales MB, Pérez-Encinas M, Sánchez-Sánchez MJ, Cuello R, Roldán-Pérez A, Vives S, Benzo-Callejo G, Colorado M, García-Fortes M, Sayas MJ, Olivier C, Recio I, Conde-Royo D, Bienert-García Á, Vahi M, Muñoz-García C, Seri-Merino C, Tormo M, Vall-llovera F, Foncillas MÁ, Martínez-Cuadrón D, Sanz MÁ, Montesinos P. Use of Venetoclax in Patients with Relapsed or Refractory Acute Myeloid Leukemia: The PETHEMA Registry Experience. Cancers (Basel) 2022; 14:cancers14071734. [PMID: 35406512 PMCID: PMC8997036 DOI: 10.3390/cancers14071734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/12/2022] [Accepted: 03/24/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary The use of venetoclax combined with hypomethylating agents or low-dose cytarabine in patients with newly diagnosed acute myeloid leukemia unfit for intensive chemotherapy was recently approved. However, the evidence in relapse or refractory patients is still scarce. The cohort of patients included in our study was heavily pretreated and had a poor performance status. It is still necessary to identify those patients at higher risk of early death who would not benefit from this type of treatment. For these ultra-high-risk patients, other treatment strategies should be followed. Abstract The effectiveness of venetoclax (VEN) in relapsed or refractory acute myeloid leukemia (RR-AML) has not been well established. This retrospective, multicenter, observational database studied the effectiveness of VEN in a cohort of 51 RR-AML patients and evaluated for predictors of response and overall survival (OS). The median age was 68 years, most were at high risk, 61% received ≥2 therapies for AML, 49% had received hypomethylating agents, and ECOG was ≥2 in 52%. Complete remission (CR) rate, including CR with incomplete hematological recovery (CRi), was 12.4%. Additionally, 10.4% experienced partial response (PR). The CR/CRi was higher in combination with azacitidine (AZA; 17.9%) than with decitabine (DEC; 6.7%) and low-dose cytarabine (LDAC; 0%). Mutated NPM1 was associated with increased CR/CRi. Median OS was 104 days (95% CI: 56–151). For the combination with AZA, DEC, and LDAC, median OS was 120 days, 104 days, and 69 days, respectively; p = 0.875. Treatment response and ECOG 0 influenced OS in a multivariate model. A total of 28% of patients required interruption of VEN because of toxicity. Our real-life series describes a marginal probability of CR/CRi and poor OS after VEN-based salvage. Patients included had very poor-risk features and were heavily pretreated. The small percentage of responders did not reach the median OS.
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Affiliation(s)
- Jorge Labrador
- Hematology Deparment, Hospital Universitario de Burgos, 09006 Burgos, Spain
- Research Unit, Fundación Burgos por la Investigación de la Salud (FBIS), Hospital Universitario de Burgos, 09006 Burgos, Spain;
- Correspondence: (J.L.); (P.M.)
| | - Miriam Saiz-Rodríguez
- Research Unit, Fundación Burgos por la Investigación de la Salud (FBIS), Hospital Universitario de Burgos, 09006 Burgos, Spain;
| | - Dunia de Miguel
- Hematology Deparment, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
| | | | - Carlos Rodríguez-Medina
- Hematology Deparment, Hospital de Gran Canaria Dr. Negrin, 35010 Las Palmas de Gran Canaria, Spain;
| | | | - Manuel Pérez-Encinas
- Hematology Deparment, Hospital Clínico Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - Rebeca Cuello
- Hematology Deparment, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | - Alicia Roldán-Pérez
- Hematology Deparment, Hospital Universitario Infanta Sofía, 28703 Madrid, Spain;
| | - Susana Vives
- Hematology Deparment, Hospital Germans Trias i Pujol-ICO, 08907 Badalona, Spain;
| | | | - Mercedes Colorado
- Hematology Deparment, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - María García-Fortes
- Hematology Deparment, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - María José Sayas
- Hematology Deparment, Hospital Universitario Doctor Peset, 46017 Valencia, Spain;
| | - Carmen Olivier
- Hematology Deparment, Hospital General de Segovia, 40002 Segovia, Spain;
| | - Isabel Recio
- Hematology Deparment, Complejo Asistencial de Ávila, 05071 Ávila, Spain;
| | - Diego Conde-Royo
- Hematology Deparment, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain;
| | - Álvaro Bienert-García
- Hematology Deparment, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain;
| | - María Vahi
- Hematology Deparment, Hospital Universitario Virgen de Valme, 41014 Sevilla, Spain;
| | - Carmen Muñoz-García
- Hematology Deparment, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | - Cristina Seri-Merino
- Hematology Deparment, Hospital Central de la Defensa Gómez Ulla, 28047 Madrid, Spain;
| | - Mar Tormo
- Hematology Deparment, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Ferran Vall-llovera
- Hematology Deparment, Hospital Universitari Mutua Terrasa, 08221 Barcelona, Spain;
| | | | - David Martínez-Cuadrón
- Hematology Deparment; Hospital Universitari I Politécnic La Fe, 46026 Valencia, Spain; (D.M.-C.); (M.Á.S.)
| | - Miguel Ángel Sanz
- Hematology Deparment; Hospital Universitari I Politécnic La Fe, 46026 Valencia, Spain; (D.M.-C.); (M.Á.S.)
| | - Pau Montesinos
- Hematology Deparment; Hospital Universitari I Politécnic La Fe, 46026 Valencia, Spain; (D.M.-C.); (M.Á.S.)
- Correspondence: (J.L.); (P.M.)
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Sebrango A, Vicuña I, de Laiglesia A, Millán I, Bautista G, Martín-Donaire T, Regidor C, Cabrera R, Fernandez MN. Haematopoietic transplants combining a single unrelated cord blood unit and mobilized haematopoietic stem cells from an adult HLA-mismatched third party donor. Comparable results to transplants from HLA-identical related donors in adults with acute leukaemia and myelodysplastic syndromes. Best Pract Res Clin Haematol 2011; 23:259-74. [PMID: 20837338 DOI: 10.1016/j.beha.2010.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe results of the strategy, developed by our group, of co-infusion of mobilized haematopoietic stem cells as a support for single-unit unrelated cord blood transplant (dual CB/TPD-MHSC transplants) for treatment of haematological malignancies in adults, and a comparative analysis of results obtained using this strategy and transplants performed with mobilized haematopoietic stem cells from related HLA-identical donors (RTD) for treatment of adults with acute leukaemia and myelodysplastic syndromes. Our data show that the dual CB/TPD-MHSC transplant strategy results in periods of post-transplant neutropenia, final rates of full donor chimerism and transplant-related mortality rates comparable to those of the RTD. Final survival outcomes are comparable in adults transplanted because of acute leukaemia, with different incidences of the complications that most influence these: a higher incidence of infections related to late recovery of protective immunity dependent on T cell functions, and a lower incidence of serious acute graft-versus-host disease and relapses. Recent advances in cord blood transplant techniques allow allogeneic haematopoietic stem cell transplantation (HSCT) to be a viable option for almost every patient who may benefit from this therapeutic approach. Development of innovative strategies to improve the post-transplant recovery of T cells function is currently the main challenge to further improving the possibilities of unrelated cord blood transplantation.
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Affiliation(s)
- Ana Sebrango
- Universidad Autónoma de Madrid, Hospital Universitario Puerta de Hierro, Spain.
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